Mont. Admin. R. tit. 37 | Mont. Admin. R. Title 37 — Public Health and Human Services

Chapter 37.1 Organizational Rule

Subchapter 37.1.1 Organizational Rule

Mont. Admin. R. 37.1.101 Organization of the Department

(1) Organization of the Department of Public Health and Human Services.

(a) History The Department of Public Health and Human Services was established by 1995 Laws of Montana, Chapter 546. The department is provided for in 2-15-2201, MCA.

(b) Director The director of the Department of Public Health and Human Services, appointed by the Governor, heads the department.

(c) Branches and Divisions The three department branches are Operations Services, Medicaid and Health Services, and Economic Security Services supervised by branch managers, reporting directly to the director. The department has 12 divisions. The Public Health and Safety Division reports directly to the director. Each of the divisions is headed by an administrator. The branches consist of the following divisions:

(i) Economic Security Services Branch

(A) Disability Employment and Transitions Division;

(B) Human and Community Services Division;

(D) Child and Family Services Division; and

(E) Intergovernmental Relations.

(ii) Medicaid and Health Services Branch

(A) Senior and Long Term Care Division;

(B) Developmental Services Division;

(D) Health Resources Division.

(iii) Operations Services Branch

(A) Office of Fair Hearings;

(B) Business and Financial Services Division;

(D) Technology Services Division.

(d) Administratively Attached Boards and Councils Attached to the department for administrative purposes only are several boards and councils created by state statutes. These boards are listed in (4). Assistance from the department for the boards and councils is provided as required by 2-15-121, MCA.

(2) Director's Office The director supervises the department's three branch managers and the division administrator for Public Health and Safety Division. In addition, the director provides supervision to the Office of Human Resources, the Office of Legal Affairs, the Prevention Resource Center, the Public Information Office, and Policy Services.

(a) Office of Human Resources This office provides administration of the classification and pay plans, employee relations, labor negotiations, leave administration, employment, and staff development.

(b) Office of Legal Affairs This office provides legal assistance to the department, supervises the adoption of administrative rules, and coordinates the use of external legal counsel.

(c) Prevention Resource Center This office coordinates the department's prevention efforts with an emphasis on Montana comprehensive youth prevention programs in areas such as substance abuse and child and family safety. This office oversees Montana VISTA program.

(d) Public Information Office This office provides information to the public about the agency's programs and services.

(e) Office of Governmental Support This office provides a uniform approach to providing information and assistance to the media, stakeholders, tribes, other government entities, and constituents.

(f) Intergovernmental Relations The intergovernmental relations specialist position coordinates department projects and legislative proposals and communicates the status of those projects with staff, legislative committees, and outside parties.

(g) Tribal Relations Manager This office is responsible for guiding the department's government relations with Montana Native American Tribes.

(3) Organizational Structure

(a) Operations Services Branch This branch provides direct supervision over the Office of Fair Hearings, Business and Financial Services Division, Quality Assurance Division, and the Technology Services Division. The branch manager develops policy on major issues affecting operations and, as the chief operating and chief financial officer, is responsible for the department's budget, finance, technology, and oversight activities.

(i) Office of Fair Hearings This office provides direct supervision and accounting, budgeting, and reporting services for the branch. The Office of Fair Hearings is responsible for administrative hearings for the department except for child support.

(ii) Business and Financial Services Division This division provides fiscal and internal support services to the agency by developing, implementing and monitoring accounting and fiscal processes and systems. This office oversees the department's budgeting processes, and supports and conducts statistical analyses of the major programs. The division manages records, assets, office space agreements, and building safety and maintenance.

(iii) Quality Assurance Division This division is responsible for comprehensive and coordinated quality assurance programs, including detecting and investigating abusive or fraudulent practices within benefit programs, reducing Medicaid costs by identifying other responsible parties, conducting internal and independent audits, and providing state health care and day care licensing and health care certification for Medicare and Medicaid.

(iv) Technology Services Division This division is responsible for planning, design, development, implementation, operation, and security of information technology systems and networks for the department. The division administrator is the department's chief information officer.

(b) Medicaid and Health Services Branch This branch provides direct supervision over the Senior and Long Term Care Division, Developmental Services Division, Addictive and Mental Disorders Division, Health Resources Division, the Medicaid Systems Support Program, and the Healthy Montana Kids Program. The branch also provides medical, rehabilitative, and mental health services for Montanans through a variety of programs. The branch manager oversees and coordinates programs and activities of the branch and, as the state Medicaid and Healthy Montana Kids (known federally as CHIP) director, establishes policy for the Montana Medicaid and Healthy Montana Kids program.

(i) Senior and Long Term Care Division This division plans and coordinates the delivery of publicly funded long term care and support services to elderly Montanans and Montanans with physical and other disabilities. The division manages two nursing facilities for veterans located in Columbia Falls and Glendive, Montana.

(ii) Developmental Services Division This division provides for community-based training and residential services for persons with developmental disabilities. It plans and coordinates services for children with mental illness. The division manages the Montana Developmental Center, a state facility for adults.

(iii) Addictive and Mental Disorders Division This division provides, directly and through independent providers, a statewide continuum of prevention, treatment, and rehabilitation services for people with chemical dependency and adult mental illness. The division manages three state facilities that provide mental health and chemical dependency services for adults. The Montana Chemical Dependency Center provides drug and alcohol treatment services for adults, the Montana Mental Health Nursing Care Center provides long-term care for people with mental illness who require nursing home care, and the Montana State Hospital provides inpatient psychiatric hospital services to adults with serious mental illness.

(iv) Health Resources Division This division administers preventive and acute care Medicaid services for adults and children in the Healthy Montana Kids Program.

(v) Medicaid Systems Support Program This program works in conjunction with the state Medicaid director and division administrators by providing oversight and guidance on management of the Medicaid programs. It also oversees the Medicaid Management Information System (MMIS) contractor that is responsible for the processing and payment of Medicaid claims.

(c) Economic Security Services Branch This branch provides direct supervision over the Human and Community Services Division, Child Support Services Division, Child and Family Services Division, and the Disability Employment and Transitions Program. The branch delivers a broad range of social services to communities in Montana. The branch manager develops an organized approach to family economic security, assists with interdepartmental issues such as system development and tribal relations and develops strategies to manage scarce resources.

(i) Disability Employment and Transitions Division This division supervises department programs that help people with disabilities find employment and successfully interact within their community. This work is accomplished through the Blind and Low Vision Services Division which provides services to the visually impaired.

(ii) Human and Community Services Division This division provides support for low-income Montanans in securing basic needs such as food, energy, child care, and income. In addition, the division assists Montanans in achieving self-sufficiency through employment and training. The division determines eligibility for Medicaid and the Healthy Montana Kids Program.

(iii) Child Support Services Division (CSSD) This division establishes paternity, locates obligated parents, establishes and modifies legal obligations requiring parents to provide medical and financial support for their children, and enforces those obligations. Services are provided to families receiving assistance under Montana's Temporary Assistance for Needy Families (TANF) program, or under the federal TANF program, Medicaid, or IV-E programs. Services are also provided to parents or custodians who apply for CSSD services, or who are referred through the interstate IV-D system.

(iv) Child and Family Services Division This division administers programs to protect children and youth from abuse, neglect, and abandonment. The division works with communities and providers to support the strengths of families to increase their ability to nurture and provide for their children. The division provides child protective services (including investigatory services, emergency protective services, voluntary protective services, court-ordered protective services, and permanency services) to children and families, licenses family foster homes, child placing agencies and adoption agencies, and provides adoption services to children in the custody of the state of Montana.

(d) Public Health and Safety Division This division has primary responsibility for communicable disease control and prevention, public health emergency preparedness, chronic disease prevention and health promotion, emergency medical services, maternal and child health services, clinical and environmental laboratory services, and coordinating, supporting, and strengthening the state's public health system.

(4) Administratively attached entities

(a) Board of Public Assistance created by 2-15-2203, MCA.

(b) Committee on Telecommunications Access Services for Persons with Disabilities created by 2-15-2212, MCA.

(d) Montana Children's Trust Fund Board created by 2-15-2214 and 52-7-101, MCA.

(e) State Trauma Care Committee created by 2-15-2216, MCA.

(f) Traumatic Brain Injury Advisory Council created by 2-15-2217, MCA.

(5) Information or Submissions General inquiries regarding the department may be addressed to the director. Specific inquiries regarding the functions of each division may be addressed to the administrator of that division. Requests for fair hearings should be addressed to the county or state office whose action is contested or to the Department of Public Health and Human Services, Office of Fair Hearings, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953. Requests for fair hearings pertaining to child support should be addressed to the Office of Administrative Law Judge, 111 N. Jackson, Suite 2B, Helena, MT 59601. All requests for declaratory rulings and for participation in rulemaking may be addressed to the Office of Legal Affairs, unless the notice in the Montana Administrative Register makes specific provisions for submissions. The general address for the department, unless otherwise stated, is P.O. Box 4210, Helena, MT 59604-4210.

(6) Personnel Roster Addresses of the director's office and each division are as follows:

Director's Office, Department of Public Health and Human Services, 111 N. Sanders Street, P.O. Box 4210, Helena, MT 59604-4210.

Administrator, Addictive and Mental Disorders Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905.

Administrator, Business and Financial Services Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

Administrator, Child and Family Services Division, 301 S. Park, P.O. Box 8005, Helena, MT 59620-8005.

Administrator, Child Support Services Division, 3075 N. Montana, P.O. Box 202943, Helena, MT 59620-2943.

Administrator, Disability Employment and Transitions Division, Arcade Building, 111 N. Jackson, P.O. Box 4210, Helena, MT 59604-4210.

Administrator, Developmental Services Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

Administrator, Health Resources Division, 1400 Broadway, Rm. A203, P.O. Box 202951, Helena, MT 59620-2951.

Administrator, Human and Community Services Division, Arcade Building, 111 N. Jackson, P.O. Box 202925, Helena, MT 59620-2925.

Administrator, Public Health and Safety Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

Administrator, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

Administrator, Senior and Long Term Care Division, 2030 11th Avenue, P.O. Box 4210, Helena, MT 59604-4210.

Administrator, Technology Services Division, 111 N. Sanders, P.O. Box 4210, Helena, Montana 59604.

(7) Agency Organizational Chart A descriptive organizational chart of the Department of Public Health and Human Services is attached.

Official policy figure

History

Authorizing statute(s): 2-4-201, 2-4-202, MCA
Implementing statute(s): 2-4-201, 2-15-112, MCA
History: NEW, Eff. 7/1/95; AMD, Eff. 3/31/99; AMD, Eff. 9/30/01; AMD, Eff. 12/31/01; AMD, Eff. 3/31/02; AMD, Eff. 7/1/03; AMD, Eff. 7/1/04; AMD, Eff. 9/30/04; AMD, Eff. 6/30/06; AMD, Eff. 12/31/06; AMD, Eff. 12/31/09; AMD, Eff. 12/31/11; AMD, Eff. 3/31/12; AMD, Eff. 3/31/14.

Chapter 37.2 Department Procedures

Subchapter 37.2.1 Rule Making, Declaratory Rulings and Petitions for Rule Changes

Mont. Admin. R. 37.2.101 Procedures for Adopting, Amending, and Repealing Agency Rules

(1) The department of public health and human services, for purposes of establishing departmental rulemaking procedures, adopts and incorporates by reference attorney general's model procedural rules 1 through 7 found in ARM 1.3.102 through 1.3.210, except for the attorney general's sample rule notice forms. A copy of the attorney general's model rules may be obtained by contacting the Attorney General's Office, Justice Building, 215 N. Sanders, P.O. Box 201401, Helena, MT 59620-1401, telephone (406) 444-2026.

(2) The department utilizes its own rule notice forms which meet all Montana Administrative Procedure Act (MAPA) requirements. Samples of these forms can be obtained from the Department of Public Health and Human Services, Office of Legal Affairs, 111 N. Sanders, P.O. Box 4210, Helena MT 59604-4210, telephone (406) 444-5622.

History

Authorizing statute(s): Sec. 2-4-201, MCA
Implementing statute(s): Sec. 2-4-201, MCA
History: AMD, Eff. 7/5/73; AMD, 1982 MAR p. 298, Eff. 2/12/82; TRANS, from SRS, 1996 MAR p. 2433; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.102 Procedures for the Issuance of Declaratory Rulings

(1) The department of public health and human services adopts and incorporates by reference attorney general's model procedural rules 22 through 24 and 28 found in ARM 1.3.227 through 1.3.229 and 1.3.233 which set forth the procedures for the issuance of declaratory rulings. A copy of the model rules may be obtained by contacting the Attorney General's Office, Justice Building, 215 N. Sanders, P.O. Box 201401, Helena, MT 59620-1401, telephone (406) 444-2026.

History

Authorizing statute(s): Sec. 2-4-202, MCA
Implementing statute(s): Sec. 2-4-501, MCA
History: NEW, 1982 MAR p. 298, Eff. 2/12/82; TRANS, from SRS, 1996 MAR p. 2433; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.103 Exercise of Regulatory Discretion During Emergency

During the period of time set forth in (8), the department will exercise regulatory discretion and waive strict compliance with the following categories of administrative rules to the limited extent that they conflict with the department's implementation of federal COVID-19-related guidance, waivers, or rules, as follows:

(1) Training and other training-related annual recertification requirements in congregate care facilities:

(a) provisions of ARM Title 37, chapter 34, related to services of the developmental disabilities program and the home and community-based services program (HCBS);

(b) provisions of ARM Title 37, chapter 40, related to home and community-based services for elderly and physically disabled persons;

(d) provisions of ARM Title 37, chapter 100, related to community residences; and

(e) provisions of ARM Title 37, chapter 106, related to the licensure of health care facilities.

(2) Staffing-related licensing and certification requirements in congregate care facilities:

(a) provisions of ARM Title 37, chapter 40, related to home and community-based services for elderly and physically disabled persons;

(b) provisions of ARM Title 37, chapter 90, related to the home and community-based services waiver for adults with severe and disabling mental illness;

(d) provisions of ARM Title 37, chapter 100, related to community residences; and

(e) provisions of ARM Title 37, chapter 106, related to the licensure of health care facilities.

(3) Licensing and certification requirements related to permissible premises, settings, or construction standards in situations:

(a) provisions of ARM Title 37, chapter 97, related to the licensure of youth care facilities;

(b) provisions of ARM Title 37, chapter 100, related to community residences; and

(4) Telehealth face-to-face requirements for the provision of medical services:

(a) ARM 37.27.102(9);

(b) ARM 37.27.902(2) and (3), to the extent that provider manuals require face-to-face interactions;

(d) ARM 37.34.3005(2), to the extent that the rates manual requires face-to-face interactions;

(e) ARM 37.40.702(8) and (9);

(f) ARM 37.40.805(1) through (3), to the extent Medicare normally requires face-to-face encounters;

(g) ARM 37.40.1005(4), to the extent such provision requires in-person meetings;

(h) ARM 37.40.1114(4), to the extent such provision requires in-person meetings;

(i) ARM 37.86.901(2);

(j) ARM 37.86.902(2)(b);

(k) ARM 37.86.3405(2);

(l) ARM 37.86.4402(1);

(m) ARM 37.87.703(1)(h), to the extent that such provision requires face-to-face interactions for home support services;

(n) ARM 37.87.903(7), to the extent the provider manual requires face-to-face interactions;

(o) ARM 37.87.1410(6)(b);

(p) ARM 37.88.101(2), to the extent the provider manual requires face-to-face interactions;

(q) ARM 37.89.501(2);

(r) ARM 37.106.1916(5);

(s) ARM 37.106.1935(4), to the extent such provision requires in-person or face-to-face contacts for targeted case management services; and

(t) ARM 37.106.2011(3), to the extent such provision requires in-person, in-home meetings.

(5) Any provision of ARM 37.82.205 and 37.84.107, to the extent that the rule would end eligibility for any individual enrolled as of March 18, 2020, unless the individual ceases to be a state resident or requests a voluntary disenrollment. Waiver of such requirements and provisions shall not exceed the end of the month in which the nationwide COVID-19 public health emergency ends.

(6) Licensing or certification requirements for congregate care facilities that require background checks, as long as the facility has submitted fingerprint background checks to the appropriate authority and has conducted other background checks, including but not limited to name background checks:

(a) provisions of ARM 37.97.132 and 37.97.140, related to the licensure of youth care facilities; and

(b) provisions of ARM 37.100.138(1) and (2) and 37.100.165(5), related to community residences.

(7) If the intensive care unit of a licensed hospital, critical access hospital, or licensed medical assistance facility is 70% occupied, swing-bed requirements in:

(a) ARM 37.40.402(1)(b)(i)(A) through (D); and

(b) ARM 37.40.405(1)(b) and (2), to the extent necessary to facilitate payment under Medicaid.

(8) This rule is intended to be of limited duration to provide flexibilities to the state's health care industry and related human service organizations as they respond to the COVID-19 pandemic. The rule is repealed and the provisions of this rule expire upon the expiration or rescinding of the nationwide COVID-19 public health emergency determination, issued under section 319 of the Public Health Service Act, 42 U.S.C. § 247d, initially on January 31, 2020, and subsequently renewed by the secretary of the U.S. Department of Health and Human Services, or at the conclusion of any transition period or of phase-down requirements relating to federal waivers issued by the Centers for Medicare and Medicaid Services in response to the COVID-19 pandemic, whichever is later.

History

Authorizing statute(s): 50-5-103, 50-5-215, 52-2-111, 52-2-603, 53-2-201, 53-6-113, 53-6-402, 53-24-204, 53-24-209, MCA
Implementing statute(s): 50-5-103, 50-5-202, 50-5-203, 50-5-204, 50-5-215, 52-2-603, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-131, 53-6-142, 53-6-402, 53-24-204, 53-24-208, 53-24-209, MCA
History: NEW, 2021 MAR p. 1791, Eff. 12/11/21.

Subchapter 37.2.2 Public Participation

Mont. Admin. R. 37.2.201 Model Procedural Rules

(1) The Department of Public Health and Human Services, for purposes of establishing department public participation procedures, adopts and incorporates by reference the Attorney General's model procedural rules ARM 1.3.101 and 1.3.102.

History

Authorizing statute(s): 2-3-103, 2-4-201, MCA
Implementing statute(s): 2-3-103, 2-4-201, MCA
History: NEW, 2021 MAR p. 1790, Eff. 1/1/22.

Mont. Admin. R. 37.2.202 Public Participation

(1) Public participation is encouraged and assisted to the fullest extent practicable. Participation must be consistent with other requirements of state law and the rights and requirements of personal privacy. The major objectives of such participation include:

(a) greater responsiveness of governmental actions to public concerns and priorities; and

(b) improved public understanding of official programs and actions.

(2) Prior to the adoption, amendment, or repeal of a rule or policy, the department shall, where the decision is of significant public interest, give adequate notice and opportunity to participate in the decision-making process.

History

Authorizing statute(s): 2-3-103, 2-4-201, MCA
Implementing statute(s): 2-3-103, 2-4-201, MCA
History: NEW, 2021 MAR p. 1790, Eff. 1/1/22.

Mont. Admin. R. 37.2.203 Actions Considered to Be of Significant Public Interest

(1) The adoption, amendment, or repeal of any regulation or written policy that implements, interprets, or prescribes law or policy, or practice requirements of the department, are considered actions of significant public interest to require notice and opportunity for public participation in the decision-making process.

(2) In all other cases, whether the decision is one of significant public interest will be determined by the person within the department who is proposing the decision according to the following considerations:

(a) the decision regards a matter which is controversial;

(b) the number of persons who will be affected by the decision;

(d) the department has witnessed a high level of citizen interest.

History

Authorizing statute(s): 2-3-103, 2-4-201, MCA
Implementing statute(s): 2-3-103, 2-4-201, MCA
History: NEW, 2021 MAR p. 1790, Eff. 1/1/22.

Mont. Admin. R. 37.2.204 Notice and Means for Public Participation

(1) If it is determined that significant public interest is involved, one or more of the following steps, as applicable, shall be taken to assist public participation in the decision-making process:

(a) a proceeding or hearing is held in compliance with the provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA;

(b) a public hearing, after appropriate notice is given, is held pursuant to any other provision of state law, a local ordinance, or regulation; or

(c) a news release, legal advertisement, or other method of publication will be given to news media within the area to be affected which shall include the name of a person within the department most familiar with the proposed action, that person's departmental address, and a telephone number where interested persons may submit their data, views, or arguments, orally or in written form, concerning the proposed action. This information will also be posted on the department's website.

History

Authorizing statute(s): 2-3-103, 2-4-201, MCA
Implementing statute(s): 2-3-103, 2-4-201, MCA
History: NEW, 2021 MAR p. 1790, Eff. 1/1/22.

Mont. Admin. R. 37.2.205 Public Requests for Information

(1) Citizens desiring information about anything mentioned in these rules or about anything concerning the department and public participation should contact the Public Information Officer, Department of Public Health and Human Services, P.O. Box 4210, Helena, Montana 59604-4210, or visit the department's website at dphhs.mt.gov .

History

Authorizing statute(s): 2-3-103, 2-4-201, MCA
Implementing statute(s): 2-3-103, 2-4-201, MCA
History: NEW, 2021 MAR p. 1790, Eff. 1/1/22.

Subchapter 37.2.3 Recovery and Offset of Debts

Mont. Admin. R. 37.2.301 Purpose and Scope

(1) Except as provided in (2) , this subchapter implements for the department and the department of revenue the mechanisms provided in Title 17, chapter 4, MCA, for recovery and offset of monetary sums owing to the state of Montana related to the provision of services through the programs administrated by the department.

(2) The recovery and offset of debts being enforced or collected by the department under Title IV-D of the Social Security Act is implemented by ARM 37.62.1501, 37.62.1503 and 37.62.1505.

(3) The provisions of this subchapter are not the department's exclusive means of debt collection, but are in addition to any other means of offset, recovery or other debt collection procedures authorized by law.

History

Authorizing statute(s): Sec. 17-4-110 and 53-2-201, MCA
Implementing statute(s): Sec. 17-4-104, 53-2-108 and 53-2-201, MCA
History: NEW, 1994 MAR p. 3198, Eff. 12/23/94; TRANS, from SRS, 1996 MAR p. 2433; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.302 Definitions

(1) "Debt" means a monetary sum owed to the state of Montana including but not limited to sums owed arising out of overpayments received by recipients and providers of public assistance. Overpayments include payments made as the result of fraud, mistake or department error.

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

(3) "Offset" means a deduction from monies due to a person or entity from the state for the purpose of recovering in total or in part a debt owed by the person or entity to the state. An offset is undertaken by the department of revenue under the authority of 17-4-105 , MCA in accordance with that agency's rules and policies. Offset may include but is not limited to an offset of a person or entity's state tax return.

(4) "Program" means any program of services or benefits for the public administrated by the department including but not limited to:

(a) aid for dependent families (AFDC) ;

(b) medicaid;

(d) AFDC and JOBS related daycare;

(e) low income energy assistance program (LIEAP) ;

(f) the former state general relief program;

(g) rehabilitation services; and

(h) visual services.

(5) "Recovery" means any measure undertaken by the state auditor's office under the authority of 17-4-101 , MCA et seq. in accordance with that agency's rules and policies as a means of recovering a debt owed by a person or entity to the state of Montana. Recovery may include but is not limited to assignment to a collection agency and litigation.

History

Authorizing statute(s): Sec. 17-4-110 and 53-2-201, MCA
Implementing statute(s): Sec. 17-4-104, 53-2-108 and 53-2-201, MCA
History: NEW, 1994 MAR p. 3198, Eff. 12/23/94; TRANS, from SRS, 1996 MAR p. 2433; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.2.305 Referral for Recovery and Offset

(1) The department under the authority of 17-4-104 , MCA may refer to the department of revenue for recovery and offset a debt owed to the department by a program recipient or by a provider of program services.

(2) The department may refer to the department of revenue any debt of a program recipient or a provider of program services including but not limited to those arising out of intentional or unintentional actions of the recipient or provider and those due to mistake upon the part of the department.

(3) The department must determine that a debt is uncollectable by the department before the debt may be referred to the department of revenue.

History

Authorizing statute(s): Sec. 17-4-110, MCA
Implementing statute(s): Sec. 17-4-104, 53-2-108 and 53-2-201, MCA
History: NEW, 1994 MAR p. 3198, Eff. 12/23/94; TRANS, from SRS, 1996 MAR p. 2433; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.2.306 Uncollectable Debt

(1) A debt is uncollectable by the department, if the department has determined that:

(a) the debt is owing to the department;

(b) the debtor has either not pursued available administrative due process within the department or has failed to prevail in the available administrative due process within the department or in any appeal from that administrative due process to the state or federal courts;

(d) the department has no administrative means such as recoupment from current payments to a recipient or provider by which to recover the debt.

(2) The department has made all reasonable efforts to collect a debt when the debt remains owed in whole or part after:

(a) the department has utilized appropriate notices directed at the debtor's last known address to inform the debtor of the debt owed and the debtor cannot be contacted; or

(b) the department has provided the debtor with an opportunity to enter into a repayment agreement based on a schedule for debt repayment that the department determines is appropriate and the debtor has failed to cooperate or the debtor is failing to repay the debt.

(3) A debtor is failing to repay a debt when the debtor has failed to make three monthly payments for which the department has provided notice of delinquency.

History

Authorizing statute(s): Sec. 17-4-110 and 53-2-201, MCA
Implementing statute(s): Sec. 17-4-104, 53-2-108 and 53-2-201, MCA
History: NEW, 1994 MAR p. 3198, Eff. 12/23/94; TRANS, from SRS, 1996 MAR p. 2433.

Subchapter 37.2.5 Self-Sufficiency Trusts

Mont. Admin. R. 37.2.501 Self-Sufficiency Trusts: Purpose

(1) These rules provide for the acceptance by the state of monies from a certain type of trust, known as a self-sufficiency trust, to be used to purchase services to supplement the services that a person with a disability receives from the state. These rules also provide for the receipt of donated monies to be used for the purchase of certain human services.

(2) A properly constituted self-sufficiency trust allows a person to obtain additional resources for enhancing the quality of the person's life while maintaining the person's eligibility for certain state funded human services.

(3) These rules are not written to correspond to or to provide guidance concerning any requirements that may be necessary for a trust to be in compliance with state laws relating to trusts or the federal and state tax codes.

(4) The department is not responsible for advising or directing a party in the various legal requirements necessary for the establishment of a trust in relation to state trust law and federal and state tax codes.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 935, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.502 Self-Sufficiency Trusts: Definitions

For the purposes of these rules, the following definitions apply:

(1) "Department" means the department of public health and human services provided for in Title 2, chapter 15, part 22, MCA.

(2) "Department funded services" means services and items normally purchased by the department for recipients of its programs. Department funded services are typically provided by a service provider through a contract with the department or by fee reimbursement from the department. The term also includes services provided by a service provider through a contract with the department of corrections or by free reimbursement from the department of corrections.

(3) "Beneficiary" means a person who is eligible to be a beneficiary of a self-sufficiency trust as provided in ARM 37.2.503.

(4) "Life care plan" means a written plan established to govern the provision of supplemental services purchased with the monies of a self-sufficiency trust.

(5) "Person with a disability" means a disabled person as defined at 45 USC 1382c(a) (3) (1995) who has a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. 45 USC 1382c(a) (3) (1995) is a federal statute that is adopted and incorporated by this reference. A copy of the cited regulation is available upon request from the Department of Public Health and Human Services, Office of Legal Affairs, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(6) "Self-sufficiency trust", as defined at 53-18-101 (2) , MCA, means a trust to benefit a person with a disability established, held and managed by a nonprofit corporation that is a 501(c) (3) organization under the United States Internal Revenue Code of 1954, as amended, and that is organized under the Montana Nonprofit Corporation Act, Title 35, chapter 2, MCA. The corporation must have as one of its principal purposes the use of trust monies for the care and treatment of a person or persons with disabilities who are or could be the recipients of department funded services. The monies of individual self-sufficiency trusts may be pooled together by a nonprofit corporation for management and investment purposes.

(7) "Self-sufficiency trust account" means the account established by the state for the purpose of receiving monies from self-sufficiency trusts for the purchase of supplemental services by the state for eligible beneficiaries.

(8) "Service provider" means a person or corporation that provides department funded services or supplemental services to a beneficiary.

(9) "Special charitable account" means the account within the state's self-sufficiency trust account established for the purpose of receiving charitable donations to fund services for persons who have developmental disabilities, mental illness and physical disabilities or who are otherwise eligible for department services, as defined by the department.

(10) "Supplemental services" means services and items that are in addition to the department funded services an eligible beneficiary is receiving from the department.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 935, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.503 Self-Sufficiency Trusts: Eligible Beneficiary

(1) The beneficiary of a self-sufficiency trust must be:

(a) a resident of the state of Montana;

(b) a person with a disability; and

(c) potentially eligible for services provided by the department or for mental health services provided by the department of corrections.

(2) A person of 18 or more years of age has a disability only if the person is unable to engage in any substantial gainful activity due to the disability.

(3) Services provided by the department include:

(a) developmental disabilities services;

(b) vocational rehabilitation services;

(d) severe disabilities services;

(e) weatherization services;

(f) low income energy assistance;

(g) aid for dependent children;

(h) food stamps; and

(i) medicaid services.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 935, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.505 Self-Sufficiency Trusts: Qualifying Trusts

(1) To qualify as a self-sufficiency trust, an individual trust must meet the following criteria:

(a) The individual trust must be established and managed by a nonprofit corporation which has as one of its principal purposes the use of trust monies for the care and treatment of a person or persons with disabilities who are or could be the recipients of state funded services;

(b) The individual trust must be for the sole benefit of a person or persons with disabilities who are or could be the recipients of the state funded services listed in ARM 37.2.503(3) ;

(c) The individual trust must be funded by the beneficiary, by a parent, grandparent or legal guardian of the beneficiary, or at the direction of a court;

(d) The individual trust must provide that the trust monies may only be expended on supplemental services;

(e) The individual trust must provide that upon the death of the beneficiary the state be reimbursed, to the extent the monies remaining in the trust allow, an amount equal to the total cost to the state of providing medicaid services to the beneficiary;

(f) The individual trust must provide that upon the death of the beneficiary, in accordance with IRS codes, rulings and interpretations, monies are donated from the remainder of the trust to the special charitable account as described in ARM 37.2.511;

(g) The expenditure of monies from the individual trust on behalf of a beneficiary must be governed by a life care plan approved by the department in accordance with ARM 37.2.508; and

(h) The individual trust must be established in accordance with state laws governing trusts and with relevant federal and state tax codes, rulings and interpretations.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 935, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.508 Self-Sufficiency Trusts: Life Care Plan Approval and Payment

(1) A life care plan must include:

(a) the name and address of the beneficiary;

(b) a description of the specific supplemental services to be purchased;

(d) the amount of money available to purchase the supplemental services; and

(e) any other information necessary for the department to be able to decide whether it is feasible to purchase the specified supplemental services.

(2) A life care plan must meet the following criteria in order to be approved by the department:

(a) The supplemental services specified in the plan must be currently available and can be reasonably expected to be available for the beneficiary when necessary;

(b) The supplemental services specified in the life care plan can be purchased in a manner consistent with the practices of the department;

(c) The beneficiary's trust account must have sufficient monies over the term of the plan to fund the supplemental services to be purchased under the plan; and

(d) The services and items specified in the plan are supplemental services as defined in ARM 37.2.502.

(3) The department will notify the self-sufficiency trust corporation of the department's decision to approve or disapprove a life care plan.

(4) The self-sufficiency trust corporation must provide the department with a payment schedule by which the monies necessary for the reimbursement of the cost of the supplemental services specified in the plan will be deposited to the state's self-sufficiency trust account so as to provide payments for the purchase of the services.

(5) The department will not approve the life care plan for a person who is or could be eligible for state funded mental health services unless the department of corrections approves the plan and is committed to managing the delivery of the supplemental services specified in the plan.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 1135, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.509 Self-Sufficiency Trusts: Life Care Plan Implementation

(1) The department manages the purchase and delivery of the supplemental services specified in an approved life care plan.

(2) The department may contract with a service provider to manage on behalf of the department the delivery of supplemental services specified in a life care plan.

(3) A contract for the management of the purchase and delivery of supplemental services specified in a life care plan must provide the following:

(a) the name and address of the beneficiary;

(b) the supplemental services to be purchased and delivered;

(d) the types and quantity of the supplemental services to be delivered;

(e) the amount of any reasonable administrative cost the service provider may charge for the management of the purchase and delivery of the supplemental services; and

(f) any other information necessary to secure the purchase and delivery of supplemental services.

(4) Prior to the purchase of a service or item, the money to purchase the service or item must be available in the state's self-sufficiency trust account.

(5) The department reimburses the charges for supplemental services based upon billing provided after the delivery of the services.

(6) The department may terminate the delivery of supplemental services if the amount of funds deposited in the state's self-sufficiency trust account for that particular beneficiary is not sufficient for the management and purchase of the services specified in the life care plan.

(7) A life care plan may be modified only with the written approval of the department.

(8) A self-sufficiency trust desiring to terminate supplemental services must provide the department with written notification 30 days prior to the date when the services are to terminate.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 1135, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.511 Self-Sufficiency Trusts: Special Charitable Account

(1) The special charitable account provides monies to fund services for recipients of the programs of services specified in ARM 37.2.503(3) on an individual or group basis.

(2) The special charitable account is funded with monies donated by individual trust accounts as provided in ARM 37.2.505 (1) (f) by other charitable donations, and by any other permissible means.

(3) The expenditure of monies from the special charitable account is subject to the legislative appropriation process.

(4) Services for a person are provided in accordance with the provisions of a life care plan developed by the department and approved by the special charitable account review board.

(5) The special charitable account review board is a 3 person board appointed by the department director to review and approve proposed life care plans developed by the department to purchase services for persons with funds from the special charitable account and to review and approve other expenditures from the account.

(6) The special charitable account review board consists of the following members:

(a) a department employee;

(b) a member of the board of directors of an organization which provides self-sufficiency trust services; and

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 1135, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.512 Self-Sufficiency Trusts: Reporting Requirements

(1) A service provider, managing the purchase and delivery of supplemental services must provide an annual report to the department.

(2) The department must provide an annual report on an active individual self-sufficiency trust to the managing self-sufficiency trust corporation specifying the following:

(a) the name and address of the eligible beneficiary who received supplemental services;

(b) a description of the supplemental services provided;

(d) the cost of the supplemental services provided; and

(e) information about the impact of the supplemental services on the beneficiary.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 1135, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.513 Self-Sufficiency Trusts: State Self-Sufficiency Trust Account

(1) Monies of a self-sufficiency trust, in order to be expended by the state, must be transferred to the department for deposit to the state self-sufficiency trust account.

(2) Monies from a self-sufficiency trust received by the department are deposited in the state's self-sufficiency trust account. The monies for each beneficiary are individually accounted for in the trust account.

(3) The department must return monies to a self-sufficiency trust along with any interest earned on the monies if the department is unable to obtain the supplemental services specified in the life care plan and the life care plan is not revised.

(4) The department must disburse monies from the special charitable account in the self-sufficiency trust account in accord with the appropriation process and the direction of the special charitable account review board.

History

Authorizing statute(s): Sec. 53-2-201 and 53-18-103, MCA
Implementing statute(s): Sec. 53-18-101, 53-18-102, 53-18-103, 53-18-104 and 53-18-105, MCA
History: NEW, 1995 MAR p. 1135, Eff. 5/26/95; TRANS, from SRS, 1996 MAR p. 2433.

Mont. Admin. R. 37.2.520 Achieving a Better Life Experience (able) Program: Purpose

(1) The purpose of the ABLE program is to provide Montana residents with access to a tax-favored program designed to provide secure funding for qualified disability-related expenses on behalf of individuals with disabilities that will supplement, but not supplant, benefits provided through public or private sources.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-102 MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.521 Definitions

The following definitions, found in 53-25-103, MCA, apply to this subchapter:

(1) "Account" means an eligible participating account established under Title 53, chapter 25, MCA, by or on behalf of an eligible individual.

(2) "Account owner" means the designated beneficiary of the account.

(3) "Annual contribution limit" means the limit established in section 529A(b)(2) of the Internal Revenue Code, 26 U.S.C. 529A(b)(2).

(4) "Application" means a form executed by or on behalf of a prospective account owner to enter into a participating trust agreement and open an account. The application incorporates the participating trust agreement by reference.

(5) "Committee" means the achieving a better life experience program oversight committee established in 53-25-105, MCA.

(6) "Contribution" means a payment to an account for the benefit of a designated beneficiary.

(7) "Department" means the Department of Public Health and Human Services provided for in 2-15-2201, MCA.

(8) "Designated beneficiary" means the eligible individual on whose behalf an account is established.

(9) "Eligible individual" means an eligible individual as defined in section 529A(e)(1) of the Internal Revenue Code, 26 U.S.C. 529A(e)(1).

(10) "Financial institution" means a bank, commercial bank, national bank, savings bank, savings and loan association, credit union, insurance company, trust company, investment adviser, or other similar entity that is authorized to do business in this state.

(11) "Investment products" means, without limitation, certificates of deposit, savings accounts paying fixed or variable interest, financial instruments, one or more mutual funds, and a mix of mutual funds.

(12) "Member of the family" means, with respect to a designated beneficiary, a member of the family of the designated beneficiary as defined in section 529A(e)(4) of the Internal Revenue Code, 26 U.S.C. 529A(e)(4).

(13) "Nonqualified withdrawal" means a withdrawal from the account that is not:

(a) a qualified withdrawal;

(b) a withdrawal made as the result of the death of the designated beneficiary of an account; or

(14) "Participating trust agreement" means an agreement between an account owner and the department or its designee that creates a trust interest in the trust and provides for participation in the program.

(15) "Program" means the Montana achieving a better life experience program provided for in 53-25-101, et seq., MCA and authorized under section 529A of the Internal Revenue Code, 26 USC 529A.

(16) "Program manager" means a financial institution that acts as an agent of the trust as provided in 53-25-112, MCA.

(17) "Qualified disability expenses" means qualified disability expenses as defined in section 529A(e)(5) of the Internal Revenue Code, 26 USC 529A(e)(5).

(18) "Qualified withdrawal" means a withdrawal from an account to pay the qualified disability expenses of the beneficiary of the account. A qualified withdrawal may be made by the beneficiary, by an agent of the beneficiary who has a power of attorney for the beneficiary, or by the beneficiary's legal guardian.

(19) "Rollover distribution" means a transfer of funds made:

(a) from one account in another state's qualified program to an account for the benefit of the same designated beneficiary or an eligible individual who is a family member of the former designated beneficiary; or

(b) from one account to another account for the benefit of an eligible individual who is a family member of the former designated beneficiary.

(20) "Trust" means the achieving a better life experience savings trust as provided in 53-25-121, MCA.

(21) "Trustee" means the department in its capacity as trustee of the trust.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-103 MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.522 Fees

(1) There is a one-time application fee of $25 for opening a new account. The fee must be paid when the new account is established.

(2) Financial institutions acting as program managers may impose fees upon account owners. Program management fees must be approved by the department before they can be imposed.

(3) Application fees collected must be remitted to the department and placed in a state special revenue account and only be used for administration of the program.

(4) Program management fees will be retained by each program manager as compensation for program management services.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-109, 53-25-112, MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.525 Duties of Program Manager

(1) Each program manager must do the following:

(a) generally administer and carry out the program according to the directions and policies of the department and applicable law;

(b) keep adequate records of each account that is under its direction, keep such account segregated from other accounts and post contributions to accounts within no later than the business day that it receives verification that such contributions consist of fully collected funds;

(c) provide the department and all appropriate governmental and regulatory agencies all reports and information as may be required or deemed necessary to obtain tax advantages available under state or federal laws;

(d) provide regular statements at least annually, within 31 days of the annual period to which they apply, to each account owner showing all contributions, withdrawals, and earnings posted to each account during the previous reporting period;

(e) comply with the terms and conditions of its contract with the department;

(f) take all actions required to keep the program in compliance with the requirements of the ABLE Act and all reasonable action not contrary to the ABLE Act, these rules or the depository or program manager's contract to manage its program accounts so that it is treated as a qualified ABLE Act program under section 529A(b) of the Internal Revenue Code, 26 USC 529A(b);

(g) comply with all other laws and regulations applicable to the program manager;

(h) retain or provide copies to the department of all applications and related documentation received pursuant to these rules;

(i) include in any application, participating trust agreement, contract, offering or disclosure document, and any other document identified by the department that may be used in connection with a contribution to an account an express statement that the account is not insured by the state and that the principal deposited and any investment return are not guaranteed by the state; and

(j) include in any application or participating trust agreement a statement that the program must provide that a portion or all of the balance remaining in the account of a deceased designated beneficiary must be distributed to a state that files a claim against the designated beneficiary or the account itself with respect to benefits provided to the designated beneficiary under that state's Medicaid plan.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-109, 53-25-110, 53-25-113, MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.526 Opening of Accounts: Qualifications

(1) An account may be opened by or on behalf of an eligible individual who is a resident of Montana or a resident of a state that has entered into a contract with Montana to provide its residents access to the program.

(2) An eligible individual or the eligible individual's legal guardian or agent under a power of attorney may open an account for the benefit of the eligible individual by:

(a) completing an application and a participating trust agreement supplied by the program manager;

(b) making the minimum contribution required by the program manager; and

(3) The application or participating trust agreement must include:

(a) the name, address, telephone number, and social security number or employer identification number of the contributor;

(b) the name, address, telephone number, and social security number of the eligible individual who will be the designated beneficiary and account owner;

(d) the certification relating to no excess contributions adopted by the department;

(e) the designation of the type of account to be opened if more than one type of account is offered;

(f) the certification that money in the account will be used solely to save for and to pay for the account owner's qualified disability expenses;

(g) the certification that the account will not be used or pledged as security for a loan;

(h) copies of documents establishing a legal guardianship or power of attorney if the account is established by a legal guardian or individual acting pursuant to a power of attorney; and

(i) any other information the department requires.

(4) Unless required by federal law or regulation, money in any account may not be counted as a resource in determining eligibility for an assistance program operated under Title 53, MCA, or any other federal, state, or local government means-tested program.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-109, 53-25-120, MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.527 Contributions and Limits

(1) Subject to the limitations in (2), any person, including a nonresident of Montana and an individual who is not the account owner, may make a contribution to an account.

(2) All contributions to accounts must be in cash and may not exceed the annual contribution limit found in section 529(A)(b)(2) of the Internal Revenue Code, 26 USC 529(b)(2).

(3) Contributions may be made following payroll deduction plans to which the contributor and his or her employer are parties. In such case, the employer, on behalf of the contributor, will send the contribution to the program manager, as agent for the trustee.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-109, MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.530 Withdrawals

(1) Qualified withdrawals from an account are:

(a) a withdrawal from an account to pay the qualified disability expenses of an account owner;

(b) a withdrawal made as the result of the death of the account owner; or

(2) A qualified withdrawal may be made by the account owner, by an agent of the account owner who has a power of attorney for the beneficiary, or by the account owner's legal guardian for qualified disability expenses.

(3) Nonqualified withdrawals are any withdrawals from an account other than qualified withdrawals and are subject to a recapture tax, as allowed under section 529A(c)(3) of the Internal Revenue Code and as implemented by the Montana Department of Revenue.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-110 MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.531 Reporting Requirements

(1) At least annually, within 31 days of the annual period to which they apply, the program manager must provide to each account owner an account statement. The statement must include:

(a) a balance of the account at the beginning of the reporting period;

(b) all activity during the reporting period including deposits, withdrawals, penalties paid, and income earned; and

(2) A program manager must prepare and provide to account owners such information as the Internal Revenue Service or federal income tax law may require be provided to account owners by the required deadlines.

(3) A program manager must prepare and provide to the Department of Revenue (DOR) such information as the director of DOR may request to permit the DOR to verify the $3,000 income deduction permitted by 15-30-2110(12), MCA.

(4) A program manager, upon request of the department, must provide to the department copies of the reports that it provides to account owners.

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-109, 53-25-118, MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Mont. Admin. R. 37.2.532 Termination of Program Manager

(1) If the department determines not to renew a contract with an existing program manager, then the department, as trustee of the trust, may take appropriate action consistent with the interest of the program and the accounts.

(2) Except as provided in (3), if the department does not renew a contract with a program manager, at the end of the term of the nonrenewed contract, the program manager must:

(a) continue to administer accounts already established with the program manager, including accepting additional contributions;

(b) not establish new accounts unless and until a new program contract is executed with the department; and

(c) comply with all rules or policies established by the department or the terms of a contract between the department and the nonrenewed program manager executed for the purpose of administering and managing the existing accounts.

(3) The department may terminate a contract with a program manager or prohibit the continued investment of funds with a nonrenewed program manager at any time for good cause on the recommendation of the committee.

(4) Upon termination of a program manager contract for good cause or prohibition of investment upon recommendation of the committee, the department must take custody of account funds held at the financial institution and must promptly reinvest the funds with another financial institution selected as a program manager by the department and into the same investment products or substantially similar investment products.

(5) Subject to (6), prior to terminating a contract or prohibiting investment, the department must give account owners notice of the termination and a period of up to 30 days to voluntarily terminate the account and to select another program manager with which to establish an account.

(6) If termination of a program manager causes an emergency that may lead to a loss of funds to any account owner, the department may take emergency action as necessary or appropriate to prevent the loss of funds. After taking emergency action, the department must provide notice to account owners and opportunity for action as provided in (5).

History

Authorizing statute(s): 53-25-104, MCA
Implementing statute(s): 53-25-109, 53-25-112, MCA
History: NEW, 2016 MAR p. 1575, Eff. 9/3/16.

Subchapter 37.2.7 State Facility Reimbursement

Mont. Admin. R. 37.2.701 Definitions

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

(2) "Discretionary income" is determined by subtracting fixed expenses from the total gross income or adjusted gross income from the most recent IRS tax return plus depreciation and voluntary retirement contributions which are deducted from the gross income on the tax return.

(3) "Financially responsible person" means a spouse of a resident, the natural or adoptive parents of a resident under 18 years of age or a guardian or conservator to the extent of the guardian's or conservator's responsibility for the financial affairs of the person who is a resident under applicable Montana law establishing the duties and limitations of guardianship or conservatorships.

(4) "Fixed expenses" means the amount determined by the department under ARM 37.2.703.

(5) "Income" means the amount determined by the department under ARM 37.2.702.

(6) "Liquid assets" means stocks, bonds, certificates of deposit, etc. which can be readily converted to cash.

(7) "Personal needs" means the reasonable cost of toiletries, newspapers, or other personal comfort items not normally supplied by an institution. The department will use the standards for medicaid guidelines as a minimum. The standards for medicaid guidelines are published in the Department Medical Assistance Guidelines Manual (see MA 904-1 and 904-3) . A copy of these standards can be obtained from the Department of Public Health and Human Services, Fiscal Services Division, 111 N. Sanders, P.O. Box 6429, Helena, MT 59604-6429.

(8) "Real property" means land and permanent attachments including trees, buildings and infrastructure.

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-401, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; AMD, 1984 MAR p. 1367, Eff. 9/14/84; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.702 Income

(1) Income means economic benefit received by a resident or financially responsible person from any source, and includes, but is not limited to:

(a) gross wages, salaries, tips, commissions, bonuses and other earnings;

(b) draws or advances against future earnings;

(d) net receipts from nonfarm self-employment (receipts from a nonfarm business, profession or occupation, after deductions for reasonable operating expenses) ;

(e) net receipts from farm self-employment, whether an owner, tenant, or sharecropper (receipts from a farm or ranch, after deductions for reasonable operating expenses) ;

(f) net rental income (receipts from rental property after deductions for reasonable operating expenses) ;

(g) periodic payments from social security, unemployment compensation insurance, union strike funds, workers compensation, veterans benefits, public assistance (including, but not limited to, aid to families with dependent children or temporary assistance for needy families, supplemental security income and non-federally funded general assistance or general relief) and other government payments or benefits, disability benefits and training stipends;

(h) alimony, child support and military family allotments or other regular support from an absent family member or someone not living in the household;

(i) private pensions, government employee pensions (including military retirement pay) , railroad retirement and regular insurance, trust or annuity payments;

(j) college or university scholarships, grants, fellowships and assistantships;

(k) dividends, interest or net royalties;

(l) distributions from estates or trusts, net gambling and lottery winnings; capital gains; proceeds from the sale of personal or real property (house, automobile, etc.) ; tax refunds, federal earned income credit, government subsidies or grants; gifts, one-time insurance payments, recoveries for injury or loss; and

(m) the value of non-cash benefits (including but not limited to inkind compensation, personal use of a business vehicle, housing, food, utilities and payment of personal expenses or obligations) .

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-405, MCA
History: NEW, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.703 Fixed Expenses

(1) Fixed expenses shall be limited to reasonable and necessary living and mandatory expenses over which the resident or responsible person has little or no control, and which have been incurred or committed to prior to admission. These expenses may include, but are not limited to:

(a) housing expenses such as:

(i) rent payment;

(ii) lease payment;

(iii) mortgage;

(iv) property taxes;

(v) property insurance;

(vi) mortgage insurance;

(vii) heat;

(viii) electricity;

(ix) water and sewer;

(x) waste disposal;

(xi) phone; and

(xii) special improvement districts (SIDs) and rural improvement districts (RIDs) ;

(b) transportation expenses such as:

(i) vehicle payment;

(ii) vehicle lease;

(iii) vehicle insurance;

(iv) license;

(v) vehicle maintenance;

(vi) fuel; and

(vii) public transportation;

(i) actual medically related cost after subtracting insurance reimbursement; and

(ii) medical and nursing home insurance premiums;

(d) food expense;

(e) clothing;

(f) union dues;

(g) lodge dues which include life insurance;

(h) court ordered debt or payment (child support, alimony, etc.) ;

(i) taxes such as:

(i) federal;

(ii) state;

(iii) social security;

(j) mandatory retirement;

(k) voluntary retirement up to social security contribution;

(l) life insurance;

(m) burial contract committed to prior to or during the inpatient stay;

(n) child or adult day care;

(o) education; and

(p) employment expenses.

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-405, MCA
History: NEW, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.705 Ability to Pay Determination

(1) Upon receipt of sufficient financial information and documentation, the department may determine the fixed expenses of the resident or financially responsible person. The following shall apply to food, clothing and transportation expenses:

(a) allowances for food and clothing needs shall be based on data reported periodically by the USDA center for nutrition policy and promotion. A copy of the allowances for food and clothing are available upon request from the Department of Public Health and Human Services, Fiscal Services Division, 111 N. Sanders, P.O. Box 6429, Helena, MT 59604-6429; and

(b) transportation expenses shall be allowed for the actual cost of operating one vehicle per family, unless a second vehicle is essential to the production of income. If no vehicle is owned, the actual cost of public transportation shall be allowed.

(2) Ability to pay shall be determined by dividing the resident or financially responsible person’s discretionary income as defined in ARM 37.2.701 by the number of persons dependent upon that income, including the resident or financially responsible person. The quotient shall be the resident's share of discretionary income or the ability to pay.

(3) The ability to pay shall be reduced by the monthly personal needs as defined in ARM 37.2.701 for the resident as determined by the department. If the department learns that the personal needs allowance is not being used for the resident’s benefit, the department may discontinue the allowance.

(4) Liquid assets which exceed eligibility standards for medicaid shall be considered available to pay the cost of care unless protected as follows:

(a) as protected by law;

(b) an order of the court; or

(5) The department shall determine ability to pay based on the real property of a resident or the resident's spouse as follows:

(a) if the real property has been listed or advertised for sale, or is not occupied as the home of the resident, the resident's spouse, or a dependent child or parent of the resident or the resident's spouse, it shall be considered as provided in 53-1-405 , MCA; or

(b) upon the sale of real property, the proceeds shall be considered available to pay the cost of care and shall be added to the ability to pay unless the property sale proceeds will be used to purchase a home within 18 months or are used for primary residence living expenses.

(6) The department shall review each determination of ability to pay as follows:

(a) annually, as provided in 53-1-408 , MCA; or

(b) upon the request of a resident or financially responsible person providing documentation of a changed circumstance that would substantially affect the previous determination;

(c) the determination shall be effective upon completion of the review, unless the department finds one of the conditions in 53-1-408 , MCA applies. Refunds of any overpayment resulting from an assessment retroactively reduced because of a new determination of ability to pay shall be made according to 53-1-405 , MCA.

History

Authorizing statute(s): Sec. 53-1-403 and 53-1-405, MCA
Implementing statute(s): Sec. 53-1-405, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; AMD, 1984 MAR p. 1367, Eff. 9/14/84; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.706 Procedure to Obtain Financial Information for Ability to Pay Determination

(1) Upon admission or commitment to one of the institutions listed in 53-1-402 , MCA, a representative of the department shall contact the resident or financially responsible person to obtain information and documentation for use in assessing the resident's or financially responsible person's ability to pay the resident’s cost of care.

(2) The department shall allow the resident or financially responsible person 30 days from the date of the request or date of mailing to respond. If the resident or financially responsible person is contacted by mail, the department shall allow an additional three days for the response.

(3) If the resident or financially responsible person does not provide or cooperate with the department in obtaining the requested financial information and documentation within 30 days, the department may determine ability to pay, up to the full cost of care based on the information gathered by the department under 53-1-406 , MCA.

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-406, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; AMD, 1984 MAR p. 1367, Eff. 9/14/84; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.707 Monthly Payment Amount

(1) The charge assessed against each resident or financially responsible person shall be the lower of:

(a) the full cost of care, as determined by recorded charges, less any payments received from other sources, except that payments received from a managed care organization administering a mental health managed care program under contract with the department shall not reduce the charge;

(b) the amount of the adjusted ability to pay determination; or

(c) the maximum parental liability, for parents of a long-term resident shall be based on data reported periodically by the United States department of agriculture (USDA) center for nutrition policy and promotion. The liability shall commence on the 121st day of care. The current maximum parental liability amount is available upon request from the Department of Public Health and Human Services, Fiscal Services Division, 111 N. Sanders, P.O. Box 6429, Helena, MT 59604-6429.

(2) The department may accept a monthly payment that is less than the assessed charges, with the balance accumulating as a liability of the resident or financially responsible person under the following circumstances:

(a) pending the sale of liquid assets or real property available to pay the cost of care;

(b) pending the anticipated receipt of income; or

(c) when a resident whose care treatment plans provide for discharge and economic independence within one year, and additional funds are needed for:

(i) savings to furnish and initiate an independent living arrangement for the resident upon release from the facility. Under this provision, funds shall not be conserved beyond the point that the resident would no longer meet the asset eligibility limits for SSI or medicaid; or

(ii) purchase of clothing and other reasonable personal expenses the client will need to enter an independent living arrangement.

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-405, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.710 Third Party Resources

(1) Applicable medicare, medicaid, or personal insurance or similar health care benefits shall be considered as a resource of the resident.

(2) Upon verification of the receipt of third party payments made directly to a resident or financially responsible person, the department may enforce the automatic assignment of rights provided in 53-1-414 , MCA.

History

Authorizing statute(s): Sec. 53-1-403 and 53-1-405, MCA
Implementing statute(s): Sec. 53-1-405 and 53-1-414, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; AMD, 1984 MAR p. 1367, Eff. 9/14/84; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99.

Mont. Admin. R. 37.2.711 Maintenance of Charge Records

(1) The department shall maintain records of services provided to residents, and shall prepare a monthly itemized statement for each resident receiving chargeable services. Charges shall be recorded for each service and for each day the resident is at the institution at midnight. No per diem charge shall be recorded for the day the resident leaves, unless the resident dies or is admitted and discharged from the institution during the same day.

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-403 and 53-1-405, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99.

Mont. Admin. R. 37.2.712 Procedure for Failure to Pay

(1) Accounts which are delinquent shall be identified by the department at 60, 90 and 120 day intervals. The department may notify a resident or financially responsible person whose account is delinquent 90 days of its intent to use the department of administration debt collection service for debt collection unless payment is received in 30 days.

(2) If no response or payment is received before the 120th day, the department may issue a second notice stating that action has been taken, and requesting that all correspondence and/or payment be directed to the department of administration.

(3) If a resident or financially responsible person dies owing a delinquent account, the department may notify the heirs, devisees, personal representative or attorney of its claim against any estate.

History

Authorizing statute(s): Sec. 53-1-403 and 53-1-404, MCA
Implementing statute(s): Sec. 53-1-411, MCA
History: NEW, 1983 MAR p. 302, Eff 4/15/83; AMD, 1984 MAR p. 1367, Eff. 9/14/84; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99.

Mont. Admin. R. 37.2.713 Refunds and Retroactive Assessments

(1) If in the process of reviewing a resident ' s or responsible person ' s ability to pay, the department determines that information has been misrepresented on a previous financial statement, which if honestly represented would have resulted in a higher ability to pay determination, a retroactive adjustment of the monthly payment amount based on the increased ability to pay will be made.

(2) If a new determination results in a retroactive reduction of a prior monthly payment amount, and the account has been paid in full for that time period, a refund will be made.

(3) If combined payments from more than one payer are received which exceed the cost of care, a refund will be initiated with the appropriate party or intermediary listed as designated recipient.

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-408, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99.

Mont. Admin. R. 37.2.720 Ability to Pay, Administrative Review and Fair Hearing

(1) If the resident or a financially responsible person is aggrieved by the department's determination of ability to pay, that person may request an administrative review regarding the determination. The administrative review is subject to and shall be conducted in accordance with this rule.

(2) The request for administrative review must be:

(a) submitted to the department in writing;

(b) state the reasons the person contends that the determination is incorrect or fails to comply with legal requirements;

(c) include any additional information and substantiating documentation which the person wishes the department to consider in the administrative review;

(d) be received by the department within 30 days of mailing of the department's ability to pay determination letter; and

(e) be mailed or delivered to the Department of Public Health and Human Services, Fiscal Services Division, 111 N. Sanders, P.O. Box 6420, Helena, MT 59604-6420.

(3) A resident or financially responsible person aggrieved by an adverse department administrative review determination under this rule may request a fair hearing in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): Sec. 53-1-403, MCA
Implementing statute(s): Sec. 53-1-407 and 53-1-408, MCA
History: NEW, 1983 MAR p. 302, Eff. 4/15/83; AMD, 1984 MAR p. 1367, Eff. 9/14/84; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Subchapter 37.2.9 Community Services Block Grants

Mont. Admin. R. 37.2.901 Purpose

(1) The purpose of the community services block grant is to alleviate the causes of poverty within the state.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981
History: NEW, 1982 MAR p. 1272, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; TRANS, from SRS, 2000 MAR p. 745.

Mont. Admin. R. 37.2.902 Definitions

For purposes of this subchapter, the following definitions apply:

(1) "Act" means the Omnibus Budget Reconciliation Act of 1981.

(2) "Contractor" means human resource development council, one of the state's 10 organizations designated as a community action agency under the provisions of section 210 of the Economic Opportunity Act of 1964 which is a nonprofit community organization serving low income persons in a multicounty area that has the same boundaries as one or more substate planning districts established by executive order of the governor.

(3) "County" means the board of county commissioners.

(4) "CSBG" means the community services block grant.

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

(6) "Director" means the director of the department of public health and human services.

(7) "Poverty line" means the official poverty line established by the director of the federal office of management and budget.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981 and Sec. 53-10-501, MCA
History: NEW, 1982 MAR p. 1222, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; AMD, 1983 MAR p. 754, Eff. 7/1/83; TRANS, from SRS, 2000 MAR p. 745; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.906 Contractor Plan

(1) To receive its allotment of CSBG funds, as determined under ARM 37.2.915, each contractor must submit, by October 1 of each year, its contractor plan to the department for review and approval. If the federal CSBG appropriation has not been determined to such a degree that estimates of allocations are feasible, the submittal date will be revised accordingly.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981 and Sec. 53-10-504, MCA
History: NEW, 1982 MAR p. 1222, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; AMD, 1983 MAR p. 754, Eff. 7/1/83; TRANS, from SRS, 2000 MAR p. 745.

Mont. Admin. R. 37.2.907 Contractor Plan Assurances and Content

(1) A contractor must assure in its contractor plan that it will only use the funds:

(a) to provide a range of services and activities having a measurable and potentially major impact on causes of poverty in the community or those areas of the community where poverty is a particularly acute problem;

(b) to provide activities designed to assist low income participants including the elderly poor:

(i) to secure and retain meaningful employment;

(ii) to attain an adequate education;

(iii) to make better use of available income;

(iv) to obtain and maintain adequate housing and a suitable living environment;

(v) to obtain emergency assistance through loans or grants to meet immediate and urgent individual and family needs, including the need for health services, family needs, including the need for health services, nutritious food, housing and employment related assistance;

(vi) to remove obstacles and solve problems which block the achievement of self-sufficiency;

(vii) to achieve greater participation in the affairs of the community; and

(viii) to make more effective use of other programs related to the purpose of this subchapter.

(c) to provide on an emergency basis for the provision of such supplies and services, nutritious foodstuffs, and related services, as may be necessary to counteract conditions of starvation and malnutrition among the poor;

(d) to coordinate and establish linkages between governmental and other social services programs to assure the effective delivery of services to low income individuals;

(e) to encourage the use of entities in the private sector of the community in efforts to ameliorate poverty in the community; and

(f) to meet department-identified priorities which address one or more of the eligible activities described in (1) (a) through (e) .

(2) Not all of items in (1) (b) through (f) must be proposed in a contractor plan. However, the contractor does have to certify that it is providing a range of services and activities having a measurable and potentially major impact on the causes of poverty in its community, commensurate with the amount of money received.

(3) The contractor plan shall contain the additional assurances that:

(a) CSBG funds will not be used to provide voters and prospective voters with transportation to the polls or provide similar assistance in connection with an election or any voter registration activity;

(b) CSBG funds will be used to provide for coordination between anti-poverty programs and, where appropriate, with emergency energy crisis intervention programs under Title XXVI of the Act (relating to low income home energy assistance) conducted in the county;

(c) fiscal control and fund accounting procedures will be established as may be necessary to assure the proper disbursal of and accounting for CSBG funds;

(d) the contractor will prepare and submit to the state, at least once every two years, an independent audit of the CSBG funds;

(e) amounts found not to have been expended in accordance with the Act or the contractor plan will be repaid to the state;

(f) no person shall on the ground of race, color, national origin or sex be excluded from participation in, be denied the benefits of or be subjected to discrimination under any program or activity funded, in whole or in part, with CSBG funds. Any prohibition against discrimination on the basis of age under the Age Discrimination Act of 1975 or with respect to an otherwise qualified handicapped individual as provided in Section 504 of the Rehabilitation Act of 1973 shall also apply to any such program or activity;

(g) CSBG funds will not be used for the purchase or improvement of land, or the purchase, construction or permanent improvement (other than low cost residential weatherization or other energy-related home repair) of any building or other facility;

(h) it will permit and cooperate with any federal or state investigation related to the CSBG; and

(i) each contractor must have a board of directors constituted so as to assure that:

(i) one-third of the members of the board are elected public officials currently holding office or their representatives, except that if the number of elected officials reasonably available and willing to serve is less than one-third of the membership of the board, membership on the board of appointive public officials may be counted in meeting such one-third requirements;

(ii) at least one-third of the members are persons chosen in accordance with democratic selection procedures adequate to assure that they are representative of the poor in the area served; and

(iii) the remainder of the members are officials or members of business, industry, labor, religious, welfare, education or other major groups and interests in the community.

(4) The contractor plan must contain:

(a) evidence that an assessment of needs has been undertaken to determine the best expenditures of CSBG funds;

(b) a description of which services and activities will be carried out and the means to be used to provide those services and activities. Such description shall also include the geographic areas to be served and categories or characteristics of individuals to be served. If direct services are planned, only individuals with income below the poverty line are eligible; and

(5) The program period will begin January 1 and end on December 31 of the same year. All contractor plans/budget material must be proposed for completion during that period. Should unusual or extraordinary circumstances occur, the department will consider requests for amendments to the contractor plan.

(6) The contractor plan shall be submitted on forms provided by the department.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981 and Sec. 53-10-504, MCA
History: NEW, 1982 MAR p. 1222, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; AMD, 1983 MAR p. 754, Eff. 7/1/83; TRANS, from SRS, 2000 MAR p. 745; AMD, 2003 MAR p. 2440, Eff. 10/31/03.

Mont. Admin. R. 37.2.908 Contractor Plan Approval, Disapproval, Amendments

(1) The contractor shall submit the plan to the county governing bodies within its multicounty area. A county governing body may approve, disapprove, or offer amendments to the plan. If the county governing body and the contractor cannot agree as to the plan's components, the department shall prepare and approve a plan for such county.

(2) The department will, within 45 working days of plan receipt, notify the contractor of approval/disapproval of each contractor plan.

(3) The department will base its review of the contractor plan on whether or not:

(a) the contractor plan demonstrates that it provides a range of services and activities having a measurable and potentially major impact on causes of poverty in the community, or those areas of the community where poverty is a particularly acute problem;

(b) all assurances and requirements of ARM 37.2.907 have been met.

(4) The department may disapprove a plan, in whole or in part, only if the plan conflicts with a state or federal law. If the contractor plan is either partially or totally unacceptable, the department will work with the contractor to develop an acceptable proposal. If an acceptable proposal can not be developed within thirty days after notice of disapproval, CSBG funds reserved for an affected county shall be distributed to contractors with approved contractor plans.

(5) If a contractor plan is disapproved, a contractor has the right to appeal to the director. The director's decision shall be the final administrative decision.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981 and Sec. 53-10-504, MCA
History: NEW, 1982 MAR p. 1222, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; AMD, 1983 MAR p. 754, Eff. 7/1/83; TRANS, from SRS, 2000 MAR p. 745.

Mont. Admin. R. 37.2.915 Contractor Allotments

(1) From the available CSBG funds, the department shall retain 5% for cost of administration of the grant and 5% for special projects.

(2) The balance of the block grant funds after any retention pursuant to (1) must be distributed to contractors that are eligible to receive such funding as follows:

(a) $500,000, or if the balance of the block grant funds is less than $500,000, then the entire balance of the block grant funds must be equally divided among the eligible contractors; and

(b) the balance of the block grant funds after distribution under (1) and (2) (a) must be divided among eligible contractors as follows:

(i) one-half based upon the percentage of the state's population residing within the contractor's area; and

(ii) one-half based upon the percentage of the state's population with income below the poverty line residing within the contractor's area.

(3) General population allocation: each contractor shall receive an amount equal to the population residing in the contractor's area according to the most recent U.S. decennial census divided by the population of the state of Montana according to the most recent U.S. decennial census times the amount available for allocation according to general population distribution in (2) (b) (i) .

(4) Poverty population allocation: each eligible contractor shall receive an amount equal to the population residing in the contractor's area which has income below the poverty line according to the most recent U.S. decennial census divided by the population of the state of Montana which has income below the poverty line according to the most recent U.S. decennial census times the amount available for allocation according to poverty population distribution in (2) (b) (ii) . If the results of the most recent U.S. decennial census are unavailable, the most current and accurate information available will be used.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981 and Sec. 53-10-502, MCA
History: NEW, 1982 MAR p. 1222, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; AMD, 1983 MAR p. 754, Eff. 7/1/83; AMD, 1994 MAR p. 1725, Eff. 6/24/94; TRANS, from SRS, 2000 MAR p. 745.

Mont. Admin. R. 37.2.916 Release of Allotments

(1) Release of allotments is contingent upon receipt by the department of the federal CSBG funds. As those funds are received, they will be disbursed by the department.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981
History: NEW, 1982 MAR p. 1222, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; TRANS, from SRS, 2000 MAR p. 745.

Mont. Admin. R. 37.2.920 Reports

(1) Within 90 days of the end of the grant period or the completion of a contractor's planned activities, whichever comes first, the contractor will submit to the department certification that all assurances and services or activities contained in its approved plan have been complied with and achieved.

(2) Upon request, the contractor will submit to the department any reports, forms or documents deemed necessary in order to determine how the funds were expended and for which services or activities.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): HB 2 of the First Special Session, 1981
History: NEW, 1982 MAR p. 1222, Eff. 6/18/82; AMD, 1983 MAR p. 21, Eff. 1/14/83; TRANS, from SRS, 2000 MAR p. 745.

Mont. Admin. R. 37.2.925 Termination or Reduction of Allotment

(1) The allotment of a contractor who currently receives CSBG funding or who received funding in the previous program period can be terminated or reduced below the proportional share currently being received or received in the previous program period only for cause. The term "cause" includes but is not limited to:

(a) a statewide redistribution of funds in response to:

(i) the results of the most recent available census or other appropriate data;

(ii) the establishment of a new entity eligible for funding; or

(iii) severe economic dislocation; or

(b) the contractor's failure to comply with the terms of its agreement to provide services.

(2) The allotment of a contractor who currently receives CSBG funding or who received funding in the previous program period can be terminated or reduced only after the contractor has been notified and given an opportunity for a hearing on the record before the director or the director's designee. A request for a hearing from a contractor must be submitted to the department in writing within 30 days of the date of notice of the termination or reduction. The decision of the director or the director's designee shall be subject to review by the secretary of health and human services.

(a) Upon request, the secretary shall review the record and issue a written determination stating the secretary's reasons for that determination.

(b) In cases where a contractor requests review by the secretary, the termination or reduction of the contractor's allotment is not final until the secretary has affirmed the state's finding of cause.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-10-502, MCA
History: NEW, 1994 MAR p. 1725, Eff. 6/24/94; TRANS, from SRS, 2000 MAR p. 745.

Subchapter 37.2.11 State Reimbursement Rate for Health Care Providers

Mont. Admin. R. 37.2.1101 Purpose

(1) The purpose of these rules is to implement 53-6-1312, MCA, which establishes the Medicaid schedule of rates as the reimbursement rates that the State of Montana (State) pays for health care services provided to an individual who does not qualify for Medicaid, Medicare, a health insurer, or another private or governmental program that pays for health care costs and is:

(a) in the custody of the Department of Corrections; or

(b) a resident, by commitment or otherwise, of the Montana State Hospital, the Montana Mental Health Nursing Care Center, the Montana Chemical Dependency Center, or the Montana Developmental Center.

(2) The State will process these health care claims through the Department of Public Health and Human Services' Medicaid claims processing agent.

History

Authorizing statute(s): 53-6-1318, MCA
Implementing statute(s): 53-6-1312, MCA
History: NEW, 2015 MAR p. 2313, Eff. 1/1/16.

Mont. Admin. R. 37.2.1102 A Provider Must Enroll in Medicaid and Accept the Medicaid Reimbursement Rate to Receive Payment by State

(1) To receive payment from the State for health care services provided to an individual identified in 53-6-1312, MCA, a provider must:

(a) be enrolled as a Montana Medicaid provider;

(b) accept the Montana Medicaid rates as full payment for all health care services; and

(2) A provider who accepts an individual identified in 53-6-1312, MCA, as a patient is agreeing to accept the Medicaid rate as payment in full.

(3) In service settings where an individual identified in 53-6-1312, MCA, is accepted as a patient by a provider who arranges for services by other providers, all providers performing services are deemed to have accepted reimbursement from the State at the Montana Medicaid rates.

(4) A provider may not "balance bill" or seek payment in addition to, or in lieu of, the payment by the State. "Balance bill" means a provider bills the patient, or responsible party, the difference between the amount the state reimburses for services and what the provider chooses to charge.

History

Authorizing statute(s): 53-6-1318, MCA
Implementing statute(s): 53-6-1312, MCA
History: NEW, 2015 MAR p. 2313, Eff. 1/1/16.

Mont. Admin. R. 37.2.1103 Provider Requirements

(1) Except for the administrative rules listed in (2), the provider requirements of ARM Title 37, chapter 85, subchapter 4, "Provider Requirements," apply to the delivery of health care services provided to an individual identified in 53-6-1312, MCA. For purposes of this subchapter, a reference to "Montana Medicaid" or "Medicaid" in ARM Title 37, chapter 85, subchapter 4 is understood to mean payments made under 53-6-1312, MCA.

(2) The following administrative rules do not apply to providers receiving payment for services provided to an individual identified in 53-6-1312, MCA:

(a) ARM 37.85.407, Third Party Liability;

(b) ARM 37.85.411, Provider Rights;

(d) ARM 37.85.416, Statistical Sampling Audits.

(3) A provider who disputes a payment is entitled to an administrative hearing on the matter according to the procedures of the department responsible for payment. A provider who is aggrieved by a final written decision is entitled to a judicial review of the decision.

History

Authorizing statute(s): 53-6-1318, MCA
Implementing statute(s): 53-6-1312, MCA
History: NEW, 2015 MAR p. 2313, Eff. 1/1/16.

Mont. Admin. R. 37.2.1104 Cost Sharing Does Not Apply

(1) The cost sharing requirements of ARM 37.84.108 and 37.85.204 do not apply to the individuals identified in 53-6-1312, MCA. An individual identified in 53-6-1312, MCA, is neither a member nor a program participant as defined at 53-6-1302, MCA.

History

Authorizing statute(s): 53-6-1318, MCA
Implementing statute(s): 53-6-1312, MCA
History: NEW, 2015 MAR p. 2313, Eff. 1/1/16.

Subchapter 37.2.12 Behavioral Health System for Future Generations Capital Projects

Mont. Admin. R. 37.2.1201 Allocation of Funds Appropriated to the Department of Administration for Behavioral Health System for Future Generations Capital Projects

(1) The purpose of this rule is to establish the process by which the funds appropriated to the Department of Administration (DOA) for capital projects in connection with the behavioral health system for future generations initiative will be allocated and spent under section 9, ch. 739, Montana Laws 2023.

(2) The department will use the same process for the identification and approval of capital projects and the allocation of the appropriated funds referenced in (1) for such capital projects as for the other BHSFG initiatives. If any part of such process is infeasible in the department's judgment, the department will use an equivalent alternative approach.

(3) Upon approval by the Governor of a capital project concept, a project plan for the capital project shall be developed by the department and approved by the BHSFG Commission. The project plan may be revised and updated as needed. The funds allocated to the capital project from the amounts referenced in (1) shall be expended pursuant to the project plan.

(4) The department shall consult with the Architecture and Engineering Division of the Department of Administration on the proposed capital projects to be funded with the appropriations referenced in (1).

(5) Upon approval of a capital project concept by the Governor and approval of the project plan for an approved capital project by the BHSFG Commission, the department will notify the Department of Environmental Quality of the project for potential inclusion in the state building energy conservation program. The department will use any funds provided under the state building energy conservation program to offset or add to the allocated and authorized funding for the project.

History

Authorizing statute(s): Sec. 4(1), Ch. 739, L. 2023
Implementing statute(s): Sec. 2, 4, 9, 11, Ch. 739, L. 2023
History: NEW, 2024 MAR p. 2272, Eff. 9/21/24.

Chapter 37.5 Fair Hearings and Contested Case Proceedings

Subchapter 37.5.1 Applicable Hearing Procedures

Mont. Admin. R. 37.5.101 Applicable Hearing Procedures

(1) This chapter specifies the fair hearing procedures applicable to department actions in the various programs administered by the department. This chapter does not grant any right to a hearing, but specifies the hearing rules that apply where a right to hearing is otherwise granted by law or rule.

History

Authorizing statute(s): 50-1-202, 53-2-201, 53-6-113, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 42-10-104, 50-1-202, 50-4-612, 50-5-103, 50-6-103, 50-6-402, 50-15-102, 50-15-103, 50-15-121, 50-15-122, 50-31-104, 50-52-102, 50-53-103, 52-1-103, 52-2-111, 52-3-406, 53-2-201, 53-2-904, 53-4-202, 53-4-212, 53-4-606, 53-4-1004, 53-6-111, 53-6-113, 53-6-131, 53-6-402, 53-20-305, 53-24-208, 69-8-412, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.103 Public Assistance, Daycare, Medical, Licensure, and Refugee Assistance Programs: Applicable Hearing Procedures

(1) Hearings contesting adverse department actions under the programs specified in (1)(a) through (1)(k) are available to the extent granted in and according to the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337, except as otherwise provided by department rule.

(a) aging services;

(b) daycare benefits, except the Child and Adult Food program;

(d) food stamps;

(e) foster care maintenance services;

(f) foster care support services;

(g) Low Income Energy Assistance Program (LIEAP);

(h) Low Income Weatherization Program (LIWAP);

(i) Medical Assistance program (Medicaid);

(j) refugee assistance; and

(k) licensure and registration of daycare centers, family daycare homes, and group daycare homes under Title 52, chapter 2, part 7, MCA.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 41-3-1103, 52-1-103, 52-3-406, 53-2-201, 53-2-904, 53-4-212, 53-4-606, 53-6-111, 53-6-113, 69-8-412, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2007 MAR p. 47, Eff. 1/12/07.

Mont. Admin. R. 37.5.105 Nursing Facility Related Cases: Applicable Hearing Procedures

(1) Hearings contesting a transfer or discharge of a nursing facility resident by a nursing facility are available to the extent granted in 42 CFR part 431, subpart E and shall be conducted in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337. A resident shall be considered a claimant for purposes of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(a) Although the department is required by federal law to provide a hearing forum for hearings contesting a transfer or discharge of a nursing facility resident by a nursing facility, the department is not a party to the hearing. The contested action is the action of a nursing facility rather than the department. In such cases, relief may not be granted against the department.

(2) Except as provided in (2)(a), department fair hearings for nursing facilities contesting a department action denying or terminating the facility's Medicaid provider agreement or imposing civil monetary penalties or other alternative remedies for noncompliance with the nursing facility participation requirements in 42 CFR part 483 are not available, because a hearing regarding the same action is available from the federal Medicare/Medicaid agency.

(a) A nursing facility that participates only in the Montana Medicaid program, and not in the Medicare program, and for whom no federal appeal is available with respect to the same issue is entitled to a hearing before the department to the extent granted in 42 CFR part 431, subpart D, with respect to a department action to deny or terminate participation in Medicaid or otherwise sanction the facility for noncompliance with the nursing facility participation requirements in 42 CFR part 483. To the extent a hearing is available under this rule, the hearing shall be conducted in accordance with and subject to the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 and 42 CFR part 431, subpart D.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-113, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.107 State Institutions, Admission, Discharge, and Ability to Pay for Care: Applicable Hearing Procedures

(1) Hearings relating to determinations of ability to pay for cost of care in a state institution are available to the extent granted in 53-1-407 , MCA and shall be conducted in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337. The resident or financially responsible person shall be considered a claimant for purposes of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(2) Persons contesting denial of admission to or involuntary discharge from a state institution shall have only such rights of appeal or hearing as is specifically granted by statute or department rule, including but not limited to ARM 37.45.501 and 37.66.130. The provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 do not apply to appeals under ARM 37.45.501 or 37.66.130.

(3) Persons contesting denial of admission to or discharge from the Montana Developmental Center and the Eastmont Human Services Center shall have such rights of appeal or hearing as provided in ARM 37.5.117.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-407, 53-21-402, 53-21-411, 53-21-413, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.109 Chemical Dependency Program Certification: Applicable Hearing Procedures

(1) Hearings contesting adverse department actions regarding denial, suspension, revocation, limitation or restriction of approval of chemical dependency treatment programs, and chemical dependency education courses are available to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337. The person or entity aggrieved by the adverse department action shall be considered a provider for purposes of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(2) Hearings contesting denial, suspension, revocation, limitation or restriction of chemical dependency treatment programs under ARM Title 37, chapter 27, subchapter 1 shall be conducted as provided in ARM 37.5.117.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.113 Mental Health Services Plan: Applicable Hearing Procedures

(1) Hearings relating to the Mental Health Services Plan (MHSP), are available to the extent provided in ARM 37.89.131. The procedures specified in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 apply to such hearings, subject to the provisions of ARM 37.89.131.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.114 Children's Mental Health Bureau (cmhb) Medicaid Services: Applicable Hearing Procedures

(1) Except as otherwise provided in department rule, hearings contesting adverse department actions relating to CMHB Medicaid services are available to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337, and as further provided in the CMHB Medicaid Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

History

Authorizing statute(s): 50-1-202, 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-6-116, 53-21-701, 53-21-702, 53-21-703, MCA
History: NEW, 2016 MAR p. 1707, Eff. 9/24/16.

Mont. Admin. R. 37.5.115 Developmental Disabilities Programs: Applicable Hearing Procedures

(1) Hearings relating to the Developmental Disability Services program are available as follows:

(a) except as otherwise provided by department rule, hearings contesting adverse department actions in the Developmental Disabilities Services program are available to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(b) hearings contesting a determination by the residential facility screening team that a person is not seriously developmentally disabled and therefore that a commitment or recommitment is not appropriate are available to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337, subject to the provisions of ARM 37.34.2313;

(c) hearings contesting adverse determinations by the Developmental Disabilities Screening Review Board are available to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337, subject to the provisions of ARM 37.34.2313;

(d) hearings contesting adverse department determinations regarding services under the Medicaid Home and Community Services program for persons with developmental disabilities are available to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337, subject to the provisions of ARM 37.34.919;

(e) hearings contesting adverse department actions regarding certification of a person to assist or supervise clients in taking medication are available to the extent provided and according to the procedures specified in ARM 37.34.114, and the provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 and do not apply to such hearings;

(f) hearings contesting adverse actions regarding the individual planning process are available to the extent provided and according to the procedures specified in ARM 37.34.1114 and 37.34.1115, and the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 do not apply to such hearings;

(g) hearings contesting adverse actions regarding the residential facility screening process are available to the extent provided and according to the procedures specified in ARM 37.34.234, and the provisions of 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 do not apply to such hearings; and

(h) hearings contesting adverse department actions regarding aversive procedures approved for habilitation of a person with developmental disabilities are available to the extent provided and according to the procedures specified in ARM 37.34.1426, and the provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 do not apply to such hearings.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-402, 53-20-125, 53-20-127, 53-20-128, 53-20-129, 53-20-133, 53-20-203, 53-20-204, 53-20-205, 53-20-206, 53-20-209, 53-20-504, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.116 Intermediate Care Facility for the Developmentally Disabled (icf/Dd): Applicable Hearing Procedures

(1) Hearings relating to involuntary transfers and discharge from an intermediate care facility for the developmentally disabled are available, subject to the following extent:

(a) Involuntary transfer or discharge is defined in ARM 37.106.2805.

(b) A resident may exercise his or her right to appeal an involuntary transfer or discharge by submitting a written request for fair hearing to the Department of Public Health and Human Services, Office of Fair Hearings, P.O. Box 202953, Helena, MT 59620-2953, within 30 days of notice of transfer or discharge.

(c) The parties to a hearing regarding a contested transfer or discharge are the facility and the resident contesting the transfer or discharge. The department is not a party to such a proceeding and relief may not be granted to either party against the department in a hearing regarding a contested transfer or discharge.

(d) Hearings regarding a contested transfer or discharge shall be conducted in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.313, 37.5.322, 37.5.325, 37.5.334 and a resident shall be considered a claimant for purposes of these rules.

(e) The request for appeal of a transfer or discharge does not automatically stay the decision of the facility to transfer or discharge the resident. The hearing officer may, for good cause shown, grant a resident's request to stay the facility's decision pending a hearing.

(f) The hearing officer's decision following a hearing shall be the final decision for the purposes of judicial review under ARM 37.5.334.

History

Authorizing statute(s): 50-5-103, 50-5-238, MCA
Implementing statute(s): 53-5-103, 50-5-201, 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.5.117 Certain Title 50 Programs and Other Programs for Which No Procedure Is Otherwise Specified: Applicable Hearing Procedures

(1) Hearings under the programs specified in this rule are available to the extent specifically provided by law, including the Montana Code Annotated and department rules. The provisions of ARM 37.5.311 and 37.5.318 do not apply to such hearings. Such hearings shall be conducted in accordance with the Montana Administrative Procedure Act and ARM 37.5.304, 37.5.307, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(a) vital statistics under Title 50, chapter 15, MCA;

(b) food establishment licensure and enforcement under Title 50, chapter 50, MCA;

(d) campground and trailer court licensure and enforcement under Title 50, chapter 52, MCA;

(e) laboratory licensure under 50-1-210, MCA;

(f) licensure and enforcement of public swimming pools, spas and other water features under Title 50, chapter 53, MCA;

(g) emergency medical services licensure and enforcement under Title 50, chapter 6, MCA;

(h) designation of health care facilities as trauma facilities under Title 50, chapter 6, part 4, MCA;

(i) health care facility licensure and enforcement under Title 50, chapter 5, MCA;

(j) denial or revocation of a certificate of public advantage under Title 50, chapter 4, part 6, MCA;

(k) enforcement of the Montana Food, Drug, and Cosmetic Act, Title 50, chapter 31, MCA;

(l) department findings or determinations of abuse, neglect or misappropriation of resident funds by a nurse aide in a nursing facility under 42 CFR 488.335, subject to the provisions of 42 CFR 488.335;

(m) refusal, revocation or suspension of a certificate of sanitation under ARM Title 37, chapter 112, subchapter 1;

(n) denial of an application for approval of chemical dependency treatment programs under ARM Title 37, chapter 27, subchapter 1;

(o) requests for departmental review of final decisions under the Healthy Montana Kids (HMK) Plan;

(p) denial, suspension, restriction, revocation or reduction to provisional status of a child placing agency license under ARM Title 37, chapter 93, subchapter 2;

(q) denial, suspension, revocation or nonrenewal of a youth foster care license or youth care facility license under ARM Title 37, chapter 97, subchapter 1;

(r) denial of a license for a community home for persons with developmental disabilities under ARM Title 37, chapter 100, subchapters 3 and 4;

(s) assessment of a tobacco education fee against an employee or owner of an establishment under 16-11-308, MCA;

(t) denial or other determinations of the amount, duration or continuation of an adoption subsidy under ARM Title 37, chapter 52, subchapter 2;

(u) requests for review of determinations by the department regarding pharmaceutical manufacturer's rebate agreements pursuant to ARM 37.86.1102; and

(v) any department program with respect to which a right to hearing is specifically granted by law, including department rule, but for which a hearing process is not otherwise provided by department rule.

History

Authorizing statute(s): 50-1-202, 53-2-201, 53-4-1009, 53-6-113, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 42-10-104, 50-1-202, 50-4-612, 50-5-103, 50-6-103, 50-6-402, 50-15-102, 50-15-103, 50-15-121, 50-15-122, 50-31-104, 50-52-102, 50-53-103, 52-2-111, 53-2-201, 53-4-1004, 53-4-1009, 53-4-1105, 53-6-101, 53-6-111, 53-6-113, 53-6-402, 53-20-305, 53-24-208, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2008 MAR p. 2669, Eff. 1/1/09; AMD, 2010 MAR p. 1197, Eff. 1/15/10; AMD, 2010 MAR p. 2217, Eff. 10/1/10.

Mont. Admin. R. 37.5.118 Determinations of Reports of Child Abuse, Neglect, and Exploitation: Applicable Hearing Procedures

(1) Hearings contesting substantiated reports of child abuse, neglect or exploitation are available to the extent provided in ARM 37.47.610. The procedures specified in ARM 37.5.304, 37.5.307, 37.5.313, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 apply to such hearings, subject to the limitations specified in ARM 37.47.615.

(2) No hearing is available for child abuse or neglect reports that are not determined as substantiated.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 2-4-612, 41-3-203, 41-3-204, MCA
History: NEW, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2010 MAR p. 539, Eff. 2/26/10; AMD, 2015 MAR p. 306, Eff. 7/1/15; AMD, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.5.119 Long-Term Care Facility Certificate of Need: Applicable Hearing Procedures

(1) Hearings relating to a long-term care facility certificate of need are available to the extent granted and as provided in 50-5-306, MCA, ARM 37.106.115, and 37.106.120. The provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 do not apply to such hearings.

(2) Hearings relating to a long-term care facility certificate of need will be conducted in person in Helena, Montana, at a location designated by the department, unless the parties mutually agree to conduct the hearing telephonically.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-306, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.5.121 Women, Infants, Children (wic) Program: Applicable Hearing Procedures

(1) Hearings relating to the Women, Infants, Children (WIC) program are available to the extent provided in and according to the procedures specified in ARM Title 37, chapter 59. The provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 do not apply to such hearings.

History

Authorizing statute(s): 50-1-202, 53-2-201, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.123 Child and Adult Care Food Program (cacfp): Applicable Administrative Review (appeal) Procedures for Institutions, Responsible Principals, and Responsible Individuals

(1) Administrative reviews (appeals) are available to the extent granted in 7 CFR 226.6. The provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.331, 37.5.334, and 37.5.337 do not apply to such administrative reviews.

(2) An administrative review of adverse actions will be limited to a review of the written information, federal policies, 7 CFR 226, state laws, and administrative rules, policies and procedures governing the program unless the affected institution or its responsible principals or individuals request a hearing in addition to, or in lieu of, a review of written information.

(3) A notice of action from the department to the institution and responsible principals and individuals will be issued as required by 7 CFR 226.6(k). The notice of action required by 7 CFR 226.6(k) must state that in the event the institution or responsible principals and individuals choose an administrative review of an action, a hearing will be held by the review official in addition to, or in lieu of, a review of written information, only if the institution or the responsible principals or individuals so requests in the letter requesting an administrative review.

(4) An administrative review will be conducted in person in Helena, Lewis and Clark County, Montana, at a location designated by the Office of Fair Hearings, unless the parties mutually agree to conduct the administrative review telephonically.

(5) The written request for an administrative review must be received by the Office of Fair Hearings within 15 calendar days of the date of receipt of the notice of action by the institution or, in the event of a serious deficiency, the date of receipt by the responsible principals and individuals.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2004 MAR p. 577, Eff. 3/12/04.

Mont. Admin. R. 37.5.124 Child and Adult Care Food Program (cacfp): Applicable Administrative Review (appeal) Procedures for Day Care Homes

(1) Administrative reviews (appeals) are available to the extent granted in 7 CFR 226.6(l). The provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.331, 37.5.334, 37.5.337 do not apply to such administrative reviews.

(2) An administrative review of an intent to terminate a day care home provider's agreement for cause or a suspension of their participation will be limited to a review of the written documentation provided to the Office of Fair Hearings, federal policies, 7 CFR 226, state laws and administrative rules, the requirements shown in the sponsor/provider agreement, and policies and procedures governing the Child and Adult Care Food program. This review will be performed by allowing the parties to submit written documentation to support their claim.

(3) A day care home provider must request an administrative review in writing. The written request must be received by the Office of Fair Hearings at the Department of Public Health and Human Services, Office of Fair Hearings, P.O. Box 202953, Helena, MT 59620-2953 within 15 calendar days of receipt by the day care home provider of the notice of intent to terminate or notice of suspension. The written request for administrative review must include the date the notice of intent to terminate or notice of suspension was received by the day care home provider.

(4) The day care home provider may refute the findings contained in the notice of intent to terminate or notice of suspension by submitting written documentation to the administrative review officials at the Office of Fair Hearings. The sponsor and provider must submit copies of the documentation in written format to the Office of Fair Hearings.

(5) In order for documentation to be considered, the day care home provider must submit written documentation to the administrative review official at the Office of Fair Hearings no later than 30 calendar days after receipt by the day care home provider of the notice of intent to terminate or notice of suspension. The sponsoring organization must submit written documentation to the administrative review official at the Office of Fair Hearings no later than 15 calendar days after the date the sponsor receives from the Office of Fair Hearings the acknowledgment of the hearing request referred to in (6)(a).

(6) When a request for an administrative review from a day care home provider is received by the Office of Fair Hearings, the Office of Fair Hearings will:

(a) acknowledge receipt by notifying the department, the sponsor and the day care home provider of the request for administrative review within five calendar days and include the final date for rendering a decision;

(b) consider only written documentation submitted by the sponsoring organization and the day care home (or their authorized representatives). Day care home providers and sponsors will not be contacted for additional information. The decision will be based entirely upon the written documentation provided to the Office of Fair Hearings within the time limits cited in (5), and on federal and state laws, 7 CFR 226, rules, regulations, the requirements stated in the sponsor/provider agreement, and policies and procedures governing the program; and

(c) render a final decision within 60 calendar days of receipt of the written request for an administrative review from the day care home provider. This time limit is a federal administrative requirement for the department and may not be used as a basis for overturning the department's action if a decision is not made within the specified time limit.

(7) The determination made by the administrative review official is the final administrative determination to be afforded the day care home.

(8) Documentation may be submitted to the Office of Fair Hearings only once. The first submission of documentation is the only written documentation from the provider and sponsor that may be reviewed by the hearing officer. No other submitted written documentation will be considered.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2004 MAR p. 577, Eff. 3/12/04.

Mont. Admin. R. 37.5.125 Vocational Rehabilitation and Blind and Low Vision Services Programs: Applicable Hearing Procedures

(1) Hearings relating to the provision of vocational rehabilitation services inclusive of the Blind and Low Vision Services program are available to the extent granted and as provided in ARM 37.30.1401 and in ARM 37.30.2310. The provisions of ARM 37.5.307, 37.5.310, 37.5.311, 37.5.316, 37.5.328, and 37.5.331 do not apply to such hearing

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-7-102, 53-7-206, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-106, 53-7-206, 53-7-314, 53-7-315, 53-19-112, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2007 MAR p. 48, Eff. 1/12/07.

Mont. Admin. R. 37.5.127 Telecommunications Access Program: Applicable Hearing Procedures

(1) Hearings relating to the Telecommunications Access program are available to the extent granted and as provided in ARM 37.36.901 and 37.36.902. The provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 do not apply to such hearings.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.129 Child Support Services: Applicable Hearing Procedures

(1) Hearings relating to child support services matters are available to the extent granted and as provided in ARM Title 37, chapter 62, subchapter 9. Unless specifically referenced in that subchapter, the provisions of any other rule do not apply to such hearings.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.5.131 Department Hearing Procedures, Scope, and Subordination to Certain Other Law

(1) There is no right to a hearing in any matter except as specifically provided by law, including department rule.

(2) There is no right to a hearing in a contract dispute between the department and any other person or entity except as specifically provided by the terms of the contract or as specifically provided by state law.

(3) The rules in this chapter are subject to the provisions of any applicable federal statute or regulation, whether now in existence or hereafter adopted.

(4) The rules in this chapter are subject to any other provision of Montana statute or department rule applicable to the particular program or matter at issue.

History

Authorizing statute(s): 50-1-202, 53-2-201, 53-6-113, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 42-10-104, 50-1-202, 50-4-612, 50-5-103, 50-6-103, 50-6-402, 50-15-102, 50-15-103, 50-15-121, 50-15-122, 50-31-104, 50-52-102, 50-53-103, 52-1-103, 52-2-111, 53-2-201, 53-2-904, 53-3-406, 53-4-202, 53-4-212, 53-4-606, 53-4-1004, 53-6-111, 53-6-113, 53-6-131, 53-6-402, 53-20-305, 53-24-208, 69-8-412, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Subchapter 37.5.3 Formal and Informal Hearing and Appeal Procedures

Mont. Admin. R. 37.5.301 Applicability

(1) This rule and ARM 37.5.304, 37.5.307, 37.5.310, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 apply only to hearings in the program areas specified in ARM 37.5.101, 37.5.103, 37.5.105, 37.5.107, 37.5.109, 37.5.113, 37.5.114, 37.5.115, 37.5.117, 37.5.119, 37.5.121, 37.5.123, 37.5.125, 37.5.127, 37.5.129, 37.5.131, and 37.5.301, and must not be construed to grant a right to hearing in any other matter.

(2) The provisions of this rule, ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337 are subject to the provisions of ARM 37.5.101, 37.5.103, 37.5.105, 37.5.107, 37.5.109, 37.5.113, 37.5.115, 37.5.117, 37.5.119, 37.5.121, 37.5.123, 37.5.125, 37.5.127, 37.5.129, and 37.5.131.

(3) Where a right to a hearing is granted in ARM 37.5.103, 37.5.105, 37.5.107, 37.5.109, 37.5.113, 37.5.114, 37.5.115, 37.5.117, 37.5.119, 37.5.121, 37.5.123, 37.5.125, 37.5.127, and 37.5.129, or any other rule of the department, the right to hearing is not absolute but is subject to all applicable provisions of these rules and other applicable law.

History

Authorizing statute(s): 50-1-202, 53-2-201, 53-6-113, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 42-10-104, 50-1-202, 50-4-612, 50-5-103, 50-6-103, 50-6-402, 50-15-102, 50-15-103, 50-15-121, 50-15-122, 50-31-104, 50-52-102, 50-53-103, 52-1-103, 52-2-111, 52-3-406, 53-2-201, 53-2-904, 53-4-202, 53-4-212, 53-4-606, 53-4-1004, 53-6-111, 53-6-113, 53-6-131, 53-6-402, 53-20-305, 53-24-208, 69-8-412, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2016 MAR p. 1707, Eff. 9/24/16.

Mont. Admin. R. 37.5.304 Definitions

For purposes of this subchapter, unless the context requires otherwise, the following definitions apply:

(1) "Adverse action" means:

(a) a failure of the department to provide a claimant an opportunity to make application or reapplication for benefits;

(b) a failure of the department to act with reasonable promptness on a claimant's application for benefits;

(c) an action by the department denying, suspending, reducing or terminating benefits of a claimant, or an action by the department demanding repayment of or to recover an overpayment of benefits to a claimant;

(d) an action by the department establishing conditions on the manner or form of benefits, including restrictive benefits or protective payments, or establishing conditions for the receipt of benefits, including a work requirement;

(e) an action by the department to deny, terminate, or fail to renew certification or a provider agreement for the Medicaid program to any nursing facility or intermediate care facility for the mentally retarded;

(f) an action by the department to deny, suspend, reduce, revoke, or terminate licensure, registration, certification, or enrollment of a provider or to fail to renew certification, enrollment, licensure, or the registration certificate of a provider who has applied for renewal;

(g) an action by the department establishing the rate of reimbursement for a provider or denying in whole or in part a provider's claim for services or items;

(h) an action by the department demanding repayment of or to recover an overpayment made to a provider, or to impose a penalty or sanction against a medical assistance provider under ARM Title 37, chapter 85, subchapter 5;

(i) a department determination of ability to pay for the cost of care in an institution under 53-1-405, MCA;

(j) a department determination that a Medicaid applicant or recipient is permanently institutionalized;

(k) a determination that the department intends to impose a lien upon the applicant's or recipient's real property pursuant to 53-6-171, MCA;

(l) an action by the department denying or reducing a provider's quality incentive adjustment as provided in ARM 37.80.205;

(m) an action by the department denying or reducing a special needs adjustment as provided in ARM 37.80.205;

(n) a department's substantiation determination of a report of child abuse, neglect, or exploitation under ARM Title 37, chapter 47, subchapter 6;

(o) a determination by the department regarding a pharmaceutical

manufacturer's rebate due under ARM Title 37, chapter 86, subchapter 11;

(p) a department determination denying, reducing, terminating, or failing to act upon a guardianship subsidy request within one year of the request as provided in ARM Title 37, chapter 50, subchapter 11;

(q) a department determination denying, reducing, terminating, or failing to act upon an adoption subsidy request within one year of the request as provided in ARM Title 37, chapter 50, subchapter 11;

(r) a department determination denying, reducing, terminating, or failing to act upon an application for a license to provide foster care or kinship care; or

(s) an action by the department to:

(i) deny, suspend or cancel a license for a swimming pool, spa, or other water feature;

(ii) issue an order immediately closing the swimming pool, spa, or other water feature; or

(iii) order corrective action to be taken at a swimming pool, spa, or other water feature.

(2) "Authorized representative" means legal counsel, relative, friend or other spokesman specifically authorized by the claimant in writing or by law to represent the claimant in matters pertaining to the receipt of benefits from this department.

(3) "Benefit" means any form of assistance provided by or through the department to an eligible recipient under the department's administrative rules.

(4) "Board" means the Board of Public Assistance provided for in 2-15-2203, MCA.

(5) "Claimant" means:

(a) an applicant for or recipient of benefits from the department whether an individual or household and includes the claimant's authorized representative;

(b) a resident or financially responsible person as defined in 53-1-401, MCA;

(d) a subject of a substantiated report of child abuse or neglect; or

(e) any other person or entity as provided by department rule.

(6) "Credible allegation of fraud" may be an allegation, which has been verified by the State, from any source. Allegations are considered to be credible when they have indicia of reliability and the state Medicaid agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case-by-case basis. Allegations may include, but are not limited to, the following:

(a) fraud hotline complaints;

(b) claims data mining; or

(7) "Department" means the Department of Public Health and Human Services provided for in 2-15-2201, MCA.

(8) "He" and other words used in the masculine gender include the feminine and the neuter.

(9) "Hearing officer" means an individual hired or appointed by the department to conduct a hearing under the authority of the Montana Administrative Procedure Act and the department's rules.

(10) "Local office" means a county department, a regional office, a bureau if there is no regional office, or a division if there is neither a regional office nor a bureau.

(11) "Local supervisor" means a county director or his designee, a regional supervisor, a bureau chief if there is no regional supervisor, or a division administrator if there is neither a regional supervisor nor bureau chief.

(12) "Medical assistance provider" means any individual or organization providing services to eligible claimants under the Montana Medicaid program established under Title 53, chapter 6, MCA.

(13) "Provider" means an individual or organization licensed, enrolled or registered by the department or authorized by the department to provide services to a person eligible for benefits, except the term does not include contractors. For purposes of this subchapter, "provider" includes:

(a) any individual or organization seeking to obtain or retain any license, enrollment or certification required to provide services to eligible persons or the general public;

(b) a medical assistance provider;

(d) any other person or entity as provided by department rule.

History

Authorizing statute(s): 41-3-208, 50-53-103, 52-2-111, 52-2-622, 52-2-704, 53-2-201, 53-2-606, 53-4-212, 53-6-111, 53-6-113, 53-7-102, 53-20-305, MCA
Implementing statute(s): 41-3-202, 41-3-208, 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, 52-2-603, 52-2-704, 52-2-726, 53-2-201, 53-2-606, 53-6-101, 53-6-107, 53-6-111, 53-6-113, 53-20-305, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1984 MAR p. 1633, Eff. 11/16/84; AMD, 1985 MAR p. 943, Eff. 7/12/85; AMD, 1992 MAR p. 1496, Eff. 7/17/92; AMD, 1993 MAR p. 3069, Eff. 1/1/94; AMD, 1994 MAR p. 1744, Eff. 7/1/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2008 MAR p. 2669, Eff. 1/1/09; AMD, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2823, Eff. 12/23/11; AMD, 2014 MAR p. 976, Eff. 5/9/14; AMD, 2015 MAR p. 306, Eff. 3/27/15.

Mont. Admin. R. 37.5.305 Applicability of Notice Requirements

(1) This rule, ARM 37.5.503 and 37.5.505 apply only to claimants under the following programs:

(a) Developmental Disabilities program;

(b) Temporary Assistance for Needy Families (TANF);

(d) Medical Assistance program (Medicaid);

(e) Low Income Energy Assistance Program (LIEAP);

(f) Low Income Weatherization Program (LIWAP);

(g) mental health managed care services;

(h) refugee assistance;

(i) daycare benefits, except child and adult food care;

(j) foster care maintenance services;

(k) foster care support services; and

(l) any other program as provided by department rule.

History

Authorizing statute(s): 50-1-202, 53-2-201, 53-6-113, MCA
Implementing statute(s): 41-3-1103, 50-1-202, 52-1-103, 53-2-201, 53-2-904, 53-4-202, 53-4-606, 53-6-111, 53-6-113, 53-6-131, 53-20-305, 69-8-412, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2007 MAR p. 47, Eff. 1/12/07.

Mont. Admin. R. 37.5.307 Opportunity for Hearing

(1) A claimant who is aggrieved by an adverse action of the department will be afforded the opportunity for a hearing as provided in this chapter.

(2) A request for a hearing is any clear written expression by the claimant or an authorized representative to contest an adverse action, except that a request for hearing concerning food stamp benefits may be oral.

(3) The freedom to request a hearing must not be interfered with in any way. The local office of public assistance or child care resource and referral agency will assist a claimant who seeks help in requesting a hearing.

(4) A request for a hearing by a claimant must be received by the department within 90 days from the date of mailing of notice of the adverse action, except as otherwise provided in these rules.

(5) A hearing request from a claimant must be received in writing within 30 days of the date of mailing of notice of the adverse action regarding:

(a) a department determination of ability to pay for the cost of care in an institution under 53-1-405, MCA;

(b) a nursing facility's transfer or discharge of a nursing facility resident;

(d) a proposal by the department to file a lien under 53-6-171, MCA.

(6) Except for fair hearing requests on a substantiated report, hearing requests must be mailed or delivered to the Office of Fair Hearings, P.O. Box 202953, Helena, MT 59620-2953. Requests for fair hearings on substantiated reports must be mailed to the Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, MT 59620.

(7) Cases in which the sole issue is one of state or federal policy may be consolidated for a single group hearing. Each claimant will be permitted to present their own case.

(8) A provider other than a medical assistance provider who is aggrieved by an adverse action of the department must be granted the right to hearing as provided in this chapter, except as otherwise provided in other department rules.

(a) Except as provided in (2)(b), request for a hearing from a provider must be received by the department in writing within 30 days after the date of mailing of notice of the department's adverse action.

(b) A request for a hearing from a day care facility applicant, licensee, registrant, or legally unregistered provider must be received by the department in writing within ten days after the date of mailing of notice of the department's adverse action denying, suspending, canceling, reducing, modifying, or revoking a legally unregistered provider payment number or a day care license or registration certificate.

(9) Medical assistance providers aggrieved by adverse department actions, other than medical assistance providers appealing eligibility determinations as a real party in interest, will be granted the right to a hearing as provided in ARM 37.5.310.

(a) A medical assistance provider appealing a recipient eligibility determination as a real party in interest is entitled to a hearing according to the procedures and subject to the requirements applicable to claimants except as provided in (3)(b).

(b) It is the provider's responsibility to verify that Medicaid eligibility has been established. If a medical assistance provider receives information from the department indicating that a recipient has not or may not have been determined eligible for Medicaid, as, for example, in an explanation of benefits code on a statement of remittance, the provider must take appropriate action to verify or establish eligibility. A hearing request by the medical assistance provider as a real party in interest regarding the recipient's Medicaid eligibility will not be considered timely if received by the department more than 90 days after the earlier of:

(i) receipt of the information indicating that the recipient has not or may not have been determined Medicaid eligible; or

(ii) adequate notice to the claimant of the adverse action.

(c) A medical assistance provider is not entitled to notice from the department of an adverse action regarding a claimant's eligibility for medical assistance, except that:

(i) if the medical assistance provider has submitted to the county office making the eligibility determination a written request for notice of a determination on a pending application for medical assistance, the county office must mail to the provider a copy of the same notice provided to the claimant; and

(ii) if the medical assistance provider has submitted to the county office responsible to monitor and administer a recipient's ongoing eligibility a written request for notice of termination of eligibility for medical assistance, the county office must mail to the provider a copy of any notice of termination provided to the claimant.

(10) There is no opportunity for hearing under this chapter on departmental activities that are not defined as an adverse action in ARM 37.5.304, unless a right to hearing under this chapter is specifically granted by other department rule. A dispute regarding a contract between the department and a provider or other person or entity is not an adverse action by the department and there is no opportunity for fair hearing concerning such disputes.

History

Authorizing statute(s): 2-4-201, 41-3-208, 41-3-1142, 52-2-111, 52-2-112, 52-2-403, 52-2-704, 52-3-304, 52-3-804, 53-2-201, 53-2-606, 53-2-803, 53-3-102, 53-4-111, 53-4-212, 53-4-403, 53-4-503, 53-5-304, 53-6-111, 53-6-113, 53-6-402, 53-7-102, 53-20-305, MCA
Implementing statute(s): 2-4-201, 41-3-202, 41-3-205, 41-3-1103, 52-2-603, 52-2-704, 52-2-726, 53-2-201, 53-2-306, 53-2-401, 53-2-606, 53-2-801, 53-4-112, 53-4-212, 53-4-404, 53-4-503, 53-4-513, 53-5-304, 53-6-111, 53-6-113, 53-6-402, 53-20-305, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1984 MAR p. 1633, Eff. 11/16/84; AMD, 1985 MAR p. 943, Eff. 7/12/85; AMD, 1992 MAR p. 1496, Eff. 7/17/92; AMD, 1993 MAR p. 3069, Eff. 1/1/94; AMD, 1994 MAR p. 1744, Eff. 7/1/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2001 MAR p. 1107, Eff. 6/22/01; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2007 MAR p. 47, Eff. 1/12/07; AMD, 2007 MAR p. 2132, Eff. 12/21/07; AMD, 2015 MAR p. 306, Eff. 3/27/15.

Mont. Admin. R. 37.5.310 Administrative Review and Fair Hearing Process for Medical Assistance Providers

(1) The following administrative review and fair hearing process applies to all medical assistance providers that are aggrieved by an adverse action of the department, except medical assistance providers appealing eligibility determinations as a real party in interest.

(2) A medical assistance provider, other than a medical assistance provider appealing an eligibility determination as a real party in interest, aggrieved by an adverse action of the department may request an administrative review. The request must be in writing, must state in detail the provider's objections, and must include any substantiating documents and information which the provider wishes the department to consider in the administrative review. The request must be mailed or delivered to the Department of Public Health and Human Services, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and should be addressed or directed to the division of the department that issued the contested determination. The request for administrative review must be received by the department within 30 days of mailing of the department's written determination.

(a) Within the 30 days a provider may request in writing an extension of up to 15 days for submission of a request for administrative review. The department may grant further extensions for good cause shown. Requests for further extensions must be in writing, must be received by the department within the period of any previous extension, and must demonstrate good cause for the extension.

(b) The provider may also request a conference as part of the administrative review. If the provider requests an administrative review conference, the conference must be held at a time scheduled by the department as provided in ARM 37.5.318(3) through (3)(c)(ii). If a provider requests a conference as part of the administrative review, any substantiating materials the provider wishes the department to consider as part of the review may be submitted no later than the time of the conference. The conference may be conducted by the department or its designee and shall be based on the department's records and determination and the provider's written objections and substantiating materials, if any.

(c) No later than 60 days following receipt of the written objections and substantiating materials, if any, or the conference, whichever is later, the department must mail a written determination concerning the provider's objections and substantiating materials and the position the department takes concerning the determination.

(d) A provider must exhaust in a timely manner the administrative review process provided in this rule before requesting a fair hearing. A provider that has not exhausted the administrative review process, including a provider that fails to timely request an administrative review, is not entitled to a fair hearing before the department or the board.

(3) In the event the provider is aggrieved by an adverse department administrative review determination, the following fair hearing procedures will apply. In addition to the authority granted in ARM 37.5.313, the hearings officer may dismiss a fair hearing request if a provider fails to meet any of the requirements of (3)(a) through (3)(e).

(a) The written request for a fair hearing must be mailed or delivered to the Department of Public Health and Human Services, Quality Assurance Division, Office of Fair Hearings, P.O. Box 202953, Helena, MT 59620-2953.

(b) The request must be signed by the provider or his designee.

(c) The fair hearing request must be received not later than the 30th calendar day following the date of mailing of the department's written administrative review determination.

(d) The fair hearing request must contain a short and plain statement of each reason the provider contends the department's administrative review determination fails to comply with applicable law, regulations, rules, or policies.

(e) The provider must serve a copy of the hearing request upon the department's division that issued the contested determination within three working days of filing the request. Service by mail is permitted.

(f) The hearings officer will conduct the fair hearing in accordance with the applicable provisions of this subchapter at Helena, Montana. The hearing shall be in person except that the hearing may be conducted by telephone as mutually agreed by the parties.

(g) The hearings officer will render a written proposed decision within 90 calendar days of final submission of the matter to him.

(4) In the event the provider or department is aggrieved by a hearings officer's proposed decision, the provider or department may request review by the Board of Public Assistance as provided in ARM 37.5.331.

(5) The provisions of this rule apply in addition to the other applicable provisions of this subchapter, except that the provisions of this rule shall control in the event of a conflict with the other provisions of this subchapter.

History

Authorizing statute(s): 2-4-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-2-606, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1992 MAR p. 1496, Eff. 7/17/92; AMD, 1993 MAR p. 3069, Eff. 1/1/94; AMD, 1994 MAR p. 1744, Eff. 7/1/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.311 Informal Reconsideration

(1) A provider or other person may request an informal reconsideration of a department action in the following cases:

(a) where the hearing is to be held after the effective date of a denial, termination, or nonrenewal of enrollment, certification, or registration;

(b) where the department intends to withhold or suspend payments to a medical assistance provider pursuant to ARM 37.85.513; or

(2) The informal reconsideration includes:

(a) written notice to the provider of the department action and the findings upon which it was based, if not otherwise already provided;

(b) the provider's written refutation of the department's findings, which must be received by the department within 15 days after mailing of the department's notice under (2)(a); and

(3) This rule does not require that the informal reconsideration or any hearing be conducted prior to the department action.

(4) An informal reconsideration under this rule is not subject to the provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA.

(5) An informal reconsideration is a different and separate form of procedure from an administrative review and/or fair hearing. A provider or other person is not entitled to an administrative review, fair hearing, or other process in addition to an informal reconsideration unless specifically provided by department rule or otherwise required by law.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.313 Dismissal of Hearing

(1) A hearing may be dismissed when:

(a) the request for a hearing is withdrawn by the claimant or provider or his representative:

(i) except as provided in (1)(a)(ii), the request for hearing must be withdrawn in writing;

(ii) a request for hearing contesting an adverse department action under the Food Stamp program or the Temporary Assistance for Needy Families (TANF) Financial Assistance program may be withdrawn by oral request of the claimant;

(iii) within ten days of an oral request under (1)(a)(ii) the hearing officer must provide a written notice to the claimant confirming the withdrawal request and providing the claimant with an opportunity to reinstate the hearing request as provided in (1)(a)(iv);

(iv) a hearing request that was orally withdrawn under (1)(a)(ii) may be reinstated if the claimant notifies the office of fair hearings within ten days of receiving the confirmation of dismissal under (1)(a)(iii);

(v) if a hearing request is reinstated under (1)(a)(iv), the hearing must be completed within the time frames required by federal law;

(b) the claimant or provider or his representative without good cause fails to appear at the hearing;

(d) either federal or state law requires automatic benefit changes for a class of claimants unless the issue is incorrect benefit adjustments;

(e) the department does not have jurisdiction over the subject matter or the appeal procedure;

(f) the contested action is not an adverse action;

(g) the contested action is not an action of the department, but rather an action of a provider or other person or entity, unless department rule specifically grants a right to hearing with respect to actions by the person or entity;

(h) the claimant or provider is not aggrieved by the contested adverse action;

(i) the hearing request, considered together with other documentation in the record, demonstrates that the only issue is one of constitutionality or other issue beyond the hearing officer's power or jurisdiction; or

(j) the provisions of any other department rule so provides.

(2) A pending hearing may be dismissed when the claimant or provider or his representative fails to respond to or comply with a request or order from the hearing officer, including but not limited to a request or order to inform the hearing officer whether the party wishes to proceed further with the fair hearing case, if the party has been warned that failure to respond or comply will result in dismissal. A hearing dismissed under this subsection may be reinstated by the hearing officer only if the claimant, provider or his representative demonstrates good cause for the failure to respond or comply upon which dismissal was based.

(3) The list of grounds for dismissal in this rule is not exclusive. Unless inconsistent with particular rules in this chapter or other applicable law, dismissal may be granted based upon other principles of general law.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2001 MAR p. 1107, Eff. 6/22/01; AMD, 2007 MAR p. 47, Eff. 1/12/07.

Mont. Admin. R. 37.5.316 Continuation of Public Assistance Benefits

(1) This rule regarding continuation of benefits applies only to benefits under the following programs:

(a) TANF cash assistance;

(b) food stamps; and

(2) For purposes of this rule, benefits include services being received under the Medicaid home and community-based services program for persons who are elderly or who have a disability, or developmental disability services funded under the Medicaid program. Applicants for such services who are aggrieved by a department determination are not entitled to Medicaid Home and Community Based Services under this rule.

(3) If a claimant requests a hearing within the period between the date of the notice and the date of the adverse action and the claimant is receiving benefits at that time, at the request of the claimant benefits shall be continued until the earlier of the expiration of the current eligibility or authorization period or issuance of a hearing decision except as provided in (7) and (8) of this rule.

(4) If the claimant establishes that his failure to request a hearing within the notice period was for good cause the department shall at the request of the claimant, reinstate the benefits to their prior level until the earlier of the expiration of the current eligibility or authorization period or issuance of a hearing decision, except as provided in (6) and (7) of this rule.

(5) If an action is taken without timely notice and the claimant requests a hearing within ten days of the mailing of the notice of the action, at the request of the claimant benefits shall be reinstated and continued until the earlier of the expiration of the current eligibility or authorization period or issuance of a hearing decision if the case is one in which the applicant is entitled to a hearing and the hearing is not subject to dismissal under ARM 37.5.313.

(6) A claimant is not entitled to continued benefits if, after a hearing, the hearing officer makes a determination in writing that the sole issue is one of state or federal law or policy and no valid issue of improper benefit calculation, or misapplication or misinterpretation of state or federal law or policy exists.

(7) Except as provided in (6), once continued or reinstated, benefits may not be reduced or terminated prior to a hearing decision unless:

(a) the eligibility, or authorization period expires, although the claimant may reapply and may be determined eligible for benefits;

(b) a subsequent change affecting claimant's benefits occurs while the hearing is pending and a subsequent hearing is not requested after notice of adverse action resulting from the subsequent change; or

(8) If a claimant requests a hearing on an adverse action concerning food stamp benefits and does not positively indicate whether continued benefits are requested, the department shall assume that continuation of benefits is desired and the benefits shall be issued on the same basis as authorized immediately prior to the notice of adverse action. If a recipient specifically waives continuation of food stamp benefits, the department shall terminate benefits pending a hearing decision in the contested case. This subsection applies only to food stamp benefits, and not to benefits of any other kind.

(9) Regardless of any other provision of this rule, a claimant is not entitled to continuation of benefits unless the decision at issue is a rescission by the department of a specific eligibility or authorization period previously granted by the department, such as eligibility for a specified time period or authorization for a particular service or quantity of services. A claimant is not entitled to a continuation of benefits where the department granted the benefit for a particular period of time or in a particular quantity and the contested action is the department's denial of an additional grant of benefits for an additional period of time or quantity of services.

(10) A claimant is not entitled to continuation of benefits when the issue is the lack of a negotiated FIA as specified at ARM 37.78.216(2).

(11) A claimant is not entitled to continuation of benefits for any month that TANF cash assistance benefits have been issued for a required filing unit member in another case or state.

(12) A claimant is not entitled to continuation of benefits if the department demonstrates at the hearing that continuation of benefits would pose a risk of harm to the claimant or another person.

(13) Benefits paid to a claimant pending a hearing decision are subject to recovery by the department if the adverse action is sustained.

(14) This rule shall not be construed to provide continuation of benefits with respect to an action taken by a provider rather than the department.

(15) This rule shall not be construed to prevent or delay a department action against a provider. If an adverse action is taken against a provider, payments may be withheld pending the final hearing decision.

History

Authorizing statute(s): 52-2-111, 53-2-201, 53-2-606, 53-2-803, 53-3-102, 53-4-111, 53-4-212, 53-6-111, 53-6-113, 53-7-102, MCA
Implementing statute(s): 52-2-112, 53-2-201, 53-2-306, 53-2-606, 53-2-801, 53-3-107, 53-4-112, 53-6-111, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1984 MAR p. 1633, Eff. 11/16/84; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 2921, Eff. 10/18/02.

Mont. Admin. R. 37.5.318 Administrative Review

(1) Upon the request for a hearing by a claimant or a provider, other than a medical assistance provider, the department shall conduct an administrative review with the purpose of resolving the case and avoiding an unnecessary hearing. This review may be conducted in person or by telephone. In person reviews shall be conducted at a place designated by the reviewer and reasonably convenient to the claimant or as designated by the hearing officer.

(a) No administrative review is required by this rule:

(i) if the department provides by other rule for an administrative review or other substantially equivalent process prior to a hearing request. If the department provides by rule for such a process, a hearing may not be granted unless the claimant or provider has exhausted the process in a timely manner; or

(ii) in any of the following matters:

(A) hearings pursuant to ARM 37.5.105 contesting a transfer or discharge of a nursing facility resident by a nursing facility;

(B) hearings pursuant to the Youth Access to Tobacco Act, Title 16, chapter 11, part 3, MCA;

(2) An administrative review includes:

(a) an informal conference with the department, subject to (3); and

(b) a review of relevant facts, legal authority and circumstances involved in the adverse action by the department and the preparation of an administrative review report for submission to the hearing officer within 20 days from the date the request for administrative review is mailed from the hearing officer to the person responsible for conducting the review, or within such other longer period specified by the hearing officer or agreed upon by the parties.

(3) The department official designated to conduct the administrative review may schedule the administrative review conference and must notify the claimant or provider of the date, time and place of the conference. If the claimant or provider cannot appear at the date and time set for the conference, the claimant or provider shall be given a reasonable opportunity to reschedule the conference. An additional opportunity or opportunities to reschedule may be granted for good cause shown.

(a) The conference shall be conducted at the office of the department official designated to conduct the administrative review, or may be conducted telephonically.

(b) The notification of the date, time, and place may inform the claimant or provider that if the claimant or provider fails to appear at the date, time, and place scheduled or fails to cooperate reasonably in scheduling and completing the conference, the conference will not be rescheduled and the administrative review report will be completed without a conference.

(c) The official designated to conduct the administrative review may proceed to conduct and complete the administrative review report without a conference if:

(i) the notification permitted by (3)(b) has been provided and the claimant or provider does not appear at the conference at the time scheduled and the conference has not been rescheduled; or

(ii) the claimant or provider does not cooperate reasonably in scheduling and completing the conference.

(4) An adverse action may be reversed or modified by the department or its designee at any time before, during or after the administrative review, in which case a hearing will not be held unless the claimant or provider is aggrieved by the modified adverse action and requests that the hearing be held.

(a) If the adverse action is modified or reversed by the department and the benefits which are the subject of the adverse action include county funds, a county human services or welfare office may request the hearing officer to hold the hearing if it is aggrieved by the action of the division administrator.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1985 MAR p. 943, Eff. 7/12/85; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.322 Hearing Officer, Powers, and Duties

(1) A hearing shall be conducted by an impartial individual appointed or hired by the department as hearing officer who has had no direct involvement in the initial determination of the adverse action.

(2) The hearing officer may:

(a) require the furnishing of such information, the attendance of witnesses, depositions upon oral examination or written questions, written interrogatories, and the production of such books, records, papers, documents, and other objects as may be necessary and proper for purposes of the hearing. For this purpose, the hearing officer may, and upon request of any party to a hearing, shall issue subpoenas for witnesses or subpoenas duces tecum;

(b) except in a hearing to which the department is not a party, order the department or, where appropriate, the local office to pay witness fees, mileage and other actual and necessary expenses as provided under the Rules of Civil Procedure for district courts of the state of Montana of a witness subpoenaed at the request of a claimant if, in the judgment of the hearing officer, the testimony of that witness is essential to the claimant's case;

(c) disqualify himself at any time on the filing of a timely and sufficient affidavit of personal bias or other disqualification;

(d) direct the parties to appear and confer in a prehearing conference to consider definition and simplification of the issues or other matters to aid in the orderly and efficient conduct of the hearing;

(e) allow, for good cause shown, a third party to represent a claimant as an authorized representative in those instances where written authorization of the claimant is not obtainable;

(f) grant a continuance at the request of a party for good cause shown or with the consent of all parties;

(g) take judicial notice of state and federal laws and regulations and facts within the general knowledge of the public;

(h) grant summary judgment according to the provisions of Rule 56, Montana Rules of Civil Procedure; and

(i) require a party to comply with reasonable and appropriate orders or requests not in conflict with these rules and necessary to assure the orderly conduct of prehearing and hearing procedures or to avoid unnecessary proceedings or expense.

(3) A hearing officer shall:

(a) administer oaths and affirmations:

(b) ensure that all relevant issues are considered;

(d) regulate the conduct of the hearing consistent with due process to ensure an orderly hearing;

(e) prepare a proposal for decision consisting of proposed findings of fact, conclusions of law and a recommended order deciding the case based on the evidence and the testimony contained in the hearing record.

(4) In provider hearings, if a motion is filed, or as otherwise ordered by the hearing officer in a particular claimant hearing, the following rules apply to motions:

(a) Upon filing of a motion or within five days thereafter, the moving party must state the reasons. The statement may be accompanied by appropriate supporting documents. Within ten days thereafter, the adverse party must file an answer statement which also may be accompanied by appropriate supporting documents. Within ten days thereafter movant may file a reply brief or other appropriate responsive documents.

(b) Failure to file a statement required under (4)(a) may subject the motion to summary ruling. Failure to file a statement within five days by the moving party shall be deemed an admission that the motion is without merit. Failure to file an answer statement within ten days by an adverse party shall be deemed an admission that the motion is well taken. Reply statements by movants are optional and failure to file will not subject a motion to summary ruling. The hearing officer may grant extensions of these filing time limits.

(d) Unless oral argument is ordered, the motion is deemed submitted at the expiration of any applicable time limit without supporting briefs having been filed. If oral argument is ordered, the motion will be deemed submitted at the close of argument unless the hearing officer orders additional briefs in which case the motion will be deemed submitted as of the date designated as the time for filing the final brief.

(5) For purposes of this rule, time computation shall be governed by Rule 6(a), Montana Rules of Civil Procedure.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1985 MAR p. 943, Eff. 7/12/85; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.325 Hearing Procedure

(1) A claimant's hearing shall be conducted:

(a) by telephone conference, unless a party to the hearing requests an in-person hearing; and

(b) at a reasonable time and date.

(2) Except as otherwise provided by department rule, a claimant's hearing shall be held in the county seat of the county of the claimant's residence, unless the parties to the hearing agree to a different location. In the case of an appeal of an adverse action by a county human services or welfare office which is not the county of the claimant's residence, the hearing may be held in the county whose adverse action is being appealed at that county's option, if that county agrees to pay all the actual and necessary expenses incurred by the claimant and necessary witnesses to attend the hearing.

(3) Hearings for medical assistance providers and for pharmaceutical manufacturers under Title 37, chapter 86, subchapter 11, shall be held at Helena, Montana and shall be in person except that the hearing may be conducted by telephone as mutually agreed by the parties. The department may designate the place of hearing either by notifying the Office of Fair Hearings in writing that hearings in a particular program will generally be held in a particular place or by designating the place of hearing on a case by case basis.

(4) The hearing officer shall notify the claimant or provider or his authorized representative by certified mail at least ten days in advance of the time and place of the hearing. The claimant or provider may waive in writing the right to ten days notice.

(a) The notice of hearing shall include:

(i) the name, address, and telephone number of the person to notify in the event that it is not possible for the claimant or provider to attend the hearing;

(ii) notification that the hearing request will be dismissed if the claimant or provider or his authorized representative fails to appear at the hearing without good cause;

(iii) with respect to claimants only, the department's hearing procedures and any other information that would contribute to claimant's understanding of the proceedings and effective presentation at the hearing;

(iv) an explanation of claimant's or provider's rights as enumerated in this rule; and

(v) notification of the claimant's right to request an in-person hearing.

(5) The claimant or provider shall have adequate opportunity:

(a) to examine the contents of his case file, except for those portions which the claimant is precluded from examining by state or federal law or regulation or directive of a medical professional, and all documents, and records to be used by the department at the hearing at a reasonable time prior to the hearing as well as during the hearing. Portions of the case file, documents, and records that the claimant is not allowed to examine are not admissible as evidence at the hearing;

(b) at his option, to present his case himself or with the aid of an authorized representative;

(d) to establish all pertinent facts and circumstances;

(e) to advance arguments without undue interference; and

(f) to question or refute any testimony or evidence, including opportunities to confront and cross-examine adverse witnesses.

(6) Discovery shall be available to the parties. The department adopts and incorporates by reference the Attorney General's Model Rule ARM 1.3.217 which sets forth the procedures for discovery in contested cases. A copy of the model rule may be obtained by contacting either the Attorney General's Office, 215 North Sanders, P.O. Box 201401, Helena, MT 59620-1401 or Department of Public Health and Human Services, Office of Legal Affairs, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-2-206, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 2-4-602, 53-2-201, 53-6-101, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1981 MAR p. 1111, Eff. 10/1/81; AMD, 1984 MAR p. 1633, Eff. 11/16/84; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2008 MAR p. 2669, Eff. 1/1/09.

Mont. Admin. R. 37.5.328 Proposal for Decision by Hearing Officer

(1) The proposal for decision shall:

(a) be based on the facts and evidence admitted in the hearing record as applied to pertinent state and federal law and regulation;

(b) consist of proposed findings of fact, proposed conclusions of law, and a recommended order; and

(2) A copy of the proposal for decision shall be mailed to all parties and, if applicable, the local department office, regional office, central office, or other interested persons.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-111, 53-4-212, 53-6-111, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, 53-2-306, 53-4-112, 53-6-111, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1984 MAR p. 1633, Eff. 11/16/84; AMD, 1987 MAR p. 2395, Eff. 12/25/87; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.331 Notice of Appeal and Review of Proposal for Decision

(1) If a party is aggrieved by an adverse proposal for decision, a request for review may be made by filing notice of appeal in accordance with this rule.

(2) The notice of appeal must be made to and shall be decided by the Board of Public Assistance, Department of Public Health and Human Services, Office of Fair Hearings, P.O. Box 202953, Helena, MT 59620-2953 in cases arising from the following programs:

(a) Temporary Assistance for Needy Families (TANF);

(b) food stamps;

(d) developmental disabilities services;

(e) Low Income Energy Assistance Program (LIEAP);

(f) Low Income Weatherization Assistance Program (LIWAP);

(g) refugee assistance;

(h) mental health services plan; and

(i) Healthy Montana Kids (HMK).

(3) The notice of appeal must be received by the Office of Fair Hearings within 15 days of the date of mailing of the proposal for decision.

(4) The following procedures apply in a board of public assistance review of a proposal for decision:

(a) Parties may file briefs no later than ten days before the meeting of the board for review, except that reply briefs may be filed within five days after actual receipt of an initial brief.

(i) Copies of all briefs shall be served upon all parties.

(ii) An original and four copies of each brief shall be filed with the Board of Public Assistance, P.O. Box 202953, Helena, MT 59620-2953.

(b) Oral arguments to the board are permitted at the board hearing.

(c) The board's review and decision must comply with the provisions of 2-4-621, MCA. For purposes of 2-4-621, MCA, the board shall be considered the "agency", but this rule shall not be construed to confer upon the board any authority to determine department policy.

(d) The board may not consider or make a part of the record any evidence not admitted in evidence by the hearing officer for purposes of the hearing. If the admission or consideration of additional evidence is necessary to the decision, the matter shall be remanded to the hearing officer for additional proceeding as ordered by the board.

(5) Except as otherwise provided by department rule, in all cases not specified in (2), the notice of appeal must be made to the department director in accordance with 2-4-621, MCA. The review shall be conducted and decided by the director or the director's designee.

(6) A notice of appeal of a matter appealed to the director may be made in writing to the Director, Department of Public Health and Human Services, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210. The request must be received by the director within 15 days of the mailing of the proposal for decision.

(7) The proposal for decision prepared by the hearing officer is the final agency decision, without further action by the board, the director or the director's designee, unless a request for review is received within 15 days of the date of mailing of the proposal for decision. The 15 day time limit may be extended if a party can show good cause but in no event shall the period of time be extended beyond 45 days.

(8) If a request is received within the specified time period, the board, the director, or the director's designee shall consider the proposal for decision, the exceptions filed, briefs or oral argument presented, and the record of the hearing, and shall:

(a) notify the parties and, if applicable, the local office, regional office, central office, or other interested person of the decision; and

(b) notify the claimant or provider or other party of his right to judicial review.

History

Authorizing statute(s): 52-2-704, 52-2-726, 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 52-2-704, 53-2-201, 53-2-606, 53-4-1004, 53-4-1009, 53-4-1105, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1984 MAR p. 1633, Eff. 11/16/84; AMD, 1985 MAR p. 943, Eff. 7/12/85; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2007 MAR p. 47, Eff. 1/12/07; AMD, 2010 MAR p. 2217, Eff. 10/1/10.

Mont. Admin. R. 37.5.334 Judicial Review

(1) A party who is aggrieved by a final decision may seek judicial review of that decision by filing a petition in district court within 30 days after service of the final decision as provided in 2-4-702 , MCA.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, 53-3-113, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; AMD, 1987 MAR p. 2395, Eff. 12/25/87; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.5.337 Availability of Hearing Records

(1) The proposal for decision, the verbatim transcript, if requested by a party, all exhibits, papers and requests filed in the proceeding, and, if applicable, the decision of the board or the director or the director's designee on review under ARM 37.5.331 and of a court on any subsequent judicial review shall constitute the exclusive record. The record shall be available to the claimant for inspection and copying at a place accessible to him at a reasonable time.

(2) All hearing decisions shall be available to the public for inspection and copying, except that the names and addresses and any other identifying information of claimants shall be kept confidential.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Subchapter 37.5.5 Notice Requirements for Public Assistance Programs

Mont. Admin. R. 37.5.503 Notice Upon Application for Public Assistance

(1) At the time of application for benefits administered by the department, including but not limited to Temporary Assistance for Needy Families (TANF), food stamps, Medicaid, LIEAP, LIWAP, refugee assistance, and daycare benefits, a claimant shall be informed in writing of:

(a) the claimant's right to a hearing;

(b) how a hearing may be obtained;

(d) notice of the possible penalties for intentional program violations; and

(e) any other information specifically required by applicable law, including department rule.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2007 MAR p. 47, Eff. 1/12/07.

Mont. Admin. R. 37.5.505 Notice Upon Adverse Public Assistance Action

(1) Upon an adverse action by the department affecting benefits administered by the department, including but not limited to Temporary Assistance for Needy Families (TANF), food stamps, Medicaid, LIEAP, LIWAP, refugee assistance, and daycare benefits, the claimant shall be provided adequate and timely notice.

(a) This rule applies only to adverse actions against claimants;

(b) Notice and hearing rights of providers are governed by ARM 37.5.307; and

(2) If the adverse action proposed by the department is the suspension, reduction or termination of benefits of the claimant, notice is timely if it is mailed at least ten days prior to the time the proposed adverse action is to become effective.

(3) Adequate notice need not be provided prior to the date of adverse action but may be mailed at the time the adverse action is taken in the following instances:

(a) the department has factual information of death of claimant or payee (and no relative is available to serve as payee) or of all members of the household if claimant is a household for purposes of the Food Stamp program;

(b) claimant provides a signed written statement requesting termination or reduction of benefits;

(c) when the fact that claimant has been accepted for benefits in another jurisdiction has been established, except that for purposes of the Food Stamp program the department need only establish that claimant has moved from the project area;

(d) when claimant was notified in writing that benefits would automatically terminate at the time that the grant for or the certification of benefits was made, including a special allowance for a specific period, benefits received to restore lost benefits, and benefits provided pending approval of benefits under another program; and

(e) in the case of benefits received under the Food Stamp program as follows:

(i) the claimant's allotment varies from month to month within the certification period to account for anticipated change and the claimant was so notified at the time of certification;

(ii) claimant or member of claimant household is subject to a lockout or strike and signs a waiver of notice of adverse action to allow the department to reduce or terminate benefits when the claimant or member of claimant household receives income from employment again;

(iii) a member of claimant household is disqualified for fraud, or the benefits of the claimant household are reduced or terminated to reflect the disqualification of the member as provided for in 7 CFR 273.16; and

(iv) the department initiates a mass change as described in 7 CFR 273.12(e).

(f) in the case of benefits received under all programs except the Food Stamp program:

(i) the claimant enters an institution and further benefits do not qualify for federal financial participation;

(ii) claimant is placed in skilled or intermediate nursing care or long-term hospitalization;

(iii) claimant's whereabouts are unknown and mail is returned with no forwarding address;

(iv) claimant is a child receiving benefits under the TANF program and is removed from his home by judicial determination or is voluntarily placed in foster care by legal guardian;

(v) a change in claimant's medical care is prescribed by his physician; and

(vi) claimant has provided information which requires termination or reduction of assistance and has indicated in writing that he understands the consequences of providing the information.

(4) In the case of probable fraud in all programs except the Food Stamp program, notice of adverse action is timely if mailed at least five days prior to the effective date of the adverse action.

(5) Notice is adequate if it includes:

(a) a statement of the proposed adverse action;

(b) the reason for the proposed adverse action;

(d) a statement of the claimant's right to a hearing;

(e) how to obtain a hearing;

(f) telephone number to call for additional information;

(g) the right to be represented by legal counsel, friend, relative or other spokesman;

(h) the availability of free legal assistance if such assistance is known to the department program manager involved in the denial of the claim;

(i) if applicable, whether or not benefits are to be continued and the liability of the claimant for benefits received pending hearing if the hearing decision is adverse; and

(j) any other information as specifically required by applicable law, including department rule.

(6) A notice is effective for purposes of this rule if the notice substantially complies with the requirements of (5). A notice shall not be considered inadequate for purposes of this rule based upon good faith errors or omissions that are not prejudicial to the substantial rights of the claimant.

(7) A claimant is not entitled to advance notice of an adverse determination regarding medical necessity of services under the Medicaid program. The department may review medical necessity as provided in ARM 37.85.410 and notice of any adverse action may be provided within a reasonable time after a determination, even though the services may have been provided at an earlier date.

History

Authorizing statute(s): 53-2-201, 53-2-606, 53-4-212, 53-6-113, 53-7-102, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1979 MAR p. 489, Eff. 5/25/79; AMD, 1979 MAR p. 812, Eff. 7/27/79; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2007 MAR p. 47, Eff. 1/12/07.

Subchapter 37.5.6 Certification of Long Term Care Facilities Informal Dispute Resolution

Mont. Admin. R. 37.5.601 Purpose

(1) The purpose of ARM 37.5.601 through 37.5.615 is to supplement those provisions of the Code of Federal Regulations (CFR) which provide the requirements nursing facilities must meet in order to participate in the Medicaid program, and which govern the certification of these facilities by the state survey agency for participation in the Medicaid program.

(2) All nursing facilities must be certified by the state survey agency in order to participate in the Medicaid program and receive reimbursement from that program. Nursing facilities must comply with the applicable provisions of 42 CFR parts 442, 483 and 488, updated through February 2004 as well as the definitions and standards outlined in this chapter. The department adopts and incorporates by reference 42 CFR parts 442, 483 and 488, updated through February 2004. A copy of the cited requirements is available from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

(3) The state survey agency shall apply the applicable provisions of 42 CFR parts 442, 483 and 488, updated through February 2004, as well as the definitions and standards outlined in this chapter to both the survey and certification process and the informal dispute resolution process when issuing or reviewing a deficiency citation to a nursing facility.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-106, 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.5.602 Definitions

The following definitions shall apply to nursing facilities participating in the Medicaid program, and to the certification of nursing facilities for participation in the Medicaid program by the state survey agency, as provided for at 42 CFR parts 442, 483 and 488. The following definitions shall also be applicable to the informal dispute resolution process required by 42 CFR 488.331, and outlined in this subchapter. These definitions are in addition to those found in the CFR:

(1) "Actual harm" means the facility's failure to comply with any federal or state standard or condition for participation in the Medicaid program resulted in harm to a resident in one of the following ways:

(a) an identifiable and substantial impairment of cognitive or psychological functioning or emotional well being;

(b) an identifiable and substantial impairment of any bodily organ or function;

(d) death.

(2) "Avoidable" means capable of being prevented through the application of an ongoing process of assessment, planning, intervention, monitoring, and evaluation that is consistent with currently accepted standards of practice for facilities.

(3) "Centers for Medicare and Medicaid Services (CMS)" means the federal agency that contracts with the state survey agency to perform nursing facility surveys on its behalf.

(4) "Complaint survey" or "complaint investigation survey" means a survey of a nursing facility conducted by the state survey agency following receipt of a complaint or allegation that the nursing facility has violated a federal or state standard or condition for participation in the Medicaid program. The purpose of a complaint survey is to determine compliance with federal and state standards and conditions for participation in the Medicaid program.

(5) "Deficiency citation" means the state survey agency's determination of a facility's failure to meet any federal or state standard or condition for participation in the Medicaid program, as recorded by the state survey agency on the form designated for this purpose by the Centers for Medicare and Medicaid Services (CMS).

(6) "Department" means the Department of Public Health and Human Services provided for in 2-15-2201 , MCA.

(7) "Facility" or "nursing facility" means a nursing facility or a distinct part of a nursing facility that participates in the Medicaid program.

(8) "Immediate jeopardy" means a situation in which immediate corrective action is necessary because the facility's failure to comply with any federal or state standard or condition for participation in the Medicaid program has caused, or is likely to cause, serious injury, harm, impairment or death to a resident.

(9) "Informal dispute resolution (IDR)" means the process required by 42 CFR 488.331 by which a facility is given an informal opportunity, at the facility's request, to dispute a deficiency citation.

(10) "Minimal harm" means the facility's failure to comply with any federal or state standard or condition for participation in the Medicaid program resulting in harm to a resident in one of the following ways:

(a) an identifiable, but less than substantial, impairment of cognitive or psychological functioning or emotional well being; or

(b) an identifiable, but less than substantial, impairment of any bodily organ or function.

(11) "Potential for more than minimal harm" means actual harm is likely to occur due to the facility's failure to comply with any federal or state standard or condition for participation in the Medicaid program.

(12) "Presiding official" means an individual appointed or hired by the department to preside over or conduct informal dispute resolution proceedings. The presiding official may not have been directly involved in the certification survey regarding which informal dispute resolution has been requested.

(13) "Resident" means an individual residing in a nursing facility.

(14) "Revisit" or "survey revisit" means a follow-up survey conducted by the state survey agency subsequent to the citation of a deficiency for the purpose of determining whether the facility now meets the requirements for participation in the Medicaid program.

(15) "Scope and severity" of a deficiency refers to a determination of the state survey agency regarding:

(a) whether a cited deficiency constitutes:

(i) no actual harm with a potential for minimal harm;

(ii) no actual harm with a potential for more than minimal harm but not immediate jeopardy;

(iii) actual harm that is not immediate jeopardy; or

(iv) immediate jeopardy to resident health or safety; and

(b) whether a cited deficiency:

(i) is isolated;

(ii) constitutes a pattern; or

(iii) is widespread.

(16) "Serious" means having important or dangerous consequences, as in the phrase "a serious injury".

(17) "Standard survey" means the survey of each nursing facility conducted by the state survey agency at least every 15 months in accordance with 42 CFR part 488, subpart E. The purpose of a standard survey is to determine compliance with federal and state standards and conditions for participation in the Medicaid program.

(18) "State survey agency" means the Department of Public Health and Human Services to the extent that the department conducts Medicaid surveys of facilities on behalf of and under contract with the federal CMS pursuant to 53-6-106 , MCA, section 1864 of the Social Security Act (42 USC 1395aa), and 42 CFR 488.10 and 488.11.

(19) "Substandard quality of care" means any deficiency citation related to 42 CFR 483.13, resident behavior and facility practices; 43 CFR 483.15, quality of life; or 42 CFR 483.25 quality of care that constitutes:

(a) immediate jeopardy to resident health or safety;

(b) a pattern of or widespread actual harm that is not immediate jeopardy; or

(20) "Substantial compliance" means a level of compliance with the federal or state standards or conditions for participation in the Medicaid program such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm.

(21) "Tag" means the reference number utilized by the state survey agency on the statement of deficiencies to designate a standard or condition of participation with which a facility is out of compliance. Each tag corresponds to one or more federal regulations pertaining to the standards and conditions for participation in the Medicaid program.

(22) "Unavoidable" means not capable of being prevented through the application of an ongoing process of assessment, planning, intervention, monitoring, and evaluation that is consistent with currently accepted standards of practice for facilities. An unavoidable decline occurs when appropriate interventions have been consistently implemented, but despite these interventions, the resident's condition has declined.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-106, 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.5.603 Opportunity for Informal Dispute Resolution

(1) A facility may request an informal dispute resolution to refute a deficiency citation made by the state survey agency.

(2) An informal dispute resolution is a different and separate form of procedure from an administrative review and/or fair hearing. A facility is not entitled to an administrative review, fair hearing or other process in addition to an informal dispute resolution unless specifically provided for by department rule or otherwise required by law.

(3) Informal dispute resolution is an informal opportunity for the facility to dispute deficiency citations. Informal dispute resolutions conducted under this chapter are subject to neither the provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA, nor to statutory rules or provisions regarding civil procedure or evidence.

(4) This rule does not require that the informal dispute resolution be conducted prior to the state survey agency making a recommendation to the CMS.

(5) Nothing in this chapter shall be construed to impede, prevent or delay any enforcement action or proceedings by the CMS or the department, acting as the State Medicaid Agency.

(6) The determination of the presiding official who conducts the informal dispute resolution is not binding upon CMS nor does it affect any right the facility may have to pursue any available federal administrative hearings or appeals processes.

(7) Only one informal dispute resolution to dispute deficiencies cited is available for either a standard survey or a complaint investigation survey.

(8) Regardless of whether a facility has used the opportunity for informal dispute resolution at the standard or complaint investigation survey, a facility may request an additional informal dispute resolution under the following circumstances:

(a) if a deficiency cited as a result of a standard or complaint survey continues at a survey revisit (that is, the facility has failed to correct a deficiency cited as a result of the standard or complaint survey prior to the revisit), the facility may request informal dispute resolution to dispute citation of the deficiency at the survey revisit;

(b) if a new deficiency is cited as a result of a survey revisit or as the result of an informal dispute resolution, the facility may request informal dispute resolution to dispute citation of the deficiency at the survey revisit or following informal dispute resolution; or

(c) if, on the basis of new facts discovered at the survey revisit, or as the result of an informal dispute resolution, a new example of a deficiency cited as a result of a standard or complaint survey is added following the survey revisit, or following informal dispute resolution, the facility may request informal dispute resolution to dispute the new example of the deficiency citation.

(9) A second informal dispute resolution is not available if a different deficiency is cited at the survey revisit or as a result of an informal dispute resolution but the factual basis for the deficiency is the same as the factual basis for a deficiency cited in the original standard or complaint investigation.

(10) Scope and severity classification of the deficiency citation(s) shall not be the sole basis of a facility's dispute of a state survey agency deficiency citation unless the scope and severity assessment constitutes substandard quality of care or immediate jeopardy. The informal dispute resolution process may, however, result in a change in the scope and severity classification.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.5.606 Informal Dispute Resolution Facility Requirements

(1) A request for informal dispute resolution must be in writing and either received by the department or postmarked within ten calendar days of the facility's receipt of the state survey agency's written deficiency citations. The department will accept timely applications by fax.

(2) A facility's failure to submit a timely request for informal dispute resolution shall be deemed a waiver of the facility's right to request informal dispute resolution, and the department shall be entitled to deny any request for informal dispute resolution which is not either received by the department or postmarked within ten calendar days following the facility's receipt of the state survey agency's written deficiency citations.

(3) Requests for an informal dispute resolution must be mailed or delivered to the Office of Fair Hearings, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953 or faxed to the attention of the Office of Fair Hearings at (406) 444-3980.

(4) The written request for an informal dispute resolution must:

(a) list the specific survey deficiency citation(s) being disputed and briefly summarize the facility's objections to each survey deficiency citation;

(b) specify whether the facility desires:

(i) a record review;

(ii) a telephone conference; or

(iii) an in-person conference;

(c) provide the name, address, and telephone number of the person who is coordinating the informal dispute resolution for the facility; and

(d) specify whether legal counsel will represent the facility at the informal dispute resolution, so that the department may arrange for legal representation as well. The informal dispute resolution will be cancelled and rescheduled if the facility does not notify the presiding official in its request for informal dispute resolution that it will be represented by legal counsel, but subsequently appears at the informal dispute resolution with legal counsel.

(5) Any substantiating materials the facility wishes to have considered as part of the informal dispute resolution process must be mailed to the presiding official and must be received or postmarked no later than seven calendar days prior to the time of any scheduled telephone or in-person conference, or prior to the deadline set by the presiding official for receipt of substantiating materials in the case of a record review. The facility shall clearly:

(a) identify and describe the relevance of any material submitted;

(b) label and cross reference all attachments to the disputed citation;

(d) indicate the desired outcome for each disputed citation.

(6) The facility shall provide to the state survey agency a duplicate copy of all substantiating materials submitted to the presiding official.

(7) The facility may request in writing, at the same time the informal dispute resolution is requested, supporting documentation for a disputed deficiency citation from the state survey agency as specified in ARM 37.5.607(3).

(8) Prior to the commencement of any informal dispute resolution conducted via in-person or telephone conference, a facility representative with authority to act on the facility's behalf must present to the presiding official a signed statement listing all of the participants who will be present on the facility's behalf. This statement:

(a) must specify that the facility feels the named persons are necessary to present the facility's case;

(b) must state that the facility takes responsibility to ensure that any person appearing on the facility's behalf will comply with all applicable federal and state health information security, privacy, and confidentiality regulations; and

(c) may list as participants staff members of a professional association(s) or legal counsel who are advising or representing the facility in the informal dispute resolution.

(9) Any observer who is not representing or advising the state survey agency or the facility must leave the informal dispute resolution during any portion of the proceedings where protected health information will be disclosed.

(10) Any person who is the subject of protected health care information discussed during an informal dispute resolution shall be entitled to receive, upon written request, a list of the names of anyone that participated in the informal dispute resolution.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.5.607 Informal Dispute Resolution State Survey Agency Responsibilities

(1) The state survey agency shall not interfere with the right of a facility to request an informal dispute resolution.

(2) The state survey agency must give the facility notice of the facility's right to request informal dispute resolution at the same time that written deficiency citation(s) findings are sent. This notice must inform the facility of:

(a) the name, address and telephone number of the person the facility must contact to request informal dispute resolution;

(b) the specific information that must be contained in the facility request for informal dispute resolution, as specified in ARM 37.5.606;

(d) a statement that the facility must inform the presiding official of its intent to be represented by legal counsel as specified in ARM 37.5.606(4).

(3) Upon written request of the facility, the state survey agency must mail supporting documentation used in reaching its deficiency citation(s) to the facility and the presiding official. This documentation must be received or postmarked no later than seven calendar days prior to any scheduled telephone or in person conference, or prior to the deadline set by the presiding official for receipt of substantiating materials in the case of a record review. The facility must specify each disputed deficiency for which it is requesting supporting documentation. Information will only be provided for disputed deficiencies. The state survey agency may charge the facility $.20 per page to cover the cost of retrieving, copying and mailing this information. There will not be a charge if fewer than 20 pages are produced.

(4) The state survey agency shall review and take into consideration the information submitted by the facility prior to the informal dispute resolution. The state survey agency shall notify both the facility and the presiding official prior to the informal dispute resolution conference of any changes to the deficiency citation(s) or scope and severity classification(s) it intends to make.

(5) Following informal dispute resolution, the state survey agency shall take one or more of the following actions in accordance with the written recommendation of the presiding official or the written determination of CMS:

(a) an existing deficiency citation may be amended, modified, deleted, or remain unchanged;

(b) the scope and severity of an existing deficiency citation may be changed;

(d) an existing deficiency may be cited under a different tag.

(6) If a deficiency is deleted:

(a) the deficiency must be signed, dated and marked "deleted" by the state survey agency and any enforcement action(s) recommended or imposed solely because of that deficiency must be rescinded. In addition, the scope and severity classification is adjusted to reflect only the remaining findings; or

(b) the facility may request a new written deficiency citation form that does not have the deleted deficiencies printed on it. The clean form must have the remaining applicable plan of correction placed upon it and be signed by the facility's representative before it can replace the original in the facility's public file. If a clean, signed plan of correction is not provided, the original deficiency citation form with the signed plan of correction may be disclosed.

(7) If the state survey agency disagrees with the determination of the presiding official, the state survey agency may, but is not required to, include with its official recommendation to the CMS or to the State Medicaid Agency a written statement stating that it disagrees with the determination of the presiding official, and specifying the reason(s) why it disagrees. A copy of this statement must also be sent to the facility and the presiding official.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.5.610 Informal Dispute Resolution Process

(1) Upon receipt by the department of a timely written request for informal dispute resolution complying with the requirements of this chapter, the department shall designate an individual who was not directly involved in the certification survey for which informal dispute resolution was requested to serve as the presiding official.

(2) If the facility has requested an in-person or telephone conference, the presiding official will schedule the informal dispute resolution conference and provide at least ten calendar days advance notice to the facility and state survey agency of the date, time and place or telephone conference call information set for the informal dispute resolution. Each party to the informal dispute resolution shall be given one reasonable opportunity to reschedule a telephonic or in-person informal dispute resolution conference.

(3) If the facility has requested a record review, the presiding official will set a deadline for submission of substantiating or relevant information and materials by the facility and the state survey agency.

(4) All in-person conferences will be held in Helena, Montana.

(5) All facility costs associated with the informal dispute resolution process, including, but not limited to, witness and attorney fees, shall be borne by the facility, regardless of the outcome of the informal dispute resolution.

(6) The presiding official will conduct the informal dispute resolution conference in a way that allows for an orderly presentation of facts. The presiding official may:

(a) limit testimony and/or rebuttal of information by either the facility or the state survey agency that is irrelevant, redundant or beyond the scope of the informal dispute resolution;

(b) determine whether facility and state survey agency witnesses will be allowed to ask each other questions and limit those questions in accordance with (6)(a);

(d) request additional documentation; and

(e) permit a facility or the state survey agency to submit additional substantiating materials at the informal dispute resolution in the case of an in-person or telephone conference, or after the deadline set by the presiding official in the case of a record review, but only if the presiding officer is satisfied that, despite diligent efforts, the facility or the state survey agency was unable to comply with the time limits for submission of materials established by this chapter. All additional substantiating materials presented must meet the requirements of ARM 37.5.606, and two copies of the materials must be presented, one for the presiding official and one for the other party.

(7) The informal dispute resolution will be confined to disputes over the factual basis of the deficiency citations and the subsequent application of federal or state laws and regulations governing the survey and certification processes. The informal dispute resolution may not be used to challenge the:

(a) adequacy, accuracy, or fairness of the state or federal regulations;

(b) classification of deficiencies as to scope and severity unless the state survey agency is alleging substandard quality of care or immediate jeopardy;

(d) survey team compliance with a requirement of the survey process unless this failure by the survey team has a significant impact on the relevance of the deficiency; or

(e) consistency of the survey team in citing deficiencies in previous surveys of this facility or of other facilities.

(8) After reviewing all materials and information presented by the parties, the presiding official shall determine whether:

(a) the facility has demonstrated that any disputed deficiency should not have been cited;

(b) whether any deficiency should be deleted, amended, or modified;

(d) whether any deficiency should be cited under a different tag; and

(e) whether any additional deficiencies should be cited.

(9) The presiding official shall provide the state survey agency and the facility with a written opinion stating his or her recommendation.

(10) The deficiency citation form shall be amended as specified in ARM 37.5.607 based on the determination of the presiding official or the determination of CMS. If any amendments are made, the amended deficiency citation form will be sent to the facility and CMS.

(11) Determinations made by the presiding official shall be limited to the particular facts surrounding the disputed deficiency citation. No precedent will be set by the presiding official's determination, and no presiding official determination shall be binding upon the state survey agency in subsequent surveys or informal dispute resolution proceedings, nor shall any such determination be binding upon the presiding official presiding over any subsequent informal dispute resolution proceeding.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.5.611 Informal Dispute Resolution, Centers for Medicare and Medicaid Services (cms) Responsibilities

(1) The presiding official shall make a written recommendation to CMS, the facility and the state survey agency following the informal dispute resolution.

(2) CMS shall have the final authority to make a determination in the informal dispute resolution process. CMS may accept, reject or amend the recommendation of the presiding official.

(3) If CMS notifies the state survey agency that CMS is making the final determination following informal dispute resolution, the state survey agency will not issue the deficiency citation form until CMS instructs the state to do so.

(4) The deficiency citation form shall be amended as specified in ARM 37.5.607 based on the written determination of CMS. If any amendments are made based on the CMS determination, the amended deficiency citation form will be sent by the state survey agency to CMS and the facility.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.5.615 Incorporation of Standards for Monitoring and Referral for Medications and Treatments in the Certification Process

(1) In compliance with 53-6-109 , MCA, the following facility monitoring and referral standards for medications and treatments shall be used in the survey and certification process:

(a) the facility shall have a process in place to monitor all residents who receive a medication or treatment for excessive dose, duplicate therapy, excessive duration, inadequate monitoring based on current practice standards, inadequate indications or contraindications for use, adverse consequences which indicate the dose should be reduced or discontinued, or any combination of these reasons;

(b) the facility must notify the attending physician and, if appropriate, the facility medical director, the consulting pharmacist and/or other appropriate medical professionals when it identifies any of the conditions outlined in (1)(a) and request his or her review of continuing the medication or treatment as ordered. Such notifications, and any resulting conclusions about continuing the medication or treatment or any changes in medications or treatments must be documented in the resident's medical record by the facility staff;

(c) if the process described in (1)(a) is in place and is being fully implemented and utilized, but a violation of any federal or state standard or condition for participation in the Medicaid program still exists, the state survey agency will cite the deficiency on the facility's deficiency citation form. The state survey agency will also refer the attending physician to the board of medical examiners for review of the care provided by the physician; or

(d) if the process described in (1)(a) is not in place or is not being implemented or utilized fully and a violation of any federal or state standard or condition for participation in the Medicaid program exists, the state survey agency will cite the deficiency on the facility's deficiency citation form.

History

Authorizing statute(s): 53-6-109, 53-6-113, MCA
Implementing statute(s): 53-6-109, 53-6-113, MCA
History: NEW, 2004 MAR p. 736, Eff. 4/9/04.

Chapter 37.6 Office of Inspector General

Subchapter 37.6.1 Overall Office Rules

Mont. Admin. R. 37.6.102 Subpoena

(1) The Department of Public Health and Human Services (department) Office of Inspector General (OIG) has the authority, when conducting investigations, to issue subpoenas to compel the production of financial records, documents, records, or data, including information in electronic form, relevant to its investigation of fraud, waste, and abuse in health care services and public assistance programs administered by the department as defined in ARM Title 37.

(2) A subpoena may be directed to enrolled or formally enrolled Montana Medicaid or CHIP providers, recipients of public assistance, or other third parties in possession or knowledge of documents or records deemed relevant and material to the inquiry.

(3) OIG shall issue a subpoena only when the person who is the subject of the investigation fails to voluntarily provide the information and the information is otherwise unavailable to OIG through less intrusive means.

(4) The subpoena request must be signed by the director of the department and the inspector general.

(5) Investigative subpoenas issued under this rule may be enforced as provided by 2-4-104, MCA.

History

Authorizing statute(s): 53-2-112, MCA
Implementing statute(s): 53-2-112, MCA
History: NEW, 2026 MAR, Notice No. 2026-367, Eff. 7/25/26.

Chapter 37.8 Records and Statistics

Subchapter 37.8.1 General

Mont. Admin. R. 37.8.101 Registrars, General

(1) The department shall provide to each county clerk and recorder the name, address and telephone number of the local registrars in that county.

(2) Each local registrar shall submit to the department and the county clerk and recorder the name, address, and telephone number of at least one proposed deputy registrar, who may function as a deputy after receiving written authorization from the department to do so. The deputy registrar may function as registrar when the registrar is unavailable.

(3) Each registrar must report to the department and the county clerk and recorder any change in the name, address, or telephone number for the registrar or the deputy registrar.

(4) Before resigning or retiring as registrar, a registrar must send the department notification of the fact and a recommendation for a replacement. A resignation or retirement will be effective the last day of the month the notification is received by the department. The appointment of a replacement registrar will be effective the first day of the month after the replacement receives the appointment letter.

(5) On the fifth day of every month, each local registrar must mail to the department all original certificates, (birth, death, and fetal death) filed with the registrar during the previous month.

History

Authorizing statute(s): Sec. 50-15-102 and 50-15-103, MCA
Implementing statute(s): Sec. 50-15-103, 50-15-104, 50-15-105 and 50-15-109, MCA
History: NEW, 1981 MAR p. 1187, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02.

Mont. Admin. R. 37.8.102 Definitions

In addition to the definitions contained in 50-15-101, MCA, the following definitions apply to this chapter:

(1) "Amendment" means alteration or addition of any item on the face of a vital record after it is on file with the department, in a county clerk and recorder's office, or with a clerk of district court.

(2) "Ashes" which are the result of a cremation of a human body are considered the same as a dead body as defined in 50-15-101(3), MCA.

(3) "Authorized certifier" means, in relation to a certified copy of a vital record, either a county clerk and recorder or a person designated by the department to issue certified copies on its behalf.

(4) "Certified copy" means a document copied or electronically extracted from a vital record filed with the department or from a duplicate copy of that record filed with a county clerk and recorder and that is printed on the department's security paper and contains an attestation by an official designated by the department that the document is a true and correct copy of the information contained in the original vital record.

(5) "Certifying official" means an individual authorized to issue a certified copy of a vital record by the department or a county clerk and recorder.

(6) "Department" means the Department of Public Health and Human Services, Office of Vital Statistics.

(7) "Filing date" means the date a vital record is accepted for registration by the department.

(8) "Literal format" means, in regard to a date, the name of the month spelled out, the numerical day of the month, and the numerical four-digit year, e.g., January 1, 1998.

(9) "Next of kin" means the spouse, parents, adult children, and adult brothers and sisters of a registrant and any other person declared next of kin by a court of competent jurisdiction.

(10) "Registrant" means an individual for whom a vital record is completed and filed, including, for example, the decedent on a death certificate, the person for whom a birth certificate is filed, the husband and wife on a divorce record, and the bride and groom on a marriage record.

(11) "Summary of evidence" means a number assigned to an affidavit, administrative order, or court order which is used to track the evidence provided to amend, correct, or reissue a vital record.

(12) "Supporting documentation" means any document required as evidence for the filing of a delayed vital record or for verification of changes to original data or adding missing data on a filed vital record.

History

Authorizing statute(s): 50-15-102, 50-15-103, MCA
Implementing statute(s): 50-15-101, 50-15-103, 50-15-224, MCA
History: NEW, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08; AMD, 2017 MAR p. 2436, Eff. 12/23/17; AMD, 2021 MAR p. 926, Eff. 7/24/21.

Mont. Admin. R. 37.8.103 Local Registrar Duties

(1) A local registrar accepting a paper vital record for filing shall add the filing date and sign a death, birth, fetal death, or stillborn certificate. The registrar shall forward the original document to the department and one duplicate to the county clerk and recorder as required by 50-15-109, MCA.

(2) The local registrar shall retain one duplicate, which must be easily accessible for reference. The local registrar may not further copy or provide any copies of the retained duplicate.

(3) A registrar must retain for two years each copy of a paper certificate recorded in accordance with 50-15-109, MCA. After two years, the local registrar shall destroy the triplicate copy of the certificates. The destruction of any certificate must be reported in writing to the department.

(4) Submission to and acceptance of an electronic image of a birth, death, or fetal death certificate by the department through the department's approved electronic registration system constitutes an official filing of a record. All certified paper copies generated from electronically filed records must be accepted as though they contain all required signatures.

(5) A paper filing occurs when the local registrar accepts the certificate. An electronic filing occurs when the record passes all validation checks and is assigned a state file number. If both a paper certificate and an electronic filing exist, the electronic filing is considered the original certificate and it must be filed first.

(6) When leaving the position of local registrar, the outgoing registrar must deliver all records, manuals, and materials to the succeeding registrar or to another person designated by the department.

History

Authorizing statute(s): 50-15-102, 50-15-103, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-109, 50-15-124, MCA
History: Eff. 12/31/72; AMD, Eff. 12/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.104 Authorized Format for Submission of a Vital Record

(1) All vital records, such as marriage license applications, birth certificates, death certificates, fetal death certificates, and marriage certificates, shall be submitted electronically using the department’s electronic registration system, and in rare instances where access to the department’s electronic registration system is unavailable, submitted on forms provided or authorized by the department.

(2) When vital records are submitted outside of the department’s electronic registration system due to unavailability of the system, each vital record application and certificate must be typed or plainly written in unfading black ink that is legible on all copies or must be completed using computer printers that produce dense and legible characters in black. The characters entered onto these forms must be adequate for high quality reproduction by microfilming or photocopying and may not contain any alterations or obliteration of the original data.

(3) If the preparation of a certificate or application is so poor as to make the reading of the form difficult or if the entries are not dark enough to reproduce satisfactorily, the registrar shall notify the person who submitted the certificate or application that it is unacceptable. The person who filed the certificate or application must prepare and file a new certificate or application within ten days after receipt of the notification.

(4) Special characters are allowed in the first, middle, and last name fields of the record. The special characters allowed for use are only those characters with consonants or vowels. Special characters or symbols not associated with consonants or vowels, such as numbers, dollar signs, and exclamation marks, are not permitted.

History

Authorizing statute(s): 50-15-102, 50-15-103, MCA
Implementing statute(s): 40-1-107, 50-15-102, 50-15-103, 50-15-121, 50-15-124, MCA
History: Eff. 12/31/72; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08; AMD, 2025 MAR, Notice No. 37-1075, Eff. 3/17/25; AMD, 2026 MAR, Notice No. 2026-852, Eff. 8/8/26.

Mont. Admin. R. 37.8.105 Preservation of Old Records

(1) Employees of the department, for purposes of making old or faded records suitable for microfilming or photocopying may:

(a) trace those parts of the record that are too dim to be microfilmed;

(b) retype the record on a separate form and microfilm the retyped copy; or

(2) If (1) (b) or (c) are employed, the original record must be retained for reference purposes.

(3) In no case may the department or any of its employees change the substance or contents of any vital record.

(4) If the original vital record is illegible and the substance or content cannot definitely be determined, illegible portions must not be retraced, and, if retyped, the copy shall indicate those portions of the original that were illegible.

History

Authorizing statute(s): Sec. 50-15-102 and 50-15-103, MCA
Implementing statute(s): Sec. 50-15-102 and 50-15-103, MCA
History: NEW, 1981 MAR p. 1187, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03.

Mont. Admin. R. 37.8.106 Amendment of Vital Records

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-204, 50-15-223, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-204, 50-15-223, MCA
History: NEW, 1981 MAR p. 1187, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03; REP, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.107 Amendment of Vital Record

(1) Any requested or court ordered amendment to a filed birth or death record must be submitted in writing to the department. On receipt of a request or court order, the department may immediately notify the appropriate county clerk and recorder to suspend the issuance of the affected record until the department issues a letter of correction.

(2) Application for the amendment of marriage applications, licenses, certificates, or marital termination reports (which are not part of the decree) may be made by either party directly to the clerk of district court that issued the marriage license or has on file the marital termination orders. The clerk of district court will make the changes and forward a copy of the corrected document to the department.

(3) Except in those cases specified in (4) and (5), a vital record may only be amended by an order from a court with appropriate jurisdiction, the original data provider, or those persons authorized by 50-15-121(1), MCA.

(4) The demographic information of a death record may be amended by the next of kin, the informant listed on the death certificate, the funeral director, or the person in charge of the final disposition of the body. If any information provided by the informant is disputed after the record has been filed, changes to the demographic data must be made pursuant to an order from a court with appropriate jurisdiction.

(5) Applications to amend the medical certification of cause of death must only be made by the physician who provided the medical certification, or a coroner or state medical examiner if the coroner or medical examiner assumed responsibility for the case. If the cause of death certification is disputed, changes to the cause of death certification must be made pursuant to an order from a court with appropriate jurisdiction.

(6) The department's supervisory staff may amend a vital record when the nature of the amendment is needed to protect the integrity, accuracy, and validity of the record.

(7) A court order that changes a vital record must indicate if an amended or substitute record is to be created. If the court order does not indicate a preference, the record will be amended.

(8) Except as provided in (5) and (6), any subsequent change to information previously amended under this rule requires an order from a court with appropriate jurisdiction.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-204, 50-15-223, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-204, 50-15-223, 50-15-403, MCA
History: NEW, 2008 MAR p. 169, Eff. 1/1/08; AMD, 2015 MAR p. 1492, Eff. 9/25/15; AMD, 2019 MAR p. 2057, Eff. 1/1/20.

Mont. Admin. R. 37.8.108 Amendment Process and Document Requirements

(1) Except as noted in ARM 37.8.311, a filed original vital record must be amended by either electronic means by maintaining an audit trail of the amended record in the department’s electronic registration system or, for non-electronic records, by placing a line through the information to be deleted and typing the new information above the line. Printed copies of amended electronic records shall display the most recent changes made to the record in a manner determined by the department. If the change to the record is to add missing or blank information, the added information must be entered in the appropriate location.

(2) Any certified copy of a vital record issued in the state that was amended or corrected within the first year after filing will not be marked "AMENDED"; however, the summary evidence number and the date of the correction will be indicated. Any vital record amended one year or more after the event will be marked "AMENDED" and will contain the summary evidence number and the date the alterations occurred.

(3) The documentation that justifies the amendment of a vital record must be made available upon request to any person receiving a certified copy.

(4) In cases other than those cited in ARM 37.8.311, the department may amend any portion of a vital record if a requestor submits a correction affidavit.

(a) The correction affidavit must include the following information:

(i) the name of the registrant or registrants appearing on the record;

(ii) the date and place of birth, birth resulting in a stillbirth, death, or fetal death;

(iii) the specific items on the record that are to be changed, including the information as presently shown and the proposed corrected information;

(iv) the relationship of the affiant to the registrant;

(v) certification by the affiant that all affected parties concur with the changes; and

(vi) supporting documentation provided by the affiant as irrefutable proof that the amendment(s) are correct.

(b) If not all parties agree to the changes, an order from a court with appropriate jurisdiction is required.

(5) The department will determine the number and suitability of the supporting documentation required as irrefutable proof to sustain the accuracy of the amendment(s).

(6) Supporting documents must not be altered and must meet the following criteria:

(a) For any person under the age of five, the document(s) must be dated at least one year before the date of the application or within the first year of birth.

(b) For any person five years of age or older, the documents must be dated at least five years before the date of application or within three years after the date of birth.

(7) Upon request, the department will provide a list of suggested supporting documents.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-204, 50-15-208, 50-15-223, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-204, 50-15-208, 50-15-223, MCA
History: NEW, 2008 MAR p. 169, Eff. 1/1/08; AMD, 2015 MAR p. 1492, Eff. 9/25/15; AMD, 2025 MAR, Notice No. 37-1075, Eff. 3/17/25.

Mont. Admin. R. 37.8.109 Registrar's Monthly Statement of Certificates Filed

(1) To facilitate and to ensure proper accounting, local registrars shall submit to the department, on a monthly, weekly, or biweekly basis, statements of the certificates that have been filed in the registrar's county. If submitted on a monthly basis, the local registrars shall submit the statements on or before the fifth day of each month. The statements must be recorded on forms supplied by the department, and must indicate the number of birth, death, and fetal death certificates filed in the registrar's county. If no certificates were filed, the statement must so indicate.

History

Authorizing statute(s): 50-15-102, 50-15-103, MCA
Implementing statute(s): 50-15-102, 50-15-107, 50-15-109, MCA
History: Eff. 12/31/72; AMD, Eff. 12/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.110 Payment of Fees to Local Registrars

(1) The department shall certify to the treasurer of each county the number of births, deaths, and fetal deaths registered in such county, with the names of the local registrars, and the amounts due them. Such certifications must be made annually unless in the opinion of the department it is desirable to make them more often.

(2) Registrars are entitled to a payment of $1 per certificate or monthly report filed.

History

Authorizing statute(s): Sec. 50-15-102, 50-15-103 and 50-15-107, MCA
Implementing statute(s): Sec. 50-15-102 and 50-15-107, MCA
History: Eff. 12/31/72; AMD, Eff. 12/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02.

Mont. Admin. R. 37.8.116 Fees for Certification, File Searches, and Other Vital Records Services

(1) The fee for a certified copy (photocopy or computer-produced) of a birth certificate, a fetal death certificate, an acknowledgment of paternity, or a delayed birth registration is $16.

(2) The fee for a certified copy (photocopy or computer-produced) of a death certificate is $16 for each copy, including any additional certified copies requested at the same time as the first certified copy.

(3) The fee for an informational copy of a death certificate is $16 for each copy.

(4) The department will charge a fee of $10 per name for a record search within any period of five years or less. If the record is not located, the fee will not be refunded. If the request is for more than five years, an additional fee of $1 per year over the first five years will be charged.

(5) The fee for providing record information for statistical or administrative purposes as allowed by law is $5 for each five-year period per name.

(6) The fee to process a finalized adoption or a rescission of an adoption is $25. A certified copy of the new certificate will be provided for a fee of $16.

(7) The fee to create a birth certificate pursuant to a court order is $25. A certified copy of the new certificate will be provided for a fee of $16.

(8) The fee to open a court ordered sealed file is $25.

(9) The fee for filing a delayed registration of a vital record is $25. A certified copy of the delayed certificate will be provided for a fee of $16.

(10) The fee for establishing a birth certificate due to a home birth is $25. A certified copy of the certificate will be provided for a fee of $16.

(11) The fee for amending or correcting a vital record after one year from the date of filing is $25. A certified copy of the amended record will be provided to the person requesting the amendment or correction for a fee of $16.

(12) The fee for a search of the putative father registry is $10 per name.

(13) The fee to provide electronic copies of index files is $50 per monthly update and $50 for an annual update.

(14) The fee for producing aggregate statistics is $50 per hour for programming and processing if that processing takes more than half an hour's work on existing programs.

(15) The fee for a disinterment permit is $5. The local registrar will collect the fee, $2 of which must be remitted to the department.

(16) Overpayment of a required fee received in the office of vital statistics will be refunded if in excess of $5, and any overpayment of less than $5 will be refunded, if the applicant requests it in writing within one year after the payment to the department.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-111, MCA
Implementing statute(s): 42-2-218, 50-15-111, MCA
History: Eff. 12/31/72; AMD, 1981 MAR p. 1188, Eff. 10/16/81; AMD, 1983 MAR p. 731, Eff. 7/1/83; AMD, 1992 MAR p. 143, Eff. 1/31/92; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 4/1/02; AMD, 2016 MAR p. 893, Eff. 5/21/16; AMD, 2019 MAR p. 2057, Eff. 1/1/20; AMD, 2021 MAR p. 926, Eff. 7/24/21; AMD, 2024 MAR p. 2282, Eff. 9/21/24.

Mont. Admin. R. 37.8.126 Access to Records

(1) Anyone who submits a completed state-approved application must provide proof of identification before obtaining a certified or noncertified copy of a vital record.

(2) If a death certificate lists the cause of death as "pending," a certified or noncertified copy will be issued that has the cause of death information removed.

(3) The following people may obtain a certified copy of a birth record:

(a) a registrant, upon establishing the registrant's identity to the satisfaction of the certifying official;

(b) a spouse, child, or parent of a registrant to whom the requested record pertains, upon establishing identification and relationship to the registrant to the satisfaction of the certifying official;

(c) a grandparent whose child is listed as a parent on the grandchild's birth certificate upon establishing identification and relationship to the satisfaction of the certifying official;

(d) a caretaker relative providing a medical authorization affidavit issued under 40-6-501 and 40-6-502, MCA, or an educational authorization affidavit issued under 20-50-503, MCA;

(e) an individual having legal guardianship of the registrant, upon submitting a copy of a legal document showing proof of the guardianship;

(f) an individual who needs a certified copy to protect his or her personal or property rights, upon submitting a notarized or certified document that states that the applicant is required to obtain a certified copy in order to protect the applicant's personal or property rights; or

(g) an authorized representative of the registrant, or an authorized representative of the spouse, child, parent, or legal guardian of a registrant, upon establishing their identity to the satisfaction of the certifying official.

(4) The following people may not receive a copy, certified or uncertified, of a registrant's birth records:

(a) a former spouse whose marriage to the registrant was terminated through divorce, annulment, or invalidation unless the former spouse can demonstrate a need to protect individual or property rights; or

(b) a natural parent of an adopted child when the parent does not have parental rights to that child.

(5) Birth certificates may be released to the public no earlier than 30 years after the date of birth. Only noncertified copies will be released.

(6) A certified copy of certificate of birth that resulted in a stillbirth may only be issued to the following:

(a) either parent if listed on the certificate; or

(b) those persons listed in 50-15-121(1), MCA, upon receipt of an order from a court with appropriate jurisdiction.

(7) Informational noncertified copies of a certificate of a birth that resulted in a stillbirth may be released to the public no earlier than 30 years after the date of delivery.

(8) A clerk of the district court may issue a certified copy of a marriage or marital termination record to anyone listed in (3) after receiving a completed application for the record and establishing the identity of the requestor and the requestor's relationship to the registrants.

(9) A certifying official may not file, issue or certify a copy of a vital record from another state or country.

(10) Unless authorized by the department, a county certifying official may not provide a copy, certified or otherwise, of a birth certificate in the official's custody to another county's certifying official for filing.

History

Authorizing statute(s): 50-15-103, 50-15-121, 50-15-122, MCA
Implementing statute(s): 20-50-503, 40-6-501, 40-6-502, 50-15-103, 50-15-121, 50-15-122, MCA
History: NEW, 1983 MAR p. 1351, Eff. 9/30/83; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2008 MAR p. 169, Eff. 1/1/08; AMD, 2009 MAR p. 1671, Eff. 9/25/09; AMD, 2015 MAR p. 1492, Eff. 9/25/15.

Mont. Admin. R. 37.8.127 Application for Copy of Vital Record

(1) Each application for a certified copy of a vital record should be on a department-approved application form. Written applications not using the department-approved application form must contain the applicant's name, signature, address, and the purpose for which the certified copy is needed. All applications must include either a copy of the requestor's valid identification, or the requestor's signature on the application must be notarized.

(2) For a certified or noncertified copy of a birth record, in addition to the requirements of (1), the request must include:

(a) the registrant's full name and date of birth;

(b) the place (town or rural location, and county) of birth;

(d) the father's full name, if available; and

(e) the applicant's relationship to the registrant.

(3) For a certified or noncertified copy of a death record, in addition to the requirements of (1), the application must include:

(a) the registrant's full name;

(b) the date of death; and

(4) Upon request, the department will provide a list of acceptable forms of identification needed from the requestor.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-121, 50-15-122, MCA
Implementing statute(s): 50-15-103, 50-15-121, 50-15-122, MCA
History: NEW, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.128 Contents of Certified and Non-Certified Copies

(1) Each certified copy of a vital record issued in Montana must include:

(a) the date the copy is issued;

(b) the name of the authorized certifier;

(d) the seal (raised or embossed) of the issuing agency or office.

(2) Each certified birth record must include, in addition to the items in (1):

(a) the given name of the registrant;

(b) the surname of the registrant along with any generational identifiers present on the original filed document such as Jr., Sr., etc.;

(d) county of birth;

(e) sex;

(f) the date the original record was filed, in literal format; and

(g) the names of the registrant's parents. If the mother's or father's name is not included on the filed document, the phrase "NOT RECORDED" must be displayed on the certified copy where the mother's or father's name would normally appear; and

(h) if the registrant of a birth record is deceased, each copy must clearly indicate "DECEASED" on the face of the copy.

(3) Each certified death record must include, in addition to the items in (1):

(a) the given name of the registrant;

(b) the surname of the registrant along with any generational identifier present on the original filed document such as Jr., Sr., etc.;

(d) the date of birth in literal format;

(e) the county of death;

(f) the sex; and

(g) the date the record was filed, in literal format.

(4) Each certified copy of a birth that resulted in a stillbirth record must include, in addition to the items in (1):

(a) the full given name of the registrant if provided on the record;

(b) the surname of the registrant along with any generational identifier present on the original filed document such as Jr., Sr., etc.;

(d) the county of delivery;

(e) the sex; and

(f) the date the record was filed, in literal format.

(5) Noncertified copies of a certificate must:

(a) be printed on white nonsecurity paper;

(b) at the top of the certificate, be stamped "FOR INFORMATIONAL PURPOSES ONLY";

(d) not be signed.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-121, 50-15-124, MCA
Implementing statute(s): 50-15-103, 50-15-121, 50-15-122, 50-15-124, MCA
History: NEW, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.129 Format and Paper Requirements for Certified Copies

(1) With the exception noted in (2), all certified copies of birth, death, and fetal death records must be issued on paper that contains the following security features:

(a) sensitized security paper;

(b) background security design;

(d) consecutive numbering;

(e) prismatic printing;

(f) complex colors;

(g) watermark;

(h) intaglio border; and

(i) embossed hologram.

(2) Any alternate method of issuing a certified copy must be approved by the department, in writing, before its official use.

(3) Each certified copy of a vital record issued in Montana must contain the heading "STATE OF MONTANA" centered at the top of the copy, and, if issued by a county clerk and recorder, a centered heading naming the county of issuance immediately below the "STATE OF MONTANA" heading.

(4) Each certified copy of a vital record issued in Montana must contain the following certification and issuance statements at the bottom:

This certifies that this document is a true duplication of the original information on file with the Department of Public Health and Human Services. | Signature or facsimile Certifying official's title

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-122, 50-15-124, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-121, 50-15-122, 50-15-123, 50-15-124, MCA
History: NEW, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Subchapter 37.8.3 Birth

Mont. Admin. R. 37.8.301 Certificate of Birth

(1) A certificate of birth for every child born in Montana must be completed and filed within ten calendar days after the date of birth.

(2) If a birth occurs in a health care facility, the certificate must be filed by the attending physician, physician's designee, the person in charge of the health care facility, or the designee of that person.

(3) If a birth occurs en route to a health care facility, the person in charge of the health care facility or that person's designee must prepare and file the birth certificate in accordance with 50-15-221(3), MCA.

(4) With the exception of a birth that occurs en route to a health care facility, if a birth occurs somewhere other than in a health care facility, a birth certificate must be prepared and filed by the person indicated by 50-15-221(4), MCA, along with a signed and notarized affidavit stating:

(a) the state and county of the birth;

(b) the name of the person or persons, if any, in attendance at the birth;

(d) the father's full name, if available, and the mother's full maiden name.

(5) If no one in attendance at the birth is available, the local registrar will comply with 50-15-202, MCA, and complete the certificate using information obtained with reasonable certainty.

(6) All births must be filed using either a current paper form or Montana's Electronic Birth Registration System.

(7) The information in the section of a birth certificate labeled "information for medical and health use only" is provided to the department only, and is neither considered to be nor certified as part of the legal birth certificate.

(8) All dates must be in literal format (e.g., January 1, 2000, instead of 1-1-00).

(9) If a birth occurs somewhere other than in a health care facility and is not attended by a physician or a licensed midwife, and the birth certificate is filed before the first birthday, additional evidence in support of the facts of the birth is required. A certificate for the birth must be completed and filed by the individual responsible for filing the certificate as stated in 50-15-221(4), MCA, and include evidence of the pregnancy, evidence that the infant was born alive, and evidence the birth occurred within this state, as stated in (10) through (12).

(10) Evidence of a pregnancy is:

(a) a prenatal record;

(b) a statement from a physician or other health care provider qualified to determine pregnancy;

(c) a report of a home visit by a public health nurse or other health care provider that indicates the mother was pregnant at the time of the visit; or

(d) other evidence acceptable by the department.

(11) Evidence that the infant was born alive includes:

(a) a statement from the physician or other health care provider who saw or examined the infant;

(b) an observation of the infant during a home visit by a public health nurse; or

(12) Evidence of the mother's presence in Montana on the date of birth includes:

(a) if the birth occurred in the mother's residence:

(i) a driver's license or a state-issued identification card that lists the mother's current residence;

(ii) a rent or mortgage receipt dated near the date of birth that includes the mother's name and address;

(iii) any type of utility, telephone, or other bill dated near the time of birth that includes the mother's name and address; or

(iv) other evidence acceptable to the department.

(b) if the birth occurred outside of the mother's place of residence and the mother is a resident of Montana, such evidence must consist of:

(i) an affidavit from the tenant of the premises where the birth occurred, that the mother was present on those premises at the time of birth;

(ii) evidence of the affiant's residence similar to that required in (12)(a)(i);

(iii) evidence of the mother's residence in the state similar to that required in (12)(a)(i); or

(iv) other evidence acceptable to the department.

(13) If the mother is not a resident of Montana, such evidence must consist of clear and convincing evidence acceptable to the department.

(14) The department will determine the acceptability of all documentary evidence submitted in support of a birth outside a health care facility. Documents presented must be in the form of the original record or a duly certified copy thereof or a notarized signed statement from the custodian of the record attesting to the accuracy of the record.

History

Authorizing statute(s): 50-15-102, 50-15-103, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-109, 50-15-112, 50-15-113, 50-15-201, 50-15-124, 50-15-202, 50-15-221, MCA
History: Eff. 12/31/72; AMD, 1977 MAR p. 124, Eff. 7/26/77; AMD, 1981 MAR p. 1188, Eff. 10/16/81; AMD, 1987 MAR p. 1481, Eff. 8/28/87; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.302 Parental Review of Birth Certificate Information

(1) Before a mother who recently gave birth in or en route to a health care facility leaves the facility in which the birth occurred, the health care facility administrator or the administrator's authorized designee shall present a completed birth certificate to a parent of the child so they may verify the information contained in the birth certificate. When the parent agrees that the information is correct, the certificate will be entered into the electronic birth registration system by the administrator’s authorized designee or preparer. A checkbox is present in the online system that must be checked by the preparer if the parent has agreed the information presented to them is correct. The checkbox reads, "I certify that the personal information provided on this certificate is correct to the best of my knowledge and belief." If the information is not correct, the birth certificate must be redone with the correct information and presented again to the parent.

(2) A parent's informational copy (not a certified copy) of the birth certificate must be given to the parent at the time he or she reviews and approves the certificate.

(3) If a birth occurs outside of a health care facility, the person responsible for certifying the live birth and filing the birth certificate under the provisions of 50-15-221(4), MCA, must fulfill the same duties as those specified in (1) and (2) for a health care facility administrator.

History

Authorizing statute(s): 50-15-102, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-108, 50-15-109, 50-15-221, MCA
History: Eff. 12/31/72; AMD, Eff. 12/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2026 MAR, Notice No. 2025-176, Eff. 1/24/26.

Mont. Admin. R. 37.8.303 Delayed Birth Certificate

(1) Any person born in the state of Montana whose birth was not properly recorded within one year after the birth may have their birth record filed as a delayed birth certificate if the requirements of this rule are met.

(2) The request for a delayed birth certificate must be filed by the individual, the individual’s parents, or the individual’s adult children on a Montana delayed birth registration form available from the department.

(3) The person filing the form must submit to the department at least three documents proving the individual's name, the date and place of birth, and the individual's parents' names. The documentation must meet the following minimum requirements:

(a) Each document must be dated at least one year before the date of the application or within the first year of birth.

(b) Each document must include the individual’s month, date, and year of birth or age, and their full name as it should appear on the birth certificate.

(d) One document may be an affidavit from an individual present at the birth and at least 18 years of age at that time.

(e) Of the documents that are not an affidavit, at least one document must establish the town or county and state of birth of the individual, and one document must establish the full names of both parents, including the mother’s maiden name.

(f) Copies of documents issued by a government agency must be certified. Altered documents of any kind will not be accepted.

(4) If an application for a delayed birth certificate is incomplete or does not meet the department's issuance criteria as listed above, the department shall notify the individual of:

(a) the deficiencies;

(b) the procedures necessary to rectify the deficiencies; and

(c) the right to seek an order from a court of competent jurisdiction to obtain registration of the delayed birth certificate.

(5) If, after notification, the application is not actively pursued for a period of 180 days, the application and supporting documents will be returned to the applicant and a new fee, application and supporting documentation will be required to reapply.

History

Authorizing statute(s): 50-15-102, 50-15-204, MCA
Implementing statute(s): 50-15-103, 50-15-204, MCA
History: Eff. 12/31/72; AMD, Eff. 12/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2026 MAR, Notice No. 2026-857, Eff. 7/25/26.

Mont. Admin. R. 37.8.306 Certificate of Nonviable Birth

(1) Upon request by either parent made in accordance with the requirements of 50-15-209, MCA, and this rule, the department will issue a certificate of nonviable birth.

(2) All requests for issuance of a certificate of nonviable birth must be made by completing the department's Application for Certificate of Nonviable Birth (version 1.0) form, which the department adopts and incorporates by reference. The form is available electronically at www.dphhs.mt.gov/vitalrecords/vitalrecordsforms or by contacting the Office of Vital Records at P.O. Box 4210, Helena, MT, 59604, 406-444-2685.

History

Authorizing statute(s): 50-15-209, MCA
Implementing statute(s): 50-15-209, MCA
History: NEW, 2024 MAR p. 335, Eff. 2/24/24.

Mont. Admin. R. 37.8.307 Certificate of Birth Resulting in a Stillbirth

(1) Upon request by either parent, a certificate of birth resulting in a stillbirth must be filed within ten calendar days after the date of the delivery or the date the certificate was requested to be filed. If the delivery meets the definition of a stillbirth as defined in 50-15-101, MCA, the person in charge of the final disposition of the fetus must file a properly completed Montana Certificate of Fetal Death.

(2) If a stillbirth delivery occurs in Montana and a certificate of fetal death has not been filed, additional evidence must be provided to support the facts of the pregnancy, that the delivery resulted in a stillbirth, and that the delivery occurred within this state.

(3) Acceptable examples of evidence of pregnancy include the following:

(a) prenatal record;

(b) a statement from a physician or other health care provider qualified to determine pregnancy;

(c) a report of a home visit by a public health nurse or other health care provider that indicates that the mother was pregnant at the time of the visit; or

(d) other evidence acceptable by the department.

(4) Evidence that the birth was stillborn includes the following:

(a) a completed and filed Montana Certificate of Fetal Death;

(b) a statement from the physician or other health care provider who saw and examined the stillborn child; or

(5) Evidence of the mother's presence in Montana on the date of delivery includes the following:

(a) if the delivery occurred in the mother's residence:

(i) a driver's license or a state-issued identification card that lists the mother's current residence;

(ii) a rent or mortgage receipt that includes the mother's name and address;

(iii) any type of utility, telephone, or other bill that includes the mother's name and address; or

(iv) other evidence acceptable to the department.

(b) if the delivery occurred outside of the mother's place of residence and the mother is a resident of Montana, such evidence must consist of:

(i) an affidavit from the tenant of the premises where the delivery occurred stating that the mother was present on those premises at the time of delivery; and

(ii) evidence of the affiant's residence similar to that required in (5)(a); and

(iii) evidence of the mother's residence in the state similar to that required in (5)(a); or

(iv) other evidence acceptable to the department.

(6) If the mother is not a resident of Montana, proof that a stillbirth occurred in Montana outside of a health care facility must consist of clear and convincing evidence acceptable to the department.

(7) The department shall determine the acceptability of all documentary evidence submitted in support of a stillbirth that occurred outside of a health care facility.

(8) Documents presented must be in the form of the original record or a duly certified copy thereof or a notarized signed statement from the custodian of the record or document attesting to the accuracy of the record.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-208, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-208, MCA
History: NEW, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.309 Children Born Out of Wedlock, Certificate for

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-15-102, MCA
Implementing statute(s): Sec. 50-15-103 and 50-15-109, MCA
History: Eff. 12/31/72; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; REP, 2002 MAR p. 397, Eff. 2/15/02.

Mont. Admin. R. 37.8.310 Adoption

(1) A certificate of adoption must include the following information:

(a) the child's name (before adoption) , sex, date and place of birth, and names of natural parents;

(b) name, date and place of birth and residence of adoptive parents at the time of the child's adoption;

(d) name and address of the attorney or agency handling the adoption;

(e) if this is a stepparent adoption or single parent adoption, indication of that fact; and

(f) certification by the clerk of a district court.

(2) Once a registrar has been notified of an adoption, the registrar must send all original birth documents to the department within 30 days.

History

Authorizing statute(s): Sec. 50-15-102 and 50-15-303, MCA
Implementing statute(s): Sec. 50-15-102, 50-15-303 and 50-15-311, MCA
History: NEW, 1981 MAR p. 1187, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02.

Mont. Admin. R. 37.8.311 Adoptions, Name Changes, and Sex Changes

(1) The department will replace the original birth certificate with a new one without indicating that the information was amended in cases of adoption, a determination of paternity, an acknowledgment of paternity, or legitimation.

(2) In order to establish the replacement certificate, the department must be provided with the following:

(a) For an adoption:

(i) a certified copy of the certificate of adoption; and

(ii) a certified copy of the final order of adoption.

(b) For a legitimation:

(i) a notarized Acknowledgement of Paternity for Legitimation; and

(ii) a certified copy of the marriage certificate.

(i) a certified copy of the court order establishing paternity under 40-6-123, MCA, which must contain:

(A) the child's name as it appears on the original certificate;

(B) the child's date and county of birth; and

(d) For an acknowledgement of paternity when the last name of the child is being changed:

(i) a notarized Acknowledgement of Paternity signed by both parents; and

(ii) a notarized request for a new certificate signed by both parents.

(3) Once paternity has been established, the registrant's last name may only be changed through an adoption, legitimation, or court order.

(4) Except in the cases specified in ARM 37.8.108, the amendment of a registrant's given name or surname on a birth certificate may be made only if the department receives a certified copy of an order from a court with appropriate jurisdiction. The court order that directs the name change must include the registrant's name as it appears on the certificate, the registrant's date of birth, the county of birth, if available, and information sufficient to locate and identify the record to be amended. If the court order directs the issuance of a new certificate, the record will not show amendments, and the new certificate will not indicate on its face that it was amended. The procedure to add a first name, middle name, or both, to a birth record that is more than one year old, as in the case when a child is not named at birth, is regulated under ARM 37.8.108.

(5) For any period in which the department is subject to an injunction against enforcement of S.B. 280, codified at 50-15-224, MCA, or S.B. 280 is held invalid, (5)(b) applies. Otherwise, (5)(a) applies.

(a) The sex of a registrant as cited on a certificate may be amended only if the department receives a certified copy of an order from a court with appropriate jurisdiction indicating that the sex of an individual born in Montana has been changed by surgical procedure. The order must contain sufficient information for the department to locate the original record. If the registrant's name is also to be changed, the order must indicate the full name of the registrant as it appears on the original birth certificate and the full name to which it is to be amended. If the order directs the issuance of a new certificate that does not show amendments, the new certificate will not indicate on its face that it was amended. If the sex of an individual was listed incorrectly on the original certificate, refer to ARM 37.8.108.

(b) The sex of a registrant as cited on a certificate may be corrected only if:

(i) the sex of an individual was listed incorrectly on the original certificate as a result of a scrivener's error or a data entry error, and the department receives a correction affidavit and supporting documents, consistent with ARM 37.8.108(4), (5), and (6), including a copy of the records of the health care facility or attending health care professional, contemporaneous to the birth, that identify the sex of the individual, with an affidavit from the health care facility or professional attesting to the date and accuracy of the records; or

(ii) the sex of the individual was misidentified on the original certificate and the department receives a correction affidavit and supporting documents, consistent with ARM 37.8.108(4) and (5), including a copy of the results of chromosomal, molecular, karyotypic, DNA, or genetic testing that identify the sex of the individual, together with an affidavit from the health care facility, health care professional, or laboratory testing facility that conducted the test and/or analyzed the test results, attesting to the test results and their accuracy.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-204, 50-15-208, 50-15-223, MCA
Implementing statute(s): 50-15-102, 50-15-103, 50-15-203, 50-15-204, 50-15-208, 50-15-223, 50-15-224,MCA
History: NEW, 2008 MAR p. 169, Eff. 1/1/08; AMD, 2015 MAR p. 1492, Eff. 9/25/15; AMD, 2017 MAR p. 2436, Eff. 12/23/17; AMD, 2021 MAR p. 926, Eff. 7/24/21; AMD, 2022 MAR p. 1752, Eff. 9/10/22.

Subchapter 37.8.6 Marriage

Mont. Admin. R. 37.8.601 Marriage Applications and Licenses

(1) In addition to the information required by 40-1-107 , MCA, the marriage license application form must contain the following information, which must be reported to the department:

(a) the names and places of birth of the parents of each party;

(b) the date and place of the marriage, the name of the officiant, and whether it will be a religious or civil ceremony.

(2) The marriage license application form must indicate whether the parties are related to each other, and if so, the relationship.

(3) The marriage license application form must also contain the following information, for the benefit of local officials:

(a) whether prior applications were rejected, and if so, why;

(b) whether either party is under the influence of intoxicating liquor or narcotic drugs;

(d) the certification by the parties of the foregoing information; and

(e) signature of the judge where required, and notarization by the clerk of court.

History

Authorizing statute(s): Sec. 50-15-102, MCA
Implementing statute(s): Sec. 40-1-107, 50-15-102, 50-15-103 and 50-15-301, MCA
History: Eff. 12/31/72; AMD, Eff. 4/5/76; AMD, 1981 MAR p. 1188, Eff. 10/16/81; AMD, 1987 MAR p. 1481, Eff. 8/28/87; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02.

Mont. Admin. R. 37.8.602 Report of Dissolution or Invalidity of Marriage

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-15-102, MCA
Implementing statute(s): Sec. 50-15-103, 50-15-302 and 50-15-303, MCA
History: NEW, 1981 MAR p. 1187, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; REP, 2002 MAR p. 397, Eff. 2/15/02.

Subchapter 37.8.8 Death

Mont. Admin. R. 37.8.801 Death Certificate

(1) A certificate of death for each death that occurs in Montana must be completed and filed using either a current Montana certificate of death form or Montana's Electronic Death Registration System.

(2) Death certificate forms may be obtained from the department or printed using commercial computer software that produces the approved form.

(3) The person in charge of the final disposition of the dead body must present the death certificate to the physician, advanced practice registered nurse, or coroner for cause of death certification within three working days after being notified of the death or receiving the authorization for removal, transportation, and final disposition of a dead body, which ever occurs first.

(4) The certifying physician, advanced practice registered nurse, or coroner must complete and return the death certificate to the person in charge of the final disposition of the body within 48 hours of receipt. If the cause of death certification is pending results, then the cause of death must be listed as "pending." When the final results are received, they must be sent to the department using a correction affidavit.

(5) The certifying physician, advanced practice registered nurse, or coroner may only certify and amend the date of death, time of death, place of death, or cause of death data. A certifying physician, advanced practice registered nurse, or coroner aware of errors in the demographic data must notify the person in charge of final disposition of the body of any errors.

(6) For the purpose of the death certificate, any professional registered nurse licensed by the state of Montana may provide pronouncement of death information.

(7) The person in charge of final disposition of a body may only certify the demographic data on the death certificate. The person in charge of final disposition of a body aware of errors in the cause of death data must notify the certifying physician or coroner of the error.

(8) Within ten calendar days after the date of the death or the date it was first discovered, the person in charge of final disposition of a body must file a properly completed death certificate with the local registrar of the county where the death occurred.

History

Authorizing statute(s): 50-15-102, 50-15-103, 50-15-403, MCA
Implementing statute(s): 50-15-109, 50-15-124, 50-15-403, 50-15-405, MCA
History: Eff. 12/31/72; AMD, 1977 MAR p. 124, Eff. 7/26/77; AMD, 1981 MAR p. 1188, Eff. 10/16/81; AMD, 1987 MAR p. 1481, Eff. 8/28/87; AMD, 1993 MAR p. 3023, Eff. 1/1/94; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08; AMD, 2015 MAR p. 1492, Eff. 9/25/15.

Mont. Admin. R. 37.8.802 Fetal Death Certificate

(1) A fetal death certificate must be completed and filed as specified in 50-15-403, MCA, using a Montana certificate of fetal death form.

(2) Fetal death certificate forms must be obtained from the department.

(3) The person in charge of the final disposition of the body of a fetus must present the fetal death certificate to the physician, advanced practice registered nurse, or coroner for cause of death certification within three working days after being notified of the death or receiving the authorization for removal, transportation, and final disposition of a dead body, whichever occurs first.

(4) The certifying physician, advanced practice registered nurse, or coroner must complete and return the fetal death certificate to the person in charge of final disposition of the fetal body within 48 hours after receiving the certificate. If the cause of fetal death is pending, then the cause of death on the certificate must be listed as "pending." When the final results are received, they must be sent to the department using a correction affidavit.

(5) The certifying physician, advanced practice registered nurse, or coroner may only certify and amend the date, hour, and place of delivery; cause of death data; or medical and health information on a fetal death certificate. A certifying physician, advanced practice registered nurse, or coroner who is aware of any error in the demographic data must notify the person in charge of final disposition of the body of the fetus of the error.

(6) The person in charge of final disposition of the body of a fetus may only certify the demographic data on the fetal death certificate. The person in charge of final disposition of the body of a fetus who is aware of an error in the cause of death data must notify the certifying physician, advanced practice registered nurse, or coroner of the error.

(7) Within ten calendar days after the date of the fetal death or the date it was first discovered, the person in charge of final disposition of the body of the fetus must file a properly completed fetal death certificate with the local registrar of the county where the death occurred.

History

Authorizing statute(s): 50-15-102, 50-15-124, MCA
Implementing statute(s): 50-15-102, 50-15-109, 50-15-124, 50-15-403, 50-15-405, MCA
History: NEW, 1981 MAR p. 1187, Eff. 10/16/81; AMD, 1987 MAR p. 1481, Eff. 8/28/87; AMD, 1993 MAR p. 3023, Eff. 1/1/94; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2015 MAR p. 1492, Eff. 9/25/15.

Mont. Admin. R. 37.8.803 Notification of Health Officers by Registrar, When

(1) In the case of death from a dangerous, communicable disease occurring in a registration district in which the local registrar has no jurisdiction as health officer, the registrar shall immediately notify the health officer having jurisdiction of the name and address of the deceased person and the name of the physician who attended the same, so that all precautions regarding quarantine, isolation, conduct of public funerals and disinfection of premises as required by the public health law and regulations of the department may be properly observed.

(2) The provisions of (1) apply in the case of deaths from the diseases listed in ARM 37.114.203.

(3) Persons in charge of interment are responsible for the strict observance of the regulations of the department relative to the burial of bodies dead of communicable diseases.

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202, MCA
History: Eff. 12/31/72; AMD, Eff. 12/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460.

Mont. Admin. R. 37.8.804 Court Ordered Filing of Birth or Death Certificate

(1) Only a Montana district court with appropriate jurisdiction may order a birth or a death certificate be filed for a birth or a death that occurred within Montana.

(2) A local registrar may not complete a court ordered birth certificate. The court order must be submitted directly to the department, whereupon a certificate will be prepared and placed on file.

(3) A local registrar may not complete a court ordered death certificate. The court order must be submitted directly to the local coroner, who will prepare and file the certificate with the department.

(4) When a court order from a Montana district court with appropriate jurisdiction directs the preparation and filing of a birth certificate, the information necessary to complete the certificate must be specified in the order.

(5) When a death is legally presumed but not confirmed, as in the case where the body has not been found, a death certificate may be filed only by the order of a Montana district court with appropriate jurisdiction directing the local coroner to prepare and file a death certificate with the department and specifying the information necessary to complete the certificate.

History

Authorizing statute(s): 50-15-102, 50-15-103, MCA
Implementing statute(s): 50-15-204, 50-15-404, MCA
History: NEW, 1985 MAR p. 275, Eff. 3/29/85; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Mont. Admin. R. 37.8.808 Dead Body Removal Authorization

(1) A completed dead body removal authorization form must include, as a minimum:

(a) insofar as possible, the decedent's full name or, in the case of a fetal death, the full name of the mother;

(b) the place of death, including city, county, name and address of facility if applicable, address of a place which is not a named facility or the specific geographic location if an address does not exist;

(d) a signed and dated authorization statement along with, if applicable, a signed and dated certification of oral authorization;

(e) a signed and dated statement of assumption of responsibility for filing the death or fetal death certificate; and

(f) social security number of the decedent.

(2) The physician, physician's designee, coroner having jurisdiction or mortician who authorizes the removal of a dead body or the remains of a fetal death from the place of death must complete a dead body removal authorization on the department's form and, before or at the time of removal, if the person authorizing removal is:

(a) a physician or physician's designee, give all three copies of the form to the person in charge of disposition;

(b) a coroner or mortician, retain a copy of the completed form and give the other two copies to the person in charge of disposition, unless (2) (c) applies; or

(3) The person who removes a dead body or the remains of a fetal death from the place of death must retain a copy of the completed department dead body removal authorization form for that removal and mail or otherwise deliver the remaining copy or copies to the local registrar within 48 hours of the body's removal.

(4) If the registrar receives more than one copy of a completed dead body removal authorization form, he must retain one copy and provide the other copy to the coroner having jurisdiction.

History

Authorizing statute(s): Sec. 50-15-102, MCA
Implementing statute(s): Sec. 50-15-102 and 50-15-405, MCA
History: NEW, 1993 MAR p. 3023, Eff. 1/1/94; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2003 MAR p. 2441, Eff. 10/31/03.

Mont. Admin. R. 37.8.809 Notification of Failure to File

(1) A local registrar must immediately notify the department, orally or in writing, whenever:

(a) the registrar has received a completed dead body removal authorization form for a decedent but does not receive a death or fetal death certificate, whichever is appropriate, for the same decedent within 10 days after the death occurred or was discovered.

(b) the registrar has received a death or fetal death certificate for a decedent but has not received a dead body removal authorization form for that same decedent.

History

Authorizing statute(s): Sec. 50-15-102, MCA
Implementing statute(s): Sec. 50-15-106, MCA
History: NEW, 1993 MAR p. 3023, Eff. 1/1/94; TRANS, from DHES, 1997 MAR p. 1460.

Mont. Admin. R. 37.8.816 Disinterment Permits

(1) A disinterment permit must be completed and filed using a department disinterment permit form.

(2) Disinterment permit forms are available from the local registrar and will be provided to the registrar by the department.

(3) The request for disinterment must be made by the decedent's next of kin, by an order from a Montana district court with appropriate jurisdiction, or by a public official authorized by law to make such a request. The endorsement on the permit must indicate the source of authority for the request and reasonable cause for the disinterment. If there is a dispute about a disinterment, and all affected parties do not concur, an order from a Montana district court with appropriate jurisdiction directing the disinterment is required.

(4) The permit consists of five copies that must be distributed as follows:

(a) The original copy must accompany the body for use by the receiving cemetery or crematory.

(b) A copy must be retained by the cemetery where the disinterment occurs, by the applicant to whom the permit is issued, and by the local registrar.

(5) To facilitate and assure proper accounting, the department may issue prenumbered permit forms to local registrars as required.

History

Authorizing statute(s): 50-15-102, 50-15-407, MCA
Implementing statute(s): 50-15-407, MCA
History: NEW, Eff. 8/4/73; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2002 MAR p. 397, Eff. 2/15/02; AMD, 2008 MAR p. 169, Eff. 1/1/08.

Subchapter 37.8.16 Institutions

Mont. Admin. R. 37.8.1601 Information Recorded

(1) The records of all hospitals or other facilities or institutions for the care of persons must contain the following information: Full name of patient; address; sex; race; marital status; date of birth; age; occupation; birthplace; name of father; birthplace of father; maiden name of mother; birthplace of mother; disease at entrance; dates of entrance, discharge, removal, or death and other information required for the completion of birth, death and fetal death certificates.

(2) The requirements of Title 50, chapter 15, MCA, shall be literally enforced. Hospitals, other institutions, doctors offices, morticians, communal colonies and all other persons responsible for the generation or recording of vital statistics shall furnish such information or reports as required by Title 50, chapter 15, MCA, or the rules of the department.

History

Authorizing statute(s): Sec. 50-15-102, MCA
Implementing statute(s): Sec. 50-15-103, 50-15-108 and 50-15-109, MCA
History: Eff. 12/31/72; AMD, Eff. 12/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 1997 MAR p. 1460.

Subchapter 37.8.18 Tumor Registry

Mont. Admin. R. 37.8.1801 Reportable Tumors

(1) The following tumors are designated as reportable:

(a) malignant neoplasm, with the exception of a basal or squamous carcinoma of the skin;

(b) skin cancer of the labia, vulva, penis or scrotum;

(i) meningioma (cerebral meninges);

(ii) pinealoma (pineal gland); or

(iii) adenoma (pituitary gland);

(d) carcinoid tumor, whether malignant, benign or not otherwise specified (NOS).

(2) A benign tumor other than one of those listed in (1) may be reported to the department for inclusion in the tumor registry if prior approval has been obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Montana Central Tumor Registry, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(3) A tumor which is otherwise reportable, but has been diagnosed and recorded using the words "apparently", "appears", "comparable with", "compatible with", "consistent with", "favors", "malignant appearing", "most likely", "presumed", "probable", "suspected", "suspicious", or "typical of" with reference to that tumor is considered reportable.

(4) In order for the department to maintain current reporting, hospitals and physicians shall submit to the department information on reportable tumors within six months from the first inpatient or outpatient date that the patient was seen with cancer; independent laboratories shall submit to the department information on reportable tumors within six months from the date the laboratory service associated with the tumor was rendered.

History

Authorizing statute(s): 50-15-706, MCA
Implementing statute(s): 50-15-703, MCA
History: NEW, 1982 MAR p. 391, Eff. 2/26/82; AMD, 1985 MAR p. 1857, Eff. 11/30/85; AMD, 1988 MAR p. 726, Eff. 4/15/88; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2009 MAR p. 87, Eff. 1/30/09.

Mont. Admin. R. 37.8.1802 Required Records, Initial Admission and Treatment

(1) Whenever a hospital initially provides medical services to any patient relating to a tumor designated as reportable by ARM 37.8.1801, it must collect, record, and make available to the department the following information about that patient:

(a) name and current physical address of patient;

(b) patient's physical address at time of diagnosis;

(d) name of spouse, if any;

(e) phone number;

(f) race, Hispanic origin if applicable, sex, and marital status;

(g) age at diagnosis, place of birth, and month, day, and year of birth;

(h) name, address, and phone number of friend or relative to act as contact, plus relationship of that contact to patient;

(i) date and place of initial diagnosis;

(j) primary site of tumor (paired organ);

(k) sequence of primary tumors if more than one;

(l) other primary tumors;

(m) method of confirming diagnosis;

(n) histology, including dates, place, histologic type and slide number;

(o) summary staging, including whether in situ, localized, regional, distant or unstaged, with no information, or whether AJCC or TNM staging is utilized, and, if so, the findings of this staging;

(p) description of tumor and its spread, if any, including size in centimeters, number of positive nodes, number of nodes examined and site of distant metastases;

(q) procedures done to diagnose or stage tumors including dates, procedures, and results (such as physical exams, scopes, x-rays, scans, or lab tests);

(r) cumulative summary of all first course therapy directed at the subject tumor, including:

(i) date of therapy;

(ii) specific type of surgery or radiation therapy, if any, and details of chemical, hormonal, or other kinds of treatment; and

(iii) if no therapy given, reason for lack of therapy.

(s) status at time of latest recorded information, i.e., whether alive or dead, tumor in evidence, or recurring, or status unknown;

(t) if recurrence of tumor, date, type, and distant sites of first recurrence;

(u) names of physicians primarily and secondarily responsible for follow up;

(v) date of each follow up;

(w) if patient has died, date of death, place, cause, and whether autopsy performed;

(x) primary payer at diagnosis;

(y) usual occupation and industry; and

(z) tobacco and alcohol use history.

(2) As used in this rule, "first course therapy" includes all methods of treatment recorded in the treatment plan and administered to the patient before disease progression or recurrence.

History

Authorizing statute(s): 50-15-706, MCA
Implementing statute(s): 50-15-703, MCA
History: NEW, 1982 MAR p. 391, Eff. 2/26/82; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2009 MAR p. 87, Eff. 1/30/09; AMD, 2023 MAR p. 304, Eff. 3/25/23.

Mont. Admin. R. 37.8.1803 Required Records, Follow Up

(1) Whenever a patient for whom information has been provided to the tumor registry is admitted to the hospital providing the information on an inpatient or outpatient basis for further treatment related to the tumor for which original registration in the tumor registry was made, the hospital must keep on file the following information:

(a) patient's name, noting any change from previous records;

(b) any paired organ involvement, noting sequence;

(d) date, type of procedure and findings of any surgery or other exploratory measure;

(e) date and type of any administration of radiation;

(f) date of any administration of hormones, chemotherapy, immunotherapy or any other kind of treatment;

(g) date of death and/or last follow up;

(h) if death has occurred, the place, cause and whether an autopsy was performed;

(i) if an autopsy was performed, its findings pertaining to cancer;

(j) status at time of latest recorded information, i.e., whether alive or dead, tumor in evidence, or has recurred, or status is unknown;

(k) if recurrence of tumor, date, type, and distant sites of first recurrence; and

(l) names of those physicians primarily and secondarily responsible for follow up treatment.

History

Authorizing statute(s): 50-15-706, MCA
Implementing statute(s): 50-15-703, MCA
History: NEW, 1982 MAR p. 391, Eff. 2/26/82; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2009 MAR p. 87, Eff. 1/30/09.

Mont. Admin. R. 37.8.1808 Required Records, Independent Clinical Laboratories

(1) Whenever a clinical laboratory which is not owned or operated by a hospital provides laboratory services for any patient relating to a tumor designated as reportable by ARM 37.8.1801, it must collect, record, and make available to the department the following information about that patient:

(a) name and current address of patient;

(b) patient's address at time of diagnosis;

(d) name of spouse, if any;

(e) race, sex, and marital status;

(f) age at diagnosis, month, day, and year of birth;

(g) date and place of initial diagnosis;

(h) primary site of tumor (paired organ);

(i) sequence of primary tumors, if more than one;

(j) method of confirming diagnosis;

(k) histology, including dates, place, histologic type, and slide number;

(l) summary staging, including whether in situ, localized, regional, distant or unstaged, with no information, or whether AJCC or TNM staging is utilized, and, if so, the findings of the staging;

(m) description of tumor and its spread, if any, including size in centimeters, number of positive nodes, number of nodes examined, and site of distant metastasis;

(n) status at time of latest recorded information, i.e., whether alive or dead, tumor in evidence, or recurring, or status unknown; and

(o) names of physicians primarily and secondarily responsible for follow up.

History

Authorizing statute(s): 50-15-706, MCA
Implementing statute(s): 50-15-703, MCA
History: NEW, 1985 MAR p. 1857, Eff. 11/30/85; TRANS, from DHES, 1997 MAR p. 1460; AMD, 2003 MAR p. 2441, Eff. 10/31/03; AMD, 2009 MAR p. 87, Eff. 1/30/09.

Chapter 37.10 Emergency Health Services

Subchapter 37.10.1 Living Wills

Mont. Admin. R. 37.10.101 Definitions

(1) "POLST" means Provider Orders for Life-Sustaining Treatment, a comprehensive statewide method of identifying a patient's wishes for providing palliative care, medical interventions, or withholding resuscitative measures to terminally ill patients who have a declaration governing the withholding or withdrawal of life-sustaining treatment or for whom a do-not-resuscitate (DNR) order has been issued pursuant to 50-10-101, et seq., MCA.

(2) "POLST form" means a uniform, single form for statewide use, approved by the department and Board of Medical Examiners, indicating either that a valid and current declaration pursuant to 50-9-103, MCA, has been executed and that the declarant is a qualified patient as defined in 50-9-102, MCA, or that a provider has issued a DNR order for the patient pursuant to 50-10-101, et seq., MCA.

(3) "Provider" means a physician, or advanced practice registered nurse. A physician assistant with a valid agreement with a supervising physician who has delegated the authority to sign DNR orders may also be considered a provider.

History

Authorizing statute(s): 50-9-110, MCA
Implementing statute(s): 50-9-102, 50-9-106, MCA
History: NEW, 1989 MAR p. 2232, Eff. 12/22/89; TRANS, from DHES, 1997 MAR p. 1462; AMD, 2008 MAR p. 2356, Eff. 11/7/08; AMD, 2022 MAR p. 1881, Eff. 9/24/22.

Mont. Admin. R. 37.10.104 Living Will Protocol for Ems Personnel

(1) The living will protocol may also be designated the "POLST protocol". Providers may use POLST to implement DNR orders, or the end of life treatment decisions by a patient expressed through a living will or otherwise.

(2) For a patient who has completed a POLST form, emergency medical services personnel must follow the POLST protocol for providing palliative care or withholding life-sustaining procedures from a patient if a patient meets the following criteria:

(a) The identity of the patient has been clearly established and the personnel have been presented with any one of the following:

(i) a POLST form for the patient; or

(ii) a written DNR order signed and dated by a provider.

(b) An unresponsive person is wearing a POLST necklace or bracelet (no further identification is necessary).

History

Authorizing statute(s): 50-9-110, MCA
Implementing statute(s): 50-9-102, 50-9-103, MCA
History: NEW, 1989 MAR p. 2232, Eff. 12/22/89; TRANS, from DHES, 1997 MAR p. 1462; AMD, 2009 MAR p. 86, Eff. 11/7/08; AMD, 2022 MAR p. 1881, Eff. 9/24/22.

Mont. Admin. R. 37.10.105 Sources of Polst Identification

(1) POLST forms, cards, necklaces, and bracelets may be obtained only through:

(a) physicians;

(b) licensed hospice programs;

(d) hospitals;

(e) skilled nursing facilities;

(f) long term care facilities; and

(g) any other entity specifically approved by the department.

History

Authorizing statute(s): 50-9-110, MCA
Implementing statute(s): 50-9-102, MCA
History: NEW, 1989 MAR p. 2232, Eff. 12/22/89; TRANS, from DHES, 1997 MAR p. 1462; AMD, 2008 MAR p. 2356, Eff. 11/7/08; AMD, 2022 MAR p. 1881, Eff. 9/24/22.

Mont. Admin. R. 37.10.108 Do-Not-Resuscitate Protocol

(1) POLST is the system used by medical professionals to identify and administer appropriate care, including DNR orders, to terminally ill patients.

(2) When issuing a DNR order for a patient with a terminal condition, medical professionals are encouraged to use the POLST form and follow the DNR/POLST protocol approved by the Board of Medical Examiners and the department. The department adopts and incorporates by reference the Montana Provider Orders for Life-Sustaining Treatment (POLST) protocol (last revised September 2019), which is accessible at the Board of Medical Examiner's website. A copy of the POLST protocol may also be obtained by contacting the department's EMS and Trauma System Section, 1400 Broadway, Room C303A, P.O. Box 202951, Helena, MT 59620-2951, 406-444-3895.

History

Authorizing statute(s): 50-10-105, MCA
Implementing statute(s): 50-10-101, MCA
History: NEW, 2008 MAR p. 2356, Eff. 11/7/08; AMD, 2022 MAR p. 1881, Eff. 9/24/22.

Chapter 37.12 Laboratories

Subchapter 37.12.2 Approval of Laboratories

Mont. Admin. R. 37.12.201 Registration

(1) Every person, firm or corporation operating or maintaining a laboratory in which body fluids, secretions or excretions are examined for the determination of the presence or absence of an infectious agent in the material examined or in the person or animal from which it was secured shall register annually with the department, giving the name of such laboratory, its location and the name of the person or persons owning or operating the same.

(2) All laboratories doing public health work in the state of Montana shall register with the department. Such laboratories which meet the standards of the department shall be designated as approved laboratories.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: Eff. 12/31/72; TRANS, from DHES, 2001 MAR p. 2246; AMD, 2023 MAR p. 180, Eff. 2/25/23.

Mont. Admin. R. 37.12.205 Approval

(1) Laboratories which, after inspection, are found to conform to the standards required by the department will be given a certificate of approval, and such laboratories will thereafter be designated as approved laboratories.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: Eff. 12/31/72; TRANS, from DHES, 2001 MAR p. 2246; AMD, 2023 MAR p. 180, Eff. 2/25/23.

Mont. Admin. R. 37.12.206 Inspections

(1) An authorized representative of the state laboratory shall make an annual inspection of all registered laboratories, and at such other times as he or the department may deem advisable.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: Eff. 12/31/72; TRANS, from DHES, 2001 MAR p. 2246; AMD, 2023 MAR p. 180, Eff. 2/25/23.

Subchapter 37.12.3 Licensure of Laboratories Conducting Analyses of Public Water Supplies

Mont. Admin. R. 37.12.301 Definitions

For the purpose of this subchapter:

(1) "Accuracy" means the degree of agreement between an observed value and an accepted reference value.

(2) "Analyte" means the substance or thing for which a water sample is analyzed to determine its presence or quantity.

(3) "Bachelor degree or equivalent" means a college degree with the equivalent of 30 semester hours in a biological or physical science program or at least four years of experience in a specific related scientific discipline.

(4) "Certification officer" means a representative of the department who conducts assessments of laboratories to determine if they should be approved for licensure. The representative may be a third party contractor who acts under the authority of the department.

(5) "Chemical hygiene plan" means a document written by a laboratory that describes the procedures used to store, handle, and dispose of chemicals in the laboratory.

(6) "Conditional licensure" refers to a laboratory applying for a license for the first time that is in compliance with most requirements for licensure but has not yet met all of the requirements of this subchapter, but whose deficiencies do not affect the capability of the laboratory to perform valid analyses.

(7) "Contaminated" means exceeding a maximum contaminant level established in ARM Title 17, chapter 38, subchapter 2.

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

(9) "Environmental laboratory" means the environmental laboratory of the Department of Public Health and Human Services that is responsible for the licensing of laboratories performing drinking water analyses in Montana.

(10) "Environmental Protection Agency (EPA)" means the United States Environmental Protection Agency.

(11) "EPA laboratory certification manual" means the EPA publication entitled "Manual for the Certification of Laboratories Analyzing Drinking Water," January 2005, 5th edition (EPA 815-R-05-004).

(12) "Holding time" means the maximum time that a sample may be held prior to preparation or analysis.

(13) "Initial demonstration of analytical capability" means the procedure described in the method cited in 40 CFR part 136, appendix A, as amended August 28, 2017, for chemistry analysis, used to determine a laboratory's accuracy and precision in applying an analytical method.

(14) "Interdependent analyte group" means a group of analytes, as determined by the department, for which the ability to correctly identify and quantify a single analyte in the group indicates the ability to correctly identify and quantify other analytes in the group.

(15) "Interim licensure" refers to a status that may be granted by the certifying agency to a fully licensed laboratory without an on-site inspection for a particular analyte or interdependent analyte group if the certifying agency determines with appropriate documentation that the laboratory has the appropriate instrumentation, is using a previously approved method, has adequately trained personnel to perform the analyses, and has satisfactorily analyzed PT samples, if available for the analytes in question.

(16) "Key personnel" means a laboratory's director, supervisor, and quality assurance officer, all of whom meet the requirements of the EPA laboratory certification manual.

(17) "Method detection limit" means the minimum concentration of a substance that can be measured and reported with 99% confidence that the analyte concentration is greater than zero as determined from analysis of a sample containing the analyte in a given matrix as described in 40 CFR part 136, appendix B, as amended August 28, 2017.

(18) "Performance evaluation (PE) sample" means a sample obtained through a source approved by the environmental laboratory whose composition is unknown to the laboratory performing the analysis and which is used to evaluate the ability of the laboratory to produce precise and accurate results.

(19) "Precision" means the degree to which a set of observations or measurements of the same property, usually obtained under similar conditions, conform to themselves. Precision is usually expressed as standard deviation, variance or range, in either absolute or relative terms.

(20) "Proficiency testing (PT)" refers to testing an unknown sample to evaluate the ability of the laboratory to produce precise and accurate results and is used interchangeably with performance evaluation (PE).

(21) "Provisional licensure" refers to the downgraded status of a laboratory previously holding full certification due to noted deficiencies, but in the opinion of the certifying agency the laboratory can still demonstrate their ability to consistently produce valid data.

(22) "Quality assurance plan" means a document written by a laboratory that describes the procedures used to ensure that routinely generated analytical data are scientifically valid and that their precision and accuracy are within defined limits.

(23) "Safe Drinking Water Act" means the federal law set out in 42 USC 300f through 300j-11, governing drinking water programs.

(24) "Standard operating procedures (SOPs)" means a laboratory's written document which details the steps of an operation, analysis, or action whose techniques and procedures are thoroughly prescribed and is accepted by the laboratory as the procedure for performing certain routine or repetitive tasks.

(25) "Variance" means written approval from the environmental laboratory allowing a laboratory to use a method, procedure, or equipment other than that required by these rules that meets the purpose and intent of these rules and that has been shown to have no adverse material effects on the accuracy of analyses.

(26) "Waiver" means written approval from the environmental laboratory exempting a laboratory from a requirement of these rules if the environmental laboratory finds that the requirement is inapplicable to the particular practice of that laboratory.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11; AMD, 2023 MAR p. 305, Eff. 3/25/23.

Mont. Admin. R. 37.12.304 Laboratory Licensure: Coverage

(1) A laboratory that conducts analyses of water from public water supplies must meet the licensure requirements of these rules before the analyses or reports of the analyses may be accepted by the Department of Environmental Quality (DEQ) for the purpose of meeting the requirements of Title 75, chapter 6, MCA, and rules of the DEQ concerning public water supplies.

(2) A laboratory may be licensed to perform microbiology testing, chemical testing, or both. Microbiology testing and chemical testing are separate licensure categories. If a laboratory requests licensure for both categories, it must submit to the department a separate license application and undergo a separate inspection for each category, and it will receive a separate license for each category for which it qualifies.

(3) A license granted by the department constitutes permission to perform only those analyses of analytes and using only those methods for which the laboratory requests the licensure to cover and that the department finds the laboratory is capable of performing in accordance with the provisions of this subchapter.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.305 Procedure for Licensure

(1) Any laboratory not currently licensed but desiring licensure under this subchapter must:

(a) submit a completed application to the Department of Public Health and Human Services, Laboratory Services Bureau, 1400 Broadway, Cogswell Building, P.O. Box 4369, Helena, MT 59604-4369, on forms provided by the department. The application must include:

(i) the legal name of the laboratory;

(ii) the name of the laboratory owner;

(iii) the laboratory mailing address;

(iv) the full address of the physical location of the laboratory;

(v) the laboratory hours of operation;

(vi) a description of qualifications of key personnel and technical employees;

(vii) the name and daytime phone number of the laboratory director;

(viii) the name and daytime phone number of the laboratory's quality assurance officer;

(ix) the name and daytime phone number of the laboratory contact person; and

(x) the laboratory's quality assurance plan and documentation of the laboratory's implementation and adherence to the quality assurance plan.

(b) be enrolled in a proficiency testing program;

(c) apply for approval to analyze at least one analyte or interdependent analyte group by a method the department approves under ARM 37.12.333;

(d) pay all applicable fees prescribed by ARM 37.12.310 prior to the department's processing of the application; and

(e) submit a statement of assurance of compliance signed and dated by the laboratory owner, director, and quality assurance officer, which shall include:

(i) an acknowledgment that the applicant understands that, once licensed, the laboratory must continually comply with the requirements for licensure in this subchapter in order to remain licensed;

(ii) an acknowledgment that the department may make unannounced inspections of the laboratory for the purpose of assessing compliance with these rules and that a refusal to allow entry to the laboratory premises by the department's authorized representatives is grounds for denial or revocation of its license;

(iii) a statement that the applicant laboratory will perform all proficiency testing audits according to acceptable methods, in accordance with department requirements, and at their own expense; and

(iv) a statement that there is no misrepresentation in the information provided in the application.

(2) When the laboratory submits the documentation required by ARM 37.12.333, the department shall conduct an on-site assessment at a date and time agreed to by the laboratory director to determine whether the laboratory complies with the minimum requirements of this subchapter and that the laboratory can produce valid results.

(3) At the time of scheduling the assessment, the department's certification officer shall specify what staff, equipment, and supplies need to be on hand during the evaluation and what tests need to be run in order to determine whether the laboratory can meet the licensure requirements set out in this subchapter.

(4) If possible, the evaluations will be scheduled to occur within 45 days after the department determines the application is complete, except in the case of applications received in May, June, July, or August, which will be scheduled for evaluation no later than October 31 of the same year.

(5) The certification officer shall provide the laboratory director with a written report of the department's findings from the on-site assessment.

(6) If the department determines that the laboratory does not meet the requirements for licensure:

(a) the department will send the laboratory written notice of that fact, the grounds for the decision, and the right to submit a plan of correction within 30 days after receipt of the notice for minor deficiencies and within 15 days after receipt of the notice for major deficiencies;

(b) if a plan of correction is not received by the deadline or if the plan of correction is inadequate to correct the deficiencies, the department will issue a written denial of the license, the grounds for denial, and the right to an appeal pursuant to the Montana Administrative Procedure Act.

(7) If the on-site assessment is satisfactory or, if it is not, if implementation of the plan of correction successfully eliminates the deficiencies cited, the department shall issue a final decision in writing granting the type of license requested and stating which analyte(s) or interdependent analyte group(s) the laboratory is approved to analyze.

(8) A license expires on the expiration date listed on the license, unless revoked earlier. To avoid a lapse in licensure, a laboratory must submit, on a form provided by the department, a completed application for renewal and the required fee for licensure prior to the expiration of the license.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.306 Standards, Inspections, and Tests Required for Licensure

(1) In order to be licensed, a laboratory must:

(a) meet all of the applicable personnel, equipment, training, and facility requirements of this subchapter;

(b) at least once during the three-year term of its license, pass an on-site inspection by an agent of the environmental laboratory that shows compliance with the requirements of these rules for the license category in question;

(c) if the laboratory performs chemical analyses, have performed analyses on at least two performance evaluation (PE) samples for each analyte or interdependent analyte group and each method each year during the term of its license; and

(d) if the laboratory performs microbiological analyses, have successfully performed analyses on at least two performance evaluation (PE) samples for each analyte and method each year during the term of its license.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.310 Licensure Fees

(1) The following fees calculated on a flat fee yearly schedule, must be submitted to the department, under the circumstances noted, by laboratories conducting analyses of public water supplies. All licensure fees are due January 1 of each calendar year. New laboratories that wish to be licensed prior to July 1 will pay full licensure fees; after July 1 of the fiscal year the licensure fees will be prorated 50%:

(a) $250 with an application for an initial microbiology, inorganic chemistry, or organic chemistry license. This application fee will only be charged when issuing a first-time license or issuing a new license after a license has lapsed;

(b) $550 licensure fee for an organic chemistry license for an in-state laboratory;

(d) $350 licensure fee for an inorganic chemistry license for an in-state laboratory;

(e) $600 licensure fee for an inorganic chemistry license for a laboratory licensed by reciprocity;

(f) $350 licensure fee for a microbiology license for an in-state laboratory;

(g) $600 licensure fee for a microbiology license for a laboratory licensed by reciprocity;

(h) $300 plus travel expenses for an inspection to determine if the holder of a conditional license qualifies for a full license or for a second inspection during the three-year term of a license that is necessary for approval of a new laboratory location; there is no charge for one inspection during the term of the license;

(i) $125 per day for training in the environmental laboratory;

(j) $300 per day, plus travel expenses of environmental laboratory staff, for on-site training and technical assistance outside of licensure inspections by the Laboratory Services Bureau staff.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 1999 MAR p. 1230, Eff. 6/4/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.311 Duration of License

(1) A license granted to an in-state laboratory is for a three year period provided:

(a) all of the requirements of this subchapter continue to be met for the type of license granted;

(b) the laboratory completes annual questionnaires from the department designed to update the department on personnel and procedures; and

(c) the laboratory remits to the department the appropriate annual licensure fee and any other fees due pursuant to ARM 37.12.310.

(2) A reciprocal license granted to an out-of-state laboratory is for the same period as the license, certification or other approval granted by the approving authority, provided that:

(a) all of the requirements of ARM 37.12.313 continue to be met;

(b) the laboratory completes annual questionnaires designed to update the department on personnel and procedures; and

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202 and 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 1999 MAR p. 1230, Eff. 6/4/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03.

Mont. Admin. R. 37.12.312 License

(1) In the case of a laboratory applying for a license for the first time, the department may grant a conditional license to a laboratory that:

(a) is in compliance with all requirements for licensure but has not yet analyzed a second PE sample or does not have records of historical performance; or

(b) does not comply with all of the requirements of this subchapter, but whose deficiencies do not affect the capability of the laboratory to perform valid analyses.

(2) Conditional licensure will be granted only after an on-site inspection and is in effect for one year or until full licensure is granted under provisions of ARM 37.12.311, whichever is earlier.

(3) In order for a laboratory applying for a chemistry license for the first time to upgrade from conditional licensure status to fully licensed status, it must perform analyses of a minimum of two PE samples over the course of a year that indicate at least two successful analyses of each analyte or interdependent analyte group and method for which they seek licensure to analyze, and undergo a second on-site inspection that shows full compliance with licensure standards.

(4) In order for a laboratory applying for a microbiology license for the first time to upgrade from conditional licensure status to fully licensed status, a microbiology laboratory must be in continual operation for one year, analyze and successfully pass at least two performance evaluation (PE) sets for each analyte and method, and undergo a second on-site inspection to verify that its methodologies and quality control meet the standards of this subchapter.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.313 Reciprocity

(1) The department may issue a license to an out-of-state laboratory to perform analyses for public drinking water systems in Montana provided that the laboratory:

(a) applies for licensure and is currently approved by the Environmental Protection Agency or the state in which the laboratory is located if that state has a certification program approved by EPA for laboratories analyzing water from public water supplies;

(b) the EPA or the state's certifying authority, whichever is appropriate, provides the department with a copy of the laboratory's current certification and most recent inspection report;

(c) the requirements for certification in the approving state are no less stringent than the requirements for resident laboratories in the state of Montana;

(d) the laboratory submits qualification information for all key personnel and provides the department with a current copy of the laboratory's quality assurance plan;

(e) the laboratory performs, analyzes, and successfully passes PE audits for analytes from sources approved by the department. The provider of the PE samples shall report results of the analyses directly to the department; and

(f) the laboratory complies with the notification requirements of ARM 37.12.324, 37.12.325, and 37.12.326.

(2) The department may license a laboratory that is accredited by the National Environmental Laboratory Accreditation Program (NELAP) if:

(a) it provides evidence of its accreditation and applies for licensure on that basis;

(b) it obtains approval from the department of the testing procedures for each analyte or interdependent analyte group and method and meets the approval requirements of this rule; and

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.314 Restriction of License

(1) The department may downgrade a laboratory to provisional status and place conditions upon the license of a laboratory. The provisionally licensed laboratory must notify clients of its downgraded status in writing, on any applicable report. The department will notify the Department of Environmental Quality of any laboratories that have been downgraded to provisional status. Downgrading to provisional status may occur under the following circumstances:

(a) the laboratory reports results of an analysis of PE samples that are outside acceptable limits, and does not successfully perform analysis on a second set of PE samples within 90 days of receipt of the original report, or it fails to report results of a PE sample analysis for any analyte that the laboratory is approved to analyze. In this case:

(i) the laboratory's license is provisional only in regard to the laboratory's approval to conduct analyses of the particular analyte or method involved;

(ii) the provisional status remains in effect until the next available PE results are reported to the department, at which time:

(A) the conditions will be removed if acceptable PE results are reported to the department; or

(B) approval to conduct the analysis in question will be revoked if unacceptable PE results are reported to the department.

(b) the laboratory notifies the department, after the fact, of changes in personnel, equipment, or a change in location that have a material effect on the analyses of analytes for which it is approved. In this case, provisional approval will remain in effect until:

(i) the department has re-evaluated the laboratory; and

(ii) those analyses affected by the changes are conducted on PE samples and the results are evaluated by the department, at which time the conditions may be removed if the analyses meet the standards of these rules or approval to do those tests may be revoked if the standards are not met.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.315 Revocation or Denial of License

(1) The department may deny or revoke a license at any time that a laboratory is not in compliance with the requirements for licensure under this subchapter, including if the laboratory:

(a) fails to analyze and report results of at least two PE samples per year;

(b) reports unacceptable results or fails to report the results of analyses of two consecutive PE samples for an analyte for which the laboratory is approved;

(c) fails to correct cited deficiencies within the time specified by the department or fails to adhere to conditions of a waiver or variance;

(d) no longer employs a director or analysts who have satisfied the requirements of this subchapter;

(e) does not use EPA-approved methods to perform analyses;

(f) does not perform required quality control procedures;

(g) falsifies data or engages in deceptive practices such as reporting another laboratory's data without giving credit on the report to the laboratory which performed the analysis;

(h) reports data that were obtained using equipment, procedures, analysts, methods, or facilities that are not approved by the department;

(i) fails to report to the Department of Environmental Quality within the time frames described in ARM 37.12.341 the results of any sample required under ARM Title 17, chapter 38, subchapter 2, and accepted by the laboratory for analysis, that exceeds a maximum contaminant level (MCL) or triggers additional actions; or

(j) fails to report results on forms or formats acceptable to the Department of Environmental Quality.

(2) The department will send the laboratory written notice of the denial or revocation of a license that indicates the grounds for the revocation or denial and the right to an appeal of the decision pursuant to the Montana Administrative Procedure Act.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.316 Reissuance of License

(1) The department will issue a license to a laboratory whose license has been denied or revoked when the laboratory demonstrates to the department that all appropriate requirements listed in the EPA laboratory certification manual are satisfied and when a compliance schedule has been set to meet all additional requirements of this subchapter.

(2) If the laboratory does not fulfill the terms of the compliance plan, the license will again be revoked pursuant to ARM 37.12.315.

(3) A laboratory may request technical assistance from the department to remediate any deficiencies. The department shall provide the technical assistance as soon as is practical.

(4) The department adopts and incorporates by reference the EPA laboratory certification manual (EPA 815-R-05-004, "Manual for the Certification of Laboratories Analyzing Drinking Water," January 2005), which contains criteria, procedures, and quality assurance standards required by the EPA that must be met by laboratories analyzing drinking water to determine compliance with the federal Clean Water Act and its rules. A copy of the manual may be obtained from the Department of Public Health and Human Services, Laboratory Services Bureau, 1400 Broadway, Cogswell Building, P.O. Box 4369, Helena, MT 59604-4369, telephone (406)444-3444, or may be downloaded at the EPA web site: https://www.epa.gov/dwlabcert/laboratory-certification-manual-drinking-water .

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11; AMD, 2023 MAR p. 305, Eff. 3/25/23.

Mont. Admin. R. 37.12.320 Proficiency Testing

(1) For a laboratory to become approved and to maintain approval for conducting analyses for an analyte or an interdependent analyte group by a specific method, the laboratory must, at its own expense, meet the proficiency testing requirements of this rule.

(2) In order to initially obtain and to maintain approval, the laboratory must:

(a) whenever required by the EPA, enroll and participate in a proficiency testing program approved by the environmental laboratory for each analyte or interdependent analyte group, or, for each analyte or interdependent analyte group and method for which proficiency testing is not available or required, the laboratory must establish, maintain, and document the accuracy and reliability of its procedures through a quality assurance plan;

(b) successfully participate in at least two proficiency tests annually;

(c) prior to obtaining approval, notify the department of the authorized proficiency testing program or programs in which it has enrolled for each analyte or interdependent analyte group and method approved under its license to analyze;

(d) follow the proficiency testing provider's instructions for preparing the proficiency testing sample and must analyze the proficiency testing sample as if it were a client sample;

(e) direct the proficiency testing provider to send, either in hard copy or electronically, a copy of each evaluation of the laboratory's proficiency testing audit results to the department; and

(f) authorize the proficiency testing provider to release to the department all information necessary for the department to assess the laboratory's compliance with this rule.

(3) In addition to the requirements of (2), in order to remain approved for testing an analyte or interdependent analyte group, a laboratory must:

(a) in each calendar year, successfully complete at least two separate proficiency testing audits for each analyte or interdependent analyte group and method;

(b) maintain a paper or electronic copy of all proficiency testing records, including analytical data and worksheets and a copy of the proficiency testing provider report forms authorized by the environmental laboratory and used by the laboratory to record proficiency testing results for a period of five years;

(c) for every proficiency test, ensure that the director of the laboratory signs and retains an attestation statement stating that the laboratory followed the proficiency sample provider's instructions for preparing the proficiency sample and analyzed the proficiency testing sample as if it were a client sample; and

(d) analyze and report to the provider the results of the proficiency test by the deadline set by the proficiency testing provider.

(4) A laboratory may not:

(a) perform multiple analyses (such as replicates or duplicates) that are not normally performed in the course of analysis of a routine sample;

(b) average the results of multiple analyses for reporting when not specifically required to do so by the analytic method in question;

(c) permit anyone other than bona fide laboratory employees who perform the analyses on a day-to-day basis for the laboratory to participate in the generation of data or reporting of results;

(d) discuss the results of a proficiency testing audit with any other laboratory until after the deadline set for receipt of results by the proficiency testing provider;

(e) if the laboratory has multiple testing sites or separate locations, discuss the results of a proficiency testing audit across sites or locations until after the deadline set for receipt of results by the proficiency testing provider;

(f) send proficiency testing samples or portions of samples to another laboratory to be tested; or

(g) knowingly receive a proficiency testing sample from another laboratory for analysis and fail to notify the department of the receipt of the other laboratory’s sample within five business days of discovery.

(5) Results of proficiency tests must be within the control limits established by the EPA as specified in the EPA laboratory certification manual (EPA 815-R-05-004) "Manual for the Certification of Laboratories Analyzing Drinking Water," January 2005) for each analysis for which the laboratory requests approval.

(a) Specific chemistry acceptance criteria are listed in Table IV-10. "MCL and Proficiency Testing Sample Acceptance Criteria in the CFR, Primary and Secondary Drinking Water Regulations" of the EPA laboratory certification manual.

(b) Specific microbiology acceptance criteria is correctly analyzing a minimum of nine of ten samples, with no false negative result (i.e., a single false positive result would be considered acceptable).

(6) The department may require the testing of other samples, such as blind samples or split samples, as needed to evaluate laboratory performance.

(7) The laboratory must participate in an authorized proficiency testing program for at least 12 months before changing to another proficiency testing provider for the analyte or interdependent analyte group, unless there are extenuating circumstances.

(8) A laboratory must notify and have approval from the department before changing enrollment in an authorized proficiency testing program, and if the reason for changing providers is a result of extenuating circumstances, the laboratory must also delineate the reasons for the requested change.

(9) The department adopts and incorporates by reference the acceptance limits for regulated parameters in chapter IV of the EPA laboratory certification manual (EPA 815-R-05-004, "Manual for the Certification of Laboratories Analyzing Drinking Water," January 2005), which contains the critical elements for chemistry that a laboratory must meet, including the acceptance limits required by the EPA for metals, inorganics, volatile organic compounds and synthetic organics in drinking water samples. A copy of chapter IV may be obtained from the Department of Public Health and Human Services, Laboratory Services Bureau, 1400 Broadway, Cogswell Building, P.O. Box 4369, Helena, MT 59604-4369, telephone (406)444-3444, or may be downloaded at the EPA web site: https://www.epa.gov/dwlabcert/laboratory-certification-manual-drinking-water .

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11; AMD, 2023 MAR p. 305, Eff. 3/25/23.

Mont. Admin. R. 37.12.324 Required Notification of Changes

(1) Whenever a laboratory makes any change in personnel or equipment that has a material effect on the analysis of analytes, the laboratory must notify the department of that fact within 30 days after making the change, but prior to reporting results of tests used in regulatory compliance. A change in personnel is defined as the loss or replacement of the laboratory supervisor or a situation in which a trained and experienced analyst is no longer available to analyze a particular parameter for which licensure has been granted.

(2) After receiving the notification, the department may place conditions upon the laboratory's license pursuant to ARM 37.12.314.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.325 Required Notification of Change in Name

(1) A licensed laboratory that changes its name or business organizational status must report the change in writing to the department within 30 days of the change.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.326 Required Notification of Change in Location

(1) A licensed laboratory which intends to change its physical location shall notify the department 90 days prior to the relocation. The notification shall include the following:

(a) the full physical address of the new location;

(b) a notification of any personnel, equipment, or analytic method changes which will occur as a result of the relocation; and

(c) a signed statement either that the laboratory quality assurance plan will not be affected by the relocation, or, if it will be, that the plan will be revised to address the necessary changes.

(2) If, in view of the information received pursuant to (1), the department is satisfied that the laboratory can produce valid results at the new location, it shall place conditions on the laboratory license as specified in ARM 37.12.314.

(3) The department shall conduct an on-site inspection at the new location within 60 days after the relocation is completed.

(4) Within 30 days after the on-site inspection, the department shall issue a determination either that the laboratory license is:

(a) revoked;

(b) its provisional status is retained; or

(5) If the department's decision is to revoke the license, the procedure followed will be that set out in ARM 37.12.315.

(6) The term of the license remains the same as it was for the original site.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.327 Access to Facility and Records

(1) A laboratory applying for a license and a licensed laboratory must allow department representatives access to the laboratory facility and public water supply records during laboratory operating hours to determine initial or continued compliance with this subchapter.

(2) Whenever possible, inspections will be scheduled in advance so that they do not interfere with routine laboratory operations. However, whenever necessary to protect public health, unannounced inspections will be conducted.

(3) If an unannounced inspection causes a business hardship or may result in harm to laboratory clients, the laboratory director will give the department notice of that fact at the time of inspection and the department will make whatever accommodations may be made to alleviate the hardship or harm while still protecting public health.

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202 and 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99.

Mont. Admin. R. 37.12.330 Blind Sample Testing

(1) The department may submit blind samples for analyses to a license applicant or a licensed laboratory in such a manner that the applicant or licensed laboratory is unaware of the identity of the submitter. The laboratory shall credit any charges for blind samples to the department when later notified that a sample was a blind sample.

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202 and 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99.

Mont. Admin. R. 37.12.333 Approval to Conduct Analyses

(1) Analyses must be conducted using current EPA approved methods in accordance with the analytical requirements set forth in 40 CFR 141.

(2) Alternate analytical procedures are not permitted unless such procedures satisfy 40 CFR 141.27 and have been approved by the EPA.

(3) An applicant laboratory must request approval to analyze for an analyte or interdependent analyte group and the method(s) used as part of its application for licensure or renewal of a license.

(4) Approval for such analyses will be granted only after an on-site assessment. The applicant laboratory shall submit:

(a) documentation that it has the necessary equipment and qualified technical employees to preform the tests;

(b) for chemistry analysis, documentation that the laboratory has successfully passed two proficiency testing audits for the analyte and method in question from an approved proficiency testing program;

(d) documentation of its initial demonstration of analytical capability; and

(e) documentation establishing the laboratory's method detection limit for each chemical analyte.

(5) If the department is satisfied from its assessment that the applicant laboratory can produce valid results, it shall grant approval for the analyte or interdependent analyte group by a specific method.

(6) At a time other than when applying for a license renewal, a licensed laboratory may request approval to analyze for an additional analyte or interdependent analyte group by submitting a written request together with the documentation required in (1).

(a) If the analyte for which approval is requested is an addition to, or a group similar to, analytes that have already received approval, the certifying agency may grant interim approval for the analyte which shall remain in effect until the next review for license renewal as long as the laboratory continues to successfully complete proficiency testing on the analyte.

(b) If the analyte for which approval is requested is unrelated to previously approved analytes, or requires specialized equipment and/or personnel training, the certifying agency shall require a new application packet and an application fee to be submitted, as well as an update of the laboratory licensure file, and shall perform an on-site assessment prior to approval.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.336 Quality Assurance

(1) A licensed laboratory must develop and implement a quality assurance program that is an integrated system of activities involving planning, quality control, quality assessment, reporting, and quality improvement to ensure that its services meet its standards of quality with its stated level of confidence.

(2) The quality assurance program must address the type of testing activities the licensed laboratory undertakes and how quality assurance activities may change with changes in sample volumes. The quality assurance program must include a quality assurance plan and documentation of quality assurance activities.

(3) As part of its quality assurance program, each licensed laboratory must develop and adhere to a quality assurance plan. The laboratory must include and address the following essential items in the quality assurance plan:

(a) listing of key individuals, laboratory organization and lines of responsibility;

(b) position descriptions;

(d) staff training;

(e) general quality control procedures;

(f) frequency of proficiency testing;

(g) proficiency testing audit handling;

(h) reporting of proficiency testing results;

(i) analytical methods and SOPs with annual reviews and dates of revisions of the methods and SOPs;

(j) sample handling procedures;

(k) data reduction, validation, reporting, and verification (an SOP may be referenced);

(l) record keeping, quality assurance review of data, and reporting of results;

(m) equipment operation and calibration;

(n) physical facility factors that may affect quality;

(o) corrective action policy and procedures;

(p) definitions of terms used in the quality assurance plan;

(q) frequency and procedure of quality reviews and the content of reports to the laboratory director; and

(r) frequency, procedure, and documentation of preventive maintenance.

(4) For chemistry laboratories the plan must also include:

(a) calibration procedures for chemistry (an SOP may be referenced);

(b) instrument performance checks;

(d) field or laboratory matrix replicates;

(e) reference samples;

(f) laboratory fortified blanks and laboratory fortified matrix spikes;

(g) initial demonstration of method capability and use of control charts; and

(h) qualitative identification and confirmation of contaminants.

(5) As part of the quality assurance program, the laboratory must document and retain records for a period of five years demonstrating that it has maintained compliance with its quality assurance program. The laboratory may be requested by the department to provide quality assurance data to monitor compliance.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.337 Safety

(1) A laboratory shall develop and maintain a safety program, including an education-based safety program, which meets the requirements of the Montana Safety Culture Act, Title 39, chapter 71, part 15, MCA, and ARM 24.30.2501 through 24.30.2558 implementing that act and adopted by the Department of Labor and Industry.

(a) The department adopts and incorporates by reference those portions of ARM 24.30.2501 through 24.30.2558, which contain requirements that employers must meet concerning the establishment of educational safety programs and safety programs for employers who employ more than five employees. A copy of those rules may be obtained from the Department of Public Health and Human Services, Office of Legal Affairs, 111 North Sanders, Sanders Building, P.O. Box 4210, Helena, MT 59604-4210.

(2) The laboratory shall develop and maintain a chemical hygiene plan.

(3) Where safety methods are included in an analytic method approved by the department, they must be included in the method's SOP and adhered to by the laboratory's analysts performing the procedure.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.338 Laboratory Equipment and Supplies

(1) A laboratory must have, at a minimum, the equipment and supplies necessary to perform an approved analytical method for each contaminant analysis for which approval is requested pursuant to ARM 37.12.305.

(2) The equipment and supplies must meet the specifications required by the approved analytical method used and the specifications specified in the EPA laboratory certification manual for that method.

(3) Analytical reagent (AR) grade chemicals or better must be used for analyses.

(4) The laboratory must have a source of distilled, deionized, or reagent grade water that meets all the requirements listed in the EPA laboratory certification manual and the requirements of the analytical method being used.

(5) The department adopts and incorporates by reference the standards contained in the EPA laboratory certification manual (EPA 815-R-05-004, "Manual for the Certification of Laboratories Analyzing Drinking Water," January 2005) for sources of distilled, deionized water, or reagent grade water. A copy of the manual may be obtained from the Department of Public Health and Human Services, Laboratory Services Bureau, 1400 Broadway, Cogswell Building, P.O. Box 4369, Helena, MT 59604-4369, telephone (406)444-3444, or may be downloaded at the EPA web site: https://wwwepa.gov/dwlabcert/laboratory-certification-manual-drinking-water .

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11; AMD, 2023 p. 305, Eff. 3/25/23.

Mont. Admin. R. 37.12.341 Reporting Requirements

(1) All results of samples collected from a public water supply system and accepted by the laboratory for analysis that exceed a maximum contaminant level (MCL) or that trigger additional actions under ARM Title 17, chapter 38, subchapter 2 must be promptly, on the day the result is determined or no later than noon the next working day, reported by the laboratory to the Montana Department of Environmental Quality (MDEQ). Results must be reported to the Public Water Supply Section of the MDEQ either electronically to dpws@mt.gov or by telephone to (406) 444-1947. The written sample result must be submitted to MDEQ on forms and in formats approved by the MDEQ within 48 hours of completion of the analysis. When a maximum contaminant level as set out in ARM Title 17, chapter 38, subchapter 2 is found to be exceeded in any sample, the reporting laboratory accepting the sample for analysis from the water supplier must notify the water supplier of that result within 24 hours after the analysis is completed.

(2) The analytical result of all microbiological or chemical samples accepted by the laboratory for analysis, other than those which are defined in ARM 37.12.341(1), must be reported to the MDEQ within a week after completion of the analysis. The results must be submitted on forms and in formats approved by the MDEQ.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.342 Reporting Results from Other Laboratories

(1) If a laboratory refers testing to another laboratory, that referral laboratory must be licensed in Montana to perform drinking water analysis for that analyte and method.

(2) A laboratory that reports analyses performed by other laboratories is required to report all analyte results that are used for regulatory compliance, to the Montana Department of Environmental Quality.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2011 MAR p. 2286, Eff. 10/28/11.

Mont. Admin. R. 37.12.345 Critical Elements for Chemistry Laboratory Licensure

(1) In order to be licensed to perform chemical analyses, a laboratory must meet the standards contained in this rule.

(2) Analysts in training must be supervised by an experienced analyst who meets all of the requirements of this rule.

(3) Supervising analysts must verify all results of testing performed by analysts in training and cosign those results.

(4) The laboratory's analysts must:

(a) meet all of the qualifications and conditions set forth in chapter IV of the EPA laboratory certification manual, and if responsible for the operation of analytical instrumentation, complete specialized training offered by the manufacturer or another qualified training facility approved by the department, or served a period of apprenticeship under an experienced analyst. The duration of this apprenticeship should be proportional to the sophistication of the instrument; and

(b) provide certification and/or training and experience documentation to the department for review and approval as part of the laboratory licensure and inspection process.

(5) The department adopts and incorporates by reference chapter IV of the EPA laboratory certification manual (EPA 815-R-05-004, "Manual for the Certification of Laboratories Analyzing Drinking Water," January 2005), which establishes qualifications for staff training and experience and conditions for approval of laboratories conducting chemical analyses of public drinking water. A copy of chapter IV may be obtained from the Department of Public Health and Human Services, Laboratory Services Bureau, 1400 Broadway, Cogswell Building, P.O. Box 4369, Helena, MT 59604-4369, telephone (406) 444-3444, or may be downloaded at the EPA web site: https://www.epa.gov/dwlabcert/laboratory-certification-manual-drinking-water .

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11; AMD, 2023 MAR p. 305, Eff. 3/25/23.

Mont. Admin. R. 37.12.346 Critical Elements for Microbiology Laboratory Licensure

(1) In order to be licensed to perform microbiological analyses, a laboratory must meet the standards contained in this rule.

(2) Individual analysts must be approved by the state as meeting the standards of this rule in order to perform microbiological analysis of drinking water samples.

(3) Analysts in training must be supervised by an experienced analyst who meets all of the requirements of this rule.

(4) Supervising analysts must verify all results of testing performed by analysts in training and co-sign those results.

(5) A laboratory must meet all of the qualifications and conditions set forth in chapter V of the EPA laboratory certification manual.

(a) Analysts must have a minimum of two days of training at the environmental laboratory with a successful evaluation from the state training personnel. Documentation of independent certification or prior experience and training as approved by the department may be substituted for this training.

(6) The department adopts and incorporates by reference chapter V of the EPA laboratory certification manual (EPA 815-R-05-004, "Manual for the Certification of Laboratories Analyzing Drinking Water," January 2005), which establishes qualifications for staff training and experience and conditions for

approval of laboratories conducting microbiological analyses of public drinking water. A copy of the above chapter V may be obtained from the Department of Public Health and Human Services, Laboratory Services Bureau, 1400 Broadway, Cogswell Building, P.O. Box 4369, Helena, MT 59604-4369, telephone: (406) 444-3444, or may be downloaded at the EPA web site: https://www.epa.gov/dwlabcert/laboratory-certification-manual-drinking-water .

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 75-6-106, MCA
History: NEW, 1999 MAR p. 291, Eff. 2/12/99; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2011 MAR p. 2286, Eff. 10/28/11; AMD, 2023 MAR p. 305, Eff. 3/25/23.

Subchapter 37.12.4 Fees for Laboratory Analyses

Mont. Admin. R. 37.12.401 Laboratory Fees for Analyses

(1) Fees for clinical and environmental analyses performed by the laboratory of the department are set to reflect the actual costs of the tests and services provided.

(2) The department will maintain a list of all tests available from the lab and the price of each test. The department adopts and incorporates by reference the Public Health Laboratory Testing Fee Schedule and the Environmental Laboratory Testing Fee Schedule effective January 1, 2026, which is available on the web site of the Department of Public Health and Human Services at https://dphhs.mt.gov/publichealth/LaboratoryServices/index, and by mail upon request to the lab at the Department of Public Health and Human Services, Public Health and Safety Division, P.O. Box 6489, Helena, MT 59604-6489.

(3) The fee for a specific lab test will be lowered by the department to a level not exceeding the cost to the department of the test in question whenever a change of analysis method warrants lower fees.

(4) Fees for analyses other than those listed will be established at the level of comparable analyses.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1997 MAR p. 1041, Eff. 6/24/97; AMD, 1998 MAR p. 671, Eff. 3/13/98; AMD, 1999 MAR p. 1229, Eff. 6/4/99; AMD, 2000 MAR p. 1663, Eff. 6/30/00; TRANS, from DHES, 2001 MAR p. 2246; AMD, 2003 MAR p. 2442, Eff. 10/31/03; AMD, 2003 MAR p. 2551, Eff. 11/14/03; AMD, 2006 MAR p. 2043, Eff. 8/25/06; AMD, 2007 MAR p. 973, Eff. 7/6/07; AMD, 2008 MAR p. 1486, Eff. 7/18/08; AMD, 2010 MAR p. 1207, Eff. 5/14/10; AMD, MAR p. 228, Eff. 1/31/14; AMD, 2015 MAR p. 828, Eff. 7/1/15; AMD, 2018 MAR p. 649, Eff. 4/1/18; AMD, 2021 MAR p. 184, Eff. 3/1/21; AMD, 2023 MAR p. 1889, Eff. 1/1/24; AMD, 2024 MAR p. 2025, Eff. 9/1/24; AMD, 2026 MAR, Notice No. 2025-156, Eff. 2/1/26.

Authorizing statute(s): 40-1-206, MCA
Implementing statute(s): 40-1-206, MCA
History: NEW, 1983 MAR p. 1353, Eff. 9/30/83; TRANS, from DHES, 2001 MAR p. 2246; REP, 2023 MAR p. 180, Eff. 2/25/23.

Subchapter 37.12.8 Prenatal Care Serological Tests

Mont. Admin. R. 37.12.801 Approved Tests

(1) The approved tests shall include a standard serological test for syphilis, rubella immunity, and blood group including O, A, B, AB, and Rho(D) .

History

Authorizing statute(s): Sec. 50-19-101, MCA
Implementing statute(s): Sec. 50-19-101, MCA
History: NEW, Eff. 1/5/74; TRANS, from DHES, 2001 MAR p. 2246.

Mont. Admin. R. 37.12.802 Approved Laboratory

(1) The required prenatal tests shall be done in a laboratory approved by the department of public health and human services.

History

Authorizing statute(s): Sec. 50-19-104, MCA
Implementing statute(s): Sec. 50-19-104, MCA
History: NEW, Eff. 1/5/74; TRANS, from DHES, 2001 MAR p. 2246.

Chapter 37.14 Radiation Control

Subchapter 37.14.1 General Provisions

Mont. Admin. R. 37.14.101 Policy

(1) Except as otherwise specifically provided, this chapter applies to all persons who receive, possess, use, transfer, own or acquire any source of radiation; provided, however, that nothing in these rules shall apply to any person to the extent such person is subject to regulation by the United States nuclear regulatory commission. Regulation by Montana of source material, byproduct material, and special nuclear material in quantities not sufficient to form a critical mass is subject to the provisions of the agreement between Montana and the United States nuclear regulatory commission and to 10 CFR Part 150 of its regulations.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.102 Definitions

As used in this chapter, these terms have the definitions set forth below. Additional definitions used only in a certain subchapter will be found in that subchapter.

(1) "Accelerator-produced material" means any material made radioactive by a particle accelerator.

(2) "Act" means Title 75, chapter 3, MCA.

(3) "Agreement state" means any state with which the US nuclear regulatory commission or the US atomic energy commission has entered into an effective agreement under subsection 274b. of the Atomic Energy Act of 1954, as amended (73 Stat. 689) .

(4) "Airborne radioactive material" means any radioactive material dispersed in the air in the forms of dusts, fumes, mists, vapors, or gases.

(5) "Airborne radioactivity area" means:

(a) any room, enclosure, or operating area in which airborne radioactive material exists in concentrations in excess of the amounts specified in Appendix A, Table I, Column 1, of subchapter 7; or

(b) any room, enclosure, or operating area in which airborne radioactive material exists in concentrations which, averaged over the number of hours in any week during which individuals are in the area, exceed 25% of the amounts specified in Appendix A, Table I, Column 1 of subchapter 7.

(6) "Byproduct material" means a radioactive material (except special nuclear material) yielded in or made radioactive by exposure to the radiation incident to the process of producing or utilizing special nuclear material.

(7) "Calendar quarter" means not less than 12 consecutive weeks nor more than 14 consecutive weeks. The first calendar quarter of each year shall begin in January and subsequent calendar quarters shall be so arranged such that no day is included in more than 1 calendar quarter and no day in any 1 year is omitted from inclusion within a calendar quarter. No licensee or registrant shall change the method observed by him of determining calendar quarters for purposes of these rules except at the beginning of a calendar year.

(8) "CFR" means code of federal regulations.

(9) "Curie" means a unit of measurement of radioactivity. One curie (Ci) is that quantity of radioactive material which decays at the rate of 3.7 x 10 10 disintegrations per second (dps) . Commonly used submultiples of the curie are the millicurie and the microcurie. One millicurie (mCi) =0.001 curie=3.7 x 10 7 dps. One microcurie ( : Ci) =0.000001 curie=3.7 x 10 4 dps.

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

(11) "Depleted uranium" means the source material uranium in which the isotope uranium-235 is less than 0.711 weight percent of the total uranium present. Depleted uranium does not include special nuclear material.

(12) "Dose" as used in this chapter means absorbed dose or dose equivalent as appropriate.

(a) "Absorbed dose" is the energy imparted to matter by ionizing radiation per unit mass of irradiated material at the place of interest. The special unit of absorbed dose is the rad.

(b) "Dose equivalent" is a quantity that expresses on a common scale for all radiation a measure of the postulated effect on a given organ. It is defined as the absorbed dose in rads times certain modifying factors. The unit of dose equivalent is the rem.

(13) "Dose commitment" means the total radiation dose to a part of the body that will result from retention in the body of radioactive material. For purposes of estimating the dose commitment, it is assumed that from the time of intake the period of exposure to retained material will not exceed 50 years.

(14) "Exposure" means the quotient of dQ by dm where "dQ" is the absolute value of the total charge of the ions of 1 sign produced in air when all the electrons (negatrons and positrons) liberated by photons in a volume element of air having mass "dm" are completely stopped in air.

(15) "Exposure rate" means the exposure per unit of time, such as Roentgen (R) per minute and mR per hour.

(16) "Former United States atomic energy commission (AEC) or United States nuclear regulatory commission (NRC) licensed facilities" means nuclear reactors, nuclear fuel reprocessing plants, uranium enrichment plants, or critical mass experimental facilities where AEC or NRC licenses have been terminated.

(17) "Healing arts" means diagnostic and/or healing treatment of human and animal maladies including but not limited to the following which are duly licensed by the state of Montana for the lawful practice of: medicine and its associated specialties, dentistry, veterinary medicine, osteopathy, chiropractic, and podiatry.

(18) "High radiation area" means any area, accessible to individuals, in which there exists radiation at such levels that a major portion of the body could receive in any 1 hour a dose in excess of 100 millirems.

(19) "Human use" means the internal or external administration of radiation or radioactive material to human beings.

(20) "Individual" means any human being.

(21) "Inspection" means an official examination or observation including but not limited to, tests, surveys, and monitoring to determine compliance with rules, regulations, orders, requirements and conditions of the department.

(22) "License" means a license issued by the department in accordance with the rules adopted by the department.

(23) "Licensee" means any person who is licensed by the department in accordance with these rules and the act.

(24) "Licensing state" means any state with regulations equivalent to the suggested state regulations for control of radiation relating to, and an effective program for, the regulatory control of NARM.

(25) "Major processor" means a user processing, handling, or manufacturing radioactive material exceeding Type A quantities as unsealed sources or material, or exceeding 4 times Type B quantities as sealed sources, but does not include nuclear medicine programs, universities, industrial radiographers or small industrial programs. Type A quantity and Type B quantity is a quantity of radioactive material the aggregate radioactivity of which does not exceed that specified in the following table:

Transport Groups (see Table A) | Type A Quantity (in curies) | Type B Quantity (in curies) I | 0.001 | 20 II | 0.05 | 20 III | 3 | 200 IV | 20 | 5,000 V | 20 | 50,000 VI and VII | 1,000 | 5,000 Special form | 20* | 5,000

*Except that for californium-252, the limit is 2 Ci.

(26) "NARM" means any naturally occurring or accelerator-produced radioactive material except source material.

(27) "Natural radioactivity" means radioactivity of naturally occurring nuclides.

(28) "Occupational dose" means exposure of an individual to radiation:

(a) in a restricted area; or

(b) in the course of employment in which the individual's duties involve exposure to radiation; provided, that occupational dose shall not be deemed to include any exposure of an individual to radiation for the purpose of diagnosis or therapy of such individual.

(29) "Ore refineries" means all processors of a radioactive material ore.

(30) "Particle accelerator" means any machine capable of accelerating electrons, protons, deuterons, or other charged particles in a vacuum and of discharging the resultant particulate or other radiation into a medium at energies usually in excess of 1 MeV.

(31) "Person" means "any individual, corporation, partnership, firm, association, trust, estate, public or private institution, group, agency, political subdivision or agency thereof, and any legal successor, representative, agent or agency of the foregoing, other than the United States nuclear regulatory commission, any successor thereto, or federal agencies licensed by the nuclear regulatory commission."

(32) "Personnel monitoring equipment" means devices (e.g., film badges, pocket dosimeters, and thermoluminescent dosimeters) designed to be worn or carried by an individual for the purpose of estimating the dose received by the individual.

(33) "Pharmacist" means an individual licensed by this state to compound and dispense drugs, prescriptions, and poisons.

(34) "Physician" means a duly licensed physician authorized to dispense drugs in the practice of medicine in Montana.

(35) "Rad" means the special unit of absorbed dose. One rad equals one hundredth of a joule per kilogram of material; for example, if tissue is the material of interest, then 1 rad equals 100 ergs per gram of tissue.

(36) "Radiation" means ionizing radiation, i.e., gamma rays and x-rays, alpha and beta particles, high speed electrons, neutrons, and other nuclear particles.

(37) "Radiation area" means any area, accessible to individuals, in which there exists radiation at such levels that a major portion of the body could receive in any 1 hour a dose in excess of 5 millirems, or in any 5 consecutive days a dose in excess of 100 millirems.

(38) "Radiation machine" means any device capable of producing radiation except those which produce radiation only from radioactive material.

(39) "Radiation safety officer" means one who has the knowledge and responsibility to apply appropriate radiation protection regulations.

(40) "Radioactive material" means any material (solid, liquid, or gas) which emits radiation spontaneously.

(41) "Radioactivity" means the disintegration of unstable atomic nuclei by the emission of radiation.

(42) "Registrant" means any person who is registered with the department and is legally obligated to register with the department pursuant to this chapter and the act.

(43) "Registration" means "the registering with the department by the legal owner, user, or authorized representative of sources of ionizing radiation in the manner prescribed by rule."

(44) "Regulations of the US department of transportation" means the regulations in 49 CFR Parts 100-189.

(45) "Rem" means a measure of the dose of any radiation to body tissue in terms of its estimated biological effect relative to a dose received from an exposure to 1 roentgen (R) of x-rays. (1 millirem (mrem) =0.001 rem) For the purpose of this chapter, any of the following is considered to be equivalent to a dose of 1 rem:

(a) An exposure of 1 R of X, or gamma radiation.

(b) A dose of 1 rad due to X, gamma, or beta radiation.

(d) A dose of 0.1 rad due to neutrons or high energy protons.

(i) If it is more convenient to measure the neutron flux, or equivalent, than to determine the neutron absorbed dose in rads, 1 rem of neutron radiation may, for purposes of this chapter, be assumed to be equivalent to 14 million neutrons per square centimeter incident upon the body; or if there exists sufficient information to estimate with reasonable accuracy the approximate distribution in energy of the neutrons, the incident number of neutrons per square centimeter equivalent to 1 rem may be estimated from the following table:

Neutron Flux Dose Equivalents

Neutron energy (MeV) | Number of neutrons per square centimeter for a dose equivalent of 1 rem (neutrons/cm 2 ) | Average flux density to deliver 100 millirems in 40 hours (neutrons/cm 2 per second) Thermal . . . . . . . . . . . . . . 970 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 670 0.0001 . . . . . . . . . . . . . . . 720 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500 0.005 . . . . . . . . . . . . . . . . 820 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 570 0.02 . . . . . . . . . . . . . . . . . 400 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 0.1 . . . . . . . . . . . . . . . . . . 120 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 0.5 . . . . . . . . . . . . . . . . . . . 43 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 1.0 . . . . . . . . . . . . . . . . . . . 26 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.5 . . . . . . . . . . . . . . . . . . . 29 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 5.0 . . . . . . . . . . . . . . . . . . . 26 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7.5 . . . . . . . . . . . . . . . . . . . 24 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 10.0 . . . . . . . . . . . . . . . . . . 24 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 10 to 30 . . . . . . . . . . . . . . . 14 x 10 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

(46) "Research and development" means theoretical analysis, exploration, or experimentation; or the extension of investigative findings and theories of a scientific or technical nature into practical application for experimental and demonstration purposes, including the experimental production and testing of models, devices, equipment, materials, and processes. Research and development does not include the internal or external administration of radiation or radioactive material to human beings.

(47) "Restricted area" (controlled area) means any area access to which is controlled by the licensee or registrant for purposes of protection of individuals from exposure to radiation and radioactive material. "Restricted area" shall not include any areas used for residential quarters, although a separate room or rooms in a residential building may be set apart as a restricted area.

(48) "Roentgen" (R) means the special unit of exposure. One roentgen equals 2.58 x 10 -4 coulombs/kilogram of air.

(49) "Sealed source" means radioactive material that is permanently bonded or fixed in a capsule or matrix designed to prevent release and dispersal of the radioactive material under the most severe conditions which are likely to be encountered in normal use and handling.

(50) "Source material" means uranium, thorium, or any other material which the department or the United States nuclear regulatory commission declares by order to be source material or ores containing 1 or more of the foregoing materials in such concentration as the department or the nuclear regulatory commission declares by order to be source material after the nuclear regulatory commission has determined the material in such concentration to be source material.

(51) "Source of radiation" means any radioactive material, or any device or equipment emitting or capable of producing radiation.

(52) "Special form" means any of the following physical forms of licensed material of any transport group:

(a) The material is in solid form having no dimension less than 0.5 millimeter or at least 1 dimension greater than 5 millimeters; does not melt, sublime, or ignite in air at a temperature of 1,000 E F; will not shatter or crumble if subjected to the percussion test described in Table B of this subchapter; and is not dissolved or converted into dispersible form to the extent of more than 0.005% by weight by immersion for 1 week in water at 68 E F or in air at 86 E F.

(b) The material is securely contained in a capsule having no dimension less than 0.5 millimeter or at least 1 dimension greater than 5 millimeters, which will retain its contents if subjected to the tests prescribed in Appendix B of this subchapter and which is constructed of materials which do not melt, sublime, or ignite in air at 1,475 E F, and do not dissolve or convert into dispersible form to the extent of more than 0.005% by weight by immersion for 1 week in water at 68 E F or in air at 86 E F.

(53) "Special nuclear material in quantities not sufficient to form a critical mass" means uranium enriched in the isotope U-235 in quantities not exceeding 350 grams of contained U-235; uranium-233 in quantities not exceeding 200 grams; plutonium in quantities not exceeding 200 grams; or any combination of them in accordance with the following formula: For each kind of special nuclear material, determine the ratio between the quantity of that special nuclear material and the quantity specified above for the same kind of special nuclear material. The sum of such ratios for all of the kinds of special nuclear material in combination shall not exceed "1" (i.e., unity) . For example, the following quantities in combination would not exceed the limitation and are within the formula:

175 (grams contained U-235) | + 50(grams U-233) | + 50(grams Pu ) | =1 350 | 200 | 200 |

(54) "Survey" means an evaluation of the production, use, release, disposal, and/or presence of sources of radiation under a specific set of conditions to determine actual or potential radiation hazards. When appropriate, such evaluation includes, but is not limited to tests, physical examination and measurements of levels of radiation or concentration of radioactive material present.

(55) "Test" means a method for determining the characteristics of condition of sources of radiation or components thereof.

(56) "Transport group" means any 1 of 7 groups into which radionuclides in normal form are classified, according to their toxicity and their relative potential hazard in transport, in Table A of this subchapter.

(a) Any radionuclide not specifically listed in 1 of the groups in Table A shall be assigned to 1 of the groups in accordance with the following table:

Radioactive half-life

(b) For mixtures of radionuclides the following shall apply:

(i) If the identity and respective activity of each radionuclide are known, the permissible activity of each radionuclide shall be such that the sum, for all groups present, of the ratio between the total activity for each group to the permissible activity for each group will not be greater than unity.

(ii) If the groups of the radionuclides are known but the amount in each group cannot be reasonably determined, the mixture shall be assigned to the most restrictive group present.

(iii) If the identity of all or some of the radionuclides cannot be reasonably determined, each of those unidentified radionuclides shall be considered as belonging to the most restrictive group which cannot be positively excluded.

(iv) Mixtures consisting of a single radioactive decay chain where the radionuclides are in the naturally occurring proportions shall be considered as consisting of a single radionuclide. The group and activity shall be that of the first member present in the chain, except that if a radionuclide "X" has a half-life longer than that of that first member and an activity greater than that of any other member, including the first, at any time during transportation, the transport group of the nuclide "X" and the activity of the mixture shall be the maximum activity of that nuclide "X" during transportation.

(57) "US department of energy" means the department of energy established by Public Law 95-91, August 4, 1977, 91 Stat. 565, 42 USC 7101, et seq., to the extent that the department exercises functions formerly vested in the US atomic energy commission, its chairman, its members, officers and components and transferred to the US energy research and development administration and to the administrator thereof pursuant to sections 104(b) , (c) and (d) of the Energy Reorganization Act of 1974 (Public Law 93-438, October 11, 1974, 88 Stat. 1233 at 1237, effective January 19, 1975) and retransferred to the secretary of energy pursuant to section 301(a) of the Department of Energy Organization Act (Public Law 95-91, August 4, 1977, 91 Stat. 565 at 577-578, 42 USC 7151, effective October 1, 1977) .

(58) "Unrefined and unprocessed ore" means ore in its natural form prior to any processing, such as grinding, roasting, beneficiating, or refining.

(59) "Unrestricted area" (uncontrolled area) means any area access to which is not controlled by the licensee or registrant for purposes of protection of individuals from exposure to radiation and radioactive material, and any area used for residential quarters.

(60) "Waste handling licensees" mean persons licensed to receive and store radioactive wastes prior to disposal and/or persons licensed to dispose of radioactive waste.

(61) "Worker" means an individual engaged in work under a license or registration issued by the department and controlled by a licensee or registrant, but does not include the licensee or registrant.

History

Authorizing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.106 Exemptions

(1) The department may, upon application therefor or upon its own initiative, grant such exemptions or exceptions from the requirements of this chapter as it determines are authorized by law and will not result in undue hazard to public health and safety or property.

(2) Common and contract carriers, freight forwarders, and warehousemen, who are subject to the rules and regulations of the US department of transportation or the US postal service (39 CFR Parts 14 and 15) , are exempt from this chapter to the extent that they transport or store sources of radiation in the regular course of their carriage for another or storage incident thereto. Private carriers who are subject to the rules and regulations of the US department of transportation are exempt from this chapter to the extent that they transport sources of radiation. Common, contract, and private carriers who are not subject to the rules and regulations of the US department of transportation or the US postal service are subject to the applicable rules of this chapter.

(3) Any US department of energy contractor or subcontractor and any US nuclear regulatory commission contractor or subcontractor of the following categories operating within Montana is exempt from this chapter to the extent that such contractor or subcontractor under his contract receives, possesses, uses, transfers or acquires sources of radiation:

(a) prime contractors performing work for the US department of energy at US government-owned or controlled sites, including the transportation of sources of radiation to or from such sites and the performance of contract services during temporary interruptions of such transportation;

(b) prime contractors of the US department of energy performing research in, or development, manufacture, storage, testing or transportation of, atomic weapons or components thereof;

(c) prime contractors of the US department of energy using or operating nuclear reactors or other nuclear devices in a United States government-owned vehicle or vessel; and

(d) any other prime contractor or subcontractor of the US department of energy or of the US nuclear regulatory commission when the department and the nuclear regulatory commission jointly determine:

(i) that the exemption of the prime contractor or subcontractor is authorized by law; and

(ii) that under the terms of the contract or subcontract, there is adequate assurance that the work thereunder can be accomplished without undue risk to the public health and safety.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-104, 75-3-201 and 75-3-203, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.107 Records

(1) Each licensee and registrant shall maintain records showing the receipt, transfer, and disposal of all sources of radiation. Additional record requirements are specified elsewhere in this chapter.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-204, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.108 Inspections

(1) Each licensee and registrant shall afford the department at all reasonable times opportunity to inspect sources of radiation and the premises and facilities wherein such sources of radiation are used or stored.

(2) Each licensee and registrant shall make available to the department for inspection, upon reasonable notice, records maintained pursuant to this chapter.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-107, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.115 Tests

(1) Each licensee and registrant shall perform upon instructions from the department, or shall permit the department to perform, such reasonable tests as the department deems appropriate or necessary including, but not limited to, tests of:

(a) sources of radiation;

(b) facilities wherein sources of radiation are used or stored;

(d) other equipment and devices used in connection with utilization or storage of licensed or registered sources of radiation.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.116 Prohibited Uses

(1) No person may use hand-held fluoroscopic screens or shoe-fitting fluoroscopic devices.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.120 Communications

(1) All communications and reports concerning this chapter, and applications filed thereunder, should be addressed to the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 2025953, Helena, MT 59620-5953.

TABLE A

TRANSPORT GROUPING OF RADIONUCLIDES

Element 1 | Radionuclide 2 | Group Actinium (89) Americium (95) Antimony (51) Argon (18) Arsenic (33) | Ac-227 Ac-228 Am-241 Am-243 Sb-122 Sb-124 Sb-125 Ar-37 Ar-41 Ar-41 (uncompressed) 3 As-73 As-74 As-76 As-77 | I I I I IV III III VI II V IV IV IV IV Astatine (85) Barium (56) Berkelium (97) Beryllium (4) Bismuth (83) Bromine (35) Cadmium (48) Calcium (20) Californium (98) Carbon (6) | At-211 Ba-131 Ba-133 Ba-140 Bk-249 Be-7 Bi-206 Bi-207 Bi-210 Bi-212 Br-82 Cd-109 Cd-115 m Cd-115 Ca-45 Ca-47 Cf-249 Cf-250 Cf-252 C-14 | III IV II III I IV IV III II III IV IV III IV IV IV I I I IV

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

3 Uncompressed means at a pressure not exceeding 1 atmosphere.

m Mestastable state.

Element 1 | Radionuclide 2 | Group Cerium (58) Cesium (55) Chlorine (17) Chromium (24) Cobalt (27) | Ce-141 Ce-143 Ce-144 Cs-131 Cs-134 m Cs-134 Cs-135 Cs-136 Cs-137 Cl-36 Cl-38 Cr-51 Co-56 Co-57 Co-58 m Co-58 Co-60 | IV IV III IV III III IV IV III III IV IV III IV IV IV III Copper (29) Curium (96) Dysprosium (66) Erbium (68) Europium (63) Fluorine (9) Gadolinium (64) Gallium (31) Germanium (32) | Cu-64 Cm-242 Cm-243 Cm-244 Cm-245 Cm-246 Dy-154 Dy-165 Dy-166 Er-169 Er-171 Eu-150 Eu-152 m Eu-152 Eu-154 Eu-155 F-18 Gd-153 Gd-159 Ga-67 Ga-72 Ge-71 | IV I I I I I III IV IV IV IV III IV III II IV IV IV IV III IV IV

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

m Mestastable state.

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

3 Uncompressed means at a pressure not exceeding 1 atmosphere.

m Mestastable state.

Element 1 | Radionuclide 2 | Group Lutetium (71) Magnesium (12) Manganese (25) Mercury (80) Mixed fission products Molybdenum (42) Neodymium (60) Neptunium (93) Nickel (28) | Lu-172 Lu-177 Mg-28 Mn-52 Mn-54 Mn-56 Hg-197 m Hg-197 IV Hg-203 IV (MFP) Mo-99 Nd-147 Nd-149 Np-237 Np-239 Ni-56 Ni-59 Ni-63 Ni-65 | III IV III IV IV IV IV IV IV II IV IV IV I I III IV IV IV Niobium (41) Osmium (76) | Nb-93 m Nb-95 Nb-97 Os-185 Os-191 m Os-191 Os-193 | IV IV IV IV IV IV IV Palladium (46) Phosphorus (15) Platinum (78) Plutonium (94) | Pd-103 Pd-109 P-32 Pt-191 Pt-193 Pt-193 m Pt-197 m Pt-197 Pu-238 (F) Pu-239 (F) Pu-240 Pu-241 (F) Pu-242 | IV IV IV IV IV IV IV IV I I I I I

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

m Mestastable state.

(F) Fissile material.

RADIATION CONTROL

Element 1 | Radionuclide 2 | Group Polonium (84) Potassium (19) Praseodymium (59) Promethium (61) Protactinium (91) Radium (88) Radon (86) Rhenium (75) | Po-210 K-42 K-43 Pr-142 Pr-143 Pm-147 Pm-149 Pa-230 Pa-231 Pa-233 Ra-223 Ra-224 Ra-226 Ra-228 Rn-220 Rn-222 Re-183 Re-186 Re-187 Re-188 Re-Natural | I IV III IV IV IV IV I I II II II I I IV II IV IV IV IV IV Rhodium (45) Rubidium (37) Ruthenium (44) Samarium (62) Scandium (21) | Rh-103 m Rh-105 Rb-86 Rb-87 Rb-Natural Ru-97 Ru-103 Ru-105 Ru-106 Sm-145 Sm-147 Sm-151 Sm-153 Sc-46 Sc-47 Sc-48 | IV IV IV IV IV IV IV IV III III III IV IV III IV IV

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

m Mestastable state.

Element 1 | Radionuclide 2 | Group Selenium (34) Silicon (14) Silver (47) Sodium (11) Strontium (38) | Se-75 Si-31 Ag-105 Ag-110 m Ag-111 Na-22 Na-24 Sr-85 m Sr-85 Sr-89 Sr-90 Sr-91 Sr-92 Sr-89 Sr-90 Sr-91 III Sr-92 II | IV IV IV III IV III IV IV IV III II III IV III II III II Sulfur (16) Tantalum (73) Technetium (43) | S-35 Ta-182 Tc-96 m Tc-96 Tc-97 m Tc-97 Tc-99 m Tc-99 | IV III IV IV IV IV IV IV Tellurium (52) Terbium (65) Thallium (81) | Te-125 m Te-127 m Te-127 Te-129 m Te-129 Te-131 m Te-132 Tb-160 Tl-200 Tl-201 Tl-202 Tl-204 | IV IV IV III IV III IV III IV IV IV III

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

m Mestastable state.

RADIATION CONTROL

Element 1 | Radionuclide 2 | Group Thorium (90) Thulium (69) Tin (50) Tritium (1) | Th-227 Th-228 Th-230 Th-231 Th-232 Th-234 Th-Natural Tm-168 Tm-170 Tm-171 Sn-113 Sn-117 m Sn-121 Sn-125 H-3 H-3 (as a gas, as luminous paint, or adsorbed on solid material) | II I I I III II III III III IV IV III III IV IV VII Tungsten (74) Uranium (92) Vanadium (23) | W-181 W-185 W-187 U-230 U-232 U-233 (F) U-234 U-235 (F) U-236 U-238 U-Natural U-Enriched (F) U-Depleted V-48 V-49 Y-91 m Y-91 Y-92 Y-93 | IV IV IV II I II II III II III III III III IV III III III IV IV

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

m Mestastable state.

(F) Fissile material.

Element 1 | Radionuclide 2 | Group Xenon (54) | Xe-125 Xe-131 m Xe-131 m (uncompressed) 3 Xe-133 Xe-133 (uncompressed) 3 Xe-135 Xe-135 (uncompressed) 3 | III III V III VI II V Ytterbium (70) Yttrium (39) Zinc (30) Zirconium (40) | Yb-175 Y-88 Y-90 (uncompressed) 3 Zn-65 Zn-69 m Zn-69 Zr-93 Zr-95 Zr-97 | IV III IV IV IV IV IV III IV

1 Atomic number shown in parentheses.

2 Atomic mass number shown after the element symbol.

3 Uncompressed means at a pressure not exceeding 1 atmosphere.

m Mestastable state.

TABLE B

TESTS FOR SPECIAL FORM LICENSED MATERIAL

Free Drop - A free drop through a distance of 30 feet onto a flat essentially unyielding horizontal surface, striking the surface in such a position as to suffer maximum damage.
Percussion - Impact of the flat circular end of a 1 inch diameter steel rod weighing 3 pounds, dropped through a distance of 40 inches. The capsule or material shall be placed on a sheet of lead, of hardness number 3.5 to 4.5 on the Vickers scale, and not more than 1 inch thick, supported by a smooth essentially unyielding surface.
Heating - Heating in air to a temperature of 1,475 E F and remaining at that temperature for a period of 10 minutes.
Immersion - Immersion for 24 hours in water at room temperature. The water shall be a pH 6 - pH 8, with a maximum conductivity of 10 micromhos per centimeter.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.3 Registration of Radiation Machine Facilities

Mont. Admin. R. 37.14.301 Purpose

(1) This subchapter provides for the registration of radiation machine facilities.

(2) In addition to the requirements of this subchapter, all registrants are subject to the applicable provisions of other rules of this chapter.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.302 Definitions

(1) For purposes of this subchapter "facility" means the location at which 1 or more devices or sources are installed and/or located within 1 building, vehicle, or under 1 roof and are under the same administrative control.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.306 Exemptions

(1) Electronic equipment that produces radiation incidental to its operation for other purposes is exempt from the registration and notification requirements of this subchapter, providing dose equivalent rate averaged over an area of 10 square centimeters does not exceed 0.5 mrem per hour at 5 cm from any accessible surface of such equipment. The production, testing, or factory servicing or such equipment shall not be exempt.

(2) Radiation machines while in transit or storage incident thereto are exempt from the requirements of this subchapter.

(3) Domestic television receivers are exempt from the requirements of this subchapter.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.307 Registration

(1) The owner or person having possession of any radiation machine shall:

(a) Register such machine with the department within 30 days following the effective date of this chapter or after acquisition of such machine and prior to its use. Registration shall be on forms available from the department.

(b) Designate an individual who will be responsible for radiation protection for the machine. Such individuals shall:

(i) be qualified by training and experience concerning all hazards and precautions involved in operating the machine for which he is responsible;

(ii) upon request by the department provide a detailed program of radiation safety for effective compliance with the applicable requirements of this chapter;

(iii) give instructions concerning hazards and safety practices to individuals who may be occupationally exposed to radiation from the machine; and

(iv) make surveys and carry out other procedures as required by this chapter.

(c) When, in the opinion of the department, the individual designated to be responsible for radiation safety does not have qualifications sufficient to insure such safety, the department may order the registrant to designate another individual who meets the requirements of this subsection.

(2) The registrant shall notify the department within 10 days after any change which renders the information on the registration no longer accurate.

(3) The owner or person having possession of any registered radiation machine shall re-register such machine with the department every 2 years as long as the activity requiring such registration continues.

(4) No person, in any advertisement, shall refer to the fact that a radiation machine is registered with the department and no person shall state or imply that any activity under such registration has been approved by the department.

(5) Whenever a manufacturer, his agent or a dealer sells or transfers title to a radiation machine, said manufacturer, his agent or the dealer shall give written notification thereof to the department. Written notification shall be given within 15 days of such sale or transfer of title and shall include the name and address of the new owner or owners.

(6) Whenever an owner sells, transfers title, or disposes of a radiation machine, said owner shall give written notification thereof to the department. This written notification shall be given within 15 days of such sale, transfer of title, or disposal, and shall include the name and address of the owner and details of the final disposal of the machine.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.315 Out-of-State Radiation Machines

(1) Whenever any radiation machine is to be brought into Montana, for any temporary use, the person proposing to bring such machine into Montana shall give written notice to the department at least 2 working days before such machine is to be used in Montana. The notice shall include:

(a) the type of radiation machine;

(b) the nature, duration, and scope of use; and

(2) If, for a specific case, the 2 working-day period would impose an undue hardship on the person, upon application to the department, permission to proceed sooner may be granted.

(3) The person referred to in (1) of this rule shall:

(a) comply with all applicable rules of the department;

(b) supply the department with such other information as the department may reasonably request; and

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.5 Licensing of Radioactive Material

Mont. Admin. R. 37.14.501 Purpose

(1) This subchapter provides for the licensing of radioactive material. No person shall receive, possess, use, transfer, or acquire radioactive material except as authorized in a specific or general license issued pursuant to this subchapter or as otherwise provided in this subchapter.

(2) In addition to the requirements of this subchapter, all licensees are subject to the requirements of ARM Title 37, chapter 14, subchapters 1, 7 and 17. Licensees engaged in industrial radiographic operations are subject to the requirements of ARM Title 37, chapter 14, subchapter 8, and licensees using sealed sources in the healing arts are subject to the requirements of ARM Title 37, chapter 14, subchapter 11.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202 and 75-3-404, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.505 Exemptions: Source Material

(1) Any person is exempt from this subchapter to the extent that such person receives, possesses, uses, or transfers source material in any chemical mixture, compound, solution, or alloy in which the source material is by weight less than 1/20 of 1% (0.05%) of the mixture, compound, solution, or alloy.

(2) Any person is exempt from this subchapter to the extent that such person receives, possesses, uses, or transfers unrefined and unprocessed ore containing source material; provided that, except as authorized in a specific license, such person shall not refine or process such ore.

(3) Any person is exempt from this subchapter to the extent that such person receives, possesses, uses, or transfers:

(a) any quantities of thorium contained in:

(i) incandescent gas mantles,

(ii) vacuum tubes,

(iii) welding rods,

(iv) electric lamps for illuminating purposes provided that each lamp does not contain more than 50 milligrams of thorium,

(v) germicidal lamps, sunlamps, and lamps for outdoor or industrial lighting provided that each lamp does not contain more than 2 grams of thorium,

(vi) rare earth metals and compounds, mixtures, and products containing not more than 0.25% by weight thorium, uranium, or any combination of these, or

(vii) personnel neutron dosimeters, provided that each dosimeter does not contain more than 50 milligrams of thorium;

(b) source material contained in the following products:

(i) glazed ceramic tableware, provided that the glaze contains not more than 20% by weight source material,

(ii) glassware, glass enamel and glass enamel frit containing not more than 10% by weight source material, but not including commercially manufactured glass brick, pane glass, ceramic tile or other glass, glass enamel or ceramic used in construction, or

(iii) piezoelectric ceramic containing not more than 2% by weight source material;

(d) any finished product or part fabricated of, or containing, tungsten-thorium or magnesium-thorium alloys, provided that the thorium content of the alloy does not exceed 4% by weight and that this exemption shall not be deemed to authorize the chemical, physical, or metallurgical treatment or processing of any such product or part;

(e) uranium contained in counterweights installed in aircraft, rockets, projectiles, and missiles, or stored or handled in connection with installation or removal of such counterweights, provided that

(i) the counterweights are manufactured in accordance with a specific license issued by the US nuclear regulatory commission, authorizing distribution by the licensee pursuant to 10 CFR Part 40,

(ii) each counterweight has been impressed with the following legend clearly legible through any plating or other covering: "DEPLETED URANIUM". The requirements specified in (3) (e) (ii) and (iii) of this rule need not be met by counterweights manufactured prior to December 31, 1969; provided, that such counterweights are impressed with the legend "CAUTION--RADIOACTIVE MATERIAL--URANIUM", as previously required by this chapter.

(iii) each counterweight is durably and legibly labeled or marked with the identification of the manufacturer and the statement: "UNAUTHORIZED ALTERATIONS PROHIBITED", and

(iv) this exemption shall not be deemed to authorize the chemical, physical, or metallurgical treatment or processing of any such counterweights other than repair or restoration of any plating or other covering;

(f) uranium used as shielding constituting part of any shipping container which is conspicuously and legibly impressed with the legend "CAUTION--RADIOACTIVE SHIELDING--URANIUM" and which meets the specifications for containers for radioactive material prescribed in 49 CFR Part 173, section 173.394 or 173.395, of the US department of transportation regulations;

(g) thorium contained in finished optical lenses, provided that each lens does not contain more than 30% by weight of thorium, and that this exemption shall not be deemed to authorize either:

(i) the shaping, grinding, or polishing of such lens or manufacturing processes other than the assembly of such lens into optical systems and devices without any alteration of the lens, or

(ii) the receipt, possession, use, or transfer of thorium contained in contact lenses, or in spectacles, or in eyepieces in binoculars or other optical instruments;

(h) uranium contained in detector heads for use in fire detection units, provided that each detector head contains not more than 0.005 microcurie of uranium; or

(i) thorium contained in any finished aircraft engine part containing nickel-thoria alloy, provided that

(i) the thorium is dispersed in the nickel-thoria alloy in the form of finely divided thoria (thorium dioxide) , and

(ii) the thorium content in the nickel-thoria alloy does not exceed 4% by weight.

(4) The exemptions in (3) of this rule do not authorize the manufacture of any of the products described.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-104 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.506 Exemptions: Radioactive Material Other Than Source Material

(1)

(a) Except as provided in (b) below, any person is exempt from this subchapter to the extent that such person receives, possesses, uses, transfers, or acquires products or materials containing radioactive material in concentrations not in excess of those listed in Schedule A of this subchapter, with the exception of radium 226 for which the exempt concentration is 5 x 10

-6

mCi/ml (u Ci/gm) .

(b) No person may introduce radioactive material into a product or material knowing or having reason to believe that it will be transferred to persons exempt under (a) above or equivalent regulations of the US nuclear regulatory commission, any agreement state or licensing state, except in accordance with a specific license issued pursuant to ARM 37.14.542 (1) or the general license provided in ARM 37.14.551 .

(2)

(a) Except as provided in (c) and (d) below, any person is exempt from this chapter to the extent that such person receives, possesses, uses, transfers or acquires radioactive material in individual quantities each of which does not exceed the applicable quantity set forth in Schedule B of this subchapter.

(b) ARM 37.14.506 (2) does not authorize the production, packaging or repackaging of radioactive material for purposes of commercial distribution, or the incorporation of radioactive material into products intended for commercial distribution.

(c) No person may, for purposes of commercial distribution, transfer radioactive material in the individual quantities set forth in Schedule B of this subchapter, knowing or having reason to believe that such quantities of radioactive material will be transferred to persons exempt under (2) of this rule or equivalent regulations of the US nuclear regulatory commission, any agreement state or licensing state, except in accordance with a specific license issued by the US nuclear regulatory commission pursuant to 10 CFR Part 32, section 32.18 or by the department pursuant to ARM 37.14.542 (2) which license states that the radioactive material may be transferred by the licensee to persons exempt under (2) or the equivalent regulations of the US nuclear regulatory commission, any agreement state or licensing state.

(3) Except for persons who apply radioactive material to, or persons who incorporate radioactive material into the following products, any person is exempt from this subchapter to the extent that he receives, possesses, uses, transfers, or acquires the following products: (Authority to transfer possession or control by the manufacturer, processor, or producer of any equipment, device, commodity, or other product containing byproduct material whose subsequent possession, use, transfer, and disposal by all other persons are exempted from regulatory requirements may be obtained only from the US Nuclear Regulatory Commission, Washington, DC 20555.)

(a) Timepieces or hands or dials containing not more than the following specified quantities of radioactive material and not exceeding the following specified levels of radiation:

(i) 25 millicuries of tritium per timepiece.

(ii) 5 millicuries of tritium per hand.

(iii) 15 millicuries of tritium per dial (bezels when used shall be considered as part of the dial) .

(iv) 100 microcuries of promethium-147 per watch or 200 microcuries of promethium-147 per any other timepiece.

(v) 20 microcuries of promethium-147 per watch hand or 40 microcuries of promethium-147 per other timepiece hand.

(vi) 60 microcuries of promethium-147 per watch dial or 120 microcuries of promethium-147 per other timepiece dial (bezels when used shall be considered as part of the dial) .

(vii) The levels of radiation from hands and dials containing promethium-147 will not exceed, when measured through 50 milligrams per square centimeter of absorber:

(A) For wrist watches, 0.1 millirad per hour at 10 centimeters from any surface.

(B) For pocket watches, 0.1 millirad per hour at 1 centimeter from any surface.

(viii) One microcurie of radium-226 per timepiece in timepieces acquired prior to the effective date of this chapter.

(b) Lock illuminators containing not more than 15 millicuries of tritium or not more than 2 millicuries of promethium-147 installed in automobile locks. The levels of radiation from each lock illuminator containing promethium-147 will not exceed 1 millirad per hour at 1 centimeter from any surface when measured through 50 milligrams per square centimeter of absorber.

(c) Precision balances containing not more than 1 millicurie of tritium per balance or not more than 0.5 millicurie of tritium per balance part.

(d) Automobile shift quadrants containing not more than 25 millicuries of tritium.

(e) Marine compasses containing not more than 750 millicuries of tritium gas and other marine navigational instruments containing not more than 250 millicuries of tritium gas.

(f) Thermostat dials and pointers containing not more than 25 millicuries of tritium per thermostat.

(g) Electron tubes; provided, that each tube does not contain more than 1 of the following specified quantities of byproduct material:

(i) 150 millicuries of tritium per microwave receiver protector tube or 10 millicuries of tritium per any other electron tube.

(ii) 1 microcurie of cobalt-60.

(iii) 5 microcuries of nickel-63.

(iv) 30 microcuries of krypton-85.

(v) 5 microcuries of cesium-137.

(vi) 30 microcuries of promethium-147.

And provided further, that the levels of radiation from each electron tube containing byproduct material do not exceed 1 millirad per hour at 1 centimeter from any surface when measured through 7 milligrams per square centimeter of absorber. For purposes of (g) , "electron tubes" include spark gap tubes, power tubes, gas tubes including glow lamps, receiving tubes, microwave tubes, indicator tubes, pick-up tubes, radiation detection tubes, and any other completely sealed tube that is designed to conduct or control electrical currents.

(h) Ionizing radiation measuring instruments containing, for purposes of internal calibration or standardization, a source of radioactive material not exceeding the applicable quantity set forth in Schedule B of this subchapter.

(i) Spark gap irradiators containing not more than 1 microcurie of cobalt-60 per spark gap irradiator for use in electrically ignited fuel oil burners having a firing rate of at least 3 gallons (11.4 liters) per hour.

(4)

(a) Except for persons who manufacture, process, or produce self-luminous products containing tritium, krypton-85, or promethium-147, any person is exempt from this chapter to the extent that such person receives, possesses, uses, transfers, or acquires tritium, krypton-85 or promethium-147 in self-luminous products manufactured, processed, produced, imported, or transferred in accordance with a specific license issued by the US nuclear regulatory commission pursuant to 10 CFR Part 32, section 32.22, which license authorizes the transfer of the product to persons who are exempt from regulatory requirements. The exemption in (a) does not apply to tritium, krypton-85, or promethium-147 used in products for frivolous purposes or in toys or adornments.

(b) Any person is exempt from this chapter to the extent that such person receives, possesses, uses, or transfers articles containing less than 0.1 microcurie of radium-226 which were acquired prior to the effective date of this chapter.

(5)

(a) Except for persons who manufacture, process, or produce gas and aerosol detectors containing radioactive material, any person is exempt from this chapter to the extent that such person receives, possesses, uses, transfers, or acquires radioactive material in gas and aerosol detectors designed to protect life or property from fire and airborne hazards provided that detectors containing radioactive material shall have been manufactured, imported, or transferred in accordance with a specific license issued by the US nuclear regulatory commission pursuant to 10 CFR Part 32, section 32.26; or a licensing state pursuant to ARM

(b) Gas and aerosol detectors previously manufactured and distributed to general licensees in accordance with a specific license issued by an agreement state shall be considered exempt under (a) above, provided that the device is labeled in accordance with the specific license authorizing distribution of the generally licensed device, and provided further that they meet the requirements of ARM 37.14.542 (3) .

(c) Gas and aerosol detectors containing NARM previously manufactured and distributed in accordance with a specific license issued by a licensing state shall be considered exempt under (a) above, provided that the device is labeled in accordance with the specific license authorizing distribution, and provided further that they meet the requirements of ARM 37.14.542 (3) .

(6) Any person is exempt from this chapter to the extent that such person receives, possesses, uses, transfers, or acquires synthetic plastic resins containing scandium-46 which are designed for sand consolidation in oil wells. Such resins shall have been manufactured or imported in accordance with a specific license issued by the US nuclear regulatory commission, or shall have been manufactured in accordance with the specifications contained in a specific license issued by the department or any agreement state to the manufacturer of such resins pursuant to licensing requirements equivalent to those in 10 CFR Part 32, sections 32.16 and 32.17, of the regulations of the US nuclear regulatory commission. This exemption does not authorize the manufacture of any resins containing scandium-46.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-104 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; AMD, 1980 MAR p. 2926, Eff. 11/15/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.510 Licenses: Types of Licenses

(1) Licenses for radioactive materials are of 2 types: general and specific. General licenses provided in this subchapter are effective without the filing of applications with the department or the issuance of licensing documents to the particular persons, although the filing of a certificate with the department may be required by the particular general license. The general license is subject to all other applicable portions of this chapter and any limitations of the general license.

(2) Specific licenses require the submission of an application to the department and the issuance of a licensing document by the department. The licensee is subject to all applicable portions of this chapter as well as any limitations specified in the licensing document.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.511 General Licenses: Source Material

(1) A general license is hereby issued authorizing use and transfer of not more than 15 pounds of source material at any 1 time by persons in the following categories:

(a) Pharmacists using the source material solely for the compounding of medicinals.

(b) Physicians using the source material for medicinal purposes.

(d) Commercial and industrial firms, and research, educational, and medical institutions, and state and local governmental agencies for research, development, educational, commercial or operational purposes.

(e) And provided, that no such person shall, pursuant to this general license, receive more than a total of 150 pounds of source material in any 1 calendar year.

(2) Persons who receive, possess, use, or transfer source material pursuant to the general license issued in (1) of this rule are exempt from the provisions of ARM Title 37, chapter 14, subchapters 7 and 17, to the extent that such receipt, possession, use, or transfer is within the terms of such general license; provided, however, that this exemption shall not be deemed to apply to any such person who is also in possession of source material under a specific license issued pursuant to this subchapter.

(3) A general license is hereby issued authorizing the receipt of title to source material without regard to quantity. This general license does not authorize any person to receive, possess, use, or transfer source material.

(4)

(a) A general license is hereby issued to receive, acquire, possess, use, or transfer, in accordance with the provisions of (b) through (e) below, depleted uranium contained in industrial products or devices for the purpose of providing a concentrated mass in a small volume of the product or device.

(b) The general license in (a) above applies only to industrial products or devices which have been manufactured either in accordance with a specific license issued to the manufacturer of the products or devices pursuant to ARM 37.14.542 (13) or in accordance with a specific license issued to the manufacturer by the US nuclear regulatory commission or an agreement state which authorizes manufacture of the products or devices for distribution to persons generally licensed by the US nuclear regulatory commission or an agreement state.

(c)

(i) Persons who receive, acquire, possess, or use depleted uranium pursuant to the general license established by (a) above shall file department form MRH-12, "Registration Certificate--Use of Depleted Uranium Under General License", with the department. The form shall be submitted within 30 days after the first receipt or acquisition of such depleted uranium. The registrant shall furnish on department form MRH-12 the following information and such other information as may be required by that form:

(A) name and address of the registrant;

(B) a statement that the registrant has developed and will maintain procedures designed to establish physical control over the depleted uranium described in (a) above and designed to prevent transfer of such depleted uranium in any form, including metal scrap, to persons not authorized to receive the depleted uranium; and

(C) name and/or title, address, and telephone number of the individual duly authorized to act for and on behalf of the registrant in supervising the procedures identified in (B) above.

(ii) The registrant possessing or using depleted uranium under the general license established by (a) above shall report in writing to the department any changes in information furnished by him in department form MRH-12, "Registration Certificate--Use of Depleted Uranium Under General License". The report shall be submitted within 30 days after the effective date of such change.

(d) A person who receives, acquires, possesses, or uses depleted uranium pursuant to the general license established by (a) above:

(i) Shall not introduce such depleted uranium, in any form, into a chemical, physical, or metallurgical treatment or process, except a treatment or process for repair or restoration of any plating or other covering of the depleted uranium.

(ii) Shall not abandon such depleted uranium.

(iii) Shall transfer or dispose of such depleted uranium only by transfer in accordance with the provisions of ARM 37.14.547 . In the case where the transferee receives the depleted uranium pursuant to the general license established by (a) above, the transferor shall furnish the transferee a copy of this rule and a copy of department form MRH-12. In the case where the transferee receives the depleted uranium pursuant to a general license contained in the US nuclear regulatory commission's or agreement state's regulation equivalent to (a) above, the transferor shall furnish the transferee a copy of this rule and a copy of department form MRH-12 accompanied by a note explaining that use of the product or device is regulated by the US nuclear regulatory commission or agreement state under requirements substantially the same as those in this rule.

(iv) Within 30 days of any transfer, shall report in writing to the department the name and address of the person receiving the depleted uranium pursuant to such transfer.

(v) Shall not export such depleted uranium except in accordance with a license issued by the US nuclear regulatory commission pursuant to 10 CFR Part 110.

(e) Any person receiving, acquiring, possessing, using, or transferring depleted uranium pursuant to the general license established by (a) above is exempt from the requirements of ARM Title 37, chapter 14, subchapters 7 and 17, with respect to the depleted uranium covered by that general license.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.512 General Licenses: Radioactive Material Other Than Source Material

(1) A general license is hereby issued to transfer, receive, acquire, possess, and use radioactive material incorporated in the following devices or equipment which have been manufactured, tested and labeled by the manufacturer in accordance with a specific license issued to the manufacturer by the US nuclear regulatory commission for use pursuant to 10 CFR Part 31, section 31.3. This general license is subject to the provisions of ARM 37.14.107 , 37.14.108 , 37.14.115 , 37.14.116 , 37.14.506 (1) (b) , 37.14.526 , 37.14.547 , 37.14.550 , 37.14.552 , and Title 37, chapter 14, subchapters 7 and 17.

(a) Devices designed for use as static eliminators which contain, as a sealed source or sources, radioactive material consisting of a total of not more than 500 microcuries of polonium-210 per device.

(b) Devices designed for ionization of air which contain as a sealed source or sources, radioactive material consisting of a total of not more than 500 microcuries of polonium-210 per device or a total of not more than 50 millicuries of hydrogen-3 (tritium) per device.

(4)

(a) A general license is hereby issued to commercial and industrial firms and to research, educational and medical institutions, individuals in the conduct of their business, and state or local government agencies to receive, acquire, possess, use, or transfer in accordance with the provisions of (b) through (d) below, radioactive material, excluding special nuclear material, contained in devices designed and manufactured for the purpose of detecting, measuring, gauging or controlling thickness, density, level, interface location, radiation, leakage, or qualitative or quantitative chemical composition, or for producing light or an ionized atmosphere.

(b) The general license in (a) above applies only to radioactive material contained in devices which have been manufactured and labeled in accordance with the specifications contained in a specific license issued by the department pursuant to ARM 37.14.542 (4) or in accordance with the specifications contained in a specific license issued by the US nuclear regulatory commission, an agreement state or a licensing state, which authorizes distribution of devices to persons generally licensed by the US nuclear regulatory commission, an agreement state or a licensing state.

(c) Any person who receives, acquires, possesses, uses, or transfers radioactive material in a device pursuant to the general license in (a) above:

(i) shall assure that all labels affixed to the device at the time of receipt, and bearing a statement that removal of the label is prohibited, are maintained thereon and shall comply with all instructions and precautions provided by such labels;

(ii) shall assure that the device is tested for leakage of radioactive material and proper operation of the on/off mechanism and indicator, if any, at no longer than 6-month intervals or at such other intervals as are specified in the label, however,

(A) devices containing only krypton need not be tested for leakage of radioactive material, and

(B) devices containing only tritium or not more than 100 microcuries of other beta and/or gamma emitting material or 10 microcuries of alpha emitting material and devices held in storage in the original shipping container prior to initial installation need not be tested for any purpose;

(iii) shall assure that the tests required by (ii) above and other testing, installation, servicing, and removal from installation involving the radioactive materials, its shielding or containment, are performed:

(A) in accordance with the instructions provided by the labels, or

(B) by a person holding an applicable specific license from the department, the US nuclear regulatory commission, an agreement state or a licensing state to perform such activities;

(iv) shall maintain records showing compliance with the requirements of (ii) and (iii) above. The records shall show the results of tests. The records also shall show the dates of performance of, and the names of persons performing, testing, installing, servicing, and removing from installation concerning the radioactive material, its shielding or containment. Records of tests for leakage of radioactive material required by (ii) above shall be maintained for 1 year after the next required leak test is performed or until the sealed source is transferred or disposed of. Records of tests of the on/off mechanism and indicator required by (ii) above shall be maintained for 1 year after the next required test of the on/off mechanism and indicator is performed or until the sealed source is transferred or disposed of. Records which are required by (iii) above shall be maintained for a period of 2 years from the date of the recorded event or until the device is transferred or disposed of;

(v) Upon the occurrence of a failure of or damage to, or any indication of a possible failure of or damage to, the shielding of the radioactive material or the on/off mechanism or indicator, or upon the detection of 0.005 microcurie or more removable radioactive material, shall immediately suspend operation of the device until it has been repaired by the manufacturer or other person holding an applicable specific license from the department, the US nuclear regulatory commission, an agreement state or a licensing state to repair such devices, or disposed of by transfer to a person authorized by an applicable specific license to receive the radioactive material contained in the device and, within 30 days, furnish to the department a report containing a brief description of the event and the remedial action taken;

(vi) shall not abandon the device containing radioactive material;

(vii) except as provided in (viii) below, shall transfer or dispose of the device containing radioactive material only by transfer to a specific licensee of the department, the US nuclear regulatory commission, an agreement state, or a licensing state whose specific license authorizes him to receive the device and within 30 days after transfer of a device to a specific licensee shall furnish to the department a report containing identification of the device by manufacturer's name and model number and the name and address of the person receiving the device. No report is required if the device is transferred to the specific licensee in order to obtain a replacement device;

(viii) shall transfer the device to another general licensee:

(A) where the device remains in use at a particular location. In such case the transferor shall give the transferee a copy of this rule and any safety documents identified in the label on the device and within 30 days of the transfer, report to the department the manufacturer's name and model number of device transferred, the name and address of the transferee, and the name and/or position of an individual who may constitute a point of contact between the department and the transferee; or

(B) where the device is held in storage in the original shipping container at its intended location of use prior to initial use by a general licensee; and

(ix) shall comply with the provisions of ARM 37.14.751 and 37.14.755 , for reporting radiation incidents, theft, or loss of licensed material, but shall be exempt from the other requirements of ARM Title 37, chapter 14, subchapters 7 and 17.

(d) The general license in (a) above does not authorize the manufacture of devices containing radioactive material.

(e) The general license provided in (a) above is subject to the provisions of ARM 37.14.107 , 37.14.108 , 37.14.115 , 37.14.116 and 37.14.526 , 37.14.547 , 37.14.550 , and 37.14.552 .

(5)

(a) A general license is hereby issued to receive, acquire, possess, and use tritium or promethium-147 contained in luminous safety devices for use in aircraft, provided:

(i) each device contains not more than 10 curies of tritium or 300 millicuries of promethium-147; and

(ii) each device has been manufactured, assembled or imported in accordance with a specific license issued by the US nuclear regulatory commission, or each device has been manufactured or assembled in accordance with the specifications contained in a specific license issued by the department or any agreement state to the manufacturer or assembler of such device.

(b) Persons who receive, acquire, possess, or use luminous safety devices pursuant to the general license in (a) above are exempt from the requirements of ARM Title 37, chapter 17, subchapters 7 and 17, except that they shall comply with the provisions of ARM 37.14.751 and 37.14.755 .

(c) This general license does not authorize the manufacture, assembly, or repair of luminous safety devices containing tritium or promethium-147.

(d) This general license does not authorize the ownership, receipt, acquisition, possession or use of promethium-147 contained in instrument dials.

(e) This general license is subject to the provisions of ARM 37.14.107 , 37.14.108 , 37.14.115 , 37.14.116 , 37.14.526 , 37.14.547 , 37.14.550 , and 37.14.552 .

(6) A general license is hereby issued to own radioactive material without regard to quantity. Notwithstanding any other provisions of this subchapter, this general license does not authorize the manufacture, production, transfer, receipt, possession or use of radioactive material.

(7)

(a) A general license is hereby issued to those persons listed below to receive, acquire, possess, use, and transfer, in accordance with the provisions of (d) and (e) below, americium-241 in the form of calibration or reference sources:

(i) any person who holds a specific license issued by the department which authorizes him to receive, possess, use, and transfer radioactive material; and

(ii) any person who holds a specific license issued by the US nuclear regulatory commission which authorizes him to receive, possess, use, and transfer special nuclear material.

(b) A general license is hereby issued to receive, possess, use, and transfer plutonium in the form of calibration or reference sources in accordance with the provisions of (d) and (e) below to any person who holds a specific license issued by the department which authorizes him to receive, possess, use, and transfer radioactive material.

(c) A general license is hereby issued to receive, possess, use, and transfer radium-226 in the form of calibration or reference sources in accordance with the provisions of (d) and (e) below to any person who holds a specific license issued by the department which authorizes him to receive, possess, use, and transfer radioactive material.

(d) The general licenses in (a) , (b) and (c) above apply only to calibration or reference sources which have been manufactured in accordance with the specifications contained in a specific license issued to the manufacturer or importer of the sources by the US nuclear regulatory commission or which have been manufactured in accordance with the specification contained in a specific license issued to the manufacturer by the department, any agreement state or licensing state.

(e) The general licenses provided in (a) , (b) , and (c) above are subject to the provisions of ARM 37.14.107 , 37.14.108 , 37.14.115 , 37.14.116 , 37.14.526 , 37.14.547 , 37.14.550 , 37.14.552 , and Title 37, chapter 14, subchapters 7 and 17. In addition, persons who receive, acquire, possess, use, or transfer 1 or more calibration or reference sources pursuant to these general licenses:

( i ) shall not possess at any 1 time, at any 1 location of storage or use, more than 5 microcuries of americium-241, 5 microcuries of plutonium, or 5 microcuries of radium-226 in such sources;

(ii) shall not receive, possess, use, or transfer such source unless the source, or the storage container, bears a label which includes 1 of the following statements, as appropriate, or a substantially similar statement which contains the information called for in 1 of the following statements, as appropriate:

(A) The receipt, possession, use and transfer of this source, Model , Serial No. , are subject to a general license and the regulations of the US nuclear regulatory commission or of a state with which the commission has entered into an agreement for the exercise of regulatory authority. Do not remove this label.

CAUTION--RADIOACTIVE MATERIAL-- THIS SOURCE CONTAINS

(AMERICIUM-241 or PLUTONIUM--show only the name of the appropriate material.)

DO NOT TOUCH RADIOACTIVE PORTION OF THIS SOURCE.

Name of manufacturer of importer

(B) The receipt, possession, use and transfer of this source, Model ,

Serial No. , are subject to a general license and the regulations of any licensing

state. Do not remove this label. CAUTION--RADIOACTIVE MATERIAL--THIS SOURCE

CONTAINS RADIUM-226. DO NOT TOUCH RADIOACTIVE PORTION OF THIS SOURCE.

Name of manufacturer or importer

(iii) shall not transfer, abandon, or dispose of such source except by transfer to a person authorized by a license from the department, the US nuclear regulatory commission, an agreement state or a licensing state to receive the source;

(iv) shall store such source, except when the source is being used, in a closed container adequately designed and constructed to contain americium-241, plutonium, or radium-226 which might otherwise escape during storage; and

(v) shall not use such source for any purpose other than the calibration of radiation detectors or the standardization of other sources.

(f) These general licenses do not authorize the manufacture of calibration or reference sources containing americium-241, plutonium, or radium-226.

(8)

(a) A general license is hereby issued to any physician to receive, possess, transfer, or use radioactive material set forth below for the stated diagnostic uses, provided, however, that the use is in accordance with the provision of (b) , (c) and (d) below, the radioactive material is in the form of capsules, disposable syringes, or other prepackaged individual doses; and the radioactive material has been manufactured in accordance with a specific license issued by the department pursuant to ARM

( i ) iodine-131 as sodium iodide (Na 131 I) for measurement of thyroid uptake;

(ii) iodine-131 as iodinated human serum albumin (IHSA) for determinations of blood and blood plasma volume;

(iii) iodine-125 as iodinated human serum albumin (IHSA) for determinations of blood and blood plasma volume;

(iv) ( reserved )

(v) cobalt-58 for the measurement of intestinal absorption of cyanocobalamin ;

(vi) cobalt-60 for the measurement of intestinal absorption of cyanocobalamin ; and

(vii) chromium-51 as sodium radiochromate for determination of red blood cell volumes and studies of red blood cell survival time.

(b) No physician shall receive, possess, use, or transfer radioactive material pursuant to the general license established by (a) above until he has filed department form MRH-10, "Certificate--Medical Use of Radioactive Material Under General License" with the department and received from the department a validated copy of the department form MRH-10 with certification number assigned. The generally licensed physician shall furnish on department form MRH-10 the following information and such other information as may be required by that form:

(i) name and address of the generally licensed physician;

(ii) a statement that the generally licensed physician is a duly licensed physician (authorized to dispense drugs) in the practice of medicine in Montana; and

(iii) a statement that the generally licensed physician has appropriate radiation measuring instruments to carry out the diagnostic procedures for which he proposes to use radioactive material under the general license of this (8) and that he is competent in the use of such instruments.

(c) A physician who receives, possesses, or uses a pharmaceutical containing radioactive material pursuant to the general license established by (a) above shall comply with the following:

(i) He shall not possess at any 1 time, pursuant to the general license in (a) above more than:

(A) 200 microcuries of iodine-131,

(B) 200 microcuries of iodine-125,

(D) 5 microcuries of cobalt-58,

(E) 5 microcuries of cobalt-60, and

(F) 200 microcuries of chromium-51;

(ii) he shall store the pharmaceutical in the original shipping container, or a container providing equivalent radiation protection until administered;

(iii) he shall use the pharmaceutical only for the uses authorized by (a) above;

(iv) he shall not administer the pharmaceutical to a woman with confirmed pregnancy or to a person under 18 years of age; and

(v) he shall not transfer the radioactive material to a person who is not authorized to receive it pursuant to a license issued by the department, the US nuclear regulatory commission, any agreement state or licensing state, or in any manner other than in the unopened, labeled shipping container as received from the supplier, except by administering it to a patient.

(d) The generally licensed physician possessing or using radioactive material under the general license of (a) above shall report in duplicate to the department, any changes in the information furnished by him in the "Certificate--Medical Use of Radioactive Material Under General License", department form MRH-10. The report shall be submitted within 30 days after the effective date of such change.

(e) Any person using radioactive material pursuant to the general license of (a) above is exempt from the requirements of ARM Title 37, chapter 14, subchapters 7 and 17, with respect to the radioactive material covered by the general license.

(9)

(a) A general license is hereby issued to any physician, clinical laboratory or hospital to receive, acquire, possess, transfer, or use, for any of the following stated tests, in accordance with the provisions of (b) through (f) below, the following radioactive materials in prepackaged units:

(i) Iodine-125, in units not exceeding 10 microcuries each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(ii) Iodine-131, in units not exceeding 10 microcuries each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(iii) Carbon-14, in units not exceeding 10 microcuries each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(iv) Hydrogen-3 (tritium) , in units not exceeding 50 microcuries each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(v) Iron-59, in units not exceeding 20 microcuries each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(vi) Cobalt-57, in units not exceeding 10 microcuries each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(vii) Selenium-75, in units not to exceed 10 microcuries each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(viii) Mock Iodine-125 reference or calibration sources, in units not exceeding 0.05 microcurie of iodine-129 and 0.005 microcurie of americium-241 each for use in in vitro clinical or laboratory tests not involving internal or external administration of radioactive material, or the radiation therefrom, to human beings or animals.

(b) No person shall receive, acquire, possess, use or transfer radioactive material pursuant to the general license established by (a) above until he has filed department form MRH-11, "Certificate--In Vitro Testing with Radioactive Material Under General License", with the department and received from the department a validated copy of department form MRH-11 with certification number assigned, or until he has been authorized pursuant to ARM 37.14.540 (3) (c) to use radioactive material under the general license in (9) . The physician, clinical laboratory or hospital shall furnish on department form MRH-11 the following information and such other information as may be required by that form:

(i) name and address of the physician, clinical laboratory or hospital;

(ii) the location of use; and

(iii) a statement that the physician, clinical laboratory or hospital has appropriate radiation measuring instruments to carry out in vitro clinical or laboratory tests with radioactive material as authorized under the general license in (a) above and that such tests will be performed only by personnel competent in the use of such instruments and in the handling of the radioactive material.

(c) A person who receives, acquires, possesses or uses radioactive material pursuant to the general license established by (a) above shall comply with the following:

(i) The general licensee shall not possess at any 1 time, pursuant to the general license in (a) above, at any 1 location of storage or use, a total amount of iodine-125, iodine-131, selenium-75, iron-59, and/or cobalt-57 in excess of 200 microcuries.

(ii) The general licensee shall store the radioactive material, until used, in the original shipping container or in a container providing equivalent radiation protection.

(iii) The general licensee shall use the radioactive material only for the uses authorized by (a) above.

(iv) The general licensee shall not transfer the radioactive material to a person who is not authorized to receive it pursuant to a license issued by the department, the US nuclear regulatory commission, any agreement state or licensing state, nor transfer the radioactive material in any manner other than in the unopened, labeled shipping container as received from the supplier.

(v) The general licensee shall dispose of the mock iodine-125 reference or calibration sources described in (a) (viii) above as required by ARM 37.14.740 .

(d) The general licensee shall not receive, acquire, possess, or use radioactive material pursuant to (a) above:

(i) Except as prepackaged units which are labeled in accordance with the provisions of an applicable specific license issued pursuant to ARM 37.14.542 (8) in accordance with the provisions of a specific license issued by the US nuclear regulatory commission, any agreement state or licensing state which authorizes the manufacture and distribution of iodine-125, iodine-131, carbon-14, hydrogen-3 (tritium) , iron-59, selenium-75, cobalt-57, or mock iodine-125 to persons generally licensed under (9) or its equivalent, and

(ii) unless 1 of the following statements, as appropriate, or a substantially similar statement which contains the information called for in 1 of the following statements, appears on a label affixed to each prepackaged unit or appears in a leaflet or brochure which accompanies the package:

(A) This radioactive material shall be received, acquired, possessed, and used only by

physicians, clinical laboratories or hospitals and only for in vitro clinical or laboratory tests

not involving internal or external administration of the material, or the radiation therefrom, to

human beings or animals. Its receipt, acquisition, possession, use, and transfer are subject

to the regulations and a general license of the US nuclear regulatory commission or of a state

with which the commission has entered into an agreement for the exercise of regulatory authority.

Name of manufacturer

(B) This radioactive material shall be received, acquired, possessed, and used only by

physicians, clinical laboratories or hospitals and only for in vitro clinical or laboratory tests

not involving internal or external administration of the material, or the radiation therefrom,

to human beings or animals. Its receipt, acquisition, possession, use and transfer are subject

to the regulations and a general license of a licensing state.

Name of manufacturer

(e) The physician, clinical laboratory or hospital possessing or using radioactive material under the general license of (a) above shall report in writing to the department, any changes in the information furnished by him in the "Certificate--In Vitro Testing with Radioactive Material Under General License", department form MRH-11. The report shall be furnished within 30 days after the effective date of such change.

(f) Any person using radioactive material pursuant to the general license of (a) above is exempt from the requirements of ARM Title 37, chapter 14, subchapters 7 and 17, with respect to radioactive material covered by that general license, except that such persons using the mock iodine-125 described in (a) (viii) above shall comply with the provisions of ARM 37.14.740 , 37.14.751 , and 37.14.755 .

(10)

(a) A general license is hereby issued to receive, acquire, possess, use, and transfer strontium-90 contained in ice detection devices, provided each device contains not more than 50 microcuries of strontium-90 and each device has been manufactured or imported in accordance with a specific license issued by the US nuclear regulatory commission or each device has been manufactured in accordance with the specifications contained in a specific license issued by the department or any agreement state to the manufacturer of such device.

(b) Persons who receive, acquire, possess, use, or transfer strontium-90 contained in ice detection devices pursuant to the general license in (a) above:

(i) shall, upon occurrence of visually observable damage, such as a bend or crack or discoloration from overheating to the device, discontinue use of the device until it has been inspected, tested for leakage and repaired by a person holding a specific license from the US nuclear regulatory commission or an agreement state to manufacture or service such devices; or shall dispose of the device pursuant to the provisions of ARM 37.14.740 .

(ii) shall assure that all labels affixed to the device at the time of receipt, and which bear a statement which prohibits removal of the labels, are maintained thereon; and

(iii) are exempt from the requirements of ARM Title 37, chapter 14, subchapters 7 and 17, except that such persons shall comply with the provisions of ARM 37.14.740 , 37.14.751 , and 37.14.755 .

(c) This general license does not authorize the manufacture, assembly, disassembly or repair of strontium-90 in ice detection devices.

(d) This general license is subject to the provisions of ARM 37.14.107 , 37.14.108 , 37.14.115 , 37.14.116 , 37.14.526 , 37.14.547 , 37.14.550 , and 37.14.552 .

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.513 General Licenses: Intrastate Transportation of Radioactive Material

(1) A general license is hereby issued to any common or contract carrier to transport and store radioactive material in the regular course of their carriage for another or storage incident thereto, provided the transportation and storage is in accordance with the applicable requirements of the regulations, appropriate to the mode of transport, of the US department of transportation insofar as such regulations relate to the loading and storage of packages, placarding of the transporting vehicle, and incident reporting. Any notification of incidents referred to in those requirements shall be filed with, or made to, the department. Persons who transport and store radioactive material pursuant to the general license in this subsection are exempt from the requirements of ARM Title 37, chapter 14, subchapters 7 and 17.

(2) A general license is hereby issued to any private carrier to transport radioactive material, provided the transportation is in accordance with the applicable requirements of the regulations, appropriate to the mode of transport, of the US department of transportation insofar as such regulations relate to the loading and storage of packages, placarding of the transporting vehicle, and incident reporting. Any notification of incidents referred to in those requirements shall be filed with, or made to, the department.

(a) Persons who transport radioactive material pursuant to the general license in (2) are exempt from the requirements of ARM Title 37, chapter 14, subchapters 7 and 17, to the extent that they transport radioactive material.

(b) Physicians, as defined in ARM 37.14.102 are exempt from the requirements of (2) to the extent that they transport radioactive material for use in the practice of medicine.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.520 Specific Licenses: Filing Application for Specific Licenses

(1) Applications for specific licenses shall be filed on a form prescribed by the department.

(2) The department may at any time after the filing of the original application, and before the expiration of the license, require further statements in order to enable the department to determine whether the application should be granted or denied or whether a license should be modified or revoked.

(3) Each application shall be signed by the applicant or licensee or a person duly authorized to act for and on his behalf.

(4) An application for a license may include a request for a license authorizing 1 or more activities.

(5) In his application, the applicant may incorporate by reference information contained in previous applications, statements, or reports filed with the department provided such references are clear and specific.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.521 Specific Licenses: General Requirements for the Issuance of Specific Licenses

A license application will be approved if the department determines that:

(1) the applicant is qualified by reason of training and experience to use the material in question for the purpose requested in accordance with this chapter in such a manner as to minimize danger to public health and safety or property;

(2) the applicant's proposed equipment, facilities, and procedures are adequate to minimize danger to public health and safety or property;

(3) the issuance of the license will not be inimical to the health and safety of the public; and

(4) the applicant satisfies any applicable special requirements in ARM 37.14.540 , 37.14.541 , or 37.14.542 .

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.522 Specific Licenses: Issuance of

(1) Upon a determination that an application meets the requirements of the act and the rules of the department, the department will issue a specific license authorizing the proposed activity in such form and containing such conditions and limitations as it deems appropriate or necessary.

(2) The department may incorporate in any license at the time of issuance, or thereafter by appropriate rule, regulation, or order, such additional requirements and conditions with respect to the licensee's receipt, possession, use, and transfer of radioactive material subject to this subchapter as it deems appropriate or necessary in order to:

(a) minimize danger to public health and safety or property;

(b) require such reports and the keeping of such records, and to provide for such inspections of activities under the license as may be appropriate or necessary; and

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.526 Specific Licenses: Specific Terms and Conditions of License

(1) Each license issued pursuant to this subchapter shall be subject to all the provisions of the act, now or hereafter in effect, and to all rules, regulations, and orders of the department.

(2) No license issued or granted under this subchapter and no right to possess or utilize radioactive material granted by any license issued pursuant to this subchapter shall be transferred, assigned, or in any manner disposed of, either voluntarily or involuntarily, directly or indirectly, through transfer of control of any license to any person unless the department shall, after securing full information find that the transfer is in accordance with the provisions of the act, and shall give its consent in writing.

(3) Each person licensed by the department pursuant to this subchapter shall confine his use and possession of the material licensed to the locations and purposes authorized in the license.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.527 Specific Licenses: Expiration of Licenses

(1) Except as provided in ARM 37.14.528 (2) , each specific license shall expire at the end of the day, in the month and year stated therein.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.528 Specific Licenses: Renewal of License

(1) Applications for renewal of specific licenses shall be filed in accordance with ARM 37.14.520 .

(2) In any case in which a licensee, not less than 30 days prior to expiration of his existing license, has filed an application in proper form for renewal or for a new license authorizing the same activities, such existing license shall not expire until the application has been finally determined by the department.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.529 Specific Licenses: Amendment of Licenses at Request of Licensee

(1) Applications for amendment of a license shall be filed in accordance with ARM 37.14.520 and shall specify the respects in which the licensee desires his license to be amended and the grounds for such amendment.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.535 Specific Licenses: Department Action on Applications to Renew and Amend

(1) In considering an application by a licensee to renew or amend his license, the department will apply the criteria set forth in ARM 37.14.521 , 37.14.540 , 37.14.541 or 37.14.542 , as applicable.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.540 Specific Licenses: Special Requirements for Issuance of Certain Specific Licenses for Radioactive Material

(1) In addition to the requirements set forth in ARM 37.14.521 , a specific license for human use of radioactive material in institutions will be issued if:

(a) the applicant has appointed a medical isotopes committee of at least 3 members to evaluate all proposals for research, diagnostic, and therapeutic use of radioactive material within that institution. Membership of the committee should include physicians expert in internal medicine, hematology, therapeutic radiology, and a person experienced in assay of radioactive material and protection against radiation;

(b) the applicant possesses adequate facilities for the clinical care of patients;

(c) the physician designated on the application as the individual user has substantial experience in the handling and administration of radioactive material and, where applicable, the clinical management of radioactive patients; and

(d) if the application is for a license to use unspecified quantities or multiple types of radioactive material, the applicant's staff has substantial experience in the use of a variety of radioactive materials for a variety of human uses.

(2)

(a) An application by an individual physician or group of physicians for a specific license for human use of radioactive material will be approved if:

(i) the applicant satisfies the general requirements specified in ARM 37.14.521 ;

(ii) the application is for use in the applicant's practice in an office outside a medical institution;

(iii) the applicant has access to a hospital possessing adequate facilities to hospitalize and monitor the applicant's radioactive patients whenever it is advisable; and

(iv) the applicant has extensive experience in the proposed use, the handling and administration of radionuclides, and where applicable, the clinical management of radioactive patients.

(b) The department will not approve an application by an individual physician or group of physicians for a specific license to receive, possess, or use radioactive material on the premises of a medical institution unless:

(i) the use of radioactive material is limited to:

(A) the administration of radiopharmaceuticals for diagnostic or therapeutic purposes,

(B) the performance of diagnostic studies on patients to whom a radiopharmaceutical has been administered,

(D) the calibration and quality control checks of radioactive assay instrumentation, radiation safety instrumentation and diagnostic instrumentation;

(ii) the physician brings the radioactive material with him and removes the radioactive material when he departs. (The institution cannot receive, possess, or store radioactive material other than the amount of material remaining in the patient) ; and

(iii) the medical institution does not hold a radioactive material license under (1) of this rule.

(3)

(a) Subject to the provisions of (b) , (c) , and (d) below, an application for a specific license pursuant to (1) , (2) , or (4) of this rule for any medical use or uses of radioactive material specified in 1 or more of Groups I to VI, inclusive, of Schedule C of this subchapter will be approved for all of the uses within the group or groups which include the use or uses specified in the application if:

(i) the applicant satisfies the requirements of (1) , (2) , or (4) of this rule;

(ii) the applicant, or the physician designated in the application as the individual user, has adequate clinical experience in the types of uses included in the group or groups;

(iii) the applicant, or the physicians and all other personnel who will be involved in the preparation and use of the radioactive material, have adequate training and experience in the handling of radioactive material appropriate to their participation in the uses included in the group or groups;

(iv) the applicant's radiation detection and measuring instrumentation is adequate for conducting the procedures involved in the uses included in the group or groups; and

(v) the applicant's radiation safety operating procedures are adequate for handling and disposal of the radioactive material involved in the uses included in the group or groups.

(b) Any licensee or registrant who is authorized to use radioactive material pursuant to 1 or more groups in (a) above and Schedule C of this subchapter is subject to the following conditions:

(i) For groups I, II, IV, and V, no licensee or registrant shall receive, possess, or use radioactive material except as a radiopharmaceutical manufactured in the form to be administered to the patient, labeled, packaged, and distributed in accordance with a specific license issued by the department pursuant to ARM 37.14.542 (10) , a specific license issued by the US nuclear regulatory commission, or a specific license issued by an agreement state or a licensing state pursuant to equivalent regulations.

(ii) For Group III, no licensee or registrant shall receive, possess, or use generators or reagent kits containing radioactive material or shall use reagent kits that do not contain radioactive material to prepare radiopharmaceuticals containing radioactive material, except:

(A) reagent kits not containing radioactive material that are approved by the department, the US nuclear regulatory commission, an agreement state or a licensing state for use by persons licensed pursuant to (3) and Schedule C of this subchapter or equivalent regulations; or

(B) generators or reagent kits containing radioactive material that are manufactured, labeled, packaged, and distributed in accordance with a specific license issued by the department pursuant to ARM 37.14.542 (11) , a specific license issued by the US nuclear regulatory commission, or a specific license issued by an agreement state or a licensing state pursuant to equivalent regulations.

(iii) For Group VI, no licensee or registrant shall receive, possess, or use radioactive material except as contained in a source or device that has been manufactured, labeled, packaged, and distributed in accordance with a specific license issued by the department pursuant to ARM 37.14.542 (12) , a specific license issued by the US nuclear regulatory commission, or a specific license issued to the manufacturer by an agreement state or a licensing state pursuant to equivalent regulations.

(iv) For Group III, any licensee or registrant who uses generators or reagent kits shall elute the generator or process radioactive material with the reagent kit in accordance with instructions which are approved by the department, the US nuclear regulatory commission, an agreement state or a licensing state and are furnished by the manufacturer on the label attached to or in the leaflet or brochure which accompanies the generator or reagent kit.

(v) For Group VI any licensee who possesses and uses sources or devices containing radioactive material shall:

(A) cause each source or device containing more than 100 microcuries of radioactive material with a half-life greater than 30 days, except iridium-192 seeds encased in nylon ribbon, to be tested for contamination and/or leakage at intervals not to exceed 6 months or at such other intervals as are approved by the department, the US nuclear regulatory commission, an agreement state or a licensing state and described by the manufacturer on the label attached to the source, device, or permanent container thereof, or in the leaflet or brochure which accompanies the source or device. Each source or device shall be so tested prior to its first use unless the supplier furnishes a certificate that the source or device has been so tested within 6 months prior to the transfer;

(B) assure that the test required by (A) above shall be capable of detecting the presence of 0.005 microcurie of radioactive material on the test sample or in the case of radium, the escape of radon at the rate of 0.001 microcurie per 24 hours. The test sample shall be taken from the source or from the surfaces of the device in which the source is permanently or semi-permanently mounted or stored on which one might expect contamination to accumulate. Records of leak test results shall be kept in units of microcuries and maintained for inspection by the department;

(C) if the test required by (A) above reveals the presence of 0.005 microcurie or more of removable contamination or in the case of radium, the escape of radon at the rate of 0.001 microcurie per 24 hours, immediately withdraw the source from use and cause it to be decontaminated and repaired or to be disposed of in accordance with department rules. A report shall be filed within 5 days of the test with the department, describing the equipment involved, the test results, and the corrective action taken;

(D) follow the radiation safety and handling instructions approved by the department, the US nuclear regulatory commission, an agreement state or a licensing state and furnished by the manufacturer on the label attached to the source, device or permanent container thereof, or in the leaflet or brochure which accompanies the source or device, and maintain such instruction in a legible and conveniently available form;

(E) conduct a quarterly physical inventory to account for all sources and devices received and possessed. Records of the inventories shall be maintained for inspection by the department and shall include the quantities and kinds of radioactive material, location of sources and devices, and the date of the inventory;

(F) assure that needles or standard medical applicator cells containing radium-226, or cobalt-60 as wire are not opened while in the licensee's possession unless specifically authorized by a license issued to him by the department; and

(G) assure that patients containing cobalt-60, cesium-137, iridium-192 and/or radium-226 implants shall remain hospitalized until the implants are removed.

(c) Any licensee who is licensed pursuant to (3) (a) above for 1 or more of the medical use groups in Schedule C of this subchapter also is authorized to use radioactive material under the general license in ARM 37.14.512 (9) for the specified in vitro uses without filing department form MRH-11 as required in ARM 37.14.512 (9) (b) ; provided, that the licensee is subject to the other provisions of ARM 37.14.512 (9) .

(d) Any licensee who is licensed pursuant to (3) (a) above for 1 or more of the medical use groups in Schedule C of this subchapter also is authorized, subject to the provisions of (d) and (e) below, to receive, possess, and use for calibration and reference standards:

(i) any radioactive material listed in Group I, Group II, or Group III of Schedule C of this subchapter with a half-life not longer than 100 days, in amounts not to exceed 15 millicuries total;

(ii) any radioactive material listed in Group I, Group II, or Group III of Schedule C of this subchapter with half-life greater than 100 days in amounts not to exceed 200 microcuries total;

(iii) technetium-99m in amounts not to exceed 30 millicuries; and

(iv) any radioactive material, in amounts not to exceed 3 millicuries per source, contained in calibration or reference sources that have been manufactured, labeled, packaged, and distributed in accordance with a specific license issued by the department pursuant to ARM 37.14.542 (12) , a specific license issued by the US nuclear regulatory commission, or a specific license issued to the manufacturer by an agreement state or a licensing state pursuant to equivalent regulations.

(e)

(i) Any licensee or registrant who possesses sealed sources as calibration or reference sources pursuant to (d) above shall cause each sealed source containing radioactive material, other than hydrogen-3, with a half-life greater than 30 days in any form other than gas to be tested for leakage and/or contamination at intervals not to exceed 6 months. In the absence of a certificate from a transferor indicating that a test has been made within 6 months prior to the transfer, the sealed sources should not be used until tested, provided, however, that no leak tests are required when:

(A) the source contains 100 microcuries or less of beta and/or gamma emitting material or 10 microcuries or less of alpha emitting material, or

(B) the sealed source is stored and is not being used; such sources shall, however, be tested for leakage prior to any use or transfer unless they have been leak tested within 6 months prior to the date of use or transfer.

(ii) The leak test shall be capable of detecting the presence of 0.005 microcuries of radioactive material on the test sample. The test sample shall be taken from the sealed source or from the surfaces of the device in which the sealed source is mounted or stored on which contamination might be expected to accumulate. Records of leak test results shall be kept in units of microcuries and maintained for inspection by the department.

(iii) If the leak test reveals the presence of 0.005 microcuries or more of removable contamination, the licensee or registrant shall immediately withdraw the sealed source from use and shall cause it to be decontaminated and repaired or to be disposed of in accordance with ARM Title 37, chapter 14, subchapters 5 and 7. A report shall be filed within 5 days of the test with the department describing the equipment involved, the test results, and the corrective action taken.

(f) Any licensee or registrant who possesses and uses calibration and reference sources pursuant to (d) (iv) above shall:

(i) follow the radiation safety and handling instructions approved by the department, the US nuclear regulatory commission, an agreement state or a licensing state and furnished by the manufacturer on the label attached to the source, or permanent container thereof, or in the leaflet or brochure that accompanies the source, and maintain such instruction in a legible and conveniently available form; and

(ii) conduct a quarterly physical inventory to account for all sources received and possessed. Records of the inventories shall be maintained for inspection by the department and shall include the quantities and kinds of radioactive material, location of sources, and the date of the inventory.

(4) In addition to the requirements set forth in ARM 37.14.521 , a specific license for human use of sealed sources will be issued only if the applicant or, if the application is made by an institution, the individual user:

(a) has specialized training in the diagnostic or therapeutic use of the sealed source considered, or has experience equivalent to such training, and

(b) is a physician.

(5) In addition to the requirements set forth in ARM 37.14.521 , a specific license for use of sealed sources in industrial radiography will be issued if:

(a) the applicant will have an adequate program for training radiographers and radiographer's assistants and submits to the department a schedule or description of such program which specifies the:

(i) initial training,

(ii) periodic training,

(iii) on-the-job training,

(iv) means to be used by the licensee to determine the radiographer's knowledge and understanding of an ability to comply with department rules and licensing requirements, and the operating and emergency procedures of the applicant, and

(v) means to be used by the licensee to determine the radiographer's assistant's knowledge and understanding of and ability to comply with the operating and emergency procedures of the applicant;

(b) the applicant has established and submits to the department satisfactory written operating and emergency procedures;

(c) the applicant will have an adequate internal inspection system, or other management control, to assure that license provisions, rules, and the applicant's operating and emergency procedures are followed by radiographers and radiographer's assistants;

(d) the applicant submits to the department a description of his overall organizational structure pertaining to the industrial radiography program, including specified delegations of authority and responsibility for operation of the program;

(e) the applicant who desires to conduct his own leak tests has established adequate procedures to be followed in leak testing sealed sources for possible leakage and contamination and submits to the department a description of such procedures including:

(i) instrumentation to be used,

(ii) method of performing tests, e.g., points on equipment to be smeared and method of taking smear, and

(iii) pertinent experience of the person who will perform the test; and

(f) the licensee shall conduct a program for inspection and maintenance of radiographic exposure devices and storage containers to assure proper functioning of components important to safety.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.541 Specific Licenses: Special Requirements for Specific Licenses of Broad Scope

(1) This rule prescribes requirements for the issuance of specific licenses of broad scope for radioactive material ("broad licenses") and certain rules governing holders of such licenses. Authority to transfer possession of control by the manufacturer, processor, or producer of any equipment, device, commodity, or other product containing by-product material whose subsequent possession, use, transfer, and disposal by all other persons are exempted from regulatory requirements may be obtained only from the US Nuclear Regulatory Commission, Washington, DC 20555.

(2) The different types of broad licenses are set forth below:

(a) "Type A specific license of broad scope" is a specific license authorizing receipt, acquisition, ownership, possession, use and transfer of any chemical or physical form of the radioactive material specified in the license, but not exceeding quantities specified in the license, for any authorized purposes. The quantities specified are usually in the multi-curie range.

(b) A "Type B specific license of broad scope" is a specific license authorizing receipt, acquisition, ownership, possession, use and transfer of any chemical or physical form of radioactive material specified in Schedule D of this subchapter, for any authorized purposes. The possession limit for a Type B broad license, if only 1 radionuclide is possessed thereunder, is the quantity specified for that radionuclide in Schedule D, Column I. If 2 or more radionuclides are possessed thereunder, the possession limit for each is determined as follows: For each radionuclide, determine the ratio of the quantity possessed to the applicable quantity specified in Schedule D, Column I, for that radionuclide. The sum of the ratios for all radionuclides possessed under the license shall not exceed unity.

(c) A "Type C specific license of broad scope" is a specific license authorizing receipt, acquisition, ownership, possession, use and transfer of any chemical or physical form of radioactive material specified in Schedule D of this subchapter, for any authorized purpose. The possession limit for a Type C broad license, if only 1 radionuclide is possessed thereunder, is the quantity specified for that radionuclide in Schedule D, Column II. If 2 or more radionuclides are possessed thereunder, the possession limit is determined for each as follows: For each radionuclide determine the ratio of the quantity possessed to the applicable quantity specified in Schedule D, Column II for that radionuclide. The sum of the ratios for all radionuclides possessed under the license shall not exceed unity.

(3) An application for a Type A specific license of broad scope will be approved if:

(a) the applicant satisfies the general requirements specified in ARM 37.14.521 ;

(b) the applicant has engaged in a reasonable number of activities involving the use of radioactive material; and

(c) the applicant has established administrative controls and provisions relating to organization and management, procedures, record keeping, material control and accounting, and management review that are necessary to assure safe operations, including:

(i) the establishment of a radiation safety committee composed of such persons as a radiation safety officer, a representative of management, and persons trained and experienced in the safe use of radioactive material;

(ii) the appointment of a radiation safety officer who is qualified by training and experience in radiation protection, and who is available for advice and assistance on radiation safety matters; and

(iii) the establishment of appropriate administrative procedures to assure:

(A) control of procurement and use of radioactive material;

(B) completion of safety evaluations of proposed uses of radioactive material which take into consideration such matters as the adequacy of facilities and equipment, training and experience of the user, and the operating or handling procedures; and

(C) review, approval, and recording by the radiation safety committee of safety evaluations of proposed uses prepared in accordance with (B) above prior to use of the radioactive material.

(4) An application for a Type B specific license of broad scope will be approved if:

(a) the applicant satisfies the general requirements specified in ARM 37.14.521 ; and

(b) the applicant has established administrative controls and provisions relating to organization and management, procedures, record keeping, material control and accounting, and management review that are necessary to assure safe operations, including:

(i) the appointment of a radiation safety officer who is qualified by training and experience in radiation protection, and who is available for advice and assistance on radiation safety matters, and

(ii) the establishment of appropriate administrative procedures to assure:

(A) control of procurement and use of radioactive material,

(C) review, approval, and recording by the radiation safety officer of safety evaluations of proposed uses prepared in accordance with (B) above prior to use of the radioactive material.

(5) An application for a Type C specific license of broad scope will be approved if:

(a) the applicant satisfies the general requirements specified in ARM 37.14.521 ;

(b) the applicant submits a statement that radioactive material will be used only by, or under the direct supervision of, individuals who have received:

(i) a college degree at the bachelor level, or equivalent training and experience, in the physical or biological sciences or in engineering, and

(ii) at least 40 hours of training and experience in the safe handling of radioactive material, and in the characteristics of ionizing radiation, units of radiation dose and quantities, radiation detection instrumentation, and biological hazards of exposure to radiation appropriate to the type and forms of radioactive material to be used; and

(c) the applicant has established administrative controls and provisions relating to procurement of radioactive material, procedures, record keeping, material control and accounting, and management review necessary to assure safe operations.

(6) Specific licenses of broad scope are subject to the following conditions:

(a) Unless specifically authorized, persons licensed pursuant to this rule shall not:

(i) conduct tracer studies in the environment involving direct release of radioactive material;

(ii) receive, acquire, own, possess, use or transfer devices containing 100,000 curies or more of radioactive material in sealed sources used for irradiation of materials;

(iii) conduct activities for which a specific license issued by the department under ARM 37.14.540 or 37.14.542 is required; or

(iv) add or cause the addition of radioactive material to any food, beverage, cosmetic, drug, or other product designed for ingestion or inhalation by, or application to, a human being.

(b) Each Type A specific license of broad scope issued under this subchapter shall be subject to the condition that radioactive material possessed under the license may only be used by, or under the direct supervision of, individuals approved by the licensee's radiation safety committee.

(c) Each Type B specific license of broad scope issued under this subchapter shall be subject to the condition that radioactive material possessed under the license may only be used by, or under the direct supervision of, individuals approved by the licensee's radiation safety officer.

(d) Each Type C specific license of broad scope issued under this subchapter shall be subject to the condition that radioactive material possessed under the license may only be used by, or under the direct supervision of, individuals who satisfy the requirements of (5) of this rule.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.542 Specific Licenses: Special Requirements for a Specific License to Manufacture, Assemble, Repair, or Distribute Commodities, Products, or Devices Which Contain Radioactive Material

(1)

(a) In addition to the requirements set forth in ARM

(i) the applicant submits a description of the product or material into which the radioactive material will be introduced, intended use of the radioactive material and the product or material into which it is introduced, method of introduction, initial concentration of the radioactive material in the product or material, control methods to assure that no more than the specified concentration is introduced into the product or material, estimated time interval between introduction and transfer of the product or material, and estimated concentration of the radioactive material in the product or material at the time of transfer; and

(ii) the applicant provides reasonable assurance that the concentrations of radioactive material at the time of transfer will not exceed the concentrations in Schedule A of this subchapter, that reconcentrating of the radioactive material in concentrations exceeding those in Schedule A is not likely, that use of lower concentrations is not feasible, and that the product or material is not likely to be incorporated in any food, beverage, cosmetic, drug or other commodity or product designed for ingestion or inhalation by, or application to, a human being.

(b) Each person licensed under (1) shall file an annual report with the department which shall identify the type and quantity of each product or material into which radioactive material has been introduced during the reporting period; name and address of the person who owned or possessed the product or material, into which radioactive material has been introduced, at the time of introduction; the type and quantity of radionuclide introduced into each such product or material; and the initial concentrations of the radionuclide in the product or material at time of transfer of the radioactive material by the licensee. If no transfers of radioactive material have been made pursuant to (1) during the reporting period, the report shall so indicate. The report shall cover the year ending June 30, and shall be filed within 30 days thereafter.

(2) Authority to transfer possession or control by the manufacturer, processor, or producer of any equipment, device, commodity, or other product containing by-product material whose subsequent possession, use, transfer, and disposal by all other persons are exempted from regulatory requirements may be obtained only from the US Nuclear Regulatory Commission, Washington, DC 20555.

(a) An application for a specific license to distribute naturally-occurring and accelerator-produced radioactive materials (NARM) to persons exempted from this subchapter pursuant to ARM 37.14.506 (2) will be approved if:

(i) the radioactive material is not contained in any food, beverage, cosmetic, drug, or other commodity designed for ingestion or inhalation by, or application to, a human being;

(ii) the radioactive material is in the form of processed chemical elements, compounds, or mixtures, tissue samples, bioassay samples, counting standards, plated or encapsulated sources, or similar substances, identified as radioactive and to be used for its radioactive properties, but is not incorporated into any manufactured or assembled commodity, product, or device intended for commercial distribution; and

(iii) the applicant submits copies of prototype labels and brochures and the department approves such labels and brochures.

(b) The license issued under (a) above is subject to the following conditions:

(i) No more than 10 exempt quantities shall be sold or transferred in any single transaction. However, an exempt quantity may be composed of fractional parts of 1 or more of the exempt quantity provided the sum of the fractions shall not exceed unity.

(ii) Each exempt quantity shall be separately and individually packaged. No more than 10 such packaged exempt quantities shall be contained in any outer package for transfer to persons exempt pursuant to ARM 37.14.506 (2) . The outer package shall be such that the dose rate at the external surface of the package does not exceed 0.5 millirem per hour.

(iii) The immediate container of each quantity or separately packaged fractional quantity of radioactive material shall bear a durable, legible label which:

(A) identifies the radionuclide and the quantity of radioactivity, and

(B) bears the words "Radioactive Material".

(iv) In addition to the labeling information required by (iii) above, the label affixed to the immediate container, or an accompanying brochure, shall:

(A) state that the contents are exempt from licensing state requirements,

(B) bear the words "Radioactive Material--Not for Human Use--Introduction into Foods, Beverages, Cosmetics, Drugs, or Medicinals, or into Products Manufactured for Commercial Distribution is Prohibited--Exempt Quantities should not be Combined", and

(C) set forth appropriate additional radiation safety precautions and instructions relating to the handling, use, storage, and disposal of the radioactive material.

(c) Each person licensed under (2) shall maintain records identifying, by name and address, each person to whom radioactive material is transferred for use under ARM 37.14.506 (2) or the equivalent regulations of a licensing state, and stating the kinds and quantities of radioactive material transferred. An annual summary report stating the total quantity of each radionuclide transferred under the specific license shall be filed with the department. Each report shall cover the year ending June 20, and shall be filed within 30 days thereafter. If no transfers of radioactive material have been made pursuant to (2) during the reporting period, the report shall so indicate.

(3) An application for a specific license authorizing the incorporation of NARM into gas and aerosol detectors to be distributed to persons exempt under ARM 37.14.506 (3) (c) will be approved if the application satisfies requirements equivalent to those contained in 10 CFR Part 32, section 32.26.

(4)

(a) An application for a specific license to manufacture or distribute devices containing radioactive material, excluding special nuclear material, to persons generally licensed under ARM

(i) the applicant satisfies the general requirements of ARM 37.14.521 ;

(ii) the applicant submits sufficient information relating to the design, manufacture, prototype testing, quality control, labels, proposed uses, installation, servicing, leak testing, operating and safety instructions, and potential hazards of the device to provide reasonable assurance that:

(A) the device can be safely operated by persons not having training in radiological protection,

(B) under ordinary conditions of handling, storage, and use of the device, the radioactive material contained in the device will not be released or inadvertently removed from the device, and it is unlikely that any person will receive in any period of 1 calendar quarter a dose in excess of 10% of the limits specified in the table in ARM 37.14.705 (1) , and

(C) under accident conditions (such as fire and explosion) associated with handling, storage, and use of the device, it is unlikely that any person would receive an external addition dose or dose commitment in excess of the following organ doses:

Whole body; head and trunk; active blood-forming organs; gonads; or lens of eye | 15 rams Hands and forearms; feet and ankles; localized areas of skin averaged over areas no larger than 1 square centimeter | 200 rams Other organs | 50 rams

(iii) each device bears a durable, legible, clearly visible label or labels approved by the department, which contain in a clearly identified and separate statement:

(A) instructions and precautions necessary to assure safe installation, operation, and servicing of the device (documents such as operating and service manuals may be identified in the label and used to provide this information) ,

(B) the requirement, or lack of requirement, for leak testing, or for testing any on/off mechanism and indicator, including the maximum time interval for such testing, and the identification of radioactive material by isotope, quantity of radioactivity, and date of determination of the quantity, and

(C) the information called for in 1 of the following statements, as appropriate, in the same or substantially similar form:

(I) The receipt, possession, use and transfer of this device, Model , Serial No. , are subject to a general license or the equivalent and the regulations of the US nuclear regulatory commission or a state with which the US nuclear regulatory commission has entered into an agreement for the exercise of regulatory authority. This label shall be maintained on the device in a legible condition. Removal of this label is prohibited.

CAUTION--RADIOACTIVE MATERIAL

(Name of manufacturer or distributor)

(II) The receipt, possession, use, and transfer of this device, Model , Serial No. , are subject to a general license or the equivalent, and the regulations of a licensing state. This label shall be maintained on the device in a legible condition. Removal of this label is prohibited.

CAUTION--RADIOACTIVE MATERIAL

(Name of manufacturer or distributor)

(D) The model, serial number, and name of the manufacturer or distributor may be omitted from the foregoing label provided the information is elsewhere specified in labeling affixed to the device.

(b) In the event the applicant desires that the device be required to be tested at intervals longer than 6 months, either for proper operation of the on/off mechanism and indicator, if any, or for leakage of radioactive material or for both, he shall include in his application sufficient information to demonstrate that such longer interval is justified by performance characteristics of the device or similar devices and by design features which have a significant bearing on the probability or consequences of leakage of radioactive material from the device or failure of the on/off mechanism and indicator. In determining the acceptable interval for the test for leakage of radioactive material, the department will consider information which includes, but is not limited to:

(i) primary containment (source capsule) ;

(ii) protection of primary containment;

(iii) method of sealing containment;

(iv) containment construction material;

(v) form of contained radioactive material;

(vi) maximum temperature withstood during prototype tests;

(vii) maximum pressure withstood during prototype tests;

(viii) maximum quantity of contained radioactive material;

(ix) radiotoxicity of contained radioactive material; and

(x) operating experience with identical devices or similarly designed and constructed devices.

(c) In the event the applicant desires that the general license under ARM 37.14.512 (4) or under equivalent regulations of the US nuclear regulatory commission, an agreement state or a licensing state be authorized to install the device, collect the sample to be analyzed by a specific licensee for leakage of radioactive material, service the device, test the on/off mechanism and indicator, or remove the device from installation, he shall include in his application written instructions to be followed by the general licensee, estimated calendar quarter doses associated with such activity or activities, and bases for such estimates. The submitted information shall demonstrate that performance of such activity or activities by an individual untrained in radiological protection, in addition to other handling, storage, and use of devices under the general license, is unlikely to cause that individual to receive a calendar quarter dose in excess of 10% of the limits specified in the table in ARM 37.14.705 (2) .

(d) Each person licensed under (4) to distribute devices to generally licensed persons shall:

(i) Furnish a copy of the general license contained in ARM 37.14.512 (4) to each person to whom he directly or through an intermediate person transfers radioactive material in a device for use pursuant to the general license contained in ARM 37.14.512 (4) .

(ii) Furnish a copy of the general license contained in the US nuclear regulatory commission's, agreement state's or licensing state's regulation equivalent to ARM 37.14.512 (4) or alternatively, furnish a copy of the general license contained in ARM 37.14.512 (4) , to each person to whom he directly or through an intermediate person transfers radioactive material in a device for use pursuant to the general license of the US nuclear regulatory commission, the agreement or the licensing state. If a copy of the general license in ARM 37.14.512 (4) is furnished to such person, it shall be accompanied by a note explaining that the use of the device is regulated by the US nuclear regulatory commission, agreement state or licensing state under requirements substantially the same as those in ARM 37.14.512 (4) .

(iii) Report to the department all transfers of such devices to persons for use under the general license in ARM 37.14.512 (4) . Such report shall identify each general licensee by name and address, an individual by name and/or position who may constitute a point of contact between the department and the general licensee, the type and model number of device transferred, and the quantity and type of radioactive material contained in the device. If 1 or more intermediate persons will temporarily possess the device at the intended place of use prior to its possession by the user, the report shall include identification of each intermediate person by name, address, contact, and relationship to the intended user. If no transfers have been made to persons generally licensed under ARM 37.14.512 (4) during the reporting period, the report shall so indicate. The report shall cover each calendar quarter and shall be filed within 30 days thereafter.

(iv) Reports to other agencies include:

(A) Report to the US nuclear regulatory commission all transfers of such devices to persons for use under the US nuclear regulatory commission general license.

(B) Report to the responsible state agency all transfers of devices manufactured and distributed pursuant to ARM 37.14.542 (4) for use under a general license in that state's regulations equivalent to ARM 37.14.512 (4) .

(C) Such reports shall identify each general licensee by name and address, an individual by name and/or position who may constitute a point of contact between the department and the general licensee, the type and model of the device transferred, and the quantity and type of radioactive material contained in the device. If 1 or more intermediate persons will temporarily possess the device at the intended place of use prior to its possession by the user, the report shall include identification of each intermediate person by name, address, contact, and relationship to the intended user. The report shall be submitted within 30 days after the end of each calendar quarter in which such a device is transferred to the generally licensed person.

(D) If no transfers have been made to US nuclear regulatory commission licensees during the reporting period, this information shall be reported to the US nuclear regulatory commission.

(E) If no transfers have been made to general licensees within a particular state during the reporting period, this information shall be reported to the responsible state agency upon request of the agency.

(5) An application for a specific license to manufacture, assemble, or repair luminous safety devices containing tritium or promethium-147 for use in aircraft, for distribution to persons generally licensed under ARM 37.14.512 (5) will be approved subject to the following conditions:

(a) The applicant satisfies the general requirements specified in ARM 37.14.521 , and

(b) the applicant satisfies the requirements of 10 CFR Part 32, sections 32.53, 32.54, 32.55, 32.56, 32.101, or their equivalent.

(6) An application for a specific license to manufacture calibration and reference sources containing americium-241, plutonium or radium-226 to persons generally licensed under ARM 37.14.512 (7) will be approved subject to the following conditions:

(a) The applicant satisfies the general requirement of ARM 37.14.521 and

(b) the applicant satisfies the requirements of 10 CFR Part 32, sections 32.57, 32.58, 32.59, 32.102, and 10 CFR Part 70, section 70.39, or their equivalent.

(7) In addition to requirements set forth in ARM 37.14.521 , a specific license authorizing the distribution of radioactive material for use by physicians under the general license in ARM 37.14.512 (8) will be issued if:

(a) the applicant submits evidence that the radioactive material is to be manufactured, labeled, and packaged in accordance with a new drug application which the commissioner of food and drugs, food and drug administration, has approved, or in accordance with a license for a biologic product issued by the secretary, department of health, education, and welfare; and

(b) one of the following statements, as appropriate, or a substantially similar statement which contains the information called for in 1 of the following statements, appears on the label affixed to the container or appears in the leaflet or brochure which accompanies the package:

(i) This radioactive drug may be received, possessed, and used only by physicians licensed in the practice of medicine. Its receipt, possession, use and transfer are subject to the regulations and a general license or its equivalent of the US nuclear regulatory commission or of a state with which the commission has entered into an agreement for the exercise of regulatory authority.

(Name of manufacturer)

(ii) This radioactive drug may be received, possessed, and used only by physicians licensed in the practice of medicine. Its receipt, possession, use and transfer are subject to the regulations and a general license or its equivalent of a licensing state.

(Name of manufacturer)

(8) An application for a specific license to manufacture or distribute radioactive material for use under the general license of ARM 37.14.512 (9) will be approved if:

(a) The applicant satisfies the general requirements specified in ARM 37.14.521 .

(b) The radioactive material is to be prepared for distribution in prepackaged units of:

(i) Iodine-125 in units not exceeding 10 microcuries each.

(ii) Iodine-131 in units not exceeding 10 microcuries each.

(iii) Carbon-14 in units not exceeding 10 microcuries each.

(iv) Hydrogen-3 (tritium) in units not exceeding 50 microcuries each.

(v) Iron-59 in units not exceeding 20 microcuries each.

(vi) Cobalt-57 in units not exceeding 10 microcuries each.

(vii) Selenium-75 in units not exceeding 10 microcuries each.

(viii) Mock iodine-125 in units not exceeding 0.05 microcurie of iodine-129 and 0.005 microcurie of americium-241 each.

(i) identifying the radioactive contents as to chemical form and radionuclide, and indicating that the amount of radioactivity does not exceed 10 microcuries of iodine-125, iodine-131, carbon-14, cobalt-57, or selenium-75; 50 microcuries of hydrogen-3 (tritium) ; 20 microcuries of iron-59; or mock iodine-125 in units not exceeding 0.05 microcurie of iodine-129 and 0.005 microcurie of americium-241 each; and

(ii) displaying the radiation caution symbol described in ARM 37.14.725 (1) (a) and the words, "CAUTION--RADIOACTIVE MATERIAL", and "Not for Internal or External Use in Humans or Animals".

(d) One of the following statements, as appropriate, or a substantially similar statement which contains the information called for in 1 of the following statements, appears on a label affixed to each prepackaged unit or appears in a leaflet or brochure which accompanies the package:

(i) This radioactive material may be received, acquired, possessed, and used only by physicians, clinical laboratories or hospitals and only for in vitro clinical or laboratory tests not involving internal or external administration of the material, or the radiation therefrom, to human beings or animals. Its receipt, acquisition, possession, use, and transfer are subject to the regulations and a general license of the US nuclear regulatory commission or of a state with which the commission has entered into an agreement for the exercise of regulatory authority.

(Name of manufacturer)

(ii) This radioactive material may be received, acquired, possessed, and used only by physicians, clinical laboratories or hospitals and only for in vitro clinical or laboratory tests not involving internal or external administration of the material, or the radiation therefrom, to human beings or animals. Its receipt, acquisition, possession, use, and transfer are subject to the regulations and a general license of a licensing state.

(Name of manufacturer)

(e) The label affixed to the unit, or the leaflet or brochure which accompanies the package, contains adequate information as to the precautions to be observed in handling and storing such radioactive material. In the case of the mock iodine-125 reference or calibration source, the information accompanying the source must also contain directions to the licensee regarding the waste disposal requirements set out in ARM 37.14.740 .

(9) An application for a specific license to manufacture and distribute ice detection devices to persons generally licensed under ARM 37.14.512 (10) will be approved subject to the following conditions:

(a) the applicant satisfies the general requirements of ARM 37.14.521 , and

(b) the criteria of 10 CFR Part 32, sections 32.61, 32.62, 32.103, are met.

(10) An application for a specific license to manufacture and distribute radiopharmaceuticals containing radioactive material for use by persons licensed pursuant to ARM 37.14.540 (3) for the uses listed in Group I, Group II, IV, or V of Schedule C of this subchapter will be approved if:

(a) The applicant satisfies the general requirements specified in ARM 37.14.521 ;

(b) The applicant submits evidence that:

(i) the radiopharmaceutical containing radioactive material will be manufactured, labeled, and packaged in accordance with the federal Food, Drug and Cosmetic Act or the Public Health Service Act, such as a new drug application (NDA) approved by the food and drug administration (FDA) , a biologic product license issued by FDA or a "Notice of claimed investigational exemption for a new drug" (IND) that has been accepted by the FDA, or

(ii) the manufacture and distribution of the radiopharmaceutical containing radioactive material is not subject to the federal Food, Drug and Cosmetic Act and the Public Health Service Act;

(c) The applicant submits information on the radionuclide, chemical and physical form, packaging including maximum activity per package, and shielding provided by the packaging of the radioactive material which is appropriate for safe handling and storage of radiopharmaceuticals by group licensees; and

(d)

(i) The label affixed to each package of the radiopharmaceutical contains information on the radionuclide, quantity, and date of assay and the label affixed to each package, or the leaflet or brochure which accompanies each package, contains a statement that the radiopharmaceutical is licensed by the department for distribution to persons licensed pursuant to ARM

(ii) The labels, leaflets or brochures required by (d) (i) above are in addition to the labeling required by the food and drug administration (FDA) and they may be separate from or, with the approval of FDA, may be combined with the labeling required by FDA.

(11) An application for a specific license to manufacture and distribute generators or reagent kits containing radioactive material for preparation of radiopharmaceuticals by persons licensed pursuant to ARM 37.14.540 (3) for the uses listed in Group II of Schedule C of this subchapter will be approved if:

(a) The applicant satisfies the general requirements specified in ARM 37.14.521 ;

(b) the applicant submits evidence that:

(i) the generator or reagent kit is to be manufactured, labeled and packaged in accordance with the federal Food, Drug and Cosmetic Act or the Public Health Service Act, such as a new drug application (NDA) approved by the food and drug administration (FDA) , a biologic product license issued by FDA, or a "Notice of claimed investigational exemption for a new drug" (IND) that has been accepted by the FDA, or

(ii) the manufacture and distribution of the generator or reagent kit are not subject to the federal Food, Drug and Cosmetic Act and the Public Health Service Act;

(c) the applicant submits information on the radionuclide, chemical and physical form, packaging including maximum activity per package, and shielding provided by the packaging of the radioactive material contained in the generator or the reagent kit;

(d) the label affixed to the generator or reagent kit contains information on the radionuclide, quantity, and date of assay; and

(e) the label affixed to the generator or reagent kit, or the leaflet or brochure which accompanies the generator or reagent kit, contains:

(i) adequate information, from a radiation safety standpoint, on the procedures to be followed and the equipment and shielding to be used in elating the generator or processing radioactive material with the reagent kit, and

(ii) a statement that this generator or reagent kit (as appropriate) is approved for use by persons licensed by the department pursuant to ARM 37.14.540 (3) and Schedule C, Group III of this subchapter or under equivalent licenses of the US nuclear regulatory commission, an agreement state or a licensing state. The labels, leaflets or brochures required by (11) are in addition to the labeling required by FDA and they may be separate from or, with the approval of FDA, may be combined with the labeling required by FDA.

NOTE: Although the department does not regulate the manufacture and distribution of reagent kits that do not contain radioactive material, it does regulate the use of such reagent kits for the preparation of radiopharmaceuticals containing radioactive material as part of its licensing and regulation of the users of radioactive material. Any manufacturer of reagent kits that do not contain radioactive material who desires to have his reagent kits approved by the department for use by persons licensed pursuant to ARM 37.14.540 (3) and Group III of Schedule C of this subchapter may submit the pertinent information specified in (11) .

(12) An application for a specific license to manufacture and distribute sources and devices containing radioactive material to persons licensed pursuant to ARM 37.14.540 (3) for use as a calibration or reference source or for the uses listed in Group VI of Schedule C of this subchapter will be approved if:

(a) The applicant satisfies the general requirements in ARM 37.14.521 .

(b) The applicant submits sufficient information regarding each type of source or device pertinent to an evaluation of its radiation safety, including:

(i) the radioactive material contained, its chemical and physical form, and amount,

(ii) details of design and construction of the source or device,

(iii) procedures for, and results of, prototype tests to demonstrate that the source or device will maintain its integrity under stresses likely to be encountered in normal use and accidents,

(iv) for devices containing radioactive material, the radiation profile of a prototype device,

(v) details of quality control procedures to assure that production sources and devices meet the standards of the design and prototype tests,

(vi) procedures and standards for calibrating sources and devices,

(vii) legend and methods for labeling sources and devices as to their radioactive content, and

(viii) instructions for handling and storing the source or device from the radiation safety standpoint; these instructions are to be included on a durable label attached to the source or device or attached to a permanent storage container for the source or device; provided, that instructions which are too lengthy for such label may be summarized on the label and printed in detail on a brochure which is referenced on the label.

(c) The label affixed to the source or device, or to the permanent storage container for the source or device, contains information on the radionuclide, quantity, and date of assay, and a statement that the name of source or device is licensed by the department for distribution to persons licensed pursuant to ARM 37.14.540 (3) and Schedule C, Group VI of this subchapter or under equivalent licenses of the US nuclear regulatory commission, an agreement state or a licensing state, provided, that such labeling for sources which do not require long term storage (e.g., gold-198 seeds) may be on a leaflet or brochure which accompanies the source.

(d) In the event the applicant desires that the source or device be required to be tested for leakage of radioactive material at intervals longer than 6 months, he shall include in his application sufficient information to demonstrate that such longer interval is justified by performance characteristics of the source or device or similar sources or devices and by design features that have a significant bearing on the probability or consequences of leakage of radioactive material from the source.

(e) In determining the acceptable interval for test of leakage of radioactive material, the department will consider information that includes, but is not limited to:

(i) primary containment (source capsule) ,

(ii) protection of primary containment,

(iii) method of sealing containment,

(iv) containment construction materials,

(v) form of contained radioactive material,

(vi) maximum temperature withstood during prototype tests,

(vii) maximum pressure withstood during prototype tests,

(viii) maximum quantity of contained radioactive material,

(ix) radiotoxicity of contained radioactive material, and

(x) operating experience with identical sources or devices or similarly designed and constructed sources or devices.

(13) Requirements for license to manufacture and distribute industrial products containing depleted uranium for mass-volume applications.

(a) An application for a specific license to manufacture industrial products and devices containing depleted uranium for use pursuant to ARM 37.14.511 (4) or equivalent regulations of the US nuclear regulatory commission or an agreement state will be approved if:

(i) the applicant satisfies the general requirements specified in ARM 37.14.521 ;

(ii) the applicant submits sufficient information relating to the design, manufacture, prototype testing, quality control procedures, labeling or marking, proposed uses, and potential hazards of the industrial product or device to provide reasonable assurance that possession, use, or transfer of the depleted uranium in the product or device is not likely to cause any individual to receive in any period of 1 calendar quarter a radiation dose in excess of 10% of the limits specified in ARM 37.14.705 (2) ; and

(iii) the applicant submits sufficient information regarding the industrial product or device and the presence of depleted uranium for a mass-volume application in the product or device to provide reasonable assurance that unique benefits will accrue to the public because of the usefulness of the product or device.

(b) In the case of an industrial product or device whose unique benefits are questionable, the department will approve an application for a specific license under (13) only if the product or device is found to combine a high degree of utility and low probability of uncontrolled disposal and dispersal of significant quantities of depleted uranium into the environment.

(c) The department may deny any application for a specific license under (13) if the end use(s) of the industrial product or device cannot be reasonably foreseen.

(d) Each person licensed pursuant to (a) above shall:

(i) maintain the level of quality control required by the license in the manufacture of the industrial product or device, and in the installation of the depleted uranium into the product or device;

(ii) label or mark each unit to:

(A) identify the manufacturer of the product or device and the number of the license under which the product or device was manufactured, the fact that the product or device contains depleted uranium, and the quantity of depleted uranium in each product or device; and

(B) state that the receipt, possession, use, and transfer of the product or device are subject to a general license or the equivalent and the regulations of the US nuclear regulatory commission or of an agreement state;

(iii) assure that the depleted uranium before being installed in each product or device has been impressed with the following legend clearly legible through any plating or other covering: "Depleted Uranium";

(iv)

(A) furnish a copy of the general license contained in ARM

(B) furnish a copy of the general license contained in the US nuclear regulatory commission's or agreement state's regulation equivalent to ARM 37.14.511 (4) and a copy of the US nuclear regulatory commission's or agreement state's certificate, or alternatively, furnish a copy of the general license contained in ARM 37.14.511 (4) and a copy of department form MRH-12 to each person to whom he transfers depleted uranium in a product or device for use pursuant to the general license of the US nuclear regulatory commission or an agreement state, with a note explaining that use of the product or device is regulated by the US nuclear regulatory commission or an agreement state under requirements substantially the same as those in ARM 37.14.511 (4) ;

(v) report to the department all transfers of industrial products or devices to persons for use under the general license in ARM 37.14.511 (4) . Such report shall identify each general licensee by name and address, an individual by name and/or position who may constitute a point of contact between the department and the general licensee, the type and model number of device transferred, and the quantity of depleted uranium contained in the product or device. The report shall be submitted within 30 days after the end of each calendar quarter in which such a product or device is transferred to the generally licensed person. If no transfers have been made to persons generally licensed under ARM 37.14.511 (4) during the reporting period, the report shall so indicate;

(vi)

(A) report to the US nuclear regulatory commission all transfers of industrial products or devices to persons for use under the US nuclear regulatory commission general license,

(B) report to the responsible state agency all transfers of devices manufactured and distributed pursuant to (13) for use under a general license in that state's regulations equivalent to ARM 37.14.511 (4) ,

(C) such report shall identify each general licensee by name and address, an individual by name and/or position who may constitute a point of contact between the agency and the general licensee, the type and model number of the device transferred, and the quantity of depleted uranium contained in the product or device. The report shall be submitted within 30 days after the end of each calendar quarter in which such product or device is transferred to the generally licensed person,

(D) if no transfers have been made to US nuclear regulatory commission licensees during the reporting period, this information shall be reported to the US nuclear regulatory commission,

(E) if no transfers have been made to general licensees within a particular agreement state during the reporting period, this information shall be reported to the responsible agreement state agency; and

(vii) keep records showing the name, address, and point of contact for each general licensee to whom he transfers depleted uranium in industrial products or devices for use pursuant to the general license provided in ARM 37.14.511 (4) or equivalent regulations of the US nuclear regulatory commission or of an agreement state. The records shall be maintained for a period of 2 years and shall show the date of each transfer, the quantity of depleted uranium in each product or device transferred, and compliance with the report requirements of this subchapter.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.543 Specific Licenses: Persons Possessing a License for Source, Byproduct, or Special Nuclear Material in Quantities Not Sufficient to Form a Critical Mass

(1) Any person who, on the effective date of this chapter, possesses a general or specific license for source, byproduct, or special nuclear material in quantities not sufficient to form a critical mass, issued by the US nuclear regulatory commission, shall be deemed to possess a like license issued under this subchapter and the act, such license to expire either 90 days after receipt from the department of a notice of expiration of such license, or on the date of expiration specified in the US nuclear regulatory commission license, whichever is earlier.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.546 Existing Specific Licenses: Narm

(1) Any person who, on the effective date of this chapter, possesses NARM for which a specific license is required by the act or this subchapter shall be deemed to possess such a license issued under the act and this subchapter. Such license shall expire 90 days after the effective date of this chapter; provided, however, that if within the 90 days the person possessing such material files an application in proper form for a license, such existing license shall not expire until the application has been finally determined by the department.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.547 Specific Licenses: Transfer of Material

(1) No licensee shall transfer radioactive material except as authorized pursuant to this rule.

(2) Except as otherwise provided in his license and subject to the provisions of (3) and (4) of this rule, any licensee may transfer radioactive material:

(a) to the department. A licensee may transfer material to the department only after receiving prior approval from the department;

(b) to the US department of energy;

(d) to any person authorized to receive such material under terms of a general license or its equivalent, or a specific license or equivalent licensing document, issued by the department, the US nuclear regulatory commission, any agreement state or any licensing state, or to any person otherwise authorized to receive such material by the federal government or any agency thereof, the department, any agreement state or any licensing state; or

(e) as otherwise authorized by the department in writing.

(3) Before transferring radioactive material to a specific licensee of the department, the US nuclear regulatory commission, an agreement state or a licensing state, or to a general licensee who is required to register with the department, the US nuclear regulatory commission, an agreement state or a licensing state prior to receipt of the radioactive material, the licensee transferring the material shall verify that the transferee's license authorizes the receipt of the type, form, and quantity of radioactive material to be transferred.

(4) The following methods for the verification required by (3) of this rule are acceptable:

(a) The transferor may have in his possession, and read, a current copy of the transferee's specific license or registration certificate;

(b) the transferor may have in his possession a written certification by the transferee that he is authorized by license or registration certificate to receive the type, form and quantity of radioactive material to be transferred, specifying the license or registration certificate number, issuing agency, and expiration date;

(c) for emergency shipments the transferor may accept oral certification by the transferee that he is authorized by license or registration certificate to receive the type, form, and quantity of radioactive material to be transferred, specifying the license or registration certificate number, issuing agency, and expiration date; provided, that the oral certification is confirmed in writing within 10 days;

(d) the transferor may obtain other sources of information compiled by a reporting service from official records of the department, the US nuclear regulatory commission, the licensing agency of an agreement state or a licensing state as to the identity of licensees and the scope and expiration dates of licenses and registration; or

(e) when none of the methods of verification described in (a) , (b) , (c) , or (d) above are readily available or when a transferor desires to verify that information received by 1 of such methods is correct or up-to-date, the transferor may obtain and record confirmation from the department, the US nuclear regulatory commission, or the licensing agency of an agreement state or a licensing state that the transferee is licensed to receive the radioactive material.

(5) Preparation for shipment and transport of radioactive material shall be in accordance with the provisions of ARM 37.14.552 .

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.550 Specific Licenses: Modification, Revocation, and Termination

(1) The terms and conditions of all licenses shall be subject to amendment, revision, or modification or the license may be suspended or revoked by reason of amendments to the act, or by reason of rules and orders issued by the department.

(2) Any license may be revoked, suspended, or modified, in whole or in part, for any material false statement in the application or any statement of fact required under provisions of the act, or because of conditions revealed by such application or statement of fact or any report, record, or inspection or other means which would warrant the department to refuse to grant a license on an original application, or for violation of, or failure to observe any of the terms and conditions of the act, or of the license, or of any rule or order of the department.

(3) Except in cases of willfulness or those in which the public health, interest or safety requires otherwise, no license shall be modified, suspended, or revoked unless, prior to the institution of proceedings therefor, facts or conduct which may warrant such action shall have been called to the attention of the licensee in writing and the licensee shall have been afforded an opportunity to demonstrate or achieve compliance with all lawful requirements.

(4) The department may terminate a specific license upon request submitted by the licensee to the department in writing.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.551 Reciprocity

(1) Subject to this chapter, any person who holds a specific license from the US nuclear regulatory commission or any agreement state or licensing state, and issued by the agency having jurisdiction where the licensee maintains an office for directing the licensed activity and at which radiation safety records are normally maintained, is hereby granted a general license to conduct the activities authorized in such licensing document within this state for a period not in excess of 180 days in any calendar year provided that:

(a) the licensing document does not limit the activity authorized by such document to specified installations or locations;

(b) the out-of-state licensee notifies the department in writing at least 3 days prior to engaging in such activity. Such notification shall indicate the location, period, and type of proposed possession and use within the state, and shall be accompanied by a copy of the pertinent licensing document. If, for a specific case, the 3-day period would impose an undue hardship on the out-of-state licensee, he may, upon application to the department, obtain permission to proceed sooner. The department may waive the requirement for filing additional written notifications during the remainder of the calendar year following the receipt of the initial notification from a person engaging in activities under the general license provided in (1) .

(c) the out-of-state licensee complies with all applicable rules of the department and with all the terms and conditions of his licensing document, except any such terms and conditions which may be inconsistent with applicable rules of the department;

(d) the out-of-state licensee supplies such other information as the department may request; and

(e) the out-of-state licensee shall not transfer or dispose of radioactive material possessed or used under the general license provided in (1) except by transfer to a person:

(i) specifically licensed by the department or by the US nuclear regulatory commission to receive such material, or

(ii) exempt from the requirements for a license for such material under ARM 37.14.506 (1) .

(2) Notwithstanding the provisions of (1) of this rule, any person who holds a specific license issued by the US nuclear regulatory commission or an agreement state authorizing the holder to manufacture, transfer, install, or service a device described in ARM 37.14.512 (4) (a) within areas subject to the jurisdiction of the licensing body is hereby granted a general license to install, transfer, demonstrate or service such a device in this state provided that:

(a) such person shall file a report with the department within 30 days after the end of each calendar quarter in which any device is transferred to or installed in this state. Each such report shall identify each general licensee to whom such device is transferred by name and address, the type of device transferred, and the quantity and type of radioactive material contained in the device;

(b) the device has been manufactured, labeled, installed, and serviced in accordance with applicable provisions of the specific license issued to such person by the US nuclear regulatory commission or an agreement state;

(c) such person shall assure that any labels required to be affixed to the device under regulations of the authority which licensed manufacture of the device bear a statement that "Removal of this label is prohibited"; and

(d) the holder of the specific license shall furnish to each general licensee to whom he transfers such device or on whose premises he installs such device a copy of the general license contained in ARM 37.14.512 (4) .

(3) The department may withdraw, limit, or qualify its acceptance of any specific license or equivalent licensing document issued by another agency, or any product distributed pursuant to such licensing document, upon determining that such action is necessary in order to prevent undue hazard to public health and safety or property.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-101 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.552 Transportation: Preparation of Material

(1) For the purposes of this rule, a licensee who transports his own licensed material as a private carrier is considered to have delivered such material to a carrier for transport.

(2) No licensee shall deliver any radioactive material to a carrier for transport, unless:

(a) the licensee complies with the applicable requirements of the regulations, appropriate to the mode of transport, of the US department of transportation insofar as such regulations relate to the packaging of radioactive material, and to the monitoring, marking and labeling of those packages;

(b) the licensee has established procedures for opening and closing packages in which radioactive material is transported to provide safety and to assure that, prior to the delivery to a carrier for transport, each package is properly closed for transport; and

(c) prior to delivery of a package to a carrier for transport, the licensee shall assure that any special instructions needed to safely open the package are sent to or have been available to the consignee.

(3) Section (2) of this rule shall not apply to the transportation of licensed material, or to the delivery of licensed material to a carrier for transport, where such transportation is subject to the regulations of the US department of transportation or the US postal service.

SCHEDULE A

EXEMPT CONCENTRATIONS

__________

1 Values are given in Column I only for those materials normally used as gases.

2 µ C1/gm for solids.

__________

1 Values are given in Column I only for those materials normally used as gases.

2 µ C1/gm for solids.

__________

1 Values are given in Column I only for those materials

normally used as gases.

2 µ C1/gm for solids.

__________

1 Values are given in Column I only for those materials normally used as gases.

2 µ C1/gm for solids.

NOTE 1: Many radioisotopes disintegrate into isotopes which are also radioactive. In expressing the concentrations in Schedule A the activity stated is that of the parent isotope and takes into account the daughters.

NOTE 2: For purposes of ARM 37.14.506 where there is involved a combination of isotopes, the limit for the combination should be derived as follows: determine for each isotope in the product the ratio between the concentration present in the product and the exempt concentration established in Schedule A for the specific isotope when not in combination. The sum of such ratios may not exceed "1" (i.e., unity) .

EXAMPLE: Concentration of Isotope A in Product +

Exempt concentration of Isotope A

Concentration of Isotope B in Product # 1

Exempt concentration of Isotope B

__________

1 Values are given in Column I only for those materials

normally used as gases.

2 μ C1/gm for solids.

SCHEDULE B

EXEMPT QUANTITIES

Radioactive Material Microcuries

Antimony-122 (Sb 122) 100

Antimony-124 (Sb 124) 10

Antimony-125 (Sb 125) 10

Arsenic-73 (As 73) 100

Arsenic-74 (As 74) 10

Arsenic-76 (As 76) 10

Arsenic-77 (As 77) 100

Barium-131 (Ba 131) 10

Barium-133 (Ba 133) 10

Barium-140 (Ba 140) 10

Bismuth-210 (Bi 210) 1

Bromine-82 (Br 82) 10

Cadmium-109 (Cd 109) 10

Cadmium-115m (Cd 115m) 10

Cadmium-115 (Cd 115) 100

Calcium-45 (Ca 45) 10

Calcium-47 (Ca 47) 10

Carbon-14 (C 14) 100

Cerium-141 (Ce 141) 100

Cerium-143 (Ce 143) 100

Cerium-144 (Ce 144) 1

Cesium-129 (Cs 129) 100

Cesium-131 (Cs 131) 1,000

Cesium-134m (Cs 134m) 100

Cesium-134 (Cs 134) 1

Cesium-135 (Cs 135) 10

Cesium-136 (Cs 136) 10

Cesium-137 (Cs 137) 10

Chlorine-36 (Cl 36) 10

Chlorine-38 (Cl 38) 10

Chromium-51 (Cr 51) 1,000

Cobalt-57 (Co 57) 100

Cobalt-58m (Co 58m) 10

Cobalt-58 (Co 58) 10

Cobalt-60 (Co 60) 1

Copper-64 (Cu 64) 100

Dysprosium-165 (Dy 165) 10

Dysprosium-166 (Dy 166) 100

Erbium-169 (Er 169) 100

Erbium-171 (Er 171) 100

Europium-152 (Eu 152)9.2h 100

Europium-152 (Eu 152)13 yr 1

Europium-154 (Eu 154) 1

Radioactive Material Microcuries

Europium-155 (Eu 155) 10

Fluorine-18 (F 18) 1,000

Gadolinium-153 (Gd 153) 10

Gadolinium-159 (Gd 159) 100

Gallium-67 (Ga 67) 100

Gallium-72 (Ga 72) 10

Germanium-71 (Ge 71) 100

Gold-198 (Au 198) 100

Gold-199 (Au 199) 100

Hafnium-181 (Hf 181) 10

Holmium-166 (Ho 166) 100

Hydrogen-3 (H 3) 1,000

Indium-111 (In 111) 100

Indium-113m (In 113m) 100

Indium-114m (In 114m) 10

Indium-115m (In 115m) 100

Indium-115 (In 115) 10

Iodine-123 (I 123) 100

Iodine-125 (I 125) 1

Iodine-126 (I 126) 1

Iodine-129 (I 129) 0.1

Iodine-131 (I 131) 1

Iodine-132 (I 132) 10

Iodine-133 (I 133) 1

Iodine-134 (I 134) 10

Iodine-135 (I 135) 10

Iridium-192 (Ir 192) 10

Iridium-194 (Ir 194) 100

Iron-52 (Fe 52) 10

Iron-55 (Fe 55) 100

Iron-59 (Fe 59) 10

Krypton-85 (Kr 85) 100

Krypton-87 (Kr 87) 10

Lanthanum-140 (La 140) 10

Lutetium-177 (Lu 177) 100

Manganese-52 (Mn 52) 10

Manganese-54 (Mn 54) 10

Manganese-56 (Mn 56) 10

Mercury-197m (Hg 197m) 100

Mercury-197 (Hg 197) 100

Mercury-203 (Hg 203) 10

Molybdenum-99 (Mo 99) 100

Neodymium-147 (Nd 147) 100

Neodymium-149 (Nd 149) 100

Nickel-59 (Ni 59) 100

Nickel-63 (Ni 63) 10

Nickel-65 (Ni 65) 100

Niobium-93m (Nb 93m) 10

Radioactive Material Microcuries

Niobium-95 (Nb 95) 10

Niobium-97 (Nb 97) 10

Osmium-185 (Os 185) 10

Osmium-191m (Os 191m) 100

Osmium-191 (Os 191) 100

Osmium-193 (Os 193) 100

Palladium-103 (Pd 103) 100

Palladium-109 (Pd 109) 100

Phosphorus-32 (P 32) 10

Platinum-191 (Pt 191) 100

Platinum-193m (Pt 193m) 100

Platinum-193 (Pt 193) 100

Platinum-197m (Pt 197m) 100

Platinum-197 (Pt 197) 100

Polonium-210 (Po 210) 0.1

Potassium-42 (K 42) 10

Potassium-43 (K 43) 10

Praseodymium-142 (Pr 142) 100

Praseodymium-143 (Pr 143) 100

Promethium-147 (Pm 147) 10

Promethium-149 (Pm 149) 10

Radium-226 (Ra 226) 0.1

Rhenium-186 (Re 186) 100

Rhenium-188 (Re 188) 100

Rhodium-103m (Rh 103m) 100

Rhodium-105 (Rh 105) 100

Rubidium-81 (Rb 81) 10

Rubidium-86 (Rb 86) 10

Rubidium-87 (Rb 87) 10

Ruthenium-97 (Ru 97) 100

Ruthenium-103 (Ru 103) 10

Ruthenium-105 (Ru 105) 10

Ruthenium-106 (Ru 106) 1

Samarium-151 (Sm 151) 10

Samarium-153 (Sm 153) 100

Scandium-46 (Sc 46) 10

Scandium-47 (Sc 47) 100

Scandium-48 (Sc 48) 10

Selenium-75 (Se 75) 10

Silicon-31 (Si 31) 100

Silver-105 (Ag 105) 10

Silver-110m (Ag 110m) 1

Silver-111 (Ag 111) 100

Sodium-22 (Na 22) 10

Sodium-24 (Na 24) 10

Strontium-85 (Sr 85) 10

Strontium-89 (Sr 89) 1

Radioactive Material Microcuries

Strontium-90 (Sr 90) 0.1

Strontium-91 (Sr 91) 10

Strontium-92 (Sr 92) 10

Sulphur-35 (S 35) 100

Tantalum-182 (Ta 182) 10

Technetium-96 (Tc 96) 10

Technetium-97m (Tc 97m) 100

Technetium-97 (Tc 97) 100

Technetium-99m (Tc 99m) 100

Technetium-99 (Tc 99) 10

Tellurium-125m (Te 125m) 10

Tellurium-127m (Te 127m) 10

Tellurium-127 (Te 127) 100

Tellurium-129m (Te 129m) 10

Tellurium-129 (Te 129) 100

Tellurium-131m (Te 131m) 10

Tellurium-132 (Te 132) 10

Terbium-160 (Tb 160) 10

Thallium-200 (Tl 200) 100

Thallium-201 (Tl 201) 100

Thallium-202 (Tl 202) 100

Thallium-204 (Tl 204) 10

Thulium-170 (Tm 170) 10

Thulium-171 (Tm 171) 10

Tin-113 (Sn 113) 10

Tin-125 (Sn 125) 10

Tungsten-181 (W 181) 10

Tungsten-185 (W 185) 10

Tungsten-187 (W 187) 100

Vanadium-48 (V 48) 10

Xenon-131m (Xe 131m) 1,000

Xenon-133 (Xe 133) 100

Xenon-135 (Xe 135) 100

Ytterbium-175 (Yb 175) 100

Yttrium-87 (Y 87) 10

Yttrium-90 (Y 90) 10

Yttrium-91 (Y 91) 10

Yttrium-92 (Y 92) 100

Yttrium-93 (Y 93) 100

Zinc-65 (Zn 65) 10

Zinc-69m (Zn 69m) 100

Zinc-69 (Zn 69) 1,000

Zirconium-93 (Zr 93) 10

Zirconium-95 (Zr 95) 10

Zirconium-97 (Zr 97) 10

Any radioactive material not listed above other than alpha emitting radioactive material 0.1

Note 1: For purposes of ARM 37.14.521 where there is involved a combination of isotopes,

the limit for the combination should be derived as follows:

Determine the amount of each isotope possessed and 1,000 times the amount in

Schedule B for each of those isotopes when not in combination. The sum of the ratios

of those quantities may not exceed 1 (i.e., unity) .

Example:

Amt. of Isotope A possessed + Amt. of Isotope B possessed < 1

1000 x Schedule B quantity 1000 x Schedule B quantity

for Isotope A for Isotope B

SCHEDULE C

GROUPS OF MEDICAL USES OF RADIOACTIVE MATERIAL

Group I. Use of prepared radiopharmaceuticals for certain diagnostic studies involving measurements of uptake, dilution and excretion (does not include uses involving imaging and tumor localizations)

(1) Iodine-131 as sodium iodide (Na 131 I) for measurement of thyroid uptake.

(2) Iodine-125 as sodium iodide (Na 125 I) for measurement of thyroid uptake.

(3) Iodine-131 as iodinated human serum albumin (IHSA) for determination of blood and blood plasma volume and for studies of cardiovascular function and protein turnover.

(4) Iodine-125 as iodinated human serum albumin (IHSA) for determination of blood and blood plasma volume and for studies of cardiovascular function and protein turnover.

(5) Iodine-131 as labeled rose bengal for liver function studies.

(6) Iodine-125 as labeled rose bengal for liver function studies.

(7) Iodine-131 as labeled fats or fatty acids for fat absorption studies.

(8) Iodine-125 as labeled fats or fatty acids for fat absorption studies.

(9) Iodine-131 as labeled iodopyracet, sodium iodohippurate, sodium diatrizoate, diatrizoate methylglucamine, sodium diprotrizoate, sodium acetrizoete, or sodium iothalamate for kidney function studies.

(10) Iodine-125 as labeled iodopyracet, sodium iodohippurate, sodium diatrizoate, distrizoate methylglucamine, sodium diprotrizoate, sodium acetrizoate, or sodium iothalamate for kidney function studies.

(11) Cobalt-57 as labeled cyanocobalamin for intestinal absorption studies.

(12) Cobalt-58 as labeled cyanocobalamin for intestinal absorption studies.

(13) Cobalt-60 as labeled cyanocobalamin for intestinal absorption studies.

(14) Chromium-51 as sodium chromate for determination of red blood cell volume and studies of red blood cell survival time and gastrointestinal blood loss.

(15) Chromium-51 as labeled human serum albumin for gastrointestinal protein loss studies.

(16) Iron-59 as chloride, citrate, or sulfate for iron turnover studies.

(17) Potassium-42 as chloride for potassium space determinations.

(18) Sodium-24 as chloride for sodium space determinations.

(19) Technetium-99m as pertechnetate for blood flow studies.

(20) Mercury as chlormerodrin for kidney function studies.

(21) Any radioactive material in a radiopharmaceutical and for a diagnostic use involving measurements of uptake, dilution, or excretion for which a "Notice of Claimed Investigational Exemption for a New Drug" (IND) has been accepted by the Food and Drug Administration (FDA) .

(22) Iodine-123 as sodium iodide (NaI) for measurement of thyroid uptake.

Group II. Use of prepared radiopharmaceuticals for diagnostic studies involving imaging and tumor localizations

(1) Iodine-131 as sodium iodide for thyroid imaging.

(2) Iodine-125 as sodium iodide for thyroid imaging.

(3) Iodine-131 as iodinated human serum albumin (IHSA) for brain tumor localizations and cardiac imaging.

(4) Iodine-131 as macroaggregated iodinated human serum albumin for lung imaging.

(5) Iodine-131 as colloidal (microaggregated) iodinated human serum albumin for liver imaging.

(6) Iodine-131 as labeled rose bengal for liver imaging.

(7) Iodine-131 as iodopyracet, sodium iodohippurate, sodium diatrizoate, diatrizoate methyglucamine, sodium diprotrizoate, or sodium acetrizoate for kidney imaging.

(8) Iodine-131 as sodium iodipamide for cardiac imaging.

(9) Iodine-131 as iodinated human serum albumin (IHSA) for placenta localization.

(10) Chromium-51 as sodium chromate for spleen imaging.

(11) Chromium-51 as labeled human serum albumin for placenta localization.

(12) Gold-198 in colloidal form for liver imaging.

(13) Mercury-197 as labeled chlormerodrin for kidney and brain imaging.

(14) Mercury-203 as labeled chlormerodrin for brain imaging.

(15) Selenium-75 as labeled selenomethionine for pancreas imaging.

(16) Strontium-85 as nitrate or chloride for bone imaging in patients with suspected or diagnosed cancer.

(17) Technetium-99m as pertechnetate for brain imaging.

(18) Technetium-99m as pertechnetate for thyroid imaging.

(19) Technetium-99m as pertechnetate for salivary gland imaging.

(20) Technetium-99m as pertechnetate for blood pool imaging, including placenta localization.

(21) Technetium-99m as labeled sulfur colloid for liver, spleen, and bone marrow imaging.

(22) Technetium-99m as labeled macroaggregated human serum albumin for lung imaging.

(23) Any radioactive material in a radiopharmaceutical prepared from a reagent kit listed in (4) of Group III.

(24) Any radioactive material in a radiopharmaceutical and for a diagnostic use involving imaging for which a "Notice of Claimed Investigational Exemption for a New Drug" (IND) has been accepted by the Food and Drug Administration (FDA) .

(25) Fluorine-18 in solution for bone imaging.

(26) Strontium-87m for bone imaging.

(27) Iodine-125 as fibrinogen for detection and monitoring of developing deep vein thrombosis.

(28) Ytterbium-169 as labeled diethylenetriamine-pentaacetic acid (DTPA) for cistornography.

(29) Iodine-123 as sodium iodide (NaI) for thyroid imaging.

(30) Indium-113m as chloride for blood pool imaging, including placenta localization.

Group III. Use of generators and reagent kits for the preparation and use of radiopharmaceuticals containing radioactive material for certain diagnostic uses

(1) Molybdenum-99/technetium-99m generators for the elution of technetium-99m as pertechnetate for:

(i) brain imaging;

(ii) thyroid imaging;

(iii) salivary gland imaging;

(iv) blood pool imaging including placenta localization;

(v) blood flow studies; and

(vi) use with reagent kits for preparation and use of radiopharmaceuticals containing technetium-99m as provided in (4) and (5) of this group.

(2) Yttrium-87/strontium-87m generators for the elution of strontium-87m for bone imaging.

(3) Technetium-99m as pertechnetate for use with reagent kits for preparation and use of radiopharmaceuticals containing technetium-99m as provided in (4) and (5) of this group.

(4) Reagent kits for preparation of technetium-99m labeled:

(i) sulfur colloid for liver, spleen, and bone marrow imaging;

(ii) iron-ascorbate-diethylenetriaminepentaacetic acid complex for kidney imaging;

(iii) diethylenetriaminepentaacetic acid (Sn) for kidney imaging and kidney function studies;

(iv) diethylenetriaminepentaacetic acid (Sn) for brain imaging;

(v) human serum albumin microspheres for lung imaging;

(vi) polyphosphates for bone imaging;

(vii) macroaggregated human serum albumin for lung imaging;

(viii) distannous etidronate complex for bone imaging;

(ix) stannous pyrophosphate for bone and cardiac imaging;

(x) human serum albumin for heart blood pool imaging; and

(xi) medronate sodium for bone imaging.

(5) Any generator or reagent kit for preparation and diagnostic use of a radiopharmaceutical containing radioactive material for which generator or reagent kit a "Notice of Claimed Investigational Exemption for a New Drug" (IND) has been accepted by the Food and Drug Administration (FDA) .

(6) Tin-113/indium-113m generators for the elution of indium-113m as chloride for:

(i) blood pool imaging including placenta localization.

Group IV. Use of prepared radiopharmaceuticals for certain therapeutic uses that do not normally require hospitalization for purposes of radiation safety

(1) Iodine-131 as iodide for treatment of hyperthyroidism and cardiac dysfunction.

(2) Phosphorus-32 as soluble phosphate for treatment of polycythemia vera, leukemia, and bone metastases.

(3) Phosphorus-32 as colloidal chromic phosphate for intracavitary treatment of malignant effusions.

(4) Any radioactive material in a radiopharmaceutical and for a therapeutic use not normally requiring hospitalization for purposes of radiation safety for which a "Notice of Claimed Investigational Exemption for a New Drug" (IND) has been accepted by the Food and Drug Administration (FDA) .

Group V. Use of prepared radiopharmaceuticals for certain therapeutic uses that normally require hospitalization for purposes of radiation safety

(1) Gold-198 as colloid for intracavitary treatment of malignant effusions.

(2) Iodine-131 as iodide for treatment of thyroid carcinoma.

(3) Any radioactive material in a radiopharmaceutical and for a therapeutic use normally requiring hospitalization for radiation safety reasons for which a "Notice of Claimed Investigational Exemption for a New Drug" (IND) has been accepted by the Food and Drug Administration (FDA) .

Group VI. Use of sources and devices containing radioactive material for certain medical uses

(1) Americium-241 as a sealed source in a device for bone mineral analysis.

(2) Cesium-137 encased in needles and applicator cells for topical, interstitial, and intracavitary treatment of cancer.

(3) Cobalt-60 encased in needles and applicator cells for topical, interstitial, and intracavitary treatment of cancer.

(4) Gold-198 as seeds for interstitial treatment of cancer.

(5) Iodine-125 as a sealed source in a device for bone mineral analysis.

(6) Iridium-192 as seeds encased in nylon ribbon for interstitial treatment of cancer.

(7) Strontium-90 sealed in an applicator for treatment of superficial eye conditions.

(8) Radon-222 as seeds for topical, interstitial, and intracavitary treatment of cancer.

(9) Radium-226 as a sealed source for topical, interstitial, and intracavitary treatment of cancer.

(10) Iodine-125 as seeds for interstitial treatment of cancer.

SCHEDULE D

LIMITS FOR BROAD LICENCES

Radioactive Material | Col. I curies | Col. II curies Antimony-122 | 1 | 0.01 Antimony-124 | 1 | 0.01 Antimony-125 | 1 | 0.01 Arsenic-73 | 10 | 0.1 Arsenic-74 | 1 | 0.01 Arsenic-76 | 1 | 0.01 Arsenic-77 | 10 | 0.1 Barium-131 | 10 | 0.1 Barium-140 | 1 | 0.01 Beryllium-7 | 10 | 0.1 Bismuth-210 | 0.1 | 0.001 Bromine-82 | 10 | 0.1 Cadmium-109 | 1 | 0.01 Cadmium-115m | 1 | 0.01 Cadmium-115 | 10 | 0.1 Calcium-45 | 1 | 0.01 Calcium-47 | 10 | 0.1 Carbon-14 | 100 | 1. Cerium-141 | 10 | 0.1 Cerium-143 | 10 | 0.1 Cerium-144 | 0.1 | 0.001 Cesium-131 | 100 | 1. Cesium-134m | 100 | 1. Cesium-134 | 0.1 | 0.001 Cesium-135 | 1 | 0.01 Cesium-136 | 10 | 0.1 Cesium-137 | 0.1 | 0.001 Chlorine-36 | 1 | 0.01 Chlorine-38 | 100 | 1. Chromium-51 | 100 | 1. Cobalt-57 | 10 | 0.1 Cobalt-58m | 100 | 1. Cobalt-58 | 1 | 0.01 Cobalt-60 | 0.1 | 0.001 Copper-64 | 10 | 0.1 Dysprosium-165 | 100 | 1. Dysprosium-166 | 10 | 0.1 Erbium-169 | 10 | 0.1 Erbium-171 | 10 | 0.1 Europium-152 (9.2h) | 10 | 0.1 Europium-152 (13 y) | 0.1 | 0.001 Europium-154 | 0.1 | 0.001 Europium-155 | 1 | 0.01 Fluorine-18 | 100 | 1.

Radioactive Material | Col. I curies | Col. II curies Gadolinium-153 | 1 | 0.01 Gadolinium-159 | 10 | 0.1 Gallium-72 | 10 | 0.1 Germanium-71 | 100 | 1. Gold-198 | 10 | 0.1 Gold-199 | 10 | 0.1 Hafnium-181 | 1 | 0.01 Holmium-166 | 10 | 0.1 Hydrogen-3 | 100 | 1. Indium-113m | 100 | 1. Indium-114m | 1 | 0.01 Indium-115m | 100 | 1. Indium-115 | 1 | 0.01 Iodine-125 | 0.1 | 0.001 Iodine-126 | 0.1 | 0.001 Iodine-129 | 0.1 | 0.001 Iodine-131 | 0.1 | 0.001 Iodine-132 | 10 | 0.1 Iodine-133 | 1 | 0.01 Iodine-134 | 10 | 0.1 Iodine-135 | 1 | 0.01 Iridium-192 | 1 | 0.01 Iridium-194 | 10 | 0.1 Iron-55 | 10 | 0.1 Iron-59 | 1 | 0.01 Krypton-85 | 100 | 1. Krypton-87 | 10 | 0.1 Lanthanum-140 | 1 | 0.01 Lutetium-177 | 10 | 0.1 Manganese-52 | 1 | 0.01 Manganese-54 | 1 | 0.01 Manganese-56 | 10 | 0.1 Mercury-197m | 10 | 0.1 Mercury-197 | 10 | 0.1 Mercury-203 | 1 | 0.01 Molybdenum-99 | 10 | 0.1 Neodymium-147 | 10 | 0.1 Neodymium-149 | 10 | 0.1 Nickel-59 | 10 | 0.1 Nickel-63 | 1 | 0.01 Nickel-65 | 10 | 0.1 Niobium-93m | 1 | 0.01 Niobium-95 | 1 | 0.01 Niobium-97 | 100 | 1. Osmium-185 | 1 | 0.01 Osmium-191m | 100 | 1. Osmium-191 | 10 | 0.1

Radioactive Material | Col. I curies | Col. II curies Osmium-193 | 10 | 0.1 Palladium-103 | 10 | 0.1 Palladium-109 | 10 | 0.1 Phosphorus-32 | 1 | 0.01 Platinum-191 | 10 | 0.1 Platinum-193m | 100 | 1. Platinum-193 | 10 | 0.1 Platinum-197m | 100 | 1. Platinum-197 | 10 | 0.1 Polonium-210 | 0.1 | 0.0001 Potassium-42 | 1 | 0.01 Praseodymium-142 | 10 | 0.1 Praseodymium-143 | 10 | 0.1 Promethium-147 | 1 | 0.01 Promethium-149 | 10 | 0.1 Radium-226 | 0.01 | 0.0001 Rhenium-186 | 10 | 0.1 Rhenium-188 | 10 | 0.1 Rhodium-103m | 1,000 | 10. Rhodium-105 | 10 | 0.1 Rubidium-86 | 1 | 0.01 Rubidium-87 | 1 | 0.01 Ruthenium-97 | 100 | 1. Ruthenium-103 | 1 | 0.01 Ruthenium-105 | 10 | 0.1 Ruthenium-106 | 0.1 | 0.001 Samarium-151 | 1 | 0.01 Samarium-153 | 10 | 0.1 Scandium-46 | 1 | 0.01 Scandium-47 | 10 | 0.1 Scandium-48 | 1 | 0.01 Selenium-75 | 1 | 0.01 Silicon-31 | 10 | 0.1 Silver-105 | 1 | 0.01 Silver-110m | 0.1 | 0.001 Silver-111 | 10 | 0.1 Sodium-22 | 0.1 | 0.001 Sodium-24 | 1 | 0.01 Strontium-85m | 1,000 | 10. Strontium-85 | 1 | 0.01 Strontium-89 | 1 | 0.01 Strontium-90 | 0.01 | 0.0001 Strontium-91 | 10 | 0.1 Strontium-92 | 10 | 0.1 Sulphur-35 | 10 | 0.1 Tantalum-182 | 1 | 0.01 Technetium-96 | 10 | 0.1 Technetium-97m | 10 | 0.1

Radioactive Material | Col. I curies | Col. II curies Technetium-97 | 10 | 0.1 Technetium-99m | 100 | 1. Technetium-99 | 1 | 0.01 Tellurium-125m | 1 | 0.01 Tellurium-127m | 1 | 0.01 Tellurium-127 | 10 | 0.1 Tellurium-129m | 1 | 0.01 Tellurium-129 | 100 | 1. Tellurium-131m | 10 | 0.1 Tellurium-132 | 1 | 0.01 Terbium-160 | 1 | 0.01 Thallium-200 | 10 | 0.1 Thallium-201 | 10 | 0.1 Thallium-202 | 10 | 0.1 Thallium-204 | 1 | 0.01 Thulium-170 | 1 | 0.01 Thulium-171 | 1 | 0.01 Tin-113 | 1 | 0.01 Tin-125 | 1 | 0.01 Tungsten-181 | 1 | 0.01 Tungsten-185 | 1 | 0.01 Tungsten-187 | 10 | 0.1 Vanadium-48 | 1 | 0.01 Xenon-131m | 1,000 | 10. Xenon-133 | 100 | 1. Xenon-135 | 100 | 1. Ytterbium-175 | 10 | 0.1 Yttrium-90 | 1 | 0.01 Yttrium-91 | 1 | 0.01 Yttrium-92 | 10 | 0.1 Yttrium-93 | 1 | 0.01 Zinc-65 | 1 | 0.01 Zinc-69m | 10 | 0.1 Zinc-69 | 100 | 1. Zirconium-93 | 1 | 0.01 Zirconium-95 | 1 | 0.01 Zirconium-97 | 1 | 0.01

Any radioactive material other than source material, special nuclear material, or alpha emitting radioactive material not listed above. 0.1 0.001

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.7 Standards for Protection Against Radiation

Mont. Admin. R. 37.14.701 Purpose and Scope

(1) This subchapter establishes standards for protection against radiation hazards. Except as otherwise specifically provided, this subchapter applies to all licensees or registrants. Nothing in this subchapter shall be interpreted as limiting the intentional exposure of patients to radiation for the purpose of medical diagnosis or therapy.

(2) In addition to complying with the requirements set forth in this subchapter, every reasonable effort should be made to maintain radiation exposures, and releases of radioactive material in effluents to unrestricted areas, as low as is reasonably achievable. The term "as low as is reasonably achievable" means as low as is reasonably achievable taking into account the state of technology, and the economics of improvements in relation to benefits to the public health and safety, and other societal and socioeconomic considerations, and in relation to the utilization of ionizing radiation in the public interest.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.705 Permissible Doses, Levels and Concentrations: Radiation Dose to Individuals in Restricted Areas

(1) For determining the doses specified in this rule, a dose from X or gamma rays up to 10 MeV may be assumed to be equivalent to the exposure measured by a properly calibrated appropriate instrument in air at or near the body surface in the region of the highest dose rate.

(2) Except as provided in (3) of this rule, no licensee or registrant shall possess, use, receive, or transfer sources of radiation in such a manner as to cause any individual in a restricted area to receive in any period of 1 calendar quarter from all sources of radiation in the licensee's or registrant's possession a dose in excess of the limits specified in the following table:

Rems per calendar quarter

Whole body; head and trunk;

active blood-forming organs;

lens of eyes; or gonads . . . . . . . . . . ........................................................1 1/4

Hands and forearms; feet

and ankles . . . . . . . . . . . . . . . . ...............................................................18 3/4

Skin of whole body . . . . . . . . . . . . . ..........................................................7 1/2

(3) A licensee or registrant may permit an individual in a restricted area to receive a dose to the whole body greater than that permitted under (2) of this rule, provided:

(a) during any calendar quarter the dose to the whole body from sources of radiation in the licensee's or registrant's possession shall not exceed 3 rems;

(b) the dose to the whole body, when added to the accumulated occupational dose to the whole body, shall not exceed 5(N-18) rems where "N" equals the individual's age in years at his last birthday; and

(c) the licensee or registrant has determined the individual's accumulated occupational dose to the whole body on department form MRH-30 or on a clear and legible record containing all the information required in that form and has otherwise complied with the requirements of ARM 37.14.706 . As used in (3) , "dose to the whole body" shall be deemed to include any dose to the whole body, gonads, active blood-forming organs, head and trunk, or lens of eye.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.706 Permissible Doses, Levels, and Concentrations: Determination of Accumulated Dose

(1) This rule contains requirements which must be satisfied by licensees or registrants who propose, pursuant to ARM 37.14.705 (3) to permit individuals in a restricted area to receive exposure to radiation in excess of the limits specified in ARM 37.14.705 (2) .

(2) Before permitting any individual in a restricted area to be exposed to radiation in excess of the limits specified in ARM 37.14.705 (2) , each licensee or registrant shall:

(a) obtain a certificate on department form MRH-30 or on a clear and legible record containing all the information required in that form, signed by the individual, showing each period of time after the individual attained the age of 18 in which the individual received an occupational dose of radiation; and

(b) calculate on department form MRH-30, in accordance with the instructions appearing therein, or on a clear and legible record containing all the information required in that form, the previously accumulated occupational dose received by the individual and the additional dose allowed for that individual under ARM 37.14.705 (3) .

(c) In the preparation of department form MRH-30, or a clear and legible record containing all the information required in that form, the licensee or registrant shall make a reasonable effort to obtain reports of the individual's previously accumulated occupational dose. For each period for which the licensee or registrant obtains such reports, he shall use the dose shown in the report in preparing the form. In any case where a licensee or registrant is unable to obtain reports of the individual's occupational dose for a previous complete calendar quarter, it shall be assumed that the individual has received the occupational dose specified in whichever of the following columns apply:

(d) The licensee or registrant shall retain and preserve records used in preparing department form MRH-30 until the department authorizes their disposition. If calculation of the individual's accumulated occupational dose for all periods prior to January 1, 1961, yields a result higher than the applicable accumulated dose value for the individual as of that date, as specified in ARM 37.14.705 (3) (b) , the excess may be disregarded.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.707 Permissible Doses, Levels, and Concentrations: Exposure of Individuals to Concentrations of Radioactive Material in Air in Restricted Areas

(1) No licensee shall possess, use, or transfer radioactive material in such a manner as to permit any individual in a restricted area to inhale a quantity of radioactive material in any period of 1 calendar quarter greater than the quantity which would result from inhalation for 40 hours per week for 13 weeks at uniform concentrations of radioactive material in air specified in Appendix A, Table I, Column 1 of this subchapter. If the radioactive material is of such form that intake by absorption through the skin is likely, individual exposures to radioactive material shall be controlled so that the uptake of radioactive material by any organ from either inhalation or absorption or both routes of intake in any calendar quarter does not exceed that which would result from inhaling such radioactive material for 40 hours per week for 13 weeks at uniform concentrations specified in Appendix A, Table I, Column 1 of this subchapter.

(a) Since the concentration specified for tritium oxide vapor assumes equal intakes by skin absorption and inhalation, the total intake permitted is twice that which would result from inhalation alone at the concentration specified for H-3(S) in Appendix A, Table I, Column 1 of this subchapter for 40 hours per week for 13 weeks.

(b) For radon-222, the limiting quantity is that inhaled in a period of 1 calendar year. For radioactive material designated "Sub" in the "Isotope" column of Appendix A, Table I of this subchapter, the concentration value specified is based upon exposure to the material as an external radiation source. Individual exposures to these materials may be accounted for as part of the limitation on individual dose in ARM 37.14.705 . These nuclides shall be subject to the precautionary procedures required by (4) (a) of this rule.

(c) Multiply the concentration values specified in Appendix A, Table I, Column 1 of this subchapter by 6.3 x 10 8 ml to obtain the quarterly quantity limit. Multiply the concentration value specified in Appendix A, Table I, Column 1 of this subchapter by 2.5 x 10 9 ml to obtain the annual quantity limit for Rn-222.

(d) Significant intake by ingestion or injection is presumed to occur only as a result of circumstances such as accident, inadvertence, poor procedure, or similar special conditions. Such intakes must be evaluated and accounted for by techniques and procedures as may be appropriate to the circumstances of the occurrence. Exposures so evaluated shall be included in determining whether the limitation on individual exposures in (1) has been exceeded.

(e) Regulatory guidance on assessment of individual intakes of radioactive material is given in Regulatory Guide 8.9, "Acceptable Concepts, Models, Equations and Assumptions for a Bioassay Program." Single copies of Regulatory Guide 8.9 are available from the Office of Standards Development, US Nuclear Regulatory Commission, Washington, DC 20555, upon written request.

(2) No licensee shall possess, use, or transfer mixtures of U-234, U-235, and U-238 in soluble form in such a manner as to permit any individual in a restricted area to inhale a quantity of such material in excess of the intake limits specified in Appendix A, Table I, Column 1 of this subchapter. If such soluble uranium is of a form such that absorption through the skin is likely, individual exposures to such material shall be controlled so that the uptake of such material by any organ from either inhalation or absorption or both routes of intake does not exceed that which would result from inhaling such material at the limits specified in Appendix A, Table I, Column 1 of this subchapter and (1) (c) of this rule.

(3) For purposes of determining compliance with the requirements of this rule, the licensee shall use suitable measurements of concentrations of radioactive materials in air for detecting and evaluating airborne radioactivity in restricted areas and in addition, as appropriate, shall use measurements of radioactivity in the body, measurements of radioactivity excreted from the body, or any combination of such measurements as may be necessary for timely detection and assessment of individual intakes of radioactivity by exposed individuals. It is assumed that an individual inhales radioactive material at the airborne concentration in which he is present unless he uses respiratory protective equipment. When assessment of a particular individual's intake of radioactive material is necessary, intakes less than those which would result from inhalation for 2 hours in any 1 day or for 10 hours in any 1 week at uniform concentrations specified in Appendix A, Table I, Column 1 of this subchapter need not be included in such assessment, provided that for any assessment in excess of these amounts the entire amount is included.

(4) The licensee shall, as a precautionary procedure, use process or other engineering controls, to the extent practicable, to limit concentrations of radioactive materials in air to levels below those which delimit an airborne radioactivity area.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.708 Permissible Doses, Levels, and Concentrations: Exposure of Minors

(2) No licensee or registrant shall possess, use, or transfer sources of radiation in such a manner as to cause any individual within a restricted area, who is under 18 years of age, to receive in any period of 1 calendar quarter from all sources of radiation in such licensee's or registrant's possession a dose in excess of 10% of the limits specified in the table in ARM 37.14.705 (2) .

(3) No licensee shall possess, use, or transfer radioactive material in such a manner as to cause any individual within a restricted area, who is under 18 years of age, to be exposed to airborne radioactive material in an average concentration in excess of the limits specified in Appendix A, Table II, of this subchapter. For purposes of this section, concentrations may be averaged over periods not greater than a week.

(4) The provisions of ARM 37.14.707 (4) (b) and (5) shall apply to exposures subject to (3) of this rule except that the references in ARM 37.14.707 (4) (b) and (5) to Appendix A, Table I, Column 1 of this subchapter shall be deemed to be references to Appendix A, Table II, Column 1 of this subchapter.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.709 Permissible Doses, Levels, and Concentrations: External Sources in Unrestricted Areas

(1) It is the intent of this rule to limit radiation levels so that it is unlikely that individuals in unrestricted areas would receive a dose to the whole body in excess of 0.5 rem in any 1 year. If, in specific instances, it is determined by the department that this intent is not met, the department may, pursuant to ARM 37.14.116 , impose such additional requirements on the licensee or registrant as may be necessary to meet the intent.

(2) Except as authorized by the department pursuant to (3) of this rule, no licensee or registrant shall possess, use, or transfer sources of radiation in such a manner as to create in any unrestricted area from such sources of radiation in his possession:

(a) radiation levels which, if an individual were continuously present in the area, could result in his receiving a dose in excess of 2 millirems in any 1 hour; or

(b) radiation levels which, if an individual were continuously present in the area could result in his receiving a dose in excess of 100 millirems in any 7 consecutive days.

(3) Any person may apply to the department for proposed limits upon levels of radiation in unrestricted areas in excess of those specified in (2) of this rule resulting from the applicant's possession or use of sources of radiation. Such applications should include information as to anticipated average radiation levels and anticipated occupancy times for each unrestricted area involved. The department will approve the proposed limits if the applicant demonstrates to the satisfaction of the department that the proposed limits are not likely to cause any individual to receive a dose to the whole body in any period of 1 calendar year in excess of 0.5 rem.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.710 Permissible Doses, Levels, and Concentrations: Radioactivity in Effluents to Unrestricted Areas

(1) A licensee shall not possess, use, or transfer licensed material so as to release to an unrestricted area radioactive material in concentrations which exceed the limits specified in Appendix A, Table II of this subchapter except as authorized pursuant to ARM 37.14.741 or (2) of this rule. For purposes of this rule, concentrations may be averaged over a period not greater than 1 year.

(2) An application for a license or amendment may include proposed limits higher than those specified in (1) of this rule. The department will approve the proposed limits if the applicant demonstrates:

(a) that the applicant has made a reasonable effort to minimize the radioactivity contained in effluents to unrestricted areas; and

(b) that it is not likely that radioactive material discharged in the effluent would result in the exposure of an individual to concentrations of radioactive material in air or water exceeding the limits specified in Appendix A, Table II of this subchapter.

(3) An application for higher limits pursuant to (2) of this rule shall include information demonstrating that the applicant has made a reasonable effort to minimize the radioactivity discharged in effluents to unrestricted areas, and shall include, as pertinent:

(a) information as to flow rates, total volume of effluent, peak concentration of each radionuclide in the effluent, and concentration of each radionuclide in the effluent averaged over a period of 1 year at the point where the effluent leaves a stack, tube, pipe, or similar conduit;

(b) a description of the properties of the effluents, including:

(i) chemical composition,

(ii) physical characteristics, including suspended solids content in liquid effluents, and nature of gas or aerosol for air effluents,

(iii) the hydrogen ion concentrations (pH) of liquid effluents, and

(iv) the size range of particulates in effluents released into air;

(c) a description of the anticipated human occupancy in the unrestricted area where the highest concentration of radioactive material from the effluent is expected, and, in the case of a river or stream, a description of water uses downstream from the point of release of the effluent;

(d) information as to the highest concentration of each radionuclide in an unrestricted area, including anticipated concentrations averaged over a period of 1 year:

(i) in air at any point of human occupancy, or

(ii) in water at points of use downstream from the point of release of the effluent;

(e) the background concentration of radionuclides in the receiving river or stream prior to the release of liquid effluent;

(f) a description of the environmental monitoring equipment, including sensitivity of the system, and procedures and calculations to determine concentrations of radionuclides in the unrestricted area and possible reconcentrations of radionuclides; and

(g) a description of the waste treatment facilities and procedures used to reduce the concentration of radionuclides in effluents prior to their release.

(4) For the purposes of this rule, the concentration limits in Appendix A, Table II of this subchapter shall apply at the boundary of the restricted area. The concentration of radioactive material discharged through a stack, pipe or similar conduit may be determined with respect to the point where the material leaves the conduit. If the conduit discharges within the restricted area, the concentration at the boundary may be determined by applying appropriate factors for dilution, dispersion, or decay between the point of discharge and the boundary.

(5) In addition to limiting concentrations in effluent streams, the department may limit quantities of radioactive material released in air or water during a specified period of time if it appears that the daily intake of radioactive material from air, water, or food by a suitable sample of an exposed population group, averaged over a period not exceeding 1 year, would otherwise exceed the daily intake resulting from continuous exposure to air or water containing one-third the concentration of radioactive material specified in Appendix A, Table II of this subchapter.

(6) The provisions of this rule do not apply to disposal of radioactive material into sanitary sewerage systems, which is governed by ARM 37.14.742 .

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.711 Permissible Doses, Levels, and Concentrations: Orders Requiring Furnishing of Bioassay Services

(1) Where necessary or desirable in order to aid in determining the extent of an individual's exposure to concentrations of radioactive material, the department may incorporate license provisions or issue an order requiring a licensee or registrant to make available to the individual appropriate bioassay services and to furnish a copy of the reports of such services to the department.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.720 Precautionary Procedures: Surveys

(1) Each licensee or registrant shall make or cause to be made such surveys as may be necessary for him to establish compliance with this subchapter.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.721 Precautionary Procedures: Personnel Monitoring

(1) Each licensee or registrant shall supply appropriate personnel monitoring equipment to, and shall require the use of such equipment by:

(a) Each individual who enters a restricted area under such circumstances that he receives, or is likely to receive, a dose in any calendar quarter in excess of 25% of the applicable value specified in ARM 37.14.705 (2) .

(b) Each individual under 18 years of age who enters a restricted area under such circumstances that he receives, or is likely to receive, a dose in any calendar quarter in excess of 5% of the applicable value specified in ARM 37.14.705 (2) .

(d) Licensees or registrants who use personnel dosimeters to satisfy a requirement of this subchapter shall utilize personnel dosimetry services approved by the department.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.725 Precautionary Procedures: Caution Signs, Labels, and Signals

(1) Except as otherwise authorized by the department, symbols prescribed by this rule shall use the conventional radiation caution colors: magenta or purple on yellow background.

(a) The symbol prescribed by this rule is the conventional 3-blade design:

Cross-hatch area is to be magenta or purple. Background is to be yellow. To put this symbol in perspective, "A" represents the radius of the center circle.

Official policy figure

(b) In addition to the contents of signs and labels prescribed in this rule, a licensee or registrant may provide on or near such signs and labels any additional information which may be appropriate in aiding individuals to minimize exposure to radiation.

(2) Each radiation area shall be conspicuously posted with a sign or signs bearing the radiation caution symbol and the words: "CAUTION--RADIATION AREA" or "DANGER--RADIATION AREA".

(3) High radiation areas shall be distinguished as follows:

(a) Each high radiation area shall be conspicuously posted with a sign or signs bearing the radiation caution symbol and the words: "CAUTION--HIGH RADIATION AREA" or "DANGER--HIGH RADIATION AREA".

(b) Each entrance or access point to a high radiation area shall be:

(i) equipped with a control device which shall cause the level of radiation to be reduced below that at which an individual might receive a dose of 100 millirems in 1 hour upon entry into the area; or

(ii) equipped with a control device which shall energize a conspicuous visible or audible alarm signal in such a manner that the individual entering the high radiation area and the licensee or a supervisor of the activity are made aware of the entry; or

(iii) maintained locked except during periods when access to the area is required, with positive control over each individual entry.

(c) The controls required by (b) above shall be established in such a way that no individual will be prevented from leaving a high radiation area.

(d) In the case of a high radiation area established for a period of 30 days or less, direct surveillance to prevent unauthorized entry may be substituted for the controls required by (b) above.

(e) Any licensee or registrant may apply to the department for approval of methods not included in (b) and (d) above for controlling access to high radiation areas. The department will approve the proposed alternatives if the licensee or registrant demonstrates that the alternative methods of control will prevent unauthorized entry into a high radiation area, and that the requirement of (c) above is met.

(4) Each airborne radioactivity area shall be conspicuously posted with a sign or signs bearing the radiation caution symbol and the words: "CAUTION--AIRBORNE RADIOACTIVITY AREA" or "DANGER--AIRBORNE RADIOACTIVITY AREA".

(5) Additional requirements for radioactivity areas are that:

(a) Each area or room in which any radioactive material, other than natural uranium or thorium, is used or stored in an amount exceeding 10 times the quantity of radioactive material specified in Appendix B of this subchapter shall be conspicuously posted with a sign or signs bearing the radiation caution symbol and the words: "CAUTION--RADIOACTIVE MATERIAL" or "DANGER--RADIOACTIVE MATERIAL".

(b) Each area or room in which natural uranium or thorium is used or stored in an amount exceeding 100 times the quantity specified in Appendix B of this subchapter shall be conspicuously posted with a sign or signs bearing the radiation caution symbol and the words: "CAUTION--RADIOACTIVE MATERIAL" or "DANGER--RADIOACTIVE MATERIAL".

(6) Containers of radioactive material shall meet the following requirements:

(a) Except as provided in (c) below, each container of radioactive material shall bear a durable, clearly visible label identifying the radioactive contents.

(b) A label required pursuant to (a) above shall bear the radiation caution symbol and the words: "CAUTION--RADIOACTIVE MATERIAL" or "DANGER--RADIOACTIVE MATERIAL".

(i) It shall also provide sufficient information to permit individuals handling or using the containers, or working in the vicinity thereof, to take precautions to avoid or minimize exposures. This information, as appropriate, will include radiation levels, kinds of material, estimate of activity, date for which activity is estimated, etc.

(i) for containers that do not contain radioactive material in quantities greater than the applicable quantities listed in Appendix B of this subchapter;

(ii) for containers containing only natural uranium or thorium in quantities no greater than 10 times the applicable quantities listed in Appendix B of this subchapter;

(iii) for containers that do not contain radioactive material in concentrations greater than the applicable concentrations listed in Appendix A, Table I, Column 2 of this subchapter;

(iv) for containers when they are attended by an individual who takes the precautions necessary to prevent the exposure of any individual to radiation or radioactive material in excess of the limits established by this subchapter;

(v) for containers when they are in transport and packaged and labeled in accordance with regulations published by the US department of transportation;

(vi) for containers which are accessible only to individuals authorized to handle or use them (for example, containers in locations such as water-filled canals, storage vaults, or hot cells) or to work in the vicinity thereof, provided that the contents are identified to such individuals by a readily available written record; and

(vii) for manufacturing and process equipment such as piping and tanks.

(7) All radiation machines shall be labeled in a manner which cautions individuals that radiation is produced when the machine is being operated.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.726 Precautionary Procedures: Exceptions from Posting and Labeling Requirements

(1) Notwithstanding the provisions of ARM 37.14.725 :

(a) A room or area is not required to be posted with a caution sign because of the presence of a sealed source, provided the radiation level 12 inches from the surface of the source container or housing does not exceed 5 millirems per hour.

(b) Rooms or other areas in hospitals are not required to be posted with caution signs, and control of entrance or access thereto pursuant to ARM 37.14.725 is not required, because of the presence of patients containing radioactive material provided that there are personnel in attendance who will take the precautions necessary to prevent the exposure of any individual to radiation or radioactive material in excess of the limits established in this subchapter.

(c) Caution signs are not required to be posted in areas or rooms containing radioactive material for periods of less than 8 hours provided that:

(i) the material is constantly attended during such periods by an individual who shall take the precautions necessary to prevent the exposure of any individual to radiation or radioactive material in excess of the limits established in this subchapter, and

(ii) such area or room is subject to the licensee's or registrant's control.

(d) A room or other area is not required to be posted with a caution sign, and control is not required for each entrance or access point to a room or other area which is a high radiation area solely because of the presence of radioactive material prepared for transport and packaged and labeled in accordance with regulations of the US department of transportation.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.729 Precautionary Procedures: Instruction of Personnel

(1) Instructions required for individuals working in or frequenting any portion of a restricted area are specified in ARM 37.14.1706 .

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.730 Precautionary Procedures: Storage and Control of Sources of Radiation

(1) Sources of radiation shall be secured against unauthorized removal from the place of storage.

(2) Sources of radiation in an unrestricted area and not in storage shall be tended under the constant surveillance and immediate control of the licensee or registrant.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.731 Precautionary Procedures: Procedures for Picking Up, Receiving, and Opening Packages

(1) Each licensee or registrant who expects to receive a package containing quantities of radioactive material in excess of the Type A quantities specified in the table following (4) of this rule shall:

(a) if the package is to be delivered to the licensee's or registrant's facility by the carrier, make arrangements to receive the package when it is offered for delivery by the carrier; or

(b) if the package is to be picked up by the licensee or registrant at the carrier's terminal, make arrangements to receive notification from the carrier of the arrival of the package, at the time of arrival.

(2) Each licensee or registrant who picks up a package of radioactive material from a carrier's terminal shall pick up the package expeditiously upon receipt of notification from the carrier of its arrival.

(3) Each licensee or registrant, upon receipt of a package of radioactive material, shall monitor the external surfaces of the package for radioactive contamination caused by leakage of the radioactive contents. The monitoring shall be performed as soon as practicable after receipt, but no later than 3 hours after the package is received at the licensee's facility if received during the licensee's normal working hours or 18 hours if received after normal working hours. Such monitoring need not be performed on:

(a) packages containing no more than the exempt quantity specified in the table following (4) of this rule;

(b) packages containing no more than 10 millicuries of radioactive material consisting solely of tritium, carbon-14, sulfur-35 or iodine-125;

(d) packages containing only radioactive material in other than liquid form (including Mo-99/Tc-99m generators) and not exceeding the Type A quantity limit specified in the table following (4) of this rule; and

(e) packages containing only radionuclides with half-lives of less than 30 days and a total quantity of no more than 100 millicuries.

(4) If removable radioactive contamination in excess of 0.01 microcurie (22,200 disintegrations per minute) per 100 square centimeters of package surface is found on the external surface of the package, the licensee or registrant shall immediately notify, by telephone and telegraph, the final delivering carrier and the department.

Transport Group | Exempt Quantity Limit (in millicuries) | Type A Quantity Limit (in curies) I | 0.01 | 0.001 II | 0.1 | 0.050 III | 1 | 3 IV | 1 | 20 V | 1 | 20 VI | 1 | 1,000 VII | 25,000 | 1,000 Special form | 1 | 20

(5) Each licensee or registrant, upon receipt of a package containing quantities of radioactive material in excess of the Type A quantities specified in the table following (4) of this rule, other than those transported by exclusive use vehicle, shall monitor the radiation levels external to the package.

(a) The package shall be monitored as soon as practicable after receipt, but no later than 3 hours after the package is received at the licensee's facility if received during the licensee's normal working hours, or 18 hours if received after normal working hours.

(b) If radiation levels are found on the external surface of the package in excess of 200 millirems per hour, or in excess of 10 millirems per hour at 3 feet from the external surface of the package, the licensee or registrant shall immediately notify, by telephone and telegraph, the final delivering carrier and the department.

(6) Each licensee or registrant shall establish and maintain procedures for safely opening packages in which radioactive material is received, and shall assure that such procedures are followed and that due consideration is given to special instructions for the type of package being opened.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.740 Waste Disposal: General Requirement

(1) No licensee shall dispose of any radioactive material except:

(a) by transfer to an authorized recipient as provided in ARM 37.14.547 , or

(b) as authorized pursuant to ARM 37.14.710 , 37.14.741 , 37.14.742 or 37.14.743 .

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-301, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.741 Waste Disposal: Method of Obtaining Approval of Proposed Disposal Procedures

(1) Any person may apply to the department for approval of proposed procedures to dispose of radioactive material in a manner not otherwise authorized in this subchapter. Each application shall include a description of the radioactive material, including the quantities and kinds of radioactive material and levels of radioactivity involved, and the proposed manner and conditions of disposal. The application, where appropriate, should also include an analysis and evaluation of pertinent information as to the nature of the environment, including topographical, geological, meteorological, and hydrological characteristics; usage of ground and surface waters in the general area; the nature and location of other potentially affected facilities; and procedures to be observed to minimize the risk of unexpected or hazardous exposures.

(2) The department will not approve any application for a license to receive radioactive material from other persons for disposal on land not owned by the state or the federal government.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-301, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.742 Waste Disposal: Disposal by Release Into Sanitary Sewerage Systems

(1) No licensee shall discharge radioactive material into a sanitary sewerage system unless:

(a) it is readily soluble or dispersible in water; and

(b) the quantity of any radioactive material released into the system by the licensee in any 1 day does not exceed the larger of:

(i) the quantity which, if diluted by the average daily quantity of sewage released into the sewer by the licensee, will result in an average concentration equal to the limits specified in Appendix A, Table I, Column 2, of this subchapter, or

(ii) ten times the quantity of such material specified in Appendix B of this subchapter; and

(c) the quantity of any radioactive material released in any 1 month, if diluted by the average monthly quantity of water released by the licensee, will not result in an average concentration exceeding the limits specified in Appendix A, Table I, Column 2, of this subchapter; and

(d) the gross quantity of radioactive material released into the sewerage system by the licensee does not exceed 1 curie per year.

(2) Excreta from individuals undergoing medical diagnosis or therapy with radioactive material shall be exempt from any limitations contained in this rule.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-301, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.743 Waste Disposal: Disposal by Burial in Soil

(1) No licensee shall dispose of radioactive material by burial in soil unless:

(a) the total quantity of radioactive material buried at any 1 location and time does not exceed, at the time of burial, 1,000 times the amount specified in Appendix B of this subchapter;

(b) burial is at a minimum of 4 feet; and

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-301, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.744 Waste Disposal: Disposal by Incineration

(1) No licensee shall incinerate radioactive material for the purpose of disposal or preparation for disposal except as specifically approved by the department pursuant to ARM 37.14.710 and 37.14.741 .

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-301, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.750 Records, Reports and Notification: Surveys, Radiation Monitoring, Disposal

(1) Each licensee or registrant shall maintain records showing the radiation exposures of all individuals for whom personnel monitoring is required under ARM 37.14.721 . Such records shall be kept on department form MRH-31, in accordance with the instructions contained in that form, or on clear and legible records containing all the information required by department form MRH-31. The doses entered on the forms or records shall be for periods of time not exceeding 1 calendar quarter.

(2) Each licensee or registrant shall maintain records in the same units used in this subchapter, showing the results of surveys required by ARM 37.14.720 , monitoring required by ARM 37.14.731 (3) , (4) , and (5) , and disposals made under ARM 37.14.741 , 37.14.742 , and 37.14.743 .

(3) Records required by this subchapter shall be maintained for the following periods:

(a) Records of individual exposure to radiation and to radioactive material which must be maintained pursuant to the provisions of (1) of this rule and records of bioassays, including results of whole body counting examinations, made pursuant to ARM 37.14.711 shall be preserved until the department authorizes disposition.

(b) Records of the results of surveys and monitoring which must be maintained pursuant to (2) of this rule shall be preserved for 2 years after completion of the survey except that the following records shall be maintained until the department authorizes their disposition:

(i) Records of the results of surveys to determine compliance with ARM 37.14.707 (1) .

(ii) In the absence of personnel monitoring data, records of the results of surveys to determine external radiation dose.

(iii) Records of the results of surveys used to evaluate the release of radioactive effluents to the environment.

(c) Records of disposal of licensed material made pursuant to ARM 37.14.741 , 37.14.742 and 37.14.743 shall be maintained until the department authorizes their disposition.

(d) Records which must be maintained pursuant to this subchapter may be the original or a reproduced copy or microform if such reproduced copy or microform is duly authenticated by authorized personnel and the microform is capable of producing a clear and legible copy after storage for the period specified by department rules.

(e) If there is a conflict pertaining to the retention period for the same type of record, the retention period specified in this subchapter for such records shall apply unless the department, pursuant to ARM 37.14.106 (1) has granted a specific exemption from the record retention requirements specified in this subchapter.

(4) The discontinuance of or curtailment of activities, does not relieve the licensee or registrant of responsibility for retaining all records required by this rule. A licensee or registrant may, however, request the department to accept such records. The acceptance of the records by the department relieves the licensee or registrant of subsequent responsibility only in respect to their preservation as required by this rule.

History

Authorizing statute(s): Sec. 75-3-204, MCA
Implementing statute(s): Sec. 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.751 Records, Reports, and Notification: Reports of Theft or Loss of Sources of Radiation

(1) Each licensee or registrant shall report by telephone and telegraph to the department the theft or loss of any source of radiation immediately after such occurrence becomes known.

History

Authorizing statute(s): Sec. 75-3-204, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.755 Records, Reports, and Notification: Notification of Incidents

(1) Each licensee or registrant shall immediately notify the department by telephone and telegraph of any incident involving any source of radiation possessed by him and which may have caused or threatens to cause:

(a) a dose to the whole body of any individual of 25 rems or more of radiation; a dose to the skin of the whole body of any individual of 150 rems or more of radiation; or a dose to the feet, ankles, hands, or forearms of any individual of 375 rems or more of radiation; or

(b) the release of radioactive material in concentrations which, if averaged over a period of 24 hours, would exceed 5,000 times the limits specified for such materials in Appendix A, Table II of this subchapter; or

(d) damage to property in excess of $200,000.

(2) Each licensee or registrant shall within 24 hours notify the department by telephone and telegraph of any incident involving any source of radiation possessed by him and which may have caused or threatens to cause:

(a) a dose to the whole body of any individual of 5 rems or more of radiation; a dose to the skin of the whole body of any individual of 30 rems or more of radiation; or a dose to the feet, ankles, hands, or forearms of 75 rems or more of radiation; or

(b) the release of radioactive material in concentrations which, if averaged over a period of 24 hours, would exceed 500 times the limits specified for such materials in Appendix A, Table II of this subchapter; or

(d) damage to property in excess of $2,000.

(3) Any report filed with the department pursuant to this rule shall be prepared in such a manner that names of individuals who have received excessive doses will be stated in a separate part of the report.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.756 Records, Reports, and Notification: Reports of Overexposures and Excessive Levels and Concentrations

(1) In addition to any notification required by ARM 37.14.755 , each licensee or registrant shall make a report in writing within 30 days to the department of:

(a) each exposure of an individual to radiation in excess of the applicable limits in ARM 37.14.705 or 37.14.708 (2) or the license;

(b) each exposure of an individual to radioactive material in excess of the applicable limits in ARM 37.14.707 (1) , (2) or 37.14.708 (3) , or the license;

(c) levels of radiation or concentrations of radioactive material in a restricted area in excess of any other applicable limit in the license;

(d) any incident for which notification is required by ARM 37.14.755 ; and

(e) levels of radiation or concentrations of radioactive material, whether or not involving excessive exposure of any individual, in an unrestricted area in excess of 10 times any applicable limit set forth in this subchapter or in the license.

(2) Each report required under (1) of this rule shall describe the extent of exposure of individuals to radiation or to radioactive material, including estimates of each individual's exposure as required by (3) of this rule; levels of radiation and concentrations of radioactive material involved; the cause of the exposure, levels or concentrations; and corrective steps taken or planned to assure against a recurrence.

(3) Any report filed with the department pursuant to this rule shall include for each individual exposed the name, social security number, and date of birth, and an estimate of the individual's dose. The report shall be prepared so that this information is stated in a separate part of the report.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.757 Records, Reports, and Notification: Vacating Premises

(1) Each specific licensee shall, no less than 30 days before vacating or relinquishing possession or control of premises which may have been contaminated with radioactive material as a result of his activities, notify the department in writing of intent to vacate. When deemed necessary by the department, the licensee shall decontaminate the premises in such a manner as the department may specify.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.758 Records, Reports, and Notification: Notifications and Reports to Individuals

(1) Requirements for notification and reports to individuals of exposure to radiation or radioactive material are specified in ARM 37.14.1707

(2) When a licensee or registrant is required pursuant to ARM 37.14.756 to report to the department any exposure of an individual to radiation or radioactive material, the licensee or registrant shall also notify the individual. Such notice shall be transmitted at a time not later than the transmittal to the department, and shall comply with the provisions of ARM 37.14.1707(1) .

APPENDIX A

CONCENTRATIONS IN AIR AND WATER ABOVE NATURAL BACKGROUND

| | | Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Actinium (89) | Ac-227 Ac-228 | S I S I | 2x10 -12 3x10 -11 9x10-8 2x10 -8 | 6x10 -5 9x10 -3 3x10 -3 3x10 -3 | 8x10 -14 9x10 -13 3x10 -9 6x10 -10 | 2x10 -6 3x10 -4 9x10 -5 9x10 -5 Americium (95) | Am-241 Am-242m Am-242 Am-243 Am-244 | S I S I S I S I S I | 6x10 -12 1x10 -10 6x10-12 3x10 -10 4x10 -8 5x10-8 6x10 -12 1x10 -10 4x10 -6 2x10 -5 | 1x10 -4 8x10 -4 1x10 -4 3x10-3 4x10-3 4x10 -3 1x10 -4 8x10 -4 1x10 -1 1x10 -1 | 2x10 -13 4x10 -12 2x10 -13 9x10 -12 1x10 -9 2x10 -9 2x10 -13 4x10 -12 1x10 -7 8x10 -7 | 4x10 -6 3x10 -5 4x10 -6 9x10 -5 1x10 -4 1x10 -4 4x10 -6 3x10 -5 5x10 -3 5x10 -3 Antimony (51) | Sb-122 Sb-124 Sb-125 | S I S I S I | 2x10 -7 1x10 -7 2x10 -7 2x10 -8 5x10 -7 3x10 -8 | 8x10 -4 8x10 -4 7x10 -4 7x10 -4 3x10 -3 3x10 -3 | 6x10 -9 5x10 -9 5x10 -9 7x10 -10 2x10 -8 9x10 -10 | 3x10 -5 3x10-5 2x10 -5 2x1 1x10 -4 1x10 -4 Argon (18) | Ar-37 Ar-41 | Sub 2 Sub | 6x10 -3 2x10 -6 | --- --- | 1x10 -4 4x10 -8 | --- --- Arsenic (33) | As-73 As-74 As-76 As-77 | S I S I S I S I | 2x10 -6 4x10 -7 3x10 -7 1x10 -7 1x10 -7 1x10 -7 5x10 -7 4x10 -7 | 1x10 -2 1x10 -2 2x10 -3 2x10 -3 6x10 -4 6x10 -4 2x10 -3 2x10 -3 | 7x10 -8 1x10 -8 1x10 -8 4x10 -9 4x10 -9 3x10 -9 2x10 -8 1x10 -8 | 5x10 -4 5x10 -4 5x10 -5 5x10 -5 2x10 -5 2x10 -5 8x10-5 8x10 -5

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| | | Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Gallium (31) | Ga-72 | S I | 2x10 -7 2x10 -7 | 1x10 -3 1x10 -3 | 8x10 -9 6x10 -9 | 4x10 -5 4x10 -5 Germanium (32) | Ge-71 | S I | 1x10 -5 6x10 -6 | 5x10 -2 5x10 -2 | 4x10 -7 2x10 -7 | 2x10 -3 2x10 -3 Gold (79) | Au-196 Au-198 Au-199 | S I S I S I | 1x10 -6 6x10 -7 3x10 -7 2x10 -7 1x10 -6 8x10 -7 | 5x10 -3 4x10 -3 2x1 -3 1x10 -3 5x10 -3 4x10 -3 | 4x10 -8 2x10 -8 1x10 -8 8x10 -9 4x10 -8 3x10 -8 | 2x10 -4 1x10 -4 5x10 -5 5x10 -5 2x10 -4 2x10 -4 Hafnium (72) | Hf-181 | S I | 4x10 -8 7x10 -8 | 2x10 -3 2x10 -3 | 1x10 -9 3x10 -9 | 7x10 -5 7x10 -5 Holmium (67) | Ho-166 | S I | 2x10 -7 2x10 -7 | 9x10 -4 9x10 -4 | 7x10 -9 6x10 -9 | 3x10 -5 3x10 -5 Hydrogen (1) | H-3 | S I Sub 2 | 5x10 -6 5x10 -6 2x10 -3 | 1x10 -1 1x10 -1 --- | 2x10 -7 2x10 -7 4x10 -5 | 3x10 -3 3x10 -3 --- Indium (49) | In-113m In-114m | S I S I | 8x10 -6 7x10 -6 1x10 -7 2x10 -8 | 4x10 -2 4x10 -2 5x10 -4 5x10 -4 | 3x10 -7 2x10 -7 4x10 -9 7x10 -10 | 1x10 -3 1x10 -3 2x10 -5 2x10 -5 | In-115m In-115 | S I S I | 2x10 -6 2x10 -6 2x10 -7 3x10 -8 | 1x10 -2 1x10 -2 3x10 -3 3x10 -3 | 8x10 -8 6x10 -8 9x10 -9 1x10 -9 | 4x10 -4 4x10 -4 9x10 -5 9x10 -5

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| | | Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Iodine (53) | I-125 | S I | 5x10 -9 2x10 -7 | 4x10 -5 6x10 -3 | 8x10 -11 6x10 -9 | 2x10 -7 2x10 -4 | I-126 | S | 8x10 -9 | 5x10 -5 | 9x10 -11 | 3x10 -7 | | I | 3x10 -7 | 3x10 -3 | 1x10 -8 | 9x10 -5 | I-129 | S | 2x10 -9 | 1x10 -5 | 2x10 -11 | 6x10 -8 | | I | 7x10 -8 | 6x10 -3 | 2x10 -9 | 2x10 -4 | I-131 | S | 9x10 -9 | 6x10 -5 | 1x10 -10 | 3x10 -7 | | I | 3x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 | I-132 | S | 2x10 -7 | 2x10 -3 | 3x10 -9 | 8x10 -6 | | I | 9x10 -7 | 5x10 -3 | 3x10 -8 | 2x10 -4 | I-133 | S | 3x10 -8 | 2x10 -4 | 4x10 -10 | 1x10 -6 | | I | 2x10 -7 | 1x10 -3 | 7x10 -9 | 4x10 -5 | I-134 | S | 5x10 -7 | 4x10 -3 | 6x10 -9 | 2x10 -5 | | I | 3x10 -6 | 2x10 -2 | 1x10 -7 | 6x10 -4 | I-135 | S | 1x10 -7 | 7x10 -4 | 1x10 -9 | 4x10 -6 | | I | 4x10 -7 | 2x10 -3 | 1x10 -8 | 7x10 -5 Iridium (77) | Ir-190 | S | 1x10 -6 | 6x10 -3 | 4x10 -8 | 2x10 -4 | | I | 4x10 -7 | 5x10 -3 | 1x10 -8 | 2x10 -4 | Ir-192 | S | 1x10 -7 | 1x10 -3 | 4x10 -9 | 4x10 -5 | | I | 3x10 -8 | 1x10 -3 | 9x10 -10 | 4x10 -5 | Ir-194 | S | 2x10 -7 | 1x10 -3 | 8x10 -9 | 3x10 -5 | | I | 2x10 -7 | 9x10 -4 | 5x10 -9 | 3x10 -5 Iron (26) | Fe-55 | S | 9x10 -7 | 2x10 -2 | 3x10 -8 | 8x10 -4 | | I | 1x10 -6 | 7x10 -2 | 3x10 -8 | 2x10 -3 | Fe-59 | S | 1x10 -7 | 2x10 -3 | 5x10 -9 | 6x10 -5 | | I | 5x10 -8 | 2x10 -3 | 2x10 -9 | 5x10 -5 Krypton (36) | Kr-87m | Sub 2 | 6x10 -6 | --- | 1x10 -7 | --- | Kr-85 | Sub | 1x10 -5 | --- | 3x10 -7 | --- | Kr-87 | Sub | 1x10 -6 | --- | 2x10 -8 | --- | Kr-88 | Sub | 1x10 -6 | --- | 2x10 -8 | --- Lanthanum (57) | La-140 | S | 2x10 -7 | 7x10 -4 | 5x10 -9 | 2x10 -5 | | I | 1x10 -7 | 7x10 -4 | 4x10 -9 | 2x10 -5

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| Table I | Table II | Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Lead (82) | Pb-203 | S | 3x10 -6 | 1x10 -2 | 9x10 -8 | 4x10 -4 | | | I | 2x10 -6 | 1x10 -2 | 6x10 -8 | 4x10 -4 | | Pb-210 | S | 1x10 -10 | 4x10 -6 | 4x10 -12 | 1x10 -7 | | | I | 2x10 -10 | 5x10 -3 | 8x10 -12 | 2x10 -4 | | Pb-212 | S | 2x10 -8 | 6x10 -4 | 6x10 -10 | 2x10 -5 | | | I | 2x10 -8 | 5x10 -4 | 7x10 -10 | 2x10 -5 | Lutetium (71) | Lu-177 | S | 6x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | | | I | 5x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | Manganese (25) | Mn-52 | S | 2x10 -7 | 1x10 -3 | 7x10 -9 | 3x10 -5 | | | I | 1x10 -7 | 9x10 -4 | 5x10 -9 | 3x10 -5 | | Mn-54 | S | 4x10 -7 | 4x10 -3 | 1x10 -8 | 1x10 -4 | | | I | 4x10 -8 | 3x10 -3 | 1x10 -9 | 1x10 -4 | | Mn-56 | S | 8x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | | | I | 5x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | Mercury (80) | Hg-197m | S | 7x10 -7 | 6x10 -3 | 3x10 -8 | 2x10 -4 | | | I | 8x10 -7 | 5x10 -3 | 3x10 -8 | 2x10 -4 | | Hg-197 | S | 1x10 -6 | 9x10 -3 | 4x10 -8 | 3x10 -4 | | | I | 3x10 -6 | 1x10 -2 | 9x10 -8 | 5x10 -4 | | Hg-203 | S | 7x10 -8 | 5x10 -4 | 2x10 -9 | 2x10 -5 | | | I | 1x10 -7 | 3x10 -3 | 4x10 -9 | 1x10 -4 | Molybdenum(42) | Mo-99 | S | 7x10 -7 | 5x10 -3 | 3x10 -8 | 2x10 -4 | | | I | 2x10 -7 | 1x10 -3 | 7x10 -9 | 4x10 -5 | Neodymium (60) | Nd-144 | S | 8x10 -11 | 2x10 -3 | 3x10 -12 | 7x10 -5 | | | I | 3x10 -10 | 2x10 -3 | 1x10 -11 | 8x10 -5 | | Nd-147 | S | 4x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 | | | I | 2x10 -7 | 2x10 -3 | 8x10 -9 | 6x10 -5 | | Nd-149 | S | 2x10 -6 | 8x10 -3 | 6x10 -8 | 3x10 -4 | | | I | 1x10 -6 | 8x10 -3 | 5x10 -8 | 3x10 -4 | Neptunium (93) | Np-237 | S | 4x10 -12 | 9x10 -5 | 1x10 -13 | 3x10 -6 | | | I | 1x10 -10 | 9x10 -4 | 4x10 -12 | 3x10 -5 | | Np-239 | S | 8x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | | | I | 7x10 -7 | 4x10 -3 | 2x10 -8 | 1x10 -4 |

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| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Nickel (28) | Ni-59 | S | 5x10 -7 | 6x10 -3 | 2x10 -8 | 2x10 -4 | | I | 8x10 -7 | 6x10 -2 | 3x10 -8 | 2x10 -3 | Ni-63 | S | 6x10 -8 | 8x10 -4 | 2x10 -9 | 3x10 -5 | | I | 3x10 -7 | 2x10 -2 | 1x10 -8 | 7x10 -4 | Ni-65 | S | 9x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | | I | 5x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 Niobium (41) | Nb-93m | S | 1x10 -7 | 1x10 -2 | 4x10 -9 | 4x10 -4 | | I | 2x10 -7 | 1x10 -2 | 5x10 -9 | 4x10 -4 | Nb-95 | S | 5x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | | I | 1x10 -7 | 3x10 -3 | 3x10 -9 | 1x10 -4 | Nb-97 | S | 6x10 -6 | 3x10 -2 | 2x10 -7 | 9x10 -4 | | I | 5x10 -6 | 3x10 -2 | 2x10 -7 | 9x10 -4 Osmium (76) | Os-185 | S | 5x10 -7 | 2x10 -3 | 2x10 -8 | 7x10 -5 | | I | 5x10 -8 | 2x10 -3 | 2x10 -9 | 7x10 -5 | Os-191m | S | 2x10 -5 | 7x10 -2 | 6x10 -7 | 3x10 -3 | | I | 9x10 -6 | 7x10 -2 | 3x10 -7 | 2x10 -3 | Os-191 | S | 1x10 -6 | 5x10 -3 | 4x10 -8 | 2x10 -4 | | I | 4x10 -7 | 5x10 -3 | 1x10 -8 | 2x10 -4 | Os-193 | S | 4x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 | | I | 3x10 -7 | 2x10 -3 | 9x10 -9 | 5x10 -5 Palladium (46) | Pd-103 | S | 1x10 -6 | 1x10 -2 | 5x10 -8 | 3x10 -4 | | I | 7x10 -7 | 8x10 -3 | 3x10 -8 | 3x10 -4 | Pd-109 | S | 6x10 -7 | 3x10 -3 | 2x10 -8 | 9x10 -5 | | I | 4x10 -7 | 2x10 -3 | 1x10 -8 | 7x10 -5 Phosphorus(15) | P-32 | S | 7x10 -8 | 5x10 -4 | 2x10 -9 | 2x10 -5 | | I | 8x10 -8 | 7x10 -4 | 3x10 -9 | 2x10 -5

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| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Platinum (78) | Pt-191 | S | 8x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | I | 6x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 Pt-193m | S | 7x10 -6 | 3x10 -2 | 2x10 -7 | 1x10 -3 | I | 5x10 -6 | 3x10 -2 | 2x10 -7 | 1x10 -3 Pt-193 | S | 1x10 -6 | 3x10 -2 | 4x10 -8 | 9x10 -4 | I | 3x10 -7 | 5x10 -2 | 1x10 -8 | 2x10 -3 Pt-197m | S | 6x10 -6 | 3x10 -2 | 2x10 -7 | 1x10 -3 | I | 5x10 -6 | 3x10 -2 | 2x10 -7 | 9x10 -4 Pt-197 | S | 8x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | I | 6x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 Plutonium (94) | Pu-238 | S | 2x10 -12 | 1x10 -4 | 7x10 -14 | 5x10 -6 | I | 3x10 -11 | 8x10 -4 | 1x10 -12 | 3x10 -5 Pu-239 | S | 2x10 -12 | 1x10 -4 | 6x10 -14 | 5x10 -6 | I | 4x10 -11 | 8x10 -4 | 1x10 -12 | 3x10 -5 Pu-240 | S | 2x10 -12 | 1x10 -4 | 6x10 -14 | 5x10 -6 | I | 4x10 -11 | 8x10 -4 | 1x10 -12 | 3x10 -5 Pu-241 | S | 9x10 -11 | 7x10 -3 | 3x10 -12 | 2x10 -4 | I | 4x10 -8 | 4x10 -2 | 1x10 -9 | 1x10 -3 Pu-242 | S | 2x10 -12 | 1x10 -4 | 6x10 -14 | 5x10 -6 | I | 4x10 -11 | 9x10 -4 | 1x10 -12 | 3x10 -5 Pu-243 | S | 2x10 -6 | 1x10 -2 | 6x10 -8 | 3x10 -4 | I | 2x10 -6 | 1x10 -2 | 8x10 -8 | 3x10 -4 Pu-244 | S | 2x10 -12 | 1x10 -4 | 6x10 -14 | 4x10 -6 | I | 3x10 -11 | 3x10 -4 | 1x10 -12 | 1x10 -5 Polonium (84) | Po-210 | S | 5x10 -10 | 2x10 -5 | 2x10 -11 | 7x10 -7 | I | 2x10 -10 | 8x10 -4 | 7x10 -12 | 3x10 -5 Potassium (19) | K-42 | S | 2x10 -6 | 9x10 -3 | 7x10 -8 | 3x10 -4 | I | 1x10 -7 | 6x10 -4 | 4x10 -9 | 2x10 -5 Praseodymium (59) | Pr-142 | S | 2x10 -7 | 9x10 -4 | 7x10 -9 | 3x10 -5 | I | 2x10 -7 | 9x10 -4 | 5x10 -9 | 3x10 -5 Pr-143 | S | 3x10 -7 | 1x10 -3 | 1x10 -8 | 5x10 -5 | I | 2x10 -7 | 1x10 -3 | 6x10 -9 | 5x10 -5

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| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Promethium (61) | Pm-147 | S | 6x10 -8 | 6x10 -3 | 2x10 -9 | 2x10 -4 | I | 1x10 -7 | 6x10 -3 | 3x10 -9 | 2x10 -4 Pm-149 | S | 3x10 -7 | 1x10 -3 | 1x10 -8 | 4x10 -5 | I | 2x10 -7 | 1x10 -3 | 8x10 -9 | 4x10 -5 Protactinium (91) | Pa-230 | S | 2x10 -9 | 7x10 -3 | 6x10 -11 | 2x10 -4 | I | 8x10 -10 | 7x10 -3 | 3x10 -11 | 2x10 -4 Pa-231 | S | 1x10 -12 | 3x10 -5 | 4x10 -14 | 9x10 -7 | I | 1x10 -10 | 8x10 -4 | 4x10 -12 | 2x10 -5 Pa-233 | S | 6x10 -7 | 4x10 -3 | 2x10 -8 | 1x10 -4 | I | 2x10 -7 | 3x10 -3 | 6x10 -9 | 1x10 -4 Radium (88) | Ra-223 | S | 2x10 -9 | 2x10 -5 | 6x10 -11 | 7x10 -7 | I | 2x10 -10 | 1x10 -4 | 8x10 -12 | 4x10 -6 Ra-224 | S | 5x10 -9 | 7x10 -5 | 2x10 -10 | 2x10 -6 | I | 7x10 -10 | 2x10 -4 | 2x10 -11 | 5x10 -6 Ra-226 | S | 3x10 -11 | 4x10 -7 | 3x10 -12 | 3x10 -8 | I | 5x10 -11 | 9x10 -4 | 2x10 -12 | 3x10 -5 Ra-228 | S | 7x10 -11 | 8x10 -7 | 2x10 -12 | 3x10 -8 | I | 4x10 -11 | 7x10 -4 | 1x10 -12 | 3x10 -5 Radon (86) | Rn-220 | S | 3x10 -7 | --- | 1x10 -8 | --- Rn-222 3 | S | 3x10 -8 | --- | 3x10 -9 | --- Rhenium (75) | Re-183 | S | 3x10 -6 | 2x10 -2 | 9x10 -8 | 6x10 -4 | I | 2x10 -7 | 8x10 -3 | 5x10 -9 | 3x10 -4 Re-186 | S | 6x10 -7 | 3x10 -3 | 2x10 -8 | 9x10 -5 | I | 2x10 -7 | 1x10 -3 | 8x10 -9 | 5x10 -5 Re-187 | S | 9x10 -6 | 7x10 -2 | 3x10 -7 | 3x10 -3 | I | 5x10 -7 | 4x10 -2 | 2x10 -8 | 2x10 -3 Re-188 | S | 4x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 | I | 2x10 -7 | 9x10 -4 | 6x10 -9 | 3x10 -5 Rhodium (45) | Rh-103m | S | 8x10 -5 | 4x10 -1 | 3x10 -6 | 1x10 -2 | I | 6x10 -5 | 3x10 -1 | 2x10 -6 | 1x10 -2 Rh-105 | S | 8x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | I | 5x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4

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(See notes at end of appendix)

| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Rubidium (37) | Rb-86 | S | 3x10 -7 | 2x10 -3 | 1x10 -8 | 7x10 -5 | I | 7x10 -8 | 7x10 -4 | 2x10 -9 | 2x10 -5 Rb-87 | S | 5x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | I | 7x10 -8 | 5x10 -3 | 2x10 -9 | 2x10 -4 Ruthenium (44) | Ru-97 | S | 2x10 -6 | 1x10 -2 | 8x10 -8 | 4x10 -4 | I | 2x10 -6 | 1x10 -2 | 6x10 -8 | 3x10 -4 Ru-103 | S | 5x10 -7 | 2x10 -3 | 2x10 -8 | 8x10 -5 | I | 8x10 -8 | 2x10 -3 | 3x10 -9 | 8x10 -5 Ru-105 | S | 7x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | I | 5x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 Ru-106 | S | 8x10 -8 | 4x10 -4 | 3x10 -9 | 1x10 -5 | I | 6x10 -9 | 3x10 -4 | 2x10 -10 | 1x10 -5 Samarium (62) | Sm-147 | S | 7x10 -11 | 2x10 -3 | 2x10 -12 | 6x10 -5 | I | 3x10 -10 | 2x10 -3 | 9x10 -12 | 7x10 -5 Sm-151 | S | 6x10 -8 | 1x10 -2 | 2x10 -9 | 4x10 -4 | I | 1x10 -7 | 1x10 -2 | 5x10 -9 | 4x10 -4 Sm-153 | S | 5x10 -7 | 2x10 -3 | 2x10 -8 | 8x10 -5 | I | 4x10 -7 | 2x10 -3 | 1x10 -8 | 8x10 -5 Scandium (21) | Sc-46 | S | 2x10 -7 | 1x10 -3 | 8x10 -9 | 4x10 -5 | I | 2x10 -8 | 1x10 -3 | 8x10 -10 | 4x10 -5 Sc-47 | S | 6x10 -7 | 3x10 -3 | 2x10 -8 | 9x10 -5 | I | 5x10 -7 | 3x10 -3 | 2x10 -8 | 9x10 -5 Sc-48 | S | 2x10 -7 | 8x10 -4 | 6x10 -9 | 3x10 -5 | I | 1x10 -7 | 8x10 -4 | 5x10 -9 | 3x10 -5 Selenium (34) | Se-75 | S | 1x10 -6 | 9x10 -3 | 4x10 -8 | 3x10 -4 | I | 1x10 -7 | 8x10 -3 | 4x10 -9 | 3x10 -4 Silicon (14) | Si-31 | S | 6x10 -6 | 3x10 -2 | 2x10 -7 | 9x10 -4 | I | 1x10 -6 | 6x10 -3 | 3x10 -8 | 2x10 -4

______________________________

(See notes at end of appendix)

| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Silver (47) | Ag-105 | S | 6x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | I | 8x10 -8 | 3x10 -3 | 3x10 -9 | 1x10 -4 Ag-110m | S | 2x10 -7 | 9x10 -4 | 7x10 -9 | 3x10 -5 | I | 1x10 -8 | 9x10 -4 | 3x10 -10 | 3x10 -5 Ag-111 | S | 3x10 -7 | 1x10 -3 | 1x10 -8 | 4x10 -5 | I | 2x10 -7 | 1x10 -3 | 8x10 -9 | 4x10 -5 Sodium (11) | Na-22 | S | 2x10 -7 | 1x10 -3 | 6x10 -9 | 4x10 -5 | I | 9x10 -9 | 9x10 -4 | 3x10 -10 | 3x10 -5 Na-24 | S | 1x10 -6 | 6x10 -3 | 4x10 -8 | 2x10 -4 | I | 1x10 -7 | 8x10 -4 | 5x10 -9 | 3x10 -5 Strontium (38) | Sr-85m | S | 4x10 -5 | 2x10 -1 | 1x10 -6 | 7x10 -3 | I | 3x10 -5 | 2x10 -1 | 1x10 -6 | 7x10 -3 Sr-85 | S | 2x10 -7 | 3x10 -3 | 8x10 -9 | 1x10 -4 | I | 1x10 -7 | 5x10 -3 | 4x10 -9 | 2x10 -4 Sr-89 | S | 3x10 -8 | 3x10 -4 | 3x10 -10 | 3x10 -6 | I | 4x10 -8 | 8x10 -4 | 1x10 -9 | 3x10 -6 Sr-90 | S | 1x10 -9 | 1x10 -5 | 3x10 -11 | 3x10 -7 | I | 5x10 -9 | 1x10 -3 | 2x10 -10 | 4x10 -5 Sr-91 | S | 4x10 -7 | 2x10 -3 | 2x10 -8 | 7x10 -5 | I | 3x10 -7 | 1x10 -3 | 9x10 -9 | 5x10 -5 Sr-92 | S | 4x10 -7 | 2x10 -3 | 2x10 -8 | 7x10 -5 | I | 3x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 Sulfur (16) | S-35 | S | 3x10 -7 | 2x10 -3 | 9x10 -9 | 6x10 -5 | I | 3x10 -7 | 8x10 -3 | 9x10 -9 | 3x10 -4 Tantalum (73) | Ta-182 | S | 4x10 -8 | 1x10 -3 | 1x10 -9 | 4x10 -5 | I | 2x10 -8 | 1x10 -3 | 7x10 -10 | 4x10 -5

______________________________

(See notes at end of appendix)

| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Technetium(43) | Tc-96m | S | 8x10 -5 | 4x10 -1 | 3x10 -6 | 1x10 -2 | I | 3x10 -5 | 3x10 -1 | 1x10 -6 | 1x10 -2 Tc-96 | S | 6x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | I | 2x10 -7 | 1x10 -3 | 8x10 -9 | 5x10 -5 Tc-97m | S | 2x10 -6 | 1x10 -2 | 8x10 -8 | 4x10 -4 | I | 2x10 -7 | 5x10 -3 | 5x10 -9 | 2x10 -4 Tc-97 | S | 1x10 -5 | 5x10 -2 | 4x10 -7 | 2x10 -3 | I | 3x10 -7 | 2x10 -2 | 1x10 -8 | 8x10 -4 Tc-99m | S | 4x10 -5 | 2x10 -1 | 1x10 -6 | 6x10 -3 | I | 1x10 -5 | 8x10 -2 | 5x10 -7 | 3x10 -3 Tc-99 | S | 2x10 -6 | 1x10 -2 | 7x10 -8 | 3x10 -4 | I | 6x10 -8 | 5x10 -3 | 2x10 -9 | 2x10 -4 Tellurium (52) | Te-125m | S | 4x10 -7 | 5x10 -3 | 1x10 -8 | 2x10 -4 | I | 1x10 -7 | 3x10 -3 | 4x10 -9 | 1x10 -4 Te-127m | S | 1x10 -7 | 2x10 -3 | 5x10 -9 | 6x10 -5 | I | 4x10 -8 | 2x10 -3 | 1x10 -9 | 5x10 -5 Te-127 | S | 2x10 -6 | 8x10 -3 | 6x10 -8 | 3x10 -4 | I | 9x10 -7 | 5x10 -3 | 3x10 -8 | 2x10 -4 Te-129m | S | 8x10 -8 | 1x10 -3 | 3x10 -9 | 3x10 -5 | I | 3x10 -8 | 6x10 -4 | 1x10 -9 | 2x10 -5 Te-129 | S | 5x10 -6 | 2x10 -2 | 2x10 -7 | 8x10 -4 | I | 4x10 -6 | 2x10 -2 | 1x10 -7 | 8x10 -4 Te-131m | S | 4x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 | I | 2x10 -7 | 1x10 -3 | 6x10 -9 | 4x10 -5 Te-132 | S | 2x10 -7 | 9x10 -4 | 7x10 -9 | 3x10 -5 | I | 1x10 -7 | 6x10 -4 | 4x10 -9 | 2x10 -5 Terbium (65) | Tb-160 | S | 1x10 -7 | 1x10 -3 | 3x10 -9 | 4x10 -5 | I | 3x10 -8 | 1x10 -3 | 1x10 -9 | 4x10 -5 Thallium (81) | Tl-200 | S | 3x10 -6 | 1x10 -2 | 9x10 -8 | 4x10 -4 | I | 1x10 -6 | 7x10 -3 | 4x10 -8 | 2x10 -4 Tl-201 | S | 2x10 -6 | 9x10 -3 | 7x10 -8 | 3x10 -4 | I | 9x10 -7 | 5x10 -3 | 3x10 -8 | 2x10 -4 Tl-202 | S | 8x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | I | 2x10 -7 | 2x10 -3 | 8x10 -9 | 7x10 -5 Tl-204 | S | 6x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | I | 3x10 -8 | 2x10 -3 | 9x10 -10 | 6x10 -5

______________________________

(See notes at end of appendix)

| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Thorium (90) | Th-227 | S | 3x10 -10 | 5x10 -4 | 1x10 -11 | 2x10 -5 | I | 2x10 -10 | 5x10 -4 | 6x10 -12 | 2x10 -5 Th-228 | S | 9x10 -12 | 2x10 -4 | 3x10 -13 | 7x10 -6 | I | 6x10 -12 | 4x10 -4 | 2x10 -13 | 1x10 -5 Th-230 | S | 2x10 -12 | 5x10 -5 | 8x10 -14 | 2x10 -6 | I | 1x10 -11 | 9x10 -4 | 3x10 -13 | 3x10 -5 Th-231 | S | 1x10 -6 | 7x10 -3 | 5x10 -8 | 2x10 -4 | I | 1x10 -6 | 7x10 -3 | 4x10 -8 | 2x10 -4 Th-232 | S | 3x10 -11 | 5x10 -5 | 1x10 -12 | 2x10 -6 | I | 3x10 -11 | 1x10 -3 | 1x10 -12 | 4x10 -5 Th-natural | S | 6x10 -11 | 6x10 -5 | 2x10 -12 | 2x10 -6 | I | 6x10 -11 | 6x10 -4 | 2x10 -12 | 2x10 -5 Th-234 | S | 6x10 -8 | 5x10 -4 | 2x10 -9 | 2x10 -5 | I | 3x10 -8 | 5x10 -4 | 1x10 -9 | 2x10 -5 Thulium (69) | Tm-170 | S | 4x10 -8 | 1x10 -3 | 1x10 -9 | 5x10 -5 | I | 3x10 -8 | 1x10 -3 | 1x10 -9 | 5x10 -5 Tm-171 | S | 1x10 -7 | 1x10 -2 | 4x10 -9 | 5x10 -4 | I | 2x10 -7 | 1x10 -2 | 8x10 -9 | 5x10 -4 Tin (50) | Sn-113 | S | 4x10 -7 | 2x10 -3 | 1x10 -8 | 9x10 -5 | I | 5x10 -8 | 2x10 -3 | 2x10 -9 | 8x10 -5 Sn-125 | S | 1x10 -7 | 5x10 -4 | 4x10 -9 | 2x10 -5 | I | 8x10 -8 | 5x10 -4 | 3x10 -9 | 2x10 -5 Tungsten (74) | W-181 | S | 2x10 -6 | 1x10 -2 | 8x10 -8 | 4x10 -4 | I | 1x10 -7 | 1x10 -2 | 4x10 -9 | 3x10 -4 W-185 | S | 8x10 -7 | 4x10 -3 | 3x10 -8 | 1x10 -4 | I | 1x10 -7 | 3x10 -3 | 4x10 -9 | 1x10 -4 W-187 | S | 4x10 -7 | 2x10 -3 | 2x10 -8 | 7x10 -5 | I | 3x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5

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(See notes at end of appendix)

| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Uranium (92) | U-230 | S | 3x10 -10 | 1x10 -4 | 1x10 -11 | 5x10 -6 | I | 1x10 -10 | 1x10 -4 | 4x10 -12 | 5x10 -6 U-232 | S | 1x10 -10 | 8x10 -4 | 3x10 -12 | 3x10 -5 | I | 3x10 -11 | 8x10 -4 | 9x10 -13 | 3x10 -5 U-233 | S | 5x10 -10 | 9x10 -4 | 2x10 -11 | 3x10 -5 | I | 1x10 -10 | 9x10 -4 | 4x10 -12 | 3x10 -5 U-234 | S 4 | 6x10 -10 | 9x10 -4 | 2x10 -11 | 3x10 -5 | I | 1x10 -10 | 9x10 -4 | 4x10 -12 | 3x10 -5 U-235 | S 4 | 5x10 -10 | 8x10 -4 | 2x10 -11 | 3x10 -5 | I | 1x10 -10 | 8x10 -4 | 4x10 -12 | 3x10 -5 U-236 | S | 6x10 -10 | 1x10 -3 | 2x10 -11 | 3x10 -5 | I | 1x10 -10 | 1x10 -3 | 4x10 -12 | 3x10 -5 U-238 | S 4 | 7x10 -11 | 1x10 -3 | 3x10 -12 | 4x10 -5 | I | 1x10 -10 | 1x10 -3 | 5x10 -12 | 4x10 -5 U-240 | S | 2x10 -7 | 1x10 -3 | 8x10 -9 | 3x10 -5 | I | 2x10 -7 | 1x10 -3 | 6x10 -9 | 3x10 -5 U-natural | S 4 | 1x10 -10 | 1x10 -3 | 5x10 -12 | 3x10 -5 | I | 1x10 -10 | 1x10 -3 | 5x10 -12 | 3x10 -5 Vanadium (23) | V-48 | S | 2x10 -7 | 9x10 -4 | 6x10 -9 | 3x10 -5 | I | 6x10 -8 | 8x10 -4 | 2x10 -9 | 3x10 -5 Xenon (54) | Xe-131m | Sub 2 | 2x10 -5 | --- | 4x10 -7 | --- Xe-133m | Sub | 1x10 -5 | --- | 3x10 -7 | --- Xe-133 | Sub | 1x10 -5 | --- | 3x10 -7 | --- Xe-135 | Sub | 4x10 -6 | --- | 1x10 -7 | --- Ytterbium(70) | Yb-175 | S | 7x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4 | I | 6x10 -7 | 3x10 -3 | 2x10 -8 | 1x10 -4

______________________________

(See notes at end of appendix)

| Table I | Table II Element (atomic number) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Yttrium (39) | Y-90 | S | 1x10 -7 | 6x10 -4 | 4x10 -9 | 2x10 -5 | I | 1x10 -7 | 6x10 -4 | 3x10 -9 | 2x10 -5 Y-91m | S | 2x10 -5 | 1x10 -1 | 8x10 -7 | 3x10 -3 | I | 2x10 -5 | 1x10 -1 | 6x10 -7 | 3x10 -3 Y-91 | S | 4x10 -8 | 8x10 -4 | 1x10 -9 | 3x10 -5 | I | 3x10 -8 | 8x10 -4 | 1x10 -9 | 3x10 -5 Y-92 | S | 4x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 | I | 3x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 Y-93 | S | 2x10 -7 | 8x10 -4 | 6x10 -9 | 3x10 -5 | I | 1x10 -7 | 8x10 -4 | 5x10 -9 | 3x10 -5 Zinc (30) | Zn-65 | S | 1x10 -7 | 3x10 -3 | 4x10 -9 | 1x10 -4 | I | 6x10 -8 | 5x10 -3 | 2x10 -9 | 2x10 -4 Zn-69m | S | 4x10 -7 | 2x10 -3 | 1x10 -8 | 7x10 -5 | I | 3x10 -7 | 2x10 -3 | 1x10 -8 | 6x10 -5 Zn-69 | S | 7x10 -6 | 5x10 -2 | 2x10 -7 | 2x10 -3 | I | 9x10 -6 | 5x10 -2 | 3x10 -7 | 2x10 -3 Zirconium (40) | Zr-93 | S | 1x10 -7 | 2x10 -2 | 4x10 -9 | 8x10 -4 | I | 3x10 -7 | 2x10 -2 | 1x10 -8 | 8x10 -4 Zr-95 | S | 1x10 -7 | 2x10 -3 | 4x10 -9 | 6x10 -5 | I | 3x10 -8 | 2x10 -3 | 1x10 -9 | 6x10 -5 Zr-97 | S | 1x10 -7 | 5x10 -4 | 4x10 -9 | 2x10 -5 | I | 9x10 -8 | 5x10 -4 | 3x10 -9 | 2x10 -5

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(See notes at end of appendix)

| Table I | Table II Element (atomic number ) | Isotope | 1 | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) Any single radionuclide not listed above with decay mode other than alpha emission or spontaneous fission and with radioactive half- life less than 2 hours. | Sub 2 | 1x10 -6 | --- | 3x10 -8 | --- Any single radionuclide not listed above with decay mode other than alpha emission or spontaneous fission and with radioactive half- life greater than 2 hours. | | 3x10 -9 | 9x10 -5 | 1x10 -10 | 3x10 -6 Any single radionuclide not listed above, which decays by alpha emission or spontaneous fission. | | 6x10 -13 | 4x10 -7 | 2x10 -14 | 3x10 -8

1 Soluble (S) ; Insoluble (I) .

2 "Sub" means that values given are for submersion in a semi-spherical infinite cloud of airborne material.

3 These radon concentrations are appropriate for protection from radon-222 combined with its short-lived daughters. Alternatively, the value in Table I may be replaced by one-third "working level." (A "working level" is defined as any combination of short-lived radon-222 daughters, polonium-218, lead-214, bismuth-214, and polonium-214, in 1 liter of air, without regard to the degree of equilibrium, that will result in the ultimate emission of 1.3 x 105 MeV of alpha particle energy.) The Table II value may be replaced by one-thirtieth (1/30) of a "working level." The limit on radon-222 concentrations in restricted areas may be based on an annual average.

4 For soluble mixtures of U-238, U-234 and U-235 in air chemical toxicity may be the limiting factor. If the percent by weight (enrichment) of U-235 is less than 5, the concentration value for a 40-hour workweek, Table I, is 0.2 milligrams uranium per cubic meter of air average. For any enrichment, the product of the average concentration and time of exposure during a 40-hour workweek shall not exceed 8 x 10 -3 SA mCi-hr/ml, where SA is the specific activity of the uranium inhaled. The concentration value for Table II is 0.007 milligrams uranium per cubic meter of air. The specific activity for natural uranium is 6.77 x 10 -7 curies per gram uranium. The specific activity for other mixtures of U-238, U-235 and U-234, if not known, shall be:

SA= 3.6 x 10 -7 curies/gram U U-depleted

SA= (C.4 + 0.38 E + 0.0034 E 2 ) 10 -6 E > 0.72

where E is the percentage by weight of U-235, expressed as percent. Note: In any case where there is a mixture in air or water of more than 1 radionuclide, the limiting values for purposes of this Appendix should be determined as follows:

If the identity and concentration of each radionuclide in the mixture are known, the limiting values should be derived as follows: Determine, for each radionuclide in the mixture, the ratio between the quantity present in the mixture and the limit otherwise established in Appendix A for the specific radionuclide when not in a mixture. The sum of such ratios for all the radionuclides in the mixture may not exceed "1" (i.e., "unity") . Example: If radionuclides a, b, and c are present in concentrations C a , C b , and C c , and if the applicable MPC's are MPC a , MPC b , and MPC c respectively, then the concentrations shall be limited so that the following relationship exists:

C a + C b + C c

< 1

MPC a MPC b MPC c

If either the identity or the concentration of any radionuclide in the mixture is not known, the limiting values for purposes of Appendix A shall be:

a. For purposes of Table I, Col. 1 - 6x10 -13

b. For purposes of Table I, Col. 2 - 4x10 -7

c. For purposes of Table II, Col. 1 - 2x10 -14

d. For purposes of Table II, Col. 2 - 3x10 -8

If any of the conditions specified below are met, the corresponding values specified below may be used in lieu of those specified in paragraph 2 above.

a. If the identity of each radionuclide in the mixture is known but the concentration of 1 or more of the radionuclides in the mixture is not known, the concentration limit for the mixture is the limit specified in Appendix A for the radionuclide in the mixture having the lowest concentration limit; or

b. If the identity of each radionuclide in the mixture is not known, but it is known that certain radionuclides specified in Appendix A are not present in the mixture, the concentration limit for the mixture is the lowest concentration limit specified in Appendix A for any radionuclide which is not known to be absent from the mixture; or

| Table I | Table II c. Radionuclide | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) | Column 1 Air (µCi/ml) | Column 2 Water (µCi/ml) If it is known that SR-90, I-125, I-126, I-129, I-131, (I-133 Table II only) , Fb-210, Po-210, At-211, Ra-223, Ra-224, Ra-226, Ac-227, Ra-228, Th-230, Pa-231, Th-232, Th-nat, Cm-248, Cf-254, and Fm-256 are not present............... | --- | 9x10 -5 | --- | 3x10 -6 If it is known that SR-90, I-125, I-126, I-129, (I-131, I-133 Table II only) , Pb-210, Po-210, Ra-223, Ra-226, Ra-228, Pa-231, Th-nat, Cm-248, Cf-254, and Fm-256 are not present............... | --- | 6x10 -5 | --- | 2x10 -6 If it is known that Sr-90, I-129, (I-125, I-126, I-131, Table II only) , Pb-210, Ra-226, Ra-228, Cm-248, and Cf-254 are not present................... | --- | 2x10 -5 | --- | 6x10 -7 If it is known that (I-129, Table II only) , Ra-226, and Ra-228 are not present........... | --- | 3x10 -6 | --- | 1x10 -7 If it is known that alpha-emitters and Sr-90, I-129, Pb-210, Ac-227, Ra-228, Pa-230, Pu-241, and Bk-249 are not present........... | 3x10 -9 | --- | 1x10 -10 | --- If it is known that alpha-emitters and Pb-210, Ac-227, Ra-228, and Pu-241 are not present.... | 3x10 -10 | --- | 11x10 -11 | --- If it is known that alpha-emitters and Ac-227 are not present................... | 3x10 -12 | --- | 11x10 -12 | --- If it is known that Ac-227, Th-230, Pa-231, Pu-238, Pu-239, Pu-240, Pu-242, Pu-244, Cm-248, Cf-249 and Cf-241 are not present.... | 3x10 -12 | --- | 1x10 -13 | ---

If a mixture of radionuclides consists of uranium and its daughters in ore dust prior to chemical separation of the uranium from the ore, the values specified below may be used for uranium and its daughters through radium-226, instead of those from paragraph 1, 2, or 3 above.

a. For purposes of Table I, Column 1, 1x10 -10 F Ci/ml gross alpha activity; or 5x10 -11 F Ci/ml natural uranium; or 75 micrograms per cubic meter of air natural uranium.

b. For purposes of Table II, Column 1, 3x10 -12 F Ci/ml gross alpha activity; 2x10 -12 F Ci/ml natural uranium; or 3 micrograms per cubic meter of air natural uranium.

For purposes of this note, a radionuclide may be considered as not present in a mixture if (a) the ratio of the concentration of that radionuclide in the mixture (C a ) to the concentration limit for that radionuclide specified in Table II of Appendix A (MPC a ) does not exceed 1/10, (i.e., C a /MPC a # 1/10) and (b) the sum of such ratios for all radionuclides considered as not present in the mixture does not exceed 1/4, (i.e., C a /MPC a + C b /MPC b + ....... # 1/4) .

APPENDIX B

(For use in ARM 37.14.725, 37.14.742, and 37.14.743)

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1 Based on alpha disintegration rate of Th-232, Th-230 and their daughter products.

2 Based on alpha disintegration rate of U-238, U-234, and U-235.

Material | Microcuries Any alpha emitting radionuclide not listed above or mixtures of alpha emitters of unknown composition | 0.01 Any radionuclide other than alpha emitting radionuclides, not listed above or mixtures of beta emitters of unknown composition | 0.1

Note: For purposes of ARM 37.14.725, 37.14.742 and 37.14.743, where there is involved a combination of isotopes in known amounts, the limit for the combination should be derived as follows: determine, for each isotope in the combination, the ratio between the quantity present in the combination and the limit otherwise established for the specific isotope when not in combination may not exceed "1" (i.e., "unity") . Example: For purposes of ARM 37.14.743, if a particular batch contains 20,000 F Ci of Au-198 and 50,000 F Ci of C-14, it may also include not more than 300 F Ci of I-131. This limit was determined as follows:

20,000 µCi Au-198/100,000 µCi + 50,000 µCi C-14/100,000 µCi

+ 300 µCi I-131/1,000 µCi = 1

The denominator in each of the above ratios was obtained by multiplying the figure in the table by 1,000 as provided in ARM 37.14.743.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.8 Radiation Safety Requirements for Industrial Radiographic Operations

Mont. Admin. R. 37.14.801 Purpose

(1) This subchapter establishes radiation safety requirements for persons utilizing sources of radiation for industrial radiography. The requirements of this subchapter are in addition to and not in substitution for other applicable requirements of this chapter.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.802 Scope

(1) This subchapter applies to all licensees or registrants who use sources of radiation for industrial radiography. Except for those sections of this subchapter clearly applicable only to sealed radioactive sources, both radiation machines and sealed radioactive sources are covered by this subchapter.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.803 Definitions

(1) As used in this subchapter, the following definitions apply:

(a) "Enclosed radiography" means industrial radiography conducted in an enclosed cabinet or room and includes cabinet radiography and shielded room radiography.

(i) "Cabinet radiography" means industrial radiography conducted in an enclosure or cabinet so shielded that every location on the exterior meets the conditions specified in ARM 37.14.710 .

(A) "Cabinet x-ray system" means an x-ray system with the x-ray tube installed in an enclosure (hereinafter termed "cabinet") which, independently of existing architectural structures except the floor on which it may be placed, is intended to contain at least that portion of a material being irradiated, provide radiation attenuation, and exclude personnel from its interior during generation of X radiation. Included are all x-ray systems designed primarily for the inspection of carry-on baggage at airline, railroad, and bus terminals, and in similar facilities. An x-ray tube used within a shielded part of a building, or x-ray equipment which may temporarily or occasionally incorporate portable shielding is not considered a cabinet x-ray system.

(B) "Certified cabinet x-ray system" means an x-ray system which has been certified in accordance with 21 CFR 1010.2 as being manufactured and assembled pursuant to the provisions of 21 CFR 1020.40.

(ii) "Shielded-room radiography" means industrial radiography conducted in a room so shielded that every location on the exterior meets the conditions specified in ARM 37.14.709 .

(b) "Industrial radiography" means the examination of the macroscopic structure of materials by nondestructive methods utilizing sources of radiation.

(c) "Personal supervision" means supervision such that the supervisor is physically present at the radiography site and in such proximity that contact can be maintained and immediate assistance given as required.

(d) "Radiographer" means any individual who performs, or provides personal supervision of, industrial radiographic operations and who is responsible to the licensee or registrant for assuring compliance with the requirements of this chapter and all license and/or certificate of registration conditions.

(e) "Radiographer's assistant" means any individual who, under the personal supervision of a radiographer, uses sources of radiation, related handling tools, or radiation survey instruments in industrial radiography.

(f) "Radiographic exposure device" means any instrument containing a sealed source fastened or contained therein, in which the sealed source or shielding thereof may be moved, or otherwise changed, from a shielded to unshielded position for purposes of making a radiographic exposure.

(g) "Shielded position" means the location within the radiographic exposure device or storage container which, by manufacturer's design, is the proper location for storage of the sealed source.

(h) "Storage container" means a device in which sealed sources are transported or stored.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.810 Equipment Control: Limits on Levels of Radiation

(1) Radiographic exposure devices measuring less than 4 inches (10 centimeters) from the sealed source storage position to any exterior surface of the device shall have no radiation level in excess of 50 milliroentgens per hour at 6 inches (15 centimeters) from any exterior surface of the device. Radiographic exposure devices measuring a minimum of 4 inches (10 centimeters) from the sealed source storage position to any exterior surface of the device, and all storage containers for sealed sources or outer containers for radiographic exposure devices, shall have no radiation level in excess of 200 milliroentgens per hour at any exterior surface, and 10 milliroentgens per hour at 1 meter from any exterior surface. The radiation levels specified are with the sealed source in the shielded (i.e., "off") position.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.811 Equipment Control: Locking of Sources of Radiation

(1) Each source of radiation shall be provided with a lock or lockable outer container designed to prevent unauthorized or accidental production of radiation or removal or exposure of a sealed source and shall be kept locked at all times except when under the direct surveillance of a radiographer or radiographer's assistant, or as may be otherwise authorized pursuant to ARM 37.14.833 . Each storage container likewise shall be provided with a lock and shall be kept locked when containing sealed sources except when the container is under the direct surveillance of a radiographer or radiographer's assistant.

(2) Radiographic exposure devices and storage containers, prior to being moved from 1 location to another and also prior to being secured at a given location, shall be locked and surveyed to assure that the sealed source is in the shielded position.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.812 Equipment Control: Storage Precautions

(1) Locked radiographic exposure devices, storage containers, and radiation machines shall be physically secured to prevent tampering or removal by unauthorized personnel.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.813 Equipment Control: Leak Testing, Repair, Tagging, Opening, Modification, and Replacement of Sealed Sources

(1) The replacement of any sealed source fastened to or contained in a radiographic exposure device and leak testing, repair, tagging, opening, or any other modification of any sealed source shall be performed only by persons specifically authorized to do so by the department, the US nuclear regulatory commission, or any agreement state.

(2) Each sealed source shall be tested for leakage at intervals not to exceed 6 months. In the absence of a certificate from a transferor that a test has been made within the 6 month period prior to the transfer, the sealed source shall not be put into use until tested.

(3) The leak test shall be capable of detecting the presence of 0.005 microcurie of removable contamination on the sealed source. An acceptable leak test for sealed sources in the possession of a radiography licensee would be to test at the nearest accessible point to the sealed source storage position, or other appropriate measuring point, by a procedure to be approved pursuant to ARM 37.14.540 (5) (e) . Records of leak test results shall be kept in units of microcuries and maintained for inspection by the department for 6 months after the next required leak test is performed or until the sealed source is transferred or disposed of.

(4) Any test conducted pursuant to (2) and (3) of this rule which reveals the presence of 0.005 microcurie or more of removable radioactive material shall be considered evidence that the sealed source is leaking. The licensee shall immediately withdraw the equipment involved from use and shall cause it to be decontaminated and repaired or to be disposed of, in accordance with rules of the department. Within 5 days after obtaining results of the test, the licensee shall file a report with the department describing the equipment involved, the test results, and the corrective action taken.

(5) A sealed source which is not fastened to or contained in a radiographic exposure device shall have permanently attached to it a durable tag at least 1 inch square bearing the prescribed radiation caution symbol in conventional colors, magenta or purple on a yellow background, and at least the instructions:

DANGER

RADIOACTIVE MATERIAL

DO NOT HANDLE

NOTIFY CIVIL AUTHORITIES IF FOUND

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.816 Equipment Control: Quarterly Inventory

(1) Each licensee shall conduct a quarterly physical inventory to account for all sealed sources received or possessed by him.

(2) The records of the inventories shall be maintained for inspection by the department for 2 years from the date of the inventory and shall include the quantities and kinds of radioactive material, the location of sealed sources, and the date of the inventory.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.817 Equipment Control: Utilization Logs

(1) Each licensee or registrant shall maintain current logs, which shall be kept available for inspection by the department for 2 years from the date of the recorded event.

(2) These logs shall show for each source of radiation the following information:

(a) A description, or make and model number, of each source of radiation or storage container in which the sealed source is located.

(b) The identity of the radiographer to whom assigned.

History

Authorizing statute(s): Sec. 75-3-204, MCA
Implementing statute(s): Sec. 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.820 Equipment Control: Radiation Survey Instruments

(1) The licensee or registrant shall maintain sufficient calibrated and operable radiation survey instruments to make physical radiation surveys as required by this subchapter and ARM 37.14.720 . Instrumentation required by this rule shall have a range such that 2 milliroentgens per hour through 1 roentgen per hour can be measured.

(2) Each radiation survey instrument shall be calibrated:

(a) at energies appropriate for use and at intervals not to exceed 3 months and after each instrument servicing;

(b) such that accuracy within ± 20% can be demonstrated; and

(3) Records shall be kept of these calibrations for 2 years after the calibration date and maintained for inspection by the department.

History

Authorizing statute(s): 75-3-201, MCA
Implementing statute(s): 75-3-201, 75-3-202, 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.821 Equipment Control: Inspection and Maintenance: Radiographic Exposure Devices and Storage Containers

(1) Each licensee shall conduct a program of at least quarterly inspection and maintenance of radiographic exposure devices and storage containers to assure proper functioning of components important to safety. All appropriate parts shall be maintained in accordance with manufacturer's specification.

(2) Records of inspection and maintenance shall be maintained for inspection by the department until it authorizes their disposal.

(3) If any inspection conducted pursuant to this rule reveals damage to components critical to radiation safety, the device shall be removed from service until repairs have been made.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.823 Equipment Control: Inspection and Maintenance: High Radiation Area Control Devices or Alarm Systems

(1) For any high radiation area equipped with a control device or alarm system as described in ARM 37.14.725 (3) (b) , the control device or alarm system shall be tested for proper operation at the beginning of each period of use.

(2) Records of such tests shall be maintained for inspection by the department until it authorizes their disposal.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-107 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.830 Personal Radiation Safety Requirements for Radiographers and Radiographers' Assistants: Limitations

(1) No licensee or registrant shall permit any individual to act as a radiographer as defined in this subchapter until such individual:

(a) has been instructed in the subjects outlined in Appendix A of this subchapter and shall have demonstrated understanding thereof;

(b) has received copies of and instruction in this subchapter and the applicable rules of ARM Title 37, chapter 14, subchapters 7 and 17, and the appropriate license, and the licensee's or registrant's operating and emergency procedures, and shall have demonstrated understanding thereof; and

(c) has demonstrated competence to use the source of radiation, radiographic exposure device, related handling tools, and radiation survey instruments which will be employed in his assignment.

(2) No licensee or registrant shall permit any individual to act as a radiographer's assistant as defined in ARM 37.14.803 (1) (e) until such individual:

(a) has received copies of and instruction in the licensee's or registrant's operating and emergency procedures, and shall have demonstrated understanding thereof; and

(b) has demonstrated competence to use, under the personal supervision of the radiographer, the sources of radiation, radiographic exposure device, related handling tools, and radiation survey instruments which will be employed in his assignment.

(3) Each licensee or registrant shall maintain, for inspection by the department until it authorizes their disposal, records of training and testing which demonstrate that the requirements of this rule are met.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.831 Personal Radiation Safety Requirements for Radiographers and Radiographers' Assistants: Operating and Emergency Procedures

(1) The licensee's or registrant's operating and emergency procedures shall include instructions in at least the following:

(a) The handling and use of sources of radiation to be employed such that no individual is likely to be exposed to radiation doses in excess of the limits established in ARM Title 37, chapter 14, subchapter 7.

(b) Methods and occasions for conducting radiation surveys.

(d) Methods and occasions for locking and securing sources of radiation.

(e) Personnel monitoring and the use of personnel monitoring equipment.

(f) Transportation to field locations, including packing of sources of radiation in the vehicles, posting of vehicles, and control of sources of radiation during transportation.

(g) Minimizing exposure of individuals in the event of an accident.

(h) The procedure for notifying proper personnel in the event of an accident.

(i) Maintenance of records.

(j) The inspection and maintenance of radiographic exposure devices and storage containers, and radiation machines.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.832 Personal Radiation Safety Requirements for Radiographers and Radiographers' Assistants: Personnel Monitoring Control

(1) No licensee or registrant shall permit any individual to act as a radiographer or as a radiographer's assistant unless, at all times during radiographic operations, each such individual wears a direct reading pocket dosimeter and either a film badge or a thermoluminescent dosimeter. Pocket dosimeters shall have a range from zero to at least 200 milliroentgens and shall be recharged daily or at the start of each shift. Each film badge or thermoluminescent dosimeter shall be assigned to and worn by only 1 individual.

(2) Pocket dosimeters shall be read and exposure recorded daily. An individual's film badge or thermoluminescent dosimeter shall be immediately processed if his pocket dosimeter is discharged beyond its range. Reports received from the film badge or thermoluminescent dosimeter processor and records of the pocket dosimeter readings shall be maintained for inspection by the department until it authorizes their disposal.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.833 Precautionary Procedures in Radiographic Operations: Security

(1) During each radiographic operation, the radiographer or radiographer's assistant shall maintain a direct surveillance of the operation to protect against unauthorized entry into a high radiation area, as defined in ARM Title 37, chapter 14, subchapter 1, except:

(a) where the high radiation area is equipped with a control device or alarm system as described in ARM 37.14.725 (3) (b) , or

(b) where the high radiation area is locked to protect against unauthorized or accidental entry.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.840 Precautionary Procedures in Radiographic Operations: Posting

(1) Notwithstanding any provisions in ARM 37.14.726 (1) (c) , areas in which radiography is being performed shall be conspicuously posted as required by ARM 37.14.725 (2) and (3) (a) .

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.841 Precautionary Procedures in Radiographic Operations: Radiation Surveys and Survey Records

(1) No radiographic operation shall be conducted unless calibrated and operable radiation survey instrumentation as described in ARM 37.14.820 is available and used at each site where radiographic exposures are made.

(2) A physical radiation survey shall be made after each radiographic exposure utilizing radiographic exposure devices or sealed sources of radioactive material to determine that the sealed source has been returned to its shielded position.

(3) A physical radiation survey shall be made to determine that each sealed source is in its shielded position prior to securing the radiographic exposure device or storage container as specified in ARM 37.14.811 .

(4) Records shall be kept of the surveys required by (3) of this rule. Such records shall be maintained for inspection by the department for 2 years after completion of the survey. If the survey was used to determine an individual's exposure, however, the records of the survey shall be maintained until the department authorizes their disposition.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.845 Precautionary Procedures in Radiographic Operations: Records Required at Temporary Job Sites

(1) Each licensee or registrant conducting industrial radiography at a temporary site shall have the following records available at that site for inspection by the department:

(a) Appropriate license or equivalent document.

(b) Operating and emergency procedures.

(d) Survey records required pursuant to ARM 37.14.841 for the period of operation at the site.

(e) Daily pocket dosimeter records for the period of operation at the site.

(f) The latest instrument calibration and leak test record for specific devices in use at the site.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.846 Precautionary Procedures in Radiographic Operations: Special Requirements and Exemptions for Enclosed Radiography

(1) Systems for enclosed radiography designed to allow admittance of individuals shall:

(a) Comply with all applicable requirements of this subchapter and ARM 37.14.710 . If such a system is a certified cabinet x-ray system, it shall comply with all applicable requirements of this subchapter and 21 CFR 1020.40.

(b) Be evaluated at intervals not to exceed 1 year to assure compliance with the applicable requirements as specified in (a) above.

(i) Records of these evaluations shall be maintained for inspection by the department for a period of 2 years after the evaluation.

(2) Cabinet x-ray systems designed to exclude individuals are exempt from the requirements of this subchapter except that:

(a) Operating personnel must be provided with either a film badge or a thermoluminescent dosimeter and reports of the results must be maintained for inspection by the department.

(b) No registrant shall permit any individual to operate a cabinet x-ray system until such individual has received a copy of and instruction in the operating procedures for the unit and has demonstrated competence in its use. Records which demonstrate compliance with this subsection shall be maintained for inspection by the department until disposition is authorized by the department.

(c) Tests for proper operation of high radiation area control devices or alarm systems, where applicable, must be conducted and recorded in accordance with ARM 37.14.823 .

(d) The registrant shall perform an evaluation at intervals not to exceed 1 year, to determine conformance with ARM 37.14.710 . If such a system is a certified cabinet x-ray system, it shall be evaluated at intervals not to exceed 1 year to determine conformance with 21 CFR 1020.40.

(i) Records of these evaluations shall be maintained for inspection by the department for a period of 2 years after the evaluation.

(3) Certified cabinet x-ray systems shall be maintained in compliance with 21 CFR 1020.40 unless prior approval has been granted by the department pursuant to ARM 37.14.106 .

APPENDIX A

Subjects to be covered during the instruction of radiographers

I. Fundamentals of Radiation Safety

A. Characteristics of radiation

B. Units of radiation dose (mrem) and quantity of radioactivity (curie)

C. Significance of radiation dose

Radiation protection standards
iological effects of radiation dose

D. Levels of radiation from sources of radiation

E. Methods of controlling radiation dose

Working time
Working distances
Shielding

II. Radiation Detection Instrumentation to be Used

A. Use of radiation survey instruments

Operation
Calibration
Limitations

B. Survey techniques

C. Use of personnel monitoring equipment

Film badges
Thermoluminescent dosimeters
Pocket dosimeters

III. Radiographic Equipment to be Used

A. Remote handling equipment

B. Radiographic exposure devices and sealed sources

C. Storage containers

D. Operation and control of x-ray equipment

IV. The Requirements of Pertinent Federal and State Regulations

V. The Licensee's or Registrant's Written Operating and Emergency Procedures

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.10 X-Rays in the Healing Arts

Mont. Admin. R. 37.14.1001 Scope

(1) This subchapter establishes requirements for use of x-ray producing devices in the healing arts by a practitioner licensed by law to use or direct the use of such devices in the course of his professional practice or upon a prescription or other order lawfully issued in the course of his professional practice. The provisions of this subchapter are in addition to, and not in substitution for, other applicable provisions of this chapter.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1002 Definitions

As used in this subchapter:

(1) "Aluminum equivalent" means the thickness of aluminum affording the same attenuation, under specified conditions, as the material in question.

(2) "Diagnostic-type tube housing" means an x-ray tube housing so constructed that leakage radiation at a distance of one meter from the target cannot exceed 100 milliroentgens in one hour when the tube is operated at any of its specified ratings.

(3) "Enabling switch or momentary switch" means an underwriters laboratory (UL) or factory mutual (FM) switch so constructed that a single depression by the operator will provide a single exposure and that continuous pressure by the operator does not provide a continuous or multiple exposure.

(4) "Filter" means material placed in the useful beam to absorb preferentially the less penetrating radiations.

(5) "Half-value layer (hvl) " means the thickness of an absorber required to reduce a beam of radiation to one-half its incident exposure rate.

(6) "Inherent filtration" means the filtration in the useful beam due to the window of the x-ray tube and any permanent tube enclosure.

(7) "Interlock" means a device for precluding access to an area of radiation hazard either by preventing entry or by automatically removing the hazard.

(8) "Kilovolts peak (kVp) " means the crest value in kilovolts of the potential of a pulsating potential generator. When only one-half of the wave is used, the value refers to the useful half of the wave.

(9) "Lead equivalent" means the thickness of lead affording the same attenuation, under specified conditions, as the material in question.

(10) "Leakage radiation" means all radiation coming from within the tube housing except the useful beam.

(11) "NCRP" means the national council on radiation protection and measurements.

(12) "Primary protective barrier" means a barrier sufficient to attenuate the useful beam to the required degree.

(13) "Protective apron" means an apron made of attenuating materials used to reduce radiation exposure.

(14) "Protective barrier" means a barrier of attenuating materials used to reduce radiation exposure.

(15) "Protective glove" means a glove made of attenuating materials used to reduce radiation exposure.

(16) "Qualified expert" means a health physicist, medical physicist, radiologist, or other individual who can competently perform the calculations necessary to provide shielding requirements within the standards of this chapter.

(17) "Scattered radiation" means radiation that, during passage through matter, has been deviated in direction.

(18) "Secondary protective barrier" means a barrier sufficient to attenuate stray radiation to the required degree.

(19) "Shutter" means a device, generally of lead, fixed to an x-ray tube housing to intercept the useful beam.

(20) "Stray radiation" means radiation not serving any useful purpose. It includes leakage and secondary radiation.

(21) "Therapeutic-type tube housing" means an x-ray tube housing so constructed that the leakage radiation at a distance of one meter from the target cannot exceed one roentgen in one hour; and at a distance of five centimeters from any point on the surface of the housing accessible to the patient cannot exceed 30 roentgens in one hour when the tube is operated at any of its specified ratings.

(22) "Useful beam" means that part of the radiation which passes through the window, aperture, cone, or other collimating device of the tube housing.

History

Authorizing statute(s): Sec. 50-79-201 and 75-3-201, MCA
Implementing statute(s): Sec. 50-79-101, 50-79-102, 50-79-103 and 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189; AMD, 2003 MAR p. 1291, Eff. 7/1/03; AMD, 2003 MAR p. 2443, Eff. 10/31/03.

Mont. Admin. R. 37.14.1003 General Safety Provisions

(1) Diagnostic x-ray systems, for use on humans, and their associated components certified pursuant to the federal diagnostic x-ray standard shall be maintained in compliance with applicable requirements of such standard as set forth in 21 CFR, chapter I, subchapter J, as revised on April 1, 2003. The department may waive compliance with the specific requirements of this subchapter by an existing machine or installation if the registrant demonstrates, to the department's satisfaction, achievement through other means of radiation protection equivalent to that required by this chapter.

(2) No person shall make, sell, lease, transfer, lend or install x-ray equipment or the supplies used in connection with such equipment unless such supplies and equipment, when properly placed in operation and properly used, will meet the requirements of this chapter. This includes responsibility for the delivery of cones or collimators, diaphragms and adjustable diaphragms, filters, adequate timers, and fluoroscopic shutters, where applicable.

(3) Personnel monitoring shall be performed in controlled areas for each occupationally exposed individual for a minimum of a 13-week period starting each January. When a protective apron is worn, the monitoring device shall be worn at the collar outside of the apron.

(4) Safety requirements concerning the use of radiation sources are that:

(a) The registrant shall be responsible for radiation safety. He is responsible for assuring that radiation sources under his jurisdiction are used only by persons competent to use them. He is responsible for providing the instruction of personnel in safe operating procedures.

(b) A radiation safety officer, who may be the registrant himself, shall be designated for every installation and shall be approved by the department as per ARM 37.14.307 (1) (b) , if other than a licensed member of the healing arts.

(i) establish and supervise operating procedures and review them periodically to assure their conformity with this chapter;

(ii) provide personnel with instruction on proper radiation protection practices;

(iii) conduct radiation surveys and source leak tests where indicated and keep records of such surveys and tests, including summaries of corrective measures recommended and/or instituted;

(iv) assure that personal monitoring devices are used where indicated and that records are kept of the results of such monitoring;

(v) assure that interlock switches and warning signals are functioning and that signs are properly located; and

(vi) investigate each known or suspected case of excessive or abnormal exposure to determine the cause and to take steps to prevent its recurrence.

(d) The registrant shall provide safety rules to each individual operating x-ray equipment under his control, including any restrictions of the operating technique required for the safe operation of the particular x-ray apparatus, and require that the operators demonstrate familiarity with these safety rules.

(e) Deliberate exposure of an individual to the useful beam for training or demonstration purposes shall not be permitted unless there is also a medical or dental indication for the exposure and the exposure is prescribed by a practitioner of the healing arts.

(5) The general shielding safety requirements are as follows:

(a) Before construction, the floor plans and equipment arrangement of medical installations (new or modifications of existing installations) utilizing x-rays for diagnostic or therapeutic purposes shall be submitted to a qualified expert for determination of shielding requirements consistent with National Council on Radiation Protection (NCRP) and Measurements Reports No. 49 and 51, and 10 CFR part 20, as revised on January 1, 2003.

(b) A letter shall be submitted by the qualified expert to the department within 30 days of the project completion. The letter must contain at least the following information:

(i) name, address and credentials of the qualified expert;

(ii) facility site name, address and telephone number;

(iii) facility owner's name, address and telephone number;

(iv) date of installation;

(v) name and address of the manufacturer; or

(vi) if a used or reconditioned device is installed, the name and address of the previous facility or the owner of origin.

(c) Each installation shall be provided with such primary protective barriers and/or secondary protective barriers as are necessary to assure compliance with ARM 37.14.705 , 37.14.708 and 37.14.709 . This requirement shall be deemed to be met if the thickness of such barriers are equivalent to those as computed by a qualified expert and are consistent with the NCRP Reports No. 49 and 51 and 10 CFR part 20, as revised on January 1, 2003.

(d) Lead barriers shall be bonded to panels of rigid supporting material in such a manner that they will not sag or cold-flow because of their own weight and shall be protected against mechanical damage. Lead shielding less than one mm thick shall be bonded to panels of some rigid supporting material. The minimum allowable thickness of lead is 0.79mm (1/32 inches or two pounds per square foot) .

(e) Joints between different kinds of protective materials shall be so designed that the overall protection afforded by the barrier is not impaired.

(f) Joints at the floor and ceiling shall be so designed that the overall protection is not impaired.

(g) Windows, window frames, doors, and door frames shall have the same lead equivalent as that required of the adjacent wall.

(h) Holes in protective barriers shall be covered so that overall protection is not impaired.

(6) For new and modified installations only, the following are minimum design requirements for medical x-ray machine operator booths in conjunction with ARM 37.14.1006 , 37.14.1010 , 37.14.1011 , 37.14.1012 , 37.14.1020 , 37.14.1021 and 37.14.1022 . The requirements specified under (6) , (7) , (8) and their subsections do not apply to podiatry and veterinary installations. The requirements specified under (6) through (6) (b) (iii) , (6) (d) through (6) (f) (ii) do not apply to dental installations. See (7) and (8) for dental panoramic and cephalometric requirements.

(a) The operator shall be allotted 0.7 sq. meters (7.5 sq. ft.) or more of unobstructed floor space in the x-ray booths.

(i) The 0.7 sq. meters (7.5 sq. ft.) of minimum space specified under (6) (a) shall be a geometric configuration where no dimension is less that 61.0 centimeters (2.0 ft.) .

(ii) The allotted space shall exclude an encumbrance by the console, such as an overhang, cables or other similar encroachment.

(iii) An extension of straight line drawn between any point on the edge of the booth shielding and the nearest vertical edge of a vertical cassette holder, corner of the examination table or any part of the tube housing assembly shall not impinge on the unobstructed space.

(iv) The booth walls shall be 2.1 meters high (7.0 ft.) or more and shall be permanently fixed.

(v) When a door or moveable panel is used as the integral part of the booth structure, it must have a permissive device, which will prevent an exposure when the door panel is not closed.

(b) The operator's switch for the radiographic machine shall be fixed within the booth. The switch shall:

(i) be located so that it is impossible to make an exposure when the operator is outside of the protected area;

(ii) allow the operator to use the available viewing windows; and

(iii) be constructed so that a single depression by the operator will provide a single exposure and that continuous pressure by the operator does not provide a continuous or multiple exposure.

(i) be placed so the operator can have full view of the entries into the room; and

(ii) be placed so that the operator can view the patient during exposure.

(d) When the viewing system is a window, the following requirements also apply:

(i) the window shall have a visible area of 930 square centimeters (1.0 square foot) or more; and

(ii) the glass shall have the same lead equivalence or more as that required in the booth’s wall where the glass is mounted.

(e) When the viewing system is by mirrors, the mirrors shall be located to accomplish the general requirements under (6) (c) .

(f) When the viewing system is by electronic means (for example, tv) :

(i) the camera shall be located to accomplish the general requirements under (6) (c) ; and

(ii) there shall be an alternative viewing system as a backup for electronic failure.

(7) Dimensions of primary beam shielding shall exceed the largest possible beam size by 30.5 centimeters (1.0 foot) or more in every direction. Cephalometric primary beam shielding shall be deemed adequate if, for a maximum workload of 20 films a week, two-pound lead is installed (for occupied areas) .

(8) A viewing device shall be present in dental panoramic and cephalometric x-ray installations, so that the requirements of (6) (c) are met.

(9) National Council on Radiation Protection and Measurements Reports No. 49 and 51, 10 CFR part 20, as revised on January 1, 2003 and 21 CFR, chapter I, subchapter J, as revised on April 1, 2003, are incorporated into this chapter by this reference. The reports and CFR pertain to requirements for radiation protection and measurements. Copies of National Council on Radiation Protection and Measurements Reports No. 49 and 51, 10 CFR part 20 and 21 CFR, chapter I, subchapter J are available for viewing at the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, Helena, MT.

History

Authorizing statute(s): Sec. 50-79-201, 50-79-202, 50-79-204, 75-3-201 and 75-3-204, MCA
Implementing statute(s): Sec. 50-79-101, 50-79-102, 50-79-103, 50-79-104, 50-79-105, 50-79-106, 50-79-107, 50-79-108, 50-79-201, 50-79-202, 50-79-203, 50-79-204 and 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189; AMD, 2003 MAR p. 1291, Eff. 7/1/03; AMD, 2003 MAR p. 2443, Eff. 10/31/03.

Mont. Admin. R. 37.14.1005 Prohibited Use

(1) No registrant shall operate or permit the operation of x-ray equipment unless the equipment and installations meet the applicable requirements of this chapter.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): IMP, 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1006 Fluoroscopic Installations

(1) The equipment used in fluoroscopic installation shall be as follows:

(a) The tube housing shall be of a diagnostic type.

(b) During fluoroscopy and cinefluorography, the kV and the mA shall be continuously indicated.

(i) 38 centimeters on stationary fluoroscopes installed after March 28, 1980.

(ii) 35.5 centimeters on stationary fluoroscopes which are in operation prior to March 28, 1980;

(iii) 30 centimeters on all mobile fluoroscopes; and

(iv) 20 centimeters for image intensified fluoroscopes used for specific surgical application. The users operating manual must provide precautionary measures to be adhered to during the use of this device.

(d) The total filtration permanently in the useful beam shall be at least 2.5 millimeters aluminum equivalent.

(e) The equipment shall be so constructed that, under conditions of normal use, the entire cross section of the useful beam is attenuated by a primary protective barrier, permanently incorporated into the equipment and the exposure shall automatically terminate when the barrier is removed from the useful beam.

(i) The lead equivalent of the barrier of conventional fluoroscopes shall be at least 1.5 millimeters for equipment capable of operating up to 100 kVp, at least 1.8 millimeters for equipment capable of operating between 100 kVp and 125 kVp, and at least 2 millimeters for equipment capable of operating between 125 kVp and 150 kVp.

(ii) With the fluorescent screen 14 inches (35 cm) from the panel or table top, the exposure rate 2 inches (5 cm) beyond the viewing surface of the screen shall not exceed 30 mR/hr. for each R per minute at the table top with the screen in the useful beam without a patient and with the fluoroscope operating at its highest possible potential.

(iii) A collimator shall be provided to restrict the size of the useful beam to less than the area of the barrier. The x-ray tube and collimating system shall be linked with the fluorescent screen assembly so that the useful beam at the fluorescent screen is confined within the barrier irrespective of the panel-screen distance. For all new fluoroscopic units with image intensifiers sold in Montana after July 1, 1969, the useful beam shall be centered on the input phosphor and during fluoroscopy or cine recording shall not exceed the diameter of the input phosphor.

(iv) When the adjustable diaphragm is opened to its fullest extent, an unilluminated margin shall exist at all edges of the fluorescent screen when the screen is 14 inches (35 cm) from the panel surface or table top or at the fixed screen position in equipment such as orthodiascopes. In equipment used solely for image intensified fluoroscopy, the shutter shall restrict the useful beam within the diameter of the input phosphor.

(v) Collimators, adjustable diaphragms and shutters shall provide the same degree of attenuation as is required of the tube housing.

(f) The fluoroscopic exposure switch shall be a dead-man switch type.

(g) A shielding device of at least 0.25 millimeters lead equivalent for covering the Bucky slot during fluoroscopy shall be provided on all new units sold in Montana after July 1, 1969.

(h) A shield of at least 0.25 millimeters lead equivalent such as overlapping protective drapes or hinged or sliding panels shall be provided on all new units sold in Montana after July 1, 1969, to intercept scattered radiation which would otherwise reach the fluoroscopist and others near the machine.

(i) A cumulative timing device activated by the fluoroscope exposure switch shall be provided. It shall indicate the passage of a predetermined period of irradiation either by an audible signal or by temporary interruption of the irradiation when the increment of exposure time reaches a predetermined limit not exceeding 5 minutes.

(j) Image intensification shall always be provided on mobile fluoroscopic equipment. It shall be impossible to operate mobile fluoroscopic equipment unless the useful beam is intercepted by the image intensifier.

(k) Provision shall be made to intercept the scattered x-rays from the undersurface of the table top and other structures under the table. The shieldings shall provide the same degree of attenuation as is required of the tube housing, with the incident angle of the useful beam taken into consideration.

(l) Equipment to be operated in areas where explosive gases may be used shall have the approval of underwriters laboratory for such use.

(2) Ordinarily, only secondary protective barriers shall be required for shielding in fluoroscopic installations except for combined fluoroscopic-radiographic installations.

(3) The operating procedures for fluoroscopic installation areas are as follows:

(a) The allowable limits for entrance exposure rates are as follows:

(i) The exposure measured at the point where the center of the useful beam enters the patient shall not exceed 10 roentgens per minute, except during recording of fluoroscopic images or when provided with optional high level control.

(ii) When provided with optional high level control, the equipment shall not be operable at any combination of tube potential and current which will result in an exposure rate in excess of 5 roentgens per minute at the point where the center of the useful beam enters the patient unless the high level control is activated.

(A) Special means of activation of high level controls shall be required. The high level control shall only be operable when continuous manual activation is provided by the operator.

(B) A continuous signal audible to the fluoroscopist shall indicate that the high level control is being employed.

(iii) In addition to the other requirements, equipment which does not incorporate an automatic exposure control shall not be operable at any combination of tube potential and current which will result in an exposure rate in excess of 5 roentgens per minute at the point where the center of the beam enters the patient except during recording of fluoroscopic images or when provided with an optional high level control.

(iv) Compliance with the requirements of (a) above shall be determined as follows:

(A) Movable grids and compression devices shall be removed from the useful beam during the measurement.

(B) If the source is below the table, exposure rate shall be measured 1 centimeter above the table top or cradle.

(C) If the source is above the table, the exposure rate shall be measured at 30 centimeters above the table top with the end of the beam-limiting device or spacer positioned as closely as possible to the point of measurement.

(D) In a C-arm type of fluoroscope, the exposure rate shall be measured 30 centimeters from the input surface of the fluoroscopic imaging assembly.

(b) The fluoroscopist's eyes shall be sufficiently dark adapted (20 minutes) for the visual task required before commencing fluoroscopy.

(d) Protective aprons of at least 0.25 millimeters lead equivalent shall be worn in the fluoroscopy room by each person except the patient.

(e) Only persons whose presence is necessary shall be in the fluoroscopy room during x-ray exposures.

(f) Fluoroscopy shall not be used as a substitute for radiography but shall be reserved for the study of dynamics or spatial relationships or for guidance in spot-film recording of critical details.

(g) Special precautions, consistent with clinical needs, shall be taken to minimize exposure of the gonads of potentially procreative patients and exposure of the embryo or fetus in patients known to be or suspected of being pregnant.

(h) Notwithstanding ARM 37.14.721 , personnel monitoring is required for each individual who enters a controlled area.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1010 Dental Radiographic Installations

(1) The equipment used in dental radiographic installations shall be as follows:

(a) The tube housing shall be of diagnostic type.

(b) Diaphragms or cones shall be used for collimating the useful beam and provide the same degree of protection as the housing. The diameter of the useful beam at the cone tip shall not be more than 2-3/4 inches for intra-oral radiography.

(c) A cone or spacer frame shall provide a target-to-skin distance of not less than 7 inches with apparatus operating above 50 kVp or 4 inches with apparatus operating at 50 kVp or below.

(d) For equipment capable of operating up to no more than 70 kVp, the total filtration permanently in the useful beam shall be equivalent to at least 1.5 mm of aluminum. This requirement may be assumed to have been met if the half-value layer is not less than 1.5 mm aluminum at maximum possible operating voltages.

(e) For equipment capable of operating above 70 kVp, the total filtration permanently in the useful beam shall be equivalent to at least 2.5 mm of aluminum. This requirement may be assumed to have been met if the half-value layer is not less than 2.5 mm aluminum at the maximum possible operating voltage.

(f) Means shall be provided to terminate the exposure at a preset time interval, preset product of current and time, a preset number of pulses, or a preset radiation exposure to the image receptor. In addition:

(i) It shall not be possible to make an exposure when the timer is set to a "zero" or "off" position if either position is provided.

(ii) With a timer setting of 0.5 seconds or less, the average exposure period (T) shall be greater than or equal to 5 times the maximum exposure period (T max ) minus the minimum exposure period (T min ) when 4 timer tests are performed, i.e.,

T > 5(T max - T min ) .

(g) An x-ray control shall be incorporated into each x-ray system such that an exposure can be terminated by the operator at any time, except for exposure of one-half second or less.

(h) Each installation shall be provided with a protective barrier for the operator or shall be so arranged that the operator can stand at least 12 feet from the useful beam. Stationary x-ray systems installed after July 1, 1980, shall be required to have the x-ray control permanently mounted in a protected area, e.g., corridor outside the room, so that the operator is required to remain in that protected area during the entire exposure.

(2) The structural shielding requirements for dental radiographic installations shall be as follows:

(a) Dental rooms containing x-ray machines shall be provided with primary protective barriers at all areas struck by the useful beam. Consideration shall be given to the attenuation provided by the patient and the building materials in partitions.

(b) When dental x-ray units are installed in adjacent rooms or areas, protective barriers shall be provided between the rooms or areas. Consideration of the effects of the separating wall(s) shall be given in the evaluation of this protection.

(3) The operating procedures applicable to dental radiographic installations shall be as follows:

(a) Neither the dentist nor his assistant shall be permitted to hold patients or films during exposure, nor shall any individual be regularly used for this service.

(b) During each exposure, the operator shall stand at least 12 feet from the patient or behind a protective barrier.

(d) Neither the tube housing nor the pointer cone shall be hand-held during exposure.

(e) Fluoroscopy shall not be used in dental examinations.

(f) Personnel monitoring shall be performed in controlled areas for each occupationally exposed individual beyond the required 13-week period, for whom there is a reasonable possibility of receiving a dose exceeding one-fourth the applicable maximum permissible dose.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1011 Veterinary Medicine Radiographic Installations

(1) The equipment used in veterinary medicine radiographic installations shall be as follows:

(a) The tube housing shall be of diagnostic type.

(b) Diaphragms or cones shall be provided for collimating the useful beam to the area of clinical interest and shall provide the same degree of protection as is required of the housing. X-ray equipment acquired after July 1, 1980, shall be equipped with a variable rectangular collimator fitted with a light field that defines the entire area covered by the beam.

(c) Except when contraindicated for a particular radiographic purpose, the total filtration permanently in the useful beam shall not be less than 1.5 millimeters aluminum-equivalent for machines capable of operating up to no more than 70 kVp and 2.5 millimeters aluminum-equivalent for machines capable of operating in excess of 70 kVp.

(d) A device shall be provided to terminate the exposure after a preset time or exposure.

(e) A type of dead-man switch for an exposure switch shall be provided, together with an electrical cord of sufficient length so that the operator can stand out of the useful beam and at least 6 feet from the animal during all x-ray exposures.

(2) All wall, ceiling, and floor areas shall be equivalent to or provided with applicable protective barriers or shielding as required in ARM 37.14.705 , 37.14.708 , and 37.14.709 .

(3) The operating procedures applicable to veterinary medicine radiographic installations shall be as follows:

(a) The operator shall stand at least 6 feet from the tube housing and the animal during radiographic exposures. Provisions shall be made so that the operator will not be required to stand in the useful beam.

(b) Hand-held fluoroscopic screens shall not be used.

(d) No individual other than the operator shall be in the x-ray room while exposures are being made unless such individual's assistance is required.

(e) In any application in which the operator or other assisting individual is not located behind a protective barrier, clothing consisting of a protective apron having a lead-equivalent of not less than 0.5 millimeter shall be worn by the operator and any other individuals in the room during exposure.

(f) No individual shall be regularly employed to hold or support animals, or hold film during radiation exposures. Operating personnel shall not perform this service except in cases in which no other method is available. Any individual holding or supporting an animal during radiation exposure shall wear protective gloves and apron having a lead-equivalent of not less than 0.5 millimeter.

(g) Personnel monitoring shall be performed in controlled areas for each occupationally exposed individual beyond the required 13-week period, for whom there is a reasonable possibility of receiving a dose exceeding one-fourth the applicable maximum permissible dose.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1012 Radiographic Installations Other Than Dental and Veterinary Medicine

(1) The equipment used in radiographic installations in other than dental and veterinary medicine shall be as follows:

(a) The tube housing will be of diagnostic type.

(b) Suitable devices (diaphragms, cones, adjustable collimators) , capable of restricting the useful beam to the area of clinical interest shall be provided to define the beam and shall provide the same degree of attenuation as that required of the tube housing. Such devices shall be calibrated in terms of the size of the projected useful beam at specified source-film distances. For chest photofluorographic equipment, the collimator shall restrict the beam to dimensions no greater than those of the fluorographic screen and shall confine the beam to the screen.

(c) Radiographic equipment, including multipurpose machines sold in Montana after July 1, 1969, shall be equipped with adjustable rectangular collimators containing light localizers that define the entire field. Equipment installed prior to March 28, 1980, utilizing circular collimators which have met or will meet established standards will be acceptable. The field size indication on adjustable collimators shall be accurate with a tolerance not exceeding 1 inch for a source-film distance of 72 inches, the light field shall align with the x-ray field with the same degree of accuracy.

(d) The size of the x-ray beam projected by fixed aperture cones and collimators, except those used for stereo-radiography, should not exceed the minimum dimensions of the x-ray film by more than 2 inches (1 inch border) for a source-film distance of 72 inches or 1 inch (1/2 inch border) for a source-film distance of 36 inches.

(e) Except when contraindicated for a particular radiographic purpose, the aluminum equivalent of the total filtration in the primary beam shall not be less than 0.5 millimeters aluminum for machines capable of operating not over 50 kVp, 1.5 millimeters for those capable of operating between 50-70 kVp and 2.5 millimeters for those capable of operating above 70 kVp.

(f) A device shall be provided which terminates the exposure at a preset time interval or exposure. The operator shall be able to terminate the exposure at any time.

(g) A type of dead-man switch for an exposure switch, except for those used in conjunction with "spot-film", shall be required and so arranged that it cannot be operated outside a shielded area.

(h) The control panel shall include a device such as a milliammeter or equivalent to give positive indication of the production of x-rays whenever the x-ray tube is energized.

(i) The control panel shall include devices, (labeled control settings and/or meters) indicating the physical factors (such as kVp, mA, exposure time, or whether timing is automatic) used for the exposure.

(j) Machines equipped with beryllium window x-ray tubes shall contain keyed filter interlock switches in the tube housing and suitable indication on the control panel of the added filter in the useful beam if the total filtration permanently in the useful beam is less than 0.5 mm aluminum equivalent. The total filtration permanently in the useful beam shall be clearly indicated on the tube housing.

(k) Beryllium window x-ray tubes shall not be used on multipurpose radiographic equipment.

(l) Gonadal shielding shall be used for the patient when appropriate.

(m) When a patient must be held in position for radiography, mechanical supporting or restraining devices shall be used whenever possible. If the patient must be held by an individual, that individual shall be protected with appropriate shielding devices such as protective gloves and apron and he shall be so positioned that no part of his body will be struck by the useful beam and that his body is as far as possible from the edge of the useful beam.

(n) Only persons whose presence is necessary shall be in the radiographic room during exposure. All such persons shall be protected.

(2) The structural shielding of radiographic equipment in other than dental or veterinary medicine shall be as follows:

(a) All wall, floor, and ceiling areas exposed to the useful beam shall have primary barriers. Primary barriers in walls shall extend to a minimum height of 84 inches above the floor.

(b) Secondary barriers shall be provided in all wall, floor, and ceiling areas not having primary barriers or where the primary barrier requirements are lower than the secondary barrier requirements.

(c) The operator's station at the control shall be behind a protective barrier, either in a separate room, in a protected booth, or behind a shield which will intercept the useful beam and any radiation which has been scattered only once.

(d) A window of lead-equivalent glass equal to that required by the adjacent barrier or a mirror system shall be provided large enough and so placed that the operator can see the patient without having to leave the protected area during exposure.

(3) The operating procedures applicable to radiographic installations other than in dental or veterinary medicine shall be as follows:

(a) Personnel monitoring shall be performed in controlled areas for each occupationally exposed individual beyond the required 13-week period, for whom there is a reasonable possibility of receiving a dose exceeding one-fourth the applicable maximum permissible dose.

(b) No individual occupationally exposed to radiation shall be permitted to hold patients during exposures except during emergencies, nor shall any individual be regularly used for this service.

(c) Only individuals required for the radiographic procedure shall be in the radiographic room during exposure; and, except for the patient, no unprotected parts of their bodies shall be in the useful beam.

(d) The useful beam shall be restricted to the area of clinical interest.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1020 Special Requirements for Mobile Diagnostic Radiographic Equipment

(1) The equipment used in mobile diagnostic radiography shall be as follows:

(a) All requirements of ARM 37.14.1012 (1) shall be satisfied except (g) .

(b) A type of dead-man switch for an exposure switch shall be provided, together with electrical cord of sufficient length so that the operator can stand at least 6 feet from the useful beam.

(2) When a mobile unit is used routinely in 1 location, it shall be considered a fixed installation subject to the shielding requirements specified in ARM 37.14.1003 (5) and 37.14.1012 (2) .

(3) The operating procedures applicable to mobile diagnostic radiographic equipment are as follows:

(a) All provisions of ARM 37.14.1012 (3) apply.

(b) The target-to-skin distance shall not be less than 15 inches.

(d) Mobile x-ray equipment shall not be used for photofluoroscopy unless it meets the requirements for mobile fluoroscopes in ARM 37.14.1006 .

(e) The operator shall wear a protective apron or stand behind a suitable shield.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1021 Special Requirements for Chest Photofluorographic Installations

(1) The equipment used in chest photofluorographic installations shall be as follows:

(a) All requirements of ARM 37.14.1012 (1) shall be satisfied.

(b) A collimator shall restrict the useful beam to the area of the photofluorographic screen.

(2) All requirements of ARM 37.14.1003 (5) and 37.14.1012 (2) concerning structural shielding shall be satisfied.

(3) The operating procedures applicable to chest photofluorographic installations shall be as follows:

(a) All requirements of ARM 37.14.1012 (3) shall be satisfied.

(b) All individuals except the patient being examined shall be in shielded positions during exposures.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1022 Therapeutic X-Ray Installations

(1) The equipment used in therapeutic x-ray installations shall be as follows:

(a) The tube housing shall be of therapeutic type. Contact therapy machines shall meet the additional requirement that the leakage radiation at 2 inches from the surface of the housing not exceed 0.1 R/h.

(b) Permanent diaphragms or cones used for collimating the useful beam shall afford the same degree of protection as the tube housing. Adjustable or removable beam-defining diaphragms or cones shall transmit not more than 5% of the useful beam obtained at the maximum possible kilovoltage and with maximum treatment filter.

(c) The filter system shall be so arranged as to minimize the possibility of error in filter selection and alignment. The filter slot shall be so constructed that the radiation escaping through it does not produce an exposure exceeding 1 roentgen per hour at 1 meter, or, if the radiation from the slot is accessible to the patient, 30 roentgens per hour at 2 inches from the external opening. Each removable filter shall be marked with its thickness and material.

(d) A filter indication system shall be used on all therapy machines using changeable filters. It shall indicate from the control panel the presence or absence of any filter and it shall be designed to permit easy recognition of the filter in place.

(e) The x-ray tube shall be so mounted that it cannot turn or slide with respect to the aperture. A mark on the housing should show the location of the focal spot.

(f) Means shall be provided to immobilize the tube housing during stationary portal treatment.

(g) There shall be on the control panel an easily discernible indicator which will give positive information as to whether or not the x-ray tube is energized.

(h) A suitable exposure control device shall be provided to terminate the exposure after a preset exposure or dose limit. It shall be designed to preserve its accumulated response in the event of equipment failure during patient treatment. If a timer is used, it should permit accurate presetting and determination of exposure times as short as 1 second.

(i) Unless it is possible to bring the x-ray exposure rate to the prescribed value within 5 seconds after the x-ray "on" switch is energized, the tube housing on machines operating below 500 kVp shall be fitted with an "ON-OFF" shutter operated from the control panel and of lead equivalent not less than that of the tube housing. The "ON-OFF" positions of the shutter shall be indicated at the control panel.

(j) Mechanical or electrical stops shall be provided on x-ray machines capable of operating at 150 kVp or above to insure that the useful beam is oriented only toward primary barriers.

(k) Interlocks shall be provided for x-ray therapy equipment capable of operating above 75 kVp so that when any door to the treatment room is opened, either the machine will be shut off automatically or the radiation level within the room will be reduced to an average of not more than 2 mR/hr and a maximum of 10 mR/hr at a distance of 1 meter in any direction from the source. After such a shutoff or reduction in exposure rate, it shall be possible to restore the machine to full operation only from the control panel.

(l) The x-ray control circuit shall be so designed that it is not possible to energize the x-ray tube without resetting the x-ray "on" switch at the control panel.

(m) X-ray therapy machines shall be provided with a locking device to prevent unauthorized use.

(n) When a beam interceptor is provided, it shall transmit not more than 0.1% of the useful beam under any operating conditions. It shall also reduce by the same factor the radiation scattered by the patient through an angle up to 30 E from the central ray.

(o) When the relationship between the beam interceptor and the useful beam is not permanently fixed, mechanical or electrical stops shall be provided to insure that the beam is oriented only toward primary barriers.

(p) Special consideration shall be given to the safety design of x-ray machines with electron beam extraction capability such as linear accelerators.

(2) Therapeutic x-ray machines shall be structurally shielded as follows:

(a) All wall, floor, and ceiling areas that can be struck by the useful beam, plus a border of 1 foot, shall be provided with primary protective barriers.

(b) All wall, floor, and ceiling areas that, because of restrictions in the orientation of the useful beam, cannot be struck by the useful beam shall be provided with secondary protective barriers.

(3) The operating procedures applicable to therapeutic x-ray installations shall be as follows:

(a) A radiation protection survey of all new installations and existing installations not previously surveyed shall be made by, or under the direction of, a qualified expert. A resurvey shall be made after every change in equipment, workload, or operating conditions which might significantly increase the probability of persons receiving more than the MPD. If, as a result of a radiation survey, supplementary shielding is installed, another survey shall be made in order to confirm the adequacy of the shielding after the modification.

(b) The qualified expert shall report his findings in writing, including recommendations for any required corrective measures, to the person in charge of the installation, a copy of which shall be sent to the department. The report shall indicate if a further survey is necessary after corrections have been made.

(d) An x-ray therapy machine shall be calibrated by a qualified expert before use for the treatment of patients.

(e) X-ray therapy equipment capable of operating above 75 kVp shall not be operated routinely until the radiation safety of the installation has been established.

(f) Both the control panel and the patient shall be kept under observation during exposure.

(g) When a patient must be held in position for radiation therapy, mechanical supporting or restraining devices shall be used.

(h) No person other than the patient shall be in the treatment room where the tube is operated at potentials exceeding 75 kVp.

(i) If the x-ray tube of a contact therapy machine is hand-held during irradiation, the operator shall wear protective gloves and apron. A cap of at least 0.5 mm lead equivalent shall cover the aperture window of the tube housing of such apparatus when the apparatus is not being used.

(j) Lead, lead rubber, lead foil, etc., used for limiting the field, shall not transmit more than 5% of the useful beam (see Table I) .

(k) Notwithstanding ARM 37.14.721 , personnel monitoring shall be required for all persons who enter a controlled area.

TABLE I

Thickness of lead required to reduce useful beam to 5%*

Beam Quality | Required Lead Thickness millimeters Potential | Half Value Layer millimeters 60 kVp 100 kVp 100 kVp 100 kVp 140 kVp 200 kVp 250 kVp | 1.2 Al 1.0 Al 2.0 Al 3.0 Al 0.5 Cu 1.0 Cu 3.0 Cu | 0.10 0.16 0.25 0.35 0.7 1.0 1.7 400 kVp 1000 kVp | 4.0 Cu 3.2 Pb | 2.3 20.5 2000 kVp 2000 kVcp 3000 kVcp 6000 kV 8000 kV Cobalt 60 | 6.0 Pb 14.5 Pb 16.2 Pb 17.0 Pb 15.5 Pb 10.4 Pb | 43.0 63.0 70.0 74.0 67.0 47.0

*Approximate values for broad beams. The third column refers to lead or to the required equivalent lead thickness of lead-containing materials (e.g., lead, rubber, lead glass, etc.) .

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.11 Use of Sealed Radioactive Sources in the Healing Arts

Mont. Admin. R. 37.14.1101 Scope

(1) The provisions of this subchapter apply to all licensees who use sealed sources in the healing arts and are in addition to, and not in substitution for, other applicable provisions of this chapter.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1105 Interstitial , Intracavitary and Superficial Applications

(1) Sealed sources shall be accounted for, stored and transported as follows:

(a) Except as otherwise specifically authorized by the department, each licensee shall provide accountability of sealed sources and shall keep a record of the issue and return of all sealed sources. A physical inventory shall be made at least every 6 months and a written record of the inventory maintained.

(b) When not in use, sealed sources and applicators containing sealed sources shall be kept in a protective enclosure of such material and wall thickness as may be necessary to assure compliance with the provisions of ARM 37.14.705, 37.14.708 and 37.14.709.

(2) Sealed sources shall be tested for leakage and contamination as follows:

(a) All sealed sources with a half-life greater than 30 days and in any form other than gas shall be tested for leakage and/or contamination prior to initial use and at intervals not to exceed 6 months, unless otherwise specified. If there is reason to suspect that a sealed source might have been damaged, or might be leaking, it shall be tested for leakage before further use.

(b) Leak tests shall be capable of detecting the presence of 0.005 microcurie of radioactive material on the test sample or, in the case of radium, the escape of radon at the rate of 0.001 microcurie per 24 hours. Any test conducted pursuant to (a) above which reveals the presence of 0.005 microcurie or more of removable contamination or, in the case of radium, the escape of radon at the rate of 0.001 microcurie or more per 24 hours, shall be considered evidence that the sealed source is leaking. The licensee shall immediately withdraw the source from use and shall cause it to be decontaminated and repaired or to be disposed of in accordance with applicable provisions of ARM Title 37, chapter 14, subchapter 7.

(3) Radiation surveys shall be conducted as follows:

(a) The maximum radiation level at a distance of 1 meter from the patient in whom brachytherapy sources have been inserted shall be determined by measurement or calculation. This radiation level shall be entered on the patient's chart and other signs as required under (4) of this rule.

(b) The radiation levels in the patient's room and the surrounding area shall be determined, recorded, and maintained for inspection by the department.

(4) Signs and records shall be maintained as follows:

(a) In addition to the requirements of ARM 37.14.725, the bed, cubicle, or room of the hospital brachytherapy patient shall be marked with a sign indicating the presence of brachytherapy sources. This sign shall incorporate the radiation symbol and specify the radionuclide, the activity, date and the individual to contact for radiation safety instructions. The sign is not required provided the exception in ARM 37.14.726(2) is met.

(b) The following information shall be included in the patient's chart:

(i) the radionuclide administered, number of sources, activity in millicuries and time and date of administration;

(ii) the exposure rate at 1 meter, the time the determination was made, and by whom;

(iii) the radiation symbol; and

(iv) the precautionary instructions necessary to assure that the exposure of individuals does not exceed that permitted under ARM 37.14.705.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1106 Teletherapy

(1) The equipment used in teletherapy shall be as follows:

(a) The housing shall be so constructed that, at 1 meter from the source, the maximum exposure rate does not exceed 10 milliroentgens per hour when the beam control mechanism is in the "off" position. The average exposure rate measured at a representative number of points about the housing, each 1 meter from the source, shall not exceed 2 milliroentgens per hour.

(b) For teletherapy equipment installed after the effective date of this chapter, the leakage radiation measured at 1 meter from the source when the beam control mechanism is in the "on" position shall not exceed 0.1% of the useful beam exposure rate.

(d) The beam control mechanism shall be of a positive design capable of acting in any orientation of the housing for which it is designed to be used. In addition to an automatic closing device, the mechanism shall be designed so that it can be manually returned to the "off" position with a minimum risk of exposure.

(e) The closing device shall be so designed as to return automatically to the "off" position in the event of any breakdown or interruption of the activating force and shall stay in the "off" position until activated from the control panel.

(f) When any door to the treatment room is opened, the beam control mechanism shall automatically and rapidly restore the unit to the "off" position and cause it to remain there until the unit is reactivated from the control panel.

(g) There shall be at the housing and at the control panel a warning device that plainly indicates whether the beam is "on" or "off".

(h) The equipment shall be provided with a locking device to prevent unauthorized use.

(i) The control panel shall be provided with a timer that automatically terminates the exposure after a preset time.

(j) Provision shall be made to permit continuous observation of patients during irradiation.

(2) No individual shall be in the treatment room during irradiation unless that individual is the patient. Mechanical restraining or supporting devices shall be used for positioning the patient, if necessary.

(3) Teletherapy sources shall be tested for leakage and contamination in accordance with the procedures described in ARM 37.14.1105(2) . Tests of leakage may be made by wiping accessible surfaces of the housing port or collimator while the source is in the "off" position and measuring these wipes for transferred contamination.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.13 Radiation Safety Requirements for Analytical X-Ray Equipment

Mont. Admin. R. 37.14.1301 Scope

(1) This subchapter provides special requirements for analytical x-ray equipment which are in addition to the applicable requirements of other subchapters.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1302 Definitions

(1) As used in this subchapter:

(a) "Analytical x-ray equipment" means equipment used for x-ray diffraction or fluorescence analysis.

(b) "Analytical x-ray system" means a group of components utilizing x-rays to determine the elemental composition or to examine the microstructure of materials.

(c) "Fail-safe characteristics" mean a design feature which causes beam port shutters to close, or otherwise prevents emergence of the primary beam, upon the failure of a safety or warning device.

(d) "Local components" mean part of an analytical x-ray system and include areas that are struck by x-rays such as radiation source housings, port and shutter assemblies, collimators, sample holders, cameras, goniometers, detectors and shielding, but do not include power supplies, transformers, amplifiers, readout devices, and control panels.

(e) "Normal operating procedures" mean step-by-step instructions necessary to accomplish the analysis. These procedures shall include sample insertion and manipulation, equipment alignment, routine maintenance by the registrant, and data recording procedures, which are related to radiation safety.

(f) "Open-beam configuration" means an analytical x-ray system in which an individual could accidentally place some part of his body in the primary beam path during normal operation.

(g) "Primary beam" means radiation which passes through an aperture of the source housing by a direct path from the x-ray tube or a radioactive source located in the radiation source housing.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1305 Equipment Requirements

(1) A safety device which prevents the entry of any portion of an individual's body into the primary x-ray beam path or which causes the beam to be shut off upon entry into its path shall be provided on all open-beam configurations.

(a) A registrant may apply to the department for an exemption from this requirement for a safety device. Such application shall include:

(i) a description of the various safety devices that have been evaluated;

(ii) the reason each of these devices cannot be used; and

(iii) a description of the alternative methods that will be employed to minimize the possibility of an accidental exposure, including procedures to assure that operators and others in the area will be informed of the absence of safety devices.

(2) Analytical x-ray equipment shall be equipped with the following warning devices:

(a) Open-beam configurations shall be provided with a readily discernible warning device which shall indicate:

(i) whether the x-ray tube is on or off, and which shall be located near the radiation source housing, if the primary beam is controlled in this manner; or

(ii) whether the shutter is open or closed, and which shall be located near each port on the radiation source housing, if the primary beam is controlled in this manner;

(b) Warning devices shall be labeled so that their purpose is easily identified. On equipment installed after July 1, 1980, warning devices shall have fail-safe characteristics.

(3) Unused ports on radiation source housings shall be secured in the closed position in a manner which will prevent casual opening.

(4) All analytical x-ray equipment shall be labeled with a readily discernible sign or signs bearing the radiation symbol and the words:

(a) "CAUTION--HIGH INTENSITY X-RAY BEAM", or words having a similar intent, on the x-ray source housing; and

(b) "CAUTION--RADIATION--THIS EQUIPMENT PRODUCES RADIATION WHEN ENERGIZED", or words having a similar intent, near any switch that energizes an x-ray tube if the radiation source is an x-ray tube; or

(c) "CAUTION--RADIOACTIVE MATERIAL", or words having a similar intent, on the source housing if the radiation source is a radionuclide.

(5) On open-beam configurations installed after July 1, 1980, each port on the radiation source housing shall be equipped with a shutter that cannot be opened unless a collimator or a coupling has been connected to the port.

(6) An easily visible warning light labeled with the words "X-RAY ON", or words having a similar intent, shall be located near any switch that energizes an x-ray tube and shall be illuminated only when the tube is energized; or in the case of a radioactive source, near any switch that opens a housing shutter, and shall be illuminated only when the shutter is open. On equipment installed after July 1, 1980, warning lights shall have fail-safe characteristics.

(7) Each x-ray tube housing shall be so constructed that, with all shutters closed, the leakage radiation measured at a distance of 5 cm from its surface is not capable of producing a dose in excess of 2.5 mrem in 1 hour at any specified tube rating; and if radioactive sources are used, corresponding dose limits shall not exceed 2 mR per hour.

(8) Each x-ray generator shall be supplied with a protective cabinet which limits leakage radiation measured at a distance of 5 cm from its surface such that it is not capable of producing a dose in excess of 0.25 mrem in 1 hour.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1306 Area Requirements

(1) The local components of an analytical x-ray system shall be located and arranged and shall include sufficient shielding or access control such that no radiation levels exist in any area surrounding the local component group which could result in a dose to an individual present therein in excess of the dose limits given in ARM 37.14.709. For systems utilizing x-ray tubes, these levels shall be met at any specified tube rating.

(2) Radiation surveys, as required by ARM 37.14.720, shall be performed of all analytical x-ray systems sufficient to show compliance with (1) of this rule unless a registrant can demonstrate to the satisfaction of the department compliance in some other manner. These surveys shall be performed:

(a) upon installation of the equipment, and at least once every 12 months thereafter;

(b) following any change in the initial arrangement, number, or type of local components in the system;

(d) during the performance of maintenance and alignment procedures if the procedures require the presence of a primary x-ray beam when any local component in the system is disassembled or removed;

(e) any time a visual inspection of the local components in the system reveals an abnormal condition; and

(f) whenever personnel monitoring devices show a significant increase over the previous monitoring period or the readings are approaching the limits specified in ARM 37.14.705.

(3) Each area or room containing analytical x-ray equipment shall be conspicuously posted with a sign or signs bearing the radiation symbol and the words "CAUTION--X-RAY EQUIPMENT", or words having a similar intent.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1307 Operating Requirements

(1) Normal operating procedures shall be written and made available to all analytical x-ray equipment workers. No person shall be permitted to operate analytical x-ray equipment in any manner other than that specified in the procedures unless such person has obtained written approval of the radiation safety officer.

(2) No person shall bypass a safety device unless such person has obtained the approval of the radiation safety officer. Such approval, if given, shall be for a specified period of time. When a safety device has been bypassed, a readily discernible sign bearing the words "SAFETY DEVICE NOT WORKING", or words having a similar intent, shall be placed on the radiation source housing.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 681; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1308 Personnel Requirements

(1) No person shall be permitted to operate or maintain analytical x-ray equipment unless such person has received instruction in and demonstrated competence as to:

(a) identification of radiation hazards associated with the use of the equipment;

(b) significance of the various radiation warning and safety devices incorporated into the equipment, or the reasons they have not been installed on certain pieces of equipment and the extra precautions required in such cases;

(d) symptoms of an acute localized exposure; and

(e) proper procedures for reporting an actual or suspected exposure.

(2) Finger or wrist dosimetric devices shall be provided to and shall be used by:

(a) analytical x-ray equipment workers using systems having an open-beam configuration and not equipped with a safety device; and

(b) personnel maintaining analytical x-ray equipment if the maintenance procedures require the presence of a primary x-ray beam when any local component in the analytical x-ray system is disassembled or removed.

(3) Reported dose values shall not be used for the purpose of determining compliance with ARM 37.14.705 unless evaluated by a qualified expert.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 681; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.14 Radiation Safety Requirements for Particle Accelerators

Mont. Admin. R. 37.14.1401 Purpose

(1) This subchapter establishes procedures for the registration and the use of particle accelerators. In addition to the requirements of this subchapter, all registrants are subject to the requirements of ARM Title 37, chapter 14, subchapters 1, 3, 7, and 17. Registrants engaged in industrial radiographic operations are subject to the requirements of ARM Title 37, chapter 14, subchapter 8, and registrants engaged in the healing arts are subject to the requirements of ARM Title 37, chapter 14, subchapters 10 and 11. Registrants engaged in the production of radioactive material are subject to the requirements of ARM Title 37, chapter 14, subchapter 5.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1405 Registration Procedures and Requirements

(1) No person shall receive, possess, use, transfer, own, or acquire a particle accelerator except as authorized in a registration issued pursuant to this chapter or as otherwise provided for in this chapter. The general procedures for registration of particle accelerator facilities are included in ARM Title 37, chapter 14, subchapter 3.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1406 General Registration Procedure and Requirements: Human Use of Particle Accelerators

(1) In addition to the requirements of ARM Title 37, chapter 14, subchapter 3, a registration application for use of a particle accelerator will be approved only if the department determines that:

(a) the applicant is qualified by reason of training and experience to use the accelerator in question for the purpose requested in accordance with this subchapter and ARM Title 37, chapter 14, subchapters 7 and 17, in such a manner as to minimize danger to public health and safety or property;

(b) the applicant's proposed or existing equipment, facilities, operating and emergency procedures are adequate to protect health and minimize danger to public health and safety or property;

(c) the issuance of the registration will not be inimical to the health or safety of the public, and the applicant satisfies any applicable special requirement in ARM 37.14.1407;

(d) the applicant has appointed a radiation safety officer;

(e) the applicant or the applicant's staff has substantial experience in the use of particle accelerators and training sufficient for application to its intended uses;

(f) the applicant has established a radiation safety committee to approve, in advance, proposals for uses of particle accelerators, whenever deemed necessary by the department; and

(g) the applicant has an adequate training program for operators of particle accelerators.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1407 Registration Procedure: Human Use of Particle Accelerators

(1) In addition to the requirements set forth in ARM Title 37, chapter 14, subchapter 3, a registration for use of a particle accelerator in the healing arts will be issued only if:

(a) the applicant has appointed a medical committee of at least 3 members to evaluate all proposals for research, diagnostic, and therapeutic use of a particle accelerator whenever deemed necessary by the department. Membership of the committee should include physicians expert in internal medicine, hematology, therapeutic radiology, and a person experienced in depth dose calculations and protection against radiation;

(b) the individual designated on the application as the users have substantial training and experience in deep therapy techniques or in the use of particle accelerators to treat humans; and

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1415 Compliance

(1) The registrant shall be responsible for assuring that all requirements of this subchapter are met.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1416 Limitations

(1) No registrant shall permit any person to act as an operator of a particle accelerator until such person:

(a) has been instructed in radiation safety and shall have demonstrated an understanding thereof;

(b) has received copies of and instruction in this subchapter and the applicable requirements of subchapters 7 and 17, pertinent registration conditions and the registrant's operating and emergency procedures, and shall have demonstrated understanding thereof; and

(c) has demonstrated competence to use the particle accelerator, related equipment, and survey instruments which will be employed in his assignment.

(2) Either the radiation safety committee or the radiation safety officer shall have the authority to terminate the operations at a particle accelerator facility if such action is deemed necessary to protect health and minimize danger to public health and safety or property.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1417 Shielding and Safety Design Requirements

(1) A qualified expert, specifically accepted by the department, shall be consulted in the design of a particle accelerator installation and called upon to perform a radiation survey when the accelerator is first capable of producing radiation.

(2) Each particle accelerator installation shall be provided with such primary or secondary barriers as are necessary to assure compliance with ARM 37.14.705 and 37.14.709.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1418 Particle Accelerator Controls and Interlock Systems

(1) Instrumentation, readouts and controls on the particle accelerator control console shall be clearly identified and easily discernible.

(2) All entrances into a target room or other high radiation area shall be provided with interlocks that shut down the machine under conditions of barrier penetration.

(3) When an interlock system has been tripped, it shall only be possible to resume operation of the accelerator by manually resetting controls at the position where the interlock has been tripped, and lastly at the main control console.

(4) Each safety interlock shall be on a circuit which shall allow its operation independently of all other safety interlocks.

(5) All safety interlocks shall be designed so that any defect or component failure in the interlock system prevents operation of the accelerator.

(6) A scram button or other emergency power cutoff switch shall be located and easily identifiable in all high radiation areas. Such a cutoff switch shall include a manual reset so that the accelerator cannot be restarted from the accelerator control console without resetting the cutoff switch.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1425 Warning Devices

(1) All locations designated as high radiation areas, and entrances to such locations shall be equipped with easily observable flashing or rotating warning lights that operate when, and only when, radiation is being produced.

(2) Except in facilities designed for human exposure, each high radiation area shall have an audible warning device which shall be activated for 15 seconds prior to the possible creation of such high radiation area. Such warning device shall be clearly discernible in all high radiation areas and all radiation areas.

(3) Barriers, temporary or otherwise, and pathways leading to high radiation areas shall be identified in accordance with ARM 37.14.725.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1426 Operating Procedures

(1) Particle accelerators, when not in operation, shall be secured to prevent unauthorized use.

(2) The safety interlock system shall not be used to turn off the accelerator beam except in an emergency.

(3) All safety and warning devices, including interlocks, shall be checked for proper operability at intervals not to exceed 3 months. Results of such tests shall be maintained at the accelerator facility for inspection by the department.

(4) Electrical circuit diagrams of the accelerator and the associated interlock systems shall be kept current and maintained for inspection by the department and shall be available to the operator at each accelerator facility.

(5) If, for any reason, it is necessary to intentionally bypass a safety interlock or interlocks, such action shall be:

(a) authorized by the radiation safety committee or radiation safety officer;

(b) recorded in a permanent log and a notice posted at the accelerator control console; and

(6) A copy of the current operating and the emergency procedures shall be maintained at the accelerator control panel.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1430 Radiation Monitoring Requirements

(1) There shall be available at each particle accelerator facility appropriate portable monitoring equipment which is operable and has been calibrated for the appropriate radiations being produced at the facility. Such equipment shall be tested for proper operation daily and calibrated at intervals not to exceed 1 year and after each servicing and repair.

(2) A radiation protection survey shall be performed and documented by a qualified expert specifically approved by the department when changes have been made in shielding, operation, equipment, or occupancy of adjacent areas.

(3) Radiation levels in all high radiation areas shall be continuously monitored. The monitoring devices shall be electrically independent of the accelerator control and interlock systems and capable of providing a remote and local readout with visual or audible alarms at both the control panel and at entrance to high radiation areas, and other appropriate locations, so that people entering or present become aware of the existence of the hazard.

(4) All area monitors shall be calibrated at intervals not to exceed 1 year and after each servicing and repair.

(5) Whenever applicable, periodic surveys shall be made to determine the amount of airborne particulate radioactivity present in areas of airborne hazards.

(6) Whenever applicable, periodic smear surveys shall be made to determine the degree of contamination in target and other pertinent areas.

(7) All area surveys shall be made in accordance with the written procedures established by a qualified expert or the radiation safety officer of the particle accelerator facility.

(8) Records of all radiation protection surveys, calibration results, instrumentation tests, and smear results shall be kept current and on file at each accelerator facility.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201, 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1431 Ventilation Systems

(1) Means shall be provided to ensure that personnel entering any area where airborne radioactivity may be produced will not be exposed to airborne radioactive material in excess of those limits specified in ARM Title 37, chapter 14, subchapter 7, Appendix A, Table I.

(2) A registrant, as required by ARM 37.14.709 shall not vent, release or otherwise discharge airborne radioactive material to an uncontrolled area which exceed the limits specified in ARM Title 37, chapter 14, subchapter 7, Appendix A, Table II, except as authorized pursuant to ARM 37.14.710(2) or 37.14.741. For purposes of this subsection, concentrations may be averaged over a period not greater than 1 year. Every reasonable effort should be made to maintain releases of radioactive material to uncontrolled areas as far below these limits as practicable.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202 MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202 MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.17 Notices, Instructions and Reports to Workers; Inspections

Mont. Admin. R. 37.14.1701 Purpose and Scope

(1) This subchapter establishes requirements for notices, instructions and reports by licensees to individuals engaged in activities under a license and options available to such individuals in connection with department inspections of licensees to ascertain compliance with the provisions of the act and rules, orders and licenses issued thereunder regarding radiological working conditions. The sections in this subchapter apply to all persons who receive, possess, use, own or transfer sources of radiation licensed by the department pursuant to ARM Title 37, chapter 14, subchapters 3 and 5.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1705 Posting of Notices to Workers

(1) Each licensee shall post current copies of the following documents:

(a) the rules of this subchapter and of subchapter 4;

(b) the license, conditions or documents incorporated into the license by reference and amendments thereto;

(d) any notice of violation involving radiological working conditions, proposed imposition of civil penalty, or order issued pursuant to ARM Title 37, chapter 14, subchapter 1, and any response from the licensee.

(2) If posting of a document specified in (1) (a) , (b) or (c) of this rule is not practicable, the licensee may post a notice which describes the document and states where it may be examined.

(3) Form MRH-20, "Notice to Employees", shall be posted by each licensee.

(4) Department documents posted pursuant to (1) (d) of this rule shall be posted within 5 working days after receipt of the documents from the department; the licensee's response, if any, shall be posted within 5 working days after dispatch from the licensee or registrant. Such documents shall remain posted for a minimum of 5 working days or until action correcting the violation has been completed, whichever is later.

(5) Documents, notices or forms posted pursuant to this rule shall appear in a sufficient number of places to permit individuals engaged in work under the license to observe them on the way to or from any particular work location to which the document applies, shall be conspicuous, and shall be replaced if defaced or altered.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1706 Instructions to Workers

(1) All individuals working in or frequenting any portion of a restricted area:

(a) shall be kept informed of the storage, transfer, or use of sources of radiation in such portions of the restricted area;

(b) shall be instructed in the health protection problems associated with exposure to radiation or radioactive material, in precautions or procedures to minimize exposure, and in the purposes and functions of protective devices employed;

(c) shall be instructed in, and instructed to observe, to the extent within the worker's control, the applicable provisions of this chapter and licenses for the protection of personnel from exposure to radiation or radioactive material occurring in such areas;

(d) shall be instructed of their responsibility to report promptly to the licensee or registrant any condition which may lead to or cause a violation of the act, this chapter, and licenses or unnecessary exposure to radiation or radioactive material;

(e) shall be instructed in the appropriate response to warnings made in the event of any unusual occurrence or malfunction that may involve exposure to radiation or radioactive material; and

(f) shall be advised as to the radiation exposure reports which workers shall be furnished pursuant to ARM 37.14.1707.

(2) The extent of these instructions shall be commensurate with potential radiological health protection problems in the restricted area.

History

Authorizing statute(s): Sec. 75-3-201 and 75-3-202, MCA
Implementing statute(s): Sec. 75-3-201 and 75-3-202, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1707 Notifications and Reports to Individuals

(1) Radiation exposure data for an individual and the results of any measurements, analyses, and calculations of radioactive material deposited or retained in the body of an individual shall be reported to the individual as specified in this rule. The information reported shall include data and results obtained pursuant to this chapter, orders, or license conditions, as shown in records maintained by the licensee or registrant pursuant to this chapter. Each notification and report shall:

(a) be in writing;

(b) include appropriate identifying data such as the name of the licensee or registrant, the name of the individual, and the individual's social security number;

(d) contain the following statement: "This report is furnished to you under the provisions of the Montana Radiation Control Act, ARM Title 37, chapter 14, subchapter 17. You should preserve this report for further reference".

(2) Each licensee or registrant shall advise each worker annually of the worker's exposure to radiation or radioactive material as shown in records maintained by the licensee or registrant pursuant to ARM 37.14.750(1) and (3) .

(3) Each licensee or registrant shall furnish to each worker a report of the worker's exposure to radiation or radioactive material upon termination of employment. Such report shall be furnished within 30 days from the time of termination of employment or within 30 days after the exposure of the individual has been determined by the licensee or registrant, whichever is later. The report shall cover each calendar quarter in which the worker's activities involved exposure to sources of radiation and shall include the dates and locations of work under the license or registration in which the worker participated.

(4) When a licensee or registrant is required pursuant to ARM 37.14.756 to report to the department any exposure of an individual to radiation or radioactive material, the licensee or the registrant shall also provide the individual a report on the exposure data included therein. Such reports shall be transmitted at a time not later than the transmittal to the department.

History

Authorizing statute(s): Sec. 75-3-202 and 75-3-204, MCA
Implementing statute(s): Sec. 75-3-202 and 75-3-204, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1720 Inspection Procedures

(1) Each licensee or registrant shall afford to the department at all reasonable times the opportunity to inspect materials, machines, activities, facilities, premises and records pursuant to this chapter.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-107, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1721 Consultation with Workers During Inspections

(1) Agency inspectors may consult privately with workers concerning matters of occupational radiation protection and other matters related to applicable provisions of this chapter and licenses to the extent the inspectors deem necessary for the conduct of an effective and thorough inspection.

(2) During the course of an inspection, any worker may bring privately to the attention of the inspectors, either orally or in writing, any past or present condition which he has reason to believe may have contributed to or caused any violation of the act, this chapter, or license condition, or any unnecessary exposure of an individual to sources of radiation under the licensee's or registrant's control.

History

Authorizing statute(s): Sec. 75-3-202, MCA
Implementing statute(s): Sec. 75-3-107, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Subchapter 37.14.18 Stabilization of Mill Tailings Piles

Mont. Admin. R. 37.14.1801 Scope

(1) The provisions of this subchapter apply to mining, milling or manufacturing operations where wastes, tailings piles, or stockpiled ore which contain radioactive material have accumulated.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1805 Permissible Concentrations and Levels of Radiation

(1) All wastes, tailings, or stockpiled ore containing radioactive material from active or inactive mining, milling, or manufacturing operations shall be kept and maintained in such a manner as not to release to an unrestricted area radioactive material in concentrations which exceed the limits specified in ARM Title 37, chapter 14, subchapter 7, Appendix A, Table II. Permissible levels of radiation in restricted and unrestricted areas are stated in ARM 37.14.705 and 37.14.709.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Mont. Admin. R. 37.14.1806 Stabilization of Tailings Piles and Ponds from Mills

(1) Ponds from inactive mills shall be drained and covered with materials or provided with vegetative cover that will prevent wind and water erosion. Water drained from ponds from inactive mills shall be disposed of in a manner approved by the department.

(2) Taking into consideration the types of materials at each site, piles from inactive mills shall be leveled and graded so that there is, insofar as possible, a gradual slope to ensure that there shall be no low places on the pile where water might collect. Side slopes shall be stabilized by riprap, dikes, reduction of grades, vegetation, or any other method or combination of methods that will ensure stabilization.

(3) If pile edges from inactive mills are adjacent to a river, creek, gulch, or other watercourse that might reasonably be expected to erode the edges during periods of high water, the exposed slopes shall be stabilized and the edges shall be diked and riprapped sufficiently to prevent erosion of the pile.

(4) Adequate drainage ditches shall be provided around the pile edges from inactive mills to prevent surface runoff water from neighboring land from reaching and eroding the pile.

(5) Piles shall be stabilized against wind and water erosion. The method of stabilization may consist of vegetation or a cover of soil, soil containing rock or stone, cement or concrete products, petroleum products, or any other soil stabilization material presently recognized or which may be recognized in the future, or any combination of the foregoing as may be required for proper protection from wind, or water erosion.

(6) Access to a stabilized pile area shall be controlled by the operator or owner and properly posted.

(7) Active and inactive piles shall be maintained in such a manner that excessive erosion of, or environmental hazard from, radioactive materials does not occur.

(8) The owner of a tailings pile site shall give the department written notice 10 days in advance of any contemplated transfer of right, title or interest in such site by deed, lease, or other conveyance. The written notice shall contain the name and address of the proposed purchaser or transferee. Prior written approval of the department shall be obtained before the surface area of the land shall be put to use and it shall have been determined that the radiation dosage to the public resulting from the proposed use does not exceed 0.5 rem per year.

(9) With the exception of use at a mill or for reprocessing at the site or another location, prior written approval of the department must be obtained before any tailing material is removed from any active or inactive mill.

(10) Detailed plans for stabilizing tailings piles shall be submitted to the department for review and approval prior to undertaking stabilization of the pile.

(11) The department may waive individual requirements in regard to stabilization or utilization of tailings material if it can be shown that they are unnecessary or impracticable in specific cases.

History

Authorizing statute(s): Sec. 75-3-201, MCA
Implementing statute(s): Sec. 75-3-201, MCA
History: NEW, 1980 MAR p. 1069, Eff. 3/28/80; TRANS, from DHES, 1996 MAR p. 433; TRANS, from DEQ, 2000 MAR p. 189.

Chapter 37.19 Family Planning Programs

Subchapter 37.19.1 Program Deficiencies

Mont. Admin. R. 37.19.101 Definitions

As used in this subchapter, the following definitions apply:

(1) "Department" means the department of public health and human services provided for in Title 2, chapter 15, part 21, MCA.

(2) "Local board" means a governmental unit or private contractor which administers a local family planning program and with which the department has entered into an agreement to provide family planning services.

(3) "Local family planning program" means a program administered by a local board which has entered an agreement with the department and is organized pursuant to the Family Planning Services and Population Research Act of 1970, as amended (42 U.S.C. 300, et seq.) and federal regulations governing grants for family planning services (42 CFR Part 59) .

(4) "Project director" means the individual assigned by a local board to have responsibility for the day-to-day management and administration of a local family planning program on behalf of the local board.

History

Authorizing statute(s): Sec. 50-1-202(9), MCA
Implementing statute(s): Sec. 50-1-202(9) and (16), MCA
History: NEW, 1985 MAR p. 1332, Eff. 9/13/85; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.19.102 Investigation of Complaints

(1) Upon receiving a written, signed complaint alleging that a local family planning program has violated federal regulations or has committed fraud, the department will conduct an investigation or audit.

(2) If the complainant requests confidentiality, the complainant's name will remain confidential during the department's investigation.

(3) The investigation may include unannounced site visits and interviews with local program staff, as appropriate.

History

Authorizing statute(s): Sec. 50-1-202(9), MCA
Implementing statute(s): Sec. 50-1-202(9) and (16), MCA
History: NEW, 1985 MAR p. 1332, Eff. 9/13/85; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.19.103 Investigation and Audit Reports: Probationary Status

(1) Within 45 days following completion of an investigation initiated pursuant to ARM 37.19.102, or of a routine program audit conducted by the department, the department will send a written report to the local board or project director. If the department's investigation has revealed significant program deficiencies, the report shall identify such deficiencies and notify the local board or project director that the local program has been put on probation.

(2) The local board and project director will be given 1 month to correct the deficiencies. The notice of probationary status will indicate that if the deficiencies have not been corrected by the end of the 1 month probationary period, termination procedures will be initiated.

History

Authorizing statute(s): Sec. 50-1-202(9), MCA
Implementing statute(s): Sec. 50-1-202(9) and (16), MCA
History: NEW, 1985 MAR p. 1332, Eff. 9/13/95; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.19.104 Family Planning Program Termination Procedures

(1) Except as provided in (3) , upon a finding of major uncorrected program deficiencies as set forth in ARM 37.19.103, the department will notify the local board and project director of its intent to terminate the local program. This notice will identify the program deficiencies upon which the termination action is based, and will offer the opportunity for the local program to request an informal reconsideration before the department to contest the termination decision. Such request for an informal reconsideration must be received in writing by the department no later than 2 weeks after issuance of the notice of intent to terminate.

(2) If a timely request for an informal reconsideration is received, the reconsideration will be conducted within 30 days following the receipt of the request. Such informal reconsideration shall be conducted in accordance with the procedures specified for informal reconsiderations in ARM 37.5.305, and is not subject to the contested case provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA or, except as provided in this rule, the provisions of ARM 37.5.304, 37.5.307, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337. The department's final decision on termination will be made within 30 days following the reconsideration. The final decision will be accompanied by a brief statement of the department's findings.

(3) Notwithstanding the provisions of ARM 37.19.103 and this rule, upon a determination by the department that serious program deficiencies constitute an imminent threat to the health, safety or well being of the program's clients, the department may institute emergency termination procedures without first having completed the procedures set forth in ARM 37.19.103 and this rule. In such a case, the notice of intent to terminate may, if appropriate, include notification that the department will discontinue program funding within 5 days following receipt of the notice, pending final action on the termination decision.

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202, MCA
History: NEW, 1985 MAR p. 1332, Eff. 9/13/85; AMD, 2000 MAR p. 1653, Eff. 6/30/00; TRANS, from DHES, 2001 MAR p. 398.

Chapter 37.21 Documentation and Study of Abortion

Subchapter 37.21.1 Documentation and Studies of Abortion

Mont. Admin. R. 37.21.101 Definitions

(1) "Abortion" means the performance of, or assistance or participation in the performance of, or submission to, an act or operation intended to terminate a pregnancy without live birth.

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

(3) "Facility" means a hospital, health care facility, physician's office or other place in which an abortion is performed.

(4) "Viability" means the ability of a fetus to live outside the mother's womb, albeit with artificial aid.

History

Authorizing statute(s): Sec. 50-20-105, MCA
Implementing statute(s): Sec. 50-20-105, MCA
History: NEW, EMERG, Eff. 7/1/74; NEW, Eff. 10/5/74; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.21.104 Certificate of Informed Consent

(1) The written statement of informed consent required by 50-20-106 , MCA, is to be made on a form prescribed by and obtained from the department.

History

Authorizing statute(s): Sec. 50-20-106, MCA
Implementing statute(s): Sec. 50-20-106, MCA
History: NEW, EMERG, Eff. 7/1/74; NEW, Eff. 10/5/74; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.21.105 Confidentiality

(1) In connection with an abortion, the facility shall keep on file the original of each of the documents required by the Montana Abortion Control Act relating to informed consent, notice of abortion, certification of necessity of abortion to preserve the life or health of the mother, and certification of necessity of abortion to preserve the life of the mother.

(2) All reports and documents required by this act shall be treated with the confidentiality afforded to medical records, subject to such disclosure as is permitted by law.

History

Authorizing statute(s): Sec. 50-20-110, MCA
Implementing statute(s): Sec. 50-20-110, MCA
History: NEW, EMERG, Eff. 7/1/74; NEW, Eff. 10/5/74; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.21.110 Facility Report

(1) Every facility, as defined herein, shall keep on file a statement dated and certified by the physician who performed the abortion setting forth the following information:

(a) Name, address, state and county of residence, date of birth, marital status, race, educational background, and patient identification number of the woman upon whom the abortion was performed.

(b) If a minor and unmarried, name and address of her living parents, or her custodian or legal guardian.

(d) The information as to the first day of the last normal menses as provided by the woman and the number of her prior pregnancies, live births, miscarriages, induced abortions and living children.

(e) The date, and the name and location of the facility in which the abortion was performed, and the name and address of the physician performing the abortion.

(f) Information upon which the physician concluded the patient was pregnant.

(g) The medical procedure or procedures employed to administer the abortion.

(h) The approximate gestational age of the fetus.

(i) The vital signs of the fetus, after abortion, if any.

(j) If viable, the medical procedures employed to preserve the life and health of the fetus.

(k) If a premature infant was born alive and viable and the infant did not survive, the apparent cause of death.

(l) If the fetus was viable, but was endangered or destroyed during the abortion procedure prior to birth, the reason therefor.

(m) Complications in the woman resulting directly or indirectly from the abortion.

(2) The names and addresses of the patient, her parents or guardians, and the physician who performed the abortion will be kept confidential and will not be reported to the department.

History

Authorizing statute(s): Sec. 50-20-105 and 50-20-110, MCA
Implementing statute(s): Sec. 50-20-110, MCA
History: NEW, EMERG, Eff. 7/1/74; NEW, Eff. 10/5/74; AMD, 1981 MAR p. 1188, Eff. 10/16/81; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.21.111 Pathology Studies

(1) The products of conception and any other tissue removed as a consequence of the abortion shall be examined by the physician performing the abortion or by a pathologist.

(2) The pathology examination shall include, but not be limited to, a gross examination, and may include other studies at the discretion of the attending physician or the pathologist, including studies for the presence of micro-organisms or genetic defects.

(3) If the products of conception are referred to a pathologist, or if the abortion is performed within a hospital, the physician performing the abortion shall insure that all of the products of conception and any other tissue be delivered to the pathologist.

(4) If the gross examination fails to provide evidence of pregnancy, a microscopic examination shall be performed to obtain such evidence.

(5) The physician performing the abortion or the pathologist, whichever conducts the definitive examination, shall file with the facility, and the facility shall keep on file, a report containing such information as would be customarily included in such a report, and including but not limited to the following:

(a) Evidence as to whether the woman was in fact pregnant;

(b) The medical procedure employed to administer the abortion;

(d) Any apparent abnormalities observed in the products of conception.

(6) If, as a result of the abortion, a premature infant was born alive and viable, but subsequently died, the dead infant shall be delivered to a pathologist for post-mortem examination, and the report thereof shall indicate the above information and also the apparent cause of death. This requirement is subject to the provisions of 50-21-103 , MCA, if applicable.

History

Authorizing statute(s): Sec. 50-20-110, MCA
Implementing statute(s): Sec. 50-20-110, MCA
History: NEW, EMERG, Eff. 7/1/74; NEW, Eff. 10/5/74; TRANS, from DHES, 2001 MAR p. 398.

Mont. Admin. R. 37.21.115 Disposition of Fetus or Dead Infant

(1) The products of conception and any other tissue removed as a consequence of the abortion, except such tissue as necessary for examination, shall be disposed of in a manner similar to that for other surgically removed tissue at that facility, and in a way that does not endanger public health nor create a public nuisance.

(2) However, any dead fetus or infant having been removed after 20 weeks gestation may be disposed of by the facility only if the surviving parent or parents so authorize the facility. If the surviving parent or parents do not wish the fetus or infant to be disposed of by the facility, they then will be responsible for the disposition of the remains in a humane manner of their choosing.

(3) In the event that the facility is unable to secure an authorization, the facility may dispose of the dead fetus or infant in the manner indicated in (1) above.

History

Authorizing statute(s): Sec. 50-20-105, MCA
Implementing statute(s): Sec. 50-20-105, MCA
History: NEW, EMERG, Eff. 7/1/74; NEW, Eff. 10/5/74; TRANS, from DHES, 2001 MAR p. 398.

Chapter 37.25 Residential Alcohol and Drug Treatment for Indigent Juveniles

Subchapter 37.25.1 Eligibility Requirements

Mont. Admin. R. 37.25.101 Residential Alcohol and Drug Treatment for Indigent Juveniles

(1) The purpose of this rule is to establish eligibility criteria and rules for the administration of funds for residential alcohol and drug treatment for indigent juveniles.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2295.

Mont. Admin. R. 37.25.102 Definitions

For purposes of this rule, the following definitions apply:

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

(2) "Indigent juvenile" means a person under the age of 18 whose family meets the eligibility criteria for indigency set forth in ARM 37.25.107.

(3) "Residential alcohol and drug treatment" means chemical dependency treatment provided in a hospital licensed by the department of public health and human services or an inpatient hospital care component or inpatient free standing component approved by the department pursuant to ARM Title 20, chapter 3, subchapter 2.

(4) "Provider" means a residential alcohol and drug treatment facility.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2295.

Mont. Admin. R. 37.25.105 Eligibility for Services

(1) A juvenile will be eligible for residential alcohol and drug treatment payments if he meets the following eligibility criteria:

(a) The juvenile has been adjudicated as a youth in need of care pursuant to Title 41, chapter 3, MCA, a youth in need of supervision or a delinquent youth pursuant to Title 41, chapter 5, MCA, or has admitted acts sufficient to adjudicate him a youth in need of supervison or a delinquent youth through the consent adjustment process pursuant to Title 41, chapter 5, part 4, MCA; and

(b) The juvenile and his family are determined to be indigent by the department pursuant to the criteria set forth in ARM 37.25.107; and

(c) The juvenile is in need of residential alcohol and drug treatment and has been evaluated by a chemical dependency counselor certified by the department of corrections who has recommended residential treatment for the juvenile; and

(d) The juvenile will be treated in a residential alcohol and drug treatment facility approved by the department of corrections or licensed by the department of public health and human services.

(2) Residential alcohol and drug treatment benefits provided under this rule are available only to those eligible juveniles who have not received such benefits previously.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 1891, Eff. 8/26/88; TRANS, from DFS, 1997 MAR p. 2295.

Mont. Admin. R. 37.25.106 Application for Services

(1) An application for residential alcohol and drug treatment shall be submitted to the Department of Public Health and Human Services, Child and Family Services Division, Program Management Bureau, P.O. Box 202951, Helena, Montana 59620-2951 by the social worker or probation officer responsible for arranging the placement of the juvenile. Application must be made on the forms provided by the department.

(2) The person making application must provide sufficient documentation to establish that the juvenile meets the eligibility criteria set forth in ARM 37.25.105.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2295.

Mont. Admin. R. 37.25.107 Determination of Indigency

(1) Any juvenile will be determined indigent if his parents' or guardians' income does not exceed the financial eligibility requirements for the aid to families with dependent children program which are set forth in ARM 46.10.401 through 46.10.403, 46.10.406, and 46.10.505 through 46.10.513 by more than 200%.

(2) If the parents or guardians of the youth refuse to cooperate in establishing indigency, the social worker or probation officer may submit other verification or documentation which would be sufficient to document that the parents or guardians are indigent as defined in the previous paragraph.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 1891, Eff. 8/26/88; TRANS, from DFS, 1997 MAR p. 2295.

Subchapter 37.25.2 Reimbursement

Mont. Admin. R. 37.25.201 Billing, Reimbursement and Processing

The department shall make payments directly to the provider, subject to the following conditions and limitations:

(1) Providers shall submit claims for reimbursement on the forms provided by the department. The claim shall be submitted within 30 days of the last day treatment was provided to the juvenile in the facility.

(2) Providers shall be reimbursed according to the rates set forth in ARM 37.25.210. The provider will accept payment in accordance with ARM 37.25.210 as payment in full.

(3) The department will not reimburse the provider for any services other than alcohol and drug treatment.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2295.

Mont. Admin. R. 37.25.205 Erroneous or Improper Payments

(1) The department is entitled to promptly recover all payments erroneously or improperly made to a provider.

(2) The provider shall notify the department of any erroneous or improper payment and shall promptly refund the entire amount of any erroneous or improper payment.

History

Authorizing statute(s): Sec. 41-3-1103 and 53-2-108, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2295.

Mont. Admin. R. 37.25.210 Rates

(1) The department will pay providers the usual and customary charges or the rates set forth in this rule, whichever is lower.

(2) The rate for residential alcohol and drug treatment for indigent juveniles shall be $110.00 per day for each day of care actually provided, not to exceed 40 days of care. The department shall pay for the day the juvenile enters the treatment facility, but not the day the juvenile leaves the facility.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2295.

Mont. Admin. R. 37.25.215 Unavailability of Funds

(1) Payments for residential alcohol and drug treatment for indigent juveniles are subject to the availability of funds appropriated for that purpose.

(2) When the entire amount of the appropriation has been accrued in any fiscal year, the department will no longer accept applications for residential alcohol and drug treatment for indigent juveniles.

(3) The department shall send written notice to the youth courts, probation officers, department of corrections and the residential alcohol and drug treatment facilities when the entire amount of the appropriation has been accrued for the fiscal year.

(4) All providers who are providing residential alcohol and drug treatment to eligible indigent juveniles at the time of receiving the notice that the appropriated funds have been exhausted will be reimbursed for the treatment of those juveniles who have been determined eligible for benefits by the department and are receiving treatment at the time of notice. The provider shall be reimbursed according to the terms and conditions set forth in ARM 37.25.210.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1985 MAR p. 1251, Eff. 8/30/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2295.

Chapter 37.27 Chemical Dependency Programs

Subchapter 37.27.1 Approval of Chemical Dependency Programs

Mont. Admin. R. 37.27.101 State Approved Programs, Purpose

(1) The purpose of the rules in this subchapter is to establish standards for the approval of programs providing prevention, treatment, rehabilitative, and recovery services to individuals with substance use disorders and substance related issues, as provided in Title 53, chapter 24, part 2, MCA.

(2) Each public or private substance use disorder program providing services and receiving alcohol earmarked revenue funds under 53-24-108, MCA, shall be subject to approval by the department. The department will issue approval for the following substance use disorder (SUD) levels of care and specialty services, outlined in the American Society of Addiction Medicine (ASAM) Criteria and Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Manual:

(a) ASAM 3.7 Medically Monitored Intensive Inpatient Services;

(b) ASAM 3.7-WM Medically Monitored Withdrawal Management Services;

(d) ASAM 3.3 Clinically Managed Population-Specific High Intensity (adult only) Residential Services;

(e) ASAM 3.2-WM Clinically Managed Residential Withdrawal Management Services;

(f) ASAM 3.1 Clinically Managed Low Intensity (adult or adolescent) Residential Services;

(g) ASAM 2.5 Partial Hospitalization Services;

(h) ASAM 2.1 Intensive Outpatient Services;

(i) ASAM 1.0 Outpatient Services;

(j) ASAM 0.5 Early Intervention;

(k) SUD Prevention;

(l) SUD Certified Behavioral Health Peer Support Services; and

(m) SUD Targeted Case Management.

History

Authorizing statute(s): 53-24-207, MCA
Implementing statute(s): 53-24-207, MCA
History: TRANS, Ch. 280, L. 1975, Eff. 1/2/77; AMD, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2021 MAR p. 182, Eff. 2/13/21; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.102 Definitions

In addition to the terms defined in 53-24-103 , MCA:

(1) "American Society of Addiction Medicine (ASAM) Criteria" means guidelines for placement, continued stay, and transfer/discharge of individuals with addiction and co-occurring conditions developed by the American Society of Addiction Medicine.

(2) "BHDD Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health adopted and incorporated in ARM 37.27.902 . The manual can be found at: https://dphhs.mt.gov/amdd/AMDDMedicaidServicesProviderManual .

(3) "BHDD Non-Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Non-Medicaid Services Provider Manual for Substance Use Disorder adopted and incorporated in ARM 37.27.902 . The manual can be found at: https://dphhs.mt.gov/amdd/AMDDNonMedicaidServicesProviderManual .

(4) "Biopsychosocial assessment" means a comprehensive multidimensional assessment process that includes risk ratings, addresses immediate needs, and is organized in accordance with the six dimensions described in the ASAM Criteria and meets the requirements described in the BHDD Medicaid Manual.

(5) "Continuing care plan" means a plan for when a client is discharged or transferred from a particular level of care as described in the BHDD Medicaid Manual.

(6) "Facility" means a public or private organization as defined in 50-5-101, MCA. Programs approved under ARM 37.27.105 and 37.27.107 are not considered a facility.

(7) "Individualized treatment plan" means a plan of care developed in collaboration with the patient, as described in the BHDD Medicaid Manual.

(8) "Licensed addiction counselor (LAC)" means an individual licensed under requirements pursuant to Title 37, chapter 35 MCA, and ARM Title 24, chapter 219, subchapter 50, to provide addiction counseling. References in ARM 37.27.107 to a LAC do not include an addiction counselor licensure candidate registered pursuant to Title 37, chapter 35, part 2, MCA.

(9) "Program" is the general term for an organized system of services designed to address the treatment needs of clients.

(10) "Progress note" is a written record of a treatment session or service contact as defined in the BHDD Medicaid Manual.

(11) "Provisional approval" means a status of state approval granted to chemical dependency treatment programs which are requesting approval for the first time and which have not attained substantial compliance specified in these rules.

(12) "Restricted approval" means a status of provisional state approval granted to a state approved program which has failed to maintain substantial compliance to enable it to meet the requirements of this subchapter. Restricted status is issued for a maximum of 90 days in order to allow programs to meet requirements. This approval cannot be renewed.

(13) "Revoke" means invalidation of state approval of a program.

(14) "State approved program" means a program reviewed and accepted by the department to provide substance use disorder prevention, treatment, rehabilitation, and/or recovery services.

(15) "Substance use disorder (SUD)" means chemical dependency, as defined in 53-24-103, MCA.

(16) "Suspension" means invalidation of state approval of a treatment program for any period less than one year or until the department has determined that the program meets all requirements of this subchapter and notifies the program of reinstatement.

History

Authorizing statute(s): 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: TRANS, Ch. 280, L. 1975, Eff. 1/2/77; AMD, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1990 MAR p. 737, Eff. 4/13/90; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2003 MAR p. 803, Eff. 4/25/03; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.105 State Approved Programs, Prevention Providers, Requirements

(1) In order to be reimbursed for prevention services, a prevention provider must be state approved and:

(a) have a contract with the department for substance abuse primary prevention services;

(b) be the Montana Public Health Institute; or

(2) In order to become state approved, a prevention provider must complete and submit to the department the designated application.

(3) If the application and supporting documentation do not meet the application requirements, the department will notify the applicant in writing identifying the incomplete or missing information within 30 days of receipt of the application.

(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.

(b) If a response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.

(4) If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Provisional approval is granted to provide time to comply with standards. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely.

(5) The provider must submit the requested documentation to the department or provide access to the provider's premises for inspection.

(6) Within 20 days of the inspection, the department shall issue final approval or deny the application and shall send written notification of full approval or denial to the applicant.

(7) Upon receiving full approval, a provider may provide prevention and early intervention services as described by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

(8) The department will annually inspect the provider, on-site or remotely, to ensure the provider continues to meet requirements of this rule.

(9) Approved providers must follow the American Society of Addiction Medicine (ASAM) Criteria in the provision of early intervention services and adhere to requirements outlined in the BHDD Medicaid Services Provider Manual for SUD and Adult Mental Health located at: https://dphhs.mt.gov/amdd/AMDDMedicaidServicesProviderManual .

History

Authorizing statute(s): 53-2-201, 53-24-204, MCA
Implementing statute(s): 53-24-204, 53-24-207, MCA
History: NEW, 2021 MAR p. 182, Eff. 2/13/21; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.106 State Approved Programs, Substance Use Disorder Facilities

(1) In order to be reimbursed for SUD facility-based treatment services, a SUD facility must be state approved and licensed pursuant to ARM Title 37, chapter 106, subchapter 14.

(2) In order to become state approved, the SUD facility provider must complete and submit the designated application to the department. The SUD facility must be licensed for the level(s) of care indicated in the application.

(3) Federally qualified health centers, rural health clinics, Indian Health Service providers, and Tribal 638 providers do not need to be licensed for outpatient or intensive outpatient level of care, but must have SUD in their scope of practice.

(4) If the application and supporting documentation do not meet the application requirements, the department will notify the applicant in writing identifying the incomplete or missing information within 30 days of receipt of the application.

(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.

(b) If the response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.

(5) If the application and supporting documentation meet the application requirements, the department shall issue full approval. Documentation must include evidence of an active facility license.

(6) The department shall issue a final approval or deny the application and shall send written notification of full approval or denial to the applicant.

(7) The department will reimburse a state approved facility for SUD facility-based services, as outlined in the BHDD Medicaid Manual, using appropriate Common Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes on applicable department fee schedules.

(8) The department will inspect the facility once every two years, on-site or remotely, to ensure the facility continues to meet the requirements of this rule.

(9) The provider must submit the requested documentation to the department or allow the department access to the provider's premises for inspection.

(10) Approved facilities must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Manual.

History

Authorizing statute(s): 53-24-204, 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: TRANS, C. 207, L. 1975, Eff. 1/2/77; AMD, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1987 MAR p. 2383, Eff. 12/25/87; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2022 MAR p. 57, Eff. 1/15/22; AMD, 2022 MAR p. 1889, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.

Mont. Admin. R. 37.27.107 State Approved Programs, Individual Outpatient Treatment Providers

(1) In order to be reimbursed for outpatient services, an individual outpatient treatment provider must be state approved and be a licensed addiction counselor.

(2) In order to become state approved, the licensed addiction counselor (LAC) must complete and submit the designated application to the department.

(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.

(b) If a response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.

(5) The provider must submit the requested documentation to the department or allow the department access to the provider's premises for inspection.

(6) Within 20 days of the inspection, the department shall issue final approval or deny the application and shall send written notification of full approval or denial to the applicant.

(7) The department will reimburse a state approved outpatient treatment provider for American Society of Addiction Medicine (ASAM) level of care 1.0, Outpatient Services, using appropriate Common Procedural Terminology (CPT) codes.

(8) The department will annually inspect the provider, on-site or remotely, to ensure the provider continues to meet requirements of this rule.

(9) Approved providers must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Services Provider Manual.

History

Authorizing statute(s): 53-2-201, 53-24-204, MCA
Implementing statute(s): 53-24-204, 53-24-207, MCA
History: NEW, 2021 MAR p. 182, Eff. 2/13/21; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.108 Administrative Management - Governing Body

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-209, MCA
Implementing statute(s): 53-24-208, MCA
History: TRANS, C. 280, L. 1975, Eff. 1/2/77; TRANS, from DOC, 1998 MAR p. 1502; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.115 All State Approved Programs - Acceptance of Persons Into the Treatment Program

(1) The program shall ensure compliance with 53-24-209, MCA.

(2) The program shall admit and care for only those persons for whom it can provide care and services appropriate to the person's physical, emotional, and social needs.

(3) The program shall work together with the client to implement a written individualized treatment plan that identifies services and supports needed to address problems and needs identified in the biopsychosocial assessment. The individualized treatment plan is maintained on a current basis for each client.

(4) The program shall make appropriate referrals when the client needs services not offered by the program. Referrals must be documented in the client record.

(5) The program shall ensure that clients receiving prescribed medication(s), including medication for opioid use disorder, are not required to discontinue the medication as a condition for receiving services. Access to, and coordination with, qualified medical providers must be made available on-site or through referral.

History

Authorizing statute(s): 53-24-209, MCA
Implementing statute(s): 53-24-209, MCA
History: TRANS, C. 208, L. 1975, Eff. 1/2/77; AMD, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.116 Individual Outpatient Treatment Providers and Prevention Providers, Clients Rights

(1) Programs approved under ARM 37.27.105 and 37.27.107 that provide treatment (including early intervention) must develop and maintain a client rights policy that supports and protects the state and federal constitutional and statutory rights, including civil rights, of all clients. These must include the right to:

(a) receive treatment free of unlawful discrimination;

(b) receive reasonable accommodations, consistent with federal and state law;

(c) receive treatment in the least restrictive environment, consistent with law, in a manner sensitive to individual needs and which promotes dignity and self-respect;

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

(e) practice the religion of the client's choice, consistent with the Montana Religious Freedom Restoration Act and consisting the rights of others and the requirements of the treatment program. The client also has the right to be excused from any religious practice;

(f) review their own treatment records in the presence of treatment staff, consistent with 45 CFR 164.524 and other state and federal confidentiality statutes and regulations;

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

(h) be free from abuse, neglect, and financial exploitation by staff members or clients;

(i) have grievances considered in a fair and timely manner, with respect to infringements of rights described in this rule;

(j) be given a 30-day notice in the event of program closure or discontinuation of treatment services;

(k) be provided with a referral to similar treatment services, if available; and

(l) be advised how to access records to which the client is entitled.

(2) The program must inform each client and his or her representative, in an understandable manner, of the rights policy, treatment methods, and rules applicable to the client, at the time of admission or as soon thereafter as the client is capable of rational communication.

(3) The client and staff member reviewing the policy must sign a statement acknowledging the review. The statement must be maintained in the client's record.

(4) The program must post a copy of client rights in a conspicuous place in the facility, accessible to clients and staff members.

History

Authorizing statute(s): 53-24-105, 53-24-305, MCA
Implementing statute(s): 53-24-305, MCA
History: TRANS, C. 280, L. 1975, Eff. 1/2/77; AMD, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1990 MAR p. 737, Eff. 4/13/90; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.117 Individual Outpatient Treatment and Prevention Providers, Confidentiality

(1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a written client confidentiality policy pursuant to 42 CFR Part 2.

(2) The confidentiality policy must be reviewed with the client at the time of admission or as soon thereafter as the client is capable of rational communication.

(3) Policy requirements must include activities to:

(a) inform clients that federal law and regulations protect the confidentiality of alcohol and drug abuse client records; and

(b) provide clients with a summary in writing of the federal law and regulations.

(4) The written summary required in (3)(b) must include:

(a) a general description of limited circumstances under which a SUD program may acknowledge a client is present at a facility or disclose information identifying a client as an alcohol or drug abuser;

(b) a statement that violation of the federal law and regulations by a SUD program is a crime and suspected violations may be reported to appropriate authorities in accordance with these regulations;

(c) a statement that information related to a client's commission of a crime on the premises of the SUD program or against staff members of the SUD program is not protected;

(d) a statement that reports of suspected child abuse or neglect made under state law to appropriate state or local authorities are not protected; and

(e) a citation to the federal law and regulations.

(5) Client consent must be obtained for each release of information to any other person or entity if required under 42 CFR Part 2. The consent for release of information must have specific information pursuant to 42 CFR Part 2.

History

Authorizing statute(s): 53-24-204, 53-24-207, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.118 Individual Outpatient Treatment and Prevention Providers, Communicable Disease Control

(1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a policy for communicable disease control.

(2) The communicable disease policy must be reviewed annually and include:

(a) procedures to identify high risk individuals;

(b) specific procedures to address tuberculosis (TB), Hepatitis A, Hepatitis C, sexually transmitted infections (STI), and human immunodeficiency virus (HIV); and

(3) The program is responsible for the direction, provision, and quality of infection prevention and control services.

(4) Programs must implement TB protocols for all staff members and clients based upon an annual TB Risk assessment as set forth by the Montana Tuberculosis Prevention and Control Program pursuant to ARM Title 37, chapter 114, subchapter 10. Risk assessment and TB manuals are found at https://dphhs.mt.gov/publichealth/cdepi/diseases/Tuberculosis/ .

History

Authorizing statute(s): 53-24-204, 53-24-207, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.119 Individual Outpatient Treatment and Prevention Providers, Abuse or Neglect Requirements

(1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a policy that:

(a) clearly defines child abuse and neglect as defined in 41-3-102, MCA;

(b) clearly defines abuse, neglect, and exploitation of an older person or a person with a developmental disability as defined in 52-3-803 MCA;

(c) outlines the provider's responsibility to report all known or suspected incidents of abuse, neglect, or exploitation of any client within 24 hours; and

(d) addresses handling of suspected or validated incidents of abuse, neglect, or exploitation.

(2) Any provider who knows or has reasonable cause to suspect an incident of child abuse or neglect has occurred must make a report within 24 hours of the incident to the state child abuse hotline (866) 820-5437 as required in 41-3-201, MCA.

(3) Any provider who knows or has reasonable cause to suspect an incident of abuse, neglect, or exploitation of a vulnerable adult has occurred must make a report within 24 hours of the incident to Adult Protective Services or other bodies as required in 52-3-811, MCA.

(4) In addition to reporting requirements in (2) and (3), the provider must also make a report to the department in writing within 24 hours of any allegations of client abuse, neglect, or exploitation within the program.

(5) The program must document, in writing, that the proper authorities have been contacted and the abuse, neglect, or exploitation has been reported.

(6) The provider must fully cooperate with any investigation conducted because of the report.

History

Authorizing statute(s): 53-24-204, MCA
Implementing statute(s): 41-3-102, 41-3-201, 52-3-803, 52-3-811, 53-24-208, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.120 All State Approved Programs - Organization and Management

(1) The organization and management of all state approved programs shall ensure that:

(a) The program has written policies and procedures required by this subchapter.

(b) The program will develop and conduct annual program evaluations or review to assess the quality, appropriateness, and efficacy of treatment services provided. This review should examine the following:

(i) admission criteria/intake process;

(ii) assessments;

(iii) treatment planning;

(iv) documentation of implementation of treatment services;

(v) discharge and continuing care planning; and

(vi) indications of treatment outcomes.

(i) demographics;

(ii) no shows;

(iii) wait times;

(iv) abstinence and reduction of the use of substances;

(v) involvement with the criminal justice system;

(vi) stable employment, school, or training;

(vii) housing stability;

(viii) retention in services;

(ix) perception of care;

(x) social connectedness; and

(xi) use of evidence-based practices.

(d) Client records are retained according to the following guidelines:

(i) If a state approved chemical dependency program is receiving public funds through a contract, grant or written agreement with federal, state, county or city agencies, records must be retained 5 years beyond the termination date of said contract, grant, or written agreement. Records shall be retained beyond the 5 year period if an audit is in process or if any audit findings, lawsuits, or claims involving the records have not been resolved. The retention period for each year's records starts from date of submission of the annual or final report of expenditures (financial status report or equivalent) .

(ii) If a state approved program is not receiving public funds (federal, state, county or city), records must be retained 5 years beyond the fiscal year end (June 30th) in which that client was most recently discharged from that program. Records shall be retained beyond the 5 year period if an audit is in process or if any audit findings, lawsuits, or claims involving the records have not been resolved.

(e) Facilities and offices are clean and well maintained.

(f) Accounting and fiscal procedures are adopted which ensure financial accountability and meet all federal, state, and county requirements.

(g) A sliding fee schedule is adopted based on ability to pay for all individuals receiving treatment services provided by state approved programs. (53-24-108(4), MCA).

(h) The program maintains general liability insurance and professional liability insurance.

(i) Client records and documentation adhere to requirements described in the BHDD Medicaid Manual and ARM 37.85.414.

(j) Programs will submit quarterly updates to the department to ensure contact information, organizational chart, locations, hours of operation, and services provided are up to date.

History

Authorizing statute(s): 53-24-204, 53-24-207, 53-24-208, MCA
Implementing statute(s): 53-24-208, 53-24-209, 53-24-306, MCA
History: TRANS, C. 280, L. 1975, Eff. 1/2/77; AMD, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.121 All Programs - Personnel, Staff Development and Certification

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-204, 53-24-208, 53-24-215, MCA
Implementing statute(s): 53-24-204, 53-24-208, MCA
History: TRANS, C. 280, L. 1975, Eff. 1/2/77; AMD, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.122 State Approved Programs, Sanctions

(1) The department, after written notice to the program, may sanction a program's state approval upon finding that the program:

(a) fails to meet any state approval requirements established by this subchapter;

(b) fails to meet regulations or licensure standards set forth in ARM Title 37, chapter 106, subchapter 14;

(c) has failed to use state or federal funds received under contract with the department or through Montana Medicaid as required, pursuant to state or federal regulations, for the operations of a program or provision of services;

(d) has failed to comply with a performance action plan approved by the department;

(e) has committed unprofessional conduct pursuant to 37-1-316, MCA;

(f) has current orders or sanctions pursuant to 37-1-312, MCA; or

(g) has current sanctions pursuant to ARM Title 37, chapter 85, subchapter 5.

(2) The department will issue a 90-day restricted state approval to a program that has failed to meet requirements of this rule and has submitted a performance action plan approved by the department.

(3) The department will issue a suspension of state approval, for up to one year, to a program that has failed to meet requirements of this rule during a restricted state approval and has submitted a performance action plan approved by the department.

(a) Programs approved under ARM 37.27.107 will receive an immediate suspension of state approval if their professional license has been suspended by the licensing board. Suspension will be the same length of time determined by the licensing board or one year, whichever is greater.

(4) The department will revoke a program's state approval if the program:

(a) has failed to meet requirements of this rule during a suspension of their state approval;

(b) has been excluded from participation in a government health care program; or

(5) A restriction or suspension of state approval may only be issued one time within a two-year period.

(6) Any program whose state approval has been revoked under the provisions of this subchapter may not submit another application for state approval within one year from the date of revocation and all deficiencies identified in the performance action plan have been corrected.

(7) Any program whose state approval has been restricted, suspended, or revoked has the right to request a hearing as set forth in ARM Title 37, chapter 5, subchapter 3.

History

Authorizing statute(s): 53-24-204, 53-24-207, 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.128 Detoxification (emergency Care) Component Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-204, 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; REP, 2010 MAR p. 2975, Eff. 12/24/10.

Mont. Admin. R. 37.27.129 Inpatient - Hospital Component Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-204, 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; REP, 2010 MAR p. 2975, Eff. 12/24/10.

Mont. Admin. R. 37.27.130 Inpatient - Free Standing Care Component Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-204, 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; REP, 2010 MAR p. 2975, Eff. 12/24/10.

Mont. Admin. R. 37.27.135 Intermediate Care (transitional Living) Component Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-204, 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; REP, 2010 MAR p. 2975, Eff. 12/24/10.

Mont. Admin. R. 37.27.136 Outpatient Component Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-204, 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1990 MAR p. 737, Eff. 4/13/90; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2018 MAR p. 725, Eff. 5/1/18; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.137 Day Treatment Component Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2018 MAR p. 725, Eff. 5/1/18; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.27.138 Intensive Outpatient Treatment Component Requirement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-208, MCA
Implementing statute(s): 53-24-208, MCA
History: NEW, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502; AMD, 2018 MAR p. 725, Eff. 5/1/18; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Subchapter 37.27.2 Room and Board Voucher Program

Mont. Admin. R. 37.27.201 Substance Use Disorder Voucher Program, Purpose

(1) The purpose of the rules in this subchapter is to establish standards for the Substance Use Disorder Voucher Program, as provided in Title 53, chapter 24, part 2, MCA.

(2) This program is intended to cover the cost of substance use disorder treatment room and board that is not otherwise covered by insurance or another assistance program.

(3) This program is subject to available funding.

History

Authorizing statute(s): 53-24-204, MCA
Implementing statute(s): 53-24-218, MCA
History: NEW, 2024 MAR p. 967, Eff. 4/27/24.

Mont. Admin. R. 37.27.202 Substance Use Disorder Voucher Program, Definitions

In addition to the terms defined in 53-24-103, MCA, the following definitions shall apply in the interpretation and enforcement of the rules in this subchapter:

(1) "American Society of Addiction Medicine (ASAM) Criteria" means guidelines for placement, continued stay, and transfer, or discharge of individuals with addiction and co-occurring conditions developed by the American Society of Addiction Medicine.

(2) "ASAM 3.1" means substance use disorder clinically managed low-intensity residential treatment services for adults or adolescents, which is a level of care described in the ASAM Criteria. ASAM 3.1 is a licensed community-based residential facility that functions as a supportive, structured living environment. Individuals are provided stability and skills building to help prevent or minimize continued substance use. This level of care includes a minimum of five hours per week of professionally directed treatment services.

(3) "BHDD Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health adopted and incorporated by reference in ARM 37.27.902. The manual can be found at: https://dphhs.mt.gov/BHDD/BHDDMedicaidServicesProviderManual .

(4) "Substance use disorder" means chemical dependency, as defined in 53-24-103, MCA.

History

Authorizing statute(s): 53-24-204, MCA
Implementing statute(s): 53-24-218, MCA
History: NEW, 2024 MAR p. 967, Eff. 4/27/24.

Mont. Admin. R. 37.27.203 Substance Use Disorder Voucher Program, Requirements

(1) In order to participate in the substance use disorder voucher program, an individual must:

(a) live in Montana;

(b) be 14 years of age or older;

(d) meet medical necessity described in the BHDD Medicaid Manual for ASAM 3.1 services;

(e) receive a prior authorization for ASAM 3.1 services from the Quality Improvement Organization (QIO); and

(f) currently be receiving ASAM 3.1 services.

History

Authorizing statute(s): 53-24-204, MCA
Implementing statute(s): 53-24-218, MCA
History: NEW, 2024 MAR p. 967, Eff. 4/27/24.

Mont. Admin. R. 37.27.204 Substance Use Disorder Voucher Program, Reimbursement

(1) In order to be reimbursed for room and board under the Substance Use Disorder Voucher Program in ARM 37.27.201, a program must be a state-approved substance use disorder facility under ARM 37.27.106 and licensed as an ASAM 3.1 substance use disorder facility pursuant to ARM Title 37, chapter 106, subchapter 14.

(2) A provider that meets requirements in ARM 37.27.203 and seeks reimbursement for room and board under the Substance Use Disorder Voucher Program must complete and submit the designated request form to the department to obtain reimbursement for such services provided to a qualified individual.

(3) The department will review the request and provide approval or denial to the provider within 10 working days of receipt of the request.

(4) If the request is approved, the department will issue payment to the provider.

(5) The department will reimburse providers as outlined in contract or policy.

History

Authorizing statute(s): 53-24-204, MCA
Implementing statute(s): 53-24-218, MCA
History: NEW, 2024 MAR p. 967, Eff. 4/27/24.

Subchapter 37.27.3 Guidelines for County Chemical Dependency Plans

Mont. Admin. R. 37.27.301 Submission Date

(1) All county chemical dependency plans are to be submitted to the department of institutions by 5:00 p.m. December 31, 1983. The plan will include FY 84, 85, 86, and 87. The second 4-year county plans are to be submitted by December 31, 1986. Comprehensive county chemical plans are to be submitted every 4 years thereafter to the department of public health and human services by 5:00 p.m. December 31.

(2) County plan updates are to be submitted to the department of public health and human services by 5:00 p.m. December 31 of each year that a comprehensive 4-year county plan is not required.

History

Authorizing statute(s): Sec. 53-24-211, MCA
Implementing statute(s): Sec. 53-24-204, 53-24-207 and 53-24-208, MCA
History: NEW, 1979 MAR p. 1491, Eff. 11/30/79; AMD, 1983 MAR p. 1463, Eff. 10/14/83; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.302 Approval Date

(1) All county chemical dependency plans and/or updates must be approved by June 30, of each year. If the plan and/or update is not approved by June 30, the county is not eligible to receive alcohol tax funds generated under 53-24-206 , MCA.

History

Authorizing statute(s): Sec. 53-24-211, MCA
Implementing statute(s): Sec. 53-24-204, 53-24-207 and 53-24-208, MCA
History: NEW, 1979 MAR p. 1491, Eff. 11/30/79; AMD, 1983 MAR p. 1463, Eff. 10/14/83; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.303 Content of County Plans

(1) County identification form. Plans may include more than one county but an identification form must be completed for each county included in the plan. Line 4 (signature of approving county officials) must be signed by a majority of the county commissioners from each county. To be submitted by December 31 of each year.

(2) Analysis of county needs. County(ies) must analyze and describe the extent of their alcohol and drug problems within the county(ies) covered by the plan which includes a description of programs or services offered by alcohol and drug programs. To be submitted every 4 years with comprehensive plan.

(3) Treatment and rehabilitation. County( ies ) must list the names and services provided by existing chemical dependency programs within the county( ies ) . If all service components (detoxification, inpatient [hospital and free standing], intermediate-transitional living, outpatient) are not available within the county( ies ) service area, provisions must be made to obtain these services on a referral basis. Planned expansion of services should be included in this section as well as delineation of problems encountered in delivering services. To be submitted with comprehensive plan every 4 years.

(4) Fiscal year county action strategy. County( ies ) must list programs to receive alcohol tax monies during next fiscal year and determine what services each will provide and estimate allocation by service component (i.e., detoxification, outpatient, etc.) of county funds for each program. To be submitted by December 31 of each year.

(5) Prevention. County( ies ) must assess and describe chemical dependency prevention services available within the county( ies ) service area. To be submitted every 4 years with comprehensive plan.

History

Authorizing statute(s): Sec. 53-24-211, MCA
Implementing statute(s): Sec. 53-24-204, 53-24-207 and 53-24-208, MCA
History: NEW, 1979 MAR p. 1491, Eff. 11/30/79; AMD, 1983 MAR p. 1463, Eff. 10/14/83; TRANS, from DOC, 1998 MAR p. 1502.

Subchapter 37.27.5 Chemical Dependency Educational Courses

Mont. Admin. R. 37.27.501 Chemical Dependency Educational Courses: Cost of Treatment

(1) The purpose of this chapter is to establish standards for chemical dependency educational courses and the approval of those courses pursuant to 53-24-204 , MCA.

(2) Only chemical dependency treatment programs and facilities approved under 53-24-208 , MCA, and ARM 37.27.101 through 37.27.136 may receive approval for chemical dependency educational courses. Procedures for approval of educational courses will be the same as those specified in ARM 37.27.101 through 37.27.136.

(3) Chemical dependency treatment programs will charge the offender for the educational course utilizing the following:

(a) Educational courses and 1 year monitoring will be self supporting and fees charged will be based on actual costs.

(b) Initial fees (as of the effective date of this rule) and future fee increases must be reviewed and approved by the department.

(c) Offenders referred to treatment and/or monitoring via the assessment process are responsible for the costs of treatment and monitoring.

History

Authorizing statute(s): Sec. 53-24-204, 53-24-208 and 53-24-209, MCA
Implementing statute(s): Sec. 61-8-714 and 61-8-722, MCA
History: NEW, 1985 MAR p. 2011, Eff. 12/27/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1996 MAR p. 1312, Eff. 5/10/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.502 Chemical Dependency Educational Courses: Definitions

In addition to terms defined in 53-24-103 , MCA, and ARM 37.27.102, the following are defined:

(1) "Abuser" means the offender meets the DSM-IV diagnostic criteria for substance abuse.

(2) "ACT (assessment, course, treatment) program" means an assessment, educational course and/or referral to treatment. This is a three part process designed to assess, educate and to recommend treatment placement as appropriate for persons convicted of driving under the influence of intoxicating substances, UDD, MDD and third or subsequent MIP.

(3) "ACT curriculum manual" means a manual developed by department of transportation traffic safety bureau which specifically defines the course curriculum for the ACT program.

(4) "Aftercare" is defined in ARM 37.27.102.

(5) "Assessment" means, for the purpose of this subchapter, the process of identifying and labeling specific conditions such as chemical abuse or dependence; and the determination of the appropriate level of treatment for the offender. This process is described in ARM 37.27.515(1) (a) through (d) .

(6) "Assessment/evaluation instruments" are those diagnostic and screening tools utilized primarily to provide information for the counselor to assist in making a determination of the severity of an offender's chemical use. A list of suggested assessment/evaluation instruments may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, P.O. Box 202951, Helena, MT 59620-2951.

(7) "Certified chemical dependency counselor" means an individual meeting standards pursuant to 53-24-204 , MCA, and corresponding rules and regulations described in ARM 20.3.401 through 20.3.406.

(8) "Chemically dependent" means the offender meets the DSM-IV criteria for substance dependence.

(9) "Cross-referencing" is a method used to determine if similar questions are answered in the same manner on different assessment instruments. The purpose is to discover consistencies and inconsistencies in an offender's answers to questions and assess the validity of the offender's self-report.

(10) "Continuing care" refers to the aftercare recommendations of the treatment provider.

(11) "Driver control" means the records and driver control bureau of the department of justice.

(12) "DUI" means driving under the influence and, for the purpose of these rules, includes violation of an offense under 61-8-401 , MCA.

(13) "Inpatient treatment" is defined in ARM 37.27.102 and the requirements are found in ARM 37.27.129 and 37.27.130.

(14) "Intensive outpatient" is defined in ARM 37.27.102 and the requirements are found in ARM 37.27.138.

(15) "MDD" means a misdemeanor dangerous drug offense under 45-2-101 , MCA, for which completion of a dangerous drug information course is mandatory.

(16) "MDD program" means an assessment, educational course and/or referral to treatment. This is a three part process designed to assess, educate and to recommend treatment placement as appropriate for persons convicted of misdemeanor dangerous drug offense. Compliance with treatment recommendations will be at the discretion of the sentencing judge.

(17) "MDD curriculum" means the 8-hour course provided to those convicted of an MDD offense. The course may utilize the ACT curriculum manual and must include specific review of the misdemeanor drug laws and the harmful effects of dangerous drug use.

(18) "MIP (minors in possession) " means minors convicted of possession of an intoxicating substance, unlawful attempt to purchase an intoxicating substance under 45-5-624 , MCA.

(19) "MIP curriculum manual" means a manual developed by the department of public health and human services which defines the MIP course curriculum and the requirements for performing chemical dependency evaluations and referral to treatment.

(20) "MIP education course" means the community-based substance abuse information course for minors under l8 years of age convicted of an MIP under 45-5-624 or 61-8-410 , MCA.

(21) "Misuser/no patterns" means the offender does not meet the DSM-IV diagnostic criteria for either substance abuse or dependence.

(22) "Monitoring" is a process to ensure compliance with continuing care recommendations for second or subsequent offenders.

(23) "Offender" means a person convicted of DUI/per se/UDD, MIP, or a dangerous drug misdemeanor and sentenced to complete a chemical dependency educational course provided by a state approved program and/or treatment provided by a certified chemical dependency counselor.

(24) "Outpatient" is defined in ARM 37.27.102 and the requirements are found in ARM 37.27.138.

(25) "Per se" means for the purpose of this subchapter, violating the provisions of 61-8-406 , MCA, operation of vehicle by a person with alcohol concentration of 0.10 or more.

(26) "UDD" means underage drinking and driving, the operation of a vehicle by a person under the age of 21 with an alcohol concentration of 0.02 or more. For the purpose of these rules, this includes violation of an offense under 61-8-410 , MCA.

(27) "Unidentified" means the offender did not complete the assessment or exhibited a level of denial that made diagnosis impossible.

History

Authorizing statute(s): Sec. 53-24-204 and 53-24-208, MCA
Implementing statute(s): Sec. 53-24-204, 53-24-208 and 61-8-401, MCA
History: NEW, 1985 MAR p. 2011, Eff. 12/27/85; AMD, 1996 MAR p. 1312, Eff. 5/10/96; AMD, 1998 MAR p. 351, Eff. 1/30/98; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.506 Chemical Dependency Education Courses: General Educational Course Requirements

(1) This program is for persons convicted of a DUI/per se/UDD or misdemeanor dangerous drug offense and sentenced under 61-8-410 , 61-8-732 , or Title 45, chapter 9 or 10, MCA, to complete an alcohol or other dangerous drugs information course provided by a state approved program and which may include alcohol or drug treatment or both in accordance with state approved placement criteria and provided by a certified chemical dependency counselor.

(2) The ACT program is a three part process which includes:

(a) Assessment, which is the evaluation component utilized to identify chemical use patterns of DUI/per se/UDD offenders and to make appropriate recommendations for education and/or treatment. Misdemeanor dangerous drug offenders may complete the assessment with the ACT program or a state approved treatment program which offers an MDD education program.

(b) Course, which is an educational component based on the curriculum contained and explained in ARM 37.27.516 and further defined in the ACT course curriculum manual. The manual may be obtained from the Department of Transportation, Traffic Safety Bureau, 2701 Prospect Avenue, P.O. Box 201001, Helena, MT 59620-1001. Misdemeanor dangerous drug offenders must complete a specific drug education course equivalent in hours to the ACT curriculum. The course will be based on the ACT curriculum but must contain specific information on misdemeanor drug laws. The MDD course may be combined with or held separately from the DUI course. If more than eight MDD clients are enrolled at one time on a consistent basis, it is recommended that the courses be offered separately.

(c) Treatment, which is defined in 53-24-103 , MCA. Standards for treatment are required by 53-24-208 , MCA, and ARM 37.27.101 through 37.27.136. The need for treatment services must be documented and verified through assessment and state approved patient placement procedures. Treatment may be provided by the treatment program conducting the ACT program or through a referral to another treatment program.

(i) First DUI/per se/UDD offenders assessed as chemically dependent, all second and subsequent DUI/per se/UDD offenders and MDD offenders ordered by the court must complete all three components of the ACT program. The treatment provided must be at a level appropriate to the offender's alcohol/drug problem, based upon patient placement criteria as defined in ARM 37.27.120.

(3) To complete the ACT program, the offender:

(a) must enroll by the date specified by the sentencing court. If no date is specified, then within 10 days of the ACT program's receipt of the court referral notice;

(b) must start the course process within 30 days of the program's receipt of the court referral notice; and

(c) must complete the program in a minimum of 30 days from the date of enrollment, but no longer than 90 days from the date of enrollment. An exception to the 30-day minimum may be granted by the department based only on justified geographical considerations. The ACT program will notify the sentencing courts in all cases of failure to comply and the sentencing court may notify the drivers control bureau.

History

Authorizing statute(s): Sec. 53-24-204, 53-24-208 and 53-24-209, MCA
Implementing statute(s): Sec. 45-9-208, 45-10-108, 61-8-410, 61-8-714, 61-8-722 and 61-8-732, MCA
History: NEW, 1985 MAR p. 2011, Eff. 12/27/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1990 MAR p. 737, Eff. 4/13/90; AMD, 1996 MAR p. 1312, Eff. 5/10/96; AMD, 1998 MAR p. 351, Eff. 1/30/98; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.507 Education Course Requirements for Mip Offenders (mip Program)

(1) This program is for minors convicted of unlawful possession of intoxicating substance and sentenced under 45-5-624 , MCA. The requirements for the MIP education course are contained in the MIP curriculum manual. The manual may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) A person 18 to 20 years of age, who is convicted of a third or subsequent offense of possession of an intoxicating substance under 45-5-624 , MCA, and ordered to complete an alcohol information course at a state approved program shall attend and complete the ACT program, with all of its requirements.

History

Authorizing statute(s): Sec. 53-24-204 and 53-24-208, MCA
Implementing statute(s): Sec. 45-5-624 and 53-24-208, MCA
History: NEW, 1985 MAR p. 2011, Eff. 12/27/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1996 MAR p. 1312, Eff. 5/10/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.515 Chemical Dependency Educational Courses: Required Services

(1) The process for assessment shall be as follows:

(a) a minimum of three assessment/evaluation instruments must be utilized and cross-referenced as part of the assessment process. Assessment instruments are as defined in ARM 37.27.502;

(b) a minimum of two individual assessment interview sessions with a certified chemical dependency counselor must be documented in the assessment process;

(c) based on the results of the assessment process, the offender will be classified as misuser/no patterns, abuser, chemically dependent or unidentified. The results of the assessment must be documented in the offender's file; and

(d) an evaluation and recommendation report must be submitted by a certified chemical dependency counselor to the sentencing court if a first DUI/per se/UDD offender is diagnosed as chemically dependent and recommended for treatment or the DUI/per se/UDD offender has a second or subsequent offense.

(i) The report must include the assessment instruments utilized, results of the testing, problem indicators, assignment to one of the four assessment categories (i.e., misuser/no patterns, abuser, chemically dependent or unidentified) , and recommendation for treatment and corresponding rationale based on patient placement criteria as defined in ARM 37.27.120 which determines appropriate level of care.

(ii) A MDD offender diagnosed as chemically dependent will be referred back to the court with a treatment recommendation. Compliance with treatment is contingent upon the court's approval of the treatment recommendation.

(2) The process for recommending treatment shall be as follows:

(a) If a DUI/per se/MDD/UDD offender is assessed as chemically dependent or is a repeat DUI/per se/UDD offender, recommendations for treatment must be developed by the program counselor in accordance with state approved patient placement rules. The offender may disagree with the program recommendations and seek an independent assessment from a certified chemical dependency counselor. The determination from this assessment must be based on diagnosis and patient placement rules adopted by the department of public health and human services. Offenders must be advised of this right by the program.

(b) Following completion of the assessment, the certified chemical dependency counselor will submit an evaluation/recommendation report to the sentencing court which includes a determination of the appropriate model of treatment based upon state approved placement criteria. Treatment recommendations may include inpatient with aftercare, intensive outpatient with aftercare or outpatient scheduled at least once per week.

(c) Pursuant to 61-8-732 , MCA, the sentencing court must order compliance with treatment recommendations in the case of first DUI/per se/UDD offenders assessed as chemically dependent or repeat DUI/per se/UDD offenders. When the offender has disagreed with recommendations and obtained a second opinion, the sentencing court shall order the appropriate level of treatment as determined by one of the counselors.

(d) The offender may attend the approved assessment/ education and/or treatment program of the offender's choice. The approved program or certified chemical dependency counselor accepting an ACT program referral to treatment must notify the sentencing court upon completion of treatment, or upon an offender's failure to complete.

(e) Copies of the evaluation and recommendation report must be documented in the offender's file and given to the offender.

(f) A sentencing court or counselor may not require attendance at a self-help program unless the meeting is defined as "open" by the self-help program.

History

Authorizing statute(s): Sec. 53-24-204, 53-24-208 and 53-24-209, MCA
Implementing statute(s): Sec. 45-9-208, 45-10-108, 61-8-714, 61-8-722 and 61-8-732, MCA
History: NEW, 1996 MAR p. 1312, Eff. 5/10/96; AMD, 1998 MAR p. 351, Eff. 1/30/98; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.516 Chemical Dependency Educational Courses: Course Curriculum

(1) Course curriculum shall include the following (specific content of the topic areas below may be found in the ACT curriculum manual):

(a) The DUI/UDD and/or MDD educational component must include a minimum of four educational sessions totaling at least 8 hours.

(b) The curriculum will include four major topic areas:

(i) review of the laws and consequences of violating them;

(ii) physiological/ neurophysiological effects of alcohol and other drugs;

(iii) social and psychological implications of alcohol and other drug use; and

(iv) self assessment.

History

Authorizing statute(s): 53-24-204, 53-24-208, 53-24-209, MCA
Implementing statute(s): 45-9-208, 45-10-108, 61-8-401, 61-8-714, 61-8-722, 61-8-732, MCA
History: NEW, 1996 MAR p. 1312, Eff. 5/10/96; AMD, 1998 MAR p. 351, Eff. 1/30/98; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.517 Chemical Dependency Educational Courses: Monitoring Requirements

(1) One year monthly monitoring requirements:

(a) Those offenders with a second or subsequent conviction must be monitored for compliance with continuing care recommendations;

(b) Monitoring will consist of at least one face to face individual and/or group contact per month, conducted by a certified or eligible as a chemical dependency counselor, for a period of 1 year from the date of admission to the treatment program; and

(c) The treatment provider, providing the monitoring services, will notify the sentencing court within 10 days if the offender fails to comply with the continuing care recommendations.

History

Authorizing statute(s): Sec. 53-24-204, 53-24-208 and 53-24-209, MCA
Implementing statute(s): Sec. 45-9-208, 45-10-108, 61-8-714 and 61-8-722, MCA
History: NEW, 1996 MAR p. 1312, Eff. 5/10/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.521 Chemical Dependency Educational Courses: Act Program Provider Requirements

(1) Program staff requirements are as follows:

(a) Individual assessment sessions must be provided by a certified chemical dependency counselor;

(b) Assessments which recommend treatment must be performed, signed and dated by a certified chemical dependency counselor; and

(c) Staff conducting the educational course component must receive an ACT program specific training course sponsored by the traffic safety bureau within 6 months from the date of hire and also be certified or eligible as a chemical dependency counselor as defined in ARM 20.3.401 through 20.3.416.

(2) Programs shall develop policies and procedures which address the ACT program requirements of these rules and shall include:

(a) Services and staff requirements;

(b) Procedures for determining cost and fees charged for the ACT program; and

(c) Goals and objectives which address required effectiveness indicators shall include, but not be limited to ACT caseload, completion ratios, numbers of offenders recommended for treatment, and number of repeat offenders.

History

Authorizing statute(s): 53-24-204, 53-24-208, 53-24-209, MCA
Implementing statute(s): 45-9-208, 45-10-108, 61-8-714, 61-8-722, MCA
History: NEW, 1996 MAR p. 1312, Eff. 5/10/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.525 Chemical Dependency Educational Courses: Record Keeping and Reporting Requirements

(1) Record keeping and reporting requirements specific to the ACT program shall include:

(a) Alcohol and drug information system (ADIS) admission/discharge ACT program report;

(b) assessment instruments utilized;

(c) progress notes documenting the assessment interviews, which includes data to validate the assessment findings and treatment placement recommendations when appropriate and includes the counselor's observations and conclusions;

(d) documentation of educational sessions attended, dates of assessment interviews, and tracking summaries;

(e) evaluation and recommendation reports;

(f) court sentencing orders or referral forms;

(g) release of confidential information forms to the sentencing court and driver control bureau signed upon admission, and other forms as required;

(h) documentation of referral to or from another ACT program when applicable;

(i) fee charges and documentation of ability to pay if required;

(j) documentation of non-compliance where applicable; and

(k) biopsychosocial and patient placement documentation; and

(l) advisal of rights form.

History

Authorizing statute(s): Sec. 53-24-204, 53-24-208 and 53-24-209, MCA
Implementing statute(s): Sec. 45-9-208, 45-10-108, 61-8-714 and 61-8-722, MCA
History: NEW, 1996 MAR p. 1312, Eff. 5/10/96; TRANS, from DOC, 1998 MAR p. 1502.

Subchapter 37.27.7 Montana Chemical Dependency Center

Mont. Admin. R. 37.27.701 Montana Chemical Dependency Center: Purpose

(1) The Montana chemical dependency center (MCDC) is an approved public inpatient facility which provides inpatient (free standing) treatment to chemically dependent residents of Montana who demonstrate a severity of illness which matches the intensity of service.

History

Authorizing statute(s): Sec. 53-24-209, MCA
Implementing statute(s): Sec. 53-24-301, MCA
History: NEW, 1996 MAR p. 2596, Eff. 10/4/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.702 Montana Chemical Dependency Center: Definitions

(1) "Level of care" means the following for the purpose of this rule:

(a) level IV - inpatient (hospital) care as defined in ARM 37.27.102(13); requirements are found in ARM 37.27.129.

(b) level III - inpatient (free standing) care as defined in ARM 37.27.302(13); requirements are found in 37.27.130.

(c) level II - day treatment and/or intensive outpatient treatment as defined in ARM 37.27.102(8) and (15); requirements are found in ARM 37.27.137 and 37.27.138.

(d) level I - outpatient treatment as defined in ARM 37.27.102(18); requirements are found in ARM 37.27.136.

(2) "Level III justification packet" means the materials to be sent to MCDC by the certified counselor (as defined in ARM 20.3.401 through 20.3.416) to justify the admission which include the following required items:

(a) results of assessment as defined in ARM 37.27.130;

(b) copy of the biopsychosocial assessment as defined in ARM 37.27.102(4), completed by a certified counselor;

(d) identification of overriding considerations as defined in ARM 37.27.120(1)(j)(vii) if appropriate;

(e) confirmation that appropriate services are not available locally; and

(f) current discharge summary as defined in ARM 37.27.136(5)(j), if recently discharged from another level of care.

(3) "Supporting documentation" means any documentation of the history of medical or psychiatric concerns which substantiates the need for level II care and/or negates the need for level IV care.

(4) "Qualifying placement" means justification at level III in at least two of the six dimensions, as defined in ARM 37.27.120(1)(j)(i) through (vii) or one dimension with a consideration which overrides the patient placement match.

(5) "MCDC utilization review committee" means a team with clinical, medical and administrative representation, which determines the appropriateness of admission level III treatment based on the documentation submitted by the certified chemical dependency counselor.

History

Authorizing statute(s): 53-24-209, MCA
Implementing statute(s): 53-24-301, MCA
History: NEW, 1996 MAR p. 2596, Eff. 10/4/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.705 Montana Chemical Dependency Center: Applicability

(1) All state approved chemical dependency programs, Indian health services (IHS) approved Native American programs and certified chemical dependency counselors may refer clients to MCDC providing the level III justification packet is complete. In all cases the referring individual must be a certified chemical dependency counselor, who has utilized the level III justification format and the principles of patient placement.

History

Authorizing statute(s): Sec. 53-24-209, MCA
Implementing statute(s): Sec. 53-24-301, MCA
History: NEW, 1996 MAR p. 2596, Eff. 10/4/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.710 Montana Chemical Dependency Center: Criminal Justice System Referrals

(1) A court mandating or recommending chemical dependency treatment at MCDC must refer the offender to the approved chemical dependency program in their area or a certified chemical dependency counselor to complete the assessment, patient placement and confirmation that appropriate services are not available locally. The program or certified chemical dependency counselor may then refer the offender to MCDC if appropriate. The board of pardons, probation/parole officers and pre-release centers must also use this procedure.

History

Authorizing statute(s): Sec. 53-24-209, MCA
Implementing statute(s): Sec. 53-24-301, MCA
History: NEW, 1996 MAR p. 2596, Eff. 10/4/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.711 Montana Chemical Dependency Center: Admission Policies and Procedures

(1) An individual requesting admission to MCDC or a court referral must be assessed as chemically dependent pursuant to ARM 37.27.130(2) (a) , and demonstrate a severity of illness which qualifies the individual for level III care based on nationally recognized patient placement criteria. Furthermore, the certified chemical dependency counselor must confirm that the individual cannot obtain necessary care locally.

(2) The certified chemical dependency counselor must contact the admission coordinator at MCDC and request admission. The admissions coordinator will instruct the program or certified counselor in admission protocols.

(3) The certified counselor will send the completed level III justification packet and supporting documentation to MCDC.

(4) The MCDC utilization review committee will meet 5 days per week (Monday through Friday except holidays) to process and accept requests for admissions within 24 hours, providing the documentation within the level III justification packet is complete. Requests received after 11:00 a.m. on Friday will be processed on Monday.

(5) The committee may reject requests for admission based on inadequate documentation or inappropriate placement.

(6) The referring certified chemical dependency counselor will be notified of the deficiencies and be given the opportunity to correct the deficiencies and resubmit.

(7) Following acceptance of the admission request, MCDC will notify the referring certified chemical dependency counselor or state approved program of the specific date and time for the admission. The referring certified chemical dependency counselor or state approved program is responsible to arrange the travel so the individual arrives at the designated arrival time.

History

Authorizing statute(s): Sec. 53-24-209, MCA
Implementing statute(s): Sec. 53-24-301, MCA
History: NEW, 1996 MAR p. 2596, Eff. 10/4/96; TRANS, from DOC, 1998 MAR p. 1502.

Mont. Admin. R. 37.27.718 Montana Chemical Dependency Center: Discharge Process to Level Ii or I

(1) Discharge will be determined by the individual's ability to meet MCDC's established discharge criteria based on nationally recognized patient placement criteria. Discharge planning will be ongoing, during the treatment process. All clients will receive a continuing care referral to the certified chemical dependency counselor or state approved program that initiated the admission, in order to ensure participation in necessary continuing care.

History

Authorizing statute(s): Sec. 53-24-209, MCA
Implementing statute(s): Sec. 53-24-301, MCA
History: NEW, 1996 MAR p. 2596, Eff. 10/4/96; TRANS, from DOC, 1998 MAR p. 1502.

Subchapter 37.27.9 Chemical Dependency and Abuse Treatment Services

Mont. Admin. R. 37.27.901 Chemical Dependency and Abuse Treatment Services: Rehabilitation Option 32

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.902 Substance Use Disorder Services: Authorization Requirements

(1) The purpose of rules contained in this subchapter is to establish standards for the coverage and reimbursement of substance use disorder services under the Montana Medicaid Program.

(2) In addition to the requirements contained in rule, the department has developed and published the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health, dated October 1, 2025, which it adopts and incorporates by reference. The purpose of the manual is to implement requirements for utilization management and services. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities (BHDD) Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at: https://dphhs.mt.gov/bhdd/SubstanceAbuse/ProviderManualsandProgramResources.

(3) In addition to the requirements contained in rule, the department has developed and published the BHDD Division Non-Medicaid Services Provider Manual for Substance Use Disorder, dated October 1, 2025, which it adopts and incorporates by reference. The purpose of the manual is to implement requirements for utilization management and services. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities (BHDD) Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena MT 59620-2905 or at: https://dphhs.mt.gov/bhdd/SubstanceAbuse/ProviderManualsandProgramResources.

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, MCA
History: NEW, 2017 MAR p. 2081, Eff. 11/10/17; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2020 MAR p. 1161, Eff. 7/1/20; AMD, 2020 MAR p. 1740, Eff. 10/1/20; AMD, 2021 MAR p. 331, Eff. 3/27/21; AMD, 2022 MAR p. 1889, Eff. 9/24/22; AMD, 2023 MAR p. 1890, Eff. 12/23/23; AMD, 2024 MAR p. 729, Eff. 4/13/24; AMD, 2024 MAR p. 2014, Eff. 8/10/24; AMD, 2025 MAR, Notice No. 37-1104, Eff. 3/8/25; AMD, 2025 MAR, Notice No. 37-1110, Eff. 6/7/25; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26; AMD, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.

Mont. Admin. R. 37.27.903 Medicaid Substance Use Disorder Services: General Requirements

(1) General Medicaid provider requirements found in ARM 37.85.104 through 37.85.1125 are applicable to all Medicaid substance use disorder services.

(2) HELP Medicaid requirements found in ARM 37.84.101 through ARM 37.84.115 are applicable to all Medicaid substance use disorder services.

(3) All services must be delivered by facilities or programs approved by the department.

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, MCA
History: NEW, 2017 MAR p. 2081, Eff. 11/10/17; AMD, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.27.904 Chemical Dependency and Abuse Treatment Services: General Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.905 Medicaid Substance Use Disorder Services: Reimbursement

(1) Medicaid substance use disorder programs must bill for services using procedure codes, modifiers, and definitions contained in the:

(a) Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Code System (HCPCS); and

(b) American Medical Association's (AMA) Current Procedural Terminology (CPT) Codes.

(2) Subject to requirements of this rule, the Medicaid substance use disorder program pays the lower of the following for Medicaid eligible members:

(a) the Medicaid substance use disorder program's usual and customary charge for services;

(b) the reimbursement methodologies described in ARM 37.85.212; or

(c) for items or services where no Resource Based Relative Value (RBRVS) or Medicare fee is available, the department's fee schedule.

(3) The allowable Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.105.

(4) The allowable non-Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.104.

(5) The allowable Medicaid substance use disorder reimbursement rate for case management services for members with substance use disorder is stated in the department's fee schedule provided in ARM 37.85.106.

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, MCA
History: NEW, 2017 MAR p. 2081, Eff. 11/10/17; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.27.906 Medicaid Substance Use Disorders Services: Treatment Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, MCA
History: NEW, 2017 MAR p. 2081, Eff. 11/10/17; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.27.907 Chemical Dependency Bureau Medicaid Substance Dependency and Abuse Treatment Services: Rehabilitation Option 32, Financial Eligibility

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.908 Chemical Dependency and Abuse Treatment Services: Billing Procedure for Consultations with Parents

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.912 Enrollment of Medicaid Providers of Substance Dependency and Abuse Treatment Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.916 Chemical Dependency and Abuse Treatment Services: Inpatient Free Standing Treatment, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.920 Chemical Dependency and Abuse Treatment Services: Outpatient Treatment, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.921 Chemical Dependency and Abuse Treatment Services: Certain Outpatient Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Mont. Admin. R. 37.27.926 Chemical Dependency and Abuse Treatment Services: Day Treatment, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
Implementing statute(s): 53-6-101, 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
History: NEW, 2003 MAR p. 803, Eff. 4/25/03; REP, 2017 MAR p. 2081, Eff. 11/10/17.

Chapter 37.30 Vocational Rehabilitation Program

Subchapter 37.30.1 Determination of Rehabilitation Potential and Eligibility

Mont. Admin. R. 37.30.101 Definitions

(1) "Applicant" means a person who has made formal application to the department to receive vocational rehabilitation or other services administered by the Montana Vocational Rehabilitation program inclusive of the Blind and Low Vision Services program of the department.

(2) "Blindness" means a visual disability as defined at 53-7-301 , MCA.

(3) "Consumer" means a person who has been determined by the department in accordance with these rules and state and federal statutes and federal regulations pertaining to vocational rehabilitation services, and other applicable laws, to be eligible to receive vocational services administered by the Montana Vocational Rehabilitation program and who is receiving services in accordance with an individualized plan for employment (IPE).

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

(5) "Dependent" means any relative to a person by blood or marriage or anyone living in the same household with whom a person has a close interpersonal relationship and for whom a person provides a majority of their financial support.

(6) "Disability" means an existing physical or mental impairment including blindness which significantly limits, or, if not corrected, may significantly limit a person's activities or ability to function in a normal manner.

(7) "Extended employment" means a supervised work program as defined at 53-7-202 , MCA.

(8) "Financial resource" means financial assets, inclusive of stocks, bonds, certificates of deposit, and similar type assets, that can be readily converted to cash, available to the person at the time of the eligibility determination and during the course of the person's receipt of services under an IPE. Financial assets do not include resources as provided for in ARM 37.30.411.

(9) "Income" means income as defined in ARM 37.2.702.

(10) "Independent living plan" means the written individualized independent living plan (IILP) prepared by the department for persons receiving independent living rehabilitation services. This plan specifies the independent living goals and needs of the person and the services the department may provide to the person in order to assist the person attaining an improved quality of life.

(11) "Individualized plan for employment (IPE)" means the plan signed by the person and the qualified Montana vocational rehabilitation counselor which specifies the vocational rehabilitation goals and needs of the consumer and the services the department may provide to the consumer in order to assist the vocational rehabilitation of the consumer.

(12) "Montana Vocational Rehabilitation program (MVR)" means the program of federal and state authorized vocational rehabilitation services for persons with disabilities provided through the department's Disability, Employment, and Transitions Division, inclusive of the Blind and Low Vision Services program and those federal programs authorized at 29 USC 701, et seq.

(13) "Occupational license" means a license as defined at 53-7-101 and 53-7-301, MCA.

(14) "Orthotic device" means a device that activates or supplements a weakened limb or neuromuscular function.

(15) "Person with a most significant disability" means a person with a disability:

(a) who has a severe physical or mental impairment that seriously limits three or more functional capacities (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome;

(b) whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time; and

(i) one or more physical or mental disabilities resulting from amputation, arthritis, autism, blindness, burn injury, cancer, cerebral palsy, cystic fibrosis, deafness, head injury, heart disease, hemiplegia, hemophilia, respiratory or pulmonary dysfunction, mental retardation, mental illness, multiple sclerosis, muscular dystrophy, musculo-skeletal disorders, neurological disorders (including stroke and epilepsy), spinal cord conditions (including paraplegia and quadriplegia), sickle cell anemia, specific learning disability, end-stage renal disease, or another disability; or

(ii) a combination of disabilities determined on the basis of an assessment for determining eligibility and vocational rehabilitation needs to cause comparable substantial functional limitation.

(16) "Person with a significant disability" means a person with a disability:

(a) who has a severe physical or mental impairment that seriously limits at least one functional capacity (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome;

(b) whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time; and

(ii) a combination of disabilities determined on the basis of an assessment for determining eligibility and vocational rehabilitation needs to cause comparable substantial functional limitation.

(17) "Programs of higher education" are programs of formal education that lead to an advanced academic degree such as an A.A., A.S., B.A., B.S., M.A., or Ph.D. Programs of higher education do not include career, vocational, or other specialized programs that do not lead to an academic degree.

(18) "Prosthetic appliance" means an artificial device as defined at 53-7-101 and 53-7-301 , MCA.

(19) "Rehabilitation facility" or "rehabilitation program" means a facility or program operated primarily for the provision of vocational rehabilitation services to persons with disabilities.

(20) "Serious limitation" or "seriously limits" means a reduction in capacity due to severe physical or mental impairment to the degree that the person requires vocational rehabilitation services or accommodations not typically made for other persons in order to prepare for, secure, retain or regain employment.

(21) "Sheltered employment" means a program of services as defined at 53-7-202, MCA.

(22) "Support services" means support services as defined at 53-7-202, MCA.

(23) "Vocational rehabilitation services" means vocational rehabilitation services provided in 34 CFR 361.48. Vocational rehabilitation services for the purposes of subchapters 1 through 7 do not include vocational rehabilitation extended employment services, independent living rehabilitation services, and visual medical services as defined in this chapter.

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, 53-19-112, MCA
Implementing statute(s): 53-7-101, 53-7-103, 53-7-105, 53-7-106, 53-7-107, 53-7-108, 53-7-109, 53-7-201, 53-7-202, 53-7-203, 53-7-204, 53-7-205, 53-7-206, 53-7-301, 53-7-302, 53-7-303, 53-7-306, 53-7-310, 53-7-314, 53-7-315, 53-19-101, 53-19-102, 53-19-103, 53-19-104, 53-19-105, 53-19-106, 53-19-110, 53-19-112, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1985 MAR p. 1569, Eff. 10/18/85; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2004 MAR p. 1789, Eff. 8/6/04; AMD, 2013 MAR p. 789, Eff. 5/10/13.

Mont. Admin. R. 37.30.102 Vocational Rehabilitation Policy: Incorporation by Reference of Federal and State Authority

(1) The department, except as otherwise provided in this chapter, adopts and incorporates by reference, for purposes of administering the program of vocational rehabilitation services, the federal regulations specified in (2) as presented in the July 1, 2010 edition of the Code of Federal Regulations (CFR). These federal regulations, adopted by the United States Department of Education, govern the administration and delivery by the states of various aspects of vocational rehabilitation services.

(2) The following federal regulations govern the administration and delivery of vocational rehabilitation services as specified:

(a) For purposes of generally administering the program:

(i) 34 CFR 361.5 - "Applicable definitions".

(b) For purposes of administering eligibility determinations and order of selection:

(i) 34 CFR 361.36 - "Ability to serve all eligible individuals; order of selection".

(ii) 34 CFR 361.41 - "Processing referrals and applications".

(iii) 34 CFR 361.42 - "Assessment for determining eligibility and priority for services".

(iv) 34 CFR 361.43 - "Procedures for ineligibility determination".

(v) 34 CFR 361.44 - "Closure without eligibility determination".

(i) 34 CFR 361.37 - "Information and referral services".

(d) For purposes of administering confidential personal information:

(i) 34 CFR 361.38 - "Protection, use and release of personal information".

(e) For purposes of implementing individualized planning for service delivery and record of services:

(i) 34 CFR 361.45 - "Development of the individualized plan for employment".

(ii) 34 CFR 361.46 - "Content of the individualized plan for employment".

(iii) 34 CFR 361.47 - "Record of services".

(f) For purposes of the administration of service delivery:

(i) 34 CFR 361.48 - "Scope of vocational rehabilitation services for individuals with disabilities".

(g) For purposes of the implementation of informed choice for the benefit of consumers:

(i) 34 CFR 361.52 - "Opportunity to make informed choice".

(h) For purposes of prior and verbal authorization:

(i) 34 CFR 361.50(e) - "Written policies governing the provision of services for individuals with disabilities".

(i) For purposes of assuring the prior use of comparable services and benefits by consumers:

(i) 34 CFR 361.53 - "Comparable services and benefits".

(j) For purposes of administering closure of consumers from the program and monitoring employment outcomes for consumers:

(i) 34 CFR 361.55 - "Annual review of individuals in extended employment of other employment under special certificate provisions of the Fair Labor Standards Act".

(ii) 34 CFR 361.56 - "Requirements for closing the record of services of a consumer who has achieved an employment outcome".

(iii) 34 CFR 363.11 - "What information and assurances must be included in the state plan supplement".

(iv) 34 CFR 363.54 - "What requirements must a state meet before it provides for the transition of a consumer to extended services".

(k) For purposes of providing consumers with due process:

(i) 34 CFR 361.57 - "Review of counselor or counselor coordinator decisions".

(3) The department, except as otherwise provided in this chapter, adopts and incorporates by reference, for purposes of administering the program of vocational rehabilitation services, the policies specified in (4), as presented in the Montana Vocational Rehabilitation Policy Manual. Copies of the policies may be obtained through the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, 111 N. Last Chance Gulch, Suite 4C, P.O. Box 4210, Helena, MT 59604-4210.

(4) The following Montana vocational rehabilitation policies govern the administration and delivery of vocational rehabilitation services as specified:

(a) For purposes of selecting appropriate goods: Montana Vocational Rehabilitation Policy B - "Rates Of Payment" dated December 27, 2002.

(b) For purposes of staff and consumer safety: Montana Vocational Rehabilitation Policy C1 - "Personal Safety" dated May 9, 2011.

(c) For purposes of conciliation in consumer due process: Montana Vocational Rehabilitation Policy E - "Counselor Determinations" dated December 27, 2002.

(d) For purposes of self-employment service provision: Montana Vocational Rehabilitation Policy M1 - "Self-employment" dated December 27, 2002.

(e) For purposes of defining "emancipated adult" for financial eligibility determinations: Montana Vocational Rehabilitation Policy ZGD08 - "Definitions" dated December 27, 2002.

(f) For purposes of defining "individual with a most significant disability" for federal reporting and order of selection: Montana Vocational Rehabilitation Policy ZGD16 - "Definitions" dated December 27, 2002.

(g) For purposes of developing the IPE: Montana Vocational Rehabilitation Policy W - "Core Requirements of IPE" dated October 1, 2006.

(h) For purposes of emergency response to IPE change requests: Montana Vocational Rehabilitation Policy X - "On-going IPE Services" dated December 27, 2002.

History

Authorizing statute(s): 53-7-102, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-105, 53-7-106, 53-7-108, 53-7-203, 53-7-205, 53-7-302, 53-7-303, 53-7-306, 53-7-310, 53-7-314, MCA
History: NEW, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2005 MAR p. 2257, Eff. 11/11/05; AMD, 2007 MAR p. 474, Eff. 4/13/07; AMD, 2013 MAR p. 789, Eff. 5/10/13.

Mont. Admin. R. 37.30.105 Vocational Rehabilitation Program: Implementation of Rehabilitation Act of 1973

(1) The Administrative Rules of Montana at Title 37, chapter 30, subchapters 1 through 26 implement for the state of Montana the federal program of vocational rehabilitation services for persons with disabilities, codified at 29 USC 701 et seq. (1992).

(2) The administration of the Vocational Rehabilitation program, implemented by the Administrative Rules of Montana at Title 37, chapter 30, subchapters 1 through 26, is subject to the provisions of all federal statutory, regulatory or policy authorities that govern the administration of the program. Any provision in these rules that is contrary to a governing federal authority is preempted by the pertinent federal authority.

History

Authorizing statute(s): Sec. 53-7-102 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-103 and 53-7-303, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.106 Vocational Rehabilitation Program: Employment Goals

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-108 and 53-7-310, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.111 Vocational Rehabilitation Program: Order of Selection

(1) The department, in consultation with the vocational rehabilitation council, may implement an order of selection to limit eligibility for vocational rehabilitation services based upon designation by characteristics of specific populations of persons as having priority in being screened for eligibility and in receipt of services.

(2) The categories and ranking for priority of service among applicants and persons otherwise eligible for services are as follows:

(a) priority one is eligible persons with most significant disabilities experiencing serious limitations in three or more functional capacities;

(b) priority two is eligible persons with significant disabilities experiencing serious limitations in at least two functional capacities who are not in priority one; and

(3) Selection of persons to be screened for eligibility within each priority group is based on the earliest dated application.

(4) Implementation of an order of selection does not affect the status for receipt of services for a person who has been determined to be eligible for vocational services prior to the date on which an order of selection is implemented.

History

Authorizing statute(s): 53-7-102, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-105, 53-7-302, 53-7-303, MCA
History: NEW, Eff. 6/4/77; AMD, 1980 MAR p. 595, Eff. 2/15/80; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2013 MAR p. 2309, Eff. 12/13/13.

Subchapter 37.30.3 State Economic Need Policies

Mont. Admin. R. 37.30.301 Vocational Rehabilitation Program: Application

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-105, 53-7-303, 53-7-306 and 53-7-315, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.304 Vocational Rehabilitation Program: Determination of Eligibility

(1) A person is eligible for vocational rehabilitation services, if the department determines the person to be eligible in accordance with the criteria of this subchapter and subchapters 4 and 7, governing eligibility, and with the criteria adopted in applicable federal law and regulations.

(2) An applicant may receive those services determined by the department to be necessary and appropriate for assessing the applicant's eligibility.

(3) Eligibility of a person for the receipt of visual medical services, vocational rehabilitation extended employment services and independent living services is determined in accordance with ARM 37.30.2601 et seq. for visual medical services, ARM 37.30.1602 et seq. for vocational rehabilitation extended employment services and ARM 37.30.1601 et seq. for independent living services.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-203, 53-7-302, 53-7-315 and 53-19-112, MCA
Implementing statute(s): Sec. 53-7-101, 53-1-102, 53-7-103, 53-7-105, 53-7-106, 53-7-107, 53-7-201, 53-7-202, 53-7-203, 53-7-301, 53-7-302, 53-7-306, 53-7-309 and 53-19-103, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1985 MAR p. 1569, Eff. 10/18/85; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.305 Vocational Rehabilitation Program: Eligibility Criteria

(1) Vocational rehabilitation services, except those services necessary for determining eligibility for the program, are available only to a person who is determined by the department to be eligible for services.

(2) Eligibility for vocational rehabilitation services is based on the following criteria:

(a) the presence of physical or mental impairment;

(b) the person's impairment constituting or resulting in a substantial impediment to the person's employment; and

(c) the vocational rehabilitation services necessary for the person to prepare for, secure, retain or regain employment are consistent with the person's unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice.

(3) Any applicant who has been determined eligible for social security old age, survivors and disability insurance (OASDI) or supplemental security income (SSI) benefits under Titles II and XVI of the Social Security Act is presumed eligible for vocational rehabilitation services and considered an individual with a significant disability unless the department determines the applicant is not otherwise eligible for services.

(4) Eligibility of a person for the visual medical services, vocational rehabilitation extended employment services and independent living services is determined in accordance with ARM 37.30.2608 for visual medical services, ARM 37.30.1613 for vocational rehabilitation extended employment services and ARM 37.31.401 for independent living services.

(5) Eligibility for vocational rehabilitation services is not determined:

(a) with regard to sex, race, age, religion, creed, color, or national origin;

(b) solely on the basis of type of disability;

(c) upon an age limit which will, of itself, result in a finding of ineligibility for any person who otherwise meets the basic eligibility requirements; or

(d) upon a residence requirement, durational or other, which excludes from services any person who is in the state and who would be eligible for vocational rehabilitation services otherwise.

(6) A person is not eligible for vocational rehabilitation services unless the department determines that the person is utilizing all public and private benefits and services, other than rehabilitation technology, to which the person may be otherwise entitled which are of a comparable nature to those available through the vocational rehabilitation program of the department.

(7) A consumer must participate in such vocational rehabilitation services as the consumer and the department determine are appropriate for the consumer's vocational rehabilitation in accordance with the objectives of the consumer's (IPE) .

History

Authorizing statute(s): Sec. 53-7-102, 53-7-203, 53-7-302, 53-7-315 and 53-19-112, MCA
Implementing statute(s): Sec. 53-7-101, 53-7-102, 53-7-103, 53-7-105, 53-7-106, 53-7-107, 53-7-201, 53-7-202, 53-7-203, 53-7-301, 53-7-302, 53-7-303, 53-7-304, 53-7-305, 53-7-306, 53-7-307, 53-7-308, 53-7-309 and 53-19-103, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1985 MAR p. 1569, Eff. 10/18/85; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.310 Vocational Rehabilitation Program: Extended Evaluations

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-105, 53-7-108, 53-7-205, 53-7-303, 53-7-306 and 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Subchapter 37.30.4 Determination of Economic Need

Mont. Admin. R. 37.30.401 Vocational Rehabilitation Program: Purchase of Services

(1) The department, as provided in this subchapter, may expend monies for the purchase of vocational rehabilitation services for persons who are applicants seeking to be determined eligible for vocational rehabilitation services or who have been determined to be eligible to be consumers of vocational rehabilitation services.

History

Authorizing statute(s): 53-7-102, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-105, 53-7-108, 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1996 MAR p. 1320, Eff. 5/10/96; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2004 MAR p. 1789, Eff. 8/6/04.

Mont. Admin. R. 37.30.404 Vocational Rehabilitation Program: Adaptations of Standards

(1) The department may, within its discretion, use in relation to a particular consumer adaptations of the financial need standard and other standards describing specific financial limitations adopted through these rules when the department determines:

(a) one or more standards limit the consumer's access to an identified rehabilitation need in the consumer's individual employment plan;

(b) there is not a commensurate service option available through the department or another program available to the consumer to address the rehabilitation need; and

History

Authorizing statute(s): 53-7-102, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-105, 53-7-108, 53-7-205, 53-7-303, 53-7-306, 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2007 MAR p. 860, Eff. 6/22/07.

Mont. Admin. R. 37.30.405 Vocational Rehabilitation Program: Payment for Services

(1) The consumer, except as otherwise specifically authorized in this subchapter, is responsible for paying the costs for the provision of any vocational rehabilitation services that are authorized to be provided to the consumer through the consumer's IPE.

(2) An applicant or a consumer is not responsible for paying the costs for the provision of the following vocational rehabilitation services:

(a) assessment for determining eligibility and priority for vocational rehabilitation services except for trial work experience type services provided to a person with a significant disability during an exploration of the person's abilities, capabilities and capacity to perform in work situations;

(b) vocational rehabilitation counseling and guidance;

(d) job development and placement related services;

(e) personal assistance services; and

(f) any auxiliary aid or service or other rehabilitation technology, including reader services, that the department determines a person with a disability may require in order to apply for or receive vocational rehabilitation services.

(3) A consumer who is eligible for Social Security Old Age, Survivors and Disability Insurance (OASDI) or Supplemental Security Income (SSI) benefits under Titles II and XVI of the Social Security Act is not responsible for paying the costs for the provision of any services that are authorized to be provided to the consumer through the consumer's IPE.

(4) The department may pay for the costs for the provision of any services that are authorized to be provided to the consumer through the consumer's IPE to the extent that the consumer's income and financial resources, determined as provided in this rule and ARM 37.30.407, do not exceed the maximum amounts allowable for income and for financial resources calculated by the department as provided for in (4)(a) and (b).

(a) The maximum allowable level for income is a prospective 12 month annual income calculated at 250% of the 2014 U.S. Department of Health and Human Services poverty guidelines for households of different sizes.

(b) The maximum allowable value for financial resources is calculated at 50% of the maximum allowable annual income level.

(5) The department does not pay for the costs for the provision of any services that are authorized to be provided to the consumer through the consumer's IPE to the extent that those costs are reimbursable through another governmental program or there is another source of funding that is available to be applied to the costs of all or a portion of the services.

(a) If benefits from any other program or other sources of funding are not immediately available for the payment of any or all of the costs of services for the consumer, the department may temporarily pay for the costs for the provision of services until those other benefits or other sources of funding become available.

(b) If the determination of the availability of benefits or other sources of funding would delay the provision of vocational rehabilitation services to a consumer who is at extreme medical risk or who is to receive an immediate job placement opportunity, the department may temporarily pay for the costs for the provision of services until those other benefits become available. The department makes the determination of extreme medical risk based upon medical evidence provided by an appropriate licensed professional.

(6) The responsibility of a consumer for the payment of the costs for the provision of services is initially determined by the department prior to the provision to the consumer of any services listed in the consumer's IPE.

(a) The financial responsibility of a consumer is redetermined at any time that there is a change in the income and resources available to the consumer.

History

Authorizing statute(s): 53-7-102, 53-7-206, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-105, 53-7-108, 53-7-205, 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1996 MAR p. 1320, Eff. 5/10/96; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2004 MAR p. 1789, Eff. 8/6/04; AMD, 2006 MAR p. 1892, Eff. 7/28/06; AMD, 2007 MAR p. 860, Eff. 6/22/07; AMD, 2008 MAR p. 953, Eff. 5/9/08; AMD, 2009 MAR p. 941, Eff. 6/12/09; AMD, 2013 MAR p. 789, Eff. 5/10/13; AMD, 2014 MAR p. 978, Eff. 5/9/14.

Mont. Admin. R. 37.30.406 Vocational Rehabilitation Program: Information for Determination of Financial Need

(1) The department may obtain information about an applicant's or a consumer's financial resources and requirements from the person or any other reliable source.

(2) An applicant's or a consumer's consent is necessary for the department to obtain any personal financial information not otherwise available to the department under law.

(a) If an applicant or a consumer is an unemancipated minor, the consent of the person's parents or guardian is necessary for the department to obtain any personal financial information concerning the person or person's parents not otherwise available to the department under law.

(3) An applicant or a consumer who fails to provide necessary financial information to the department either directly or by consent to release cannot be determined by the department to be eligible for vocational rehabilitation services.

(4) In accordance with departmental policies, any financial or other information obtained with an applicant's or a consumer's consent or the consent of the person's parents is confidential.

(5) Any financial information relied upon by the department in determining an applicant's or a consumer's financial resources or financial requirements is available to the person upon the person's request.

(6) A consumer must report to the department any changes in income or resources. Failure to report changes in income or resources results in termination of the consumer's eligibility for the vocational rehabilitation services.

History

Authorizing statute(s): 53-7-102, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-105, 53-7-108, 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1996 MAR p. 1320, Eff. 5/10/96; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2004 MAR p. 1789, Eff. 8/6/04.

Mont. Admin. R. 37.30.407 Vocational Rehabilitation Program: Determination of Income and Financial Resources

(1) An applicant's or a consumer's income and financial resources include, if married, that of the spouse and, if unemancipated, that of the parents or guardian.

(2) An applicant's or a consumer's income does not include income expended on disability related medical, psychological, or rehabilitation expenses incurred in the course of being determined eligible for vocational rehabilitation services and of the provision of vocational rehabilitation services.

(3) An applicant's or a consumer's income and financial resources are based on the person's next 12 months' projected income and financial resources.

(a) For an applicant or a consumer who is employed seasonally, income is calculated based on income history.

(b) For an applicant or a consumer who is self-employed, income does not include business expenses.

(4) The following assets are excluded as financial resources:

(a) the home of the applicant or consumer, the spouse or the parents, in the case of a minor;

(b) a small business or farm owned by the applicant or consumer, the spouse or the parents, in the case of a minor, if that business or farm is determined by the department to be the primary source of income or is a major asset for the applicant or consumer, the spouse or the parents;

(d) the applicant's or consumer's trust funds established as a result of disability to assist with the present and future medical and independent living expenses of the applicant or consumer.

History

Authorizing statute(s): 53-7-102, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-105, 53-7-108, 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1996 MAR p. 1320, Eff. 5/10/96; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2004 MAR p. 1789, Eff. 8/6/04.

Mont. Admin. R. 37.30.411 Vocational Rehabilitation Program: Income and Resources

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-7-102, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-105, 53-7-108, 53-7-303, 53-7-306, 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1996 MAR p. 1320, Eff. 5/10/96; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.416 Vocational Rehabilitation Program: Payment of Tuition for Higher Education

(1) Prior to a determination by the department as to the amount of funding an individual should receive for the cost of tuition, an individual must apply for and pursue a federal Pell Education Grant.

(2) The department will only provide funding for the cost of tuition for a client at the program of higher education, community/junior college, vocational school, technical school or institute, or hospital school of nursing that the department determines is the most cost effective.

(3) The department, except as provided in (3)(a) and (b), provides funding for the cost of tuition for an individual at a public or private program of higher education up to but not exceeding the highest tuition charge in the Montana university system.

(a) The department provides funding for the cost of tuition to a program of higher education that is more expensive than the highest tuition in the Montana university system if the department determines that the program is not available otherwise or that the overall cost of attendance to the department inclusive of tuition, room and board, texts and supplies at the program with the more expensive tuition will be less than the overall cost of attendance at the program in the Montana university system.

(b) For tuition to a nationally recognized program, designed and staffed for persons with severe disabilities, the department provides funding for the cost of tuition.

History

Authorizing statute(s): 53-7-102, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-108, 53-7-303, 53-7-310, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1996 MAR p. 1320, Eff. 5/10/96; TRANS, from SRS, 1998 MAR p. 2040.

Subchapter 37.30.7 Nature and Scope of Services

Mont. Admin. R. 37.30.701 Vocational Rehabilitation Program: Availability of Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.702 Vocational Rehabilitation Program: Services Available to Applicants

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-103, 53-7-105, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.705 Vocational Rehabilitation Program: Personal and Vocational Adjustment Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.706 Vocational Rehabilitation Program: Physical and Mental Restoration Services

(1) Physical and mental restoration services, as described in the IPE, may be provided to the consumer in preparing for, securing, retaining or regaining an employment outcome that is consistent with the strengths, resources, priorities, concerns abilities, capabilities, interests, and informed choice of the consumer.

(2) Physical and mental restoration services are limited to those services that are specified in and provided in accordance with the provisions of the Montana Vocational Rehabilitation Manual (MVR) Policy M, regarding scope of MVR services.

(3) Physical and mental restoration services do not include medical services and procedures of an experimental nature.

(4) The department adopts and incorporates by this reference the vocational rehabilitation list of covered services dated December 27, 2002, and published by the department as Montana Vocational Rehabilitation Policy M, "Scope of Montana Vocational Rehabilitation Services", of the Montana Vocational Rehabilitation Policy Manual. A copy of the policy may be obtained through the Department of Public Health and Human Services, Disability Services Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-7-102, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-108, 53-7-303, 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2005 MAR p. 2257, Eff. 11/11/05.

Mont. Admin. R. 37.30.710 Vocational Rehabilitation Program: Travel and Moving Services

(1) Travel and moving services may be provided to an applicant or client when necessary for the person to receive the benefit of vocational rehabilitation services.

(a) Travel services may include, as necessary, transportation, meals and lodging during travel for a person and necessary attendants or escorts.

(b) Transportation, meals and lodging are reimbursed at cost or state per diem, whichever is lower.

(2) Moving services may be provided for a move necessary to the vocational rehabilitation of the client.

(a) Moving expenses are reimbursed at cost.

(3) Travel services are only available for out-of-state travel if the department determines that the travel is necessary to receive services that are not available in Montana.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.711 Vocational Rehabilitation Program: Maintenance

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.712 Vocational Rehabilitation Program: Placement Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1978 MAR p. 907, Eff. 6/24/78; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.713 Vocational Rehabilitation Program: Vocational Items

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1978 MAR p. 907, Eff. 6/24/78; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.717 Vocational Rehabilitation Program: Assistive Services for Persons with Disabilities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.718 Vocational Rehabilitation Program: Services to Family Members and Dependents

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.719 Vocational Rehabilitation Program: Other Goods and Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.723 Vocational Rehabilitation Program: Post Employment Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.724 Vocational Rehabilitation Program: Counseling and Guidance Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.725 Vocational Rehabilitation Program: Work Activity Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, Eff. 1/3/77; AMD, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.729 Guidelines and Standards for Services Provided by Clients

(1) The department, in consultation with appropriate professional, trade, business, training and other organizations and institutions, may develop standards to serve as guidelines for the quality of services an individual may provide as an employee, contractor, tradesman, professional, or businessman while that person is a client of the department.

History

Authorizing statute(s): Sec. 53-7-102, MCA
Implementing statute(s): Sec. 53-7-102 and 53-7-105, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.730 Vocational Rehabilitation Program: Provider Fees

(1) The provision of vocational rehabilitation services by the department is subject to the following financial limitations.

(a) Services subject to rates of payment are as follows:

(i) payment for physical and mental restoration services is limited to those rates specified in Montana Vocational Rehabilitation Policy R, "Fee Schedule".

(ii) payment for hospital care is limited to those rates provided in the medical assistance rates of Title 37, chapter 86, subchapters 5 and 12 of the Administrative Rules of Montana; and

(iii) payment for hospital care from a hospital in another state is at the rates as established by that state's vocational rehabilitation agency.

(2) The department adopts and incorporates by this reference the Vocational Rehabilitation Fee Schedule, dated December 12, 2011, and published by the department as Montana Vocational Rehabilitation Policy R, "Fee Schedule Appendix A", of the Montana Vocational Rehabilitation Policy Manual. A copy of the policy may be obtained through the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, 111 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-105, 53-7-108, 53-7-203, 53-7-302, 53-7-303, 53-7-306, 53-7-307, 53-7-310, MCA
History: NEW, 1982 MAR p. 1287, Eff. 7/1/82; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2005 MAR p. 2257, Eff. 11/11/05; AMD, 2007 MAR p. 2012, Eff. 12/7/07; AMD, 2013 MAR p. 789, Eff. 5/10/13.

Mont. Admin. R. 37.30.733 Vocational Rehabilitation Program: Instructional Services for Blind and Visually Impaired Vocational Rehabilitation Clients

(1) The department may arrange for instructional services to blind and visually impaired vocational rehabilitation clients.

(2) The department will not arrange for or provide instructional services if it determines that due to the time and distance involved, the services are not readily available at a reasonable cost.

(3) The department may purchase the instructional services if the department determines that the client has inadequate financial resources with which to purchase those services.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-203 and 53-7-302, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-203, 53-7-302 and 53-7-303, MCA
History: NEW, 1984 MAR p. 511, Eff. 3/30/84; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.734 Vocational Rehabilitation Program: Attendant Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.735 Vocational Rehabilitation Program: Licenses and Fees

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.736 Vocational Rehabilitation Program: Work Adjustment Training

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-302 and 53-7-315, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-108, 53-7-303 and 53-7-310, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Subchapter 37.30.8 Special Services

Mont. Admin. R. 37.30.801 Group Services Program: Availability of Services

(1) The department provides a program of financial assistance for services to persons and modifications to facilities which may be expected to contribute substantially to the rehabilitation of a group of persons with disabilities some of whom are currently or potentially clients of the vocational rehabilitation program.

(2) A service will not be developed or facility modified solely for the purpose of directly benefiting any one person with a disability.

(3) Preference will be given to services or facilities with the potential of benefiting the largest number of persons with disabilities at a minimum cost to the department.

(4) Services are limited to:

(a) correction of a particular structural problem that constitutes a barrier to persons with disabilities;

(b) purchase of equipment that will serve equally and substantively a group of persons with disabilities;

(d) provision of instructional materials to persons with disabilities.

(5) Group services are available only to the extent that the services are not otherwise available through other programs or are the financial responsibility of a facility by state or federal law.

(6) Group services assistance is available only for services and modifications that the department determines within its discretion are appropriate under the criteria of this rule and for which there is funding.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-203 and 53-7-302, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-302 and 53-7-303, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.805 Certification of Handicapped Persons for Minimum Wage Exemptions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-203 and 53-7-302, MCA
Implementing statute(s): Sec. 53-7-203, MCA
History: NEW, 1984 MAR p. 511, Eff. 3/30/84; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Subchapter 37.30.9 Civil Rights

Mont. Admin. R. 37.30.901 Statement of Civil Rights Compliance

(1) Pursuant to the provisions of Title VI of the Civil Rights Act of 1964, and the regulations issued thereunder, the vocational rehabilitation services administered by the department will be conducted in such manner that no person is excluded from participation in, denied the benefits of, or subjected to discrimination under the services provided on the ground of race, color, national origin, sex, age, physical or mental disability, creed, marital status, or political affiliation.

(2) No person will on the ground of race, color, national origin, sex, age, physical or mental disability, creed, marital status, or political affiliation be denied any services, financial aid, or other benefits provided through the vocational rehabilitation services or be provided any service, financial aid, or other benefit which is different, or is provided in a different manner, from that provided to others through the services.

(3) Employees of the department, or of other agencies or organizations participating in the vocational rehabilitation program, will not be assigned caseloads or clientele on the basis of race, color, national origin, sex, age, creed, marital status, or political affiliation of the person being served.

(4) In making determinations of the types of activity to be included in the vocational rehabilitation services, geographical or other criteria or methods of administration will not be used which have the effect of subjecting individuals to discrimination because of their race, color, national origin, sex, age, physical or mental disability, creed, marital status, or political affiliation or have the effect of defeating or substantially impairing accomplishment of the objectives of the program with respect to individuals of a particular race, color, national origin, sex, age, physical or mental disability, creed, marital status, or political affiliation.

(5) The department recognizes that its obligation to conduct the services in accordance with the requirements of the law and the regulations extends to all activities arising out of the provision of the services which are conducted by other agencies, institutions, organizations, or political subdivisions, through contracts, or other arrangements with the department. This includes any activity supported with the aid of federal financial assistance or with the aid of any nonfederal funds, property, or other resources required to be expended or made available for the services to meet matching requirements, and also includes other conditions which must be met in order to receive the federal financial assistance.

(6) The department will make available to participants, beneficiaries, and other interested persons such information regarding the provisions of pertinent federal laws and regulations, and make available such information in such manner, as may be required by the commissioner of rehabilitative services administration to apprise such persons of the protections against discrimination assured them by law and regulation and will require the same from other agencies, institutions, organizations, or political subdivisions participating in the program.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-203 and 53-7-302, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-203, 53-7-302 and 53-7-303, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; TRANS, from SRS, 1998 MAR p. 2040.

Subchapter 37.30.10 Standards for Facilities and Providers of Services

Mont. Admin. R. 37.30.1001 Standards for Providers of Services Funded Through Certain Disability, Employment, and Transitions Programs: Generally

(1) Services that the department purchases to be delivered to persons who are applicants for or who are eligible consumers of the Vocational Rehabilitation Program, the Blind and Low Vision Program, the Older Blind Program, the Independent Living Program, the Extended Employment Program, or the Visual Medical Program must be appropriate to meet the needs of the person for whom they are purchased.

(2) The department purchases services for applicants and consumers only from entities or persons that meet the required or appropriate, as determined by the department, accreditation, certification, licensure or other requirements and criteria made applicable by law, accrediting body, or as provided for in ARM Title 37, chapter 30, subchapter 1.

(3) The department reimburses the cost of professional services delivered to persons who are applicants for or who are eligible consumers of the Vocational Rehabilitation Program, the Blind and Low Vision Program, the Older Blind Program, the Independent Living Program, the Extended Employment Program, or the Visual Medical Program only if the person who is to deliver the services is currently professionally licensed to provide the type of services that are to be delivered to the applicant or consumer and is in conformance otherwise with the professional standards that are appropriate for the profession the person is practicing. A provider of professional services is a person who provides services to persons with disabilities for the purposes of furthering their employment or life skills and who are subject under state law to licensure as a particular type of professional services practitioner.

(4) The department reimburses the cost of program services delivered to persons who are applicants for or who are eligible consumers of the Vocational Rehabilitation Program, the Blind and Low Vision Program, the Older Blind Program, the Independent Living Program, the Extended Employment Program, or the Visual Medical Program only if the department, in accordance with ARM Title 37, chapter 30, subchapter 1, has certified the entity that is to deliver the program services as an enrolled provider of services and the entity is in conformance with all legal requirements necessary for the conduct of business, including but not limited to licensure, incorporation and registration, and federal and state laws and regulations on tax and wage and hour requirements. A provider of program services is an incorporated or other legal business entity that provides services to persons with disabilities for the purposes of furthering their employment or life skills.

(5) The department may evaluate through quality assurance reviews, inclusive of service inspections and consumer and provider interviews, and other measures the quality of professional and program services delivered to consumers of the Vocational Rehabilitation Program, the Blind and Low Vision Program, the Older Blind Program, the Independent Living Program, the Extended Employment Program, or the Visual Medical Program. The department based upon those evaluations and other pertinent information as it may note or receive from third parties may take any appropriate measures, including termination of the provider relationship, to assure that consumers receive appropriate and effective services and that state and federal monies are appropriately managed and accounted for.

History

Authorizing statute(s): 53-2-201, 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-2-201, 53-7-102, 53-7-103, 53-7-203, 53-7-302, 53-7-303, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2010 MAR p. 1318, Eff. 5/28/10; AMD, 2013 MAR p. 789, Eff. 5/10/13; AMD, 2013 MAR p. 2309, Eff. 12/13/13.

Mont. Admin. R. 37.30.1002 Standards for Providers of Services Funded Through Certain Disability, Employment, and Transitions Programs: Enrollment as a Provider of Program Services

(1) The department in its discretion may enroll an entity as a provider of program services for the Vocational Rehabilitation, Blind and Low Vision, or Extended Employment Programs if the entity is currently accredited as follows or is provisionally enrolled as provided for in (7) or is approved for limited enrollment by the department as provided for in (8) or (9):

(a) for providers of vocational rehabilitation and extended employment services, the entity must be accredited by either the Commission of Accreditation of Rehabilitation Facilities (CARF) or the Rehabilitation Services Accreditation System (RSAS); and

(b) for providers of low vision and blind services, the entity must be accredited by either the National Accrediting Council (NAC) or of CARF.

(2) The department in its discretion may enroll an entity as a provider of program services for the independent living programs if the entity is currently recognized and funded as an authorized independent living center by the federal Centers for Independent Living Program of the U.S. Department of Education or is provisionally enrolled as provided for in (7) or is approved for limited enrollment by the department as provided for in (8) or (9).

(3) The standard term of enrollment for a provider of program services is three years. If the enrollment is predicated upon an accreditation or authorization that is for a shorter term than three years, then the term of enrollment coincides with that term.

(4) The department may disenroll a provider at any time upon a determination by the department that the provider:

(a) is no longer accredited by an accrediting body;

(b) is no longer approved or authorized by another state or federal services program;

(c) is failing to perform in accordance with the various program and licensing standards and requirements that are applicable to the provider's service performance;

(d) is failing to prepare, maintain, or provide reports and other documentation necessary for monitoring performance and accounting for service delivery;

(e) is failing to perform in accordance with the terms of any contract the provider has entered into with the department for the delivery of vocational rehabilitation, blind and low vision, older blind, visual medical, extended employment or independent living services; or

(f) is violating or failing to conform with state or federal law.

(5) The department may review the enrollment status of a provider at any time. A review may include a site review.

(6) Copies of the standards adopted and incorporated by reference in this rule may be obtained as follows:

(a) the CARF standards may be obtained by temporary loan from the department through the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, P.O. Box 4210, Helena, MT 59604-4210 or by purchase from CARF, 4891 E. Grant Road, Tucson, AZ 85712;

(b) the NAC standards may be obtained by temporary loan from the department through the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, P.O. Box 4210, Helena, MT 59604-4210 or by purchase from NAC, 15 E. 40th Street, Suite 1004, New York, NY 10016;

(c) the RSAS standards may be obtained by temporary loan from the department through the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, P.O. Box 4210, Helena, MT 59604-4210 or by purchase from RSAS, 1309 Horne Street NE, Olympia, WA 98516; and

(d) copies of the federal requirements for a federally authorized independent living center may be obtained through the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, P.O. Box 4210, Helena, MT 59604-4210.

(7) An entity, that in accordance with (1) or (2) must receive accreditation in order to be enrolled, may be provisionally enrolled by the department until the entity receives the appropriate accreditation. A provisionally enrolled provisional enrollment may not be for more than 18 months. A provider may not receive another provisional enrollment, consecutive with a prior provisional enrollment unless the department determines that the provisional reenrollment is necessary due to matters of process relating to the accreditation and that the provider is making a good faith effort to become accredited.

(8) The department may enroll an entity that is not accredited as provided in (1) or (2), if the entity is necessary to the delivery of services to an applicant or consumer, and if the entity has formal approval to act as a provider from another state or federal services program with which the department has a cooperative agreement concerning the coordinated delivery of services.

(9) The department may provide for the limited enrollment of an entity that is not enrolled as provided for in of this rule if that entity can provide one or more services to a consumer in an area or circumstance that lacks an available enrolled provider. Limited enrollment may be limited with respect to time period, location, type of services, and any other pertinent parameters.

(10) If enrollment is denied, the department must give notice to the entity of the reasons for the decision 30 days from the date that the entity submitted a proposal to enroll.

(11) If enrollment is to be revoked by the department, the department must give notice to the provider of the reasons for the decision 30 days in advance of the date on which the department will cease to purchase services from the provider.

History

Authorizing statute(s): 53-2-201, 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-2-201, 53-7-102, 53-7-103, 53-7-203, 53-7-302, 53-7-303, MCA
History: NEW, Eff. 6/4/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1997 MAR p. 1204, Eff. 7/8/97; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2010 MAR p. 1318, Eff. 5/28/10; AMD, 2013 MAR p. 789, Eff. 5/10/13; AMD, 2013 MAR p. 2309, Eff. 12/13/13.

Mont. Admin. R. 37.30.1006 Standards for Providers: on Site Evaluation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-203, 53-7-302, 53-7-303, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2010 MAR p. 1318, Eff. 5/28/10.)

Mont. Admin. R. 37.30.1007 Standards for Providers: Professional Providers

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-203, 53-7-302, 53-7-303, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2010 MAR p. 1318, Eff. 5/28/10.

Mont. Admin. R. 37.30.1030 Rehabilitation Facilities: Policies on Establishment

(1) The department may within its discretion financially participate in the establishment and development of rehabilitation facilities.

(2) The department does not financially participate in any of the following aspects of the establishment or development of rehabilitation facilities:

(a) acquisition of land;

(b) acquisition of buildings;

(d) construction of buildings;

(e) architect's fees;

(f) site preparation;

(g) initial fixed or movable equipment; or

(h) works of art.

(3) The department does not participate financially in the establishment of work activity centers.

(4) Prior to the establishment of a rehabilitation facility, the department will certify that there is a need for the rehabilitation facility, that the establishment of the facility is consistent with the state rehabilitation facilities plan, and that the facility will be in compliance with all federal and state laws and statutes governing civil rights.

(a) In order to be approved by and to receive financial assistance from the department a rehabilitation facility must submit the complete plans, specifications and costs of all construction, equipment, and related expenses for the proposed facility to the department for final approval.

(b) The certification by the state under this rule and ARM 37.30.1002 are not a guarantee of grants nor of purchases of services by the department.

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-302, 53-7-303, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2005 MAR p. 2257, Eff. 11/11/05.

Subchapter 37.30.13 Confidential Information

Mont. Admin. R. 37.30.1301 Confidential Information

(1) The confidentiality of client information will be assured in accordance with federal and state statutes and rules and with departmental policy.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-203 and 53-7-302, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-203, 53-7-302 and 53-7-303, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; TRANS, from SRS, 1998 MAR p. 2040.

Subchapter 37.30.14 Procedures for Client Grievances

Mont. Admin. R. 37.30.1401 Fair Hearings

(1) An applicant for or consumer of services provided through this chapter who is the subject of an adverse action of the department may pursue a fair hearing as permitted by and in accordance with this rule, the applicable rules in ARM Title 37, chapter 5 specified in ARM 37.5.125 and Montana Vocational Rehabilitation Policy E, "Counselor Determinations".

(2) An adverse action is any determination made by the department with respect to an applicant's or consumer's concerning eligibility for, placement into a particular category for purposes of order of selection, or termination from services, or with respect to the selection and delivery of services delivered to a consumer under this chapter.

(3) At the time of application an applicant is informed of:

(a) the right of an applicant or consumer to a fair hearing;

(b) the procedure for requesting a fair hearing;

(d) the availability of any advocacy and free legal representation; and

(e) the availability of mediation provided through the services of a qualified impartial mediator.

(4) The department provides notice of an adverse action at least 10 days prior to the action unless the action relates to a change mandated by law or applied to the appealing party as a member of a class of consumers.

(5) An attorney or third party person may represent an appealing party. Representation must be shown by written consent. If an appealing party is unable to provide written consent, the hearing officer may make a written determination that the representative for the appealing party is proper.

(6) The hearing officer renders a written opinion, including findings and conclusions, within 30 days of final submission of the case.

(7) The hearing officer must reach a decision in the matter based on the provisions of the relevant state and federal statutory and rule authorities and of the state plan submitted by the vocational rehabilitation agency to and approved by the federal government.

(8) Appeal from a decision of a hearing officer is available as provided in ARM 37.5.334. Appeals of determinations under this chapter may not be made to the board of public assistance.

(9) The department adopts and incorporates by reference the conciliation procedures, dated December 27, 2002, and published by the department as Policy E, "Counselor Determinations", of the Montana Vocational Rehabilitation Manual. A copy of the policy may be obtained through the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, 111 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, 53-19-112, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-7-105, 53-7-106, 53-7-203, 53-7-205, 53-7-206, 53-7-302, 53-7-303, 53-7-310, 53-7-314, 53-19-103, 53-19-106, 53-19-112, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02; AMD, 2005 MAR p. 2257, Eff. 11/11/05; AMD, 2013 MAR p. 789, Eff. 5/10/13.

Mont. Admin. R. 37.30.1402 Provider Client Grievances Procedures

(1) Providers of vocational rehabilitation services must establish and maintain client grievance procedures.

(2) Any matter of grievance not adequately resolved between a provider of services and a client may be brought to the department for review and resolution.

History

Authorizing statute(s): Sec. 53-7-102 and 53-19-112, MCA
Implementing statute(s): Sec. 53-7-102 and 53-19-103, MCA
History: NEW, 1985 MAR p. 1569, Eff. 10/18/85; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.1403 Fair Hearings: Review of Fair Hearing Decisions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-7-102, 53-7-206, 53-7-302, 53-7-315 and 53-19-112, MCA
Implementing statute(s): Sec. 53-7-103, 53-7-105, 53-7-106, 53-7-203, 53-7-205, 53-7-206, 53-7-302, 53-7-303, 53-7-310, 53-7-314, 53-19-103, 53-19-106 and 53-19-112, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Subchapter 37.30.16 Extended Employment Program

Mont. Admin. R. 37.30.1602 Extended Employment Services: Objectives

(1) The objectives of the extended employment program are:

(a) to facilitate the development of appropriate employment opportunities in community-based integrated job sites for persons with severe disabilities determined by the department to be in need of extended employment;

(b) to encourage community integration of persons with disabilities by developing community-based, extended employment positions; and

(c) to provide opportunities for persons with significant disabilities who cannot be readily absorbed through the competitive job market to participate in extended employment programs in Montana.

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, MCA
Implementing statute(s): 53-7-203, 53-7-206, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.1603 Extended Employment Services: Responsibility for Functions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, MCA
Implementing statute(s): 53-7-203, 53-7-205, 53-7-206, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.1608 Extended Employment Services: Extended Employment Committees

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, MCA
Implementing statute(s): 53-7-203, 53-7-205, 53-7-206, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.1612 Extended Employment Services: Program Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-203, 53-7-206, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; REP, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.1613 Extended Employment Services: Eligibility

(1) The department develops and maintains a prioritized waiting list from which applicants for extended employment services are drawn as funding allows.

(2) Applicants are selected to be served from the waiting list based on determination of eligibility date. The applicant available for services with the earliest determination date is offered the service.

(3) A person is eligible for the extended employment program if the person has:

(a) a significant disability;

(b) historically lacked the skills of independence and other skills so as not to have been competitively employed or, if employed, the employment has been interrupted or intermittent as a result of those disabilities; and

(4) Those persons eligible for comparable services provided by the department must fully utilize those services before they may be considered for eligibility for extended employment services.

History

Authorizing statute(s): 53-7-102, 53-7-203, 53-7-206, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-203, 53-7-205, 53-7-206, MCA
History: NEW, Eff. 1/3/77; AMD, 1984 MAR p. 511, Eff. 3/30/84; AMD, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2002 MAR p. 3628, Eff. 12/27/02.

Mont. Admin. R. 37.30.1614 Extended Employment Services: Supported Employment Requirements

(1) Supported employment may be provided to a client who needs assistance in entering into competitive work in integrated work settings.

(2) Supported employment as an extended employment service may be provided only in an employment setting where:

(a) the person with disabilities is not part of a work group of other persons with disabilities and most coworkers are not disabled;

(b) the person with disabilities is part of a work group of no more than eight persons with disabilities and there is regular contact with persons who are not disabled and who are not providing support services to the persons with disabilities; or

(c) the person with disabilities works alone and is in regular contact with persons who are not disabled and who are not providing support services to the person with disabilities.

History

Authorizing statute(s): 53-7-206, MCA
Implementing statute(s): 53-7-203, 53-7-206, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.1615 Extended Employment Services: Sheltered Employment Requirements

(1) Sheltered employment as an extended employment service may be provided only in an employment setting where the employer is a sheltered employment provider and the employment setting is within a sheltered workshop or is a setting that is not a supported employment setting.

History

Authorizing statute(s): 53-7-206, MCA
Implementing statute(s): 53-7-203, 53-7-206, MCA
History: NEW, 1992 MAR p. 2572, Eff. 11/26/92; TRANS, from SRS, 1998 MAR p. 2040.

Subchapter 37.30.23 Older Blind Program

Mont. Admin. R. 37.30.2301 Older Blind Program: Definitions

Definitions for purposes of this subchapter:

(1) "Advisory council" means the Montana Vocational Rehabilitation Council.

(2) "Community awareness" means conducting activities to help improve public understanding and knowledge of the aspects of blindness and low vision and the problems facing older blind persons.

(3) "Consumer" means a person who the program has determined is eligible for and may receive older blind services.

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

(5) "Functional areas" mean types of performance and assistance necessary for a person to successfully function independently in daily life and includes mobility, access to print information, self-care, independent living skills, access to technology, recreation, and social activities.

(6) "Impediment" means, for a person, an obstacle or inability to perform a task or achieve a goal that is caused by a disabling condition.

(7) "Independent Living Plan" means the plan prepared by the department in conjunction with the consumer. This plan specifies the independent living goals of the consumer, and the older blind services the department may provide to the consumer in order to assist the consumer to attain an improved quality of life.

(8) "Independent living skills training" means training in compensatory skills, including use of adaptive equipment that allows a consumer with visual impairments to cope with vision loss, perform daily living activities, and participate more independently in the community.

(9) "Individual advocacy training" means helping a consumer to identify their independent living needs, to develop a plan of action to meet those needs, to obtain and use resource information, and to develop problem-solving skills necessary for ensuring an independent and self-determined lifestyle.

(10) "Information and referral" means providing a consumer with basic information on equipment, financial assistance, recreation, housing, and attendant care, support groups, legal rights, and other disability and community topics and resources.

(11) "Legally blind" means:

(a) a person's central visual acuity does not exceed 20/200 in the better eye with correcting lenses; or

(b) a person's visual field at the widest diameter subtends an angle no greater than 20 degrees.

(12) "Low vision" means a person has significant visual impairment that even with correction makes performance of daily tasks difficult.

(13) "Maintenance" means payments made to fund food, shelter, or clothing for a consumer.

(14) "Mobility training" means sequential instruction to a consumer in the use of remaining senses to determine position within the environment and techniques for safe movement from one place to another.

(15) "Orientation and mobility specialist" means a qualified professional in orientation and mobility either employed or contracted by the department who provides training to consumers so they can navigate safely in their home and community environments and access public transportation.

(16) "Peer counseling" means counseling and support provided to a consumer who is experiencing personal issues related to vision loss by another person or group who has had similar experiences. The peer helper functions as a role model, advocate, and resource person for the consumer.

(17) "Program" means the Blind and Low Vision Services Program administered by the department.

(18) "Qualified blind and low vision staff" or "qualified staff" means a rehabilitation teacher, vision rehabilitation therapist, orientation and mobility specialist, or the rehabilitation counselor employed by the program.

(19) "Rehabilitation counselor" means a vocational rehabilitation counselor who meets the standards of qualified professional as identified by the Montana Vocational Rehabilitation program and is employed by the program.

(20) "Rehabilitation teacher" or "vision rehabilitation therapist" means a qualified professional in rehabilitation teaching for blind and low vision persons either employed or contracted by the program who instructs consumers in functional areas of independent living.

(21) "Rehabilitation teaching services" or "vision rehabilitation therapy services" mean the assessment of a consumer's need for and training in compensatory skills for functional areas to assist the consumer in coping with vision loss.

(22) "Significant visual impairment" means a person has vision loss of acuity or field that even with correction limits a person's activities or ability to function in a normal manner.

(23) "Supportive services" mean services provided by family members or other persons, organizations, or institutions to assist the consumer in functional areas.

(24) "Totally blind" means a person has only light perception remaining or has no light perception.

(25) "Visual disability" means a person has been determined diagnostically to be totally blind, to be legally blind, to have low vision, or to have significant visual impairment.

History

Authorizing statute(s): 53-2-201, 53-7-102, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-301, 53-7-302, 53-7-303, 53-7-306, MCA
History: NEW, 2007 MAR p. 475, Eff. 1/12/07.

Mont. Admin. R. 37.30.2302 Older Blind Program: Eligibility

(1) A person may receive older blind services if the program determines that the person:

(a) has appropriately applied for services;

(b) is 55 years or older in age;

(d) due to the visual disability, will either have extreme difficulty in obtaining competitive employment or in the absence of an employment goal has feasible independent living goals;

(e) requires services available through the program that will contribute to the person's maintenance or increased independence; and

(f) meets the other requirements of this subchapter applicable to program eligibility.

(2) The presence of a visual disability and the need for program services may be determined by qualified staff based upon a functional assessment of the person's vision.

(3) A consumer's eligibility for services terminates when:

(a) a qualified staff member determines that the goals of the consumer's independent living plan have been achieved or cannot be achieved;

(b) due to fiscal or personnel resource exigencies the consumer's service delivery category is closed or the consumer is among the consumers whose service delivery is closed due to a reduction in the number of persons who can be served in the consumer's service delivery category;

(d) the consumer is no longer available for services.

(4) Prior to termination of a consumer's eligibility, the program will provide the consumer with notice of the termination and provide the consumer with the opportunity to seek an informal review of the proposed termination. If the person remains dissatisfied with the proposed termination, the person may request a fair hearing as provided for in ARM 37.30.2310.

History

Authorizing statute(s): 53-2-201, 53-7-102, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-301, 53-7-302, 53-7-303, 53-7-306, MCA
History: NEW, 2007 MAR p. 475, Eff. 1/12/07.

Mont. Admin. R. 37.30.2303 Older Blind Program: Reduction of Service Population

(1) The department, in accordance with state and federal law, administers the program to assure the fiscal integrity of the program. If the division determines that there are insufficient fiscal or personnel resources to appropriately serve consumers, the department will limit service delivery based upon the criteria in (2) through (5).

(2) For the purposes of limiting service delivery in order to meet fiscal and personnel resources exigencies, the following categories are applicable:

(a) Category 1, for consumers already accepted into the Older Blind Program.

(b) Category 2, for consumers who are totally blind.

(c) Category 3, for consumers who are legally blind and at risk of moving into a less independent environment due to vision loss.

(d) Category 4, for consumers with low vision (best acuity with correction of 20/80 or less in the better eye) or significant visual impairment that affects four or more areas of functioning, and consumers who are legally blind but not at risk of moving into a less independent environment.

(e) Category 5, for all other consumers with a significant visual impairment.

(3) For purposes of implementing service delivery limitations due to insufficient fiscal or personnel resources, the division will close, as appropriate to meet the fiscal and personnel resources exigencies, one or more categories of service delivery beginning with level 4. For each service delivery category closed, the department will initially close that category to further consumers. Consumers in that category already in receipt of services will continue to receive services unless it is necessary due to the exigencies to initiate closure of services to all persons in that category.

(4) If the department determines that there are fiscal or personnel resources available to serve some, but not all, of the consumers in a particular service delivery category, the department will continue to serve that number of consumers in that category for which it has adequate fiscal or personnel resources. Consumers to be served will be selected based upon the consumers' dates of application for the program beginning with the earliest date of application.

(5) If the department determines that there are fiscal or personnel resources available by which to begin to open a previously closed service delivery category but not serve all possibly eligible persons in that category, the department will serve that number of consumers for which it has adequate fiscal or personnel resources based upon the consumers' dates of application for the program beginning with the earliest date.

History

Authorizing statute(s): 53-2-201, 53-7-102, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-301, 53-7-302, 53-7-303, 53-7-306, MCA
History: NEW, 2007 MAR p. 475, Eff. 1/12/07.

Mont. Admin. R. 37.30.2306 Older Blind Program: Scope of Services

(1) Older blind services are services determined by qualified staff to be necessary to assist a consumer with maintaining or increasing independence consistent with a consumer's priorities, concerns, abilities, interests, and choice.

(2) Older blind services include:

(a) outreach;

(b) low vision assessment, instruction, and assessment equipment;

(d) services and equipment fostering mobility and self-sufficiency;

(e) mobility training, Braille instruction, and other services and equipment to help an older individual who is blind adjust to blindness;

(f) independent living skills training;

(g) information and referral services;

(h) peer counseling;

(i) individual advocacy training;

(j) supportive services;

(k) rehabilitation teaching services;

(l) training necessary for living in the community and participating in community activities; and

(m) any other appropriate service designed to assist with daily living activities.

(3) Services may be made available in the discretion of the program to enhance a consumer's independence, productivity, and to further the quality of life, and independence of consumers as a group. Those services include, but are not limited to:

(a) community awareness programs to enhance understanding and integration into society; and

(b) activities to help improve public understanding of problems of consumers.

(4) Services provided to an individual consumer must be provided in accordance with the independent living plan.

History

Authorizing statute(s): 53-2-201, 53-7-102, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-301, 53-7-302, 53-7-303, 53-7-306, MCA
History: NEW, 2007 MAR p. 475, Eff. 1/12/07.

Mont. Admin. R. 37.30.2310 Consumer Grievances and Fair Hearings

(1) A provider of older blind services must make available an informal procedure for resolution of any grievance that a consumer may have. Any matter of grievance not adequately resolved between a provider of services and a consumer may be brought before the department for review and resolution.

(2) An applicant for or consumer of older blind services provided through this subchapter who is the subject of an alleged adverse action of the program may pursue a fair hearing as permitted by and in accordance with this rule and ARM 37.30.1401.

History

Authorizing statute(s): 53-2-201, 53-7-102, 53-7-302, 53-7-315, MCA
Implementing statute(s): 53-7-301, 53-7-302, 53-7-303, 53-7-306, MCA
History: NEW, 2007 MAR p. 475, Eff. 1/12/07.

Subchapter 37.30.25 Blind Vendors Program

Mont. Admin. R. 37.30.2501 Definitions

(1) "Act" means the Blind Vendors Act codified as part 4 of Title 18, chapter 5, MCA.

(2) "Blind person" means a person whose central visual acuity does not exceed 20/200 in the better eye with correcting lenses or whose visual acuity is greater than 20/200 but is accompanied by a limitation in the field of vision in the better eye to such a degree that the widest diameter of the visual field subtends an angle no greater than 20 degrees as determined by an ophthalmologist or a physician skilled in diseases of the eye.

(3) "Blind vendor" means a person certified as a blind person for the purpose of this subchapter and who is operating a vending facility administered by the department.

(4) "Blind vendors program" means the program administered by the department for the purpose of providing to certified blind persons the business opportunities authorized by Title 18, chapter 5, part 4, MCA. The blind vendors program is administered in conjunction with the business enterprise program of the department.

(5) "Business enterprise facility" for the purpose of this subchapter means a vending facility administered by the department.

(6) "Certified blind person" means a blind person whom the department has determined is a blind person as defined in this subchapter, is in need of vocational opportunities, and is qualified to operate a vending facility.

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

(8) "Federal property" means buildings or portions of buildings or other real property owned or leased by the federal government excluding military reservations upon which the department may administer vending facilities by an agreement entered into under the authority of the federal Randolph-Sheppard Act, as amended.

(9) "License" means the certification of a blind person provided for in 18-5-403, MCA, for the purpose of providing vocational opportunity through a state-administered vending stand.

(10) "Licensing agency" means the visual service division, department of public health and human services, state of Montana.

(11) "Net proceeds" means the amount remaining from the sale of articles or services of vending facilities, and any vending machine or other income accruing to blind vendors after deducting the cost of such sale and other expenses (excluding set-aside charges required to be paid by such blind vendors).

(12) "Nominee" means a non-profit agency or organization designated by the state licensing agency through a written agreement to act as its agent in the provision of services to blind licensees under the state's vending facility program.

(13) "Other property" means all real property other than state or federal property as defined in this rule.

(14) "State property" means those buildings or portions of buildings or other real property owned or leased under a lease-purchase agreement, or in the case of a building, leased in its entirety by the state or agencies of the state that are utilized in the conduct of state matters and occupied principally by state employees. State property for the purpose of this subchapter does not include vocational institutions or institutions of higher education.

(15) "Vending facility" means an area and equipment inclusive of vending machines on state, federal or other property which is or may be utilized in providing a food, beverage, or other service to employees and other persons present on the property, and may include any of the following:

(a) shelters, counters, shelving, display and wall cases, refrigerating apparatus, and other appropriate auxiliary equipment that is necessary for the vending of articles that are approved by the agency, or other authority having care, custody and control of the property in or on which the vending stand is located;

(b) manual or coin operated vending machines or similar devices for vending the approved articles;

(16) "Vending machine" means a device for the dispensing of foodstuffs, liquids, or other products when money is inserted into the device. Vending machine does not include postage stamp machines or coin-operating telephones.

(17) "Vendor" means either a blind vendor or any person who is by contract temporarily managing and operating a business enterprise facility which is part of the blind vendors program.

(18) "Vocational rehabilitation programs" means those programs provided for under the federal Randolph-Sheppard Act, as amended, and Title 53, chapter 7, part 3, MCA.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-401 through 18-5-416, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2505 Establishment of Business Enterprise Facilities

(1) Upon written notification by an agency in control of state property or responsible for the construction or remodeling of state property that a vending facility is desired on the property, or, upon its own initiative, the department shall:

(a) survey the property (or blueprints, plans, and other similar, available information) to determine if the installation of a business enterprise facility for the blind vendors program is feasible and consonant with its vocational rehabilitation objectives; and if it so determined, provide for a business enterprise faciity to be installed on that property by the department.

(2) State agencies which now have a vending facility not administered by the department as a business enterprise facility shall give notice to the department when any existing agreement relating to the management of that facility terminates. At that time the department may exercise its authority to administer that facility as a business enterprise facility.

(3) The department is responsible for designating business enterprise facility locations on state and other property for the purposes of the blind vendors program.

(4) An agency responsible for state and other property shall at the direction of the department alter the property to make it suitable for a vending facility.

(5) The installation, modification, relocation, removal, and renovation of vending facilities will be subject to prior approval and supervision of the on site official responsible for the property and the department. The costs of relocation of vending facilities shall be paid by the initiator of the request.

(6) Additional vending facilities may not be installed on property having a business enterprise vending facility unless an agreement is reached between the agency and the department concerning the installation and operation of the competing vending facilities.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-411, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2510 Issuance and Conditions of Certification

(1) In order to be eligible to be a certified blind person for the purposes of this subchapter, one has to be an accepted client of the vocational rehabilitation program.

(2) Criteria in the issuance of certification. Preference will be given to blind persons who are in need of employment for economic reasons and who are residents of the state of Montana, but in all instances certifications will be issued only to persons who meet the following criteria:

(a) the person has been determined to be blind as defined in ARM 37.30.2501(2) by the department;

(b) the person is a citizen of the United States;

(d) the person is determined by the department to be qualified to operate a business enterprise facility; and

(e) the person is determined by the department to be in need of vocational opportunities.

(3) List of eligibles for placement:

(a) Applications for a position as a blind vendor will be accepted from anyone who meets the cited criteria. A record will be maintained of those applying. From this list of applications the department will select those suitable for training.

(b) Applicants who have successfully completed the training program or who have otherwise been certified as qualified blind vendors will be placed on the eligible list for placement in the following order:

(i) applicants who reside in the geographical area where a vacancy occurs or a new facility is being established;

(ii) substitute vendors who merit being placed as regular managers;

(iii) newly trained vendors; these persons will be placed on the list in order of their certification for the program;

(iv) former blind vendors who desire to return to the program and whose previous records do not preclude their return.

(4) Initial placement to be probationary:

(a) An applicant selected for placement as a blind vendor will initially be on probationary placement for a period of 6 months.

(b) The probationary placement is to provide for:

(i) adjustment of the blind vendor to the requirements of the physical environment;

(ii) adjustment of the blind vendor to the mental and physical requirements of a continuous work situation;

(iii) amelioration of any training deficiencies;

(iv) insuring that requirements of the building management can be satisfactorily filled.

(c) If during the probationary period the department determines that the probationary blind vendor is not successfully meeting the duties of facility operation or is unable to meet the requirements of the building management, the probationary appointment will be terminated unless extended at the discretion of the department.

(5) Contracting:

(a) The department will contract with certified blind vendors placed by the department for performance of their services.

(i) The contracts will be on an annual basis.

(b) Contract provisions will be in accord with these rules and may include other provisions as the department determines may be necessary for the conduct of the program, the furtherance of the services provided by the department to the vendor, and the assurance of the quality of services provided by the vendor.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-403, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; AMD, 1984 MAR p. 991, Eff. 6/29/84; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2515 Transfer and Termination

(1) If the transfer of a blind vendor from one stand to another becomes desirable or necessary, a transfer will be made only when the department, the blind vendors program and the blind vendor would benefit from such transfer. To be taken into consideration will be the vendor's capacity to perform the duties of a particular facility, relationship to the public as a result of the transfer, effect to the particular business enterprise facility, the tenure and earnings of the vendor involved.

(2) In the event of the inability of the blind vendor to fulfill his responsibilities, the department may forthwith assume the operation of the facility. When circumstances warrant such action, the blind vendor may be temporarily relieved of duties by the department.

(3) Termination:

(a) Certifications shall be issued for an indefinite period but may be terminated by the blind vendor giving 60 days written notice to the department if he desires to resign.

(b) Any certification issued to a blind vendor may be revoked by the department, by written notice when the department determines that the facility is not being operated in accordance with these rules and regulations, the terms and conditions governing the permit with the building management, or the contract with the blind vendor.

(c) Any certification may be terminated or suspended, if because of improvement of vision, the blind vendor no longer meets the criteria as defined in this rule.

(d) Any certification may be terminated or suspended because of extended illness with medically documented diagnosis of prolonged incapacity of the blind vendor to operate a vending facility in a manner consistent with the needs of the location or other available locations in the program.

(e) The blind vendor shall expressly release the department, its agents or employees from any loss, injury, damage or expense which the vendor may suffer, sustain, or incur by reason of such termination.

(f) The 60 day written notice may be waived by mutual consent of all parties concerned.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-403, 18-5-411 and 18-5-415, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; AMD, 1984 MAR p. 991, Eff. 6/29/84; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2520 Equipment, Stocks and Insurance

(1) The department will provide each business enterprise facility with fixtures and equipment in such quantity and of such quality so as to give reasonable assurance of successful operation by the vendor. Funds for this purpose may be made available from federal and state allocations or appropriations, including set aside funds.

(a) The department shall retain the right, title, and interest to all facility equipment and leases. It shall have the authority to direct, control, transfer, and dispose of such equipment when necessary.

(b) The vendor will make no additions or reductions to the facility and its operation either in the form of equipment, fixtures, goods for resale, or facilities without first obtaining authorization from the appropriate agent of the department.

(2) The department will maintain or cause to be maintained all equipment in a safe and satisfactory working condition subject to the following:

(a) Replacement in lieu of repair shall be a decision of the department.

(b) It is the vendor's responsibility to report at the first opportunity to the department any incident resulting in damage, breakage, theft, defacement or malfunction of equipment or fixtures provided for his use. The first $400 of yearly maintenance and repairs will be paid by the vendor.

(c) The vendor is authorized to arrange for emergency repairs to avoid loss of perishable stocks, to avoid endangering life or property. The reporting requirement of (b) is to be followed in all cases.

(d) Each vendor shall take reasonable care of equipment in his facility and carry out routine, day to day maintenance procedures.

(3) The department will provide to a blind vendor initial stock for resale and a "change fund" in the amount of $50.00 for opening of the business enterprise facility. The blind vendor will maintain an inventory of stock and/or cash which may exceed the value of the initial stock and "change fund" but may not be less than 80% of the initial stock and "change fund". Merchandise considered unsalable by the blind vendor shall not be included in the value of any beginning inventory. The blind vendor will be assessed the value of the initial stock against the net profit of the facility upon his resignation from the blind vendors program with the following provisions:

(a) upon resignation or termination, an inventory, valued at wholesale, shall be taken;

(b) any amount in excess of the beginning inventory shall be due the blind vendor after any outstanding obligations to suppliers are met;

(4) The department will obtain and maintain in force applicable public liability and products liability insurance with minimum limits of $500,000 each occurrence, $1,000 medical payments, $25,000 each accident.

(a) such insurance shall name the vendor and the state of Montana as named insured;

(b) the department will provide each unit with a copy of insurance coverage.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-415, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2525 Vendor Responsibilities

(1) The vendor shall receive all income derived from the operation of the business enterprise facility and any assigned vending machines after deducting the operational costs and charges mutually agreed upon. Income from vending machines on non-federal property in direct competition with the facility will be assigned to the vendor (a vending machine will be considered to be in direct competition with the business enterprise facility if it vends articles of a type authorized by the applicable license and is so located that it attracts customers who would otherwise patronize the business enterprise facility) .

(2) The duties of the vendor shall be to:

(a) perform faithfully and to the best of his ability the necessary duties in connection with the operation of the facility in accordance with the department's rules and regulations, the terms of the permits, the agreement, and shall perform in the best interests of the blind vendors program as a whole;

(b) cooperate with duly authorized representatives of the department in connection with their official responsibilities under the program;

(d) furnish such reports as the department may from time to time require;

(i) submit the SRS-VSD-BE-1 by fifteenth of each month;

(ii) submit quarterly inventory by the fifteenth of January, April, July and October;

(e) follow generally acceptable accounting practices;

(f) take no action in the derogation of, or inconsistent with, the paramount right, title, and interest of the department to the facility, its equipment and the lease or agreement with the management of the property;

(g) maintain the highest standard of personal appearance, grooming and behavior so as to win and retain the respect of the clientele of the facility;

(h) pay cash for all merchandise or immediate payment upon receipt of billing;

(i) to report to the department in writing, as soon as practicable, the occurrence of any accident at this facility. This requirement is in addition to the vendor's duty to report any accident to the insurance carrier;

(j) to report to the department any claim or suit which may be brought against the vendor as the result of any accident at the facility. This requirement is in addition to the vendor's duty to report such information to the insurance carrier.

(3) Employment of staff by a vendor:

(a) The vendor shall employ a sufficient number of employees so as to assure the efficient operation of the facility and to provide adequate service to the public. His relationship to this staff shall be the normal employer/employee relationship existing in private business enterprises.

(b) In the employment of permanent and temporary employees the vendor shall give preference to qualified legally blind individuals.

(4) Vacations and leaves of absence:

(a) Annual vacations may be taken by vendors in accord with accepted business practices. Vendors planning to take a vacation should select a substitute vendor, preferably a certified blind person, to assume responsibility for the operation of the facility. Substitute vendors shall be paid by the vendor. The selection of the substitute vendor is a responsibility of the vendor but must be approved by the department. The department must be notified in advance of the period vacations are selected.

(b) Requests for extended vacation periods or leaves of absence for other purposes shall be presented to the department. These requests will be evaluated on their individual merits.

(5) Business relationships:

(a) With vendors;

(i) the vendor shall have a free choice of the vendors from whom he is to make his purchases, provided however, that such vendors are reputable.

(b) With customers;

(i) all business enterprise facilities are to be operated on a cash basis except in unusual circumstances warranting the extension of credit to meet specific recurring customer needs, and then only after prior approval by the department.

(i) the vendor will comply with all requests concerning the operation of the facility that may be made by officials of the building in which the facility is located provided that such requests do not conflict with the certification agreement, the rules and regulations issued by the department and the contract. At no time should the vendor expect the building management or their employees to provide special services or favors.

(ii) When differences arise between the vendor and the building management, the vendor shall bring the matter to the immediate attention of the department for appropriate action.

(6) The department shall in no way be obligated by any debts incurred by the vendor, other than those authorized in writing by the appropriate agent of the department.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-415, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; AMD, 1984 MAR p. 991, Eff. 6/29/84; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2530 Training of Blind Vendors

(1) The department will provide vocational and other training services to assist the individual in preparing for the operation of a vending facility, including personal and vocational adjustment, books, tools, and other training materials. These services shall be provided to blind individuals as vocational rehabilitation services under the Rehabilitation Act of 1973 (P.L. 93-112) , as amended by the Rehabilitation Act Amendments of 1978 (P.L. 95-602) . Such programs will also include on-the-job training in all aspects of vending facility operation and upward mobility training (including further education and additional training or retraining for improved work opportunities) for all certified blind persons.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-404 and 18-5-415, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2535 Department's Set Aside Funds

(1) The department will set aside funds from the net proceeds of the operation of business enterprise facilities under the blind vendors program. To the extent that set aside funds are accumulated as provided for in (2) and (3) , those funds may be used for the purposes of:

(a) maintenance and replacement of equipment;

(b) the purchase of new equipment;

(d) assuring a fair minimum of return to vendors; or

(e) the establishment and maintenance of retirement or pension funds, health insurance contributions, paid sick leave and vacation time, if it is so determined by a majority vote of blind vendors certified by the department, after providing each such vendor information on all matters relevant to such proposed purposes.

(2) The amount of net proceeds for set aside purposes will be computed and reported on the SRS-VSD-BE-1 and paid monthly.

(3) Each unit's set aside fee will be 5% of the net proceeds.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-406, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; AMD, 1984 MAR p. 991, Eff. 6/29/84; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2540 Necessary Compliance

(1) All vendors shall be responsible for acquainting themselves with, and conforming to all laws, ordinances, and governmental rules and regulations pertinent to the conduct and operation of a business enterprise facility.

(2) It shall be the responsibility of the vendor to apply to the appropriate authority to secure required licenses, permits and authorizations.

(3) While every assistance will be given the vendor by the department it shall be the responsibility of the vendor to familiarize himself with the laws and ordinances relative to the operation of the facility and to file any necessary tax returns or other reports.

(4) This program will operate in compliance with section 80.4(b) of the regulations of the department of health, education and welfare (45 CFR, Part 80 effectuating Title VI of the Civil Rights Act of 1964) .

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-404, 18-5-413, 18-5-415, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2545 Organization and Election - State Committee of Blind Vendors

(1) Committee members shall be elected at an annual meeting of all blind vendors.

(2) The committee shall consist of 3 blind vendors, who shall select a chairperson.

(3) Nomination may be made by any of the assembled blind vendors.

(4) Committee members shall be elected for a 2 year term and may serve no more than 3 consecutive terms.

(5) The committee shall meet on an annual basis at a place within the state agreed on by them. Additional meetings may be called by the department or by the chairperson.

(6) Between meetings, functions of the committee will be carried on by individual members of the committee so designated.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-413, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2550 Functions of Committee

(1) The blind vendors committee may advise the department in all matters relating to the blind vendors program.

(2) Committee members shall be kept informed by the department of matters within its purview that are being considered for decision. The committee will receive written notice of and invitations to attend important discussion and decision making meetings in these areas.

(3) The department has the ultimate responsibility of the administration of the blind vendors program and if the department does not adopt the views and positions of the committee it will notify the committee in writing of the decision reached or the action taken and the reasons therefor.

(4) The committee shall receive and transmit to the department any grievance at the request of a vendor, and serve as advocates for such vendor in connection with such grievances.

(5) The committee actively participates with the department in the development of training and retraining program for blind vendors.

(6) If an elected committee member is unable to complete his term on the committee, the chairperson shall appoint another qualified vendor to serve his unexpired term.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-413, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2555 Temporary Operation of Facility by the Department

(1) When a qualified blind vendor is unavailable to operate a vending facility administered by the department under the blind vendors program, the department may provide, through contract, for the temporary management of that facility by a person other than a blind vendor.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-415, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2560 Contracts with Vending Companies

(1) The department will negotiate all contracts with vending companies for the installation of vending machines.

(2) The vending company will be selected by competitive bid. Contracts with vending companies will stipulate the type of equipment, periods of service, quality of service, and the flat fees to accrue to the business enterprise program. A flat fee is an agreed upon monthly unit amount of payment on a per vending machine basis to the department or its agent for purposes of the set aside fund.

(3) The department will negotiate contracts with vending machine companies for the installation of vending machines in public and other buildings in which there is no competition with an existing business enterprise facility. Proceeds from these vending machines may be used, as determined by the department, as best benefits the blind vendors program.

(4) The vendor will be provided a list of assigned vending machines, their locations, and applicable contracts.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-416, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; AMD, 1984 MAR p. 991, Eff. 6/29/84; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2565 Distribution and Use of Vending Machine Income on Federal Property

(1) Vending machine income from vending machines on federal property and other property which has been disbursed to the department by a property managing department, agency, or instrumentality of the United States under the vending machine income sharing provisions in section 395.8 of the Randolph-Sheppard Act of 1974 (PL 93-516) shall accrue to each blind vendor operating a vending operating facility on such federal property in an amount not to exceed the average net income of the total number of blind vendors within such state, as determined each fiscal year on the basis of each prior year's operation, except that vending machine income shall not accrue to any blind vendor in any amount exceeding the average net income of the total number of blind vendors in the United States.

(2) No blind vendor shall receive less vending machine income than he was receiving during the calendar year prior to January 1, 1974, as a direct result of any limitation imposed on such income under this ceiling.

(3) No limitation shall be imposed on income from vending machines, combined to create a vending facility, when such facility is maintained, serviced, or operated by a blind vendor.

(4) The department will retain vending machine income disbursed by a property managing department, agency or instrumentality of the United States in excess of the amount eligible to accrue to blind vendors.

(5) That income accrued for blind vendors will be disbursed quarterly to them by the department.

(6) Vending machine income retained by the department will be used for the establishment and maintenance of retirement or pension plans, for health insurance contributions, and for the provision of paid sick leave and vacation time for blind vendors, if it is so determined by the majority vote of the certified vendors, after each vendor has been furnished information on all matters relevant to such purposes; that any vending machines income not necessary for such purposes shall be used for one or more of the following; maintenance and replacement of equipment; purchase of new equipment; management services; and assuring a fair minimum return to vendors; and that any assessment charged to blind vendors shall be reduced pro rata in an amount equal to the total of such remaining vending machine income.

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-406, 18-5-413 and 18-5-416, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; TRANS, from SRS, 1998 MAR p. 2040.

Mont. Admin. R. 37.30.2570 Informing Vendors of Rights and Responsibilities

(1) Each blind vendor will be provided with a copy of these rules and regulations.

(2) Each blind vendor will be provided with a vending stand operator's manual explaining their duties as vendors of various type vending stands with the qualifications for the various type stand operators.

(3) Blind vendors shall be provided the opportunity for an administrative review and a fair hearing in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337 in any contested matter.

(a) A blind vendor dissatisfied with the decision rendered after a fair hearing, may pursue that due process accorded by the Randolph-Sheppard Act (20 USC 107a) .

History

Authorizing statute(s): Sec. 18-5-414, MCA
Implementing statute(s): Sec. 18-5-404 and 18-5-405, MCA
History: NEW, 1983 MAR p. 657, Eff. 6/17/83; AMD, 1984 MAR p. 991, Eff. 6/29/84; TRANS, from SRS, 1998 MAR p. 2040; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Authorizing statute(s): 53-7-302, MCA
Implementing statute(s): 53-7-302, MCA
History: NEW, 1984 MAR p. 511, Eff. 3/30/84; TRANS, from SRS, 1998 MAR p. 2040; REP, 2025 MAR, Notice No. 37-1087, Eff. 1/11/25.

Chapter 37.31 Independent Living Rehabilitation Program

Subchapter 37.31.1 General Requirements

Mont. Admin. R. 37.31.101 Independent Living Rehabilitation Program: Purposes

(1) The independent living program provides in accordance with Title VII of the federal Rehabilitation Act of 1973 (29 USC 796) comprehensive services to persons with severe disabilities to enable them to live and function independently in community settings.

(2) The program fosters the establishment of centers for independent living in communities.

(3) The independent living centers also may provide for independent living services designed to assist older persons who are blind to adjust to blindness by furthering their ability to care for their individual needs.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-315 and 53-19-112, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-302, 53-19-101, 53-19-103 and 53-19-105, MCA
History: NEW, 1985 MAR p. 1569, Eff. 10/18/85; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1997 MAR p. 1204, Eff. 7/8/97; TRANS, from SRS, 1998 MAR p. 2044.

Subchapter 37.31.2 Services

Mont. Admin. R. 37.31.201 Independent Living Rehabilitation Program: Services

(1) Independent living services include vocational rehabilitation services and other services that the department determines are necessary and will enhance the ability of persons with severe disabilities to live independently and to function within a community setting and, if appropriate, to secure and maintain appropriate employment.

(2) Independent living services are limited to those services specified in Montana's three-year state plan for independent living rehabilitation services submitted to and approved by the federal government. The Montana three-year state plan for independent living services under Title VII of the federal Rehabilitation Act of 1973 (29 USC 796) is adopted and incorporated by reference and may be obtained from the Department of Public Health and Human Services, Disability, Employment, and Transitions Division, P.O. Box 4210, Helena, MT 59604-4210.

(3) Services may include, but are not limited to:

(a) counseling;

(b) services to secure housing or shelter including housing adaptation;

(d) transportation including transportation training, assistance and referral;

(e) personal assistance, including attendant care and the training of personnel providing services;

(f) services and training for persons with cognitive and sensory disabilities, including life skills training, and interpreter and reader services;

(g) services to family members and dependents;

(h) vocational assistance and other training;

(i) information and referral;

(j) services for children with significant disabilities;

(k) advocacy and legal assistance;

(l) independent living skill training;

(m) peer counseling, including cross-disability peer counseling;

(n) individual and group social and recreational activities;

(o) outreach and recruitment;

(p) mobility training;

(q) therapeutic treatment;

(r) rehabilitation technology;

(s) surveys, directories, and other activities to identify appropriate housing, recreation opportunities, and accessible transportation, and other support services;

(t) consumer information programs on rehabilitation and independent living services especially for minorities and other groups of persons that have traditionally been unserved and underserved;

(u) prostheses and other appliances and devices;

(v) training for youth with significant disabilities to promote self-awareness and esteem, develop advocacy and self-empowerment skills, and explore career options;

(w) appropriate preventive services;

(x) community awareness programs to enhance the understanding and integration into society of persons with disabilities; and

(y) other services as may be necessary.

(4) The department may provide only those services it determines are needed, cost effective and for which funding is available.

History

Authorizing statute(s): 53-7-102, 53-7-315, 53-19-112, MCA
Implementing statute(s): 53-7-102, 53-7-103, 53-19-103, 53-19-105, MCA
History: NEW, 1985 MAR p. 1569, Eff. 10/18/85; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1997 MAR p. 1204, Eff. 7/8/97; TRANS, from SRS, 1998 MAR p. 2044; AMD, 2013 MAR p. 789, Eff. 5/10/13.

Mont. Admin. R. 37.31.206 Independent Living Rehabilitation Program: Provision of Services

(1) The department may, within its discretion, provide services to a person who is eligible for the independent living program.

(2) Only such services as are determined appropriate in accordance with the state plan for independent living may be provided to a person accepted for services.

(3) Housing adaptation services are limited to accommodations and modifications of a client's home which the department determines are necessary to the client's receipt of services.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-315 and 53-19-112, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-302, 53-19-103, 53-19-104 and 53-19-105, MCA
History: NEW, 1985 MAR p. 1569, Eff. 10/18/85; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1997 MAR p. 1204, Eff. 7/8/97; TRANS, from SRS, 1998 MAR p. 2044.

Subchapter 37.31.4 Eligibility Requirements

Mont. Admin. R. 37.31.401 Independent Living Rehabilitation Program: Eligibility Requirements

(1) Independent living services may be provided to a person with severe disabilities if:

(a) the person's ability to function independently in the community is limited by the severity of the disability; and

(b) the department determines that there is a reasonable expectation that the person will benefit from independent living services.

(2) Persons with severe disabilities not receiving other vocational and rehabilitation services provided by the department have priority for services provided under this program.

(3) The person's financial needs in relation to the costs of services will be determined as provided in ARM 37.30.401 through 37.30.411.

(4) "Person with a severe disability" means a person whose ability to function independently in family or community or whose ability to engage or continue in employment is so limited by the severity of a disability that independent living rehabilitation services are required in order to achieve a greater level of independence in functioning in family or community or engaging or continuing in employment.

History

Authorizing statute(s): Sec. 53-7-102, 53-7-103, 53-7-315 and 53-19-112, MCA
Implementing statute(s): Sec. 53-7-102, 53-7-103, 53-7-302, 53-19-103, 53-19-105 and 53-19-106, MCA
History: NEW, 1985 MAR p. 1569, Eff. 10/18/85; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1992 MAR p. 2572, Eff. 11/26/92; AMD, 1997 MAR p. 1204, Eff. 7/8/97; TRANS, from SRS, 1998 MAR p. 2044; AMD, 2002 MAR p. 3628, Eff. 12/27/02.

Chapter 37.34 Developmental Disabilities Program

Subchapter 37.34.1 General Requirements

Mont. Admin. R. 37.34.101 Purpose of the Developmental Disabilities Program

(1) The purpose of the developmental disabilities program is to provide quality community-based services in the least restrictive environment which promotes the principle of normalization for persons who are developmentally disabled.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-305, MCA
History: NEW, 1979 MAR p. 1708, Eff. 12/28/79; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 165, Eff. 2/1/13.

Mont. Admin. R. 37.34.102 Definitions

For purposes of this chapter, the following definitions apply:

(1) "Abuse" means the infliction of physical or mental injury or the deprivation of food, shelter, clothing or services necessary to maintain the physical or mental health of an older person or a person with a developmental disability without lawful authority, as described in 52-3-803, MCA. A declaration made pursuant to 50-9-103, MCA constitutes lawful authority.

(2) "Advocate" means a person who:

(a) represents the interests and rights of a person receiving services consistent with the person's interests;

(b) is not an employee of any agency directly providing services to the person receiving services; and

(3) "Applicant" means a person who applies for services, but is not yet accepted into a service program.

(4) "Board" means three meals a day or any other full nutritional regimen. A meal furnished as part of an adult day care program is not considered board.

(5) "Case manager" means the person, employed by either a contractor or the division, who assesses individual service needs, assists individuals to access services, coordinates the planning process, monitors services delivered, and provides crisis management.

(6) "Contract" means any contractual agreement, inclusive of appendices and other duly incorporated writings, for the delivery of services to persons with developmental disabilities entered into by the department with the contractor.

(7) "Contractor" or "provider" means any person or entity providing developmental disabilities services to persons with developmental disabilities through a contract with the department.

(8) "Developmental disabilities services" means the state program of services for persons with developmental disabilities managed through the developmental disabilities program of the department.

(9) "Person with a developmental disability" or "developmentally disabled person" means a person who has a developmental disability as defined in 53-20-202(3), MCA.

(10) "Direct care staff" means a person employed by a contractor in a position the duties of which focus on the hands on delivery of services to persons with developmental disabilities or to their families or both. Direct care tasks include: monitoring and delivering basic life and health care needs, implementing programs, intervening when maladaptive behaviors occur, recording progress toward meeting goals and objectives, documenting incidents, and sharing information with supervisory staff or other professionals according to the policies and procedures of the contractor. In outreach services, direct care tasks may include conducting home visits and providing specialized instruction to family members in the implementation of programs to meet individual needs.

(11) "Program" means the developmental disabilities program of the department of public health and human services.

(12) "Emergency response system" means a system which can be efficiently operated by staff or where appropriate, individuals, that ensures the safety of the people in the home or the facility in an emergency. The system includes well-rehearsed emergency procedures for the people living and working in the facility. The system includes, in addition to emergency response measures, a reliable means of communicating with on-call staff and other people who are available in the event of an emergency. The means of communication may include an immediate electronic access to ambulance, fire department, medical staff, police and other staff within the corporation.

(13) "Evaluation" means a process for making determinations regarding whether disabling conditions are present, determining individual needs and making specific recommendations or selecting treatment alternatives to address those needs.

(14) "Exploitation" means the unreasonable use of an older person or a person with a developmental disability, the person's money or the person's property to the advantage of another by means of duress, menace, fraud or undue influence.

(15) "Family" means natural parents, adoptive parents, foster parents, grandparents, guardians, stepparents, or others with whom a child lives and non-custodial parents and other persons who are legally responsible for the child's welfare.

(16) "Habilitation" means the process to assist a person with developmental disabilities in acquiring and maintaining those life skills which enable the person to cope more effectively with the demands of the environment and to improve physical, mental and social efficiency. Habilitation includes, but is not limited to, formal structured education and treatment.

(17) "Incidents" means significant events, acts or omissions not otherwise permitted which result or may result in physical or emotional harm to an individual or which intentionally deprive an individual of acknowledged rights, including, but not limited to:

(a) death;

(b) harm or illness requiring hospitalization;

(d) harm of a staff member due to actions of an individual;

(e) suicide attempts;

(f) a substantial change in residential or work placement without approval of the individual planning team;

(g) alleged unlawful activities by or affecting an individual;

(h) abuse, exploitation, neglect or sexual abuse;

(i) rights violations;

(j) an unaccounted for absence;

(k) significant property damage; or

(l) any behavior requiring the use of an emergency procedure as provided for in ARM 37.34.1401 et seq.

(18) "Integrated/inclusive community activities" means enjoyable activities that provide an individual with opportunities to participate with other members of the community.

(19) "Leisure activities" means enjoyable recreational and other activities in which an individual may actively participate.

(20) "Neglect" means the failure of a guardian; an employee of a public or private residential institution, facility, home or agency; or any person legally responsible in a residential setting for the welfare of an older person or a person with a developmental disability to provide, to the extent of legal responsibility, food, shelter, clothing or services necessary to maintain the physical or mental health of the older person or the person with a developmental disability.

(21) "Organized health care delivery systems" means an organized system of health care delivery which allows for both the direct provision of health care services as well as contracting with other qualified providers to furnish services required by an individual's plan of care.

(22) "Plan of care" means a written plan identifying the supports and services that are necessary to achieve independence, dignity, and personal fulfillment, developed for a person with developmental disabilities by the planning team on the basis of a skill assessment and determination of the strengths and needs of the person.

(23) "Planning team" means an interdisciplinary team composed of those persons specified in ARM 37.34.1107 that identifies and evaluates the needs of a person receiving services, develops a plan of care to meet those needs, periodically reviews the person's response to the plan and revises the plan accordingly.

(24) "Portability" means providing for contract funds used to support the individual in the current placement to be transferred to a new service contractor when an individual receiving services moves to another geographical area of the state or obtains services from another qualified provider contract.

(25) "Positive behavior support" means the application of a variety of behavior modification procedures and techniques to change undesirable behaviors, with an emphasis on minimizing the use of punishers and aversive programming.

(26) "Regional manager" means a person employed by the developmental disabilities program in one of five field-based supervisory positions.

(27) "Room" means shelter type expenses including all property related costs such as rental or purchase of real estate and furnishings, maintenance, utilities and related administrative services.

(28) "Sexual abuse" means the commission of sexual assault, sexual intercourse without consent, indecent exposure, deviate sexual conduct or incest, as described in Title 45, chapter 5, part 5, MCA.

(29) "Standards" means criteria developed by various sources and used by the department for the purpose of judging the adequacy of the quality and extent of service provided by providers to persons with developmental disabilities.

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-204, 53-20-205, MCA
History: NEW, 1979 MAR p. 1708, Eff. 12/28/79; AMD, 1981 MAR p. 628, Eff. 6/26/81; AMD, 1985 MAR p. 1156, Eff. 8/16/85; AMD, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1988 MAR p. 1007, Eff. 5/27/88; AMD, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1993 MAR p. 1353, Eff. 6/25/93; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 165, Eff. 2/1/13.

Mont. Admin. R. 37.34.105 Evaluation Services

(1) The division must provide for the evaluation of any person eligible for diagnostic and evaluation services either through services funded by the department or by referral to another agency.

(2) Under ARM 37.34.1101 et seq., within 30 calendar days of the enrollment of a developmentally disabled person in a provider service program, with the exception of respite and transportation services, the provider must perform a comprehensive skill assessment for that person. Each assessment must be reviewed annually by the provider. Results of the assessment must be provided to the person's planning team, including the person receiving services.

History

Authorizing statute(s): 53-20-203, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1979 MAR p. 1710, Eff. 12/28/79; AMD, 1988 MAR p. 1007, Eff. 5/27/88; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 165, Eff. 2/1/13.

Mont. Admin. R. 37.34.108 Confidentiality of Information

(1) Confidential information, for purposes of this chapter, includes the following information about any person applying for or receiving services through the developmental disabilities program:

(a) name, address, and phone number;

(b) the amount or type of services provided;

(d) agency evaluation of information;

(e) medical data, including diagnosis, treatment, and past history of disease or disability;

(f) educational, training, habilitation or any similar data;

(g) any of the above information pertaining to the immediate family members.

(2) The department and the provider must not disclose confidential information concerning the person except to department staff and providers who assist in eligibility determination, referral, or the provision of services to the person.

(3) Information, as specified, may be disclosed upon the written consent of:

(a) the person if a legally competent adult; or

(b) the person's parents, if legally responsible for the person, or the legal representative of the person.

(4) Information may be disclosed if it is in summary, statistical, or any other form which does not identify and cannot be used to identify the person.

(5) Information may be disclosed pursuant to a court order issued by a court of competent jurisdiction, to the extent required by the court order.

(6) Information may be disclosed to the extent required to take immediate life-saving measures.

(7) Information may be disclosed to the extent required by federal or state law.

(8) The disclosure of any information related to the person will be governed by requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the requirements of Title 45 Part 160 and 164 of the Code of Federal Regulations (CFR) and all other applicable state and federal laws protecting the person's privacy.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-204, 53-20-205, MCA
History: NEW, 1979 MAR p. 1710, Eff. 12/28/79; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 165, Eff. 2/1/13.

Mont. Admin. R. 37.34.109 Grievance Procedure

(1) Providers must have a written grievance procedure, approved in writing by the department prior to implementation, for resolution of grievances brought by persons receiving developmental disabilities services.

(2) The procedure must provide for resolution of a grievance within 45 days of receipt of the grievance. Resolution may be extended beyond 45 days only with written approval by the department.

(3) The person must exhaust the provider's grievance procedure before appeal of the matter may be made to the department under the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(4) Upon entry into a program and annually thereafter, the provider must advise the person of their right to present grievances. The provider must assist persons, as may be necessary, in utilizing the grievance procedure.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1979 MAR p. 1711, Eff. 12/28/79; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 165, Eff. 2/1/13.

Mont. Admin. R. 37.34.113 Certification of Persons Assisting in the Administration of Medication: Adoption of the Health and Medication Administration Manual

(1) For the purpose of certification of persons who supervise or assist in the administration of medication to persons through the state-sponsored developmental disabilities services, the department has developed and published an instructional and reference aid entitled Health and Medication Administration Manual for Persons with Intellectual/Developmental Disabilities: A Study Guide and Reference Manual, published and effective October 1, 2024. The department adopts and incorporates by reference this manual. Copies may be obtained from the Department of Public Health and Human Services, Developmental Disabilities Program, P.O. Box 4210, Helena, MT 59604.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-204, MCA
History: NEW, 2012 MAR p. 1387, Eff. 7/13/12; AMD, 2025 MAR, Notice No. 37-1103, Eff. 1/11/25.

Mont. Admin. R. 37.34.114 Certification of Persons Assisting in the Administration of Medication

(1) This rule establishes criteria and procedures under which an employee or an agent of a provider of developmental disabilities services responsible for the delivery of direct care may receive certification to assist and supervise a person in state-sponsored developmental disabilities services in taking prescribed medication.

(2) Assistance and supervision may only be given where a medication which is normally self-administered has been prescribed for the person and where the medical professional who prescribed the medication also prescribed assistance or supervision in the administration of the medication.

(3) For the purposes of this rule, the following definitions apply:

(a) "Assistance" means providing any degree of support or aid to a person who independently performs at least one component of medication-taking behavior.

(b) "Supervision" means critically observing and directing a person engaged in medication-taking behavior.

(4) An employee or an agent of a provider, in order to assist or supervise in the administration of prescribed medication to persons, must be certified by the department as herein provided unless the employee or the agent is otherwise authorized by law to provide such assistance or supervision.

(5) To be certified, an employee or agent of a provider must demonstrate knowledge of health issues relating to persons with developmental disabilities including general health, health emergencies, aspiration pneumonia, seizure disorders, and knowledge of the use and side effects of medications by achieving a score of at least 85% on a comprehensive test administered by the department.

(6) Application for certification to provide supervision and assistance in the administration of medication is made by submitting a request to be certified to the Department of Public Health and Human Services, Developmental Disabilities Program, P. O. Box 4210, Helena, MT 59604.

(7) Any provider may receive, free of charge, an instructional and reference aid entitled Health and Medication Administration Manual for Individuals with Developmental Disabilities: A Self-Paced Study Guide and Reference Manual as adopted by the department in ARM 37.34.113.

(8) The department, or an agency determined by the department, administers the comprehensive test to a qualified applicant within 30 days of receipt of the request for certification.

(9) Notice of certification or noncertification is mailed by the department within ten days of the date of testing. A notice of certification designates an effective date and an expiration date for the certification. The certification period may be for no more than a maximum of two years.

(10) A person may receive consecutive certification by retaking the test as provided in (5) through (8).

(11) Each provider shall maintain a current list of employees and agents certified to supervise and assist in the administration of medication.

(12) If a person has been receiving developmental disabilities services for 30 days and supervision and assistance is to be administered for more than ten consecutive days, this activity must be included as an objective in the written plan of care. To address the objective, an individual program plan must be prepared which describes a program to train the person to self-administer the medication and must specify at least:

(a) the target medication-taking behavior;

(b) the conditions under which such behavior should occur;

(d) the criterion for completion of the individual program plan in accordance with (14);

(e) the written strategies for training the target behavior;

(f) a data recording system which accounts for each prescribed medication dosage; and

(g) a daily data recording system which specifies progress or lack of progress toward the target behavior.

(13) Every instance of assistance or supervision provided under this rule must be recorded and must include at least the name of the person who receives medication, the name of the person who assists or supervises the taking of medication, the date and time the medication was taken, and the type of medication taken.

(14) A person is considered to be capable of self-administering medication when it has been documented that the person has self-administered all (100%) of prescribed medication dosages for a consecutive 30-day period.

(15) There are two conditions under which an individual program plan to teach self-administration of medication is no longer necessary. They are:

(a) the person has met the criterion specified in (14); or

(b) the planning team has reviewed the ongoing implementation of the individual program plan and found that the person has reached the maximum level of independence in the self-administration of medication of which the individual is currently capable. In making this decision, the team must evaluate whether:

(i) the person has made any progress;

(ii) the program has been consistently implemented;

(iii) a variety of teaching strategies has been employed;

(iv) the decision to discontinue the program will interfere with the person's ability to be served in a less restrictive environment; and

(v) the program has been in place long enough to make a decision concerning its effectiveness.

(16) If the planning team decides that an individual program plan to teach self-administration of medication is no longer necessary, the requirements concerning the need for certified personnel and recording instances of assistance and supervision must be met.

(17) The feasibility of re-instituting a program to teach self-administration of medication must be examined at subsequent meetings by the planning team. If the person's situation changes such that there is a possibility of further acquisition of the skill, a program must be initiated.

(18) The department may revoke or suspend a certification.

(a) The department may revoke certification by notifying the certified person of the reason for revocation in writing at least ten days prior to the effective date of revocation. The certified person may request, in writing, within the ten days prior to revocation, a review of the decision. A decision is issued within 30 days from the date the request for review is received. When a request for a review is made, the revocation is not effective until the review is completed and a final decision issued.

(b) The department may suspend a person's certification for a period no longer than 15 days, after which the suspension must be removed or notice of revocation issued. If notice of revocation is issued, suspension may continue until the effective date of revocation or until the decision is made.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-204, MCA
History: NEW, 1980 MAR p. 1803, Eff. 6/27/80; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2012 MAR p. 1387, Eff. 7/13/12.

Subchapter 37.34.2 Eligibility

Mont. Admin. R. 37.34.201 Eligibility: General Eligibility Requirements

(1) A person, in order to be considered for placement into a developmental disabilities services program funded through the Developmental Disabilities Program (DDP) of the department, must be determined by the department in accordance with the criteria of this rule to be a person with a developmental disability.

(2) The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual, 6th Edition, 2013, sets forth the requirements for eligibility of the DDP's service programs.

(3) Eligibility for the DDP service programs, with the exception of federally funded Part C services, must be determined in accordance with the requirements of the Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual, 6th Edition, 2013. A copy of the manual may be obtained from the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604 or at http://www.dphhs.mt.gov/dsd/ddp/EligibilityReferenceManual.pdf .

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.202 Eligibility: Evaluation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.206 Eligibility: State Funded Family Education and Support Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2011 MAR p. 1158, Eff. 6/24/11.

Mont. Admin. R. 37.34.207 Eligibility: Federally Funded Part H Family Education and Support Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.208 Eligibility: Federally Funded Intensive Family Education and Support Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.211 Eligibility: Children's Community Home Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.212 Eligibility: Children's Summer Day Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.215 Eligibility: State Funded Adult Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2011 MAR p. 1158, Eff. 6/24/11.

Mont. Admin. R. 37.34.216 Eligibility: State Funded Adult Intensive Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2011 MAR p. 1158, Eff. 6/24/11.

Mont. Admin. R. 37.34.217 Eligibility: Federally Funded Intensive Adult Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.221 Eligibility: State Funded Senior Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2011 MAR p. 1158, Eff. 6/24/11.

Mont. Admin. R. 37.34.222 Eligibility: Federally Funded Senior Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.224 Developmental Disabilities Community Services Adult Financial Eligibility

(1) On July 1, 2011, funding will terminate for all persons 19 years of age or older who were receiving developmental disability community services as of February 28, 2011 and funded by a combination of the state general fund and the federal Title XX Social Services Block Grant.

(a) Persons subject to this loss of state general fund and federal Title XX Social Services Block Grant funding may continue to receive developmental disabilities services if they apply for and are determined by the department to meet the following:

(i) the financial and categorical eligibility for the Medicaid program; and

(ii) the eligibility criteria for one of the Medicaid funded programs of home and community developmental disabilities services and are accepted into that program.

(b) For persons who have as of July 1, 2011 applied for Medicaid eligibility, but for whom Medicaid eligibility has yet to be determined, their services may be continued with Title XX Social Services Block Grant funding during the pendency of this eligibility application.

(2) For persons, 19 years of age or older, who as of February 28, 2011 were in receipt of developmental disability community services funded by a combination of the state general fund and the federal Title XX Social Services Block Grant and who are ineligible for Medicaid funded services or who are ineligible for or not accepted into a Medicaid funded developmental disabilities home and community services program, the department may, in its discretion, on or after July 1, 2011, proceed to fund developmental disabilities community services for the person with federal Title XX Social Services Block Grant funding if such funding is available.

(3) The department may apply available federal Title XX Social Services Block Grant funding under this rule to establish the eligibility of a person for developmental disabilities community services by using the method set forth in the documents dated and effective June 9, 2011 entitled "Application for Federal Title XX Social Services Block Grant Funding" and "Directions for Federal Title XX Social Services Block Grant Funding". The department adopts and incorporates those documents by reference. The documents are available from the Developmental Disabilities program, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604, and at www.dphhs.mt.gov/dsd/ddp/forms.shtml.

(4) Persons, 19 years of age or older, for whom neither Medicaid funding nor federal Title XX Social Services Block Grant funding is available will no longer be eligible to receive services from the developmental disability services program.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, 53-20-209, MCA
History: NEW, 2011 MAR p. 1311, Eff. 6/24/11.

Mont. Admin. R. 37.34.225 Developmental Disabilities Community Services Eligibility: Termination of Eligibility for a Program

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, 53-20-209, MCA
History: NEW, 2012 MAR p. 900, Eff. 6/24/11; REP, 2014 MAR p. 219, Eff. 1/31/14.

Mont. Admin. R. 37.34.226 Eligibility: Appeal Procedures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2000 MAR p. 1653, Eff. 6/30/00; REP, 2014 MAR p. 219, Eff. 1/31/14.

Authorizing statute(s): 53-2-201, 53-20-203, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-209, MCA
History: NEW, 1991 MAR p. 2266, Eff. 11/28/91; TRANS, from SRS, 1998 MAR p. 3124; REP, 2014 MAR p. 217, Eff. 1/31/14.

Subchapter 37.34.6 Family Services

Mont. Admin. R. 37.34.601 Family Services: Purpose

(1) Family services include family education and support services, children's community home services and children's summer day services.

(2) The purpose of family education and support services is to obtain or provide resources, support, training and assistance designed to assist a child and to enhance the capacity of a family to promote the development of a child.

(3) The purpose of children's community home services is to provide a healthy and safe living environment to meet the needs of children with intensive developmental disabilities who no longer reside with a natural or foster family. This living arrangement supports a child's overall development, provides opportunities for socialization and the development of leisure skills, and facilitates integration into community life.

(4) These rules define services and describe the specific services available, program components, program requirements and limitations, contractor performance requirements, and education and training requirements.

(5) The definitions used for federally funded intensive home and community family education and support services, except for those in ARM 37.34.602, are at ARM 37.34.901, et seq.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.602 Family Services: General Definitions

These definitions apply to all family services.

(1) "Children's community home" means a licensed, home-like living arrangement in which 2 to 6 children with developmental disabilities who are between 5 and 22 years of age and have intensive needs, reside under the general care and supervision of community home staff.

(2) "Children's community home services" means residential services for children with developmental disabilities who have intensive needs and who are unable to reside with their families or with a foster family. Children's community home services provide children with physical care, guidance, resource and service coordination, and direct instruction based on developmental models and principles of normalization. Children's community home services include:

(a) providing a community-based residential alternative to natural and foster homes;

(b) helping children with disabilities reach their maximum developmental potential;

(c) coordinating the provision of individualized services for children such as special education, day services, recreation, and other community-based services; and

(d) assisting children with disabilities to increase their level of personal independence, move on to less restrictive settings, and lessen their reliance on the service system.

(3) "Children's summer day services" mean day services occurring during the summer that provide both formal and informal functional education and training and leisure and recreational activities designed to promote development, independence, and acquisition of individual skills. Training is provided in such areas as self-help, social, language, pre-academic, academic, motor and prevocational.

(4) "Core services" means those services available to all children and families based on needs identified in the individual family service plan (IFSP) . Core services include evaluation and assessment, individualized family service plan, support coordination, information and referral, and procedural safeguards.

(5) "Evaluation and assessment" means a process for determining a child's initial and continuing eligibility for services. The evaluation process is a responsive and individualized set of procedures for completing the eligibility determination process in a fair and timely fashion.

(6) "Family" means natural parents, adoptive parents, foster parents, grandparents, guardians, stepparents or others with whom a child lives, and persons who are legally responsible for the child's welfare.

(7) "Family education and support services" means types of services that provide resources, supports and assistance designed to assist a child and to enhance the capacity of a family to promote the development of a child. The family, in partnership with program staff, establishes priorities and assists in the development, implementation and evaluation of the IFSP. Family education and support services include:

(a) helping children with disabilities reach their maximum potential;

(b) keeping children with their families in their home communities;

(d) helping families avoid unnecessary reliance on the service delivery system.

(8) "Family services" means family education and support services, children's community home services, and children's summer day services.

(9) "Family support specialist" means a person employed by a family services contractor to deliver support coordination services.

(10) "Individual educational program" (IEP) means, as defined at ARM 10.16.1207, a plan of outcomes and objectives which address a child's educational strengths and deficits.

(11) "Individualized family service plan" (IFSP) means a written plan for organizing and directing the delivery of family education and support services to a child and the child's family. The plan includes information regarding a family's concerns and priorities for resources, supports and assistance. The plan helps each family establish and achieve its goals. The plan is part of a dynamic planning process undertaken by an interdisciplinary team. The family is the primary member of the team and is the final decision maker.

(12) "Information and referral" means assistance by contractor staff in informing families not currently served of program criteria, evaluations, and providing direction to the most appropriate available resources which may meet their needs. Information and referral includes investigating the availability and appropriateness of various resources, explaining the options available to the family, and contacting the agencies on behalf of the family. Information and referral also includes the provision of information requested by families previously served.

(13) "Parent" means a natural parent, guardian, or a person acting as the parent of a child, or a surrogate parent who has been appointed in accordance with federal statute. The term includes grandparents, stepparents, or others with whom a child lives, and persons who are legally responsible for the child's welfare. The term does not include the state.

(14) "Procedural safeguards" mean measures to provide a child and family with appropriate involvement in the planning, development, and provision of services and to provide due process concerning decisions that they believe adversely affect the provision of services.

(15) "Resource and support wrap-around services" means items or services obtained or provided for the purpose of accomplishing IFSP objectives. These services may include assistive technology, audiology, support coordination, family education, counseling, home visits, health, nursing, nutrition, occupational therapy, physical therapy, psychology, social work, special instruction, speech-language pathology, transportation, and vision services. The component services of resource and support wrap-around services for purposes of state-funded family education and support services and for federally funded Part H family education and support services are defined in ARM 37.34.604. The component services of resource and support wrap-around services for purposes of federally funded intensive family education and support services are defined at ARM 37.34.901, et seq.

(16) "Support coordination" means assistance and services provided by a family support specialist or an intensive support coordinator to assist and enable a child and the child's family to receive the rights, procedural safeguards, and services that are provided through the family education and support services programs. Support coordination includes:

(a) assisting a family to access or modify existing community resources, both formal and informal;

(b) assisting a family to gain access to, facilitating the timely delivery of, and coordinating and monitoring the resources and services identified in the IFSP;

(d) maintaining a record of support coordination activities in each child's record;

(e) coordinating the performance of evaluations, assessments and family information gathering activities;

(f) coordinating and monitoring the delivery of available resources;

(g) informing the family of legal rights related to special services;

(h) informing families of the availability of advocacy services;

(i) coordinating with medical and health providers when requested by the family;

(j) facilitating the development of a transition plan to other services; and

(k) completing referral information when the child is ready to move to a new service.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.604 Family Services: Definitions for State Funded and Federally Funded Part H Family Education and Support Services

These definitions apply to state funded family education and support services and to federally funded Part H education and support services.

(1) "Assistive technology devices" means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of children with disabilities.

(2) "Assistive technology services" means services that directly assist a child with a disability in the selection, acquisition, or use of an assistive technology device. Assistive technology services include:

(a) evaluating the needs of a child with a disability, including a functional evaluation of the child in the child's customary environment;

(b) purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities;

(c) selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;

(d) coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing early intervention and rehabilitation plans and programs;

(e) training or technical assistance for a child with disabilities or, if appropriate, that child's family; and

(f) training or technical assistance for professionals including persons providing early intervention or rehabilitation services, or other persons who provide services to, or are otherwise substantially involved in the major life functions of children with disabilities.

(3) "Audiology services" means the identification of children with auditory impairment, using at risk criteria and appropriate audiologic screening techniques. Audiology services include:

(a) determining the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures;

(b) referral for medical and other services necessary for the habilitation or rehabilitation of children with auditory impairment;

(c) providing auditory training, aural rehabilitation, speech reading and listening device orientation and training, and other services;

(d) providing services for prevention of hearing loss; and

(e) determining the child's need for individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.

(4) "Family education, counseling, and home visits" means services provided, as appropriate, by family support specialists, and other qualified personnel, including but not limited to, psychologists, professional counselors and social workers, to assist the family of a child in understanding the special needs of the child and how to enhance the child's development.

(5) "Full service" means services, supports and resources furnished to a child and family eligible for federally funded Part H family education and support services or for state funded family education and support services. The child and family are served in accordance with an IFSP, through service coordination provided at a minimum of one staff contact per month. This service provides access to resources and support wrap-around services.

(6) "Health services" means medical services necessary to enable a child to benefit from other family education and support services during the time the child is receiving family education and support services.

(a) Health services include, but are not limited to, clean intermittent catheterization, tracheostomy care, tube feeding, the changing of dressing or colostomy collection bags, other health services, and consultation by physicians with other service providers concerning the special health care needs of children that will need to be addressed in the course of providing other early intervention services.

(b) Health services do not include services that are surgical, medical or medical-health in nature. Excluded services include, but are not limited to, cleft palate surgery, surgery for club foot, the shunting of hydrocephalus, hospitalization or management of congenital heart ailments, the prescribing of medicine or drugs for any purpose, devices necessary to control or treat a medical condition, immunization and regular well-baby care routinely recommended for all children.

(7) "Medical services only for diagnostic or evaluation purposes" means services provided by a licensed physician to determine a child's developmental status and need for family education and support services.

(8) "Nursing services" means the provision of medically necessary nursing care as prescribed by a medical professional. Nursing services include:

(a) assessing health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems;

(b) providing nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; and

(9) "Nutritional services" means services to maintain and improve the nutrition of a person. Nutritional services include:

(a) individual assessments in nutritional history and dietary intake, anthropometric, biochemical, and clinical variables, feeding skills and feeding problems, and food habits and food preferences;

(b) developing and monitoring appropriate plans to address the nutritional needs of a child based on the child's individual needs assessment; and

(10) "Occupational therapy services" means therapy services to address the functional needs of a child related to adaptive development, adaptive behavior and play, and sensory, motor, and postural development. These services are designed to improve the child's functional ability to perform tasks in home, school, and community settings. Occupational therapy services include:

(a) identification, assessment, and intervention;

(b) adapting the environment, and selecting, designing and fabricating assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and

(c) preventing or minimizing the impact of initial or future impairment, delay in development, or loss of functional ability.

(11) "Physical therapy services" means therapy services to enhance sensorimotor function through therapies addressing musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation. Physical therapy services include:

(a) screening, evaluation, and assessment of the child to identify movement dysfunction;

(b) obtaining, interpreting, and integrating information appropriate to program planning, to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and

(c) providing individual and group services to prevent, alleviate or compensate for movement dysfunction and related functional problems.

(12) "Psychological services" means services to assess a person's mental or developmental status. Psychological services include:

(a) administrating psychological and developmental tests, and other assessment procedures;

(b) interpreting assessment results;

(c) obtaining, integrating, and interpreting information about child behavior, and child and family conditions related to learning, mental health, and development; and

(d) planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, parent training, and education programs.

(13) "Social work services" means services to improve a person's social well-being. Social work services include:

(a) making home visits to evaluate a child's living conditions and patterns of parent-child interaction;

(b) preparing social or emotional developmental assessments of the child within the family context;

(c) providing individual and family-group counseling with parents and other family members and appropriate social skill-building activities with the child and parents;

(d) working with problems in a child's and family's living situation where family education and support services are provided that affect the child's maximum utilization of family education and support services; and

(e) identifying, mobilizing, and coordinating community resources and services to enable the child and family to receive maximum benefit from family education and support services.

(14) "Special instruction services" means the design of learning environments and activities to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction. Special instruction services include:

(a) planning curriculum, including the planned interaction of personnel, materials, and time and space, to achieve the outcomes in the child's IFSP;

(b) providing families with information, skills and supports to enhance the skill development of the child; and

(15) "Speech-language pathology services" means services to enhance a person's speech and language skills. Speech-language pathology services include:

(a) identifying children with communicative or oropharyngeal disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills;

(b) referral for medical or other professional services necessary for the habilitation or rehabilitation of children with communicative or oropharyngeal disorders and delays in development of communication skills; and

(c) providing of services for the habilitation, rehabilitation, or prevention of communicative or oropharyngeal disorders and delays in development of communication skills.

(16) "Transportation services" means providing the cost of travel, including but not limited to mileage or travel by taxi, common carrier, or other means, and related costs. Related costs include, but are not limited to, parking expenses necessary for a child and the child's family to receive family education and support services.

(17) "Vision services" means services to enhance or to compensate for vision loss. Vision services include:

(a) evaluating and assessing visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities;

(b) referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and

(c) training in communication skills, orientation and mobility for all environments, visual, independent living skills, and other skills necessary to activate visual motor abilities.

(18) "Other services" means family education and support services that are identified in the IFSP and that are useful in meeting the developmental needs of the child and the concerns and priorities of the family.

(19) "Respite services" means services to relieve the stress of constant care. Respite care services include, but are not limited to, respite care hours, transportation, and recreation or leisure activities for the child and family. These services are designed to meet the safety and daily care needs of each child and the needs of the child's family so as to reduce family stress generated by provision of constant care to a family member with a developmental disability. Respite services are provided based on the availability of funds.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.605 Family Services: Definitions for State Funded Family Education and Support Services

These definitions apply to state funded family education and support services.

(1) "Annual service agreement" means a yearly plan developed with a family to provide limited or follow-along family education and support services.

(2) "At risk" means a child, from birth to 6 years of age, who is at risk of a delay in development or of having a developmental disability due to environmental risk, established risk, or biological risk.

(3) "Biological risk" means a child who has a probability of aberrant development due to a history of prenatal, perinatal, neonatal, and early development events suggestive of biological insult to the developing central nervous system. The events, either singly or collectively, increase the probability of later appearing aberrant development.

(4) "Child education" means education that enables family members to conduct specific skill acquisition, stimulation, or behavioral intervention programs with the child.

(5) "Environmental risk" means a biologically sound child who has a high probability of developmental delay due to life experiences unless there is corrective intervention. Life experiences that may contribute to developmental delay include maternal and family care, health care, opportunities for expression of adaptive behaviors, and patterns of physical and social stimulation that are sufficiently limiting.

(6) "Established risk" means a child has a probability of developmental delay due to early appearing aberrant development that is related to diagnosed medical disorders of known etiology bearing relatively well known expectancies for developmental delay.

(7) "Family education" means education that enables family members to function as independently as possible in providing or obtaining services and supports for the child so that reliance on services is minimized or eliminated.

(8) "Follow-along service" means support coordination services developed and provided in accordance with an annual service agreement for one to four staff contacts per year.

(9) "Limited services" means services, supports and limited resources furnished to a child and family. Limited services are developed and provided in accordance with an annual service agreement. Limited services may include up to 4 staff contacts per year.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.609 Family Services: General Requirements

(1) Family services must be provided in accordance with the performance requirements in this rule.

(2) The department will enter into contracts with entities to provide family services.

(3) A contractor providing family services must comply with the performance requirements in this rule and the contract.

(4) All facilities, other than the parent's home, used in the provision of services must meet all applicable licensure requirements and health and safety codes.

(5) Policies and procedures must be maintained and implemented to ensure:

(a) a safe, healthy environment for all children served; and

(b) the safe transport of all children.

(6) Supervision, support, care, education, training, health monitoring and medical assistance must be provided in accordance with the needs of the child and as specified by the IFSP or IP team.

(7) Planning teams, in the planning for the provision of services, except for federally funded Part H family education and support services, must consider the level of services the individual is enrolled in and the availability of funds when making decisions regarding specific services to be provided.

(8) An emergency response system must be maintained as specified in the contract to assist children and staff for emergencies such as medical problems, behavior intervention, disasters, and other similar emergencies.

(9) The contractor must participate in the IFSP or IP team process recommending objectives, as applicable, to the team for each child.

(10) Any activities of the IP or IFSP assigned to the contractor must be implemented.

(11) Transportation must be coordinated to assist each family in meeting the child's needs.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.612 Family Services: Family Education and Support Services Requirements

(1) Family education and support services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing family education and support services must comply with the performance requirements in this rule and the contract.

(3) Core services must be provided to all families except those families who participate in limited or follow-along services.

(4) The evaluation and assessment process must consider the unique characteristics of the child, the accumulated information about the child, and the child's parents' choices regarding evaluation alternatives.

(a) During initial and ongoing contacts in the evaluation and assessment process, the child must be continually assessed and matched to eligibility requirements for available resources provided by the contractor or other service delivery systems.

(b) The evaluation and assessment process must provide the child's parents with appropriate information for making informed decisions regarding service options for their child and family.

(c) The evaluation and assessment process must be individualized in nature, must be based on the family's primary developmental and functional concerns regarding the child, and must address the child's specific characteristics.

(5) Information and referral must be provided on an as- needed basis. Information and referral to more appropriate services must be provided to children found to be ineligible for developmental disabilities services.

(6) The individualized family service plan (IFSP) must direct the provision of assistance and services to the child.

(a) The needs of the child and the family must be identified and prioritized in the IFSP.

(b) The methods and outcomes established through the IFSP must be consistent with the family's priorities and values.

(c) The family must be allowed to participate in the planning process at the level they find most comfortable. The family must receive written notification of all team meetings and may request written notification of other team members.

(d) The IFSP must meet with the approval of the family.

(e) The IFSP must include every service provided to the child and family.

(f) The funding source for each objective in the IFSP must be identified.

(g) The IFSP must include objectives and prescriptive programs related to the accomplishment of child education outcomes.

(h) Decisions as to the services, resources and supports to be provided must be made with consideration of the level of services the child is receiving and the availability of funding.

(7) Family service records must be maintained documenting each contact with or on the behalf of a child or family and describing the services provided.

(8) The IFSP must be evaluated, revised or rewritten in response to family need or as otherwise necessary.

(9) Support coordination must serve to obtain the supports and services as specified in the IFSP.

(a) Support coordination may only be provided by a family support specialist, an intensive support coordinator, or a family member.

(b) Support coordination manages the delivery of services so as to assure usage of other appropriate services before the IFSP may attempt to develop any new resource to meet an identified need.

(c) Family members may choose to take responsibility for completing certain support coordination activities in accordance with the IFSP.

(d) Each family must be assigned a family support specialist responsible for monitoring support activities.

(10) Respite services must be provided in conformity with an IFSP or an annual service agreement developed with the family.

(a) Respite services are selected in collaboration with the family.

(b) The family selects the persons to provide respite care.

(11) Procedural safeguards must be accorded to children and families receiving family education and support services.

(a) Parents must be provided the opportunity to examine, inspect or review records relating to evaluations, assessments, eligibility determination, IFSP development and implementation, individual complaints dealing with the child, and any other areas involving records about the child and the child's family.

(b) Parents must be given prior notice for matters of eligibility, evaluation, or placement of the child. Notice must be effectively given by means of native language or other communication form when appropriate.

(i) conducting the initial evaluation, child assessment, and family information gathering;

(ii) initiating the provision of services for the first time, or any time a change in service is being considered; and (iii) the exchange of personally identifiable confidential information.

(d) Parents must be allowed to decline all services or a specific service. Declining a service must not jeopardize the receipt of other services.

(e) A surrogate parent must be appointed when:

(i) no parent can be identified;

(ii) the division, appropriate state agency, or the family services agency cannot discover the whereabouts of a parent after engaging in reasonable efforts; or

(iii) the child is a ward of the state under law.

(f) Personally identifiable information must be kept confidential.

(g) An adverse decision affecting services to the child or family may be appealed.

(i) A decision must be appealed through the internal grievance procedures of the contractor. If a resolution cannot be reached with the contractor, the decision is appealable under the provisions of ARM 46.2.202, et seq.

(ii) For federally funded Part H family education and support services, a decision must be appealed through the internal grievance procedures of the contractor. If a resolution cannot be reached with the contractor, the decision is appealable in accordance with the procedures for resolving complaints regarding federally funded Part H early intervention services as provided by federal rule at 34 CFR 303.420 through 303.425. The department hereby adopts and incorporates by reference the impartial procedures for resolving individual child complaints regarding federally funded Part H early intervention services published, July 1, 1994, by the United States department of education, at 34 CFR 303.420 through 303.425.

(h) Each family must be provided with a copy of procedures for appealing decisions made by the contractor.

(i) Child and family participation in family services is on a voluntary basis.

(12) An annual consumer satisfaction survey of families who received services during the year must be conducted and the results provided to the department.

(13) A monthly waiting list must be submitted to the department's regional office according to procedures defined by the department.

(a) An inventory for client and agency planning (ICAP) must be completed and submitted for each child on the waiting list, each child enrolled in services, and upon initial enrollment, for each child waiting for or receiving limited or follow-along services.

(14) Family education and support services staff assist a family in selecting and training providers to achieve identified IFSP outcomes.

(a) A family generally may select and train providers of resource and support wrap-around services. In certain circumstances requiring specialized training, family education and support services staff may recruit, screen, and interview potential providers.

(15) Family education and support services staff monitor and document service delivery.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.613 Family Services: State Funded Family Education and Support Services Requirements

(1) State funded family education and support services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing state funded family education and support services, including limited and follow-along service, must comply with the performance requirements in this rule and the contract.

(3) The family of a child receiving limited service must have at least one annual face-to-face visit with contractor staff to develop an agreement with the family to provide access to limited resources and up to three additional support coordination contacts per year.

(4) The family of a child receiving follow-along service must have at least one annual face-to-face visit with contractor staff to develop an agreement with the family to provide up to three additional support coordination contacts per year.

(5) The contractor must recruit and maintain an up-to-date list of persons who are available to provide respite care within the geographic area served by the contractor.

(a) All persons who are recruited and maintained on the list must receive orientation.

(b) Orientation must at the minimum include:

(i) familiarization with the contractor corporation and its role in the provision of respite services; and

(ii) familiarization with a family information profile form and procedures for using the profile.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.614 Family Services: Federally Funded Part H Family Education and Support Services Requirements

(1) Federally funded Part H family education and support services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing federally funded family education and support services must comply with the performance requirements in this rule and the contract.

(3) All services must be provided in accordance with the policies and procedures contained in Montana's state plan under Part H of the Individuals with Disabilities Education Act as approved by the United States department of education. The department hereby adopts and incorporates by reference the Montana state plan under Part H of the Individuals with Disabilities Education Act as approved November, 1994, by the United States department of education. A copy of the plan may be obtained from the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(4) All services available through other accessible funding sources must be provided through those other funding sources prior to any expenditure for those services through federally funded Part H family education and support services.

(5) The contractor must recruit and maintain an up-to-date list of persons who are available to provide respite care within the geographic area served by the contractor.

(a) All persons who are recruited and maintained on the list must receive orientation.

(b) Orientation must at the minimum include:

(i) familiarization with the contractor corporation and its role in the provision of respite services; and

(ii) familiarization with a family information profile form and procedures for using the profile.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.615 Family Services: Family Education and Support Services Resource and Support Wrap-Around Services Requirements

(1) Resource and support wrap-around services must be provided in accordance with the IFSP.

(2) Resource and support wrap-around services are available for a child and family eligible under federally funded Part H family education and support services.

(3) Resources and support wrap-around services are available for a child and family under state funded family education and support services only as availability of funding allows.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.616 Family Services: Federally Funded Intensive Family Education and Support Services Requirements

(1) Federally funded intensive family education and support services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing federally funded intensive family education and support services must comply with the performance requirements in this rule and the contract.

(3) Services must be provided in accordance with the general rules governing home and community services for persons with developmental disabilities at ARM 37.34.901, et seq.

(4) A contractor must be a designated organized health care delivery system.

(5) All services available through other accessible funding sources must be provided through those sources prior to any expenditure through federally funded intensive family education and support services.

(6) At least one contact each month with or on behalf of a family for the purpose of providing support coordination, direct services or to provide supervision and consultation to subcontracted personnel must be documented.

(7) The residential status of each child on the caseload must be reported to the regional manager at the beginning of the fiscal year.

(8) All possible or actual movement from a natural home or a foster home must be reported to the regional manager as soon as possible.

(9) Recruitment activities must be done for the purpose of securing and maintaining foster families willing to consider long-term placement, including shared care or back-up foster families, respite providers and emergency placement providers.

(a) Recruitment activities and results must be coordinated with the department of family services.

(b) Families interested in providing foster care must be screened in cooperation with the licensing agency.

(10) No more than one person with severe disabilities may be placed in a home.

(11) A foster family under consideration must meet the child and, when possible, the child's natural parents, and a trial visit must take place prior to the decision regarding placement.

(12) Documentation of agreements with families and subcontracted personnel to provide paid habilitation services must be maintained.

(13) Habilitation programs must be carried out in accordance with each child's IFSP.

(14) A cost projection sheet corresponding to the plan of care must be developed at no less than 6 month intervals. The cost projection sheet must conform to allowable costs and identify funding sources.

(15) A contractual requirement that intensive family support funds be portable to another qualified intensive family support contractor must be complied with.

(16) Each family on the waiting list must be contacted at least annually to determine their continuing need for services and provide information and referral.

(17) Selection for a service opening must be made in accordance with departmental procedures.

(a) The department's regional office must be notified of service openings.

(b) Each family on the waiting list must be informed of any service openings.

(c) Written notice of screening decisions must be provided to interested families. Written notice includes description of the department's procedure for requesting a fair hearing.

(18) The provision of services to eligible children must be reported on a separate quarterly and final expenditure report for Montana's home and community services program for persons with developmental disabilities.

(19) The contractor must recruit and maintain an up-to-date list of persons who are available to provide respite care within the geographic area served by the contractor.

(a) All persons who are recruited and maintained on the list must receive orientation.

(b) Orientation must at the minimum include:

(i) familiarization with the contractor corporation and its role in the provision of respite services; and

(ii) familiarization with a family information profile form and procedures for using the profile.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.621 Family Services: Children's Community Home Services Requirements

(1) Children's community home services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing children's community home services must comply with the performance requirements in this rule and the contract.

(3) Children's community home services must ensure that the child's basic life and health care needs are met.

(4) A primary goal of children's community home services is to increase the independence of children with disabilities, especially in the areas of self-help, socialization, and community interaction.

(5) The provision of services must be based on the objectives set by each child's individual planning (IP) or individual education program (IEP) team.

(6) Residents must be provided a healthy, well-balanced diet and suitable clothing.

(7) Residents must be provided the care, habilitation and guidance necessary to meet the intensive needs.

(8) Physical care, supervision, and support must be provided according to the needs of the child.

(9) Policies and procedures must be maintained to ensure health monitoring and medical assistance is provided or secured for all children served.

(10) Weekly opportunities for a variety of integrated community activities must be provided unless otherwise specified by the IP team.

(11) Daily opportunities for a variety of leisure activities must be provided unless otherwise specified by the IP team.

(12) Facilities that the department determines are appropriate must be designed and configured so as to have the potential for certification according to ICF/MR licensing requirements for residents for whom self-evacuation is impractical.

(13) Provisions must be made in accordance with the requirements of the contract for children to remain at home during the day in cases of illness, episodic behavior, or individual schedules to accommodate service needs.

(14) Transition assistance must be provided for children and their IP teams as they move into a different setting or adult services.

(15) Education and training at a minimum must be provided in the following areas of skill development:

(a) individual self help skills, including but not limited to eating, dressing, bathing, toileting, attending to basic health care needs, telling time, and telephone use;

(b) social interaction skills, including but not limited to general manners, public behavior, sexual awareness and boundaries, and personal safety;

(c) independent living skills, including but not limited to clothing care and selection, household chores, cooking, response to emergencies, home repair and maintenance, leisure and recreational choices and skills; and

(d) community living skills, including but not limited to shopping, use of public or personal transportation, restaurant skills, and traffic safety skills.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.622 Services: Children's Summer Day Services Requirements

(1) Children's summer day services must be in accordance with the performance requirements in this rule.

(2) A contractor providing children's summer day services must comply with the performance requirements in this rule and the contract.

(3) The provision of services must be based on the objectives set by each child's individual planning (IP) or individual education program (IEP) team.

(4) Physical care, supervision, and support must be provided in accordance with the needs of the child.

(5) Weekly opportunities for a variety of integrated community activities must be provided, unless otherwise specified by the IP team.

(6) Daily opportunities for a variety of leisure activities must be provided, unless otherwise specified by the IP team.

(7) Transition assistance must be provided for children as they move into different settings or adult services.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Subchapter 37.34.7 Adult Services

Mont. Admin. R. 37.34.701 Adult Services: Purpose

(1) The purpose of adult services is to obtain resources, support, training and guidance designed to assist an individual in the individual's life.

(2) Services, in accordance with the individual planning process provided at ARM 37.34.1101, et seq., must meet the needs of the individual served. The individual, in partnership with service staff and significant others, establishes priorities, and participates in the development, implementation and evaluation of the individual plan (IP) . Planning teams, in planning for the provision of services, must consider the level of services the individual is enrolled in and the availability of funds when making decisions regarding specific services to be provided. IP objectives are designed to address areas in an individual's life where assistance is needed based on the assessments and desires of the individual. These areas may include living arrangements, work and day options, transportation, recreation and leisure, citizenship, relationships, and life management.

(3) Services must be provided in environments which enhance the quality of life for the individual. These environments must ensure that the individual's basic life and health care needs are met.

(4) Adult services must assist an adult with developmental disabilities to:

(a) enhance independence and interdependence with others in the community;

(b) expand options for participation in and contribution to society;

(d) reside, work and play in safe, healthy, integrated environments.

(5) The following principles must guide the provision of the assistance and services to an individual:

(a) The individual will have an increasing amount of control and choice in these services.

(b) The individual will have increasing options and flexibility available.

(d) The location of activities and the interaction with other persons will be as integrated as possible in the community.

(e) The service will be as least intrusive in the person's life as possible.

(f) The principles of positive programming will be used.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.702 Adult Services: Performance Requirements

(1) Adult services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing adult services, other than a contractor providing transportation services that are also available to the general public and contracting with the department to provide only transportation services, must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and the contract with the department.

(3) In the provision of adult services, the contractor must:

(a) ensure that all facilities used in the provision of services meet all applicable licensure requirements and health and safety codes;

(b) maintain and implement policies and procedures for a safe, healthy environment for all individuals served;

(c) maintain and implement policies and procedures which ensure health monitoring occurs and necessary medical assistance is provided or sought for all individuals served;

(d) provide supervision, support, care, education, and training according to the needs of the individual and as specified by the personal support plan (PSP);

(e) implement any assigned activities of the PSP;

(f) maintain and implement policies and procedures to assist individuals and staff in emergencies such as medical problems, behavior intervention, disasters, and other similar emergencies;

(g) participate in the PSP team process, recommending objectives, as applicable, to the PSP team for the individual; and

(h) coordinate transportation to assist the individual in meeting the individual's needs.

(4) A contractor providing adult services must ensure that any contractor-owned or contractor-controlled setting:

(a) is integrated in and facilitates full access of the individual to the greater community;

(b) ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid Home and Community-Based Services;

(c) is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting;

(d) ensures the individual's rights of privacy, dignity, and respect, and freedom from coercion and restraint;

(e) supports health and safety based upon the individual's needs, decisions, or desires;

(f) optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to daily activities, physical environment, and with whom to interact;

(g) provides an opportunity to seek employment and work in competitive integrated settings; and

(h) facilitates individual choice of services and supports, and who provides them.

(5) Service options and funding sources may have specific requirements that must be met.

(6) In the provision of intensive adult services, the contractor, in addition to the criteria in (3), must:

(a) provide the level of care, habilitation and guidance necessary to meet the intensive needs of the individual; and

(b) ensure, when specified in the contract, other support services needs are addressed to enhance the ability of the individual to benefit from all services and activities.

(7) In the provision of senior services, the contractor, in addition to the criteria in (3), must:

(a) implement a plan, when specified by the IP team, to allow the individual, based on individual interests and desires, to choose daily routines, including remaining at home.

(8) The department adopts and incorporates by reference 42 CFR 441.301(c)(4), as amended January 16, 2014. A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2024 MAR p. 612, Eff. 3/23/24.

Mont. Admin. R. 37.34.706 Adult Services: Community Home Services Requirements

(1) Adult community home services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing adult community home services must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and the contract with the department.

(3) Adult community home services are living arrangements in which 2 to 8 individuals, 16 years of age or older, reside with supervision, care, support and training. In addition to safe, comfortable housing, an individual is provided a healthy, well-balanced diet and is assisted in choosing, caring for and selecting for wear, suitable clothing. Community homes are available to meet a wide range of needs including those of individuals who have intensive or senior needs.

(4) In addition to these rules, community home contractors are required by 53-20-305 , MCA to meet the state of Montana licensing requirements for community homes for persons with developmental disabilities.

(5) Service options and funding sources may have specific requirements that must be met.

(6) In the provision of adult community home services, the contractor must provide:

(a) safe and comfortable housing;

(b) a healthy, well-balanced diet;

(d) weekly opportunities for a variety of integrated community activities unless otherwise specified by the IP team;

(e) daily opportunities for a variety of leisure activities unless otherwise specified by the IP team; and

(f) an emergency response system for an individual who is at home during the day without a staff person present. The contractor must have approval from the IP team prior to an individual remaining at home. The system must be approved by the IP team based on the capability of the individual to remain at home and to use the emergency response system.

(7) In the provision of intensive services, the contractor, in addition to the other requirements of this rule, must:

(a) ensure, when specified in the contract, that facilities are capable of being certified according to ICF/MR licensing requirements for residents for whom self-evacuation is impractical; and

(b) make provisions, when specified in a contract, to allow individuals to remain at home during the day in cases of illness, episodic behavior, or individual schedules to accommodate service needs, such as supported employment.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.711 Adult Services: Work or Day Services Requirements

(1) Work or day services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing work or day services must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and policies, and the contract with the department.

(3) Work or day services include facility-based services and community supported work activities. Supported work activities include individual supported employment, crews, enclaves, and volunteer work. Work or day services are available to meet a wide range of needs including those of individuals who have intensive or senior needs.

(4) Service options and funding sources may have specific requirements that must be met.

(5) In the provision of work or day services, the contractor must:

(a) provide any combination of work or day services, including supported work activities, according to the choices and needs of the individual and as specified by the IP team; and

(b) design activities, built on an array of options, that meet the needs and desires of the individual.

(6) A contractor for work or day services must ensure that medicaid home and community services monies are only expended on persons who are eligible for federally funded intensive adult services as provided in ARM 37.34.217.

(a) The person must have formerly resided in an ICF/MR or a nursing facility in order to be eligible for work services, including individual supported employment or paid work in any work or day service.

(b) The person who formerly resided in an ICF/MR or a nursing facility must not earn more than 50% of the minimum wage in a work activity center or sheltered workshop.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.712 Adult Services: Supported Living Services Requirements

(1) Supported living services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing supported living services must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and the contract with the department.

(3) A service placement designated as an independent living or transitional living placement as of June 30, 1995 or designated after June 30, 1995 as a supported living placement but specified by contract to be a not fully converted placement, is subject only to the requirements in (4) through (7) .

(4) Supported living services identify, provide, and coordinate necessary supports to maintain individuals in communities of their choice and create opportunities to have valued residential, vocational, and social opportunities. Supported living services make living arrangements available to individuals who are at least 18 years old and reside in neighborhood housing. The level and intensity of supervision, care, support, training, guidance and coordination of services and resources is based on individual needs, as determined by the IP team.

(5) Service options and funding sources may have specific requirements which must be met.

(6) In the provision of supported living services, the contractor must provide:

(a) identification of service needs including necessary resources and supports;

(b) identification, development, and access to existing resources and support networks;

(d) facilitation of personal choice, opportunities, and supports.

(7) In the provision of supported living services, the contractor must:

(a) provide supervision, support, care, training and guidance according to the needs of the individual as specified by the IP team;

(b) provide frequency of personal contact by staff with the individual as specified by the IP team;

(d) discuss and plan with the IP team, as appropriate for each individual, health and safety issues based on information gathered prior to the IP meeting including a risk assessment;

(e) recommend to the IP team a plan for each individual that will identify an emergency backup support and crisis response system to deal with problems or issues arising when support services are interrupted or delayed, or individual's needs change; and

(f) maintain the services for all supported living opportunities as described in the contract.

(8) Individuals and their representatives must have the opportunity to participate in the hiring of direct care staff assigned to work with them.

(9) There must be an individualized cost plan for each individual that includes a plan of care inclusive of supports which denote all support costs, administrative and support coordination costs.

(10) There must be portability of all or a portion of supported living funds to another qualified supported living provider as specified in the contract.

(11) There must be a consumer evaluation of supported living services conducted at least annually with a summary maintained.

(12) Supported living coordination must:

(a) teach the individual and caregivers to independently locate and establish contact with agencies who can assist them in securing the services they require. This allows them to become less reliant on the service system, generally, and supported living coordination, specifically;

(b) provide in-service training to those people providing habilitation, personal care, or other services to the recipient;

(c) manage personal and plan funding to ensure that personal and service needs are being met and that funds are efficiently utilized and accurately reported;

(d) provide for adequate supervision of the individual during the day, evening, and weekend;

(e) hire and supervise qualified staff to provide supported living services with input from the individual and caregivers;

(f) subcontract for services required by the plan of care;

(g) conduct periodic assessments of risk in order to ensure that the supported living arrangement is appropriate and safe given the individual's unique abilities and needs;

(h) conduct individual assessments specifically related to the supported living service. These assessments will not duplicate assessments completed by developmental disabilities case managers in scope or type of data collected;

(i) contract for suitable high quality housing, when necessary; and

(j) require documentation of the services provided and for approving payments to direct service providers.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.713 Adult Services: Supported Living Services Safety Requirements

(1) A contractor who provides supported living services must comply with the safety requirements in this rule.

(2) The contractor must document that the individual, with or without assistance, demonstrates the ability to respond to fire and other emergency procedures as specified in this rule, and as specified by the IP team. If the individual lives in the family home, the contractor must document that the individual, with or without assistance, demonstrates the ability to respond to fire and other emergency procedures agreed to by the family. These results must be shared with the IP team. If the individual lives in the family home the results must be shared with the family.

(3) The contractor, if it owns, leases or rents the residence or assists in locating the residence, must provide a safe and healthy living environment.

(4) The contractor must ensure that each residence meets the following life safety requirements:

(a) Smoke detectors must be present in each sleeping room and at a point centrally located in the area giving access to each separate sleeping area. A documented monthly check must occur to ensure that each detector is operating correctly.

(b) A fire extinguisher must be located in the kitchen. A documented annual check must occur to ensure that each extinguisher is operating correctly.

(c) Every room used for sleeping, living or dining must have at least 2 exits, at least 1 of which will be a door or stairway providing a means of unobstructed travel to the street or ground level outside of the building.

(d) All exits must be maintained in an unobstructed, easily traveled condition at all times.

(5) The contractor must develop and implement procedures for emergency evacuation to be followed in the case of fire or other emergency, and these emergency procedures shall include a plan for removing all persons, including individuals who need assistance in exiting.

(6) At least annually the contractor must demonstrate that the individual can evacuate safely with or without supervision.

(7) In any circumstances of a potentially unsafe or unhealthy living environment for an individual which the contractor does not own, lease or rent or which the contractor did not assist in locating, the contractor must in concert with the IP team:

(a) discuss and document with the individual and guardian the potentially unsafe or unhealthy concerns in the individual's residence;

(b) provide options to assist the individual in locating a safer and healthier residence; and

(c) ensure that the individual or guardian is making an informed decision to remain in a potentially unsafe or unhealthy residence.

(8) The contractor must maintain and implement procedures for:

(a) individualized, in-place emergency response systems. The individual must demonstrate the ability at least annually to use the system; and

(b) in-place systems for response during times when assigned staff do not report for duty.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Subchapter 37.34.9 0208 Medicaid Home and Community-Based Services Program

Mont. Admin. R. 37.34.901 0208 Medicaid Home and Community-Based Services Program: Authority

(1) The department has been granted by the United States Department of Health and Human Services (HHS) the authority, through 42 USC 1396n(c) and 42 CFR 441.300 through 441.310, to provide Medicaid home and community-based services (HCBS) to persons with developmental disabilities. These rules implement in Montana the 0208 Medicaid Home and Community Services Waiver Program for persons with developmental disabilities.

(2) In accordance with the state and federal statutes and rules generally governing the provision of Medicaid-funded home and community-based services and the federal-state agreement specifically governing the provision of the Medicaid-funded home and community waiver services to be delivered through this program, and within the fiscal limitations of the funding appropriated and available for the program, the department may determine within its discretion the following features of the program:

(a) the types of services to be available;

(b) the amount, scope, and duration of the services;

(d) individual eligibility; and

(e) delivery approach.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.902 0208 Medicaid Home and Community-Based Services Program: Generally

(1) Services and selection into services through the 0208 Medicaid Home and Community Services Waiver Program are available only to the extent that the federal approval of the state's program permits and that available funding allows.

(2) The department, in order to comply with federal requirements or to limit expenditures to available funding, may:

(a) reduce the number of persons that may be served under the program;

(b) postpone or waive implementation of a particular service of the program; or

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.906 0208 Medicaid Home and Community-Based Services Program: Eligibility

(1) A determination that a person is eligible to be considered for acceptance into the Medicaid Home and Community-Based Services (HCBS) Waiver Program does not entitle a person to selection and entry into the HCBS Waiver Program.

(2) A person is eligible to be considered for acceptance into the Medicaid HCBS Waiver Program if the person:

(a) is determined by the Developmental Disabilities Program (DDP) to be a person with a developmental disability in accordance with the criteria specified and approved in the waiver from the Centers for Medicare and Medicaid Services and in accordance with ARM Title 37, chapter 34, subchapter 2;

(b) applies for and meets the applicable Medicaid financial eligibility requirements found in ARM Title 37, chapter 82; and

(c) requires the level of care provided in an intermediate care facility for individuals with intellectual disability (ICF/IID), as determined by an evaluation of the person's service needs by the DDP.

(3) The level of care of an ICF/IID is needed when a person who is intellectually disabled:

(a) has severe medical problems requiring substantial care, but not to the extent that habilitation is impossible;

(b) has extreme deficits in self-care and daily living skills which require intensive training;

(c) has significant maladaptive social and/or interpersonal behavior patterns which require an on-going, supervised program of intervention; or

(d) has specialized service needs, and exhibits physical or mental limitations or changes similar to those expected in an older person.

(4) A person who has been admitted to an ICF/IID and who is discharged to enter services under the 0208 Medicaid HCBS Waiver Program for persons with developmental disabilities is considered to be of the level of care of an ICF/IID and need not be evaluated as provided in (2).

(5) For a person through the age of seven, the eligibility review panel (ERP) must make the determination of eligibility.

(6) The ERP must consist of the following members:

(a) a waiver-funded children's case manager;

(b) a provider's administrator or supervisor;

(d) a staff person who has had recent contact with the child, if applicable; and

(e) other members as determined by the panel, if applicable.

(7) The waiver-funded children's case manager must submit the following to the ERP for a determination of eligibility:

(a) a diagnostic statement from a physician; and

(b) any testing that reflects developmental delays; or

(d) a current psychological evaluation; and

(e) the eligibility determination form for children.

(8) For eligibility determinations made by the ERP, The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual does not apply to an eligibility determination for a child up to age seven.

(9) The ERP may determine a child is eligible if:

(a) the child has a diagnosis of a physical or mental condition that has a high probability of resulting in a developmental disability; or

(b) the child is experiencing developmental delays, with a 50% delay in one of the following areas or a 25% delay in two or more of the following areas:

(i) cognitive development;

(ii) physical developments, including vision and hearing;

(iii) speech and language development;

(iv) social and emotional development; or

(v) self-help skills.

(10) The department designee must annually administer a level of care re-determination.

(11) A child who has previously been determined eligible for services by the ERP must have a determination of eligibility by the department's eligibility specialist prior to the child's eighth birthday.

(12) For a person age eight and older, the department must make a determination of eligibility for consideration of acceptance into the 0208 HCBS Waiver Program.

(13) The department may make a determination of eligibility for acceptance into the 0208 HCBS Waiver Program as early as the age of six.

(14) The following documents must be submitted to the department's eligibility specialist to make a determination of eligibility for acceptance into the 0208 HCBS Waiver Program:

(a) a Vineland II;

(b) a current psychological evaluation, that for adults, is no more than ten years old; and

(15) The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual, as adopted in ARM 37.34.201, sets forth the requirements for eligibility of the DDP's service programs.

(16) Upon a determination of ineligibility, if the person is:

(a) on the waiting list, his or her name will be removed from the waiting list; or

(b) currently in waiver services, he or she will be exited from the 0208 HCBS Waiver Program ten days from the date of the notification letter.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.907 0208 Medicaid Home and Community-Based Services Program: Selection and Entry

(1) A person may be placed on the statewide waiting list for consideration for selection and entry into the 0208 Medicaid Home and Community-Based (HCBS) Waiver Program if the person is found eligible for the Developmental Disabilities Program (DDP) service in accordance with ARM 37.34.906.

(2) The DDP will enter the person's name onto the waiting list in chronological order based upon the date the case manager receives a complete request for services.

(3) The selection for consideration of persons with the same waiting list date will be made through a random selection process by the department.

(4) The DDP designee must notify a person selected for entry into the 0208 HCBS Waiver Program and the person's case manager in writing within ten working days of selection.

(5) Within five working days from the date of the notification letter, the department designee must present all waiver service options available to the person selected, document which providers the person requests to meet, and submit to the providers:

(a) the provider service referral packet;

(b) the plan of care; and

(6) A provider must contact the department designee within ten working days from the date the provider service referral packet was submitted to the provider and either:

(a) offer to serve the person; or

(b) decline to offer services.

(7) The person must determine which provider(s) he or she will accept services from within five days following the offer(s).

(8) The case manager must:

(a) document the person's choice of provider(s);

(b) obtain the person's or the person's legal representative's signature; and (c) maintain the documentation in the person's file.

(9) Upon acceptance of service(s), the person must begin service(s) within 45 working days from the date of the provider(s) offer to serve the person.

(10) The department may prioritize and select a person who has a life-threatening physical condition, is eligible for DDP services, and whose continued existence would be jeopardized without services.

(11) The department reserves the right to select a person from the waiting list based upon emergency criteria if all other service options have been reviewed and do not meet the person's health and safety needs. The emergency criteria are as follows:

(a) a finding of maltreatment is determined by Child Protective Services or Adult Protective Services;

(b) the death of the person's primary caregiver, or the inability of that caregiver to provide care, and no alternative caregiver is available;

(c) lack of appropriate placement for the person due to loss of housing or imminent discharge from the temporary placement or hospitalization; or

(d) non-waiver services are insufficient to meet the severe and persistent clinical and treatment needs of the person due to a crisis or emergency situation that is currently threatening the person's life or safety. In the absence of a waiver slot, the person is at risk of an out of home placement, such as an institution or higher level of care.

(12) A person who is selected for entry into the 0208 HCBS Waiver Program and does not accept waiver services will be removed from the waiting list.

(13) If the person selected for entry into the 0208 HCBS Waiver Program cannot find a provider able or willing to provide services within 90 days from the date of the selection notification letter, the opening is forfeited.

(14) A person discharged from an ICF/IID located in the state of Montana who is eligible for home and community-based services in accordance with ARM 37.34.906 is not subject to the selection criteria and entry procedures otherwise stated in this rule. The department in its discretion may provide the person with a placement in the 0208 HCBS Waiver Program.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2023 MAR p. 1624, Eff. 11/18/23.

Mont. Admin. R. 37.34.908 0208 Medicaid Home and Community-Based Services Program: Self-Directed Services, Definitions

(1) "Agency with choice model" means an agency that is the legal entity under a contract with the Developmental Disabilities Program to administratively undertake legally necessary tax and labor law compliance responsibilities in relation to the delivery of services on behalf of a person receiving services who is authorized by the program to select and direct the staff who deliver those services. The person receiving services manages the scheduling, orienting, instructing, supervising, evaluating, and work records of the staff. The contracted agency is responsible for the following activities as they pertain to the person's staff:

(a) compiles records necessary for the reporting and payment of wages and benefits for the person's staff;

(b) calculates, withholds, and pays federal and state taxes;

(d) undertakes all other legally necessary activities.

(2) "Financial management service (FMS)" means the fiscal agent who assists the person conducting the business of self-direction. The fiscal agent educates the person, self-directing and acting as an employer, as to their responsibilities, processes employment paperwork, administers necessary preemployment screening, and processes employee timesheets. The fiscal agent must withhold and pay all employment related taxes and arranges for worker's compensation for all employees.

(3) "Person with employer authority using a fiscal management service" means the person or legal representative who is the legal employer and who is responsible for all aspects of hiring and managing staff and service documentation requirements.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.909 0208 Medicaid Home and Community-Based Services Program: Self-Directed Services, Requirements

(1) A person living in a natural home or private residence may elect to self-direct some or all of their waiver services using:

(a) an agency with choice model; or

(b) an employer authority using a financial management services (FMS) option.

(2) In order to elect a self-directed service option, the person must:

(a) receive Developmental Disabilities Program (DDP) Medicaid-funded waiver services; and

(b) live in their natural home or private residence in which the person's choice of services, support worker, and schedule for delivery of service has no adverse effect on other persons receiving waiver services.

(3) A person may opt out of self-directed services at any time and receive traditional agency-based services model.

(4) A person who chooses to disenroll from the self-directed service model must contact the case manager to schedule a planning meeting to determine the services he or she requires in the traditional agency-based services model.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.911 0208 Medicaid Home and Community-Based Services Program: Available Services

(1) The following services may be provided under the Medicaid Home and Community-Based Services Program:

(a) adult foster, as provided in ARM 37.34.929;

(b) assisted living, as provided in ARM 37.34.930;

(d) caregiver training and support, as provided in ARM 37.34.934;

(e) community transition, as provided in ARM 37.34.937;

(f) companion services, as provided in ARM 37.34.926;

(g) day supports and activities, as provided in ARM 37.34.938;

(h) environmental modifications, as provided in ARM 37.34.941;

(i) homemaker, as provided in ARM 37.34.942;

(j) individual goods and services, as provided in ARM 37.34.946;

(k) meals, as provided in ARM 37.34.954;

(l) nutritionist, as provided in ARM 37.34.955;

(m) occupational therapy, as provided in ARM 37.34.956;

(n) personal care, as provided in ARM 37.34.957;

(o) personal emergency response, as provided in ARM 37.34.960;

(p) personal supports, as provided in ARM 37.34.961;

(q) physical therapy, as provided in ARM 37.34.962;

(r) private duty nursing, as provided in ARM 37.34.963;

(s) psychological evaluation, counseling, and consultation services, as provided in ARM 37.34.967;

(t) remote monitoring, as provided in ARM 37.34.968;

(u) remote monitoring equipment, as provided in ARM 37.34.971;

(v) residential habilitation, as provided in ARM 37.34.972;

(w) respite, as provided in ARM 37.34.974;

(x) retirement services, as provided in ARM 37.34.978;

(y) specialized medical equipment and supplies, as provided in ARM 37.34.925;

(z) speech therapy, as provided in ARM 37.34.979;

(aa) supported employment, follow along, as provided in ARM 37.34.980;

(bb) supported employment, individual employment support, as provided in ARM 37.34.981;

(cc) supported employment, small group, as provided in ARM 37.34.985;

(dd) supported employment, coworker support, as provided in ARM 37.34.986;

(ee) supports brokerage, as provided in ARM 37.34.987;

(ff) transportation, as provided in ARM 37.34.988.

(2) Services provided to a person through the 0208 HCBS Waiver Program are limited to the services specified in the person's individual plan of care and the individual cost plan.

(3) Services may be provided when required services exceed or are different from the services available in the Montana state plan.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.912 0208 Medicaid Home and Community-Based Services Program: Provider Requirements

(1) The Developmental Disabilities Program 0208 Comprehensive Waiver Provider Manual, dated July 1, 2024, sets forth the qualifications and standards that govern the qualified provider and service delivery processes.

(a) The department adopts and incorporates by reference the Developmental Disabilities Program 0208 Comprehensive Waiver Provider Manual, dated July 1, 2024.

(b) A copy of the Developmental Disabilities Program 0208 Comprehensive Waiver Provider Manual may be obtained through the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210.

(2) A provider must ensure that services adhere to the requirements of ARM 37.85.405.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2285, Eff. 9/21/24; AMD, 2025 MAR, Notice No. 2025-523, Eff. 11/22/25.

Mont. Admin. R. 37.34.913 0208 Medicaid Home and Community-Based Services Program: Reimbursement

(1) Reimbursement for the provision of services or items funded through the 0208 Medicaid Home and Community-Based Services Waiver Program is available in accordance with criteria and procedures in ARM 37.34.3001 and 37.34.3002.

(2) The rates of reimbursement for particular types of services and items that may be funded through the 0208 Medicaid Home and Community-Based Services Waiver Program are established in accordance with ARM 37.34.3005.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2011 MAR p. 1718, Eff. 8/26/11; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.917 0208 Medicaid Home and Community-Based Services Program: Termination of Placement

(1) The department may terminate a person's placement in the 0208 Medicaid Home and Community-Based Services Waiver Program if the person does not meet the requirements for the program, in accordance with this subchapter.

(2) The department may terminate a person's placement if:

(a) the program services or funding necessary to implement the person's service plan are unavailable from the program;

(b) the professional and other services necessary to implement the person's service plan are unavailable;

(d) the person does not participate in the planning for service delivery;

(e) the program services are no longer appropriate or cost efficient in relation to the person's needs and there are no alternative program services available by which a service plan can be implemented to provide for the person's needs;

(f) the person poses imminent risk to the health and safety of the person or another person by not participating in the program services available to that person;

(g) behaviors of the person precluded the delivery of program services as provided for in the person's service plan;

(h) behaviors of the person necessitate that the person must be served in a setting that is not available through the program or in which the services of the program may not be delivered; or

(i) health status of the person necessitates that the person must be served in a setting that is not available through the program or in which the services of the program may not be delivered.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.918 0208 Medicaid Home and Community-Based Services Program: Freedom of Choice

(1) A person determined by the department to require the level of care provided in an ICF/IID must be given a choice between placement in an ICF/IID or in the 0208 Medicaid Home and Community-Based Services (HCBS) Waiver Program.

(2) The person or legal representative must be informed of the feasible alternatives in the community, if any, available under the 0208 Medicaid HCBS Waiver Program.

(3) The Quality Improvement Specialist will complete the Waiver 5, Freedom of Choice form with the person during the initial face-to-face level of care determination and document, in the person's file, that the person was given the choice and record the choice the person made.

(4) Case managers must inform the person currently served in the 0208 HCBS Waiver Program annually of feasible alternatives in the community and provide documentation for the person's file.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.919 0208 Medicaid Home and Community-Based Services Program: Notice and Fair Hearing

(1) A person aggrieved by an adverse determination by the department may request a fair hearing as provided in ARM Title 37, chapter 5, subchapter 3.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.925 0208 Medicaid Home and Community-Based Services Program: Specialized Medical Equipment and Supplies

(1) Specialized medical equipment and supplies are equipment necessary for the waiver recipient to obtain or retain employment or to increase independent functioning in completing activities of daily living.

(2) Specialized medical equipment and supplies must:

(a) relate specifically to and be primarily for the person’s disability;

(b) have utility primarily for a person who has a disability;

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.926 0208 Medicaid Home and Community-Based Services Program: Companion Services

(1) Companion services consist of nonmedical supervision and socialization provided to a waiver recipient with a functional impairment who is age 14 or older. Companions may assist or supervise the waiver recipient with tasks such as meal preparation, laundry, light housekeeping, and shopping but do not perform these activities as discrete services. This service does not entail hands-on nursing care.

(2) Companion services delivered by legally responsible relatives involve personal care or similar services of activities of daily living and/or instrumental activities of daily living.

(3) Companion services must be provided in accordance with a therapeutic goal.

(4) Companion services may not be provided concurrent with:

(a) persons in residential settings in which primary care is funded 24/7;

(b) personal supports services; or

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.929 0208 Medicaid Home and Community-Based Services Program: Adult Foster

(1) Adult foster support is a comprehensive service in which the person resides with an unrelated caregiver, licensed as an adult foster care provider, in order to receive support and supervision.

(2) A provider may provide service for up to four unrelated persons.

(3) Room and board, items of comfort or convenience, or the cost of the maintenance and improvement of the facility are not included.

(4) Adult foster support may not be provided concurrent with the following services:

(a) personal supports;

(b) companion services;

(d) personal care services.

(5) A provider of adult foster services must be licensed in accordance with 50-5-101 through 50-5-216, MCA and ARM 37.100.101 through 37.100.175.

(6) A person may receive adult foster support independently or both adult foster support and residential training support.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.930 0208 Medicaid Home and Community-Based Services Program: Assisted Living

(1) Assisted living is a congregate residential setting that provides or coordinates personal care, homemaker services, medication oversight, social and recreation activities, 24-hour supervision and assistance to meet the unpredictable needs of the waiver recipient, activities, and health-related services. This service is for waiver recipients with conditions that preclude placement in a less restrictive setting.

(2) Room and board, items of comfort or convenience, or the cost of the maintenance and improvement of the facility are not included.

(3) Assisted living may not be provided concurrent with the following services:

(a) personal care services;

(b) homemaker services;

(d) personal supports; and

(e) residential training supports.

(4) A provider of assisted living must be licensed according to the licensing requirements located in 50-5-101 and 50-5-225, MCA through 50-5-228, MCA, and ARM 37.106.2801 through 37.106.2908.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.933 0208 Medicaid Home and Community-Based Services Program: Behavioral Support Services

(1) Behavioral support services (BSS) teach others to carry out ethical and effective behavior interventions based on positive behavior supports. Behavioral support services staff may supervise the work of others who implement behavior interventions. This service is available at two different levels.

(2) Level one services include:

(a) designing behavioral assessments and functional analysis of behavior;

(b) interpreting assessment and evaluation results for staff and unpaid caregivers;

(d) training staff and unpaid caregivers in the implementation of formal and informal behavioral support procedures; and

(e) attending planning meetings for the purpose of providing guidance and information to plan team members.

(3) Level one services may be provided by:

(a) a board-certified behavioral analyst-doctoral (BCBA-D), board-certified behavior analyst (BCBA), or board-certified assistant behavior analyst (BCaBA) under the supervision of a BCBA-D or BCBA;

(b) the following professionals, under the supervision of a BCBA or BCBA-D:

(i) an intermediate applied behavior analysis (ABA) professional; or

(ii) a person with an Institute for Applied Behavior Analysis (IABA) certification;

(c) either a person with a degree in ABA, psychology, or special education who has provided documentation of training and experience in the use of the principles of ABA as approved by the department.

(4) Level two services include all services identified in level one and:

(a) monitoring and overseeing BSS staff, including a registered behavior technician (RBT) or an intensive behavior assistant (IBA), who are directly implementing treatment; and

(b) direct implementation of treatment plans, behavior intervention procedures, skill acquisition procedures, and positive-behavior support plans by an RBT or an IBA.

(5) Level two services may be provided by:

(a) a BCBA-D or BCBA;

(b) a BCaBA under the supervision of a BCBA-D or BCBA; or

(i) an intermediate ABA professional; or

(ii) a person with an IABA certification.

(6) Level two direct treatment must be supervised by a BCBA-D, BCBA, or BCaBA and may be provided by:

(a) an RBT; or

(b) an IBA.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.934 0208 Medicaid Home and Community-Based Services Program: Caregiver Training and Support

(1) Caregiver training and support (CTS) are services for unpaid caregivers who provide training, companionship, or supervision to a person with a developmental disability in a family setting or a private noncongregate residence.

(2) Training for the caregiver may include:

(a) instruction about treatment regimens;

(b) use of specified equipment; and

(3) Caregiver training and support (CTS) must be aimed at assisting the unpaid caregiver in meeting the needs of the person directly related to their role in supporting the person as identified in the plan of care.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.937 0208 Medicaid Home and Community-Based Services Program: Community Transition Services

(1) Community transition services are nonrecurring set-up expenses for a person who is transitioning from an institution to a Developmental Disabilities Program (DDP) waiver-funded home and community-based residential service.

(2) The community transition service must be necessary to enable a person to establish a basic household.

(3) Community transition services are furnished only to the extent that:

(a) they are reasonable and necessary;

(b) clearly identified in the service plan;

(d) the services cannot be obtained from other sources.

(4) Community transition services may include:

(a) security deposits required to obtain a lease on an apartment or home;

(b) essential household furnishings and moving expenses required to occupy and use a community domicile, including furniture, window coverings, food preparation items, and bath and bed linens;

(c) set-up fees or deposits for utility or services access, including land line telephone, electricity, heating, and water;

(d) services necessary for the individual's health and safety, such as pest eradication and one-time cleaning prior to occupancy;

(e) moving expenses;

(f) necessary home accessibility adaptations; or

(g) activities to assess, arrange for, and procure needed resources as identified in the plan of care.

(5) Community transition services may not include:

(a) monthly rental or mortgage expense;

(b) food;

(d) household appliances;

(e) items that are intended for purely recreational purposes;

(f) cellular telephone service; or

(g) internet service.

(6) Community transition service is not available to a person transitioning into residential settings that are owned or leased by a Developmental Disabilities Program (DDP) funded service provider.

(7) The residential setting must be owned, leased, or rented by the person and must be considered the person's private residence.

(8) Community transition services may not exceed $3,000 per person per transition.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.938 0208 Medicaid Home and Community-Based Services Program: Day Supports and Activities

(1) Day supports and activities consist of formalized habilitation services and staff support for the acquisition, retention, or improvement in self-help, behavioral, educational, socialization, and adaptive skills.

(2) Day supports and activities are person-centered, preplanned, purposeful, documented, and scheduled activities which take place during typical working hours, in a nonresidential setting, separate from the private residence of the person or other residential living arrangements.

(3) Day supports and activities may occur within a day activity setting, in the community, or in both settings.

(4) Day supports and activities may be provided as a continuous or intermittent service.

(5) Day supports and activities must consist of community inclusion activities.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.941 0208 Medicaid Home and Community-Based Services Program: Environmental Modifications

(1) Environmental modifications are those physical adaptations to the home or vehicle required by the waiver recipient's plan of care, which are necessary to safeguard the health, welfare, and safety of the person, or which enable the person to function with greater independence and without which the person would require institutionalization.

(2) An environmental modification must:

(a) relate specifically to and be primarily for the waiver recipient;

(b) have utility primarily for waiver recipient;

(d) not be in the form of room and board or general maintenance;

(e) meet the specifications, if applicable, for the modification set by the American National Standards Institute (ANSI); and

(f) be prior authorized by the department.

(3) Environmental modifications may not include:

(a) adaptions to the home which are of general utility and are not of direct medical or remedial benefit to the waiver recipient, such as carpeting, roof repair, central air condition; or

(b) adaptations to the home which add to the total square footage of the home.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.942 0208 Medicaid Home and Community-Based Services Program: Homemaker

(1) Homemaker services are general household activities performed when the person regularly responsible for these activities is unable to manage the home or care for self or others in the home or is engaged in providing habilitation and support services to the waiver recipient. Homemaker tasks are strictly for the waiver recipient and for no other members of the household.

(2) Homemaker services may include meal preparation, cleaning, simple household repairs, laundry, shopping for food and supplies, and other routine household care.

(3) Homemaker services do not include the provision of personal care services as described in ARM 37.34.957.

(4) Homemaker services are not available to persons in residential settings in which primary care is funded 24/7 by the DDP.

(5) Homemaker services must be bundled with other services when delivered as a component of self-directed (SD) services and supports and is therefore not available as a discrete service to waiver recipients receiving SD services and supports.

(6) A homemaker must have successfully completed a background check to provide this service when only the waiver recipient is in attendance when the service is provided. In such circumstance, the homemaker will not be reimbursed for services provided when a successful background check has not been completed.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.946 0208 Medicaid Home and Community-Based Services Program: Individual Goods and Services

(1) Individual goods and services are services, supports, or goods that enhance opportunities to achieve outcomes related to living arrangements, relationships, and inclusion in the community as identified and documented in the plan of care.

(2) Individual goods and services must fall into one of the following categories:

(a) memberships and fees;

(b) recreational activities specific to a rehabilitative goal in the plan of care. Recreational activities provided under individual goods and services may be covered only when they are included in a planning outcome related to a specific residential rehabilitation goal; or

(3) Individual goods and services can be used when the item or service is not covered under any other private or publicly funded resource or other waiver service.

(4) Individual goods and services may pay for:

(a) repair of equipment when the equipment meets the authorization criteria and the repair is a cost-effective alternative;

(b) a maintenance or insurance agreement for items that meet authorization criteria when the maintenance agreement is expected to be cost effective;

(c) shipping and handling cost if the shipping cost is included in the price of the item, and is being purchased using waiver funds pursuant to the plan of care;

(d) reconditioned equipment if all authorization criteria are met and the item is considered of adequate quality, expected to be durable, and the cost is commensurate with the age and condition of the item; or

(e) vitamins and nutritional supplements when there is no other source for reimbursement and only if the waiver recipient's licensed health care provider has prescribed the specific items.

(5) Individual goods and services must be:

(a) exclusively for the benefit of the waiver recipient; and

(b) the most cost-effective alternative that reasonably meets the assessed need of the waiver recipient.

(6) Individual goods and services must:

(a) be directed exclusively toward the benefit of the waive recipient; and

(b) be the least costly alternative that reasonably meets the waiver recipient's assessed need.

(7) The service, equipment, or supply must meet one of the following criteria:

(a) promotes inclusion in the community;

(b) increases the waiver recipient's safety in the home environment; or

(8) The cost of the service, equipment, or supply must not compromise the waiver recipient's health or safety by depleting their individual cost plan to the extent they cannot receive services that provide for their health and safety.

(9) The following are not reimbursable:

(a) services, equipment, or supplies which are experimental;

(b) room and board;

(d) items solely for entertainment or recreational purposes;

(e) personal hygiene items;

(f) general clothing, food, or beverages, except specialized dietary or clothing needs; and

(g) household furnishings, cleaning supplies, and home maintenance.

(10) Individual goods and services projected to exceed $1,000 annual aggregate require prior approval by the DDP regional manager.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.947 0208 Medicaid Home and Community-Based Services Program: Job Discovery (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; REP, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.950 0208 Medicaid Home and Community-Based Services Program: Job Preparation (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; REP, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.951 0208 Medicaid Home and Community-Based Services Program: Live-in Caregiver (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; REP, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.954 0208 Medicaid Home and Community-Based Services Program: Meals

(1) Meal services provide hot or other appropriate meals once or twice a day, up to seven days a week, to ensure that a person receives adequate nourishment and to prevent institutional placement.

(2) Meal services may only be provided to a person who is not eligible to receive meals from any other source, or who need different or more extensive services than are otherwise available.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.955 0208 Medicaid Home and Community-Based Services Program: Nutritionist

(1) Nutritionist services are services related to the management of a person's nutritional needs and include:

(a) meal planning;

(b) consultation with and training for persons providing direct care; and

(2) Nutritionist services do not include the provision of meals.

(3) Nutritionists must meet the licensing requirements in Title 37, chapter 25, part 3, MCA.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.956 0208 Medicaid Home and Community-Based Services Program: Occupational Therapy

(1) Occupational therapy is as defined in 37-24-103(5), MCA.

(2) Providers of occupational therapy services must be licensed in accordance with the rules and regulations governing the profession.

(3) Occupational therapy must be provided through direct contact with a licensed therapist and the person or to train persons working directly with the person receiving the service.

(4) Occupational therapists may provide evaluation, consultation, training, and treatment.

(5) Occupational therapy may be provided when required occupational therapy services exceed Montana state plan or are different from the services available in the Montana state plan.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.957 0208 Medicaid Home and Community-Based Services Program: Personal Care

(1) Personal care services provide medically necessary in-home services to persons who are functionally limited in performing activities of daily living.

(2) Personal care services may include:

(a) assistance with personal hygiene, dressing, eating, and ambulatory needs;

(b) household tasks incidental to the health care needs of the person or otherwise necessary to maintain the person in the home; and

(3) Personal care services may be provided when the required personal care services exceed the Montana state plan or are different from the services available in the Montana state plan.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.960 0208 Medicaid Home and Community-Based Services Program: Personal Emergency Response System

(1) Personal emergency response system (PERS) is an electronic device that enables the waiver recipient to secure help in an emergency and may include a portable "help" button to allow for mobility. The response center is staffed by trained professionals. PERS services may be appropriate for persons who live alone, or who are alone for parts of the day, and have no regular caregiver for periods of time.

(2) PERS service may be delivered via a cellular phone if it is more flexible and cost effective for ensuring the health and safety of the waiver recipient. Cell phones are not for convenience or general-purpose use.

(3) To meet cellular phone guidelines, the waiver recipient must:

(a) require access to assistance or supports; and

(b) frequently be beyond the range of coverage of a PERS system.

(4) The cost of cell phone plans and monthly fees is the responsibility of the waiver recipient.

(5) The service coordinator and the team must evaluate the needs of the waiver recipient and look at the most cost-effective options.

(6) Waiver recipients may elect to add an insurance feature to prevent health and safety concerns should the phone need to be replaced.

(7) These cell phone guidelines must be reviewed with the waiver recipient prior to or at the annual planning meeting.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.961 0208 Medicaid Home and Community-Based Services Program: Personal Supports

(1) Personal supports services assist the waiver recipient in carrying out daily living tasks and other activities essential for living in the community. Services may include assistance with homemaking, personal care, general supervision, and community integration.

(2) Personal supports may also provide the necessary assistance and supports to maintain employment in a competitive, customized, or self-employment setting, or to provide supports in day programming to assist the waiver recipient in integrating in community settings.

(3) Personal supports activities are generally defined in the plan of care and are flexible in meeting the changing needs of the waiver recipient. Workers may be assigned activities that involve mentorships and activities designed to develop or maintain skills.

(4) Personal supports workers may be required to provide non-medical transportation to a waiver recipient for activities as outlined in the plan of care, including community integration activities, work or school, and other community activities. A waiver recipient receiving personal supports self-directs this service with employer authority. Other waiver services that may overlap with the activities of the personal support worker are prohibited.

(5) Personal supports may assist the waiver recipient with:

(a) ensuring the waiver recipient's health and safety are maintained;

(b) assisting the waiver recipient with hygiene, bathing, eating, dressing, grooming, toileting, transferring, or basic first aid.

(d) development of self-advocacy skills;

(e) identifying and sustaining a personal support network;

(f) household activities necessary to maintain the home-living environment;

(g) home maintenance activities;

(h) maintaining employment; and

(i) accessing opportunities.

(6) Personal supports may only be provided to a person self-directing services.

(7) Waiver services which overlap with the activities of personal supports may not be provided concurrently with personal supports including:

(a) companion services;

(b) extended personal care services;

(d) respite.

(8) Personal supports services must not overlap with, supplant, or duplicate other services provided through the waiver or Medicaid state plan services.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.962 0208 Medicaid Home and Community-Based Services Program: Physical Therapy

(1) Physical therapy is as defined in 37-11-101(7), MCA.

(2) Providers of physical therapy services must be licensed in accordance with the rules and regulations governing the profession.

(3) Physical therapy must be provided through direct contact with the therapist and the person or to train persons working directly with the person receiving the service.

(4) Physical therapist may provide supports that:

(a) improve or preserve abilities of independent functioning; and

(b) prevent, in as much as possible, chronic or progressive conditions.

(5) Physical therapy may be provided when required physical therapy services exceed the Montana state plan or are different from the services available in the Montana state plan.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.963 0208 Medicaid Home and Community-Based Services Program: Private Duty Nursing

(1) The practice of nursing services is defined in 37-8-102, MCA.

(2) Providers of nursing services must be licensed in accordance with the rules and regulations governing the profession.

(3) A waiver recipient receiving the private duty nursing must be 21 years of age or older.

(4) Private duty nursing may be provided when the required nursing services exceed the Montana state plan or are different from the services available in the Montana state plan.

(5) Services may include medical management, direct treatment, consultation, and training for the waiver recipient. The training component of this service is available for the caregiver.

(6) Private duty nursing must be provided in the location where the waiver recipient needs the service.

(7) Private duty nursing must be specified in the plan of care. It must be ordered in writing by the waiver recipient's physician, and it must be delivered by a registered nurse (RN) or a licensed practical nurse (LPN).

(8) Waiver private duty nursing services will be used after the Medicaid state plan home health nursing limits have been reached or if the service required is different from that authorized under the Medicaid state plan.

(9) Private duty nursing services must not overlap with, supplant, or duplicate other services provided through the waiver or Medicaid state plan services.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.967 0208 Medicaid Home and Community-Based Services Program: Psychological Evaluation, Counseling, and Consultation Services

(1) Psychological evaluation, counseling, and consultation services are those services provided by a licensed psychologist, licensed professional counselor, or a licensed clinical social worker within the scope of the practice of the respective professions.

(2) Service definitions for each profession may be found at the following:

(a) licensed psychologist, 37-17-102(4), MCA;

(b) licensed professional counselor, 37-23-102(3), MCA; and

(3) Psychological evaluation, counseling, and consultation services may include:

(a) individual or group therapy;

(b) consultation with providers and caregivers;

(d) participation in the individual planning process; and

(e) counseling for primary caregivers.

(4) Psychological evaluation, counseling, and consultation services are available to adult waiver recipients when the service is:

(a) recommended by a qualified professional;

(b) approved by the planning team; and

(5) Psychological evaluation, counseling, and consultation services may be provided when the required services exceed limits the Medicaid state plan or are different from the services available in the Medicaid state plan.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.968 0208 Medicaid Home and Community-Based Services Program: Remote Monitoring

(1) Remote monitoring provides oversight and monitoring within a residential setting through off-site electronic surveillance, while maintaining the health and safety of the waiver recipient receiving the service.

(2) Remote monitoring must be done in real time, by awake staff, at a monitoring base using:

(a) live video feed;

(b) motion sensing systems;

(d) web-based monitoring systems.

(3) The waiver recipient receiving remote monitoring must be 18 years of age or older.

(4) The remote monitoring staff must not participate in other duties while providing remote monitoring.

(5) The provider must have an effective emergency notification system in place to respond to any emergency within a reasonable time. The emergency response system must be written in the plan of care and must include:

(a) the circumstances in which backup supports must be contacted;

(b) the expected timeframes in which backup supports must respond; and

(c) if the response must be in person or by other means of contact, including notification to emergency responders such as police, fire, and medical services.

(6) Live HIPAA-compliant two-way communication may be provided if it is designated in a waiver recipient's plan of care.

(7) Cameras are not permitted in bathrooms or bedrooms.

(8) The case manager must fully inform the waiver recipient or their legal representative and each person who resides with the waiver recipient of what remote monitoring entails and obtain written consent from each person. The case manager must keep the written consent with the waiver recipient's plan of care.

(9) Individuals will receive the training needed to successfully utilize the technology, including how to turn off the equipment. This includes training the waiver recipient and staff on the equipment and devices that will be used.

(10) Remote monitoring may only be used in supported living settings with the purpose of:

(a) reducing or replacing the amount of residential habilitation needed by the waiver recipient; or

(b) preventing the need for additional residential habilitation.

(11) Remote monitoring providers must have a backup power supply in place at the monitoring base in the event of an electrical outage.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.971 0208 Medicaid Home and Community-Based Services Program: Remote Monitoring Equipment

(1) Remote monitoring equipment is the equipment used to operate systems such as live feed video, live audio feed, motion sensing system, radio frequency identification, web-based monitoring system, or other devices approved by the Developmental Disabilities Program (DDP). It also refers to the equipment used to engage in live two-way communication with the person being monitored.

(2) Remote monitoring equipment must include an indicator to the person being monitored that the equipment is on and operating. The indicator must be appropriate to meet the person's needs.

(3) Remote monitoring equipment must be designed to be turned off only by the person indicated in the plan of care.

(4) The provider of remote monitoring equipment must be responsible for the following:

(a) delivery of equipment to the person's residence and as needed to the room or area of the residence in which the equipment will be used;

(b) assembly and installation of the equipment, as appropriate for correct operation;

(d) conduct monthly testing of the equipment to ensure proper operation;

(e) maintain and repair equipment, as necessary; and

(f) replace equipment at any time for any reason other than misuse or damage by the person receiving the service.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.972 0208 Medicaid Home and Community-Based Services Program: Residential Habilitation

(1) Residential habilitation services support persons in acquiring, retaining, and improving self-help, social, and adaptive skills necessary to reside successfully in home and community-based settings.

(2) The service includes caregiving, skills training, and supervision to a person in a noninstitutional setting. The degree and type of care, supervision, and skills training is based on the person's needs and must be identified in the plan of care.

(3) Training may be provided in basic self-help, home and community living, and leisure and social skills.

(4) Each training objective must be specified in the plan of care and related to the long-term goals of the person.

(5) Residential habilitation must be provided where the person lives. Settings include:

(a) group homes;

(b) congregate and noncongregate living apartments; and

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.973 0208 Medicaid Home and Community-Based Services Program: Residential Training Support (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; REP, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.974 0208 Medicaid Home and Community-Based Services Program: Respite

(1) Respite care includes any services designed to meet the safety and daily care needs of the waiver recipient and the needs of the waiver recipient's caregiver in relation to reducing stress generated by the provision of constant care to the waiver recipient.

(2) Respite is only available to waiver recipients residing with primary caregivers in family settings. Respite is available when a primary caregiver is not compensated for providing some or all of the supervision and support needed by the waiver recipients.

(3) Respite providers must be selected and trained by the parents or legal representatives of the waiver recipient.

(4) Respite providers must comply with all state and federal respite standards.

(5) Respite care must not exceed a period of 24 hours per day for more than 29 consecutive days. The amount and frequency of respite care must be included in each waiver recipient's plan of care.

(6) Respite care may not be provided in a licensed adult day center for a person 18 and older.

(7) The waiver will pay the difference in cost between usual and customary rates and the increased rate charged by the provider, as described in (5), to serve a child with extraordinary support needs for children under the age of 13.

(8) Federal financial participation will not be claimed for the cost of room and board except when provided as part of respite care furnished in a facility approved by the state that is not a private residence.

(9) Respite services cannot be used in place of services otherwise available through public education programs, including education activities, after school supervision, daytime services when the school is not in session, or services available to preschool age children.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.978 0208 Medicaid Home and Community-Based Services Program: Retirement Services

(1) Retirement services are available to a waiver recipient who is age 62 or older or who has limited ability to work due to health and safety issues. Waiver recipients receiving this service are no longer able to maintain employment due to health and safety risks or are of retirement age. Retirement services are structured services consisting of day activities and residential support. Retirement services are furnished in a way which fosters the independence of each waiver recipient. Retirement services are person-centered and person-directed to the maximum extent possible.

(2) Retirement services may be provided as a continuous or intermittent service.

(3) Retirement services must be provided in a developmental disability provider-operated residence or community day activity setting.

(4) The expected outcome of retirement services is to:

(a) treat each waiver recipient with dignity and respect;

(b) maintain skills and abilities to the maximum extent possible; and

(5) Retirement services are designed to:

(a) actively stimulate, encourage, and enable active participation;

(b) develop, maintain, and increase awareness of time, place, weather, persons, and things in the environment;

(d) establish new relationships;

(e) improve or maintain flexibility, mobility, and strength;

(f) develop and maintain the senses; and

(g) maintain and build on previously learned skills.

(6) Retirement services must be delivered in a provider-operated residence and staff must meet scheduled or unpredictable needs in a way that promotes maximum dignity and independence; provides supervision, safety, and security; and provides activities to keep the waiver recipient engaged in their environment.

(7) In a provider-operated residence, only shared living spaces such as the living room, kitchen, bathroom, and recreational areas may be utilized to provide retirement services.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.979 0208 Medicaid Home and Community-Based Services Program: Speech Therapy

(1) Speech therapy is as defined in 37-15-102, MCA.

(2) Providers of speech therapy services must be licensed in accordance with the rules and regulations governing the profession.

(3) Speech therapy must be provided through direct contact with the therapist and the person or to train persons working directly with the person receiving the service.

(4) A speech therapist may provide:

(a) screening and evaluation with respect to speech and hearing functions;

(b) comprehensive speech and language evaluations when the screening indicates it is necessary;

(c) continuing interdisciplinary evaluation for the purpose of beginning, monitoring, and following up in regards to habilitation programs; and

(d) treatment services designed to develop specialized programs for communication.

(5) Speech therapy may be provided when required speech therapy services exceed the Montana state plan or are different from the services available in the Montana state plan.

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 1992 MAR p. 1490, Eff. 7/17/92; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.

Mont. Admin. R. 37.34.980 0208 Medicaid Home and Community-Based Services Program: Supported Employment, Follow Along Support

(1) Follow along support consists of habilitation services and supports that enable a waiver recipient, who is paid at or above the state's minimum wage, to stabilize and maintain employment in a competitive, customized, or self-employment setting with a goal of earning not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

(2) The waiver recipient may require follow along support when:

(a) the waiver recipient's job is in jeopardy; or

(b) a job promotion opportunity requires more complex, comprehensive, or intensive supports.

(3) Follow along support may be provided in an extended ongoing manner or intermittently as needed. Outcomes and actions needed for the waiver recipient to maintain employment must be identified in the plan of care.

(4) Follow along support may include:

(a) person-centered employment planning with or on behalf of the waiver recipient;

(b) development of skills that will make the waiver recipient employable for more hours or for additional duties;

(d) observation and job support to enhance job task skills and monitoring at the work site to ascertain the success of the job placement;

(e) the provision of job coaches to accompany the waiver recipient for short-term job skill training at the work site to help maintain employment;

(f) regular contact and/or follow up with the employer, coworkers, employed waiver recipient, parents, legal representatives, and others as needed, in order to reinforce and stabilize job placement;

(g) facilitation of natural supports at the work site;

(h) individual program development, writing task analysis, monthly reviews, and behavioral intervention programs;

(i) advocating for the waiver recipient at the employment site for purposes directly related to employment, or with persons not directly affiliated with the employment site such as parents, bus drivers, case managers, school personnel, or landlords if the waiver recipient is hired and currently working;

(j) assistance with financial paperwork and management related to the waiver recipient's employment and/or Medicaid eligibility; and

(k) assistance with medication administration considered incidental to the follow along support.

(5) The following services are not reimbursable:

(a) transportation of a waiver recipient to and from the job site;

(b) any service that is available under the Rehabilitation Act of 1973. Documentation is required to ensure that service is not available or is no longer available under a program funded under section 110 of the Rehabilitation Act of 1973, the IDEA (20 U.S.C 1401 et seq.), or EPSDT;

(d) staff continuing education – in service meetings, department meetings, individual staff development;

(e) incentive payments made to an employer to subsidize the employer's participation in a supported employment program;

(f) payments that are passed through to the waiver recipient;

(g) payments for vocational training that is not directly related to a waiver recipient's supported employment program;

(h) any activities which are not directly related to the waiver recipient's career plan;

(i) services furnished to a minor waiver recipient by a parent(s), step-parent(s), or legal guardian; and

(j) services furnished to a waiver recipient by the waiver recipient's spouse.

(6) Behavioral intervention programs may be applied as a component of follow along support services when the plan is:

(a) specifically designed to be implemented in the employment setting by the follow along staff;

(b) when developed and approved according to ARM 37.34.1401 through 37.34.1422; and

(c) developed by the person who trains the follow along staff to utilize the interventions to reduce the challenging behaviors in the employment setting.

(7) Waiver recipients may utilize the following services: individual and small group employment support, co-worker support, and day supports and activities in conjunction with follow along support.

(8) A waiver recipient may be considered inappropriately placed if they are unable to sustain competitive, customized, or self-employment. Movement to a better-fit employment setting should be considered, and the waiver recipient may need to be referred or re-referred to vocational rehabilitation.

(9) Reimbursement for follow along support and vocational rehabilitation services will not be allowed concurrently for the same job placement.

(10) The department requires all other funding sources be utilized and a denial from other funding sources before this service is authorized for payment by the Developmental Disabilities Program.

History

Authorizing statute(s): 53-6-113, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-101, 53-6-402, 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.981 0208 Medicaid Home and Community-Based Services Program: Supported Employment, Individual Employment Supports

(1) Individual employment supports are habilitation services and staff supports needed by a waiver recipient to acquire a job or career advancement in the general workforce at or above the state's minimum wage, with a goal of not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Individual employment support is delivered in a competitive, customized, or self-employment setting. The outcome of this service is paid employment in a competitive, customized, or self-employment setting within the general workforce that meets the waiver recipient's personal and career goals, as documented in the plan of care. Individual employment supports are person-centered to address the waiver recipient's employment needs and interests.

(2) Individual employment supports may include:

(a) person-centered employment planning;

(b) job development;

(d) creating a job description based on a task derived from a single traditional job (job carving);

(e) job placement;

(f) career advancement activities;

(g) job analysis;

(h) training, support, coordination, and communication in related skills needed to obtain or retain employment;

(i) job coaching;

(j) job loss support; and

(k) benefit planning support.

(3) Individual employment supports may not include:

(a) transportation of a waiver recipient to and from the job site once the waiver recipient has been hired;

(b) any service that is otherwise available under the Rehabilitation Act of 1973. Documentation is required to ensure that the service is not available or is no longer available under a program funded under section 110 of the Rehabilitation Act of 1973, the IDEA (20 U.S.C. 1401 et seq.), or EPSDT;

(d) public relations activities;

(e) staff continuing education, including in-service meetings, department meetings, or individual staff development;

(f) incentive payments made to an employer to subsidize the employer's participation in a supported employment program;

(g) payments that are passed through to the waiver recipient;

(h) payments for vocational training that is not directly related to a waiver recipient's supported employment program;

(i) any other activities that are not specific to the waiver recipient, including circumstances when the waiver recipient cannot work their scheduled hours so the job coach is working the job instead of the waiver recipient;

(j) any activities which are not directly related to the waiver recipient's career plan;

(k) services furnished to a minor waiver recipient by a parent, step-parent, or legal guardian; and

(l) services furnished to a waiver recipient by the waiver recipient's spouse.

(4) Individual employment supports will not overlap with, supplant, or duplicate other services provided through the waiver or Medicaid state plan services.

(5) Income from customized home-based businesses need not be commensurate with minimum wage requirements with other employment.

(6) Federal financial participation is not claimed for incentive payments, subsidies, or unrelated vocational training expenses such as the following:

(a) incentive payments made to an employer to encourage or subsidize the employer's participation in supported employment; or

(b) payments that are passed through to the waiver recipient.

(7) Waiver recipients may utilize small group employment, follow along, co-worker, and day supports and activities in conjunction with individual employment support.

History

Authorizing statute(s): 53-6-113, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-101, 53-6-402, 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.985 0208 Medicaid Home and Community-Based Services Program: Support Employment, Small Group Support

(1) Small group employment support consists of habilitation services and staff supports needed for groups of two to eight waiver recipients to acquire and maintain a job or position in the general workforce at or above the state's minimum wage, with a goal of not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Small group employment examples include enclaves, mobile crews, and other business-based workgroups employing small groups of waiver recipients with disabilities in the community.

(2) Small group employment support must be provided in a manner that promotes integration into the workplace and interaction between people with and without disabilities in those workplaces.

(3) Small group employment support must occur in business settings during the hours typical for the industry.

(4) Small group employment support may include:

(a) person-centered employment planning with or on behalf of the waiver recipient;

(b) job development;

(d) creating a job description based on a task derived from a single traditional job (job carving);

(e) job placement;

(f) job analysis;

(g) training and support in related skills needed to obtain and retain employment such as using community resources and public transportation;

(h) job coaching;

(i) benefit planning support;

(j) job promotion support; and

(k) career advancement support.

(5) The following services are not reimbursable:

(a) transportation of a waiver recipient to and from the job site;

(d) staff continuing education, including in-service meetings, department meetings, individual staff development;

(e) incentive payments made to an employer to subsidize the employer's participation in a supported employment program;

(f) payments that are passed through to waiver recipients of supported employment program;

(g) payments for vocational training that is not directly related to a waiver recipient's supported employment program;

(h) any activities which are not directly related to the waiver recipient's career plan;

(i) services furnished to a minor waiver recipient by a parent(s), step-parent(s), or legal guardian; and

(j) services furnished to a waiver recipient by the waiver recipient's spouse.

(6) Total hours for a waiver recipient's attendance shall not include time spent during transportation to or from the waiver recipient's residence.

(7) The department requires all other funding sources be utilized and a denial from other funding sources before this service is entered into the cost plan and approved by the Developmental Disabilities Program.

(8) Waiver recipients may utilize individual, co-worker, follow along, and day supports and activities in conjunction with small group employment support.

History

Authorizing statute(s): 53-6-113, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-101, 53-6-402, 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.986 0208 Medicaid Home and Community-Based Services Program: Support Employment, Coworker Support

(1) Coworker support service allows the Developmental Disabilities Program (DDP) and developmental disabilities provider agencies to contract with a business to provide coworker job supports as a part of the natural workplace. This service differs from supported employment, follow along support, in that it creates opportunity for services and supports to be provided by the employee of a local business where the waiver recipient is employed. Receiving mentoring from a fellow employee increases opportunities for acceptance into and thus success in the workplace community. This service is intended to provide ongoing coworker support allowing follow along support to be decreased.

(2) The purpose of supported employment coworker support is to assist the waiver recipient to:

(a) develop positive work-related habits, attitudes, and skills;

(b) acquire work etiquette directly related to their specific employment;

(d) assist the waiver recipient in becoming a part of the informal culture of the workplace;

(e) provide job skill maintenance or assistance with incorporating new tasks;

(f) facilitate other supports at the work site; and

(g) assist during breaks and/or lunch.

(3) Waiver recipients participating in this service must be employed by a business and be paid at or above the state's minimum wage, with a goal of not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

(4) Waiver recipients using coworker support services may utilize individual and small group employment support, follow along support, and day supports and activities in conjunction with coworker support.

(5) The employer is reimbursed a daily rate to offset the cost to the employer for providing the supports which may be needed to maintain the waiver recipient in the job.

(6) Coworker support and follow-along support cannot be billed for during the same time but could be billed for during the same day.

(7) The activities of this service are over and above the obligations an employer has for an employee without a disability and does not duplicate or supplant those provided under the provisions of the Individuals with Disabilities Education Improvement Act, or Section 110 of the Rehabilitation Act of 1973, or the Americans with Disabilities Acts.

(8) The waiver will not cover activities which are otherwise available under section 110 of the Rehabilitation Act of 1973, the IDEA (20 U.S.C. 1401 et seq.), or EPSDT.

(9) The department requires all other funding sources be utilized, and a denial from other funding sources before this service is entered into the cost plan and approved by the Developmental Disabilities Program.

History

Authorizing statute(s): 53-6-113, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-101, 53-6-402, 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.987 0208 Medicaid Home and Community-Based Services Program: Supports Brokerage

(1) Supports brokerage services assist the waiver recipient self-directing service with employer authority in arranging, directing, and managing self-directed services as described in the waiver recipient's plan of care. The supports broker acts as an agent of the waiver recipient or legal representative and is available to assist in identifying immediate and long-term needs, developing options to meet those needs, and accessing identified supports and services.

(2) As determined by the scope and nature of the opportunities afforded to the waiver recipient, supports brokers may provide information regarding the following:

(a) person-centered planning and how it is applied;

(b) the range and scope of the choices and options the waiver recipient has;

(d) the grievance process;

(e) risks and responsibilities of self-direction;

(f) freedom of choice of providers;

(g) waiver recipient rights;

(h) reassessment and review of schedules; and

(i) other information pertinent to managing self-directed services.

(3) The supports broker may assist the waiver recipient with:

(a) defining goals, needs, and preferences and identifying and accessing services, supports, and resources;

(b) practical skills training regarding hiring, managing, and terminating employees;

(d) development of an emergency backup plan;

(e) recognizing and reporting critical events;

(f) independent advocacy, to assist in filing grievances and complaints when necessary; and

(g) other areas related to managing services and supports.

(4) Duplicative services are not allowed concurrent with supports brokerage. In instances where activities of the supports broker duplicate the provisions of case management, the plan of care must clearly delineate the responsibilities for performance activities.

(5) The annual cap for supports brokerage is the lesser of $6,000 or 20% of the value of the individual cost plan (ICP). These values may be exceeded for a limited time period in extraordinary circumstances with prior approval of the Developmental Disabilities Program (DDP).

History

Authorizing statute(s): 53-6-113, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-101, 53-6-402, 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.988 0208 Medicaid Home and Community-Based Services Program: Transportation

(1) Transportation services are those services which enable waiver recipients to gain access to waiver and other community services, activities, and resources specified by the plan of care.

(2) Transportation may be offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the state plan, defined at 42 CFR 440.170(a), and shall not replace them.

(3) Transportation services under the waiver shall be offered in accordance with the plan of care.

(4) Family, neighbors, friends, or community agencies that can provide this service without charge must be utilized when possible.

(5) Reimbursable transportation expenses may include assistance with reasonable costs related to one or more of the following areas, as determined by the Developmental Disabilities Program (DDP):

(a) operator training and licensure;

(b) insurance; and

(c) registration or other costs associated with a waiver recipient's dependence on the use of a personal vehicle as outlined in the plan of care.

(6) The following are excluded from transportation services:

(a) adaptations or improvements to the vehicle that are of general utility, and are not of direct medical or remedial benefit to the person;

(b) purchase or lease of a vehicle;

(c) regularly scheduled upkeep and maintenance of a vehicle with the exception of upkeep and maintenance of any modifications;

(d) escort services; and

(e) transportation may not be reimbursed if bundled within another service.

(7) For self-directed services, the financial management service (FMS) may only pay mileage reimbursement upon receiving documentation that transportation was provided in accordance with Montana state requirements for operating a motor vehicle.

(8) Mileage reimbursement through the FMS may be available to the owner of the vehicle when:

(a) transportation services provided to the waiver recipient are for approved community functions;

(b) all the requirements for operating a motor vehicle that are required have been met; and

(9) A waiver recipient with employer authority using the FMS option may only be reimbursed for mileage.

(10) Transportation may be provided when required transportation services exceed the Montana state plan or are different from the services available in the Montana state plan.

(11) Legal representatives of waiver recipients and other persons who are not employees of agencies with a Developmental Disabilities Program (DDP) contract may be reimbursed for the provision of rides at the mileage rate based on the operational expense of a motor vehicle but such reimbursement shall not include:

(a) reimbursement for work performed;

(b) the driver's time; or

(c) transportation not directly related to the specific disability needs of a waiver recipient, as outlined in the plan of care.

(12) A person providing transportation services must:

(a) be 17 years of age or older;

(b) have a valid motor vehicle license;

(d) have proof of vehicle registration.

History

Authorizing statute(s): 53-6-113, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-101, 53-6-402, 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2024 MAR p. 2067, Eff. 8/24/24.

Mont. Admin. R. 37.34.989 0208 Medicaid Home and Community-Based Services Waiver Program: Waiver-Funded Children's Case Management (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-402, MCA
History: NEW, 2014 MAR p. 220, Eff. 1/31/14; REP, 2024 MAR p. 2067, Eff. 8/24/24.

Subchapter 37.34.11 Plan of Care

Mont. Admin. R. 37.34.1101 Plan of Care: Personal Support Plan: Purpose

(1) A personal support plan (PSP) is a person-driven and person-centered plan that identifies the supports and services a person receiving state-administered developmental disabilities services uses to achieve independence and personal fulfillment while meeting health and safety needs.

(a) The Developmental Disabilities Program Personal Support Plan Manual, dated July 1, 2023, sets forth requirements and criteria that govern the development of the Personal Support Plan for the developmental disabilities program of the department.

(b) The department adopts and incorporates by reference the Developmental Disabilities Program Personal Support Plan Manual, dated July 1, 2023.

(c) A copy of the manual may be obtained from the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 143, Eff. 2/1/13; AMD, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1102 Plan of Care: Personal Support Plan: Implementation (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1103 Plan of Care: Personal Support Plan: Components (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1105 Plan of Care: Personal Support Plan: Assessments (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-2-201, 53-6-402, 53-20-203, 53-20-205, MCA
History: NEW, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1107 Plan of Care: Personal Support Plan: Plan Team (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1108 Plan of Care: Personal Support Plan: Quarterly Reports (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1109 Individual Plan: Duties of the Case Manager

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 143, Eff. 2/1/13.

Mont. Admin. R. 37.34.1114 Plan of Care: Personal Support Plan: Decision Making (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1115 Individual Plan: Individual Planning Appeal Committee

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, MCA
History: NEW, 1993 MAR p. 1353, Eff. 6/25/93; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 143, Eff. 2/1/13.

Mont. Admin. R. 37.34.1117 Plan of Care: Individual Family Service Plan: Purpose (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-2-201, 53-6-402, 53-20-203, 53-20-205, MCA
History: NEW, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Mont. Admin. R. 37.34.1119 Plan of Care: Individual Family Service Plan: Implementation (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-2-201, 53-6-402, 53-20-203, 53-20-205, MCA
History: NEW, 2013 MAR p. 143, Eff. 2/1/13; REP, 2024 MAR p. 614, Eff. 3/23/24.

Subchapter 37.34.12 Adult and Family Services

Mont. Admin. R. 37.34.1201 Adult and Family Services: Education and Training Requirements

(1) Education and training must be provided in accordance with the performance requirements in this rule.

(2) An adult or family services contractor in providing education and training must comply with the performance requirements in this rule.

(3) Education and training must be directed toward the individual's attainment of goals identified by the IP or the IFSP team.

(4) There are 2 categories of training: formal and incidental. Formal training is a focused, documented effort to accomplish a training objective. Incidental training occurs incidental to daily living and is facilitated through various techniques which recognize that all individuals learn, grow and develop if given the opportunity to do so. Formal training should occur in the environment in which the knowledge, skill or ability will most likely be used.

(5) Training may be most appropriate across a variety of environments. The IP or the IFSP team identifies the settings for specific training objectives. The training method should be the most culturally normative, effective method for the individual and the skill or ability that is the subject of the training. Incidental training should occur across all settings.

(6) Training, formal or incidental, must be provided in the development of one or more of the following areas: motor/physical, communication, self-help and personal care, functional academics, community life, social and sexual, health and safety, home-related skills, adaptive behavior, leisure, work, job-specific training, and self-advocacy.

(7) Motor and physical training develops gross and fine motor skills. Training includes locomotion, body posture and control, motor coordination and physical conditioning.

(8) Communication training develops an individual's ability to affect the environment around them through other people. Training includes receptive and expressive language and control of inappropriate verbalization.

(9) Self-help and personal care training develops independence in basic daily living skills. Training includes eating, toileting, dressing, bathing, hair care, personal hygiene and grooming; clothing selection and care; care of menstrual needs; mobility and care of mobility devices.

(10) Functional academics develops academic skills directly related to independent functioning in the community. Training includes reading and survival word recognition and number concepts and recognition.

(11) Community life training develops independence in the community, locating and using community resources, and interacting with others. Training includes orientation to the community, travel and transportation; community recreation; safety, including traffic signs; shopping skills, restaurant use and use of community services.

(12) Social and sexual training develops independence and acceptance in the community. Training includes interpersonal relationships, birth control, marriage, children and pregnancy; sexual abuse and exploitation; alcohol and drug use; human development; and disease and sexually transmitted disease prevention.

(13) Health and safety training develops the skills necessary to live independently and safely in the community and to maintain optimal health. Training includes self administration of medications; first aid; nutrition; home, work and community safety and response to emergencies.

(14) Home-related skills training develops independence in managing one's own home. Training includes financial management; clothing care and selection; household chores, meal preparation and food handling; home repair and maintenance; time telling; telephone usage; and use and care of major appliances.

(15) Adaptive behavior training develops acceptable alternatives to maladaptive behavior. Training includes positive programming, dealing with difficult situations, anger management, independence, dependability, initiative, versatility and decreasing maladaptive behavior.

(16) Leisure training develops independent, age-appropriate use of free time, both through individual and group activities. Training includes crafts; individual and group games; hobbies and sports.

(17) Work training develops skills which are necessary to functioning in the work environment. Training includes small assembly; color and shape assembly; attention span/attending and following instructions; matching and sorting and simple assembly; quality of work, quantity of work and general work habits; obtaining employment, relating to supervisor and relating to peers.

(18) Job-specific training develops all the skills necessary to succeed in the paid employment that an individual is hired to perform.

(a) Training occurs within the actual job environment and addresses naturally occurring demands and contingencies.

(b) The trainer assists the employee in completing the job until all the tasks can be performed at the standards established by the employer.

(c) Trainer activities may include, but are not limited to performing the job in order to prepare a task analysis; identifying and addressing employee needs; directly training employees within the natural environment and ensuring completion of job requirements for the employer until the employee is completing the job independently.

(19) Self advocacy training develops advocacy skills. Training includes rights, responsibilities and participation in the planning process.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-203 and 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.1204 Adult and Family Services: Leisure and Community Activities

(1) Leisure and community activities must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing adult or family services in the provision of leisure and community activities must comply with the performance requirements in this rule.

(3) The individual must be allowed the opportunity to choose community activities to participate in. The individual may choose the activities based on the individual's knowledge of the variety of activities occurring within the community.

(a) The individual should be encouraged and assisted in experiencing a variety of enjoyable community activities.

(4) The individual must be allowed the opportunity to choose leisure activities to participate in. The individual may choose the activities based on the individual's knowledge of the variety of activities occurring within the individual's services and the community.

(a) The individual should be encouraged and assisted in experiencing a variety of enjoyable leisure activities.

(b) A variety of leisure activities should be available, based on the preferences of the persons receiving services.

History

Authorizing statute(s): Sec. 53-20-204, MCA
Implementing statute(s): Sec. 53-20-203 and 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124.

Subchapter 37.34.14 Behavior Support

Mont. Admin. R. 37.34.1401 Behavior Support: Purpose

(1) The purpose of the rules under this subchapter is to require the use of behavior supports intended to encourage individual growth, improve quality of life, and reduce the use of unnecessary intrusive measures for persons receiving services funded by DDP. Behavior support focuses both on what is important to the person as an individual and what is important for encouraging growth and change. This subchapter prohibits the use of or procedures which are abusive, demeaning, or cause pain or discomfort, pursuant to the provisions of ARM 37.34.1418. Emergency procedure exceptions are provided for in ARM 37.34.1420. This subchapter applies to persons receiving services from community-based providers that are funded entirely or in part by the department.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1402 Behavior Support: Applicability

(1) All children and adults receiving services from community-based providers that are funded entirely or in part by the department through DDP must be afforded the protections imposed by these rules. Any service provider approved by DDP through the provider enrollment process, (i.e., a DDP qualified service provider) must conduct its activities in accordance with these rules.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1403 Aversive Procedures: Use

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1404 Behavior Support: Definitions

For the purposes of this subchapter, the following definitions apply:

(1) "Advocate" is defined in ARM 37.34.102.

(2) "Alternative behavior" means a behavior that can, but is not likely to occur at the same time as a challenging behavior.

(3) "Challenging behavior" means a behavior that presents a risk or potential risk to the health or safety of the person or to others.

(4) “Chemical restraint” means any drug that is used for discipline or staff convenience and is not required to treat medical symptoms.

(5) "Coercion” means the practice of persuading a person to do something by using force or threats.

(6) "Contingent access” means the restriction of access to activities, places, and items, including personal possessions, as a result of the occurrence of a specified challenging behavior.

(7) "Corporal punishment" means knowingly and purposefully inflicting physical pain on a person as a disciplinary measure.

(8) “DDP” means the Developmental Disabilities Program.

(9) "Educational fine," also known as token or point removal, means a method of decreasing challenging behavior by reducing the quantity of earned tokens or points contingent upon the occurrence of a challenging behavior and the opportunity for the person to "earn back" the token(s) or point(s) by practicing the appropriate behaviors.

(10) "Exclusion time out" means a method of decreasing a challenging behavior by requiring a person to leave an ongoing reinforcing situation for a period of time, contingent on the occurrence of some previously specified challenging behavior. The person is not instructed to observe the appropriate behavior of others.

(11) "Graduated guidance" means systematically providing the minimum degree of physical assistance necessary to ensure that a desired behavior occurs. Graduated guidance is a technique combining physical guidance and fading in which the physical guidance is systematically and gradually reduced and faded according to the person’s responsiveness. Graduated guidance techniques do not include physical restraint. Graduated guidance is assistive rather than restrictive and does not involve forced compliance.

(12) "Mechanical restraint" means a physical device used to restrict the person’s movement or restrict the normal function of the person’s body. The term “mechanical restraint” does not include safety devices or medically related restraints.

(13) “Medically related restraint” means physical equipment or orthopedic appliances. Medically related restraint includes devices used to support functional body position or proper balance; surgical dressings or bandages; and supportive body bands or other restraints, including manual holds, necessary for the person to receive medical treatment, routine physical examinations, or medical tests. Medically related restraint requires a written order or other authorization from a medical practitioner who is licensed to practice medicine, including physicians, physician assistants, and nurse practitioners.

(14) "Overcorrection" means a technique used to decrease a challenging behavior, typically taking the form of asking or guiding a person to repeat the correct form of a behavior or activity. The two main types of overcorrection are restitutional overcorrection and positive practice overcorrection.

(15) "Physical enforcement" means a person is required to perform a behavior by another person using physical contact with them.

(16) "Physical prompt" means a person physically guides the person to perform a response. Physical prompts are assistive rather than restrictive and do not involve forced compliance.

(17) "Physical restraint" means the restriction of the person’s movement by holding or applying physical pressure to bring the person’s behavior under control in order to avoid the risk of serious harm to the person or other person(s). The term “physical restraint” does not include the use of physical prompts, graduated guidance, or medically related restraints.

(18) "Positive practice overcorrection" means a form of overcorrection in which the person engaging in a challenging behavior is asked or guided to repeatedly practice a specified appropriate form of the behavior.

(19) "Response cost" means a procedure reducing accumulated reinforcement upon the occurrence of a challenging behavior, thus making the behavior less likely to occur.

(20) "Restitutional overcorrection" means a form of overcorrection asking or guiding a person engaging in a challenging behavior to restore the environment to its previous state and improve on the previous conditions.

(21) "Restriction of rights" means procedures which involve withdrawal, delay, or curtailment of rights which the person may ordinarily exercise. Such withdrawal is usually in connection with a program through which the person may exercise such rights by performing specified behaviors.

(22) “Safety device” means a device used in accordance with a person’s plan of care that reduces or inhibits the person’s movement with the sole purpose of maintaining the safety of the person. Safety devices include: implements, garments, gates, locks or locking apparatuses, helmets, masks, gloves, straps, bed-rails, or belts.

(23) “Safety science” means applying scientific methods, research, and tools to understand, assess, and manage safety.

(24) "Seclusion" means requiring the person to remain alone in a room or any area behind a closed door which prevents them from leaving or being observed for a period of time.

(25) “Therapeutic care” means care administered by licensed professionals such as speech, occupational, and physical therapies and mental/emotional counseling.

(26) “Trauma informed care” means an approach to care that recognizes the widespread impact of trauma and promotes environments of healing and recovery. Trauma informed care seeks to avoid re-traumatization and to understand and respond to signs and symptoms of trauma in individuals, families, and staff.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1405 Positive Behavior Support: Description (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 2012 MAR p. 2617, Eff. 12/21/12; REP, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1408 Aversive Procedures: Systematic Program Review

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1409 Aversive Procedures: Approval Criteria

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1410 Aversive Procedures: Classification and Conditions Governing Use of Procedures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1411 Behavior Support: Behavior Assessment

(1) A behavior assessment is the gathering of information about a person’s behavior based upon multiple information sources, including:

(a) a review of the person's records;

(b) personal observations;

(d) interviews with the person; and

(e) interviews with others who have personal knowledge of the person.

(2) A behavior assessment must include:

(a) a clear and measurable description of the challenging behavior, including frequency, duration, intensity, and severity of the behavior;

(b) a clear description of the need to alter the behavior;

(c) a clear description of medical, psychological, psychiatric, physiological, and environmental conditions in terms of how they may affect the occurrence of the challenging behavior;

(d) the events, times, and situations that predict both the occurrence and the nonoccurrence of the challenging behavior;

(e) summary statement(s) which explain(s) what may be maintaining the challenging behavior; and

(f) data confirming the occurrences of the challenging behavior.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1412 Behavior Support: Behavior Support Plan

(1) The behavior support plan is a formal written plan to address needs identified in a person’s plan of care and must be developed for all persons engaging in challenging behavior. The behavior support plan must be based on a behavior assessment as described in ARM 37.34.1411.

(2) Behavior support plans:

(a) use the least restrictive intervention possible;

(b) are evaluated through timely review of specific data on the progress and effectiveness of the procedure;

(d) include target behaviors;

(e) include a description of any restrictions necessary to protect the health and safety of the person, describe why the restrictions are necessary, and list the criteria for removing them;

(f) include reactive strategies to ensure the safety of the person and others; and

(g) are included in the person's plan of care.

(3) A behavior support plan must not include the use of restrictions or acts prohibited in ARM 37.34.1418; procedures which are aversive, abusive or demeaning; or procedures that cause pain or discomfort, except as provided for in the emergency procedures allowed for in ARM 37.34.1420.

(4) Use of the person's behavior support plan requires prior written consent from the following for approval:

(a) the person;

(b) the person's parent(s) if the person is under 18 years of age; or

(5) The person's planning team and the person's providers are responsible for the implementation of the person's behavior support plan.

(6) A behavior support plan must include appropriate measures for training and monitoring staff performance throughout the implementation of the behavior support plan.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1415 Aversive Procedures: Developmental Disabilities Program Review Committee

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1418 Behavior Support: Prohibitions

(1) The following may not be restricted for any purpose, including behavior support plans or programs:

(a) education and training services;

(b) a safe environment to live, work, and receive treatment;

(d) prompt medical, dental, and therapeutic care;

(e) a nourishing, well-balanced diet;

(f) assistance of an advocate;

(g) exercise of voting rights;

(h) opportunity for religious worship;

(i) just compensation for work performed; and

(j) right to grievance processes.

(2) The following acts are prohibited in the delivery of services to a person:

(a) chemical restraint;

(b) coercion;

(d) exclusion time out;

(e) mechanical restraint;

(f) physical enforcement;

(g) physical restraint, except as authorized as an emergency procedure set forth in ARM 37.34.1420;

(h) restitutional overcorrection;

(i) seclusion; and

(j) abuse as defined in 52-3-803, MCA.

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1419 Meal Delay

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
History: 53-20-203 and 53-20-205, MCA; NEW, 1986 MAR p. 345, Eff. 4/21/86; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1420 Behavior Support: Emergency Procedures

(1) Emergencies are situations in which the person or others is/are at imminent risk of serious harm or injury due to the person’s challenging behavior.

(2) If an emergency occurs, a physical restraint may be used if necessary to prevent the imminent risk of serious harm or injury to the person or others, but only if the following requirements are met:

(a) staff members involved with the application of physical restraint must be trained to apply such restraints safely and properly;

(b) physical restraint may only be used as a last resort after other alternative measures have been tried prior to initiating the restraint;

(c) physical restraint must not result in harm or injury to the person, including restriction of blood circulation or breathing;

(d) any use of physical restraint must be for the shortest duration possible and must end as soon as it is determined that the emergency has ceased and the person’s safety and the safety of others can be ensured.

(3) Incident reporting must meet the requirements described in ARM Title 37, chapter 34, subchapter 15.

(4) Nothing in this section limits or restricts the use of medically related restraints as defined in ARM 37.34.1404.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1421 Aversive Procedures: Reimposition of Deceleration Program

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1422 Behavior Support: Restricted Procedures

(1) The following restricted procedures may be used for up to 90 calendar days as part of a behavior support plan that is developed in accordance with a person’s Home and Community-Based Services, (HCBS) health and safety modification and ARM 37.34.1412 and approved in accordance with (2):

(a) contingent access to personal possessions;

(b) contingent access to personal funds;

(d) contingent access to social activities;

(e) contingent access to specific community location(s); and

(f) response cost.

(2) A behavior support plan that includes the use of restrictive procedures must be approved by:

(a) a board-certified behavior analyst-doctoral (BCBA-D), board-certified behavior analyst (BCBA), or board-certified assistant behavior analyst (BCaBA) under the supervision of a BCBA-D or BCBA;

(b) a person with an Institute for Applied Behavior Analysis (IABA) certification or an Intermediate Applied Behavior Analysis (ABA) Professional; or

(c) a person with a degree in applied behavior analysis (ABA), psychology, or special education who has provided documentation of training and experience in the use of the principles of ABA as approved by the department.

(3) All professionals developing and approving behavior plans are encouraged to have additional training in principles of safety science and trauma informed care.

(4) A copy of the behavior support plan incorporating restricted procedures as listed in (1) must be sent to the DDP bureau chief or their designee within three working days after approval as required in (2).

(5) The DDP bureau chief or their designee must provide prior written authorization for the continued use of the restricted procedures after 90 calendar days. The designee(s) may take the form of a program review committee which is responsible for reviewing and monitoring the continued implementation and effectiveness of the behavior support plan. A behavior support plan incorporating restricted procedures must be reviewed at least once per year by the DDP program review committee.

(a) Program review committees:

(i) have at least three members;

(ii) meet at least once per month; and

(iii) can be composed of, but are not limited to psychiatrist(s), psychologist(s), board certified behavior analyst(s), provider representative(s), regional representative(s), a developmental disabilities program central office representative, a targeted case manager (TCM), a representative of Disability Rights Montana (DRM), parent/family representatives, or members currently receiving services with or without restrictions.

(6) The restricted procedures in (1) may only be used in the delivery of services to a person as authorized by these rules.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-203, MCA
History: NEW, 2012 MAR p. 2617, Eff. 12/21/12; AMD, 2025 MAR, Notice No. 2025-278, Eff. 10/11/25.

Mont. Admin. R. 37.34.1426 Aversive Procedures: Appeal Process

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1427 Aversive Procedures: Staff Certification

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Mont. Admin. R. 37.34.1428 Aversive Procedures: Unclassified Procedures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1986 MAR p. 345, Eff. 4/21/86; AMD, 1993 MAR p. 1356, Eff. 6/25/93; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2617, Eff. 12/21/12.

Subchapter 37.34.15 Incident Reporting and Handling

Mont. Admin. R. 37.34.1501 Incident Reporting and Handling, Purpose

(1) This rule governs the reporting and handling of incidents which harm, or could result in harm to, a person with a developmental disability who receives services funded by the Developmental Disabilities Program of the department.

(a) The Developmental Disabilities Program Incident Management Manual, dated January 1, 2025, sets forth further requirements and criteria that govern the incident management system for the Developmental Disabilities Program of the department.

(b) The department adopts and incorporates by reference the Developmental Disabilities Program Incident Management Manual, dated January 1, 2025.

(c) A copy of the manual may be obtained through the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(d) Incidents constituting abuse and neglect of a child as defined in 41-3-102, MCA or abuse, neglect, and/or exploitation of a person with a developmental disability as defined in 52-3-803, MCA are subject to the statutory and rule provisions governing the reporting, investigation, and protection of those circumstances.

History

Authorizing statute(s): 53-20-203, 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 148, Eff. 2/1/13; AMD, 2024 MAR p. 283, Eff. 2/10/24; AMD, 2025 MAR, 37-1105, Eff. 4/26/25.

Mont. Admin. R. 37.34.1502 Incident Reporting and Handling, Policy

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 148, Eff. 2/1/13.

Mont. Admin. R. 37.34.1506 Incident Reporting and Handling

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 148, Eff. 2/1/13.

Mont. Admin. R. 37.34.1507 Incident Reporting and Handling, Death, Suicide Attempt, Unaccounted for Absence, Emergency Hospitalization or Law Enforcement Involvement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 148, Eff. 2/1/13.

Mont. Admin. R. 37.34.1511 Incident Reporting and Handling, Investigations

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 148, Eff. 2/1/13.

Mont. Admin. R. 37.34.1512 Incident Reporting and Handling, Confidentiality

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 148, Eff. 2/1/13.

Mont. Admin. R. 37.34.1513 Incident Reporting and Handling, Client Abuse or Client Problem Behavior

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1988 MAR p. 1895, Eff. 8/26/88; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 148, Eff. 2/1/13.

Subchapter 37.34.16 Regional Councils

Mont. Admin. R. 37.34.1601 Regional Councils

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-207, MCA
Implementing statute(s): 53-20-203, 53-20-207, MCA
History: NEW, 1979 MAR p. 1721, Eff. 12/28/79; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 165, Eff. 2/1/13.

Subchapter 37.34.17 Planning and Advisory Councils

Mont. Admin. R. 37.34.1701 Preparation of Montana Developmental Disabilities State Plan

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-206, MCA
History: NEW, 1979 MAR p. 1712, Eff. 12/28/79; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 165, Eff. 2/1/13.

Subchapter 37.34.18 Minimum Standards

Mont. Admin. R. 37.34.1801 Accreditation Standards for Provider Programs of Services: Adoption and Applicability

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1985 MAR p. 1156, Eff. 8/16/85; AMD, 1990 MAR p. 1851, Eff. 9/28/90; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2000 MAR p. 3171, Eff. 11/10/00; REP, 2013 MAR p. 165, Eff. 2/1/13.

Mont. Admin. R. 37.34.1802 Accreditation Standards for Provider Programs of Services: Department Assistance

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-203, 53-20-205, MCA
History: NEW, 1985 MAR p. 1156, Eff. 8/16/85; AMD, 1990 MAR p. 1851, Eff. 9/28/90; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2000 MAR p. 3171, Eff. 11/10/00; REP, 2013 MAR p. 165, Eff. 2/1/13.

Subchapter 37.34.19 Applied Behavior Analysis Services

Mont. Admin. R. 37.34.1901 Medicaid Home and Community Services Children's Autism Program 0667: Authority

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1902 Definitions

The definitions applicable to Applied Behavior Analysis (ABA) therapy services are as follows:

(1) "Applied Behavior Analysis" (ABA) means a type of therapy that applies human behavior principles to improve a member's adaptive functioning and reduce problem behaviors due to a psychiatric and/or behavioral condition.

(2) "Autism spectrum disorder" (ASD) means a condition as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, (DSM-5-TR) of the American Psychiatric Association. The DSM-5 ASD definition is adopted and incorporated by reference. The DSM-5 defines and classifies mental disorders. A copy is available for public inspection at: Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities Division, Developmental Disabilities Program, 111 N. Sanders, Helena, MT 59604-4210. A copy may be purchased online at https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787.

(3) "Behavior identification assessment" (BIA) means a developmentally appropriate assessment that identifies strengths and weaknesses across domains and potential barriers to progress. Areas of assessment may include challenging behaviors and skill deficits, co-occurring medical and psychiatric conditions, cognitive, adaptive, and developmental functioning, and family dynamics.

(4) "Board Certified Behavior Analyst ® " (BCBA) means an individual with a graduate-level certification in behavior analysis who has been certified by the Behavior Analyst Certification Board (BACB). Professionals certified at the BCBA level are independent practitioners who provide ABA services.

(5) "Board Certified Behavior Analyst-Doctoral ® " (BCBA-D) means a Board Certified Behavior Analyst who has earned their PhD, in addition to their Master's and/or Bachelor's degrees, and had been certified by the BACB. Any reference to a BCBA in these rules includes BCBA-Ds, unless indicated otherwise.

(6) "Board Certified Assistant Behavior Analyst ® " (BCaBA) means an individual with an undergraduate level certification in behavior analysis who has been certified by the BACB. Professionals certified at the BCaBA level provide behavior analysis services under the supervision of a BCBA.

(7) "DD eligible" means a member found eligible for the receipt of state-sponsored developmental disabilities services pursuant to ARM 37.34.201.

(8) "Department" means the Montana Department of Public Health and Human Services.

(9) "Developmental disability" (DD) means a condition or disability that meets the definition of "developmental disability" set forth in 53-20-202(3), MCA.

(10) "Diagnostic evaluation" means an evaluation performed by a qualified health care professional with expertise in the diagnostic area, that establishes the qualifying diagnosis through interview, observation, and formal assessment tools appropriate to the condition for which services are requested. The qualified health care professional with expertise in the diagnosis area may use assessments from professionals outside of their fields to obtain information that contributes to the diagnostic process.

(11) "Eligibility criteria" means those criteria established for the purposes of the program of ABA services authorized by the department, as specified in the Montana Medicaid Applied Behavior Analysis Services Manual (ABA Services Manual), dated March 1, 2025. The department adopts and incorporates by reference the ABA Services Manual which provides the public with greater detail about ABA services. Any conflict between these rules and what is outlined in the ABA Services Manual should be resolved in favor of what is written in these rules. A copy may be accessed on the DPHHS website at the following link: https://medicaidprovider.mt.gov/manuals/appliedbehavioranalysisservicesmanual or a paper copy may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 or at https://medicaidprovider.mt.gov/76.

(12) "Functional impairment criteria" are defined in the ABA Services Manual.

(13) "Member" means a person enrolled in Montana Medicaid who is eligible to receive ABA services.

(14) "Provisional qualifying diagnosis" means a member's diagnosis that qualifies the member for initiation of ABA services but that has not yet been confirmed by a qualified health care professional with expertise in the diagnostic area. The diagnosis must meet functional impairment criteria and be:

(a) SED;

(b) ASD; or

(15) "Qualified health care professional with expertise in the diagnostic area," for the purpose of Montana Medicaid ABA therapy services, refers to a licensed professional with formal training in child and adolescent psychiatric diagnosis and treatment, and has training specific to SED and ASD. A qualified health care professional with expertise in the diagnostic area must belong to one of the following categories:

(a) child and adolescent psychiatrist;

(b) general psychiatrist;

(d) developmental pediatrician;

(e) neurologist;

(f) neuropsychologist or psychologist;

(g) pediatrician;

(h) family physician;

(i) family or pediatric nurse practitioner;

(j) physician assistant;

(k) clinical professional counselor; or

(l) clinical social worker.

(16) "Qualifying diagnosis" means a member's diagnosis that is established by a qualified health care professional with expertise in the diagnostic area through a diagnostic evaluation. The diagnosis must meet functional impairment criteria and the diagnosis must be:

(a) SED;

(b) ASD; or

(17) "Registered behavior technician" (RBT) means an individual with a paraprofessional certification by the BACB in behavior analysis. The RBT assists in delivering behavior analysis services and practices under the direction and close supervision of a BCBA. The supervising BCBA is responsible for all work the RBT performs.

(18) "Serious emotional disturbance" (SED), for the purposes of the program of ABA services authorized by the department, is a mental disorder as defined in the Clinical Guidelines chapter of the ABA Services Manual.

(19) "Treatment plan" means an individualized written document that has been developed from the BIA and contains all the critical features listed in the Applied Behavior Analysis Practice Guidelines for the Treatment of Autism Spectrum Disorder: Guidance for Healthcare Funders, Regulatory Bodies, Service Providers, and Consumers, Third Edition (ABA Treatment of ASD: Practice Guidelines) issued by the Behavior Analyst Certification Board, Inc. (BACB) and/or Council of Autism Service Providers. The department adopts and incorporates by reference the ABA Treatment of ASD: Practice Guidelines, which provides guidelines and other information about ABA treatment for ASD. A copy is available for public inspection at the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities Division, Developmental Disabilities Program, located at 111 N. Sanders, Helena, MT 59604-4210 and is available online at https://www.casproviders.org/asd-guidelines.

(20) "Unit of service" means 15 minutes of treatment service.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-2-201, 53-6-101, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22; AMD, 2023 MAR p. 902, Eff. 8/26/23; AMD, 2025 MAR, Notice No. 2025-276, Eff. 10/11/25.

Mont. Admin. R. 37.34.1903 Medicaid Home and Community Services Children's Autism Program 0667: Generally

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1905 Medicaid Home and Community Services Children's Autism Program 0667: Eligibility

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1907 Medicaid Home and Community Services Children's Autism Program 0667: Screening and Acceptance Determinations

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1908 Initial Eligibility

(1) For a member to qualify for initial ABA services, the member must meet the functional impairment criteria and one of the following:

(a) have a provisional qualifying diagnosis of ASD and be under 21 years of age;

(b) be DD eligible and under 21 years of age; or

(i) 17 years of age or younger; or

(ii) up to 20 years of age and enrolled in an accredited secondary school.

(2) A physician, licensed mental health professional, nurse practitioner, or psychologist must deem ABA services medically necessary to alleviate the symptoms of the stated provisional qualifying diagnosis and must document the medical necessity of the service in the form of a prescription. The prescription must state the diagnosis for which the member is being referred and that the referral is for ABA services.

(3) The BCBA must complete, and submit to the department, the ABA Services Intent to Initiate Treatment form.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1909 Medicaid and Community Services Children's Autism Program 0667: Transitioning from the Children's Autism Waiver

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1911 Medicaid and Community Services Children's Autism Program 0667: Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1912 Continued Eligibility for Additional Units of Service

(1) For a member to continue receiving ABA services after the initial 180 calendar days or the initial authorized units of service are exhausted, they must meet all criteria for continued eligibility and for additional units of service, and the department must authorize such additional units of service. The criteria for continued eligibility and additional units of service, as well as the process and rules governing authorization of additional units of service are set forth below and in the ABA Services manual.

(2) For a member to meet all criteria for continued eligibility:

(a) The member must continue to meet the age criteria for initial eligibility in ARM 37.34.1908;

(b) The member's original provisional diagnosis must then be confirmed as a qualifying diagnosis through a diagnostic evaluation, performed by one of the qualified healthcare professionals with expertise in the diagnostic area;

(c) The member must continue to meet functional impairment criteria that is supported in documentation the BCBA submits to the department;

(d) The department must deem the member eligible through its authorization process; and

(e) Both the BCBA and the referring physician, nurse practitioner, licensed mental health professional, or psychologist must deem the services medically necessary.

(3) For a member to meet the criteria for additional units of service:

(a) The member must continue to meet the eligibility criteria outlined above, the service requirements in ARM 37.34.1918, and:

(i) the BCBA providing services must have a reasonable expectation that the member will continue to benefit from the services and that the skill deficits and behaviors identified in the treatment plan will improve to a clinically meaningful extent;

(ii) the member must demonstrate progress in each of the identified treatment goals or provide a clinical explanation and modification to address a lack of progress; and

(iii) the treatment plan demonstrates that the member is not experiencing a worsening of skill deficits or behaviors due to the treatment services.

(b) The member must be excluded from eligibility for service if any of the following criteria occur:

(i) The member demonstrates consistent worsening of skill deficits and/or behaviors with the service being delivered;

(ii) The member's parent/guardian is not engaged in treatment and/or does not agree to continued service delivery;

(iii) The member has medical conditions or impairments that would prevent beneficial utilization of services;

(iv) The member has demonstrated no significant progress in treatment goals for two consecutive additional units of service request reviews, and the BCBA provider cannot sufficiently explain the lack of progress to justify continuing to authorize the service; or

(v) The member can be safely and effectively treated at a less intensive level of service or care.

(4) The BCBA must receive authorization from the department for additional units of services before such units of service can be provided.

(5) For the department to authorize additional units of service:

(a) The BCBA must complete and submit the ABA Services Additional Units of Service Request form and additional required documentation at least 14 calendar days prior to the intended onset of continued service delivery. Additional required documentation is specified in the ABA Services manual; and

(b) The member must continue to have a qualifying diagnosis that meets the criteria of (2)(b).

(6) The processes for a service provider to request additional units of service and for the department's review and authorization are outlined in the ABA Services manual's Authorization of Additional Units of Service section.

(7) If a previous request is denied, a service provider may submit a request for additional units of service if they have additional information to satisfy any deficiencies noted with respect to such denied request. This is considered a new submission and all required documents will need to be submitted again for a new department review and determination.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-111, 53-21-701, 53-21-702, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1913 Medicaid and Community Services Children's Autism Program 0667: Available Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1915 Medicaid and Community Services Children's Autism Program 0667: General Provider Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1917 Medicaid and Community Services Children's Autism Program 0667: Individual Family Service Plan

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1918 Service Requirements

(1) Services are covered only when within the scope of the provider's license. All providers must comply with all applicable state and federal statutes, rules, and regulations.

(2) Individuals receiving ABA services must meet the department's applicable initial and/or continuing eligibility criteria. The services delivered must meet all the following service requirements:

(a) The services must be approved by utilizing the processes, including the authorization process, outlined in the ABA Services manual. The ABA provider must satisfy the service requirements listed here and in the ABA Services manual.

(b) The services must be directed by a BCBA or BCBA-D. Some services may be provided by a BCaBA or an RBT if the BCaBA or RBT meets the qualifications of ARM 37.34.1930 and is supervised by the BCBA in accordance with 37-17-403 and 37-17-405, MCA.

(c) The services delivered must be consistent with the following elements as outlined in the Applied Behavior Analysis Practice Guidelines for the Treatment of Autism Spectrum Disorder: Guidance for Healthcare Funders, Regulatory Bodies, Service Providers, and Consumers, Third Edition:

(i) ABA core characteristics;

(ii) Essential practice elements; and

(iii) Assessment, formulation of treatment goals, and measurement of client progress.

(d) Services are delivered in compliance with the member’s individualized treatment plan, developed within 30 calendar days of onset of services, and containing all the critical features listed in the Applied Behavior Analysis Practice Guidelines for the Treatment of Autism Spectrum Disorder: Guidance for Healthcare Funders, Regulatory Bodies, Service Providers, and Consumers, Third Edition.

(e) Services must be provided or supervised by the BCBA, BCBA-D, or BCaBA who wrote the treatment plan.

(f) Services must be provided to the member in person, with the provider and the member in the same physical location, unless specifically authorized in writing by the department.

(3) ABA services may continue so long as the member does not meet any of the service exclusion criteria set forth in ARM 37.34.1912(3)(b).

(4) In addition to the requirements outlined in this rule, the ABA Services manual sets forth requirements, request and review processes, and procedures for ABA services with which an ABA provider must comply.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 37-17-403, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-21-701, 53-21-702, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22; AMD, 2025 MAR, Notice No. 2025-276, Eff. 10/11/25.

Mont. Admin. R. 37.34.1919 Medicaid and Community Services Children's Autism Program 0667: Notices and Fair Hearings

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1921 Medicaid and Community Services Children's Autism Program 0667: Informing Beneficiary of Choice

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1923 Medicaid and Community Services Children's Autism Program 0667: Children's Autism Training, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1924 Concurrent Services

(1) The following Montana Medicaid Children's Mental Health Bureau (CMHB) services may be provided concurrently with ABA services if ABA services are provided and billed outside the authorized treatment hours of the other programs, and if providers demonstrate and document attempts made for coordination with community-based services:

(a) partial hospital services (PHP);

(b) day treatment (Day TX);

(d) therapeutic group home (TGH);

(e) home support services (HSS);

(f) therapeutic foster care (TFC);

(g) extraordinary needs aide (ENA); and/or

(h) targeted case management (TCM) for youth with SED.

(2) The following Montana Medicaid CMHB services may not be provided concurrently with ABA services, as they are considered duplicative:

(a) community-based psychiatric rehabilitation and support services (CBPRS);

(b) psychiatric residential treatment facility (PRTF);

(d) intensive outpatient services (IOP).

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-21-701, 53-21-702, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1925 Medicaid and Community Services Children's Autism Program 0667: Children's Autism Training, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1927 Medicaid and Community Services Children's Autism Program 0667: Waiver-Funded Children's Case Management

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1929 Medicaid and Community Services Children's Autism Program 0667: Waiver-Funded Children's Case Management, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1930 Provider Requirements

(1) A BCBA/BCBA-D must:

(a) comply with, and agree to be bound by, all laws, rules, regulations, and policies generally applicable to Medicaid providers including the provisions of ARM 37.85.401, 37.85.402, 37.85.406, 37.85.407, 37.85.410, 37.85.414, and 37.85.415;

(b) be licensed and have met the licensure requirements for the State of Montana set forth in 37-17-403 and 37-17-405, MCA;

(d) maintain responsibility for billing for BCaBA's and RBT's services and assuring that the services are delivered in accordance with the member's Treatment Plan.

(2) A BCaBA must:

(a) be licensed and have met the licensure requirements for the State of Montana set forth in 37-17-403 and 37-17-405, MCA; and

(b) work under the oversight of a BCBA who assumes full professional responsibility for the services delivered and billed.

(3) An RBT must work under the oversight of a BCBA who bills and assumes full responsibility for services delivered.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-21-701, 53-21-702, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22; AMD, 2025 MAR, Notice No. 2025-276, Eff. 10/11/25.

Mont. Admin. R. 37.34.1931 Medicaid and Community Services Children's Autism Program 0667: Respite, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1933 Medicaid and Community Services Children's Autism Program 0667: Respite, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1935 Medicaid and Community Services Children's Autism Program 0667: Environmental Modification, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1936 Provider Reimbursement

(1) The department will pay providers of ABA services the lesser of:

(a) the provider's actual submitted charge for services; or

(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.106.

(2) Claims must be submitted by, or on behalf of, a BCBA licensed by the State of Montana and enrolled as a Montana Medicaid provider.

(3) The provider may not:

(a) utilize Current Procedural Terminology (CPT) codes not approved by the department; or

(b) exceed the authorized units of service in an authorized 180 calendar day timespan.

(4) The department may review the medical necessity of services or items at any time, either before or after payment, in accordance with the provisions of ARM 37.85.410. If the department determines that services or items were not medically necessary, or otherwise not in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.

(5) The department may not authorize provider's reimbursement retroactively for failure to submit timely, complete, and required documentation.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-21-701, 53-21-702, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1937 Medicaid and Community Services Children's Autism Program 0667: Environmental Modification, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1939 Medicaid and Community Services Children's Autism Program 0667: Adaptive Equipment, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1941 Medicaid and Community Services Children's Autism Program 0667: Adaptive Equipment, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1942 Hearing Rights

(1) Providers who are aggrieved by an adverse department action under these rules may request a hearing to the extent provided, and according to the procedures specified, in ARM 37.85.411.

History

Authorizing statute(s): 2-4-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1943 Medicaid and Community Services Children's Autism Program 0667: Occupational Therapy, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1945 Medicaid and Community Services Children's Autism Program 0667: Occupational Therapy, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1947 Medicaid and Community Services Children's Autism Program 0667: Physical Therapy, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1949 Medicaid and Community Services Children's Autism Program 0667: Physical Therapy, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1951 Medicaid and Community Services Children's Autism Program 0667: Speech Therapy, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1953 Medicaid and Community Services Children's Autism Program 0667: Speech Therapy, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1955 Medicaid and Community Services Children's Autism Program 0667: Transportation, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1957 Medicaid and Community Services Children's Autism Program 0667: Transportation, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1959 Medicaid and Community Services Children's Autism Program 0667: Individual Goods and Services, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1961 Medicaid and Community Services Children's Autism Program 0667: Individual Goods and Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1963 Medicaid and Community Services Children's Autism Program 0667: Program Design and Monitoring, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Mont. Admin. R. 37.34.1965 Medicaid and Community Services Children's Autism Program 0667: Program Design and Monitoring, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 2085, Eff. 10/12/12; REP, 2022 MAR p. 1850, Eff. 9/24/22.

Subchapter 37.34.20 Discontinuation of Services

Mont. Admin. R. 37.34.2001 Discontinuation of Services: Purpose

(1) These rules provide a process by which a contracted provider of state-funded developmental disabilities home and community-based services may seek to discontinue the delivery of services to a person who is in receipt of services from that provider.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-205, MCA
History: NEW, 2012 MAR p. 2622, Eff. 12/21/12.

Mont. Admin. R. 37.34.2003 Discontinuation by Provider of Service Delivery: Provider Initiated

(1) When a person receiving developmental disability community services from a service provider refuses to cooperate in service delivery as provided for in their plan of care or otherwise fails to substantively engage in their plan of care or when, following good faith efforts, the person's health and safety needs cannot be met by the provider, the provider may follow the process provided in these rules to be relieved of service delivery responsibilities for the person. The provider will continue to provide services to ensure the persons' health and safety during the course of the process provided for in this rule.

(2) The provider who wishes to discontinue the services must provide notice of the provider's intent to discontinue services in writing and submit the notice to:

(a) the regional manager or designee of the developmental disabilities program (DDP) of the region in which the person resides;

(b) the person with a developmental disability;

(d) the legal representative for the person, if applicable;

(e) the advocate for the person, if applicable; and

(f) the designee at the state facility, if applicable.

(3) The statement of intent to discontinue services must include:

(a) the issues that the provider contends cause the need to discontinue the services; and

(b) thorough documentation of the past and current efforts made by the provider and others to provide the services to the person.

(4) The regional manager or designee will schedule a meeting within two working days after the receipt of the notice of intent to discontinue services from the provider. The meeting will include the regional manager or the regional manager's designee, the members of the person's plan of care team, the provider, and if applicable, a designee from the state facility. The meeting may be conducted telephonically. If the person's legal representative is not available within two working days, the meeting must be scheduled at the earliest possible time the legal representative is available. If the person or a legal representative is unable to participate in the plan of care meeting, the case manager must document the reasons for the absence and the attempts made to reschedule the meeting with the person or the person's legal representative.

(5) The purpose of the meeting is to review the basis for the notice and determine if a change in the configuration of the current services or additional supports may assist the person to remain in or return to services with the current provider and, if so, identify those services or supports. If the planning team determines additional services or supports may assist the person to remain with the current provider, the planning team must develop a supplemental plan of care which identifies the actions to implement the determination for the person's services.

(6) The department reviews the supplemental plan of care developed by the planning team to assess the feasibility of the plan and to suggest further changes if desired. If the plan provides for the delivery of additional services or for interim supports to the person at an additional cost, the department must approve those through an adjustment to the person's individual cost plan.

(7) If the planning team cannot reach consensus on the implementation of a supplemental plan of care, the person(s) who does not agree may submit their disagreement along with the justification for their disagreement to the DDP program director or designee. The DDP program director or designee must:

(a) make a determination within three working days; and

(b) provide the determination in writing to the members of the planning team.

(8) If a person who is the subject of a discontinuation of services process is admitted to Montana Developmental Center, Montana State Hospital, a hospital, or to any other facility, the person's ongoing discontinuation of services process and all applicable dates are suspended until the person returns to the community service unless the department determines that the person's admission is on a long-term basis. Admission to a facility is inclusive of commitment, emergency detention, emergency admission, court-ordered precommitment detention, voluntary admission, or any other process resulting in a person being placed in a facility.

(9) If it is determined in the course of planning that an alternative provider is needed, the case manager will assist the person, the legal representative, or both in seeking an alternative provider. The case manager will place the person on the port list. If additional funding is required, the case manager will also place the person on the waiting list for screening into an opening with sufficient funding.

(10) A provider must, in good faith, participate in the implementation of a supplemental plan of care.

(11) The regional manager or designee will schedule a meeting between 15 to 30 calendar days prior to the expiration of the 90 calendar days to review the outcome of the supplemental plan of care. The meeting will include the regional manager or the regional manager's designee, the members of the person's plan of care team, the provider, and, if applicable, a designee from the state facility. The meeting may be conducted telephonically. If the person's legal representative is not available within two working days, the meeting must be scheduled at the earliest possible time the legal representative is available. If the person or a legal representative is unable to participate in the plan of care meeting, the case manager must document the reasons for the absence and the attempts made to schedule the meeting with the person or the person's legal representative.

(12) At the expiration of 90 calendar days following the receipt by the department of a proper notice of intent to discontinue services from a provider, the provider may proceed with the discontinuation of services for the person, if the provider, as determined by the department and the planning team, has participated in good faith in a supplemental plan of care if applicable, and the basis for the discontinuation action remains.

(13) A provider must abide by applicable statutes or regulations of the state of Montana regarding the relationship between the provider as the landlord and the person as the tenant.

(14) The person or the person's legal representative maintains their right to a fair hearing as provided for in ARM 37.5.115.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-205, MCA
History: NEW, 2012 MAR p. 2622, Eff. 12/21/12; AMD, 2013 MAR p. 1099, Eff. 6/21/13.

Mont. Admin. R. 37.34.2005 Discontinuation of Services: Part C

(1) Each contractor providing Part C services must have a written policy covering discontinuation of Part C or FES services.

(2) Prior to providing Part C or FES services to a family, the contractor will have each family read the discontinuation of services policy referenced in (1), or will read the policy to the family, and have the family acknowledge receipt of the discontinuation criteria by their signature.

(3) The contractor must have documentation in each family's file that confirms the following:

(a) the reason for discontinuation of services;

(b) for Part C, notification provided to the family of the pending discontinuation of services in accordance with the requirements of CFR Section 303.421; and

(4) The contractor must specify the reason for discontinuation of services. The reason must include one of the following:

(a) the family declines services, either by:

(i) notifying the contractor of their decision to decline services; or

(ii) failing to respond to at least two attempts by the contractor to contact them regarding continuation of services. Contractors must document these attempts in the family file.

(b) the person is transitioned into a more appropriate service;

(d) the person is determined ineligible;

(e) the contractor has evidence of misuse of agency funds by the family;

(f) the family moves from the service area; or

(g) the death of the person.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6 402, 53-20-205, MCA
History: NEW, 2012 MAR p. 2622, Eff. 12/21/12.

Mont. Admin. R. 37.34.2007 Discontinuation of Services: Fair Hearing Requirements

(1) A person who is aggrieved of a change in services resulting from a discontinuation of services process under these rules is entitled to a fair hearing as provided for at ARM 37.5.115.

History

Authorizing statute(s): 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-402, 53-20-205, MCA
History: NEW, 2012 MAR p. 2622, Eff. 12/21/12.

Subchapter 37.34.21 Staffing

Mont. Admin. R. 37.34.2101 Staffing: Applicability

(1) This subchapter specifies requirements applicable to provision of developmental disability program services. These rules are in addition to requirements generally applicable to Medicaid providers as otherwise provided in state and federal statute, rules, regulations, and policies.

(2) A contractor who contracts to provide developmental disabilities services funded by the developmental disabilities program must employ, in the provision of services to persons eligible for those services, staff who are able to demonstrate the ability to meet the needs of the persons that the contractors serve.

(3) A contractor who contracts to provide developmental disabilities services is subject to this subchapter.

(4) A contractor providing transportation services, that are also available to the general public, who contracts with the department only to provide transportation services is not subject to this subchapter.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 1847, Eff. 10/18/13

Mont. Admin. R. 37.34.2102 Staffing: Staff Competencies

(1) The contractor must have, for each staff position, a written position description that specifies the physical requirements and the minimum standards for education and experience.

(2) The contractor must conduct a screening and a background check of a person prior to a person assuming their duties and responsibilities. A screening and background check must include a criminal background check through the Montana Department of Justice or another background check entity that provides a national background check.

(3) The contractor must verify to the department, upon hire, that each staff person has the ability to meet the competencies to perform the tasks and responsibilities of their position in the provision of developmental disabilities program services.

(4) The contractor must verify to the department, annually, that each staff person has the ability to meet the competencies to perform the tasks and responsibilities of their position in the provision of developmental disabilities program services, as determined by completion of the training requirements within the established timeframes.

(5) Upon hiring of a staff person, inclusive of administrative and management services, the contractor must review the list of excluded individuals and entities maintained by the Office of Inspector General of the U.S. Department of Health and Human Services and the excluded parties list system at the System for Award Management maintained by the federal General Services Administration (GSA) to determine whether the person appears on either of these lists and if the person appears on one of the lists, must:

(a) report the listing to the department immediately; and

(b) take the appropriate action to terminate the person if the person is employed in a manner that is not permissible under the applicable federal requirements.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2013 MAR p. 1847, Eff. 10/18/13

Mont. Admin. R. 37.34.2106 Staffing: Staff Competencies for Family Education and Support Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 1847, Eff. 10/18/13

Mont. Admin. R. 37.34.2107 Staffing: Staff Competencies for Community Home, Intensive Community Home, Supported Living, Work or Day Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 1847, Eff. 10/18/13

Mont. Admin. R. 37.34.2111 Staffing: Contractor Staffing for Services

(1) For each person served, the contractor must provide the number of staff with appropriate training and guidance required to ensure the quality and effectiveness of services to be delivered in accordance with the person's plan of care and individual cost plan.

(2) The contractor must ensure the presence of on-site awake night staff in applicable programs, sufficient to meet the needs of the persons the contractor serves.

(3) For noncongregate services or agency-based self-directed services, the contractor must provide for emergency back-up staff sufficient to meet the needs of the persons the contractor serves. This requirement is satisfied only if, in lieu of the absent caregiver, the on-call back-up staff actually appear and engage in providing the service.

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 1847, Eff. 10/18/13

Mont. Admin. R. 37.34.2112 Staffing: Contractor Staffing for Supported Living Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-204, MCA
Implementing statute(s): 53-20-205, MCA
History: NEW, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; REP, 2013 MAR p. 1847, Eff. 10/18/13

Subchapter 37.34.23 Certification of Professional Persons

Mont. Admin. R. 37.34.2301 Residential Facility Screening: Purpose

(1) The commitment of a person to the Montana Development Center as a person with a serious developmental disability in need of the services of that residential facility or commitment under a community treatment plan is subject to statutory procedures and requirements of Title 52, chapter 20, part 1, MCA, inclusive of the formal residential facility screening team process. The Manual for the Screening of Persons Being Considered for Civil Commitment to the Montana Development Center or to a Community Treatment Plan, effective August 28, 2012, sets forth further requirements and criteria that govern the residential facility screening team.

(2) The department adopts and incorporates by reference the Manual for the Screening of Persons Being Considered for Civil Commitment to the Montana Development Center or to a Community Treatment Plan, effective August 28, 2012.

(3) A copy of the manual may be obtained through the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-20-133, MCA
Implementing statute(s): 53-20-102, 53-20-106, 53-20-112, 53-20-116, 53-20-121, 53-20-125, 53-20-127, 53-20-128, 53-20-129, 53-20-133, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2012 MAR p. 2630, Eff. 12/21/12.

Mont. Admin. R. 37.34.2302 Residential Facility Screening: Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-133, MCA
Implementing statute(s): 53-20-102, 53-20-106, 53-20-112, 53-20-116, 53-20-121, 53-20-125, 53-20-127, 53-20-128, 53-20-129, 53-20-133, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2630, Eff. 12/21/12.

Mont. Admin. R. 37.34.2306 Residential Facility Screening: Administration and Composition of Screening Team

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-133, MCA
Implementing statute(s): 53-20-133, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2630, Eff. 12/21/12.

Mont. Admin. R. 37.34.2307 Residential Facility Screening: Responsibilities of Developmental Disabilities Professionals and Qmrp's

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-133, MCA
Implementing statute(s): 53-20-112, 53-20-116, 53-20-128, 53-20-129, 53-20-133, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2630, Eff. 12/21/12.

Mont. Admin. R. 37.34.2308 Residential Facility Screening: Responsibilities of the Screening Team

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-133, MCA
Implementing statute(s): 53-20-125, 53-20-127, 53-20-128, 53-20-129, 53-20-133, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2630, Eff. 12/21/12.

Mont. Admin. R. 37.34.2309 Residential Facility Screening: Determination of Screening Team

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-20-133, MCA
Implementing statute(s): 53-20-125, 53-20-127, 53-20-128, 53-20-129, 53-20-133, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; REP, 2012 MAR p. 2630, Eff. 12/21/12.

Mont. Admin. R. 37.34.2313 Residential Facility Screening: Appeal of Screening Team Determination or Recommendation

(1) If the residential facility screening team determines that the individual is not seriously developmentally disabled and therefore a commitment or recommitment is not appropriate, the individual or the individual's authorized representative aggrieved by the determination may request a fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337, from the department, within 30 days of the determination that the individual is not seriously developmentally disabled.

(2) If the residential facility screening team recommends commitment or recommitment, the recommendation goes to the district court, and the parties can request a hearing from the court, as provided in 53-20-125 , MCA.

History

Authorizing statute(s): Sec. 53-20-133, MCA
Implementing statute(s): Sec. 53-20-125, 53-20-127, 53-20-128, 53-20-129 and 53-20-133, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.34.2316 Residential Facility Screening: Certification of Developmental Disabilities Professionals

(1) Developmental disabilities professionals are certified for the following purposes:

(a) to recommend, when requested by a party to a commitment proceeding to the district court or by the district court, the most appropriate habilitation plan or treatment plan for an individual for whom commitment or recommitment is being sought;

(b) to evaluate at the request of the residential facility screening team, as provided in ARM 37.34.2307 and 37.34.2309, an individual being considered for commitment or recommitment, by gathering information, conducting, as directed by the residential facility screening team or as requested by the individual's case manager, psychological testing and assessment, compiling information, writing reports to the residential facility screening team, and providing a report to the residential facility screening team to assist in the team's review of the case regarding commitment.

History

Authorizing statute(s): Sec. 53-20-106 and 53-20-133, MCA
*Implementing statute(s): *
History: IMP, Sec. 53-20-106, MCA; NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.2317 Residential Facility Screening: the Certification Committee for Development Disabilities Professionals

(1) Developmental disabilities professionals are certified by the certification committee for developmental disabilities professionals.

(2) The purposes of the certification committee are to:

(a) review all applications of persons requesting certification as developmental disabilities professionals;

(b) certify developmental disabilities professionals in accordance with these rules; and

(c) perform other duties set forth by these rules or assigned to the certification committee by the director of the department.

(3) The certification committee for developmental disabilities professionals includes the following members:

(a) a person appointed by the governor;

(b) four persons appointed by the director of the department, at least two of whom represent the developmental disabilities program and, who are familiar with the roles and responsibilities of developmental disabilities professionals.

(4) Members of the certification committee shall serve at the convenience of the appointing authority.

(5) The person appointed by the governor serves as chairperson of the committee. Meetings of the certification committee shall be called by the chairperson. The certification committee meets as needed, but no fewer than 4 times per year, to review applicants.

History

Authorizing statute(s): Sec. 53-20-106 and 53-20-133, MCA
*Implementing statute(s): *
History: IMP, Sec. 53-20-106, MCA; NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.2318 Residential Facility Screening: Certification Procedures for Developmental Disabilities Professionals

(1) The certification procedures for a professional person are the following:

(a) submission of application forms by the applicant;

(b) a review by the certification committee, within 90 days of receipt of all required application materials, to determine the qualifications of the applicant for certification;

(c) an issuance or denial of certification or provisional certification of the application by the certification committee;

(i) the certification committee may issue provisional certification that limits the specific services, the conditions under which the developmental disabilities professional can provide services, or the time period such certification shall be effective, or any combination thereof;

(d) notification to the applicant within 30 days of the committee's determination.

(2) Certification expires 3 years from the date of certification.

(3) The certification committee may revoke certification for cause by notifying the certified developmental disabilities professional in writing of the reasons for revocation at least 10 days prior to the effective date of revocation.

(4) The certification committee establishes and implements procedures to assure timely and efficient review of applicants.

History

Authorizing statute(s): Sec. 53-20-106 and 53-20-133, MCA
Implementing statute(s): Sec. 53-20-106, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.2319 Residential Facility Screening: Qualifications of Developmental Disabilities Professionals

(1) A developmental disabilities professional must be:

(a) a licensed psychologist;

(b) a licensed psychiatrist; or

(i) has training and experience in psychometric testing and evaluation; and

(ii) has experience in the field of developmental disabilities.

(2) Experience in the field of developmental disabilities may include:

(a) evaluation;

(b) planning;

(d) treatment; and

(e) consultation.

(3) Applicants must supply transcripts and other appropriate records that document relevant training and experience.

(4) The certification committee retains the right to determine the appropriateness of any experience for certification purposes.

History

Authorizing statute(s): Sec. 53-20-106 and 53-20-133, MCA
Implementing statute(s): Sec. 53-20-106, MCA
History: NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124.

Mont. Admin. R. 37.34.2320 Residential Facility Screening: Right to Appeal Certification Committee Decisions

(1) Any action of the certification committee concerning certification denial or revocation may be appealed to the department.

(a) The notice of appeal shall be directed to the director of the department.

(b) The appeal shall be in writing and shall set forth the nature of the grievance and arguments supporting the grievance and actions desired. The appealing party may also present oral argument.

(c) The appealing party shall be notified in writing 10 days prior to the hearing. The written notice shall contain the date, time and location of the hearing.

(2) All findings of the department director or designee are binding on the certification committee.

History

Authorizing statute(s): Sec. 53-20-106 and 53-20-133, MCA
*Implementing statute(s): *
History: IMP, Sec. 53-20-106, MCA; NEW, 1991 MAR p. 1849, Eff. 10/1/91; AMD, 1996 MAR p. 2188, Eff. 8/9/96; TRANS, from SRS, 1998 MAR p. 3124.

Subchapter 37.34.29 Autism Grant Program

Mont. Admin. R. 37.34.2901 Incorporation by Reference of Rules for the Submission and Review of Applications for the Autism Facilities Grant

(1) The Department of Public Health and Human Services adopts and incorporates by reference the Autism Facilities Grant Manual for the 2025 Biennium.

(2) The manual incorporated by reference in (1) contains the following:

(a) eligible applicants and projects;

(b) general requirements for applying for the Autism Facilities Grant;

(d) administrative procedures and requirements.

(3) Copies of the manual adopted by reference in (1) may be obtained from the Department of Public Health and Human Services, Developmental Disabilities Program, or on the web site at https://dphhs.mt.gov/BHDD/DisabilityServices/developmentaldisabilities/ .

History

Authorizing statute(s): 53-20-173, MCA
Implementing statute(s): 53-20-173, 53-20-174, MCA
History: NEW, 2024 MAR p. 758, Eff. 4/13/24.

Subchapter 37.34.30 Reimbursement for Services

Mont. Admin. R. 37.34.3001 Reimbursement for Services: Generally

(1) The following requirements and limitations govern the reimbursement of providers for the provision of services and items delivered to persons who are currently eligible for and accepted into one or more of the developmental disabilities services programs administered by the department. These requirements are in addition to any other federal and state requirements governing the funding and delivery of the various services provided through the program.

(2) Reimbursement for services and items is only available:

(a) through payments made to providers that have a current contract with the department authorizing the provider to deliver developmental disabilities services;

(b) for services and items that are authorized in rule or federal agreements for delivery through the particular developmental disabilities services program that the person is authorized by the DDP to participate in;

(c) when the particular services and items delivered are authorized for delivery to the person through the person's individual cost plan (ICP) as provided for in ARM 37.34.3002, or if the ICP is not applicable, the planning and authorization procedures applicable to the particular program;

(d) if the person has received the services and items authorized; and

(e) when delivered in accordance with applicable professional and facility licensing authorities.

(3) The contracted provider must be:

(a) currently enrolled in conformance with ARM 37.85.402 as a Montana Medicaid provider as evidenced by a signed current provider enrollment agreement, unless the type of provider is expressly exempted from the requirement by the department; and

(b) designated by the Developmental Disabilities Program (DDP) to be a qualified developmental disabilities provider, unless the program does not require the provision of the particular type of service or item by or through a qualified provider process.

(4) The department reimburses for a service or item at the lower of:

(a) the rate applicable to the particular service or item as established through rule; or

(b) the provider's usual and customary fee that is charged to any and all parties for the delivery of the service or item.

(5) Reimbursement for the delivery of a service or item delivered to a person through the department's DDP is payment in full and the provider may not receive further reimbursement for the service or item from the program, other departmental programs, or the person, or other parties.

(6) A provider in order to receive reimbursement for a service or item must properly invoice for the service or item through the DDP's electronic billing system unless the service or item is not reimbursed through that payment system.

(7) A provider may seek reimbursement from a person receiving services for a service or an item only if the service or item is not covered for Medicaid purposes and the billing is allowed for and conducted in accordance with ARM 37.85.406(11)(a).

(8) A provider may not seek or obtain reimbursement from the person for a service or item that, though reimbursable by the DDP as a service or item, has not been reimbursed by the program due to the failure of the provider to properly seek reimbursement for the service or item or due to the failure of the provider to properly deliver the service or item to the person.

(9) Reimbursement is not available for services and items:

(a) the DDP determines are not delivered in accordance with the quality assurance standards applicable to those services and items;

(b) provided while a person is a resident of an intermediate care facility for the developmentally disabled, an intermediate nursing care facility, or a skilled nursing care facility, as those facilities are defined in 50-5-101, MCA; or

(c) reimbursable as either a Medicaid state plan service or through any other local government, state, or federal program for which the person is eligible or would be eligible upon application.

(10) The department has the right to recover as a sum owing to the department reimbursement received by a provider that is an overpayment or is improperly obtained.

(11) Overpayments and improper payments include but are not limited to any departmental reimbursement obtained by a provider that:

(a) does not conform to the requirements and limitations of this rule or any other rules governing the administration and delivery of the services and items for which the reimbursement is obtained;

(b) does not compensate for actual delivery of the services and items for which the reimbursement is obtained;

(d) is due to departmental mistake; or

(e) is due to other circumstances.

(12) The department or its agents may recover overpayments by any available means including withholding of further reimbursement payments.

(13) Reimbursement for services and items is not made directly to persons receiving DDP funded services.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-402, 53-20-203, 53-20-205, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; AMD, 2013 MAR p. 1212, Eff. 7/12/13.

Mont. Admin. R. 37.34.3002 Reimbursement for Services: Individual Cost Plans

(1) Authorization for the reimbursement to a provider for the delivery of particular services and items to a person receiving Developmental Disabilities Program (DDP) funded services is based on the implementation of an individual cost plan (ICP) for the person prior to the delivery of those services and items.

(2) Total reimbursement for the services and items delivered to a person may not exceed the sum designated for the person's fiscal year maximum in the person's ICP.

(3) For each service specified in a person's ICP, the total sum expended for the service may not exceed the sum designated as available for that service in the person's ICP.

(4) An ICP is developed by the person's case manager. For services reimbursed on time units the case manager estimates the levels of service delivery based on a reasonable assessment of the direct care staff time necessary to meet the health and safety needs of the person. The case manager uses the standardized reimbursement rates and any specified rates of reimbursement for particular services and items to calculate the amount of monies necessary to fund the services and items to be provided to the person.

(5) Neither the Montana resource allocation tool nor the plan of care may be used to authorize reimbursement for services or items.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-402, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; AMD, 2013 MAR p. 1212, Eff. 7/12/13.

Mont. Admin. R. 37.34.3005 Reimbursement for Services of Medicaid Funded Developmental Disabilities Home and Community-Based Services (hcbs) Waiver Programs

(1) Reimbursement through the Developmental Disabilities Program's (DDP) Medicaid Home and Community-Based Services Waiver Programs is only available to a provider for services or items:

(a) delivered in accordance with the requirements and limitations of ARM 37.34.3001;

(b) delivered in accordance with the terms and conditions of the formal approval by the Centers for Medicare & Medicaid (CMS) governing each waiver program; and

(2) The department adopts and incorporates by this reference the rates of reimbursement and the delivery of services and items available through each Home and Community-Based Services Waiver Program as specified in the Montana Developmental Disabilities Program Rates and Billing Manual, effective July 1, 2025. A copy of the manual may be obtained through the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and at https://dphhs.mt.gov/BHDD/DisabilityServices/developmentaldisabilities/ddpratesinf.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-402, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; AMD, 2013 MAR p. 1212, Eff. 7/12/13; AMD, 2014 MAR p. 1408, Eff. 7/1/14; AMD, 2015 MAR p. 827, Eff. 7/1/15; AMD, 2016 MAR p. 1709, Eff. 9/24/16; AMD, 2017 MAR p. 2312, Eff. 1/1/18; AMD, 2018 MAR p. 1610, Eff. 8/11/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18; AMD, 2018 MAR p. 2543, Eff. 12/22/18; AMD, 2019 MAR p. 1171, Eff. 8/10/19; AMD, 2020 MAR p. 1529, Eff. 8/8/20; AMD, 2021 MAR p. 1679, Eff. 11/20/21; AMD, 2022 MAR p. 1316, Eff. 7/23/22; AMD, 2023 MAR p. 1023, Eff. 9/9/23; AMD, 2024 MAR p. 968, Eff. 4/27/24; AMD, 2024 MAR p. 2072, Eff. 8/24/24; AMD, 2026 MAR, Notice No. 2025-129, Eff. 3/21/26.

Mont. Admin. R. 37.34.3006 Reimbursement for Services: the 0371 Community Supports Program of Medicaid Funded Home and Community Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-402, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; REP, 2013 MAR p. 1212, Eff. 7/12/13.

Mont. Admin. R. 37.34.3007 Reimbursement for Services: the 0667 Autism Program of Medicaid Funded Home and Community Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-402, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; REP, 2013 MAR p. 1212, Eff. 7/12/13.

Mont. Admin. R. 37.34.3012 Reimbursement for Services: Home and Community Services Funded with Non-Medicaid Monies

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-2-201, 53-20-203, 53-20-205, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; REP, 2013 MAR p. 1212, Eff. 7/12/13.

Mont. Admin. R. 37.34.3013 Reimbursement for Services: Part C Early Intervention Services Program

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-20-204, MCA
Implementing statute(s): 53-2-201, 53-20-203, 53-20-205, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; REP, 2013 MAR p. 1212, Eff. 7/12/13.

Mont. Admin. R. 37.34.3015 Reimbursement for Services: Targeted Case Management Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2011 MAR p. 1718, Eff. 8/26/11; REP, 2013 MAR p. 1212, Eff. 7/12/13.

Chapter 37.36 Montana Accessible Communications Program

Subchapter 37.36.1 General Provisions

Mont. Admin. R. 37.36.101 Definitions

For purposes of this chapter, the following definitions apply:

(1) "Appropriate communication device" means the communication device which most efficiently allows access to an ordinary telecommunications system by a person with a telecommunications usage disability.

(2) "Committee" means the committee on telecommunications access services, formerly known as the committee on telecommunications access services for the handicapped, established in 2-15-2212, MCA.

(3) "Deaf" means having a full or partial decrease in the ability to detect or understand sounds or discriminate speech.

(4) "Deaf-blind" means:

(a) being deaf, severely hearing disabled or hard of hearing; and

(b) being blind or visually disabled; and

(c) requiring the use of specialized telecommunications equipment to communicate effectively using an ordinary telecommunications system.

(5) "Director" means the person employed by the committee on telecommunications services to administer the Montana Accessible Communications (MTAC) program.

(6) "End user connection" means a customer's connection to a service provider's network.

(7) "Family" means the person with a telecommunications usage disability and the relatives with whom the person resides as specified in (7)(a) through (7)(d), except that if the person with a telecommunications usage disability is a foster child, "family" means the foster child only and does not include the persons with whom the foster child resides, whether related or unrelated to the child. Relatives of the person with a telecommunications usage disability included in the household when the person is not a foster child are:

(a) the spouse;

(b) the mother and/or father, if the person with a telecommunications usage disability is a minor child. This includes biological parents and parents by adoption and, at the option of the person with a telephone usage disability, may include stepparents;

(c) minor children. This includes biological children and children by adoption and, at the option of the person with a telecommunications usage disability, may include stepchildren; and

(d) minor siblings, but only if the person with a telecommunications usage disability is a minor. This includes half-siblings and, at the option of the person with a telecommunications usage disability, may include stepsiblings.

(8) "Family income" means the combined income of all members of the family of the person with the telecommunications usage disability.

(9) "Hard of hearing" means having a hearing loss to the extent that the person requires specialized telecommunications equipment to communicate effectively using an ordinary telecommunications system.

(10) "Income" means income as defined in ARM 37.2.702.

(11) "MTAC" means Montana Accessible Communications.

(12) "Mobility disabled" means having reduced function of the arms and hands, making activities related to moving, turning or pressing objects difficult or impossible. The term includes difficulty in using a wide range of telecommunications equipment.

(13) "Person with a telecommunications usage disability" means an individual who is deaf, deaf-blind, hard-of-hearing, speech disabled, or mobility disabled and is in need of specialized telecommunications equipment.

(14) "Program" means Montana Accessible Communications.

(15) "Service provider" means an entity that offers services to subscribers in Montana to allow two or more persons in different locations to communicate orally, without regard to the technology or medium the entity uses to provide the telecommunications service and access to the telecommunications relay service. The term includes providers of telecommunications service including but not limited to providers of internet protocol-enabled voice communications service.

(16) "Specialized telecommunications equipment" means any telecommunications device which enables or assists a person with a telecommunications usage disability to communicate with others by means of the public switched telephone network or internet protocol-enabled voice communications service. The term includes but is not limited to telecommunications devices, puff-blow devices, electronic artificial larynx devices, amplified handsets, telebraille, and equipment for the mobility disabled .

(17) "Speech disabled" means having a speech impediment which renders speech on an ordinary telecommunications system unclear and susceptible to misunderstanding.

(18) "Subscriber" means an end user who receives telecommunications network access from a service provider.

(19) "Telecommunications" means the transmission, between or among points specified by the user, of information of the user's choosing without a change in the form or content of the information upon receipt.

History

Authorizing statute(s): 53-19-305, 53-19-307, MCA
Implementing statute(s): 53-19-305, 53-19-307, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2004 MAR p. 1398, Eff. 6/18/04; AMD, 2009 MAR p. 1672, Eff. 9/25/09; AMD, 2024 MAR p. 2283, Eff. 9/21/24.

Subchapter 37.36.2 Assessment, Reporting, and Records

Mont. Admin. R. 37.36.201 Assessment

(1) A fee of ten cents per month shall be assessed on each end user connection provided and billed and against any prepaid options by a service provider.

(a) A service provider that periodically bills subscribers for services shall bill subscribers for the fee.

(b) In the case of subscribers who are not billed periodically, including but not limited to subscribers who purchase prepaid wireless telecommunication services for a flat fee, the service provider shall collect the fee using one of the following methods:

(i) by including in the price of the service a fee of ten cents for each 30-day period during which the subscriber is authorized to use the services;

(ii) by collecting the fee on a monthly basis from each subscriber whose account balance is equal to or greater than the fee; or

(iii) by collecting the fee of ten cents per month times the number of prepaid subscribers. The service provider shall calculate the number of prepaid subscribers by dividing total intrastate monthly revenue by the average revenue for each prepaid subscriber of the wireless industry.

(2) Subscribers are not required to pay the assessment in the month they first receive access to the telecommunications network but must pay the assessment in the month their access terminates.

History

Authorizing statute(s): 53-19-305, 53-19-307, MCA
Implementing statute(s): 53-19-311, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2009 MAR p. 1672, Eff. 9/25/09.

Mont. Admin. R. 37.36.202 Exemptions

(1) The following are exempt from the assessment provided in ARM 37.36.201:

(a) federal agencies and tax-exempt instrumentalities of the federal government;

(b) Indian tribes, with regard to end user connections on the tribe's reservation only;

(d) official station testing lines owned by a provider; and

(e) coin operated telephones owned by a provider.

(2) All other subscribers of a local exchange company must pay the assessment provided in ARM 37.36.201.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, 53-19-311, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2009 MAR p. 1672, Eff. 9/25/09.

Mont. Admin. R. 37.36.206 Reporting Requirements

(1) Each provider must complete and file with the Department of Revenue a quarterly reporting form on or before the last day of the month following the end of each calendar quarter.

(2) The quarterly reporting form must provide the following information:

(a) ending date of the calendar quarter covered by the return being filed;

(b) name and address of the provider;

(d) number of nonexempt end user connections for the quarter;

(e) amount of fee computed by multiplying the total number of nonexempt end user connections times ten cents per month of service during the quarter;

(f) credits for uncollectible accounts, incorrect billings, and other appropriate adjustments if the provider elects to take a credit;

(g) amounts collected in the quarter for any accounts reported as uncollectible in a previous quarter if the provider has elected to take a credit under (f);

(h) credits for 3/4 of 1% of the total charges billed and collected each month to cover administrative expenses if the provider elects to take a credit; and

(i) the amount remitted with the return.

History

Authorizing statute(s): 53-19-305, 53-19-307, MCA
Implementing statute(s): 53-19-305, 53-19-311, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2009 MAR p. 1672, Eff. 9/25/09.

Mont. Admin. R. 37.36.207 Examination of Records

(1) An authorized agent of the committee may examine the records and other supporting data from which the quarterly returns required by ARM 37.36.202 were prepared during regular business hours with a minimum of two weeks prior notice.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-312, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Subchapter 37.36.4 Equipment

Mont. Admin. R. 37.36.401 Loans

(1) Specialized telecommunications equipment will be loaned to a person who satisfies the eligibility requirements of ARM 37.36.603 after the individual has received training and signed a written agreement accepting the conditions of the loan prescribed in ARM 37.36.612.

(2) If more than one person in a single household is eligible for a loan, the household is not limited to one piece of equipment but is entitled to specialized telecommunications equipment for each eligible member of the household.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-307, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2004 MAR p. 1398, Eff. 6/18/04.

Mont. Admin. R. 37.36.402 Ownership

(1) All equipment loaned through MTAC will remain the property of the state of Montana. All equipment will be recorded and tracked for a minimum of five years by serial number, state of Montana identification tag and name, address, and telephone number of recipient.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-307, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2004 MAR p. 1398, Eff. 6/18/04; AMD, 2024 MAR p. 2283, Eff. 9/21/24.

Mont. Admin. R. 37.36.406 Security Deposit

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-307, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; REP, 2004 MAR p. 1398, Eff. 6/18/04.

Subchapter 37.36.6 Eligibility and Application Process

Mont. Admin. R. 37.36.601 Provision of Information

(1) Upon request, the program will provide an application form and informational brochure describing the eligibility requirements and application process.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Mont. Admin. R. 37.36.602 Application Process

(1) A person wishing to receive a loan of specialized telecommunications equipment shall complete the application and return it to the address designated in the application form. Application may be made by the person wishing to receive equipment, by a parent or legal guardian of a person under the age of 18 years or by a person duly authorized by the person or by a court to act on the person's behalf.

(2) In the case of an unemancipated person under the age of 18 years, a parent or legal guardian must sign the application and must assume full responsibility for the equipment and services. This is not required in the case of an emancipated person under the age of 18.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Mont. Admin. R. 37.36.603 Nonfinancial Eligibility Criteria

(1) To be eligible for a loan of specialized telecommunications equipment, an applicant, in addition to meeting the financial criteria for eligibility specified in ARM 37.36.604, must:

(a) be a resident of Montana;

(b) have a telephone usage disability;

(d) be able to demonstrate the applicant's ability to understand the nature and use of the equipment; and

(e) have regular access to telephone service.

(2) Specialized telecommunications equipment will be loaned to a person who satisfies the requirements of this rule and of ARM 37.36.604 for eligibility after the person has received training and signed a written agreement accepting the conditions of the loan prescribed in ARM 37.36.612.

(3) A person who is otherwise eligible shall not be eligible for a loan of equipment if:

(a) the person lives in a residential or treatment facility which directly or indirectly receives federal funding and which is required to be fully telephone accessible to all residents under the Rehabilitation Act of 1973, 29 USC 774; and

(b) is eligible for and can obtain specialized telecommunications devices through such federal provisions.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-307, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2004 MAR p. 1398, Eff. 6/18/04.

Mont. Admin. R. 37.36.604 Financial Eligibility Criteria

(1) Individuals whose annual family income during the 12 months immediately preceding the month of application is less than 250% of the 2025 poverty guidelines published by the U.S. Department of Health and Human Services (HHS) are eligible for a loan of specialized telecommunications equipment based on income. 250% of the HHS 2025 annual poverty guidelines for families of various sizes is specified on the Montana Accessible Communications program website, effective on January 15,2025, which rate is adopted and incorporated here by reference. A copy is available at https://dphhs.mt.gov/detd/mtac/nocostassistiveequipment, or may be obtained from the Department of Public Health and Human Services, Montana Accessible Communications Program (MTAC), P.O. Box 4210, Helena MT 59604-4210.

(2) There is no asset test to be eligible for a loan of specialized telecommunications equipment.

History

Authorizing statute(s): 53-19-305, 53-19-307, MCA
Implementing statute(s): 53-19-305, 53-19-307, MCA
History: NEW, 2004 MAR p. 1398, Eff. 6/18/04; AMD, 2006 MAR p. 1052, Eff. 4/21/06; AMD, 2009 MAR p. 1672, Eff. 9/25/09; AMD, 2013 MAR p. 788, Eff. 5/10/13; AMD, 2014 MAR p. 1400, Eff. 7/1/14; AMD, 2015 MAR p. 2146, Eff. 12/11/15; AMD, 2016 MAR p. 1710, Eff. 9/24/16; AMD, 2017 MAR p. 2082, Eff. 11/10/17; AMD, 2018 MAR p. 1611, Eff. 8/11/18; AMD, 2019 MAR p. 853, Eff. 6/22/19; AMD, 2021 MAR p. 70, Eff. 1/16/21; AMD, 2021 MAR p. 1934, Eff. 12/24/21; AMD, 2022 MAR p. 1875, Eff. 9/24/22; AMD, 2024 MAR p. 2279, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2025-112, Eff. 3/21/26.

Mont. Admin. R. 37.36.606 Verification Requirements

(1) The program may request from the applicant verification of the applicant's gross annual income and/or the applicant's telephone usage disability. The applicant must provide requested verification within 30 days of the date of request or the application will be denied.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, 53-19-307, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Mont. Admin. R. 37.36.607 Notices

(1) The applicant will be notified in writing whether the application is denied or approved. Notice must be given within 30 days of the date of receipt of the application if no verification is requested. If verification of income and/or telephone usage disability is requested, notice must be given within 30 days of the date of receipt of the necessary verification.

(2) If the application is approved, the notice must state the location where applicant may receive the equipment and the date, time and place of the training required under ARM 37.36.612.

(3) If the application is denied, the notice must state the reason for the denial and must notify the applicant of the appeal procedure provided in ARM 37.36.902.

(4) If a loan of equipment is terminated due to failure to comply with any of the conditions specified in ARM 37.36.612 or for any other reason, the recipient must be notified in writing of the reason for the termination and of the appeal procedure provided in ARM 37.36.902.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Mont. Admin. R. 37.36.610 Determination of Appropriate Telecommunication Device

(1) The program shall consult with the applicant to determine the appropriate telecommunication device or devices. However, the program shall make the final determination, taking into consideration the needs and wishes of the applicant and available funding.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, 53-19-307, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064; AMD, 2006 MAR p. 1052, Eff. 4/21/06.

Mont. Admin. R. 37.36.611 Priorities

(1) If program resources are not sufficient to provide equipment to all eligible applicants, equipment will be loaned on a first come, first served basis.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Mont. Admin. R. 37.36.612 Required Training and Conditions of Acceptance

(1) A person whose application for a loan has been approved must complete training as required by the program and must demonstrate the ability to use the equipment before specialized telecommunications equipment will be issued.

(2) A person who has completed the required training and has been issued equipment may be required to complete further training before being issued new or replacement equipment.

(3) Before equipment is issued, the person to receive equipment, or the person's parent or legal guardian if the person is under the age of 18 years and is not emancipated, must agree in writing to the following conditions:

(a) The equipment is for use with a telephone and for no other purpose. If a recipient no longer has regular access to telephone service, the loan will be terminated and the equipment must be returned to the program.

(b) The recipient must protect the equipment from damage. Any equipment which is damaged by deliberate abuse or misuse will not be replaced.

(c) Any equipment needing repair must be taken to a repair service authorized by the program or to the program office immediately. The recipient shall not take the equipment apart or attempt to repair it.

(d) Stolen equipment must be reported to the proper law enforcement authority within 24 hours of the discovery of the theft and a copy of the written theft report must be sent to the program within five days of the date of making the report.

(e) Lost equipment, other than that reported stolen, must be reported to the program within five days of loss. Lost equipment will not be replaced.

(f) Because the equipment is owned by the state of Montana, it may not be taken out-of-state for more than 90 consecutive days without written authorization in advance from the program.

(g) If the recipient's address changes within the state of Montana, recipient must notify the program of the new address within 20 days after the date of the move. If the recipient moves out of the state of Montana, the equipment must be returned prior to the move.

(h) The recipient must not sell, give away, or loan the equipment to any other person or entity.

(i) The recipient will be liable to the state of Montana for any claims for damages or expenses arising from the misuse of loaned equipment by any person or entity.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Subchapter 37.36.9 Appeal Process and Procedures

Mont. Admin. R. 37.36.901 Grounds for Appeal

(1) In accordance with the procedures set forth in ARM 37.36.902, an applicant or recipient may appeal any decision of the program regarding:

(a) eligibility for a loan;

(b) what is the appropriate communication device for the applicant or recipient;

(d) termination of a loan.

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Mont. Admin. R. 37.36.902 Appeal Procedures

(1) To appeal any program decision specified in ARM 37.36.902, an applicant or recipient must submit to the program a clear written statement that the applicant or recipient is dissatisfied with the decision and wishes to appeal it. The statement must be received by the program within 60 calendar days after the date notice of the decision is given to the applicant or recipient.

(a) If notice of a program decision is given by mail, the 60-day appeal period begins to run the day after the notice is mailed.

(2) Within 30 calendar days after receipt of an appeal, a representative of the program shall meet with the applicant or recipient to attempt to informally resolve the disputed matter. Within ten calendar days after this informal meeting, the program shall prepare a written summary of the issues in dispute and the proposed resolution and shall provide a copy to the applicant or recipient and the director.

(3) An applicant or recipient who is not satisfied with the proposed resolution of the matter after the informal meeting may request a hearing before the committee. A hearing before the committee must be held within 90 days of the date of receipt of the request for hearing. At the hearing the applicant or recipient may:

(a) be represented by legal counsel or a lay advocate; and

(b) may present evidence in support of the applicant or recipient's position, including but not limited to the testimony of witnesses, documents, or other written exhibits.

(4) When a recipient's loan is terminated from the program and the recipient files a timely appeal of the termination, the recipient shall be entitled to keep the equipment until the disputed matter is resolved. The matter is resolved when:

(a) the recipient accepts the proposed resolution after the informal meeting;

(b) the committee renders a decision after hearing; or

History

Authorizing statute(s): 53-19-307, MCA
Implementing statute(s): 53-19-305, MCA
History: NEW, 1997 MAR p. 505, Eff. 3/11/97; TRANS, from SRS, 1998 MAR p. 2064.

Chapter 37.37 Medical Necessity Requirements Therapeutic Youth Group Homes

Authorizing statute(s): 41-3-1103, 41-3-1142, 52-2-111, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 52-2-111, MCA
History: NEW, 1994 MAR p. 2739, Eff. 10/14/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; TRANS, from DFS, 1998 MAR p. 2037; REP, 2011 MAR p. 387, Eff. 3/25/11.

Authorizing statute(s): 41-3-1103, 52-1-103, 52-2-111, MCA
Implementing statute(s): 41-3-1103, 41-3-1105, 41-3-1122, MCA
History: NEW, 1995 MAR p. 2501, Eff. 11/23/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; TRANS, from DFS, 1998 MAR p. 2037; REP, 2013 MAR p. 166, Eff. 2/1/13.

Chapter 37.40 Senior and Long Term Care Services

Subchapter 37.40.1 Nursing Home Care

Mont. Admin. R. 37.40.101 Level of Care Determinations

(1) The three basic considerations in every level of care determination are the individual patient's medical, psychological, and social needs; the specific services required to fill these needs; and the health and other personnel required to adequately provide these services. Specific level of care criteria, as well as preadmission screening procedures, are found in ARM 37.40.201.

(2) Assessing a patient's medical condition and evaluating the appropriateness of services for that condition is primarily a nurse coordinator's function. If questions arise regarding the patient's medical condition or the propriety of some or all of the services ordered by the attending physician, physician advisor review, including peer review, may be requested by the attending physician.

(3) Assessing a patient's psychological and social condition and evaluating the appropriate services for that condition is primarily a function of the department or its designee.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-131, 53-6-402, MCA
History: NEW, Eff. 1/3/77; AMD, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from SRS, 2000 MAR p. 489; AMD, 2017 MAR p. 193, Eff. 2/4/17.

Mont. Admin. R. 37.40.105 Skilled Care

(1) The goal of skilled care is to provide care for patients who require general medical management and skilled nursing care on a continuing basis, but who do not require the constant availability of physician services ordinarily found only in the hospital setting.

(2) Skilled nursing care includes components which distinguish it from supportive care. Supportive care does not require professional health training. One component is the observation and assessment of the total needs of the patient. Another component is the rendering of direct services to a patient where the ability to provide the services requires specialized training, such as a registered or a licensed practical nurse.

(3) In evaluating whether the services required by the patient are the continuous skilled services which constitute skilled care, several basic principles are considered.

(a) Since skilled care represents skilled nursing care on a continuous basis, the need for a single skilled service -- for example, intramuscular injections twice a week -- would rarely justify a finding that the care constitutes skilled care.

(b) The classification of a particular service as skilled is based on the technical or professional health training required to effectively perform or supervise the service. For example, a patient, following instructions, can normally take oral medication. Consequently, the act of giving an oral medication to a patient who is too senile to take it himself would not be skilled service, even when a licensed nurse gives the medication.

(c) The importance of a particular service to an individual patient does not necessarily make it a skilled service. For example, a primary need of a non-ambulatory patient may be frequent changes of position in order to avoid development of decubiti. If changing the patient's position is the only regular and frequent service provided, it would not be a skilled service. Routine prophylactic and palliative skin care such as bathing, application of creams, etc. does not constitute skilled services. Presence of a small decubitus ulcer, rash or other relatively minor skin irritation does not generally indicate a need for skilled care. Existence of extensive decubiti or other widespread skin disorder may necessitate skilled care. Physicians' orders for treating the skin, rather than diagnosis, are the principal indication of whether skilled care is required.

(d) The possibility of adverse effects from improper performance of an otherwise unskilled service -- for example, improper transfer of patients from bed to wheelchair -- does not change it to a skilled service.

(4) Any of the following treatment services or care indicate need for skilled nursing care:

(a) oral administered medications requiring constant changes of dosage upon sudden undesirable side effects;

(b) oral medication before routine dosage established and must be watched for reactions;

(d) nasopharyngeal aspiration;

(e) recent postoperative colostomy and ileostomy care;

(f) repeated catheterizations during recent postoperative period;

(g) special services in application of dressings involving prescribed medications;

(h) initial phases of operation of inhalation equipment;

(i) physical therapy directed by the physician;

(j) intravenous or instramuscular injections except for the well controlled diabetic;

(k) patient on narcotics for pain;

(l) the very hostile, belligerent and demanding patient who is disruptive to other patients and staff, constantly refusing to take medication or treatment, may be destructive, may attack other patients or personnel, may have frequent periods of agitation and needs constant and close supervision; and

(m) the patient with severe impairments, or who is so withdrawn to the degree that he no longer can communicate and his needs must be anticipated.

History

Authorizing statute(s): Sec. 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-6-101, 53-6-131 and 53-6-402, MCA
History: NEW, Eff. 1/3/77; AMD, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.106 Intermediate Nursing Care

(1) Intermediate care services may be included in facilities licensed as a skilled nursing home or a personal care home which has a registered or a licensed practical nurse on duty eight hours a day, seven days a week, and with adequate personnel to provide the necessary nursing supervision and care to the intermediate care cases. No additional professional nurses will be required to render skilled nursing care.

(2) The intermediate nursing care patient needs some nursing service which is largely routine and whose major needs are for light personal care services. The following treatment services may indicate the need for intermediate nursing home care: oral medication after routine dosage established; routine catheter care; routine service for indwelling catheter; routine change in dressing to non-infected area; routine skin care; care of small decubitus ulcer; routine inhalation therapy; and maintenance care of colostomy or ileostomy.

(3) The following personal care services usually indicate the need for intermediate care. The incontinent patient needs to be dressed and bathed, may be a bed to chair patient, may need some restraints and constant watching for safety, needs help with toileting, needs help for ambulation or constant watching to prevent falls, needs help with eating, may be confused or senile and at times uncooperative, may have impairment, such as blindness or deafness and these impairments require some extra attention.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-113, MCA
History: NEW, Eff. 1/3/77; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.110 Services Furnished

The following sections list those services commonly furnished by nursing personnel in skilled nursing homes and their usual skill classification. Any generally non-skilled service could, because of special medical complications in an individual case, require skilled performance, supervision or observation. However, the complications and special services involved should be documented by nursing notes and/or physician orders with progress notes. These records should include the observations made of physical findings, new developments in the course of the disease, the carrying out of details of treatment prescribed, and the results of the treatment.

(1) Medications given by intravenous or intramuscular injections usually require skilled services. The frequency of injections would be particularly significant in determining whether the patient needs continuous skilled nursing care. Injections which can usually be self-administered -- for example, the well-regulated diabetic who receives a daily insulin injection -- do not require skilled services. Oral medications which require immediate changes in dosages because of sudden undesirable side effects or reactions should be administered to the patient and observed by licensed nurses, e.g., anti-coagulants, quinidine. This is a skilled service. Where a prolonged regimen of oral drug therapy is instituted, the need for continued presence of skilled nursing personnel can be presumed only during the period in which the routine is being established and changes in dosage cannot be anticipated or accomplished by unskilled personnel, e.g., digitalis.

(a) Administration of eye drops and topical ointments (including those required following cataract surgery) is not a skilled service. In Montana, institutional patients must receive all medications from licensed nurses; this fact, however, would not make the administration of oral medication a skilled service where the same type of medications are frequently prescribed for home use without skilled personnel being present.

(2) Levine tube and gastrostomy feedings must be properly prepared and administered. Supervision and observation by licensed nurses are required, thus making this procedure a skilled service.

(3) The services and observation required for nasopharyngeal aspiration constitute skilled nursing care.

(4) Colostomy or ileostomy may require skilled service during the immediate postoperative period following a newly created or revised opening. The need for such care should be documented by a physician and nursing notes. General maintenance care of this condition can usually be performed by the patient himself or by a person without professional raining and would not usually require skilled services.

(5) Repeated catheterizations during the immediate post-operative period following abdominal surgery could, with a few other skilled services, constitute continuous skilled nursing care. Routine services in connection with indwelling bladder catheters do not constitute skilled care. Catheters used in other parts of the body, such as bile ducts, chest cavity, etc., require skilled care.

(6) General methods of treating incontinence, such as use of diapers and rubber sheets, are not skilled services. A catheter used for incontinence would not require skilled care. Secondary skin problems should indicate the treatment required and should be noted in the patient's record.

(7) Special service in connection with application of dressings involving prescription medications and aseptic technique constitute skilled services. Routine changes of dressings, particularly in non-infected postoperative or chronic conditions, generally do not require skilled services or supervision.

(8) Routine care in connection with braces and similar devices appliances does not constitute skilled services. Care involving training in proper use of a particular appliance should be evaluated in relation to the need for physical therapy.

(9) The use of protective restraints generally does not require services of skilled personnel. This includes such devices as bed rails, soft binders, and wheelchair patient supports.

(10) Any regimen involving regular administration of inhalation therapy can be instituted only upon specific physician order. The initial phases of instituting such a regimen would be skilled care. However, when such administration becomes a part of regular routine, it would not generally be considered a skilled service since patients can usually be taught to operate their own inhalation equipment, or non-skilled personnel can supervise its administration, as in cases of chronic asthma, emphysema, etc.

(11) Physical therapy, one aspect of restorative care, consists of the application of a complex and sophisticated group of physical modalities and therapeutic services. Physical therapy, therefore, is a skilled service. However, a provision of physical therapy only would not justify a finding that the patient requires skilled care. In some situations, however, a patient whose primary need is for physical therapy will also require sufficient skilled nursing to meet the definition of skilled care. The need for such supportive skilled nursing on a continuing basis may be presumed when all four of the following conditions are met.

(a) The therapy is directed by the physician who determines the need for therapy, the capacity and tolerance of the patient, and the treatment objectives.

(b) The physician, in consultation with the therapist, prescribes the specific modalities to be used and frequency of therapy services.

(c) The therapy is rendered by or under the supervision of a physical therapist who meets the qualifications established by regulations; when the qualified therapist is the supervisor, he is available and on the premises of the facility while the therapy is being given, he makes regular and frequent evaluations of the patient, records findings on the patient's chart, and communicates with the physician as indicated.

(d) The therapy is actively concerned with restoration of a lost or impaired function. For example, frequent physical therapy treatments in connection with a fractured back or hip or a CVA can be presumed to be directed toward restoration of lost or impaired function during the early phase --when physical therapy can be presumed to be effective. However, when the condition has stabilized, the presumption that continuing supportive skilled nursing services are required is no longer valid. Such cases must be evaluated in relation to the specific amount of skilled nursing attention required in the individual case as evidenced by physician orders and nursing notes. The routine ambulation and/or transfer of patients is not a skilled service.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-113, MCA
History: NEW, Eff. 1/3/77; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.120 Problem Cases

(1) There are some situations in which a patient's condition requires the institutional services provided by a skilled care facility, but does not require the type of care which is defined as skilled care. Such situations often arise where a patient needs extensive personal services due to permanent handicap or general debility, and alternative living arrangements are impractical or impossible due to socio-economic, physical or emotional reasons.

(2) Certain emotional conditions, or disturbed patients may require continuous services of sufficient degree of skill as to be considered as skilled service. However, when such is the case the exact services and medications should be sufficiently documented to justify claiming this as a skilled service.

(3) When any of the following circumstances exist, there must be evidence that continuous skilled nursing service is also concurrently required and received. These are not of themselves considered skilled services, but in combination with others may be skilled services.

(a) The primary service is one or more of the following:

(i) oral medication;

(ii) skin care to prevent decubiti;

(iii) restraints;

(iv) frequent laboratory tests;

(v) routine incontinence care;

(vi) routine care for the blind;

(vii) supervision of daily living activities.

(b) The patient is capable of independent ambulation, dressing, feeding, and hygiene.

(d) The diagnosis shown is not of a type which is sufficiently specific to indicate skilled treatment regimen; i.e., the diagnosis is chronic brain syndrome, senility, arteriosclerosis, "old" CVA, etc.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-113, MCA
History: NEW, Eff. 1/3/77; TRANS, from SRS, 2000 MAR p. 489.

Subchapter 37.40.2 Screening for Skilled Nursing and Intermediate Care Services

Mont. Admin. R. 37.40.201 Preadmission Screening, Definitions

(1) "Active treatment" means:

(a) for persons with mental retardation or a related condition, a continuous program which includes aggressive consistent implementation of a program of specialized and generic training, treatment, health services and related services that is directed toward:

(i) the acquisition of the behaviors necessary for the person to function with as much self-determination and independence as possible; and

(ii) the prevention or deceleration of regression or loss of current optimal functional status. Active treatment does not include services to maintain a generally independent client who is able to function with little supervision or in the absence of a continuous treatment program.

(b) for persons with mental illness, the implementation of an individualized plan of care developed under and supervised by a physician and provided by physicians and other qualified mental health professionals, that prescribes specific therapies and activities under the supervision of trained mental health personnel for the treatment of a person who is experiencing an acute episode of severe mental illness.

(2) "Home and community services program" means the provision of services described in ARM 46.12.1401 through 46.12.1482 to a person in a community setting, who meets the nursing facility level of care requirements.

(3) "Level I screening" means a review of a nursing facility applicant to identify whether the applicant has a primary or secondary diagnosis or indications of mental retardation or of mental illness.

(4) "Level II screening" means an assessment applied to persons identified as having a primary or secondary diagnosis of mental retardation or mental illness which determines whether the person as a nursing facility applicant has need for the level of services provided by the nursing facility or by another type of facility and, if so, whether the individual requires active treatment.

(5) "Medicaid recipient" means a person who is currently medicaid eligible or who has applied for medicaid.

(6) "Mental illness" means an applicant has or has had a primary or secondary diagnosis of a major mental disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSMIIIR) , limited to schizophrenic, paranoid, major affective, schizoaffective disorders and atypical psychosis, and does not have a primary diagnosis of dementia, including Alzheimer's disease or a related disorder, which is based on a neurological assessment.

(7) "Mental retardation" means:

(a) An applicant has or has had a primary or secondary diagnosis of mild, moderate, severe or profound retardation as described in the American Association on Mental Deficiency's Manual on Classification in Mental Retardation (1983) ; or

(b) An applicant has, or has had a primary or secondary diagnosis of a condition related to mental retardation, which is a severe, chronic disability that:

(i) is attributable to:

(A) autism, cerebral palsy or epilepsy; or

(B) any other condition, other than mental illness found to be closely related to mental retardation due to an impairment of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons requiring treatment or services similar to those required for these persons;

(ii) is manifested before the person reaches age 22;

(iii) is likely to continue indefinitely; and

(iv) results in substantial functional limitations in three or more of the following areas of major life activity:

(A) self-care;

(B) understanding and use of language;

(D) mobility;

(E) self-direction or;

(F) capacity for independent living.

(8) "Nursing facility" means an institution or a distinct part of an institution which is not primarily for the care and treatment of mental diseases, and is primarily engaged in providing either:

(a) skilled nursing care and related services for residents who require medical or nursing care;

(b) rehabilitation services for the rehabilitation of injured, disabled or sick persons, or

(c) on a regular basis, health-related care and services to persons who because of their mental or physical condition require care and services above the level of room and board which can be made available to them only through institutional

facilities.

(9) "Nursing facility applicant" means any person who has been referred for or is applying for admission to a nursing facility or the home and community services program.

(10) "Preadmission screening" means a medical, psychological and social evaluation of a nursing facility applicant which:

(a) is performed prior to entry to a nursing facility or the home and community services program and includes;

(i) a level I screening to determine if an applicant has a diagnosis or indication of mental illness or mental retardation;

(ii) a level II screening if an applicant is found by the level I screening to need further assessment; and

(iii) a nursing facility screening which determines an applicant's need for nursing facility services.

(11) "Preadmission screening team" means:

(a) for a nursing facility services determination, a licensed registered nurse and a department long term care specialist;

(b) for a level I screening, a long term care specialist or other professional approved by the department; and

(c) for a level II screening, employees or contractors of the state mental retardation authority or the state mental health authority.

(12) "Problems" means functional impairments, including those involving walking, bathing, grooming, dressing, toileting, transferring, feeding, bladder incontinence, bowel incontinence, special sense impairments (such as speech or hearing) , mental and behavioral dysfunctions.

(13) "State mental health authority" means the Montana department of corrections.

(14) "State mental retardation authority" means the developmental disabilities division of the Montana department of public health and human services.

History

Authorizing statute(s): Sec. 53-2-201, 53-5-205, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111, 53-6-131, 53-6-141 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; EMERG, AMD, 1989 MAR p. 439, Eff. 4/14/89; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.202 Preadmission Screening, General Requirements

(1) This rule provides the preadmission screening requirements of the Montana medicaid program for applicants to nursing facilities participating in the Montana medicaid program.

(2) Nursing facility applicants must undergo a level I screening prior to admission to a nursing facility.

(a) A level I screening may result in the following determinations which will apply as indicated:

(i) a nursing facility applicant who has no diagnosis or any indications of mental retardation or mental illness will:

(A) if not a medicaid recipient, receive a copy of the level I screen. No further action will be taken by the department; and

(B) if a medicaid recipient, undergo a level of care determination for nursing facility services.

(ii) a nursing facility applicant who has a diagnosis or indications of mental retardation or mental illness will be referred to either the state mental health authority or the mental retardation authority for a level II screening unless determined by the level I screening to be within one of the exceptions provided for in (3) (a) of this rule.

(3) A nursing facility applicant who has a diagnosis or indications of mental retardation or mental illness may enter a nursing facility only if the applicant is determined to be in need of nursing facility services and is allowed to enter as provided for in (3) (a) or (b) of this rule;

(a) A person with a diagnosis or indications of mental retardation or mental illness who is in need of nursing facility services may enter a nursing facility without a level II screening or a determination of appropriate active treatment, if either:

(i) the person is being discharged from an acute care facility and admitted to a nursing facility for recovery from an illness or surgery for a period not to exceed 120 days and is not a danger to self or others;

(ii) the person is certified by a physician to be terminally ill (prognosis of a life expectancy of six months or less) and is not a danger to self or others;

(iii) the person is comatose, ventilator dependent, functioning at the brain stem level or diagnosed as having chronic obstructive pulmonary disease, severe Parkinson's disease, Huntington's Chorea, amyotrophic lateral schlerosis, congestive heart failure or other similar diagnosis which prohibits the person from participating in active treatment; or

(iv) the person has a primary diagnosis of dementia, including Alzheimer's disease or a related disorder, based on a neurological examination.

(b) A level II screening may result in the following determinations which will apply as indicated:

(i) Any person with mental retardation or mental illness determined not to be in need of nursing facility services, whether or not active treatment services are required, shall be considered inappropriate for placement or continued residence in a nursing facility;

(ii) Any person with mental retardation or mental illness determined to be in need of active treatment services shall be considered inappropriate for placement or continued residence in a nursing facility;

(iii) Any person with mental retardation or mental illness determined to be in need of nursing facility services but not to be in need of active treatment services shall be considered appropriate for placement or continued residence in a nursing facility;

(iv) Any person with mental retardation or mental illness determined to be in need of both nursing facility services and active treatment, who is of advanced years, competent to make an independent decision and who is not a danger to self or others shall be considered appropriate for placement or continued residence in a nursing facility if the person so chooses.

(4) Medicaid recipients must be determined by a preadmission screening team to require nursing facility services before medicaid payment for services in a nursing facility or the home and community services program will be authorized.

(a) If a person is medicaid eligible prior to admission to a nursing facility, a nursing facility screening must be requested prior to admission. Payment for nursing facility care shall be effective on the date of entry to the nursing facility if the applicant meets all eligibility requirements.

(b) If the person applies for medicaid while a resident of a nursing facility, the nursing facility screening must be done prior to initial medicaid payment. Payment shall be effective on the date of the nursing facility screening or the date of referral to the preadmission screening team, whichever is earlier.

(5) Retroactive approval for nursing facility services is available only if:

(a) the applicant is determined to be financially eligible for medicaid during the retroactive period; and

(b) the applicant had undergone a determination of need for nursing facility services either by the preadmission screening team or for purposes of medicare payment; and

(6) A nursing facility applicant who is not a medicaid recipient may request that a nursing facility screening be conducted. This screening will be performed by the preadmission screening team.

(7) Preadmission screening will be performed by persons the department determines are qualified to conduct the various elements of the screening.

(8) A nursing facility admitting a nursing facility applicant for whom a level I screening or a nursing facility screening has not been conducted may be subject to the sanctions provided at ARM 37.85.502 and to any other measures that federal or state authorities deem appropriate and necessary for the purposes of the federal Social Security Act.

History

Authorizing statute(s): Sec. 53-6-113 and 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: EMERG, NEW, 1989 MAR p. 439, Eff. 4/14/89; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.205 Preadmission Screening, Nursing Facility Services

(1) For elderly persons and physically disabled persons, the need for nursing facility service will be determined based upon the following criteria:

(a) The services of a skilled nursing facility (SNF) are needed when a person meets the criteria for skilled care as defined by Title XVIII of the Social Security Act.

(b) The services of an intermediate care facility (ICF) are needed when a person:

(i) does not qualify for skilled nursing facility care; and

(ii) is determined by the department or its designee to need care at a level higher than personal care;

(c) In order to receive home and community services, an applicant must be determined to be at risk of or require care at the intermediate level as determined by the department or its designee through a functional rating of the person. The need for such care is indicated when the person:

(i) is able to ambulate (walk or wheel) to a dining room or equivalent;

(ii) is capable of self care with minimal assistance;

(iii) has four or fewer problems determined to be low level by the department or its designee; and

(iv) requires no more than one-hour of nursing care per 24 hours.

(d) A candidate for discharge is a person who has two or less problems. This criteria does not apply to persons with a diagnosis of mental illness or mental retardation.

(2) For mentally retarded persons applying for the home and community services program, the appropriate nursing facility services will be determined based upon the following criteria:

(a) The services of an intermediate care facility for the mentally retarded (ICF/MR) are needed when a mentally retarded person:

(i) has severe medical problems requiring substantial care, but not to the extent that habilitation is impossible;

(ii) has extreme deficits in self-care and daily living skills which require intensive training; or

(iii) has significant maladaptive social and/or interpersonal behavior patterns which require an on-going, supervised program of intervention.

(b) Skilled nursing facility (SNF) level of care is needed when a person with mental retardation meets the requirements for SNF services as found in (1) (a) of this rule.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-402, MCA
History: EMERG, NEW, 1989 MAR p. 439, Eff. 4/14/89; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.206 Preadmission Screening, Redetermination of Need for Nursing Facility Services

(1) For a person who is identified as in need of nursing facility services, and is enrolled in the home and community services program, a redetermination of the need for nursing facility services will take place 90 days after enrollment and every 180 days thereafter.

(2) For a person who is identified as in need of nursing facility services in an intermediate care facility for the mentally retarded (ICF/MR) and is enrolled in the home and community services program, a redetermination will be conducted annually.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-402, MCA
History: EMERG, NEW, 1989 MAR p. 439, Eff. 4/14/89; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.207 Preadmission Screening, Qualified Mental Retardation Professional

(1) The department will approve persons as qualified mental retardation professionals for purposes of providing preadmission screening and medicaid related case management services.

(2) Qualified mental retardation professional means a person who has specialized training or one year of work experience in habilitation or related services with mentally retarded or other developmentally disabled individuals.

(3) The department will accept as evidence of specialized training the following factors:

(a) licensure or certification in a profession which involves direct care to developmentally disabled persons;

(b) documentation of training, such as certification as a developmental disabilities client programming technician; or

(4) The department will accept as evidence of work experience documentation of supervised employment in direct care to developmentally disabled persons.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-402, MCA
History: EMERG, NEW, 1989 MAR p. 439, Eff. 4/14/89; TRANS, from SRS, 2000 MAR p. 489.

Subchapter 37.40.3 Reimbursement for Skilled Nursing and Intermediate Care Services

Mont. Admin. R. 37.40.301 Scope, Applicability, and Purpose

(1) This subchapter specifies requirements applicable to provision of and reimbursement for Medicaid nursing facility services, including intermediate care facility services for individuals with intellectual disabilities. These rules are in addition to requirements generally applicable to Medicaid providers as otherwise provided in state and federal statute, rules, regulations, and policies.

(2) These rules are subject to the provisions of any conflicting federal statute, regulation or policy, whether now in existence or hereafter enacted or adopted.

(3) Reimbursement and other substantive nursing facility requirements are subject to the laws, regulations, rules, and policies then in effect. Procedural and other nonsubstantive provisions of these rules are effective upon adoption.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2016 MAR p. 1071, Eff. 7/1/16.

Mont. Admin. R. 37.40.302 Definitions

Unless the context requires otherwise in this subchapter, the following definitions apply:

(1) "Administrator" means the person licensed by the state, including an owner, salaried employee, or other provider, with daily responsibility for operation of the facility. In the case of a facility with a central management group, the administrator, for the purpose of these rules, may be a person other than the titled administrator of the facility if such person has daily responsibility for operation of the nursing facility and is currently licensed by the state as a nursing home administrator.

(2) "Case mix index (CMI) " means an assigned weight or numeric score assigned to each RUG-III grouping which reflects the relative resources predicted to provide care to nursing facility residents.

(3) "Department" means the Montana Department of Public Health and Human Services or its agents, including but not limited to parties under contract to perform audit services, claim processing and utilization review.

(4) "Department audit staff" and "audit staff" mean personnel directly employed by the department or any of the department's contracted audit personnel or organizations.

(5) "Estimated economic life" means the estimated remaining period during which property is expected to be economically usable by one or more users, with normal repairs and maintenance, for the purpose for which it was intended when built.

(6) "Fiscal year" and "fiscal reporting period" both mean the provider's internal revenue tax year.

(7) "Maintenance therapy and rehabilitation services" mean repetitive services required to maintain functions which do not involve complex and sophisticated therapy procedures or the judgment and skill of a qualified therapist and without the expectation of significant progress.

(8) "Medicaid recipient" means a person who is eligible and receiving assistance under Title XIX of the Social Security Act for nursing facility services.

(9) "Minimum data set (MDS) " means the assessment form approved by the centers for Medicare and Medicaid services (CMS) , and designated by the department to satisfy conditions of participation in the Medicaid and Medicare programs.

(10) "Minimum data set RUG-III quarterly assessment form" means the three page quarterly, optional version for RUG-III 1997 update.

(11) "Nonemergency routine transportation" means transportation for routine activities, such as outings scheduled by the facility, nonemergency visits to physicians, dentists, optometrists, or other medical providers. This definition includes such transportation when it is provided within 20 miles of the facility.

(12) "Nursing facility fee schedule" means the list of separately billable ancillary services provided in ARM 37.40.330.

(13) "Nursing facility services" means nursing facility services as provided in ARM 37.40.304 and 37.40.305.

(14) "Patient contribution" means the total of all of a resident's income from any source available to pay the cost of care, less the resident's personal needs allowance. The patient contribution includes a resident's incurment determined in accordance with applicable eligibility rules.

(15) "Patient day" means a whole 24-hour period that a person is present and receiving nursing facility services, regardless of the payment source. Even though a person may not be present for a whole 24-hour period on the day of admission or day of death, such day will be considered a patient day. When department rules provide for the reservation of a bed for a resident who takes a temporary leave from a provider to be hospitalized or make a home visit, such whole 24-hour periods of absence will be considered patient days.

(16) "Provider" means any person, agency, corporation, partnership or other entity that, under a written agreement with the department, furnishes nursing facility services to Medicaid recipients.

(17) "Rate year" means a 12-month period beginning July 1. For example, rate year 2006 means a period corresponding to the state fiscal year July 1, 2005 through June 30, 2006.

(18) "Resident" means a person admitted to a nursing facility who has been present in the facility for at least one 24-hour period.

(19) "RUG-III" means resource utilization group, version III.

(20) "RUG-III grouper version" means the resource utilization group version III algorithm that classifies residents based upon diagnosis, services provided and functional status using MDS assessment information for each resident.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7/1/93, (14)(e) Eff. 10/1/93; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1996 MAR p. 1698, Eff. 6/21/96; AMD, 1997 MAR p. 76, Eff. 1/17/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2003 MAR p. 1294, Eff. 7/1/03; AMD, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2005 MAR p. 1046, Eff. 7/1/05.

Mont. Admin. R. 37.40.304 Nursing Facility Services

(1) Nursing facility services are provided in accordance with 42 CFR, part 483, subpart B, or intermediate care facility services for individuals with intellectual disabilities provided in accordance with 42 CFR, part 483, subpart I. The department adopts and incorporates by reference 42 CFR, part 483, subparts B and I, that define the participation requirements for nursing facility and intermediate care facility for individuals with intellectual disabilities (ICF/IID) providers, copies of which may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(2) The term "nursing facility services" includes the term "long term care facility services".

(3) Nursing facility services include, but are not limited to:

(a) a medically necessary room;

(b) dietary services including dietary supplements used for tube feeding or oral feeding such as high nitrogen diet;

(d) minor medical and surgical supplies; and

(e) the use of equipment and facilities.

(4) Payment for the services listed in ARM 37.40.304 and 37.40.305 are included in the per diem rate determined by the department under ARM 37.40.307 or 37.40.336 and no additional reimbursement is provided for such services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1046, Eff. 7/1/05; AMD, 2016 MAR p. 1071, Eff. 7/1/16.

Mont. Admin. R. 37.40.305 Nursing Facility Services: Reimbursable Services

(1) Nursing facility services include but are not limited to the following or any similar items:

(a) all general nursing services, including but not limited to administration of oxygen and medications, handfeeding, incontinence care, tray service, nursing rehabilitation services, enemas, and routine pressure sore/decubitis treatment;

(b) services necessary to provide for residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life;

(c) services required to attain or maintain the highest practicable physical, mental, and psychosocial well being of each Medicaid recipient who is a resident in the facility;

(d) items furnished routinely to all residents without charge, such as resident gowns, water pitchers, basins, and bed pans;

(e) items routinely provided to residents including but not limited to:

(i) antibacterial/bacteriostatic solutions, including betadine, hydrogen peroxide, 70% alcohol, merthiolate, zepherin solution;

(ii) cotton;

(iii) denture cups;

(iv) deodorizers (room-type);

(v) distilled water;

(vi) enema equipment and/or solutions;

(vii) facial tissues and paper toweling;

(viii) finger cots;

(ix) first aid supplies;

(x) foot soaks;

(xi) gloves (sterile and unsterile);

(xii) hot water bottles;

(xiii) hypodermic needles (disposable and nondisposable);

(xiv) ice bags;

(xv) incontinence pads;

(xvi) linens for bed and bathing;

(xvii) lotions (for general skin care);

(xviii) medication-dispensing cups and envelopes;

(xix) ointments for general protective skin care;

(xx) ointments (antibacterial);

(xxi) personal hygiene items and services, including but not limited to:

(A) bathing items and services, including but not limited to towels, washcloths, and soap;

(B) hair care and hygiene items, including but not limited to shampoo, brush, and comb;

(D) miscellaneous items and services, including but not limited to cotton balls and swabs, deodorant, hospital gowns, sanitary napkins and related supplies, and tissues;

(E) nail care and hygiene items;

(F) shaving items, including but not limited to razors and shaving creme;

(G) skin care and hygiene items, including but not limited to bath soap, moisturizing lotion, and disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection; and

(H) tooth and denture care items and services, including but not limited to toothpaste, toothbrush, floss, denture cleaner and adhesive;

(xxii) safety pins;

(xxiii) sterile water and normal saline for irrigating;

(xxiv) sheepskins and other fleece-type pads;

(xxv) soaps (hand or bacteriostatic);

(xxvi) supplies necessary to maintain infection control, including those required for isolation-type services;

(xxvii) surgical dressings;

(xxviii) surgical tape;

(xxix) over-the-counter drugs (or their equivalents), including but not limited to:

(A) acetaminophen (regular and extra-strength);

(B) aspirin (regular and extra-strength);

(D) specific therapeutic classes D4B (antacids), D6S (laxatives and cathartics) and Q3S (laxatives, local/rectal) including but not limited to:

(I) Milk of Magnesia;

(II) mineral oil;

(III) suppositories for evacuation (Dulcolax and glycerine);

(IV) Maalox; and

(V) Mylanta;

(E) nasal decongestants and antihistamines;

(xxx) straw/tubes for drinking;

(xxxi) suture removal kits;

(xxxii) swabs (including alcohol swab);

(xxxiii) syringes (disposable or nondisposable hypodermic; insulin; irrigating);

(xxxiv) thermometers, clinical;

(xxxv) tongue blades;

(xxxvi) water pitchers;

(xxxvii) waste bags;

(xxxviii) wound-cleansing beads or paste;

(f) items used by individual residents which are reusable and expected to be available, including but not limited to:

(i) bathtub accessories (seat, stool, rail);

(ii) beds, mattresses, and bedside furniture;

(iii) bedboards, foot boards, cradles;

(iv) bedside equipment, including bedpans, urinals, emesis basins, water pitchers, serving trays;

(v) bedside safety rails;

(vi) blood-glucose testing equipment;

(vii) blood pressure equipment, including stethoscope;

(viii) canes, crutches;

(ix) cervical collars;

(x) commode chairs;

(xi) enteral feeding pumps;

(xii) geriatric chairs;

(xiii) heat lamps, including infrared lamps;

(xiv) humidifiers;

(xv) isolation cart;

(xvi) IV poles;

(xvii) mattress (foam-type and water);

(xviii) patient lift apparatus;

(xix) physical examination equipment;

(xx) postural drainage board;

(xxi) room (private or double occupancy as provided in ARM 37.40.331);

(xxii) raised toilet seat;

(xxiii) sitz baths;

(xxiv) suction machines;

(xxv) tourniquets;

(xxvi) traction equipment;

(xxvii) trapeze bars;

(xxviii) vaporizers, steam-type;

(xxix) walkers (regular and wheeled);

(xxx) wheelchairs (standard); and

(xxxi) whirlpool bath;

(g) laundry services whether provided by the facility or by a hired firm, except for residents' personal clothing which is dry cleaned outside of the facility; and

(h) nonemergency routine transportation as defined in ARM 37.40.302(11).

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1046, Eff. 7/1/05.

Mont. Admin. R. 37.40.306 Provider Participation and Termination Requirements

(1) Nursing facility service providers, as a condition of participation in the Montana Medicaid program must meet the following requirements:

(a) comply with and agree to be bound by all laws, rules, regulations and policies generally applicable to Medicaid providers, including but not limited to the provisions of ARM 37.85.401, 37.85.402, 37.85.406, 37.85.407, 37.85.410, 37.85.414, and 37.85.415;

(b) maintain a current license issued by the department of public health and human services under Montana law for the category and level of care being provided, or, if the facility is located outside the state of Montana, maintain a current license under the laws of the state in which the facility is located for the category and level of nursing facility care being provided;

(c) maintain a current certification for Montana Medicaid issued by the Department of Public Health and Human Services under applicable state and federal laws, rules, regulations and policies for the category and level of care being provided, or, if the facility is located outside the state of Montana, maintain current Medicaid certification in the state in which the facility is located for the category and level of nursing facility care being provided;

(d) maintain a current agreement with the department to provide the level of care for which payment is being made, or, if the facility is located outside the state of Montana, comply with the provisions of ARM 37.40.337;

(e) operate under the direction of a licensed nursing home administrator, or other qualified supervisor for the facility, as applicable laws, regulations, rules, or policies may require;

(f) for providers maintaining resident trust accounts, insure that any funds maintained in such accounts are used only for those purposes for which the resident, legal guardian, or personal representative of the resident has given written authorization. The provider must maintain personal funds in excess of $50 in an interest bearing account and must credit all interest earned to the resident's account. Resident's personal funds in amounts up to $50 must be maintained in such a manner that the resident has convenient access to such funds within a reasonable time upon request. A provider may not borrow funds from such accounts or commingle resident and facility funds for any purpose;

(g) A provider holding personal funds of a deceased nursing facility resident who received Medicaid benefits at any time shall, within 30 days following the resident's death, pay those funds as provided by law and regulation.

(h) maintain admission policies which do not discriminate on the basis of diagnosis or handicap, and which meet the requirements of all federal and state laws prohibiting discrimination against the handicapped, including persons infected with acquired immunity deficiency syndrome/human immunodeficiency virus (AIDS/HIV) ;

(i) comply with ARM 37.40.101, 37.40.105, 37.40.106, 37.40.110, 37.40.120, and 37.40.201 through 37.40.207, regarding screening for nursing facility services;

(j) comply with all applicable federal and state laws, rules, regulations, and policies regarding nursing facilities at the times and in the manner required therein, including but not limited to 42 USC 1396r(b) (5) and 1396r(c) (1994 supp.) and implementing regulations, which contain federal requirements relating to nursing home reform. The department hereby adopts and incorporates herein by reference 42 USC 1396r(b) (5) and 1396r(c) . A copy of these statutes may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(2) A provider which fails to meet any of the requirements of this rule may be denied Medicaid payments, refused further participation in the Medicaid program or otherwise sanctioned or made subject to appropriate department action, according to applicable laws, rules, regulations, or policies.

(a) Subject to applicable federal law and regulations, the department may impose a sanction or take other action against a provider that is not in compliance with federal Medicaid participation requirements. Department sanctions or actions may include imposition of any remedy or combination of remedies provided by state or federal law and regulations, including but not limited to federal regulations at 42 CFR 488, subpart F.

(3) A provider must provide the department with 30 days advance written notice of termination of participation in the Medicaid program. Notice will not be effective prior to 30 calendar days following actual receipt of the notice by the department. Notice must be mailed or delivered to the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(a) For purposes of (3) , termination includes a cessation of provision of services to Medicaid residents, termination of the provider's business, a change in the entity administering or managing the facility or a change in provider as defined in ARM 37.40.325.

(b) In the event that discharge or transfer planning is necessary, the provider remains responsible to provide for such planning in an orderly fashion and to care for its residents until appropriate transfers or discharges are effected, even though transfer or discharge may not have been completed prior to the facility's planned date of termination from the Medicaid program.

(c) Providers terminating participation in the Medicaid program must prepare and file, in accordance with applicable cost reporting rules, a close out cost report covering the period from the end of the provider's previous fiscal year through the date of termination from the program. New providers assuming operation of a facility from a terminating provider must enroll in the Medicaid program in accordance with applicable rules.

(4) A provider must notify a resident or the resident's representative of a transfer or discharge as required by 42 CFR 483.12(a) (4) , (5) , and (6) . The notice must be provided using the form prescribed by the department. In addition to the notice contents required by 42 CFR 483.12, the notice must inform the recipient of the recipient's right to a hearing, the method by which the recipient may obtain a hearing and that the recipient may represent herself or himself or may be represented by legal counsel, a relative, a friend, or other spokesperson. Notice forms are available upon request from the department. Requests for notice forms may be made to the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-6-108, 53-6-111, 53-6-113, 53-6-189, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-106, 53-6-107, 53-6-111, 53-6-113, 53-6-168, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1996 MAR p. 1698, Eff. 6/21/96; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01.

Mont. Admin. R. 37.40.307 Nursing Facility Reimbursement

(1) For nursing facility services provided by nursing facilities located within the state of Montana, the Montana Medicaid program will pay a provider, for each Medicaid patient day, a per-diem rate determined in accordance with this rule, minus the amount of the Medicaid recipient's patient contribution.

(2) Effective July 1, 2020, and in subsequent rate years, the reimbursement rate for each nursing facility will be determined using the flat-rate component specified in (2)(a) and the quality component specified in (2)(b).

(a) The flat-rate component is the same per-diem rate for each nursing facility and will be determined each year through a public process. Factors that could be considered in the establishment of this flat-rate component include the cost of providing nursing facility services and Medicaid recipient access to nursing facility services. The flat-rate component for state fiscal year (SFY) 2027 is $287.11.

(b) The quality component of each nursing facility's rate is based on the five-star rating system for nursing facility services, calculated by the Centers for Medicare & Medicaid Services (CMS). It is set for each facility based on its average five-star ratings for staffing and for quality. Facilities with an average rating of three to five stars will receive a quality-component payment. The funding for the quality-component payment will be divided by the total estimated Medicaid bed days to determine the quality component per Medicaid bed day. The quality component per bed day is then adjusted based on each facility's five-star average of staffing and quality-component scores. A facility with a five-star average of staffing and quality-component scores will receive 100% of the quality-component payment, a four-star average will receive 75%, a three-star average will receive 50%, and one- and two-star average facilities will receive 0%. Funds unused by the first allocation round will be reallocated based on the facility's percentage of unused allocation against the available funds.

(c) The total payment rate available for the period July 1, 2026, through June 30, 2027, will be the rate as computed in (2), plus any additional amount computed in ARM 37.40.311 and 37.40.361. Copies of the department's current nursing facility Medicaid reimbursement rates per facility are posted at https://medicaidprovider.mt.gov/26, or may be obtained from the Department of Public Health and Human Services, Senior and Long-Term Care Division, P.O. Box 4210, Helena, MT 59604-4210.

(3) Providers who, as of July 1 of the rate year, have not filed with the department a cost report covering a period of at least six months' participation in the Medicaid program in a newly constructed facility will have a rate set at the flat rate component as computed on July 1, 2026. Following a change in provider as defined in ARM 37.40.325, the per diem rate for the new provider will be set at the previous provider's rate, as if no change in provider had occurred.

(4) For nursing facility services provided by nursing facilities located outside the state of Montana, the Montana Medicaid program will pay a provider only as provided in ARM 37.40.337.

(5) The Montana Medicaid program will not pay any provider for items billable to residents under the provisions of ARM 37.40.331.

(6) Reimbursement for Medicare coinsurance days will be as follows:

(a) for dually eligible Medicaid and Medicare individuals, reimbursement is limited to the per-diem rate, as determined under (1) or ARM 37.40.336, or the Medicare co-insurance rate, whichever is lower, minus the Medicaid recipient's patient contribution; and

(b) for individuals whose Medicare buy-in premium is being paid under the qualified Medicare beneficiary (QMB) program under ARM 37.83.201, but are not otherwise Medicaid eligible, payment will be made only under the QMB program at the Medicare coinsurance rate.

(7) The department will not make any nursing facility per-diem or other reimbursement payments for any patient day for which a resident is not admitted to a facility bed that is licensed and certified as provided in ARM 37.40.306 as a nursing facility or skilled nursing facility bed.

(8) The department will not reimburse a nursing facility for any patient day for which another nursing facility is holding a bed under the provisions of ARM 37.40.338(1), unless the nursing facility seeking such payment has, prior to admission, notified the facility holding a bed that the resident has been admitted to another nursing facility. The nursing facility seeking such payment must maintain written documentation of such notification.

(9) Providers must bill for all services and supplies in accordance with the provisions of ARM 37.85.406. The department's fiscal agent will pay a provider the amount determined under these rules upon receipt of an appropriate billing, which reports the number of patient days of nursing facility services provided to authorized Medicaid recipients during the billing period.

(a) Authorized Medicaid recipients are those residents determined eligible for Medicaid and authorized for nursing facility services as a result of the screening process described in ARM 37.40.101, 37.40.105, 37.40.106, 37.40.110, 37.40.120, and 37.40.201, et seq.

(10) Payments provided under this rule are subject to all limitations and cost settlement provisions specified in applicable laws, regulations, rules, and policies. All payments or rights to payments under this rule are subject to recovery or nonpayment, as specifically provided in these rules.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 685, Eff. 4/30/93; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1995 MAR p. 1227, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2000 MAR p. 1754, Eff. 7/14/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2003 MAR p. 1294, Eff. 7/1/03; AMD, 2005 MAR p. 1046, Eff. 7/1/05; AMD, 2006 MAR p. 1638, Eff. 7/1/06; AMD, 2007 MAR p. 1100, Eff. 8/10/07; AMD, 2008 MAR p. 1320, Eff. 7/1/08; AMD, 2009 MAR p. 1411, Eff. 8/14/09; AMD, 2010 MAR p. 1520, Eff. 7/1/10; AMD, 2011 MAR p. 1375, Eff. 7/29/11; AMD, 2012 MAR p. 1674, Eff. 8/24/12; AMD, 2013 MAR p. 1103, Eff. 7/1/13; AMD, 2014 MAR p. 1517, Eff. 7/11/14; AMD, 2015 MAR p. 824, Eff. 7/1/15; AMD, 2016 MAR p. 1071, Eff. 7/1/16; AMD, 2017 MAR p. 1670, Eff. 9/23/17; AMD, 2018 MAR p. 1419, Eff. 7/21/18; AMD, 2018 MAR p. 2241, Eff. 11/3/18; AMD, 2019 MAR p. 973, Eff. 7/6/19; AMD, 2019 MAR p. 2252, Eff. 12/7/19; AMD, 2020 MAR p. 1330, Eff. 7/25/20; AMD, 2021 MAR p. 1139, Eff. 9/11/21; AMD, 2022 MAR p. 1081, Eff. 7/1/22; AMD, 2023 MAR p. 1032, Eff. 9/9/23; AMD, 2024 MAR p. 2269, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2025-93, Eff. 3/21/26; AMD, 2026 MAR, Notice No. 2026-113, Eff. 9/26/26.

Mont. Admin. R. 37.40.308 Rate Effective Dates

(1) A provider's per diem rate effective for the rate period July 1, 2001 through June 30, 2002 and in subsequent rate years, shall be determined in accordance with ARM 37.40.307.

(2) Except as specifically provided in these rules, per diem rates and interim rates are set no more than once a year, effective July 1, and remain in effect at least through June 30 of the following year.

(a) Nothing in this subchapter shall be construed to require that the department apply any inflation adjustment, recalculate the Medicaid case mix index or the statewide price, or otherwise adjust or recalculate per diem rates or interim rates on July 1 of a rate year, unless the department adopts further rules or rule amendments providing specifically for a rate methodology for the rate year.

(3) A provider's rate established July 1 of the rate year shall remain in effect throughout the rate year and throughout subsequent rate years, regardless of any other provision in this subchapter, until the effective date of a new rate established in accordance with a new rule or amendment to these rules, adopted after the establishment of the current rate, which specifically provides a rate methodology for the new or subsequent rate year.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 1754, Eff. 7/14/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02.

Mont. Admin. R. 37.40.309 Nursing Facility Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 2320, Eff. 1/1/18; REP, 2018 MAR p. 1419, Eff. 7/21/18.

Mont. Admin. R. 37.40.311 Rate Adjustment for County Funded Rural Nursing Facilities

(1) For each state fiscal year, the department will provide a mechanism for a one time, lump sum payment to nonstate government owned or operated facilities for Medicaid services according to the methodology specified in this rule. These payments will be for the purpose of maintaining access and viability for a class of "at risk" county affiliated facilities who are predominately rural and are the only nursing facility in their community or county or who provide a significant share of nursing facility services in their community or county.

(2) A nursing facility is eligible to participate in this lump sum payment distribution if it is a nonstate government owned or operated facility that has provided Medicaid services in the current state fiscal year.

(a) The department will calculate the amount of lump sum distribution that will be allowed for each county affiliated provider so that the total per day amount does not exceed the computed Medicare upper payment limit for these providers. Distribution of these lump sum payments will be based on the Medicaid utilization at each participating facility for the period July 1 of the previous year through June 30 of the current year.

(b) In order to qualify for this lump sum adjustment, each county on behalf of its non-state government owned or operated facility must enter into a written agreement to transfer local county funds to be used as matching funds by the department. This transfer option is voluntary, but those counties that agree to participate must abide by the terms of the written agreement.

(3) On or after July 1 of each year, the department will provide for a one time, lump sum distribution of funding to nursing facilities not participating in the funding for "at risk" facilities for the provision of Medicaid services.

(4) The department will calculate the maximum amount of the lump sum payments that will be allowed for each participating non-state government owned or operated facility, as well as the additional payments for other nursing facilities not participating in the funding for "at risk" facilities for the provision of Medicaid services in accordance with state and federal laws, as well as applicable Medicare upper payment limit thresholds. This payment will be computed as a per day add-on based upon the funding available. Distribution will be in the form of lump sum payments and will be based on the Medicaid utilization at each participating facility for the period July 1 of the preceding year through June 30 of the current year.

(5) There may be no prearranged formal or informal agreements with the nursing facility to return or redirect any portion of the lump sum nursing facility payment to the county in order to fund other Medicaid services or non-Medicaid services.

(a) Payments or credits for normal operating expenses and costs are not considered a return or redirection of a Medicaid payment.

(6) "Normal operating expenses" and "costs" include, but are not limited to:

(a) taxes, including health care provider related taxes;

(b) mill levies;

(d) payment of facility construction bonds or loans;

(e) health insurance costs, unemployment insurance, workers compensation, and other employee benefits;

(f) payments in lieu of rent based on depreciation cost of county buildings occupied by nursing facility;

(g) mortgage or rent payments;

(h) payment of building insurance;

(i) other business relationships with county governments unrelated to Medicaid in which there is no connection to Medicaid payments; and

(j) legitimate services provided by the county to the nursing facility such as building maintenance, legal services, accounting, and advertising.

(7) Charges for services must be reasonable and the services must be documented.

(a) Documentation supporting charges are subject to the audit and record retention provisions in ARM 37.85.414.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2000 MAR p. 1754, Eff. 7/14/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2003 MAR p. 1294, Eff. 7/1/03; AMD, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2005 MAR p. 1401, Eff. 7/1/05; AMD, 2006 MAR p. 1638, Eff. 7/1/06; AMD, 2017 MAR p. 1670, Eff. 9/23/17.

Mont. Admin. R. 37.40.313 Operating Cost Component

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 685, Eff. 4/30/93; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1996 MAR p. 1698, Eff. 6/21/96; AMD, 1997 MAR p. 1044, Eff. 6/24/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; REP, 2002 MAR p. 1767, Eff. 6/28/02.

Mont. Admin. R. 37.40.314 Direct Nursing Personnel Cost Component

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1996 MAR p. 1698, Eff. 6/21/96; AMD, 1997 MAR p. 1044, Eff. 6/24/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; REP, 2002 MAR p. 1767, Eff. 6/28/02.

Mont. Admin. R. 37.40.315 Staffing and Reporting Requirements

(1) Providers must provide:

(a) staffing at levels that are adequate to meet federal law, regulations, and requirements; and

(b) staffing, quality, and performance information on the online Monthly Nursing Facility Report, which includes information on occupancy, staffing, demand for services, employee training, and employee longevity.

(2) Each provider must submit to the department within 15 days following the end of each calendar month a complete and accurate Monthly Nursing Facility Report, prepared in accordance with all applicable department rules and instructions.

(a) If the department does not receive complete and accurate reports within 15 days following the end of each calendar month, the department may withhold all payments for nursing facility services until the provider complies with the reporting requirements in (2).

(3) Each provider must submit a summary of the annual resident/family satisfaction survey by January 15, for the previous year. If the summary of annual resident/family satisfaction survey is not received by January 15, the department may withhold all payments for nursing facility services until the survey is submitted.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-108, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2016 MAR p. 1071, Eff. 7/1/16; AMD, 2024 MAR p. 2269, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2025-93, Eff. 3/21/26.

Mont. Admin. R. 37.40.320 Minimum Data Set Submission, Treatment of Delays in Submission, Incomplete Assessments, and Case Mix Index Calculation

(1) Nursing facilities shall submit all minimum data set assessments and tracking documents to the Centers for Medicare and Medicaid Services (CMS) database as required by federal participation requirements, laws, and regulations.

(2) Submitted assessment data shall conform to federal data specifications and meet minimum editing and validation requirements.

(3) Retention of assessments on the database will follow the records retention policy of the Department of Public Health and Human Services. Back up tapes of each rate setting period will be maintained for a period of five years.

(4) Assessments not containing sufficient in-range data to perform a resource utilization group-III (RUG-III) algorithm will not be included in the case mix calculation during the transition period.

(5) All current assessments in the database older than six months will be excluded from the case mix index calculation.

(6) For purposes of calculating rates, the department will use the RUG-III, 34 category, index maximizer model, version 5.12. The department may update the classification methodology to reflect advances in resident assessment or classification subject to federal requirements.

(7) For purposes of calculating rates, case mix weights will be developed for each of the 34 RUG-III groupings. The department will compute a Montana specific Medicaid case mix utilizing average nursing times from the 1995 and the 1997 CMS case mix time study. The average minutes per day per resident will be adjusted by Montana specific salary ratios determined by utilizing the licensed to non-licensed ratio spreadsheet information.

(8) For purposes of calculating rates, the department shall assign each resident a RUG-III group calculated on the most current non-delinquent assessment available on the first day of the second month of each quarter as amended during the correction period. The RUG-III group will be translated to the appropriate case mix index or weight. From the individual case mix weights for the applicable quarter, the department shall determine a simple facility average case mix index, carried to four decimal places, based on all resident case mix indices. For each quarter, the department shall calculate a Medicaid average case mix index, carried to four decimal places, based on all residents for whom Medicaid is reported as the per diem payor source any time during the 30 days prior to their current assessment.

(9) Facilities will be required to comply with the data submission requirements specified in this rule and ARM 37.40.321. The department will utilize Medicaid case mix data in the computation of rates for the period July 1, 2001 through June 30, 2002 and for rate years thereafter.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.321 Correction of Erroneous or Missing Data

(1) The department will prepare and distribute resident listings to facilities by the 15th day of the third month of each quarter (cut off date) . The listings will identify current assessments for residents in the nursing facility on the first day of the second month of each quarter as reflected in the database maintained by the department. The listings will identify resident social security numbers, names, assessment reference date, the calculated RUG-III category and the payor source. Resident listings shall be signed and returned to the department by the 15th day of the first month of the following calendar quarter. Facilities who do not return this corrected resident listing by the due date will use the database information on file in their case mix calculation.

(2) If data reported on the resident listings is in error or if there is missing data, facilities will have until the 15th day of the first month of each calendar quarter to correct data submissions.

(a) Errors or missing data on the resident listings due to untimely submissions to the CMS database maintained by the Department of Public Health and Human Services (DPHHS) are corrected by transmitting the appropriate assessments or tracking documents to DPHHS in accordance with CMS requirements.

(b) Errors in key field items are corrected following the CMS key field specifications through DPHHS.

(3) The department may also use Medicaid paid claim data to determine the Medicaid residents in each facility when determining the Medicaid average case mix index for each facility.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.322 Obra Nurse Aide Testing and Training Cost Reporting

(1) Omnibus Budget Reconciliation Act of 1987 (OBRA) costs will be reimbursed under the per diem rate determined under ARM 37.40.307. No further reimbursement will be provided outside the per diem rate.

(2) Each provider must document and submit to the department on a quarterly basis information on the nurse aide certification training and competency evaluation (testing) costs, including but not limited to the costs of training for nurse aides and the costs of actual testing required for nurse aides, incurred at the facility and, in the case of competency evaluation (testing) costs for providers that are not testing entities, incurred in payment of a qualified testing entity's fee for competency evaluation (testing) . The required information must be submitted quarterly on the nurse aide certification/training and competency evaluation (testing) survey reporting form provided by the department and must include the total dollars incurred in each of the categories of facility personnel, supplies and equipment, subcontracted services and testing fees. The reporting form must include a brief description of the items included in each of the four categories.

(a) Acceptable documentation will be any documentation that adequately supports the costs claimed on the reporting form and includes all records and documentation as defined in ARM 37.40.346, such as invoices, contracts, canceled checks and time cards. This documentation is subject to desk review and audit in accordance with ARM 37.40.346. This documentation must be maintained by the facility for six years, three months from the date the form is filed with the department or until any dispute or litigation regarding the costs supported by such documentation is finally resolved, whichever is later.

(b) If a provider fails to submit the quarterly reporting form within 30 calendar days following the end of the quarter, the department may withhold reimbursement payments in accordance with ARM 37.40.346(4) (c) . All amounts so withheld will be payable to the provider upon submission of a complete and accurate nurse aide certification/training survey reporting form.

(3) Medicaid nursing facility reimbursement for the costs associated with training and competency evaluation programs for nurse aides employed in Medicare and Medicaid nursing facilities, as required under OBRA, shall be as follows:

(a) Nurse aide certification training and competency evaluation (testing) costs documented in accordance with (2) and allowable under ARM 37.40.345 will be reimbursed to the extent provided under the per diem rate determined under ARM 37.40.307. No additional reimbursement will be provided for such costs.

(4) For purposes of reporting under (2) , nurse aide tests are those tests which:

(a) demonstrate competency through testing methods which address each course requirement and include successful completion of both a written or oral examination and a demonstration of the skills required to perform the tasks required of a nurse aide;

(b) are performed at either a nursing facility which is currently in compliance with Medicaid nursing facility participation requirements or at a regional testing site at regularly scheduled testing times;

(d) do not exceed a third attempt by the individual nurse aide to successfully complete the portion of the test for which costs are reported. The written/oral examination and the skills demonstration may be taken separately if the nurse aide passed only one portion of the test in a previous exam.

(5) Competency evaluation (testing) costs reported by a provider shall include the testing entity's basic fee charged to the facility and other costs associated with competency testing, to the extent allowable under ARM 37.40.345.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 489; AMD, 2002 MAR p. 1767, Eff. 6/28/02.

Mont. Admin. R. 37.40.323 Calculated Property Cost Component

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1996 MAR p. 1698, Eff. 6/21/96; AMD, 1997 MAR p. 1044, Eff. 6/24/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2001 MAR p. 1108, Eff. 6/22/01; REP, 2002 MAR p. 1767, Eff. 6/28/02.

Mont. Admin. R. 37.40.324 Grandfathered Property Cost Component

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; TRANS, from SRS, 2000 MAR p. 489; REP, 2002 MAR p. 1767, Eff. 6/28/02.

Mont. Admin. R. 37.40.325 Change in Provider Defined

(1) Except as provided in (2) , a change in provider will be deemed to have occurred if the events described in any one of the following (1) (a) through (d) occurs:

(a) For sole proprietorship providers, a change in provider occurs where the entire sole proprietorship is sold to an unrelated party and a selling proprietor does not retain a right of control over the business.

(b) For partnership providers, a change in provider occurs where:

(i) a new partner acquires an interest in the partnership greater than 50%;

(ii) the new partner is not a related party to either a current partner or a former partner from whom the new partner acquired all or any portion of the new partner's interest; and

(iii) the current or former partners from whom the new partner acquires an interest do not retain a right of control over the partnership arising from the transferred interest.

(c) For corporation providers, a change in provider occurs where stock and the associated stockholder rights representing an interest of more than 50% in the provider's corporation is acquired by an unrelated party.

(d) For all providers, a change in provider occurs where an unrelated party acquires:

(i) the provider's title or interest in the nursing facility or a leasehold interest in the nursing facility; and

(ii) the right to control and manage the business of the nursing facility.

(2) Regardless of the provisions of (1) through (1) (d) , a change in provider will not be deemed to have occurred if the circumstances indicate that:

(a) a related party will acquire, retain or actually exercise substantial influence over the new entity; or

(b) the occurrence or transaction is undertaken primarily for the purpose of triggering a change in provider under this rule.

(3) For purposes of this rule:

(a) "Provider" means the business entity having the right to control and manage the business of the nursing facility.

(b) "Related party" means:

(i) a person, including a natural person and a corporation, who is an owner, partner or stockholder in the current provider and who has a direct or indirect interest of 5% or more or a power, whether or not legally enforceable to directly or indirectly influence or direct the actions or policies of the entity;

(ii) A spouse, ancestor, descendant, sibling, uncle, aunt, niece, or nephew of a person described in (3)(b)(i) or a spouse of an ancestor, descendant, sibling, uncle, aunt, niece or nephew of a person described in (3)(b)(i); or

(iii) a sole proprietorship, partnership corporation or other entity in which a person described in (3)(b)(i) or (ii) has a direct or indirect interest of 5% or more or a power, whether or not legally enforceable to directly or indirectly influence or direct the actions or policies of the entity.

(4) In determining whether a change in provider has occurred within the meaning of this rule, the provisions of federal Medicare law, regulation or policy or related caselaw regarding changes in ownership under the Medicare program are not applicable.

(5) As required in ARM 37.40.306, a provider must provide the department with 30 days advance written notice of a change in provider and must file a close out cost report, and new providers must enroll in the Medicaid program in accordance with applicable requirements.

(6) Any change in provider, corporate or other business ownership structure, or operation of the facility that results in a change in the National Provider Identifier (NPI) will require a provider to seek a new Medicaid provider enrollment. If the NPI is transferred with the facility, and this results in a change in the federal tax identification number, the provider will be required to seek a new Medicaid provider enrollment.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1997 MAR p. 76, Eff. 1/17/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2011 MAR p. 1375, Eff. 7/29/11; AMD, 2013 MAR p. 1103, Eff. 7/1/13.

Mont. Admin. R. 37.40.326 Interim Per Diem Rates for Newly Constructed Facilities and New Providers

(1) This rule specifies the methodology the department will use to determine the interim per diem rate for in-state providers, other than ICF/IID providers, which as of July 1 of the rate year have not filed with the department a cost report covering a period of at least six months participation in the Medicaid program in a newly constructed facility or following a change in provider as defined in ARM 37.40.325.

(a) Effective July 1, 2001, and thereafter, the rate paid to new providers that acquire or otherwise assume the operations of an existing nursing facility, that was participating in the Medicaid program prior to the transaction, will be paid the price-based reimbursement rate in effect for the prior owner/operator of the facility before the transaction as if no change in provider had occurred. These rates will be adjusted at the start of each state fiscal year in accordance with (1)(b).

(b) Effective July 1 2020, and thereafter, the rate paid to newly constructed facilities or to facilities participating in the Medicaid program for the first time will be the flat rate component specified under ARM 37.40.307(2)(a) combined with the quality component specified under ARM 37.40.307(2)(b).

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2000 MAR p. 1754, Eff. 7/14/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2014 MAR p. 1517, Eff. 7/11/14; AMD, 2016 MAR p. 1071, Eff. 7/1/16; AMD, 2020 MAR p. 1330, Eff. 7/25/20.

Mont. Admin. R. 37.40.330 Separately Billable Items

(1) In addition to the amount payable under the provisions of ARM 37.40.307(1) or (4) , the department will reimburse nursing facilities located in the state of Montana for the following separately billable items. Refer to the department's nursing facility fee schedule for specific codes and refer to healthcare common procedure coding system (HCPCS) coding manuals for complete descriptions of codes:

(a) ostomy surgical tray;

(b) ostomy face plate;

(d) ostomy filter;

(e) ostomy bags (pouches) ;

(f) ostomy belt;

(g) adhesive;

(h) adhesive remover;

(i) ostomy irrigation set and supplies;

(j) ostomy lubricant;

(k) ostomy rings;

(l) ostomy irrigation supply, cone/catheter, including brush;

(m) catheter care kit;

(n) urine test or reagent strips or tablets;

(o) blood tubing, arterial or venous;

(p) blood glucose test strips for dialysis;

(q) blood glucose test or reagent strips for home blood glucose monitor;

(r) implantable access catheter (venous, arterial, epidural, subarachnoid, peritoneal, etc.) external access;

(s) gastrostomy/jejunostomy tube, any material, any type;

(t) oropharyngeal suction catheter;

(u) implanted pleural catheter;

(v) external urethral clamp or compression device;

(w) urinary catheters;

(x) urinary insertion trays (sets) ;

(y) urinary collection bags;

(z) tracheostomy care kit for established tracheostomy;

(aa) tracheostomy, inner cannula (replacement only) ;

(bb) oxygen contents, portable, liquid;

(cc) oxygen contents, portable, gas;

(dd) oxygen contents, stationary, liquid;

(ee) oxygen contents, stationary, gas;

(ff) cannula, nasal;

(gg) oxygen tubing;

(hh) regulator;

(ii) mouth piece;

(jj) stand/rack;

(kk) face tent;

(ll) humidifier;

(mm) breathing circuits;

(nn) respiratory suction pump, home model, portable, or stationary;

(oo) nebulizer, with compressor;

(pp) feeding syringe;

(qq) nasal interface (mask or cannula type) used with positive airway device;

(rr) stomach tube - levine type;

(ss) nasogastric tubing (with or without stylet) ;

(tt) nutrition administration kits;

(uu) feeding supply kits;

(vv) nutrient solutions for parenteral and enteral nutrition therapy when such solutions are the only source of nutrition for residents who, because of chronic illness or trauma, cannot be sustained through oral feeding. Payment for these solutions will be allowed only where the department determines they are medically necessary and appropriate, and authorizes payment before the items are provided to the resident;

(ww) routine nursing supplies used in extraordinary amounts and prior authorized by the department;

(xx) oxygen concentrators and portable oxygen units (cart, E tank and regulators), if prior authorized by the department.

(i) The department will prior authorize oxygen concentrators and portable oxygen units (cart, E tank and regulators) only if:

(A) The provider submits to the department documentation of the cost and useful life of the concentrator or portable oxygen unit, and a copy of the purchase invoice.

(B) The provider maintains a certificate of medical necessity indicating the PO2 level or oxygen saturation level. This certificate of medical necessity must meet or exceed Medicare criteria and must be signed and dated by the patient's physician. If this certificate is not available on request of the department or during audit, the department may collect the corresponding payment from the provider as an overpayment in accordance with ARM 37.40.347.

(ii) The provider must attach to its billing claim a copy of the prior authorization form.

(iii) The department's maximum monthly payment rate for oxygen concentrators and portable oxygen units (cart, E tank and regulators) will be the invoice cost of the unit divided by its estimated useful life as determined by the department. The provider is responsible for maintenance costs and operation of the equipment and will not be reimbursed for such costs by the department. Such costs are considered to be covered by the provider's per diem rate.

(2) The department may, in its discretion, pay as a separately billable item, a per diem nursing services increment for services provided to a ventilator dependent resident, trach dependent resident, behavior related needs resident, wound care resident, bariatric care resident, and residents with traumatic brain injury (TBI) diagnoses if the department determines that extraordinary staffing by the facility is medically necessary based upon the resident's needs.

(a) Payment of a per diem nursing services increment under (2) for services provided to a ventilator dependent resident shall be available only if, prior to the provision of services, the increment has been authorized in writing by the department's senior and long term care division. Approvals will be effective for one month intervals and reapproval must be obtained monthly.

(b) The department may require the provider to submit any appropriate medical and other documentation to support a request for authorization of the increment. Each calendar month, the provider must submit to the department, together with reporting forms and according to instructions supplied by the department, time records of nursing services provided to the resident during a period of five consecutive days. The submitted time records must identify the amount of time care is provided by each type of nursing staff, i.e., licensed and nonlicensed.

(c) The increment amount shall be determined by the department as follows. The department shall subtract the facility's current average Medicaid case mix index (CMI) used for rate setting determined in accordance with ARM 37.40.320 from the CMI computed for the ventilator dependent resident, determined based upon the current minimum data set (MDS) information for the resident in order to determine the difference in case mix for this resident from the average case mix for all Medicaid residents in the facility. The increment shall be determined by the department by multiplying the provider's direct resident care component by the ratio of the resident's CMI to the facility's average Medicaid CMI to compute the adjusted rate for the resident. The department will determine the increment for each resident monthly after review of case mix information and five consecutive day nursing time documentation review.

(3) The department will reimburse for all Montana Medicaid covered services delivered via telemedicine/telehealth originating site fees as long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth, comply with the guidelines set forth in the applicable Montana Medicaid provider manual, and are not a service specifically required to be face-to-face.

(4) The department will reimburse for separately billable items at direct cost, with no indirect charges or mark-up added. For purposes of combined facilities providing these items through the hospital portion of the facility, direct cost will mean invoice price to the hospital with no indirect cost added.

(a) If the items listed in (1)(a) through (1)(ax) are also covered by the Medicare program and provided to a Medicaid recipient who is also a Medicare recipient, reimbursement will be limited to the lower of the Medicare prevailing charge or the amount allowed under (3). Such items may not be billed to the Medicaid program for days of service for which Medicare Part A coverage is in effect.

(b) The department will reimburse for separately billable items only for a particular resident, where such items are medically necessary for the resident and have been prescribed by a physician.

(5) Physical, occupational, and speech therapies which are not nursing facility services may be billed separately by the licensed therapist providing the service, subject to department rules applicable to physical therapy, occupational therapy, and speech therapy services.

(a) Maintenance therapy and rehabilitation services within the definition of nursing facility services in ARM 37.40.302 are reimbursed under the per diem rate and may not be billed separately by either the therapist or the provider.

(b) If the therapist is employed by or under contract with the provider, the provider must bill for services which are not nursing facility services under a separate therapy provider number.

(6) Durable medical equipment and medical supplies which are not nursing facility services and which are intended to treat a unique condition of the recipient which cannot be met by routine nursing care, may be billed separately by the medical supplier in accordance with department rules applicable to such services.

(7) All prescribed medication may be billed separately by the pharmacy providing the medication, subject to department rules applicable to outpatient drugs. The nursing facility will bill Medicare directly for reimbursement of Medicare Part B covered drugs and vaccines and their administration when they are provided to an eligible Medicare Part B recipient. Medicaid reimbursement is not available for Medicare Part B covered drugs and vaccines and related administration costs for residents that are eligible for Medicare Part B.

(8) Nonemergency routine transportation for activities other than those described in ARM 37.40.302(11), may be billed separately in accordance with department rules applicable to such services. Emergency transportation may be billed separately by an ambulance service in accordance with department rules applicable to such services.

(9) The provider of any other medical services or supplies, which are not nursing facility services, provided to a nursing facility resident may be billed by the provider of such services or supplies to the extent allowed under and subject to the provisions of applicable department rules.

(10) The provisions of (3) through (7) apply to all nursing facilities, including intermediate care facilities for individuals with intellectual disabilities, whether or not located in the state of Montana.

(11) Providers may contract with any qualified person or agency, including home health agencies, to provide nursing facility services. However, except as specifically allowed in these rules, the department will not reimburse the provider for such contracted services in addition to the amounts payable under ARM 37.40.307.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1996 MAR p. 1698, Eff. 6/21/96; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2003 MAR p. 1294, Eff. 7/1/03; AMD, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2005 MAR p. 1046, Eff. 7/1/05; AMD, 2007 MAR p. 1100, Eff. 8/10/07; AMD, 2011 MAR p. 1375, Eff. 7/29/11; AMD, 2016 MAR p. 1071, Eff. 7/1/16; AMD, 2020 MAR p. 1330, Eff. 7/25/20.

Mont. Admin. R. 37.40.331 Items Billable to Residents

(1) The department will not pay a provider for any of the following items or services provided by a nursing facility to a resident. The provider may charge these items or services to the nursing facility resident:

(a) gifts purchased by residents;

(b) social events and entertainment outside the scope of the provider's activities program;

(d) personal comfort items, including tobacco products and accessories, notions, novelties, and confections;

(e) personal dry cleaning;

(f) beauty shop services;

(g) television, radio and private telephone rental;

(h) less-than-effective drugs (exclusive of stock items) ;

(i) vitamins, multivitamins, vitamin supplements and calcium supplements;

(j) personal reading materials;

(k) personal clothing;

(l) flowers and plants;

(m) privately hired nurses or aides;

(n) specially prepared or alternative food requested instead of food generally prepared by facility; and

(o) the difference between the cost of items usually reimbursed under the per diem rate and the cost of specific items or brands requested by the resident which are different from that which the facility routinely stocks or provides (e.g., special lotion, powder, diapers) ;

(2) Services provided in private rooms will be reimbursed by the department at the same rate as services provided in a double occupancy room.

(a) A provider must provide a medically necessary private room at no additional charge and may not bill the recipient any additional charge for the medically necessary private room.

(b) A provider may bill a resident for the extra cost of a private room if the private room is not medically necessary and is requested by the resident. The provider must clearly inform the resident that additional payment is strictly voluntary.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 10/1/93; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.336 Reimbursement for Intermediate Care Facilities for Individuals with Intellectual Disabilities

(1) For intermediate care facility services for individuals with intellectual disabilities provided in facilities located in the state of Montana, the Montana Medicaid program will pay a provider a per diem rate equal to the actual allowable cost incurred by the provider during the fiscal year, determined retrospectively in accordance with ARM 37.40.345 and 37.40.346, divided by the total patient days of service during the rate year, minus the amount of the Medicaid recipient's patient contribution, subject to the limits specified in (2)(a) and (b).

(2) Payments under (1) may not exceed the following limits:

(a) Final per diem payment rates for base years shall be as specified in (1), without application of any further limit. Base years are even-numbered state fiscal years, i.e., state fiscal years 1994, 1996, and subsequent even-numbered years.

(b) Final per diem rates in non-base years are limited to the final per diem rate for the immediately preceding base year indexed from June 30 of the base year to June 30 of the rate year. The index is the final Medicare market basket index applicable to the non-base year. Non-base years are odd-numbered state fiscal years, i.e., state fiscal years 1993, 1995 and subsequent odd-numbered years.

(3) All ICF/IID providers must use a July 1 through June 30 fiscal year for accounting and cost reporting purposes.

(4) Prior to the billing of July services each rate year, the department will determine an interim payment rate for each provider. The provider's interim payment rate shall be determined based upon the department's estimate of actual allowable cost under ARM 37.40.345, divided by estimated patient days for the rate year. The department may consider, but shall not be bound by, the provider's cost estimates in estimating actual allowable costs. The provider's interim payment rate is an estimate only and shall not bind the department in any way in the final rate determination under (1) and (5).

(5) The provider's final rate as provided in (1) shall be determined based upon the provider's cost report for the rate year filed in accordance with ARM 37.40.346, after desk review or audit by the department's audit staff. The difference between actual includable cost allocable to services to Medicaid residents, as limited in (2), and the total amount paid through the interim payment rate will be settled through the overpayment and underpayment procedures specified in ARM 37.40.347.

(6) Following the sale of an intermediate care facility for individuals with intellectual disabilities after April 5, 1989, the new provider's property costs will be the lesser of historical costs or the rate used for all other intermediate care facilities, subject to the limitations in 42 USC 1396a(a)(13)(C).

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1071, Eff. 7/1/16.

Mont. Admin. R. 37.40.337 Reimbursement to Out-of-State Facilities

(1) The department will reimburse nursing facilities located outside the state of Montana for nursing facility services and any other reimbursable services or supplies provided to eligible Montana Medicaid individuals at the Medicaid rate and upon the basis established by the Medicaid agency in the state in which the facility is located.

(2) The Montana Medicaid program will pay for nursing facility services or related supplies provided to eligible Montana Medicaid individuals in nursing facilities located outside the state of Montana only when one of the following conditions is met:

(a) because of a documented medical emergency, the resident's health would be endangered if he or she was to return to Montana for medical services;

(b) the services required are not provided in Montana;

(c) the required services and all related expenses are less costly than if the required services were provided in Montana;

(d) the recipient is a child in another state for whom Montana makes adoption assistance or foster care assistance payments; or

(e) the department determines that it is general practice for recipients in the resident's particular locality to use medical resources located in another state.

(3) To receive payments, the out-of-state provider must enroll in the Montana Medicaid program. Enrollment information and instructions may be obtained from the department's fiscal intermediary.

(4) The department will reimburse a nursing facility located outside the state of Montana under the Montana Medicaid program only if, in addition to meeting other applicable requirements, the facility has submitted to the department the following information:

(a) a physician's order identifying the Montana resident and specifically describing the purpose, cause and expected duration of the stay;

(b) for nursing facility services, copies of documents from the facility's state Medicaid agency establishing or stating the facility's Medicaid per diem rate for the period the services were provided;

(c) for separately billable items, copies of documents from the facility's state Medicaid agency establishing or stating the Medicaid reimbursement payable for such items for the period the items were provided;

(d) a properly completed level I screening form for the resident, as required by ARM 37.40.201, et seq.;

(i) To the extent required by ARM 37.40.201, et seq., a level I screening must be performed prior to entry into the nursing facility to determine if there is a diagnosis of mental illness or mental retardation and if so, to conduct assessments which determine the resident's need for active treatment. A level I screening form may be obtained from the department.

(e) a copy of the preadmission-screening determination for the resident completed by the department or its designee;

(i) Payment will be made for services no earlier than the date of referral for screening or the date of screening, whichever is earlier.

(f) the resident's full name, Medicaid ID number and dates of service;

(g) a copy of the certification notice from the facility's state survey agency showing certification for Medicaid during the period services were provided; and

(h) assurances that, during the period the billed services were provided, the facility was not operating under sanctions imposed by Medicare or Medicaid which would preclude payment.

(5) Reimbursement to nursing facilities located outside the state of Montana for Medicare coinsurance days for dually eligible Medicaid and Medicare individuals shall be limited to the per diem rate established by the facility's state Medicaid agency, less the Medicaid recipient's patient contribution.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 489; AMD, 2003 MAR p. 1294, Eff. 7/1/03; AMD, 2015 MAR p. 824, Eff. 7/1/15; AMD, 2017 MAR p. 1670, Eff. 9/23/17.

Mont. Admin. R. 37.40.338 Bed Hold Payments

(1) Except as provided in (6) through (9) for therapeutic home visits, payment will be made to a provider for holding a bed for a resident only if:

(a) the provider's facility is full and has a current waiting list of potential residents during each such bed day claimed for reimbursement;

(b) the resident for whom the bed is held is temporarily receiving medical services outside the facility, except in another nursing facility, and is expected to return to the provider;

(c) the cost of holding the bed will evidently be less costly than the possible cost of extending the hospital stay until an appropriate long term care bed would otherwise become available; and

(d) the provider has received written approval from the department's senior and long term care division as provided in (4) .

(2) For purposes of (1) , a provider will be considered full if:

(a) all Medicaid certified beds are occupied or being held for a recipient who is either temporarily receiving medical services outside the provider's facility or outside the facility on a therapeutic home visit; or

(b) as to gender, if all appropriate, available beds are occupied or being held. For example, if all beds are occupied or held except for one semi-private bed in a female room, the provider is full for purposes of hold days for male recipients.

(3) For purposes of (1) , the provider must maintain and, upon request, provide to the department or its agents documentation that the absence is expected to be temporary and of the anticipated duration of the absence. Temporary absences which are of indefinite duration must be documented at least weekly by the provider to assure that the absence is indeed temporary.

(4) A provider's request for the department's written approval of bed hold days as required in (1) must be submitted to the department's senior and long term care division on the form provided by the department within 90 days after the first day of the requested bed hold period. The request must include a copy of the waiting list applicable to each bed hold day claimed for reimbursement.

(5) Where the conditions of (1) through (4) are met, providers are required to hold a bed and may not fill the bed until these conditions are no longer met. The bed may not be filled unless prior approval is obtained from the department's senior and long term care division. In situations where conditions of billing for holding a bed are not met, providers must hold the bed and may not bill Medicaid for the bed hold day until all conditions of billing are met and may not bill the resident under any circumstances.

(6) Payment will be made to a provider for holding a bed for a resident during a therapeutic home visit only if:

(a) the recipient's plan of care provides for therapeutic home visits;

(b) the recipient is temporarily absent on a therapeutic home visit; and

(c) the resident is absent from the provider's facility for no more than 72 consecutive hours per absence, unless the department determines that a longer absence is medically appropriate and has authorized the longer absence in advance of the absence. If a resident leaves the facility unexpectedly, on a weekend or a non business day for a visit longer than 72 hours, a provider must call in to the department on the next business day to receive prior authorization for the visit. If a resident is unexpectedly delayed while out on a therapeutic home visit, a provider must call the department and receive prior authorization if that delay will result in the visit exceeding 72 hours or obtain an extension for a visit that was previously approved by the department in excess of 72 hours.

(7) The department may allow therapeutic home visits for trial placement in the Home and Community Services (Medicaid Waiver) program.

(8) No more than 24 days per resident in each rate year (July 1 through June 30) will be allowed for therapeutic home visits.

(9) The provider must submit to the department's Senior and Long Term Care Division a request for a therapeutic home visit bed hold, on the appropriate form provided by the department, within 90 days of the first day a resident leaves the facility for a therapeutic home visit. Reimbursement for therapeutic home visits will not be allowed unless the properly completed form is filed timely with the department's Senior and Long Term Care Division.

(10) Approvals or authorizations of bed hold days obtained from county offices will not be valid or effective for purposes of this rule.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1996 MAR p. 1698, Eff. 6/21/96; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00.

Mont. Admin. R. 37.40.339 Medicare Hospice Benefit - Reimbursement

(1) In accordance with section 9435(b) of the Omnibus Budget Reconciliation Act of 1986, Public Law 99-509, the department may not pay a nursing facility provider for services provided to an eligible Medicaid/Medicare individual who has elected the Medicare hospice benefit.

(a) This rule applies where the hospice provider and the nursing facility provider have made a written agreement under which the hospice provider agrees to provide professional management of the individual's hospice care and the nursing facility provider agrees to provide room and board to the individual.

(b) When this rule applies, the department will pay the hospice provider in accordance with the department's rules governing Medicaid reimbursement to hospice providers.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00.

Mont. Admin. R. 37.40.345 Allowable Costs

(1) This rule applies for purposes of determining allowable costs for cost reporting periods beginning on or after July 1, 1991. Allowable costs for cost reporting periods beginning prior to July 1, 1991 will be determined in accordance with rules for allowable costs then in effect.

(2) For purposes of reporting and determining allowable costs, the department hereby adopts and incorporates herein by reference the Provider Reimbursement Manual (PRM-15), published by the United States Department of Health and Human Services, Social Security Administration, which provides guidelines and policies to implement Medicare regulations and principles for determining the reasonable cost of provider services furnished under the Health Insurance for Aged Act of 1965, as amended. A copy of the PRM-15 may be obtained through the Department of Public Health and Human Services, Senior and Long Term Care Division, P.O. Box 4210, 111 N. Sanders, Helena, MT 59604-4210. Applicability of the PRM-15 is subject to the exceptions and limitations specified in this rule.

(a) The term "allowable costs" means costs which are allowable under the provisions of this subchapter and which are considered in determining the costs of providing Medicaid nursing facility services. The determination that a cost is an allowable cost does not require the department to reimburse the provider for that cost. Providers will be reimbursed only as specifically provided in these rules.

(3) For purposes of reporting costs as required in ARM 37.40.346, allowable costs will be determined in accordance with the PRM-15, subject to the exceptions and limitations provided in these rules, including but not limited to the following:

(a) Return on net invested equity is an allowable cost only for providers of intermediate care facility services for individuals with intellectual disabilities which provide services on a for-profit basis.

(b) Allowable property costs are limited as follows:

(i) The capitalized costs of movable equipment are not allowable in excess of the fair market value of the asset at the time of acquisition.

(ii) Property-related interest, whether actual interest or imputed interest for capitalized leases, is not allowable in excess of the interest rates available to commercial borrowers from established lending institutions at the date of asset acquisition or at the inception of the lease.

(iii) Leases must be capitalized according to generally accepted accounting principles.

(iv) Depreciation of real property and movable equipment must be in accordance with American hospital association guidelines. Depreciation of real property and movable equipment based upon accelerated cost recovery guidelines is not an allowable cost.

(v) In accordance with sections 1861(v) (1) (O) and 1902(a) (13) of the Social Security Act, allowable property costs shall not be increased on the basis of a change in ownership which takes place on or after July 18, 1984. Section 1861(v) (1) (O) and section 1902(a) (13) of the Social Security Act are hereby adopted and incorporated herein by reference. The cited statutes are federal statutes governing allowability of certain facility property costs for purposes of Medicare and Medicaid program reimbursement. Copies of these sections may be obtained through the Department of Public Health and Human Services, Senior and Long Term Care Division, P.O. Box 4210, 111 N. Sanders, Helena, MT 59604-4210.

(c) Administrator compensation is allowable only as determined according to the PRM-15 provisions relating to owner compensation, and as specifically limited in this rule.

(i) For purposes of reporting and determining allowable administrator compensation, administrator compensation includes:

(A) all salary paid to the administrator for managerial, administrative, professional or other services;

(B) all employee benefits except employer contributions required by state or federal law for FICA, workers' compensation insurance (WCI) , federal unemployment insurance (FUI) , and state unemployment insurance (SUI) ;

(D) the value of all supplies, services, special merchandise, and other valuable items paid or provided for the personal use or benefit of the administrator;

(E) wages of any provider employee to the extent such employee works in the home of the administrator;

(F) the value of use of an automobile owned by the provider business to the extent used by the administrator for uses not related to patient care;

(G) personal life, health, or disability insurance premiums paid by the provider on the administrator's behalf;

(H) the rental value of any portion of the facility occupied by the administrator as a personal residence;

(i) the value of any other remuneration, compensation, fringe, or other benefits whether paid, accrued, or contingent.

(d) Allowable costs include employee benefits as follows:

(i) Employee benefits are defined as amounts accrued on behalf of an employee, in addition to direct salary or wages, and from which the employee or his beneficiary derives a personal benefit before or after the employee's retirement or death, if uniformly applicable to all employees. An item is an employee benefit only if it directly benefits an individual employee and does not directly benefit the owner, provider, or related parties.

(ii) Employee benefits include all employer contributions which are required by state or federal law, including FICA, WCI, FUI, SUI.

(iii) Costs of recreational activities or facilities available to employees as a group, including but not limited to condominiums, swimming pools, weight rooms and gymnasiums, are not allowable.

(iv) For purposes of this rule, an employee is one from whose salary or wages the employer is required to withhold FICA. Stockholders who are related parties to the corporate providers, officers of a corporate provider, and sole proprietors and partners owning or operating a facility are not employees even if FICA is withheld for them.

(v) Accrued vacation and sick leave are employee benefits if the facility has in effect a written policy uniformly applicable to all employees within a given class of employees, and are allowable to the extent they are reasonable in amount.

(e) Bad debts, charitable contributions and courtesy allowances are deductions from revenue and are not allowable costs.

(f) Revenues received for services or items provided to employees and guests are recoveries of cost and must be deducted from the allowable cost of the related items.

(g) Dues, membership fees, and subscriptions to organizations unrelated to the provider's provision of nursing facility services are not allowable costs.

(h) Charges for services of a chaplain are not an allowable cost.

(i) Subject to (4) , fees for management or professional services (e.g., management, legal, accounting or consulting services) are allowable to the extent they are identified to specific services and the hourly rate charged is reasonable in amount. In lieu of compensation on the basis of an hourly rate, allowable costs may include compensation for professional services on the basis of a reasonable retainer agreement which specifies in detail the services to be performed. Documentation that such services were in fact performed must be maintained by the provider. If the provider elects compensation under a retainer agreement, allowable costs for services specified under the agreement are limited to the agreed retainer fee.

(j) Travel costs and vehicle operating expenses related to resident care are allowable to the extent such costs are reasonable and adequately documented.

(i) Vehicle operating costs will be allocated between business and personal use based on actual mileage logs, a percentage derived from a sample mileage log and pre-approved by the department, or any other method pre-approved by the department.

(ii) For vehicles used primarily by an administrator, any portion of vehicle costs allocated to personal use shall be included as administrator compensation and subject to the limits specified in (3) (c) .

(iii) Allowable costs include automobile depreciation calculated on a straight-line basis, subject to salvage value, with a minimum of a three-year useful life. The total of automobile depreciation and interest, or comparable lease costs will not be allowable in excess of $7,500 per year.

(iv) Public transportation costs will be allowable only at tourist or other available commercial rate (not first class) .

(k) Allowable costs for purchases, leases or other transactions between related parties are subject to the following limitation:

(i) Allowable cost of services, facilities and supplies furnished to a provider by a related party or parties shall not exceed the lower of costs to the related party or the price of comparable services, facilities or supplies obtained from an unrelated party. A provider must identify such related parties and costs in the annual cost report.

(4) Costs, including attorney's fees, in connection with court or administrative proceedings are allowable only to the extent that the provider prevails in the proceeding. Where such proceedings are related to specific reimbursement amounts, the proportion of costs which are allowable shall be the percentage of costs incurred which equals the percentage derived by dividing the total cost or reimbursement on which the provider prevails by the total cost or reimbursement at issue.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2003 MAR p. 1294, Eff. 7/1/03; AMD, 2016 MAR p. 1071, Eff. 7/1/16.

Mont. Admin. R. 37.40.346 Cost Reporting, Desk Review and Audit

(1) Providers must use generally accepted accounting principles to record and report costs. The provider must, in preparing the cost report required under this rule, adjust such costs in accordance with ARM 37.40.345 to determine allowable costs.

(2) Providers must use the accrual method of accounting, except that, for governmental institutions that operate on a cash method or a modified accrual method, such methods of accounting will be acceptable.

(3) Cost finding means the process of allocating and prorating the data derived from the accounts ordinarily kept by a provider to ascertain the provider's costs of the various services provided. In preparing cost reports, all providers must use the methods of cost finding described at 42 CFR 413.24 (1997) , which the department hereby adopts and incorporates herein by reference. 42 CFR 413.24 is a federal regulation setting forth methods for allocating costs. A copy of the regulation may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210. Notwithstanding the above, distinctions between skilled nursing and nursing facility care need not be made in cost finding.

(4) All providers must report allowable costs based upon the provider's fiscal year and using the financial and statistical report forms designated and/or provided by the department. Reports must be complete and accurate. Incomplete reports or reports containing inconsistent data will be returned to the provider for correction.

(a) A provider must file its cost report:

(i) within 150 days after the end of its designated fiscal year;

(ii) within 150 days after the effective date of a change in provider as defined in ARM 37.40.325; or

(iii) for changes in providers occurring on or after July 1, 1993, within 150 days after six months participation in the Medicaid program for providers with an interim rate established under ARM 37.40.326. Subsequent cost reports are to be filed in accordance with (4) (a) (i) above and subsequent cost reports shall not duplicate previous cost reporting periods.

(b) The report forms required by the department include certain Medicare cost report forms and related instructions, including but not limited to certain portions of the most recent version of the CMS-2540 or CMS-2552 cost report forms, as more specifically identified in the department's cost report instructions. The department also requires providers to complete and submit certain Medicaid forms, including but not limited to the most recent version of the Medicaid expense statement, form DPHHS-MA-008A.

(i) In preparing worksheet A on the CMS-2540 or CMS-2552 cost report form, providers must report costs in the worksheet A category that correspond to the category in which the cost is reportable on the Medicaid expense statement, as designated in the department's cost report instructions.

(ii) For purposes of the Medicaid cost report required under this rule, all Medicare and Medicaid cost report forms must be prepared in accordance with applicable cost report instructions. Medicare cost report instructions shall apply to Medicare cost report forms to the extent consistent with Medicaid requirements, but the Medicaid requirements specified in these rules and the department's Medicaid cost reporting instructions shall control in the event of a conflict with Medicare instructions.

(c) If a provider files an incomplete cost report or reported costs are inconsistent, the department may return the cost report to the facility for completion or correction, and may withhold payment as provided in (4) (d) .

(d) If a provider does not file its cost report within 150 days of the end of its fiscal year, or if a provider files an incomplete cost report, the department may withhold from payment to the provider an amount equal to 10% of the provider's total reimbursement for the month following the due date of the report or the filing of the incomplete report. If the report is overdue or incomplete a second month, the department may withhold 20% of the provider's total reimbursement for the following month. For each succeeding month for which the report is overdue or incomplete, the department may withhold the provider's entire Medicaid payment for the following month. If the provider fails to file a complete and accurate cost report within six months after the due date, the department may recover all amounts paid to the provider by the department for the fiscal period covered by the cost report. All amounts so withheld will be payable to the provider upon submission of a complete and accurate cost report.

(e) The department may grant a provider one 30-day extension for filing the cost report if the provider's written request for the extension is received by the department prior to expiration of the filing deadline and if, based upon the explanation in the request, the department determines that the delay is unavoidable.

(f) Cost reports must be executed by the individual provider, a partner of a partnership provider, the trustee of a trust provider, or an authorized officer of a corporate provider. The person executing the reports must sign, under penalties of false swearing, upon an affirmation that he has examined the report, including accompanying schedules and statements, and that to the best of his knowledge and belief, the report is true, correct, and complete, and prepared in accordance with applicable laws, regulations, rules, policies, and departmental instructions.

(5) A provider must maintain records of financial and statistical information which support cost reports for six years, three months after the date a cost report is filed, the date the cost report is due, or the date upon which a disputed cost report is finally settled, whichever is later.

(a) Each provider must maintain, as a minimum, a chart of accounts, a general ledger and the following supporting ledgers and journals: revenue, accounts receivable, cash receipts, accounts payable, cash disbursements, payroll, general journal, resident census records identifying the level of care of all residents individually, all records pertaining to private pay residents and resident trust funds.

(b) To support allowable costs, the provider must make available for audit at the facility all business records of any related party, including any parent or subsidiary firm, which relate to the provider under audit. To support allowable costs, the provider must make available at the facility for audit any owner's or related party's personal financial records relating to the facility. Any costs not so supported will not be allowable.

(c) Cost information and documentation developed by the provider must be complete, accurate and in sufficient detail to support payments made for services rendered to recipients and recorded in such a manner to provide a record which is auditable through the application of reasonable audit procedure. This includes all ledgers, books, records and original evidence of cost (purchase requisitions, purchase orders, vouchers, checks, invoices, requisitions for materials, inventories, labor time cards, payrolls, bases for apportioning costs, etc.) which pertain to the determination of reasonable cost. The provider must make and maintain contemporaneous records to support labor costs incurred. Documentation created after the fact will not be sufficient to support such costs.

(d) The provider must make all of the above records and documents available at the facility at all reasonable times after reasonable notice for inspection, review or audit by the department or its agents, the federal department of health and human services, the Montana legislative auditor, and other appropriate governmental agencies. Upon refusal of the provider to make available and allow access to the above records and documents, the department may recover, as provided in ARM 37.40.347, all payments made by the department during the provider's fiscal year to which such records relate.

(6) Department audit staff may perform a desk review of cost statements or reports and may conduct on site audits of provider records. Such audits will be conducted in accordance with audit procedures developed by the department.

(a) Department audit staff may determine adjustments to cost reports or reported costs through desk review or audit of cost reports. Department audit staff may conduct a desk review of a cost report to verify, to the extent possible, that the provider has provided a complete and accurate report.

(b) Department audit staff may conduct on site audits of a provider's records, information and documentation to assure validity of reports, costs and statistical information. Audits will meet generally accepted auditing standards.

(c) The department shall notify the provider of any adverse determination resulting from a desk review or audit of a cost report and the basis for such determination. Failure of the department to complete a desk review or audit within any particular time shall not entitle the provider to retain any overpayment discovered at any time.

(d) The department, in accordance with the provisions of ARM 37.40.347, may collect any overpayment and will reimburse a provider for any underpayment identified through desk review or audit.

(7) A provider aggrieved by an adverse department action may request administrative review and a fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1993 MAR p. 1385, Eff. 7/1/93; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; AMD, 2000 MAR p. 492, Eff. 2/11/00; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.347 Cost Settlement Procedures

(1) The department will notify the provider of any overpayment discovered. The provider may contact the department to seek an agreement providing for repayment of the full overpayment within 60 days of mailing of the overpayment notice.

(2) Unless, within 30 days of mailing of overpayment notice to the provider, the provider enters into an agreement with the department which provides for full repayment within 60 days of mailing of the overpayment notice, the department will immediately commence offsetting from rate payments so as to complete full recovery as soon as possible.

(3) The department may recover the full overpayment amount regardless of whether the provider disputes the department's determination of the overpayment in whole or in part. A request for administrative review or fair hearing does not entitle a provider to delay repayment of any overpayment determined by the department.

(4) The department will notify the provider of any underpayment discovered. In the event an underpayment has occurred, the department will reimburse the provider promptly following the department's determination of the amount of the underpayment.

(5) Court or administrative proceedings for collection of overpayment or underpayment must be commenced within five years following the due date of the original cost report or the date of receipt of a complete cost report whichever is later. In the case of a reimbursement or payment based on fraudulent information, recovery of overpayment may be undertaken at any time.

(6) The amount of any overpayment constitutes a debt due the department as of the date the department mails notice of overpayment to the provider. The department may recover the overpayment from any person, party, transferee, or fiduciary who has benefited from either the payment or from a transfer of assets.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.351 Third Party Payments and Payment in Full

(1) Regardless of any other provision of these rules, a provider may not bill the Medicaid program for any patient day, item, service or other amount which could have been or could be paid by any other payer, including but not limited to a private or governmental insurer, or Medicare, regardless of whether the facility participates in such coverage or program. If the department finds that Medicaid has made payments in such an instance, retroactive collections may be made from the provider in accordance with ARM 37.40.347.

(a) This rule does not apply to payment sources which by law are made secondary to Medicaid.

(2) The payments allowed under ARM 37.40.307 constitute full payment for nursing facility services and separately billable items provided to a resident. A provider may not charge, bill, or collect any amount from a Medicaid recipient, other than the resident's patient contribution and any items billable to residents under ARM 37.40.331.

(3) This rule applies in addition to ARM 37.85.415.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00.

Mont. Admin. R. 37.40.352 Utilization Review and Quality of Care

(1) Upon admission and as frequently thereafter as the department may deem necessary, the department or its agents, in accordance with 42 CFR 456 subpart F (1997), may evaluate the necessity of nursing facility care for each Medicaid resident in an intermediate care facility for individuals with intellectual disabilities. 42 CFR 456 subpart F contains federal regulations which specify utilization review criteria for intermediate care facilities. The department adopts and incorporates by reference 42 CFR 456 (1997). A copy of these regulations may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-142, MCA
History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1071, Eff. 7/1/16.

Mont. Admin. R. 37.40.360 Lien and Estate Recovery Funds for One-Time Expenditures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2001 MAR p. 1108, Eff. 6/22/01; REP, 2003 MAR p. 1294, Eff. 7/1/03.

Mont. Admin. R. 37.40.361 Direct Care and Ancillary Services Workers' Wage Reporting/Additional Payments Including Lump Sum Payments for Direct Care and Ancillary Services Workers' Wage and Benefit Increases

(1) Effective for each state fiscal year and for the six months thereafter, nursing facilities must report to the department actual hourly wage and benefit rates paid for all direct care and ancillary services workers or the lump sum payment amounts for all direct care and ancillary services workers that will receive the benefit of the funds. The reported data will be used by the department for the purpose of comparing types and rates of payment for comparable services and tracking distribution of direct care wage funds to designated workers.

(2) The department will pay Medicaid certified nursing facilities located in Montana that submit an approved request to the department a lump sum payment in addition to the amount paid as provided in ARM 37.40.307 and 37.40.311 to their computed Medicaid payment rate to be used only for wage and benefit increases or lump sum payments for direct care or ancillary services workers in nursing facilities.

(a) The department will determine the lump sum payments, twice a year commencing July 1 of the state fiscal year, and again in six months from that date as a pro rata share of appropriated funds allocated for increases in direct care and ancillary services workers' wages and benefits or lump sum payments to direct care and ancillary services workers.

(b) To receive the direct care and/or ancillary services workers' lump sum payment, a nursing facility must submit for approval a request form to the department stating how the direct care and ancillary services workers' lump sum payment will be spent in the facility to comply with all statutory requirements. The facility must submit all of the information required on a form to be developed by the department in order to continue to receive subsequent lump sum payment amounts for the entire rate year. The form for wage and benefit increases will request information including, but not limited to:

(i) the number by category of each direct care and ancillary services workers that will receive the benefit of the funds, if these funds will be distributed in the form of a wage increase;

(ii) the actual per hour rate of pay before benefits and before the direct care wage increase has been implemented for each worker that will receive the benefit of the funds;

(iii) the projected per hour rate of pay with benefits after the direct wage increase has been implemented;

(iv) the number of staff receiving a wage or benefit increase by category of worker, effective date of implementation of the increase in wage and benefit; and

(v) the number of projected hours to be worked in the budget period.

(c) If these funds will be used for the purpose of providing lump sum payments (i.e., bonus, stipend, or other payment types) to direct care and ancillary services workers in nursing care facilities the form will request information including, but not limited to:

(i) the number by category of each direct care and ancillary services worker that will receive the benefit of the funds;

(ii) the type and actual amount of lump sum payment to be provided for each worker that will receive the benefit of the lump sum funding;

(iii) the breakdown of the lump sum payment by the amount that represents benefits and the direct payment to workers by category of worker; and

(iv) the effective date of implementation of the lump sum benefit.

(d) A facility that does not submit a qualifying request for use of the funds distributed under (2), that includes all of the information requested by the department, within the time established by the department, or a facility that does not wish to participate in this additional funding amount will not be entitled to their share of the funds available for wage and benefit increases or lump sum payments for direct care and ancillary services workers.

(3) A facility that receives funds under this rule must maintain appropriate records documenting the expenditure of the funds. This documentation must be maintained and made available to authorized governmental entities and their agents to the same extent as other required records and documentation under applicable Medicaid record requirements, including, but not limited to, the provisions of ARM 37.40.345, 37.40.346, and 37.85.414.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1393, Eff. 6/18/99; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 1754, Eff. 7/14/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2002 MAR p. 1767, Eff. 6/28/02; AMD, 2005 MAR p. 1046, Eff. 7/1/05; AMD, 2006 MAR p. 1638, Eff. 7/1/06; AMD, 2007 MAR p. 1100, Eff. 8/10/07; AMD, 2009 MAR p. 1411, Eff. 8/14/09; AMD, 2010 MAR p. 1520, Eff. 7/1/10; AMD, 2012 MAR p. 1674, Eff. 8/24/12; AMD, 2013 MAR p. 1103, Eff. 7/1/13; AMD, 2014 MAR p. 1517, Eff. 7/11/14; AMD, 2015 MAR p. 824, Eff. 7/1/15; AMD, 2016 MAR p. 1071, Eff. 7/1/16; AMD, 2017 MAR p. 1670, Eff. 9/23/17; AMD, 2018 MAR p. 1419, Eff. 7/21/18.

Subchapter 37.40.4 Swing-beds

Mont. Admin. R. 37.40.401 Swing-Bed Hospitals, Definitions

(1) A swing-bed hospital is a licensed hospital, critical access hospital (CAH) with swing-bed approval or licensed medical assistance facility which is medicare-certified to provide posthospital SNF care as defined in 42 CFR 409.20.

(2) Swing-bed hospital services are services provided in accordance with these rules by a swing-bed hospital which meets the swing-bed hospital participation requirements specified in these rules.

(3) "Swing-bed" means a bed approved pursuant to 42 USC 1395tt to be used to provide either acute care or extended skilled nursing care to a patient.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111, 53-6-113 and 53-6-141, MCA
History: NEW, 1984 MAR p. 996, Eff. 6/29/84; AMD, 1993 MAR p. 3069, Eff. 1/1/94; TRANS, from SRS, 2000 MAR p. 489; AMD, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.402 Swing-Bed Hospitals, Provider Participation Requirements

(1) To participate and be reimbursed as a swing-bed hospital service provider in the Montana medicaid program, a hospital must meet all of the following requirements:

(a) The hospital is a swing-bed hospital as defined in ARM 37.40.401.

(b) The hospital has fewer than 50 hospital beds and has provided written assurance to the health care financing administration that the hospital will not operate over 49 hospital beds, including swing-beds, except in connection with a catastrophic event.

(i) The hospital bed count is determined by excluding from the total licensed hospital beds:

(A) beds which because of their special nature would not be available for swing-bed use, such as newborn and intensive care beds;

(B) beds included in a separately certified skilled nursing facility or nursing facility;

(D) beds which the department determines are not consistently staffed and utilized by the hospital, as demonstrated by the hospital's staffing schedules and census records for the 12 months immediately preceding application for enrollment as a medicaid swing-bed hospital services provider.

(c) The critical access hospital (CAH) with swing-bed approval has no more than 25 acute care inpatient beds, of which no more than 15 are used for acute care at any one time for providing inpatient care.

(d) The hospital is located in a rural area of the state. A rural area is an area which is not designated as "urbanized" by the most recent official census. A copy of the bureau of the census listing of urbanized areas is available upon request from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(e) The hospital has a certificate of need from the state Department of Public Health and Human Services to provide swing-bed hospital services.

(f) The hospital does not have in effect a 24 hour nursing waiver under the provisions of 42 CFR 488.54(c).

(g) The hospital's Medicare or Medicaid swing-bed certification or approval has not been terminated within two years prior to the application for enrollment as a Medicaid swing-bed hospital services provider.

(h) The hospital meets the requirements of ARM 37.40.416(1).

(i) The hospital has applied for and the department has approved enrollment in the Medicaid program as a Medicaid swing-bed hospital services provider.

(i) As a condition of granting enrollment approval or of allowing continuing enrollment, the department may require a hospital to submit documentation or information relating to participation requirements.

(ii) The department may terminate a provider's swing-bed hospital services provider enrollment if it determines that the hospital is not in compliance with any of the requirements of this rule.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1984 MAR p. 996, Eff. 6/29/84; AMD, 1989 MAR p. 670, Eff. 5/26/89; AMD, 1993 MAR p. 3069, Eff. 1/1/94; TRANS, from SRS, 2000 MAR p. 489; AMD, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2014 MAR p. 3085, Eff. 1/1/15.

Mont. Admin. R. 37.40.405 Swing-Bed Hospitals, Special Service Requirements

(1) Before admitting a Medicaid recipient to a swing-bed, the swing-bed hospital must meet all of the following requirements:

(a) the hospital must obtain a preadmission screening to determine the level of care required by the patient's medical condition. Medicaid will not reimburse a provider for swing-bed hospital services provided to a Medicaid recipient admitted to a swing-bed unless the recipient meets the nursing facility level of care requirements specified in ARM 37.40.202 and 37.40.205. The swing-bed hospital must ensure that form DPHHS-SLTC-61, "screening notification", is completed by the department preadmission screening team to document the level of care determination.

(b) Except when a waiver is obtained under (4), the hospital must determine that no appropriate nursing facility bed is available to the Medicaid patient within a 25 mile radius of the swing-bed hospital. The hospital is required to maintain written documentation of inquiries to nursing facilities about the availability of a nursing facility bed and indicating that if a bed is not available, the hospital will provide swing-bed services to the patient. The swing-bed hospital is encouraged to enter into availability agreements with Medicaid-participating nursing facilities in its geographic region that require the nursing facility to notify the hospital of the availability of nursing facility beds and dates when beds will be available.

(i) For purposes of this rule, an "appropriate" nursing facility bed is a bed in a Medicaid-participating nursing facility which provides the level of care required by the recipient's medical condition.

(2) A Medicaid patient admitted to a swing-bed must be discharged to an appropriate nursing home bed within a 25 mile radius of the swing-bed hospital within 72 hours of an appropriate nursing home bed becoming available.

(3) The requirements of (1)(b) and (2) apply regardless of the 30-day notice requirement generally applicable to transfers and discharges under ARM 37.40.420(1). When an appropriate nursing facility bed is or becomes available, the provider must provide notice as required by ARM 37.40.420(5)(f) and must otherwise comply with the requirements of ARM 37.40.420(1) to the extent practicable in the time available before transfer to the nursing facility bed.

(4) A provider may request a waiver of the determination requirement of (1)(b) for an acute care patient of the swing-bed hospital or may request for a swing-bed patient a waiver of the transfer requirement of (2) when the recipient's attending physician verifies in writing that either the recipient's condition would be endangered by transfer to an appropriate nursing facility bed within a 25 mile radius of the swing-bed hospital or that the individual has a medical prognosis that his or her life expectancy is six months or less if the illness runs its normal course.

(a) The waiver request and physician's written verification must be submitted to the Department of Public Health and Human Services, Senior and Long Term Care Division, 2030 11th Avenue, P.O. Box 4210, Helena, MT 59640-4210. Waiver approvals granted by county offices will not be valid or effective for purposes of this rule.

(b) The waiver request and physician's written verification must be received by the nursing facility services bureau within five working days of admission to the swing-bed or within five days of availability of an appropriate nursing facility bed and the provider must obtain written approval from the Medicaid services bureau prior to billing for services provided after the date of admission to the swing-bed or the date of availability of an appropriate nursing facility bed.

(5) The department may retrospectively review the use of swing-bed services provided to Medicaid patients and may deny payments when it is determined that the requirements of this rule were not met.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1984 MAR p. 996, Eff. 6/29/84; AMD, 1989 MAR p. 670, Eff. 5/26/89; AMD, 1993 MAR p. 3069, Eff. 1/1/94; TRANS, from SRS, 2000 MAR p. 489; AMD, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2009 MAR p. 2166, Eff. 1/1/10.

Mont. Admin. R. 37.40.406 Swing-Bed Hospitals, Reimbursement

(1) Montana medicaid will reimburse swing-bed hospitals as provided in this rule for swing-bed hospital services provided in accordance with all applicable swing-bed hospital service requirements specified in ARM 37.40.401, 37.40.402, 37.40.405 and this rule and subject to all other applicable laws and regulations.

(2) For swing-bed hospital services, the Montana medicaid program will pay a provider a per diem rate as specified in (2) (a) for each medicaid patient day, plus additional reimbursement for separately billable items as provided in (2) (b) .

(a) The swing-bed hospital services per diem rate is the average medicaid per diem rate paid to nursing facilities under ARM 37.40.307 for routine services furnished during the calendar year immediately previous to the year in which the swing-bed hospital services are provided. Nursing facility routine services are those services included in the definition of "nursing facility services" specified at ARM 37.40.302.

(b) Separately billable items are those items specified in ARM 37.40.330. Swing-bed hospital service providers will be reimbursed for separately billable items at the rates specified in ARM 37.40.330 and subject to the requirements of ARM 37.40.330.

(c) The Montana medicaid program will not reimburse swing-bed hospital service providers for items billable to residents as specified in ARM 37.40.331.

(3) For purposes of reporting costs under ARM 37.86.2803, inpatient hospital services providers which also provide swing-bed hospital services shall allocate hospital inpatient general routine service costs associated with swing-bed hospital services on the medicare "carve out" method as specified in 42 CFR 413.53(a) (2) . The department adopts and incorporates by reference 42 CFR 413.53(a) (2) (2004) . A copy of 42 CFR 413.53(a) (2) may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(4) Providers must bill for all services and supplies in accordance with the provisions of ARM 37.85.406. The department's fiscal agent will pay a provider the amount determined under these rules upon receipt of an appropriate billing which reports the number of patient days of swing-bed hospital services provided to authorized Medicaid recipients during the billing period.

(5) Swing-bed hospital service providers aggrieved by adverse determinations by the department may request administrative review and fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1984 MAR p. 996, Eff. 6/29/84; AMD, 1984 MAR p. 2047, Eff. 12/28/84; AMD, 1989 MAR p. 670, Eff. 5/26/89; AMD, 1993 MAR p. 3069, Eff. 1/1/94; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2014 MAR p. 3085, Eff. 1/1/15.

Mont. Admin. R. 37.40.408 Facility Policy Requirements

(1) The facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property.

(2) The policies must provide that the facility will:

(a) not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion;

(b) not employ individuals who have been found guilty of abusing, neglecting, or mistreating residents by a court of law, or have had a finding entered into the nurse aide registry concerning abuse, neglect, mistreatment of residents or misappropriation of their property;

(c) report any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other facility staff to the nurse aide registry maintained by the department of public health and human services;

(d) ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property are reported immediately to the administrator of the facility, the long term care ombudsman, and the department of public health and human services in accordance with 52-3-811 , MCA;

(e) have evidence that all alleged violations are thoroughly investigated, and must prevent further potential abuse while the investigation is in progress;

(f) ensure that the results of all investigations must be reported to the administrator of the facility and to the department of public health and human services in accordance with 52-3-811 , MCA, within five working days of the incident; and

(g) if the alleged violation is verified, take appropriate corrective action.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-113, MCA
History: NEW, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.409 Specialized Rehabilitative Services

(1) If specialized rehabilitative services such as but not limited to physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness and mental retardation are required in the resident's comprehensive plan of care, the facility must provide the required services, or obtain the required services from an outside resource from a provider of specialized rehabilitative services.

(a) Specialized rehabilitative services must be provided under the written order of a physician by qualified personnel.

(2) The facility must assist residents in obtaining routine and 24-hour emergency dental care.

(a) The facility must, if necessary, assist the resident in making appointments, and by arranging for transportation to and from the dentist's office.

(b) The facility must promptly refer residents with lost or damaged dentures to a dentist.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-113, MCA
History: NEW, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.412 Resident Activities Program

(1) The facility must provide for an ongoing program of activities designed to meet the interests and the physical, mental, and psychosocial well being of each resident.

(2) The activities program must be directed by a qualified professional who:

(a) is a qualified therapeutic recreation specialist or an activities professional who is licensed or registered and is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after October 1, 1990;

(b) has two years of experience in a social or recreational program within the last five years, one of which was full-time in a patient activities program in a health care setting;

(d) has completed a training course approved by the state.

(3) The facility must provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-113, MCA
History: NEW, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.416 Resident Rights

(1) The swing-bed hospital must be in substantial compliance with the requirements set forth in this rule pertaining to resident rights.

(2) A provider must protect and promote the rights of each resident, including each of the following rights:

(a) The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the provider's facility.

(b) The resident has the right to be fully informed of the resident's total health status, including but not limited to medical condition, in language that the resident can understand.

(c) The resident has the right to refuse treatment, to refuse to participate in experimental research, and to formulate an advance directive as specified in 42 CFR 483.10(b) (8) . The department adopts and incorporates by reference 42 CFR 483.10(b) (8) . A copy of 42 CFR 483.10(b) (8) may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, PO Box 4210, Helena, MT 59604-4210.

(3) Each resident who is entitled to medicaid benefits has a right to be informed by the provider in writing, at the time of admission to the swing-bed or, when the resident becomes eligible for medicaid of:

(a) the items and services that are included in the swing-bed per diem rate for which the resident may not be charged, i.e., those items included in nursing facility services under ARM 37.40.302(14) or ancillary services under ARM 37.40.330(1) ; and

(b) those other items and services that the provider offers and for which the resident may be charged, and the amount of charges for those services; and

(4) The resident has the right to:

(a) choose a personal attending physician;

(b) be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident's well being; and

(c) unless adjudged incompetent or otherwise found to be incapacitated under state law, participate in planning care and treatment or changes in care and treatment.

(5) The resident has the right to personal privacy and confidentiality of personal and clinical records.

(a) Personal privacy includes accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups. The right of personal privacy does not require the provider to provide a private room for each resident.

(b) The resident may approve or refuse the release of personal and clinical records to any individual outside the facility, except when the resident is transferred to another health care institution or record release is required by law.

(6) The resident has the right to:

(a) refuse to perform services for the facility;

(b) perform services for the facility, if the resident chooses, when:

(i) the facility has documented in the plan of care the need or desire for work;

(ii) the plan specifies the nature of the services performed and whether the services are voluntary or paid;

(iii) compensation for paid services is at or above prevailing rates; and

(iv) the resident agrees to the work arrangement described in the plan of care.

(7) The resident has the right to privacy in written communications, including the right to:

(a) send and promptly receive mail that is unopened; and

(b) have access to stationery, postage, and writing implements at the resident's own expense.

(8) The resident has the right to see, and the facility must provide immediate access to any resident by, the following:

(a) subject to the resident's right to deny or withdraw consent at any time, immediate family or other relatives of the resident; and

(b) subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, others who are visiting with the consent of the resident.

(9) The resident has the right to retain and use personal

possessions, including some furnishings and appropriate clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents.

(10) The resident has the right to share a room with a spouse when married residents live in the same facility and both spouses consent to the arrangement.

(11) The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms.

(12) The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.

(13) The resident has the right to be informed in writing of the policies and procedures developed by the facility pursuant to ARM 37.40.408.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-113, MCA
History: NEW, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.420 Resident Transfer and Discharge Rights

(1) The resident has the following transfer and discharge rights. Transfer and discharge includes movement of a resident to a bed outside of the swing-bed hospital facility whether or not that bed is in the same physical plant. Transfer and discharge does not refer to movement of a resident to a bed within the same certified facility.

(2) The facility must permit each resident to remain in the facility and may not transfer or discharge the resident from the facility unless any one or more of the following apply:

(a) the transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;

(b) the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;

(d) the health of individuals in the facility would otherwise be endangered;

(e) the resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under medicare or medicaid) a stay at the facility. For a resident who becomes eligible for medicaid after admission to a facility, the facility may charge a resident only allowable charges under medicaid;

(f) the facility ceases to operate; or

(g) an appropriate nursing facility bed is available within a 25 mile radius of the swing-bed hospital, as provided in ARM 37.40.405.

(3) When the facility transfers or discharges a resident, the facility must document the reason for transfer or discharge in the resident's clinical record. The documentation must be made by the resident's physician when transfer or discharge is necessary under (2) (a) and (b) , or a physician when transfer or discharge is necessary under (2) (d) .

(4) Before a facility transfers or discharges a resident, the facility must:

(a) notify the resident and, if known, a family member or legal representative of the resident of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand;

(b) record the reasons in the resident's clinical record; and

(5) Notice of transfer or discharge must be made by the facility at least 30 days before the resident is transferred or discharged except when:

(a) the safety of individuals in the facility would be endangered;

(b) the health of the individuals in the facility would be endangered;

(d) an immediate transfer or discharge is required by the resident's urgent medical needs;

(e) a resident has not resided in the facility for 30 days; or

(f) transfer is required within 72 hours because an appropriate nursing facility bed is available within a 25 mile radius of the swing-bed hospital. In such cases, the facility must provide notice within 24 hours of determining that the nursing facility bed is available.

(6) The written notice of transfer or discharge must include the following:

(a) the reason for transfer or discharge;

(b) the effective date of transfer or discharge;

(d) a statement that the resident has the right to appeal the action to the Fair Hearings Office at the Department of Public Health and Human Services;

(e) the name, address, and telephone number of the state of Montana long term care ombudsman in the Office on Aging, Senior and Long Term Care Division; and

(f) for nursing facility residents with developmental disabilities and nursing facility residents who are mentally ill, the mailing address and telephone number of the Montana Advocacy Program, Inc.

(7) A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 2004 MAR p. 1479, Eff. 7/2/04; AMD, 2014 MAR p. 3085, Eff. 1/1/15.

Mont. Admin. R. 37.40.421 Resident Post Discharge Rights

(1) When the facility anticipates discharge, a resident must have a discharge summary that includes:

(a) a recapitulation of the resident's stay;

(b) a final summary of the resident's status which includes:

(i) medically defined conditions and prior medical history;

(ii) medical status measurement;

(iii) physical and mental functional status;

(iv) sensory and physical impairments;

(v) nutritional status and requirements;

(vi) special treatments or procedures;

(vii) mental and psychosocial status;

(viii) discharge potential;

(ix) dental condition;

(x) activities potential;

(xi) cognitive status;

(xii) drug therapy; and

(c) a post discharge plan of care that is developed with the participation of the resident and family, which will assist the resident to adjust to the new living environment.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-113, MCA
History: NEW, 2004 MAR p. 1479, Eff. 7/2/04.

Mont. Admin. R. 37.40.422 Direct Care and Ancillary Services Workers' Wage Reporting/Additional Payments Including Lump Sum Payments for Direct Care and Ancillary Services Workers' Wage and Benefit Increases

(1) Effective for the calendar year January through December, swing-bed hospitals must report to the department actual hourly wage and benefit rates paid for all direct care and ancillary services workers or the lump sum amounts paid for all direct care and ancillary services workers that will receive the benefit of a direct care and ancillary workers' wage and benefit increase.

(2) The department will use the reported data for the purpose of comparing types and rates of payment for comparable services and for tracking distribution of direct care wage funds to designated workers.

(3) The department will pay Medicaid certified swing-bed hospitals located in Montana, in accordance with this rule, lump sum payments in addition to the reimbursement rate to be used only for wage and benefit increases or lump sum payments for direct care or ancillary services workers in swing-bed hospitals.

(a) The department will determine lump sum payments January 1 of the calendar year, and again six months from that date as a pro rata share of appropriated funds allocated for increases in direct care and ancillary services workers' wages and benefits or lump sum payments to direct care and ancillary services workers.

(b) To receive the direct care or ancillary services workers' lump sum payment, a swing-bed hospital must submit:

(i) a request to the department stating how the direct care and ancillary services workers' lump sum payment will be spent in the facility in compliance with all statutory requirements; and

(ii) all of the information required on a form developed by the department in order to continue to receive subsequent lump sum payment amounts for the entire rate year.

(i) the number by category of each direct care and ancillary services workers that will receive the benefit of the increased funds, if these funds will be distributed in the form of a wage increase;

(ii) the actual per hour rate of pay before benefits and before the direct care wage increase has been implemented for each worker that will receive the benefit of the increased funds;

(iii) the projected per hour rate of pay with benefits after the direct wage increase has been implemented;

(iv) the number of workers receiving a wage or benefit increase by category of worker, effective date of implementation of the increase in wage and benefit; and

(v) the number of projected hours to be worked in the budget period.

(d) If these funds will be used for the purpose of providing lump sum payments such as bonuses, stipends, or other payment types to direct care and ancillary services workers in swing-bed hospitals, the form will request information including, but not limited to:

(i) the number by category of each direct care and ancillary services worker that will receive the benefit of the increased funds;

(ii) the type and actual amount of lump sum payment to be provided for each worker that will receive the benefit of the lump sum funding;

(iii) the breakdown of the lump sum payment by the amount that represents benefits and the direct payment to workers by category of worker; and

(iv) the effective date of implementation of the lump sum benefit.

(e) A facility that does not submit a qualifying request for use of the funds distributed under (2), that includes all of the information requested by the department, within the time established by the department, or a facility that does not wish to participate in this additional funding amount shall not be entitled to their share of the funds available for wage and benefit increases or lump sum payments for direct care and ancillary services workers.

(4) A facility that receives funds under this rule must maintain appropriate records documenting the expenditure of the funds. This documentation must be maintained and made available to authorized governmental entities and their agents to the same extent as other required records and documentation under applicable Medicaid record requirements, including, but not limited to the provisions of ARM 37.40.345, 37.40.346, and 37.85.414.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 2166, Eff. 1/1/10; AMD, 2014 MAR p. 3085, Eff. 1/1/15; AMD, 2016 MAR p. 320, Eff. 2/20/16; AMD, 2017 MAR p. 193, Eff. 2/4/17; AMD, 2018 MAR p. 196, Eff. 1/27/18.

Subchapter 37.40.7 Home Health Services

Mont. Admin. R. 37.40.701 Home Health Services Definitions

(1) "Home health agency" means an entity licensed by the Montana Department of Public Health and Human Services, certified by Medicare, and enrolled as a Medicaid provider.

(2) "Home health aide services" means services of a certified home health aide to assist with routine care not requiring specialized nursing skills and supervised by a licensed registered nurse.

(3) "Home health services" means services provided by a home health agency to a member, on a part-time or intermittent basis for the purposes of postponing or preventing institutionalization.

(a) Home health services include:

(i) skilled nursing services;

(ii) home health aide services;

(iii) physical therapy services;

(iv) occupational therapy services;

(v) speech therapy services;

(vi) disposable medical supplies for the purposes of the visit; and

(vii) medical supplies, equipment, and appliances suitable for use in any setting in which normal life activities take place and as provided in ARM 37.86.1801.

(b) Home health services do not include:

(i) personal care services as provided at ARM Title 37, chapter 40, subchapter 11;

(ii) Community First Choice services provided in ARM Title 37, chapter 40, subchapter 10;

(iii) visits made by a registered nurse for evaluating the home health needs of a member or to review the provision of home health services by a home health aide or a licensed practical nurse; and

(iv) maintenance therapy as provided at ARM Title 37, chapter 86, subchapter 6.

(4) "Home health services visit" means a personal contact with the member in a place of service for the purpose of providing a covered home health service.

(5) "Place of service" means the setting in which normal life activities take place.

(a) Place of service does not include a hospital, a nursing facility, or an intermediate care facility for individuals with intellectual disabilities.

(6) "Skilled nursing services" means professional nursing services, as defined in the Montana Nurse Practice Act, that are medically necessary to treat health care problems, provided health teaching, and/or provide health counseling.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, MCA
History: NEW, 1980 MAR p. 1761, Eff. 6/27/80; AMD, 1981 MAR p. 690, Eff. 7/17/81; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2017, Eff. 1/1/87; AMD, 1989 MAR p. 1285, Eff. 9/1/89; AMD, 1995 MAR p. 1182, Eff. 7/1/95; AMD, 1997 MAR p. 1042, Eff. 6/24/97; TRANS, from SRS, 2000 MAR p. 489; AMD, 2019 MAR p. 141, Eff. 1/26/19.

Mont. Admin. R. 37.40.702 Home Health Services, Requirements

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) A home health agency must be:

(a) licensed by the Montana department of public health and human services;

(b) Medicare certified; and

(3) Home health services may be provided by providers located outside of the borders of the state of Montana only if the service meets the requirements of ARM 37.85.207(3) and the service is prior authorized by the department or the department's designee.

(4) Home health services must be provided in accordance with the requirements of 42 CFR 440.70. The department adopts and incorporates by reference 42 CFR 440.70, as amended May 8, 2020, which sets forth requirements for home health services. A copy of the regulation may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210 or by visiting https://www.ecfr.gov/.

(5) Home health services are limited to 180 visits within 365 days from the day of the first authorized visit.

(a) The department may, within its discretion, authorize additional visits in excess of this limit. Any services exceeding this limit must be prior authorized by the department or the department's designee.

(6) Home health aide services are subject to the following limitations:

(a) Home health aide services must be prior authorized by the department or the department's designee.

(b) Home health aide services must be provided under the supervision of a registered professional nurse and in accordance with a written plan of treatment certified by a physician.

(c) A person receiving personal care attendant services or Community First Choice services may not receive home health aide services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, MCA
History: NEW, 1980 MAR p. 1761, Eff. 6/27/80; AMD, 1986 MAR p. 2017, Eff. 1/1/87; AMD, 1989 MAR p. 1285, Eff. 9/1/89; AMD, 1995 MAR p. 1182, Eff. 7/1/95; AMD, 1997 MAR p. 1042, Eff. 6/24/97; TRANS, from SRS, 2000 MAR p. 489; AMD, 2019 MAR p. 141, Eff. 1/26/19; AMD, 2024 MAR p. 2066, Eff. 8/24/24.

Mont. Admin. R. 37.40.705 Home Health Services, Reimbursement

(1) Reimbursement fees for home health services are as referenced in ARM 37.85.105(4).

(2) Home health services reimbursement includes the following services:

(a) nursing or therapy service;

(b) home health aide visit; and

(c) medical supplies, equipment, and appliances suitable for use in any setting in which normal life activities take place.

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-131, MCA
History: NEW, 1980 MAR p. 1762, Eff. 6/27/80; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2017, Eff. 1/1/87; AMD, 1989 MAR p. 1285, Eff. 9/1/89; AMD, 1990 MAR p. 1042, Eff. 6/1/90; AMD, 1991 MAR p. 1856, Eff. 9/27/91; AMD, 1995 MAR p. 1182, Eff. 7/1/95; AMD, 1997 MAR p. 1042, Eff. 6/24/97; TRANS, from SRS, 2000 MAR p. 489; AMD, 2011 MAR p. 1386, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2019 MAR p. 141, Eff. 1/26/19.

Subchapter 37.40.8 Hospice

Mont. Admin. R. 37.40.801 Hospice, Definitions

(1) "Department" means the Montana Department of Public Health and Human Services.

(2) Except for the definition of "physician," the definitions of terms defined under 42 CFR 418.3 apply for purposes of this subchapter.

(3) "Physician" means an individual licensed under the state medical practice act to practice medicine or osteopathy.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.802 Adoption and Incorporation by Reference

(1) For purposes of this subchapter, the department adopts and incorporates by reference the following sections of the Code of Federal Regulations (CFR) that are in effect as of October 1, 2025:

(a) 42 CFR 418.3, which sets forth definitions of terms.

(b) 42 CFR 418.20 through 418.30, which set forth Medicare hospice care eligibility, election, and duration of benefits.

(d) 42 CFR 418.200 through 418.205, which set forth Medicare coverage of hospice services.

(e) 42 CFR 418.301 through 418.312, which set forth Medicare hospice care payment procedures.

(2) Copies of these sections of the CFR may be obtained from the Department of Public Health and Human Services, Senior and Long-Term Care Division, P.O. Box 4210, Helena, MT 59604-4210 or by visiting https://www.ecfr.gov/.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2022 MAR p. 1672, Eff. 8/6/22; AMD, 2023 MAR p. 672, Eff. 7/8/23; AMD, 2026 MAR, Notice No. 2026-8, Eff. 9/5/26.

Mont. Admin. R. 37.40.805 Hospice, Conditions of Participation

(1) The hospice must be licensed under state law and must meet Medicare's conditions of participation for hospice programs and have a valid provider agreement with Medicare as conditions of enrollment in Medicaid. Medicare conditions of participation for hospice programs are set forth under 42 CFR 418.52 through 418.116.

(2) The above requirements are in addition to those contained in ARM 37.82.102, 37.85.401, 37.85.402, 37.85.406, 37.85.407, 37.85.410, and 37.85.414.

(3) The hospice must submit a physician listing with their provider application and update changes in the listing of the physicians who are hospice employees, including physician volunteers.

(4) The designated hospice must notify the department when the designated attending physician of a beneficiary in their care is not a hospice employee.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.806 Hospice, Covered Services

(1) To be covered, hospice services must meet the following requirements:

(a) they must be reasonable and necessary for the palliation or management of the terminal illness as well as related conditions;

(b) the beneficiary must elect hospice care in accordance with ARM 37.40.815;

(c) a plan of care must be established as set forth in ARM 37.40.805 and 37.40.807 before services are provided. The services must be consistent with the plan of care; and

(d) a certification that the beneficiary is terminally ill must be completed as set forth in ARM 37.40.808.

(2) For covered hospice services, Medicaid will generally pay for the services covered by Medicare. Medicare coverage of hospice services is described under 42 CFR 418.200 through 418.205.

(a) Physician services is a covered hospice service and must be performed by a doctor of medicine or osteopathy.

(b) Outpatient drugs and biologicals not related to the terminal conditions will be reimbursed separately under the provisions of ARM 37.86.1101, 37.86.1102, and 37.86.1105.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1990 MAR p. 539, Eff. 3/16/90; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.807 Hospice Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113 MCA
Implementing statute(s): 53-6-101 MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; REP, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.808 Hospice, Certification of Terminal Illness

(1) In order to be eligible to elect hospice care under Medicaid, a beneficiary must be certified as being terminally ill in accordance with Medicare certification requirements under 42 CFR 418.22.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.815 Hospice, Election and Waiver of Other Benefits

(1) A beneficiary eligible for hospice care or their representative must file an election statement with a particular hospice in order to receive such care. The department will follow Medicare regulations and guidelines in administering this provision, including 42 CFR 418.20 through 418.30.

(2) A beneficiary waives all rights to Medicaid payments for the duration of the election of hospice care for the following services:

(a) Hospice care provided by a hospice other than the hospice designated by the beneficiary (unless provided under arrangements made by the designated hospice).

(b) Any Medicaid services that are related to the treatment of the terminal condition for which hospice care was elected or a related condition or that are equivalent to hospice care except for:

(i) services provided by the designated hospice;

(ii) services provided by another hospice under arrangements made by the designated hospice; and

(iii) services provided by the beneficiary's attending physician if that physician is not an employee of the designated hospice or receiving compensation from the hospice for those services.

(3) The hospice chosen by the eligible beneficiary, or their representative, must file the original Notice of Election (NOE) or a copy, with the department within five calendar days of the start of Medicaid Hospice Services. NOEs must be sent to the Senior & Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210. The department may waive the consequences of failure to submit a timely filed NOE. A hospice must fully document and furnish any requested documentation to the department for a determination of exception.

(4) When the hospice election is ended due to discharge, the hospice must file a Notice of Termination of Election with the department within five calendar days after the effective date of the discharge, unless it has already filed a final claim for that beneficiary. Notice of Terminations must be sent to the Senior & Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena MT 59604-4210.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1990 MAR p. 539, Eff. 3/16/90; TRANS, from, SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2018 MAR p. 1288, Eff. 7/7/18; AMD, 2020 MAR p. 93, Eff. 1/18/20; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.816 Hospice, Revocation of Election

(1) A beneficiary or their representative may revoke the beneficiary's election of hospice care at any time during an election period. The department will follow Medicare regulations and guidelines in administering this provision, including 42 CFR 418.28.

(2) When the hospice election is ended due to revocation, the hospice must file a Notice of Revocation of Election with the department within five calendar days after the effective date of the revocation, unless it has already filed a final claim for that beneficiary. A Notice of Revocation must be sent to the Senior & Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1989 MAR p. 842. Eff. 7/1/89; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2020 MAR p. 93, Eff. 1/18/20; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.825 Hospice, Change of Hospice

(1) A beneficiary or their representative may change once in each election period the designation of the particular hospice from which hospice care will be received. The department will follow Medicare regulations and guidelines in administering this provision, including 42 CFR 418.30.

History

Authorizing statute(s): 53-6-113 MCA
Implementing statute(s): 53-6-101 MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

Mont. Admin. R. 37.40.830 Reimbursement

(1) Medicaid payment for covered hospice care will be made in accordance with the specific categories of covered hospice care and the payment amounts and procedures established by Medicare under 42 CFR 418.301 through 418.312. The specific categories of covered hospice care include:

(a) routine home care day;

(b) continuous home care day;

(d) general inpatient care day; and

(e) service intensity add-on.

(2) Hospice Routine Home Care (RHC) level of care days will be paid at one of two RHC rates. RHC per-diem payment rates for the RHC level of care will be paid depending on the timing of the day within the patient's episode of care. Days 1 through 60 will be paid at the RHC "High" rate while all other days will be paid at the RHC "Low" rate.

(3) The room and board rate to be paid a hospice for a Medicaid beneficiary who resides in a nursing facility will be the Medicaid rate established by the department in ARM 37.40.307 for the individual facility minus the amount the beneficiary pays toward their own cost of care. Payment for room and board will be made to the hospice and, in turn, the hospice will reimburse the nursing facility. General inpatient care or hospice respite care in a nursing facility will not be reimbursed directly by the Medicaid program when a Medicaid recipient elects the hospice benefit payment. Under such circumstances payment will be made to the hospice in accordance with this rule.

(a) In this context, the term "room and board" includes performance of personal care services, including assistance in the activities of daily living, socializing activities, administration of medication, maintaining the cleanliness of a resident's room, and supervision and assisting in the use of durable medical equipment and prescribed therapies.

(4) The following services performed by hospice physicians are included in the rates described in (1)(a) through (d):

(a) general supervisory services of the medical director; and

(b) participation in the establishment of plans of care, supervision of care and services, periodic review and updating of plans of care, and establishment of governing policies by the physician member of the interdisciplinary group.

(5) For services not described in (4), Medicaid will pay the hospice for those physician services furnished by hospice employees or under arrangements with the hospice in accordance with ARM 37.86.101, 37.86.104, and 37.86.105. Reimbursement for these physician services is included in the amount subject to the hospice limit described in (6). Services furnished voluntarily by physicians are not reimbursable.

(6) Services of the patient's attending physician, if he or she is not an employee of the hospice or providing services under arrangements with the hospice, are not considered hospice services and are not included in the amount subject to the hospice payment limit.

(7) Medicaid reimbursement to a hospice in a cap period is limited to a cap amount established using Medicare principles.

(8) The department will notify the hospice of the determination of program reimbursement at the end of the cap year.

(9) Payments made to a hospice during a cap period that exceed the cap amount are overpayments and must be refunded.

(10) The department adopts and incorporates by reference the Hospice Rates fee schedule, effective October 1, 2025, which sets forth Medicaid hospice reimbursement rates based on the hospice wage index that is published annually by the Centers for Medicare & Medicaid Services. The fee schedule is posted at https://medicaidprovider.mt.gov and may be obtained from the Department of Public Health and Human Services, Senior and Long-Term Care Division, P.O. Box 4210, Helena, MT 59604-4210. Pursuant to 2-4-307(9), MCA, future updates to the fee schedule to conform with the hospice wage index issued by the Centers for Medicare & Medicaid Services are incorporated by reference without additional rulemaking, and are applicable as of the date specified in the updated fee schedule.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1989 MAR p. 842, Eff. 7/1/89; TRANS, from SRS, 2000 MAR p. 489; AMD, 2014 MAR p. 328, Eff. 2/14/14; AMD, 2015 MAR p. 144, Eff. 2/13/15; AMD, 2016 MAR p. 20, Eff. 1/9/16; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2017 MAR p. 305, Eff. 3/11/17; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 1288, Eff. 7/7/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18; AMD, 2019 MAR p. 61, Eff. 1/12/19; AMD, 2020 MAR p. 93, Eff. 1/18/20; AMD, 2021 MAR p. 764, Eff. 6/26/21; AMD, 2022 MAR p. 1672, Eff. 8/6/22; AMD, 2023 MAR p. 672, Eff. 7/8/23; AMD, 2024 MAR p. 1887, Eff. 7/27/24; AMD, 2025 MAR, Notice No. 2025-522, Eff. 7/12/25; AMD, 2026 MAR, Notice No. 2026-8, Eff. 9/5/26.

Subchapter 37.40.9 Home Dialysis for End Stage Renal Disease

Mont. Admin. R. 37.40.901 Home Dialysis for End Stage Renal Disease, Definition

(1) Home dialysis service for end stage renal disease is the provision of equipment required for the renal dialysis of a recipient in his home.

(a) Related services includes training at a certified home dialysis training center for a recipient and a "back-up" person, if necessary, in dialysing a patient at home.

History

Authorizing statute(s): Sec. 53-6-113 MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-141 MCA
History: NEW, 1980 MAR p. 1789, Eff. 6/27/80; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.902 Home Dialysis for End Stage Renal Disease, Requirements

These requirements are in addition to those contained in ARM 37.85.401, 37.85.402, 37.85.406, 37.85.407, 37.85.410 and 37.85.414.

(1) The provision of home dialysis and related services by the medicaid program shall be coordinated with the Title XVIII medicare renal disease program and any other program providing the same or similar service. Application for medicare benefit is required if medicaid coverage is to be allowed.

(2) Any interest in equipment accrued by means of lease or purchase by the department shall be retained by the department. In no case will a recipient have or be entitled to any property interest in the equipment leased or purchased.

(3) Home dialysis and related services shall be provided only to a person who has been diagnosed as suffering from chronic end stage renal disease by a physician.

(4) Medical necessity and appropriateness of the services shall be subject to review by the designated professional review organization.

(5) In all cases where feasible and necessary, a member of the recipient's household shall be trained as the "back-up" person.

History

Authorizing statute(s): Sec. 53-6-113 MCA
History: Sec. 53-6-101 and 53-6-141 MCA; NEW, 1980 MAR p. 1789, Eff. 6/27/80; TRANS, from SRS, 2000 MAR p. 489.

Mont. Admin. R. 37.40.905 Home Dialysis for End Stage Renal Disease, Reimbursement

(1) Reimbursement for equipment shall be the lesser of the following:

(a) the provider's usual and customary charges which are reasonable; or

(b) the medicaid established fee for that service.

(2) Payment to a nonrelated individual for "back-up" services shall be negotiated between the department and the provider on a case-by-case basis. Members of a recipient's family shall not be reimbursed for providing this service. Reimbursement shall only be allowed in those cases where a family member is not available to provide "back-up" services.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-141, MCA
History: NEW, 1980 MAR p. 1789, Eff. 6/27/80; TRANS, from SRS, 2000 MAR p. 489; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01.

Subchapter 37.40.10 Community First Choice Services

Mont. Admin. R. 37.40.1001 Agency-Based and Self-Directed Community First Choice Services: Definitions

(1) "Activities of daily living" (ADL) means basic personal everyday activities limited to bathing, personal hygiene, transferring, positioning, eating, dressing, toileting, assistance with exercise routine performed in home, self-administered medication, including medication reminders, and meal preparation.

(2) "Agency-based services" means services provided by a qualified personal care provider agency. The agency works with the member to establish the schedule for service provision and provides the trained staff necessary for the delivery of care.

(3) "Annual review" means a member review conducted by a licensed nurse from the designated quality improvement organization once every 365 days. The review of the member's health status includes the completion of a functional assessment and service profile.

(4) "Case manager" means a nurse or social worker who is responsible for managing services provided to eligible members under the Home and Community Based Services (HCBS Waiver) Program. These case managers plan, implement, and monitor the delivery of services available through the program to the member.

(5) "Community First Choice Program" (CFCP) means a program developed in accordance with 1915(k) of the Social Security Act, which allows states the option of providing home and community-based attendant services and supports through an approved state plan. The CFC Program is developed to deliver attendant-based services through the use of a person-centered planning process that includes service coordination and member involvement to provide long-term services and supports (LTSS) to individuals in their homes or communities rather than in institutional settings.

(6) "Community First Choice Services" (CFCS) means the delivery of medically necessary in-home and community-based services provided to Medicaid eligible members whose health conditions cause them to be functionally limited in performing activities of daily living and instrumental activities of daily living.

(7) "Department" means the Montana Department of Public Health and Human Services.

(8) "Direct-Care Wage" means funding which is a supplemental payment made to Community First Choice service providers for the purpose of providing direct-care wage increases, benefits, or lump-sum payments to workers that provide direct services. These funds are distributed proportionately based on a pro rata share of appropriated funding to participating providers of CFCS. The distribution is based on the number of units of Medicaid CFCS provided by each provider agency for the distribution year relative to the total number of units provided statewide by all providers of CFCS.

(9) "Functional assessment" means an assessment that is performed by the designated quality improvement organization licensed nurse to determine if the member qualifies for CFCS and requires assistance with activities of daily living, instrumental activities of daily living, and health maintenance activities.

(10) "Health Care for Health Care Workers" means funding which is designated for the purpose of Medicaid provider rate increases when health insurance is provided for direct-care workers in the Community First Choice, personal assistance services and private duty nursing programs. The funds must be used to cover premiums for health insurance that meet defined benchmark criteria established by the department. These funds are distributed proportionately based on a pro rata share of appropriated funding to participating providers of CFCS based on the number of units of Medicaid CFCS provided by each provider for the distribution year relative to the total number of units provided statewide by all providers of service.

(11) "Health care professional" means a medical doctor, certified physician assistant, nurse practitioner or registered nurse, occupational therapist or a medical social worker, who is familiar with the member's activities of daily living. The health care professional may not be a paid employee of the CFCS provider agency.

(12) "Health maintenance activities" means health-related tasks that may be reimbursed through the Nurse Practice Act exemption in accordance with ARM 24.159.1616 and 37-8-103, MCA. These tasks are limited to bowel programs, wound care, urinary system management, and administration of medication. These activities are delivered by the member's personal care attendant when the activities, in the opinion of the physician or other health care professional, can be performed by the person if the person were physically capable and if the procedure could be safely performed in the home. A member is only able to receive these services from a personal care attendant using the self-direct model.

(13) "Instrumental activities of daily living" means activities which are limited to activities provided in accordance with the service plan, which are directly related to the member's person-centered needs. These activities are limited to the following:

(a) household tasks which are limited to cleaning the area used by the

member, changing the member's bed linens, and doing the member's laundry;

(b) shopping;

participate in recreational and community activities;

(d) yard hazard removal which provides safe access to the member's home;

and

(e) correspondence assistance which provides a member, capable of

directing the service, with assistance opening mail, filing records, and completing paperwork.

(14) "Level of care" means a functional assessment performed by the department or the department's designee to determine if an individual requires nursing facility or intermediate care facility for person with intellectual disabilities level of service. Level of care process is defined in ARM 37.40.201.

(15) "Member" means a person eligible for and enrolled as a participant in the Montana Medicaid Program.

(16) "Nurse supervisor" means a licensed nurse employed by an agency-based CFCS provider agency who completes the service plan with the member and oversees the training and orientation of personal care attendants in the delivery of CFCS.

(17) "Personal Assistance Services" (PAS) means the delivery of medically necessary in-home services provided to Medicaid eligible members whose health conditions cause them to be functionally limited in performing activities of daily living. A member must have a medical need for hands-on assistance in order to receive PAS.

(18) "Personal care attendants" means individuals who assist members with their activities of daily living, instrumental activities of daily living, and other health care needs.

(19) "Person-centered plan" means a department-generated form that is utilized in the identification of the member's goals, strengths, and preferences for service delivery. The form is developed using a person-centered planning process that focuses on learning what is important to a member and how they want to live. The ultimate goal of the person-centered planning process is increased member choice, participation, and independence, while also ensuring health and safety.

(20) "Personal Emergency Response System" (PERS) means a service which provides members with an electronic, telephonic, or mechanical system used to summon assistance in an emergency situation. The system alerts medical professionals, support staff, or other designated individuals to respond to the member's emergency request.

(21) "Personal representative" means an individual designated by a member to act on the member's behalf to hire, direct, schedule, and train personal care attendants in performing self-directed CFCS.

(22) "Plan Facilitator" means the person designated by the department to be responsible for developing and coordinating the member's person-centered plan. The plan facilitator is either a qualified case manager, when one exists, or an individual appointed by the provider agency who is responsible for development of the plan in situations where there is no qualified case manager.

(23) "Oversight staff" means the person employed by a self-directed CFCS provider agency that completes the service plan with the member and oversees the member's participation in the program.

(24) "Provider agency" means a Medicaid-enrolled provider who provides attendant-based services.

(25) "Quality Improvement Organization" (QIO) means a department-contracted entity who is responsible for completing the functional assessments for members accessing CFCS.

(26) "Self-directed services" means a service delivery option for CFCS. In this option the member, or a personal representative, takes responsibility of managing the CFCS. Under the self-directed option, the member or personal representative must hire, fire, supervise, and manage the personal care attendants. In this service option personal care attendants are employed by the provider agency.

(27) "Service Delivery Record" means a form used to document the personal care attendants' delivery of CFCS on a daily basis. The form includes:

(a) dates;

(b) times;

(d) types of tasks provided by the personal care attendant.

(28) "Service plan" means a department-generated form that captures the scope and frequency of CFCS based on the functional assessment of a member's needs for service and support.

(29) "Service profile" means a form that summarizes the member's functional need for CFCS. A licensed quality improvement organization nurse completes the service profile form. The service profile identifies the member's level of impairment, frequency and need for assistance with activities of daily living, instrumental activities of daily living, and health maintenance activities. The profile also provides the member's total authorization for CFCS on a biweekly basis.

(30) "Skill acquisition advocate" means someone who has the capacity to assess the necessity and appropriateness of a member to acquire the skills necessary to achieve independence in performing a CFCS. The skill acquisition advocate may be an occupational therapist, speech therapist, physical therapist, physician, nurse practitioner, physician assistant, registered nurse, behavior specialist, or any other qualified professional approved by the department.

(31) "Skill acquisition letter of endorsement" means a department-generated letter that is signed by a skill acquisition health advocate. The letter outlines the member's plan for receiving skill acquisition service and provides endorsement by the skill acquisition health advocate that the member is capable of achieving independence in performing the service.

(32) "Skill acquisition, maintenance, and enhancement" means a service that may be authorized in the CFCP and is designed to promote member independence. The service enables a member to receive additional support from a personal care attendant to acquire the skills necessary to achieve independence in performing a CFCS.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1002 Agency-Based and Self-Directed Community First Choice Services: Eligibility, Services Provided, and Limitations

(1) To qualify for Community First Choice Services (CFCS), a person must:

(a) be Medicaid eligible;

(b) meet the level of care criteria found at ARM 37.40.205(1); and

(2) CFCS includes assistance with the following activities:

(a) activities of daily living;

(b) instrumental activities of daily living;

(d) skill acquisition, maintenance, and enhancement; and

(e) personal emergency response systems.

(3) Instrumental activities of daily living are only authorized when the member demonstrates a medical and functional need to receive assistance with activities of daily living. Instrumental activities of daily living may not account for more than one-third of the total time allocated per two-week period for CFCS or a maximum of ten hours per two-week time period, whichever is less.

(4) Medical escort services are only authorized when the member has demonstrated a medical and functional need for CFCS. Medical escort services must be directly related to a member's medical and functional need for assistance en route to, or at the Medicaid reimbursable medical service, and are available when a family member or caregiver is unable to accompany the member.

(5) Skill acquisition, maintenance, and enhancement services are only authorized when the member demonstrates a medical and functional need to receive assistance with activities of daily living. The service may be authorized if a member is expected to achieve full independence in skill acquisition within a 90-day time period. A skill acquisition letter of endorsement signed by a skill acquisition advocate is required prior to authorization of the service.

(6) Personal emergency response system services (PERS) are only authorized when the member demonstrates a medical and functional need to receive assistance with activities of daily living.

(7) CFCS, except for medical escort services, shopping, laundry, and community integration, will be provided in the member's home.

(8) CFCS services will be provided only in residential settings that the department determines meet the Home and Community-Based Setting requirements described in 42 C.F.R. § 441.530.

(9) CFCS is not available to the following:

(a) persons residing in a hospital, a hospital providing long-term care, or a long-term care facility as defined in 50-5-101, MCA, and licensed under 50-5-201, MCA;

(b) persons who reside in assisted living or adult foster homes, as defined in 50-5-225, MCA, and licensed under 50-5-227, MCA;

(10) CFCS may not include any skilled services that require professional medical training unless otherwise permitted under 37-8-103, MCA.

(11) CFCS do not include services that maintain an entire household. CFCS do not include:

(a) cleaning floors and furniture in areas that members do not use or occupy;

(b) laundering clothing or bedding that members do not use;

(d) maintenance of animals unless the animal is a certified service animal specifically trained to meet the health and safety needs of the member;

(e) home and outside maintenance; and

(f) meal preparation for other family members.

(12) Payment to legally responsible persons for CFCS is available when an individual requires extraordinary care as demonstrated by a state-approved functional assessment. As used in this rule, the term “extraordinary care” means care exceeding the range of activities that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to ensure the health and welfare of the participant and avoid institutionalization. A legally responsible person may also be paid for services that are not considered extraordinary when an individual is unable to access non-legally responsible personal care providers because of geographic, cultural, or other factors limiting availability of care providers. A legally responsible person is defined as a:

(a) spouse; or

(b) natural, adoptive, or foster parent of a minor child.

(13) CFCS must be delivered by a CFCS personal care attendant employed by an enrolled Medicaid provider that has met the criteria established by the department for the delivery of CFCS as referenced in ARM 37.40.1017 and 37.40.1018.

(14) CFCS may not be provided to relieve a parent of child-caring or other legal responsibilities. CFCS for children with disabilities may be appropriate when the parent is unqualified or otherwise unable to provide services, and the child is at risk of institutionalization unless the services are provided.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14; AMD, 2025 MAR, Notice No. 37-1065, Eff. 1/11/25.

Mont. Admin. R. 37.40.1005 Agency-Based and Self-Directed Community First Choice Services: Person-Centered Plan Requirements

(1) In order to receive Community First Choice Services (CFCS), the member must be capable of making choices about activities of daily living and instrumental activities of daily living. The member must be able to understand the impact of these choices and assume responsibility for the choices. If the member is unable to meet these criteria, the member may have someone assist them in decision making and directing their activities. The CFCS person-centered planning process includes multiple steps to protect a member's health and safety while ensuring that member choice and control are an integral component of service delivery. Prior to delivering CFCS, the following person-centered planning requirements must be met:

(a) a licensed contract nurse must complete a functional assessment and service profile;

(b) a plan facilitator must complete the person-centered plan; and

(2) The Person-Centered Planning requirements in (1) may be delayed in the circumstances outlined in (7).

(3) The quality improvement organization will define the member's medical and functional needs in a functional assessment and service profile. The functional assessment and service profile must meet the following criteria:

(a) a licensed contract nurse will develop and review the member's functional assessment and service profile initially and will renew it at least annually; and

(b) the service profile will establish the maximum authorization for CFCS in a two-week time period.

(4) The member and plan facilitator must meet to complete a person-centered plan that identifies, in writing, member-specific goals and objectives for the delivery of CFCS. The plan facilitator must ensure the person-centered plan is completed prior to service delivery and renewed at least annually. The person-centered plan must indicate that the residential setting of the member meets the Home and Community-Based Setting requirements described in 42 CFR § 441.530. The person-centered plan will be based on the member's functional assessment and service profile as provided by the quality improvement organization.

(a) In agency-based CFCS, the CFCS provider agency nurse supervisor must participate in the initial and annual person-centered planning visit.

(b) In self-directed CFCS, the CFCS provider agency oversight staff must participate in the initial and annual person-centered planning visit.

(5) The service plan will identify the type and amount of CFCS and will govern the delivery of service. The service plan must meet the following criteria:

(a) in agency-based CFCS, the agency nurse supervisor must approve the service plan initially, and must recertify the service plan every six months;

(b) in self-directed CFCS, the provider agency oversight staff must approve the service initially, and must recertify the service plan every six months;

(d) the plan must not exceed the service profile authorization for hours delivered in a two-week time period.

(6) A member will not receive CFCS beyond the service profile authorization unless one of two conditions is met:

(a) The provider agency implements a temporary service plan as outlined in (7).

(i) In agency-based CFCS, the provider agency nurse supervisor must sign the temporary service plan and prescribe in writing the member's needs for the increase in services.

(ii) In self-directed CFCS, the provider agency oversight staff must sign the temporary service plan and prescribe in writing the member's needs for the increase in services.

(b) The provider agency approves medical escort service during the time period. The provider agency must provide documentation to ensure the escort was provided according to program parameters.

(7) If a member is at high risk for institutionalization or in need of temporary CFCS, the provider agency may implement services immediately that include assistance with the activities of daily living without the functional assessment, service profile, and person-centered plan in place. In this case, the provider agency must implement a temporary service plan. The provider agency must use a department-approved form to document the temporary service plan. The temporary service plan must prescribe in writing the member's medical and functional need for service. The provider must refer the member to the quality improvement organization for a functional assessment by the 28th day of the temporary service plan, or they must discharge the member.

(a) In self-directed CFCS, the health care professional must complete the health care professional authorization form prior to the delivery of services, and the provider agency oversight staff must complete and sign the service plan prior to the delivery of services.

(b) In agency-based CFCS, the provider agency nurse supervisor must complete and sign the temporary service plan prior to the delivery of services.

(8) The member must agree to accept the provision of CFCS as specified in the person-centered service plan.

(9) The CFCS provider must have a written complaint process. The member may receive a copy upon request. The provider must adhere to the process for any member complaints related to the person-centered planning and service-delivery process.

(10) The delivery of agency-based CFCS must be supervised by a licensed agency nurse. Supervision includes oversight of the training and orientation of direct-care workers.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14; AMD, 2025 MAR, Notice No. 37-1065, Eff. 1/11/25.

Mont. Admin. R. 37.40.1006 Self-Directed Community First Choice Services: Description and Purpose

(1) Self-directed Community First Choice Services (CFCS) are services provided to Medicaid members who choose to take the responsibility or have a representative take the responsibility of managing the CFCS. Self-directed CFCS allow the member to direct CFCS, including health maintenance tasks.

(2) Health maintenance tasks include the following:

(a) urinary systems management;

(b) bowel care;

(d) medication management.

(3) Members must provide their physician or health care professional evidence of ability to manage their CFCS and health maintenance tasks.

(a) The scope and detail of the evidence will be determined by the physician or health care professional.

(4) Members who are unable to utilize self-directed CFCS may receive services through the agency-based CFCS program managed by provider agencies under agreement with Medicaid.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1007 Self-Directed Community First Choice Services: General Requirements

(1) Self-directed Community First Choice Services (CFCS) may only be delivered by an attendant who is the employee of a Medicaid-enrolled provider and who is selected by the member or their personal representative.

(2) Agency-based CFCS managed by provider agencies under agreement with Medicaid are not available to members who are participating in the self-directed CFCS program. The use of CFCS managed by provider agencies may be permissible in the event that the member's backup plan fails.

(3) Home health and home and community-based waiver skilled nursing services are not available to members for the completion of health maintenance activities which the member has been authorized to manage. The use of home health and home and community-based waiver skilled nursing services may be permissible in the event that the member's backup plan fails. In this case the service must be prior authorized.

(4) Members who have been terminated from the self-directed program may apply for agency-based CFCS through the Medicaid CFCS program managed by approved provider agencies.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1008 Self-Directed Community First Choice Services: Member Requirements

(1) To qualify for self-directed Community First Choice Services (CFCS), the member:

(a) must be capable of assuming the management responsibilities of self-directed CFCS or have a personal representative willing to assume this responsibility. Management responsibilities include the following:

(i) recruit, hire, schedule, train, and dismiss all personal care attendants;

(ii) develop a backup plan for when a personal care attendant is unable to provide services. The backup plan identifies the process for addressing the member's functional need for service as identified on the service plan should the personal care attendant be unable to deliver services;

(iii) review, approve, sign, and date all service delivery records to provide assurance that the service plan has been followed; and

(iv) assume medical and related liability regarding the delivery of CFCS.

(b) must obtain authorization from a physician or health care professional to participate in the program;

(d) must be capable of making choices about activities of daily living, understand the impact of these choices, and assume the responsibility of the choices.

(2) The member may have a personal representative assume some or all of the responsibilities imposed by this rule. The personal representative is an immediately involved representative who meets the following criteria:

(a) is a person who is directly involved in the daily care of the member;

(b) is available to assume the responsibility of managing the member's care, including directing the care as it occurs in the home; and

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1012 Agency-Based and Self-Directed Community First Choice Services: Termination from Services

(1) Community First Choice Services (CFCS) may be terminated for any of the following reasons:

(a) the member, or other persons in the household, subjects the direct-care worker to physical or verbal abuse, sexual harassment, exposure to the use of illegal substances, or to threats of physical harm;

(b) the member requests termination of services or refuses to accept help;

(d) the member is engaging in illegal activity in the home;

(e) the member's physician requests termination of services;

(f) the member no longer has a medical need for CFCS;

(g) the member refuses the services of a direct-care worker based solely or partly on the attendant's race, creed, religion, sex, marital status, color, age, handicap, or national origin;

(h) the member refuses to accept services in compliance with the service plan;

(i) the member refuses to participate in the functional assessment, recertification, and person-centered planning visits; or

(j) the member falsifies the service delivery record.

(2) The department may terminate or reduce CFCS when funding for services is unavailable.

(3) The provider must give at least ten days advance notice to a member when CFCS are terminated for reasons listed in (1)(d) through (1)(j).

(4) The provider may immediately, but temporarily, suspend services for the reasons listed in (1)(a) through (1)(e). Following the temporary suspension of services the provider may enter into an agreement with the member to ensure that the violations of (1)(a) through (1)(e) do not reoccur. If the member fails to abide by the terms of the agreement, services may be permanently terminated.

(5) The department will provide written notice to an applicant when CFCS are initially denied to the applicant.

(6) A person may request a fair hearing for any adverse determination made by the department. Fair hearings will be conducted as provided for in ARM 37.5.304, 37.5.307, 37.5.310, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1013 Agency-Based and Self-Directed Community First Choice Services: Provider Enrollment

(1) Providers will enroll as a Community First Choice Services (CFCS)/Personal Care Services (PCS) provider, a CFCS/PCS personal emergency response system (PERS) provider, or both. Providers must enroll through the department's fiscal intermediary.

(2) CFCS/PCS providers must be a business entity formed or registered to do business under Montana law.

(3) CFCS/PCS providers must submit a description of the proposed service area, which must include, at a minimum, coverage of the entire area of at least one county or Indian reservation.

(4) CFCS/PCS providers must comply with onsite visit requirements both before and after enrollment, to verify information submitted to the department.

(5) CFCS/PCS providers must provide documentation to demonstrate the following:

(a) general liability insurance with a minimum coverage of $1,000,000 per occurrence and $2,000,000 aggregate;

(b) motor vehicle liability insurance with split limits of $500,000 per person for personal injury, $1,000,000 per accident occurrence for personal injury, and $100,000 per accident occurrence for property damage; or, combined single limits of $1,000,000 per occurrence to cover such claims as may be caused by any act, omission, or negligence of the provider or its agents, officers, representatives, assigns, or subcontractors;

(d) verification of completion of the department's mandatory CFCS/PCS training.

(6) CFCS/PCS providers must elect to deliver either the agency-based or self-directed CFCS/PCS option. Once a provider has completed a successful compliance review, the provider may enroll in the other service option.

(7) CFCS/PCS providers must use an Electronic Visit Verification (EVV) system to electronically document the delivery of services and submit claims.

(a) In accordance with 42 U.S.C. 1396b(l), the EVV system must capture the following data elements:

(i) the type of service performed;

(ii) the member receiving the service;

(iii) the date of the service;

(iv) the location of service delivery;

(v) the individual providing the service; and

(vi) the time the service begins and ends;

(b) The use of EVV is required for all members utilizing CFCS/PCS, including members for whom services are provided by a live-in caregiver.

(8) The department may contract with out-of-state agencies to provide CFCS/PCS for Montana Medicaid members temporarily living out of state.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14; AMD, 2025 MAR, Notice No. 280, Eff. 7/26/25.

Mont. Admin. R. 37.40.1016 Agency-Based and Self-Directed Community First Choice Services: Conflict of Interest Criteria

(1) In order to perform the duties of an agency-based nurse supervisor, self-directed program oversight staff, or the Community First Choice Services (CFCS) provider person-centered plan facilitator the person cannot:

(a) be related by blood or marriage to the member or to any paid caregiver for the member;

(b) be financially responsible to the member;

(d) benefit financially from the provision of assessed need for services;

(e) be employed as a direct-care worker at the agency; or

(f) have a majority ownership stake in the agency.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1017 Agency-Based Community First Choice Services: Provider Requirements

(1) Providers may enroll as a Community First Choice Services (CFCS) personal care attendant provider, a CFCS personal emergency response system provider, or both.

(2) CFCS personal care attendant providers will maintain staff resources, including a nurse supervisor and person-centered plan facilitator, to perform the necessary CFCS duties as referenced in ARM 37.40.1005. The nurse supervisor and plan facilitator may be the same person.

(3) CFCS nurse supervisors must meet the following criteria:

(a) be a licensed nurse;

(b) have at least one year's experience in aging and disability services;

(d) be free of conflict-of-interest criteria as referenced in ARM 37.40.1016.

(4) CFCS plan facilitators must meet the following criteria:

(a) have at least one year's experience in aging and disability services;

(b) receive certification in the person-centered planning process; and

(5) The CFCS personal care attendant providers must provide documentation to verify the nurse supervisor and plan facilitator credentials, certification, and training.

(6) CFCS personal emergency response system service providers will provide a service, which includes electronic, telephonic, or mechanical system to assist the member in an emergency situation. The system must be connected to a local emergency response system with the capacity to activate local emergency medical personnel.

(7) A provider of services must ensure that the services adhere to the requirements of 42 CFR 441.710(a)(1) and (a)(2), which permits reimbursement with Medicaid monies only for services within settings that meet certain qualities set forth under the regulation. These qualities include that the setting:

(a) is integrated in and facilitates full access of the individual to the greater community;

(b) ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid Home and Community-Based Services;

(c) is selected by the individual from among setting options, including non-disability specific settings and an option to choose a private unit in a residential setting;

(d) ensures the individual's rights of privacy, dignity, and respect, and freedom from coercion and restraint;

(e) optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to daily activities, physical environment, and with whom to interact.;

(f) provides an opportunity to seek employment and work in competitive integrated settings; and

(g) facilitates individual choice of services and supports, and who provides them.

(8) The department adopts and incorporates by reference 42 CFR 441.710(a)(1) and (a)(2), as amended January 16, 2014. A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Services, Senior & Long-Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14; AMD, 2024 MAR p. 612, Eff. 3/23/24.

Mont. Admin. R. 37.40.1018 Self-Directed Community First Choice Services: Provider Requirements

(1) Self-directed Community First Choice Services (CFCS) providers must employ program oversight staff to perform the following self-directed oversight activities:

(a) assist members to identify resources for personal assistants;

(b) advise the member regarding program requirements;

(d) provide documentation to ensure that the personal representative meets the participation criteria described in ARM 37.40.1008.

(2) Self-directed CFCS providers must maintain staff resources, including a program oversight staff and person-centered plan facilitator, to perform the necessary CFCS duties as referenced in ARM 37.40.1005. The program oversight staff and person-centered plan facilitator may be the same person.

(3) Self-directed program oversight staff must meet the following criteria:

(a) have at least one year's experience in aging and disability services;

(b) receive training in CFCS; and

(4) Self-directed plan facilitators must meet the following criteria:

(a) have at least one year's experience in aging and disability services;

(b) receive certification in the person-centered planning process; and

(5) The CFCS provider agency must provide documentation to verify program oversight staff and plan facilitator credentials, certification, and training.

(6) Self-directed CFCS provider agencies must act as the employer of record for direct-care workers for the purposes of payroll and federal hiring practices.

(7) A provider of services must ensure that the services adhere to the requirements of 42 C.F.R. § 441.530, which permits reimbursement with Medicaid monies only for services within settings that meet certain qualities set forth under the regulation.

(8) For the purpose of this subchapter, the department adopts and incorporates by reference 42 C.F.R. § 441.530, as amended January 16, 2014. A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Service, Senior and Long-Term Care Division, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14; AMD, 2024 MAR p. 332, Eff. 2/24/24; AMD, 2025 MAR, Notice No. 37-1065, Eff. 1/11/25.

Mont. Admin. R. 37.40.1022 Agency-Based Community First Choice Services: Provider Compliance

(1) Providers of Community First Choice Services (CFCS) will be subject to compliance reviews to provide assurance to the department that services are being provided within the rules and policy of the program.

(2) The department will conduct compliance reviews on the provider's premises and through documentation requests. The provider must supply documentation requested by the department in a reasonable time frame and no later than 30 days following the request.

(3) The reviews will take place at times determined by the department.

(4) The department will determine compliance in the following service delivery areas:

(a) service authorization documentation;

(b) high-risk authorization;

(d) service plan and member choice;

(e) service delivery;

(f) nurse supervision and oversight; and

(g) health and welfare and serious occurrence reports.

(5) The department will determine compliance in the following administrative areas:

(a) attendant training;

(b) staff credentials, certification, and training;

(d) maintenance of serious occurrence reports;

(e) member satisfaction surveys;

(f) required documentation;

(g) agency manuals and handouts, including complaint process;

(h) workers' compensation, liability, and automobile coverage; and

(i) service billing.

(6) The department will determine compliance in the following person-centered planning delivery areas:

(a) plan facilitator certification documentation;

(b) member and plan facilitator rights and responsibility documentation;

(d) risk assessment and mitigation.

(7) The department will examine a minimum of three cases or five percent of the provider's case load for the purpose of the compliance review, whichever is greater. The department will review additional cases, when necessary.

(8) The provider will meet all standards in ninety percent of the cases to be considered in compliance. If ninety percent compliance is not met, a second compliance review will be scheduled.

(9) The provider must meet all standards in ninety percent of the cases in the second review or will be subject to department sanctions as provided in ARM 37.85.401.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1023 Self-Directed Community First Choice Services: Provider Compliance

(3) The reviews will take place at times determined by the department.

(4) The department will determine compliance in the following service delivery areas:

(a) service authorization documentation;

(b) health-care professional authorization;

(d) amendments and temporary authorization;

(e) service plan and member choice;

(f) service delivery;

(g) agency program oversight; and

(h) health and welfare and serious occurrence reports.

(5) The department will determine compliance in the following administrative areas:

(a) staff credentials, certification, and training;

(b) principles of charting;

(d) member satisfaction surveys;

(e) required documentation;

(f) agency manuals and handouts, including complaint process;

(g) workers' compensation, liability, and automobile coverage; and

(h) service billing.

(6) The department will determine compliance in the following person-centered planning delivery areas:

(a) plan facilitator certification documentation;

(b) member and plan facilitator rights and responsibility documentation;

(d) risk assessment and mitigation.

(8) The provider must meet all standards in ninety percent of the cases to be considered in compliance. If ninety percent compliance is not met, a second compliance review will be scheduled.

(9) The provider must meet all standards in ninety percent of the cases in the second review or it will be subject to department sanctions as provided in ARM 37.85.401.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1026 Agency-Based and Self-Directed Community First Choice Services: Reimbursement

(1) Community First Choice Services (CFCS) may be provided up to, but not more than, 84 hours of attendant service per two-week time period per person as defined by the service profile. The department may, within its discretion, authorize additional hours in excess of this limit. Any services exceeding this limit must be prior authorized by the department. Prior authorization for excess hours may be authorized if additional assistance is required for:

(a) a period of time not to exceed three months and as the result of an acute medical episode;

(b) a period of time not to exceed three months and to prevent institutionalization during the absence of the normal caregiver; or

(2) Add-on payments for direct-care wage, bonus, and health care for health care workers are as described in ARM 37.40.1027 and 37.40.1030.

(3) CFCS include the following:

(a) personal care attendant service is a 15-minute unit and means an onsite visit specific to a member. Personal care attendant services include the performance of activities of daily living, instrumental activities of daily living, skill acquisition, maintenance, and enhancement services. The personal care attendant service rate is an all-inclusive rate and includes the provider agency's administrative, person-centered planning, supervision, and oversight duties;

(b) medical escort is a 15-minute unit and means transportation time and appointment time so the person can access an approved medical appointment;

(c) mileage is a unit of one mile and means reimbursement for mileage when an attendant uses their vehicle to transport a person on an approved shopping, community integration, or medical escort trip; and

(d) personal emergency response is a unit of service that covers the initial installation fee and monthly rental fee of the unit.

(4) The department will not reimburse a member for in-home services delivered by a privately retained attendant.

(5) Reimbursement is not available for CFCS provided by immediate family members as described in ARM 37.40.1002.

(6) Reimbursement fees for agency-based and self-directed CFCS are stated in the department's fee schedule adopted at ARM 37.85.105(4).

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14; AMD, 2015 MAR p. 822, Eff. 7/1/15.

Mont. Admin. R. 37.40.1027 Add-on Payments and Reporting Requirements for Direct-Care Workers' Wage and Lump-Sum Payments

(1) In addition to the reimbursement fee as provided in ARM 37.40.1026, 37.40.1030, 37.40.1105, and 37.85.105, the department will pay Medicaid personal assistance service and Community First Choice Services (CFCS) providers located in Montana who submit an approved request to the department, an add-on payment. Add-on payment is used only for wage and benefit increases or lump-sum payments for direct-care workers who deliver Medicaid personal assistance or CFCS.

(a) The department will determine the add-on payments, commencing July 1, 2014, as a pro rata share of appropriated funds available for increases in direct-care worker wages, lump-sum direct-care worker bonus payments, or both. A provider agency is eligible to receive a portion of the total funds based on their percentage of total utilization of personal assistance services and CFCS over the previous fiscal year.

(b) To receive the direct-care services workers' add-on payment, a provider must submit for approval an application request to the department stating how the direct-care workers' wage increase, add-on payment, or both will be spent to comply with the requirements outlined in the application. The provider must submit all of the information required on a department-approved form in order to continue to receive subsequent add-on payment amounts for the entire year.

(c) A provider must submit a qualifying request for the funds distributed under (1). The request must include all required information, within the deadlines established by the department. Providers who do not submit the qualifying request, or do not wish to participate in the add-on funding, may not be entitled to their pro rata share of the funds available for wage and benefit increase or lump-sum payments for direct-care workers.

(2) A provider that receives funds under this rule must maintain appropriate records documenting the expenditures of these funds. This documentation must be maintained and made available to authorized governmental entities and their agencies to the same extent as other required records and documentation under applicable Medicaid record requirements.

(a) Effective for the period beginning July 1, 2014, personal assistance services providers or CFCS providers must report to the department actual hourly wage and benefit rates paid for all direct-care workers or the lump-sum payment amounts for all direct-care workers who will receive these funds.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Mont. Admin. R. 37.40.1030 Add-on Payments and Reporting Requirements for Health Care Workers

(1) The department will pay Medicaid Personal Assistance Services and Community First Choice Services (CFCS) providers located in Montana, who submit an approved request to the department, an add-on payment in addition to the reimbursement fee as provided in ARM 37.40.1026, 37.40.1027, 37.40.1105, and 37.85.105. The add-on payment is to be used only to cover health insurance payments for direct-care workers who spend a majority of their time serving Medicaid personal care members.

(a) The department will determine the add-on payments, commencing July 1, 2014, as a pro rata share of appropriated funds allocated for health care for health care worker coverage. A provider agency is eligible to receive a portion of the total funds based on their percentage of total utilization of personal assistance services and CFCS over the previous fiscal year.

(b) To receive the health care for health care worker payment, a provider must submit for approval an application request to the department stating how the health care for health care worker add-on payment will be spent to comply with the application's requirements. The provider must submit all of the information required on a department-approved form in order to continue to receive subsequent add-on payment amounts for the entire year.

(c) A provider must submit an application request for the funds distributed under (1)(b). The request must include all required information, within the deadlines established by the department. Providers who do not submit the application request or do not wish to participate in the add-on funding may not be entitled to their pro rata share of the funds available for health care for health care worker coverage.

(a) Effective for the period beginning July 1, 2014, personal assistance services or CFCS providers must submit quarterly reports to the department. The report must include the names of eligible direct-care workers receiving health insurance coverage, the monthly cost of the insurance plan, and the total cost to the agency to provide health insurance coverage.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3075, Eff. 12/25/14.

Subchapter 37.40.11 Personal Assistance Services

Mont. Admin. R. 37.40.1101 Personal Care Services, Services Provided and Limitations

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-6-201, MCA
Implementing statute(s): 53-6-101, 53-6-131, 53-6-141, MCA
History: NEW, 1980 MAR p. 1105, Eff. 3/28/80; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1987 MAR p. 372, Eff. 4/17/87; AMD, 1988 MAR p. 1259, Eff. 7/1/88; AMD, 1989 MAR p. 982, Eff. 7/28/89; AMD, 1993 MAR p. 1363, Eff. 6/25/93; AMD, 1995 MAR p. 1191, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 489; REP, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1102 Personal Care Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, 53-6-141, MCA
History: NEW, 1980 MAR p. 1105, Eff. 3/28/80; AMD, 1980 MAR p. 2979, Eff. 11/29/80; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1987 MAR p. 372, Eff. 4/17/87; AMD, 1988 MAR p. 1259, Eff. 7/1/88; AMD, 1989 MAR p. 982, Eff. 7/28/89; AMD, 1993 MAR p. 1363, Eff. 6/25/93; AMD, 1995 MAR p. 1191, Eff. 7/1/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; REP, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1105 Personal Care Services, Agency-Based Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1105, Eff. 3/28/80; AMD, 1980 MAR p. 2979, Eff. 11/29/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1987 MAR p. 372, Eff. 4/17/87; AMD, 1988 MAR p. 1259, Eff. 7/1/88; AMD, 1989 MAR p. 982, Eff. 7/28/89; AMD, 1993 MAR p. 1363, Eff. 6/25/93; AMD, 1995 MAR p. 1191, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 489; AMD, 2011 MAR p. 1386, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; REP, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1106 Personal Care Services, Provider Compliance

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-101, 53-6-113, 53-2-201, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1995 MAR p. 1191, Eff. 7/1/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; REP, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1110 Agency-Based and Self-Directed Personal Assistance Services: Definitions

(5) "Department" means the Montana Department of Public Health and Human Services.

(6) "Direct-Care Wage" means funding which is a supplemental payment made to Personal Assistance Services (PAS) providers for the purpose of providing direct-care wage increases, benefits, or lump-sum payments to workers that provide direct services. These funds are distributed proportionately based on a pro rata share of appropriated funding to participating providers of PAS. The distribution is based on the number of units of Medicaid PAS provided by each provider agency for the distribution year relative to the total number of units provided statewide by all providers of PAS.

(7) "Functional assessment" means an assessment that is performed by the designated quality improvement organization licensed nurse to determine if the member qualifies for PAS and requires assistance with activities of daily living, instrumental activities of daily living, and health maintenance activities.

(8) "Health Care for Health Care Workers" means funding which is designated for the purpose of Medicaid provider rate increases when health insurance is provided for direct-care workers in the personal assistance, personal assistance services, and private duty nursing programs. The funds must be used to cover premiums for health insurance that meet defined benchmark criteria established by the department. These funds are distributed proportionately based on a pro rata share of appropriated funding to participating providers of PAS based on the number of units of Medicaid PAS provided by each provider for the distribution year relative to the total number of units provided statewide by all providers of service.

(9) "Health care professional" means a medical doctor, certified physician assistant, nurse practitioner or registered nurse, occupational therapist or a medical social worker, who is familiar with the member's activities of daily living. The health care professional may not be a paid employee of the PAS provider agency.

(10) "Health maintenance activities" means health-related tasks that may be reimbursed through the Nurse Practice Act exemption in accordance with ARM 24.159.1616 and 37-8-103, MCA. These tasks are limited to bowel programs, wound care, urinary system management, and administration of medication. These activities are delivered by the member's personal care attendant when the activities, in the opinion of the physician or other health care professional, can be performed by the person if the person were physically capable and if the procedure could be safely performed in the home. A member is only able to receive these services from a personal care attendant using the self-direct model.

(11) "Instrumental activities of daily living" means activities which are limited to activities provided in accordance with the service plan, which are directly related to the member's person-centered needs. These activities are limited to the following:

(a) household tasks which are limited to cleaning the area used by the

member, changing the member's bed linens, and doing the member's laundry; and

(b) shopping.

(12) "Member" means a person eligible for and enrolled as a participant in the Montana Medicaid Program.

(13) "Nurse supervisor" means a licensed nurse employed by an agency-based PAS provider agency who completes the service plan with the member and oversees the training and orientation of personal care attendants in the delivery of PAS.

(14) "Personal Assistance Services" (PAS) means the delivery of medically necessary in-home and community-based services provided to Medicaid eligible members whose health conditions cause them to be functionally limited in performing activities of daily living and instrumental activities of daily living. A member must have a medical need for hands-on assistance in order to receive PAS.

(15) "Personal Assistance Services Program" (PASP) means a program developed in accordance with 1905 (a)(24) of the Social Security Act, which allows states the option of providing personal assistance services through an approved state plan. The PAS Program is developed to deliver attendant-based services through the use of a person-centered planning process that includes service coordination and member involvement to provide long-term services and supports (LTSS) to individuals in their homes or communities rather than in institutional settings.

(16) "Personal care attendants" means individuals who assist members with their activities of daily living, instrumental activities of daily living, and other health care needs.

(17) "Person-centered plan" means a department-generated form that is utilized in the identification of the member's goals, strengths, and preferences for service delivery. The form is developed using a person-centered planning process that focuses on learning what is important to a member and how they want to live. The ultimate goal of the person-centered planning process is increased member choice, participation, and independence, while also ensuring health and safety.

(18) "Personal representative" means an individual designated by a member to act on the member's behalf to hire, direct, schedule, and train personal care attendants in performing self-directed PAS.

(19) "Plan Facilitator" means the person designated by the department to be responsible for developing and coordinating the member's person-centered plan. The plan facilitator is either a qualified case manager, when one exists, or an individual appointed by the provider agency who is responsible for development of the plan in situations where there is no qualified case manager.

(20) "Oversight staff" means the person employed by a self-directed PAS provider agency that completes the service plan with the member and oversees the member's participation in the program.

(21) "Provider agency" means a Medicaid-enrolled provider who provides attendant-based services.

(22) "Quality Improvement Organization" (QIO) means a department-contracted entity who is responsible for completing the functional assessments for members accessing PAS.

(23) "Self-directed services" means a service delivery option for PAS. In this option the member, or a personal representative, takes responsibility of managing the PAS. Under the self-directed option, the member or personal representative must hire, fire, supervise, and manage the personal care attendants. In this service option personal care attendants are employed by the provider agency.

(24) "Service Delivery Record" means a form used to document the personal care attendants' delivery of PAS on a daily basis. The form includes:

(a) dates;

(b) times;

(d) types of tasks provided by the personal care attendant.

(25) "Service plan" means a department-generated form that captures the scope and frequency of PAS based on the functional assessment of a member's needs for service and support.

(26) "Service profile" means a form that summarizes the member's functional need for PAS. A licensed quality improvement organization nurse completes the service profile form. The service profile identifies the member's level of impairment, frequency and need for assistance with activities of daily living, instrumental activities of daily living, and health maintenance activities. The profile also provides the member's total authorization for PAS on a biweekly basis.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1111 Agency-Based and Self-Directed Personal Assistance Services: Eligibility, Services Provided, and Limitations

(1) To qualify for Personal Assistance Services (PAS), a person must:

(a) be Medicaid eligible; and

(b) demonstrate a medical and functional need for assistance with activities

of daily living.

(2) PAS include assistance with the following activities:

(a) activities of daily living;

(b) instrumental activities of daily living; and

(3) Instrumental activities of daily living are only authorized when the member demonstrates a medical and functional need to receive assistance with activities of daily living. Instrumental activities of daily living may not account for more than one-third of the total time allocated per two-week period for PAS or a maximum of six hours per two-week time period, whichever is less.

(4) Medical escort services are only authorized when the member has demonstrated a medical and functional need for PAS. Medical escort services must be directly related to a member's medical and functional need for assistance en route to, or at the Medicaid reimbursable medical service, and are available when a family member or caregiver is unable to accompany the member.

(5) PAS, except for medical escort services, shopping, and laundry, will be provided in the member's home.

(6) PAS may not typically be provided in group home settings unless prior authorized by the department. Group home settings include licensed youth foster homes, mental health group homes, and adult intensive community home services. PAS may be authorized when the person's medical needs are beyond the scope of services normally provided by programs funding services in the group setting. For example, a person requiring additional assistance because of an acute medical episode or post-hospitalization period may receive PAS in a youth foster home setting.

(7) PAS are not available to the following:

(a) persons who reside in a hospital, hospitals providing long-term care, or a long-term care facility as defined in 50-5-101, MCA, and licensed under 50-5-201, MCA;

(b) persons who reside in assisted living or adult foster homes, as defined in 50-5-225, MCA, and licensed under 50-5-227, MCA; or

(8) PAS may not include any skilled services that require professional medical training unless otherwise permitted under 37-8-103, MCA, or ARM 24.159.1616.

(9) PAS do not include services which maintain an entire household. PAS do not include:

(a) cleaning floors and furniture in areas that members do not use or occupy;

(b) laundering clothing or bedding that members do not use;

(d) maintenance of animals unless the animal is a certified service animal specifically trained to meet the health and safety needs of the member;

(e) home and outside maintenance; and

(f) meal preparation for other family members.

(10) PAS provided by a member of the member's immediate family are not PAS for the purposes of the Medicaid program, and are not eligible for reimbursement. Immediate family member includes the following:

(a) a spouse; and

(b) a natural, adoptive, or foster parent of a minor child.

(11) PAS must be delivered by a PAS personal care attendant employed by an enrolled Medicaid provider that has met the criteria established by the department for the delivery of PAS as referenced in ARM 37.40.1126 and 37.40.1127.

(12) PAS may not be provided to relieve a parent of child-caring or other legal responsibilities. PAS for children with disabilities may be appropriate when the parent is unqualified or otherwise unable to provide services and the child is at risk of institutionalization unless the services are provided.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1114 Agency-Based and Self-Directed Personal Assistance Services: Person-Centered Plan Requirements

(1) In order to receive Personal Assistance Services (PAS), the member must be capable of making choices about activities of daily living and instrumental activities of daily living. The member must be able to understand the impact of these choices and assume responsibility for the choices. If the member is unable to meet these criteria, the member may have someone assist them in decision making and directing their activities. The PAS person-centered planning process includes multiple steps to protect a member's health and safety while ensuring that member choice and control are an integral component of service delivery. Prior to delivering PAS, the following person-centered planning requirements must be met:

(a) a licensed contract nurse must complete a functional assessment and

service profile;

(b) a plan facilitator must complete the person-centered plan; and

plan.

(2) The person-centered planning requirements in (1) may be delayed in the circumstances outlined in (7).

(a) a licensed contract nurse will develop and review the member's functional assessment and service profile initially and will renew it at least annually; and

(b) the service profile will establish the maximum authorization for PAS in a two-week time period.

(4) The member and plan facilitator must meet to complete a person-centered plan that identifies, in writing, member-specific goals and objectives for the delivery of PAS. The plan facilitator must ensure the person-centered plan is completed prior to service and renewed at least annually. The person-centered plan will be based on the member's functional assessment and service profile as provided by the quality improvement organization.

(a) In agency-based PAS, the PAS provider agency nurse supervisor must participate in the initial and annual person-centered planning visit.

(b) In self-directed PAS, the PAS provider agency oversight staff must

participate in the initial and annual person-centered planning visit.

(5) The service plan will identify the type and amount of PAS and will govern the delivery of service. The service plan must meet the following criteria:

(a) in agency-based PAS, the agency nurse supervisor must approve the service plan initially, and must recertify the service plan every six months;

(b) in self-directed PAS, the provider agency oversight staff must approve the service initially, and must recertify the service plan every six months;

(d) the plan must not exceed the service profile authorization for hours delivered in a two-week time period.

(6) A member will not receive PAS beyond the service profile authorization unless one of two conditions is met:

(a) The provider agency implements a temporary service plan as outlined in (7).

(i) in agency-based PAS, the provider agency nurse supervisor must sign the temporary service plan and prescribe in writing the member's needs for the increase in services.

(ii) in self-directed PAS, the provider agency oversight staff must sign the temporary service plan and prescribe in writing the member's needs for the increase in services.

(b) The provider agency approves medical escort service during the time period. The provider agency must provide documentation to ensure the escort was provided according to program parameters.

(7) If a member is at high risk for institutionalization or in need of temporary PAS, the provider agency may implement services immediately that include activities of daily living without the functional assessment, service profile, and person-centered plan in place. In this case the provider agency must implement a temporary service plan. The provider agency must use a department-approved form to document the temporary service plan. The temporary service plan must prescribe in writing the member's medical and functional need for service. The provider must refer the member to the quality improvement organization for a functional assessment by the 28th day of the temporary service plan or they must discharge the member.

(a) In self-directed PAS, the health care professional must complete the health care professional authorization form prior to the delivery of services and the provider agency oversight staff must complete and sign the service plan prior to the delivery of services.

(b) In agency-based PAS, the provider agency nurse supervisor must complete and sign the temporary service plan prior to the delivery of services.

(8) The member must agree to accept the provision of PAS as specified in the person-centered service plan.

(9) The PAS provider must have a written complaint process. The member may receive a copy upon request. The provider must adhere to the process for any member complaints related to the person-centered planning and service-delivery process.

(10) The delivery of agency-based PAS must be supervised by a licensed agency nurse. Supervision includes oversight of the training and orientation of direct-care workers.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1115 Self-Directed Personal Assistance Services: Description and Purpose

(1) Self-directed Personal Assistance Services (PAS) are services provided to Medicaid members who choose to take the responsibility or have a representative take the responsibility of managing the PAS. Self-directed PAS allow the member to direct PAS, including health maintenance tasks.

(2) Health maintenance tasks include the following:

(a) urinary systems management;

(b) bowel care;

(d) medication management.

(3) Members must provide their physician or health care professional evidence of ability to manage their PAS and health maintenance tasks.

(a) The scope and detail of the evidence will be determined by the physician or health care professional.

(4) Members who are unable to utilize self-directed PAS may receive services through the agency-based PAS program managed by provider agencies under agreement with Medicaid.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1116 Self-Directed Personal Assistance Services: General Requirements

(1) Self-directed Personal Assistance Services (PAS) may only be delivered by an attendant who is the employee of a Medicaid-enrolled provider and who is selected by the member or their personal representative.

(2) Agency-based PAS managed by provider agencies under agreement with Medicaid are not available to members who are participating in the self-directed PAS program. The use of PAS managed by provider agencies may be permissible in the event that the member's backup plan fails.

(4) Members who have been terminated from the self-directed program may apply for agency-based PAS through the Medicaid PAS program managed by approved provider agencies.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1117 Self-Directed Personal Assistance Services: Member Requirements

(1) To qualify for self-directed Personal Assistance Services (PAS), the member:

(a) must be capable of assuming the management responsibilities of self-directed PAS or have a personal representative willing to assume this responsibility. Management responsibilities include the following:

(i) recruit, hire, schedule, train, and dismiss all personal care attendants;

(iii) review, approve, sign, and date all service delivery records to provide assurance that the service plan has been followed; and

(iv) assume medical and related liability regarding the delivery of PAS.

(b) must obtain authorization from a physician or health care professional to participate in the program;

(d) must be capable of making choices about activities of daily living, understand the impact of these choices, and assume the responsibility of the choices.

(a) is a person who is directly involved in the daily care of the member;

(b) is available to assume the responsibility of managing the member's care, including directing the care as it occurs in the home; and

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1121 Agency-Based and Self-Directed Personal Assistance Services: Termination of Services

(1) Personal Assistance Services (PAS) may be terminated for any of the following reasons:

(b) the member requests termination of services or refuses to accept help;

(d) the member is engaging in illegal activity in the home;

(e) the member's physician requests termination of services;

(f) the member no longer has a medical need for PAS;

(g) the member refuses the services of a direct-care worker based solely or partly on the attendant's race, creed, religion, sex, marital status, color, age, handicap, or national origin;

(h) the member refuses to accept services in compliance with the service plan;

(i) the member refuses to participate in the functional assessment, recertification, and person-centered planning visits; or

(j) the member falsifies the service delivery record.

(2) The department may terminate or reduce PAS when funding for services is unavailable.

(3) The provider must give at least ten days advance notice to a member when PAS are terminated for reasons listed in (1)(f) through (1)(j).

(5) The department will provide written notice to an applicant when PAS are initially denied to the applicant.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1122 Agency-Based and Self-Directed Personal Assistance Services: Provider Enrollment

(1) Providers will enroll as a Personal Assistance Services (PAS) personal care attendant provider. Providers must enroll through the department's fiscal intermediary.

(2) PAS providers must be businesses incorporated under the laws of the state of Montana.

(3) PAS providers must submit a description of the proposed service area which must include, at a minimum, coverage of the entire area of at least one county or Indian reservation.

(4) PAS providers must comply with onsite visit requirements both before and after enrollment to verify information submitted to the department.

(5) PAS providers must provide the documentation to demonstrate the following:

(a) general liability insurance with a minimum coverage of $1,000,000 per occurrence and $2,000,000 aggregate;

(d) verification of completion of the department's mandatory PAS training.

(6) PAS providers will select to deliver either agency-based or self-directed PAS option. Once a provider has completed a successful compliance review the provider may enroll in the other service option.

(7) The department may contract with out-of-state agencies to provide PAS for Montana Medicaid members temporarily living out of state.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1125 Agency-Based and Self-Directed Personal Assistance Services: Conflict-of-Interest Criteria

(1) In order to perform the duties of an agency-based nurse supervisor, self-directed program oversight staff, or the Personal Assistance Services (PAS) provider person-centered plan facilitator the person cannot:

(a) be related by blood or marriage to the member or to any paid caregiver for the member;

(b) be financially responsible to the member;

(d) benefit financially from the provision of assessed need for services;

(e) be employed as a direct-care worker at the agency; or

(f) have a majority ownership stake in the agency.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1126 Agency-Based Personal Assistance Services: Provider Requirements

(1) Providers may enroll as a Personal Assistance Services (PAS) personal care attendant provider.

(2) PAS providers will maintain staff resources, including a nurse supervisor and person-centered plan facilitator, to perform the necessary PAS duties as referenced in ARM 37.40.1114. The nurse supervisor and plan facilitator may be the same person.

(3) PAS nurse supervisors must meet the following criteria:

(a) be a licensed nurse;

(b) have at least one year's experience in aging and disability services;

(d) be free of conflict-of-interest criteria as referenced in ARM 37.40.1125.

(4) PAS plan facilitators must meet the following criteria:

(a) have at least one year's experience in aging and disability services;

(b) receive certification in the person-centered planning process; and

(5) The PAS provider agency must provide documentation to verify the nurse supervisor and plan facilitator credentials, certification, and training.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1127 Self-Directed Personal Assistance Services: Provider Requirements

(1) Self-directed Personal Assistance Services (PAS) providers must employ program oversight staff to perform the following self-directed oversight activities:

(a) assist members to identify resources for personal assistants;

(b) advise the member regarding program requirements;

(d) provide documentation to ensure that the personal representative meets the participation criteria described in ARM 37.40.1117.

(2) Self-directed PAS providers must maintain staff resources, including a program oversight staff and person-centered plan facilitator, to perform the necessary PAS duties as referenced in ARM 37.40.1114. The program oversight staff and person-centered plan facilitator may be the same person.

(3) Self-directed program oversight staff must meet the following criteria:

(a) have at least one year's experience in aging and disability services;

(b) receive training in PAS; and

(4) Self-directed plan facilitators must meet the following criteria:

(a) have at least one year's experience in aging and disability services;

(b) receive certification in the person-centered planning process; and

(5) The PAS provider agency must provide documentation to verify program oversight staff and plan facilitator credentials, certification, and training.

(6) Self-directed PAS provider agencies must act as the employer of record for direct-care workers for the purposes of payroll and federal hiring practices.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14; AMD, 2024 MAR p. 332, Eff. 2/24/24.

Mont. Admin. R. 37.40.1131 Agency-Based Personal Assistance Services: Provider Compliance

(1) Providers of Personal Assistance Services (PAS) will be subject to compliance reviews to provide assurance to the department that services are being provided within the rules and policy of the program.

(3) The reviews will take place at times determined by the department.

(4) The department will determine compliance in the following service delivery areas:

(a) service authorization documentation;

(b) high-risk authorization;

(d) service plan and member choice;

(e) service delivery;

(f) nurse supervision and oversight; and

(g) health and welfare and serious occurrence reports.

(5) The department will determine compliance in the following administrative areas:

(a) attendant training;

(b) staff credentials, certification, and training;

(d) maintenance of serious occurrence reports;

(e) member satisfaction surveys;

(f) required documentation;

(g) agency manuals and handouts, including complaint process;

(h) workers' compensation, liability, and automobile coverage; and

(i) service billing.

(6) The department will determine compliance in the following person-centered planning delivery areas:

(a) plan facilitator certification documentation;

(b) member and plan facilitator rights and responsibility documentation;

(d) risk assessment and mitigation.

(8) The provider will meet all standards in ninety percent of the cases to be considered in compliance. If ninety percent compliance is not met, a second compliance review will be scheduled.

(9) The provider must meet all standards in ninety percent of the cases in the second review or will be subject to department sanctions as provided in ARM 37.85.401.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1132 Self-Directed Personal Assistance Services: Provider Compliance

(1) Providers of self-directed Personal Assistance Services (PAS) will be subject to compliance reviews to provide assurance to the department that services are being provided within the rules and policy of the program.

(3) The reviews will take place at times determined by the department.

(4) The department will determine compliance in the following service delivery areas:

(a) service authorization documentation;

(b) health-care professional authorization;

(d) amendments and temporary authorization;

(e) service plan and member choice;

(f) service delivery;

(g) agency program oversight; and

(h) health and welfare and serious occurrence reports.

(5) The department will determine compliance in the following administrative areas:

(a) staff credentials, certification, and training;

(b) principles of charting;

(d) member satisfaction surveys;

(e) required documentation;

(f) agency manuals and handouts, including complaint process;

(g) workers' compensation, liability, and automobile coverage; and

(h) service billing.

(6) The department will determine compliance in the following person-centered planning delivery areas:

(a) plan facilitator certification documentation;

(b) member and plan facilitator rights and responsibility documentation;

(d) risk assessment and mitigation.

(8) The provider must meet all standards in ninety percent of the cases to be considered in compliance. If ninety percent compliance is not met, a second compliance review will be scheduled.

(9) The provider must meet all standards in ninety percent of the cases in the second review or will be subject to department sanctions as provided in ARM 37.85.401.

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14.

Mont. Admin. R. 37.40.1135 Agency-Based and Self-Directed Personal Assistance Services: Reimbursement

(1) Personal Assistance Services (PAS) may be provided up to, but not more than, 80 hours of attendant service per two-week time period per person as defined by the service profile. The department may, within its discretion, authorize additional hours in excess of this limit. Any services exceeding this limit must be prior authorized by the department. Prior authorization for excess hours may be authorized if additional assistance is required for:

(a) a period of time not to exceed three months and as the result of an acute medical episode;

(b) a period of time not to exceed three months and to prevent institutionalization during the absence of the normal caregiver; or

(2) Add-on payments for direct-care wage, bonus, and health care for health care workers are subject to the requirements in ARM 37.40.1027 and 37.40.1030.

(3) PAS include the following:

(a) personal care attendant service is a 15-minute unit and means an onsite visit specific to a member. Personal care attendant services include the performance of activities of daily living, instrumental activities of daily living, and health maintenance activities. The personal care attendant service rate is an all-inclusive rate and includes the provider agency's administrative, person-centered planning, supervision, and oversight duties;

(b) medical escort is a 15-minute unit and means transportation time and appointment time so the person can access an approved medical appointment; and

(c) mileage is a unit of one mile and means reimbursement for mileage when an attendant uses their vehicle to transport a person on an approved shopping, or medical escort trip.

(4) The department will not reimburse a member for in-home services delivered by a privately retained attendant.

(5) Reimbursement is not available for PAS provided by immediate family members as described in ARM 37.40.1111.

(6) Reimbursement fees for agency-based and self-directed PAS are stated in the department's fee schedule adopted at ARM 37.85.105(4).

History

Authorizing statute(s): 53-2-201, 53-6-101, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2014 MAR p. 3086, Eff. 12/25/14; AMD, 2015 MAR p. 822, Eff. 7/1/15.

Authorizing statute(s): 53-6-113, 53-6-145, MCA
Implementing statute(s): 53-6-101, 53-6-145, MCA
History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; REP, 2014 MAR p. 3086, Eff. 12/25/14.

Subchapter 37.40.14 Home and Community-Based Services

Mont. Admin. R. 37.40.1401 Home and Community-Based Services for Elderly and Physically Disabled Persons Authority and Scope of Program

(1) The United States department of health and human services (HHS) has granted the department, through 42 CFR 441.300 through 441.310, the authority to establish a program of medicaid funded home and community-based services for persons who are elderly or who have physical disabilities and who would otherwise have to reside in and receive medicaid reimbursed care in a hospital or nursing facility.

(2) The department, in accordance with state and federal statutes and rules governing the provision of medicaid funded home and community-based services and any federal-state agreements governing the provision of medicaid funded home and community-based services and within the available funding appropriated for the program, may determine within its discretion:

(a) the types of services to be available through the program;

(b) the amount, scope and duration of the services available through the program;

(d) the total number of persons who may receive services through the program;

(e) the total number of persons who may receive services through the program by category of eligibility, geographical area or specific case management team; and

(f) eligibility of individual persons for the program.

(3) There is no entitlement to eligibility for the program.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-131, 53-6-141 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1402 Home and Community-Based Services for Elderly and Physically Disabled Person: Definitions

(1) "Adult residential care" means a residential habilitation option for consumers residing in an adult foster home, group home, or assisted living facility.

(2) "Case management" means a service that provides the planning for, arranging for, implementation of, and monitoring of the delivery of services available through the program to a consumer.

(3) "Community transitions services" means nonrecurring set-up expenses for individuals who are transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses.

(4) "Consultative clinical and therapeutic services" means services that assist unpaid and/or paid caregivers in carrying out individual service plans and are necessary to improve the individual's independence and inclusion in the community.

(5) "Consumer-directed goods and services" means services, supports, supplies, or goods not otherwise provided through this waiver or the Medicaid state plan.

(6) "Family training and support" means a service that provides training to families and others who work or play with a child with a disability.

(7) "Financial management services" means services provided by an individual called a financial manager who provides finance, employer, payroll, and related functions for the consumer or personal representative.

(8) "Habilitation" means the provision of intervention services designed for assisting a consumer to acquire, retain, and improve the self-help, socialization, and adaptive skills necessary to reside successfully at home and in the community.

(9) "Health and wellness" means services that assist consumers in acquiring, retaining, and improving self-help, socialization, and adaptive skills to reside successfully in the community.

(10) "Homemaker chore" means services provided for individuals who are unable to manage their own home or when the consumer, normally responsible for homemaking, is absent.

(11) "Independence advisor services" means services that provide an array of consumer-directed support activities to ensure the ability of consumers to direct their care successfully.

(12) "Nonmedical transportation" means the provision to a consumer of transportation through common carrier or private vehicle for access to social or other nonmedical activities.

(13) "Pain and symptom management" means a service that allows the provision of traditional and nontraditional methods of pain management.

(14) "Participant direction" means an option available to individuals who elect to direct their own care and that participants, or their representatives, have decision-making authority over certain services and take direct responsibility to manage their services with the assistance of a system of available support.

(15) "Personal assistant services" (PAS) is defined at 53-6-145, MCA and includes attendant PAS and socialization/supervision PAS.

(16) "Post-acute rehabilitation services" means the provision of therapeutic intervention to a consumer with a brain injury or other related disability in a residential or nonresidential setting.

(17) "Respite care" means the provision of supportive care to a consumer to relieve those unpaid persons normally caring for the consumer from that responsibility.

(18) "Senior companion" means services directed at providing companionship and assistance.

(19) "Serious occurrence" means a significant event which affects the health, welfare, and safety of an individual served in home and community-based services. The department has established a system of reporting and monitoring serious incidents that involve consumers served by the program in order to identify, manage, and mitigate overall risk to the individual.

(20) "Service plans" means a written plan of supports and interventions based on an assessment of the status and needs of a consumer.

(21) "Specialized child care for medically fragile children" means the provision of day care, respite care, and other direct and supportive care to a consumer under 18 years of age who is medically fragile and who, due to medical and other needs, cannot be served through traditional child care settings.

(22) "Specially trained attendant care" means an option under personal assistance that is the provision of supportive services to a consumer residing in their own residence.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11; AMD, 2024 MAR p. 2273, Eff. 9/21/24; AMD, 2025 MAR, Notice No. 2025-524, Eff. 11/22/25.

Mont. Admin. R. 37.40.1406 Home and Community-Based Services for Elderly and Physically Disabled Persons: Services

(1) The services available through the program are limited to those specified in this rule.

(2) The department may determine the particular services of the program to make available to a recipient based on, but not limited to, the following criteria:

(a) the recipient's need for a service generally and specifically;

(b) the availability of a specific service through the program and any ancillary service necessary to meet the recipient's needs;

(c) the availability otherwise of alternative public and private resources and services to meet the recipient's need for the service;

(d) the recipient's risk of significant harm or of death if not in receipt of the service;

(e) the likelihood of placement into a more restrictive setting if not in receipt of the service; or

(f) the financial costs for and other impacts on the program arising out of the delivery of the service to the person.

(3) A person enrolled in the program may be denied a particular service available through the program that the person desires to receive or is currently receiving.

(4) Bases for denying a service to a person include, but are not limited to:

(a) the person requires more supervision than the service can provide;

(b) the person's needs, inclusive of health, can no longer be effectively or appropriately met by the service;

(c) access to the service, even with reasonable accommodation, is precluded by the person's health or other circumstances;

(d) a necessary ancillary service is no longer available; and

(e) the financial costs for and other impacts on the program arising out of the delivery of the service to the person.

(5) The department may make program services for persons with intensive needs available to a recipient whom it determines, based on past medical history and current medical diagnosis, would otherwise require on a long-term basis the level of care of an inpatient hospital or a rehabilitation service setting.

(6) The following services, as defined in these rules, may be provided through the program:

(a) adult day health;

(b) adult residential care;

(d) community transition services;

(e) consultative clinical and therapeutic services;

(f) consumer-directed goods and services;

(g) day habilitation;

(h) dietetic services;

(i) environmental accessibility adaptations;

(j) family training and support;

(k) financial management;

(l) habilitation;

(m) health and wellness;

(n) homemaker chore services;

(o) homemaker;

(p) independence advisor;

(q) nonmedical transportation;

(r) nursing;

(s) nutrition services;

(t) occupational therapy;

(u) pain and symptom management;

(v) personal assistance;

w) personal emergency response systems;

(x) physical therapy;

(y) post-acute rehabilitation services;

(z) respiratory therapy;

(aa) respite care;

(bb) senior companion services;

(cc) speech pathology and audiology;

(dd) specially trained attendants;

(ee) specialized child care for medically fragile children;

(ff) specialized medical equipment and supplies; and

(gg) vehicle modifications.

(7) Monies available through the program may not be expended on the following:

(a) room and board;

(b) special education and related services as defined at 20 USC 1401(16) and (17); and

(8) The program is considered the payor of last resort. A service available through the program is not available to any extent that a service of another program is otherwise available to a recipient to meet the recipient's need for that service.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11; AMD, 2025 MAR, Notice No. 2025-524, Eff. 11/22/25.

Mont. Admin. R. 37.40.1407 Home and Community-Based Services for Elderly and Physically Disabled Persons: General Requirements

(1) Services of the program may only be provided by a provider that is enrolled with the department as a Medicaid provider or, in rare instances, through a provider with whom the department is contracting for home and community-based case management services.

(2) A facility providing services to a recipient must meet all licensing requirements including fire and safety standards as well as other service-specific requirements set forth by the department in this chapter.

(3) A provider of services must ensure that the services adhere to the requirements of 42 CFR 441.301(c)(4), which permits reimbursement with Medicaid monies only for services within settings that meet certain qualities set forth under the regulation. These qualities include that the setting:

(a) is integrated in and facilitates full access of the individual to the greater community;

(b) ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid Home and Community-Based Services;

(c) is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting;

(d) ensures the individual's rights of privacy, dignity, and respect, and freedom from coercion and restraint;

(e) supports health and safety based upon the individual's needs, decisions, or desires;

(f) optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including, but not limited to daily activities, physical environment, and with whom to interact;

(g) provides an opportunity to seek employment and work in competitive integrated settings; and

(h) facilitates individual choice of services and supports, and who provides them.

(4) A provider of services must meet the requirements necessary for the receipt of reimbursement with Medicaid monies.

(5) A provider must ensure that services adhere to the requirements of ARM 37.85.405.

(6) Immediate family members and legally responsible individuals may be paid for the provision of certain services under the following conditions:

(a) the service is identified in the federally approved waiver;

(b) the service is specified in the individual's service plan;

(c) the family member or legally responsible individual meets the provider qualifications and training standards for that service as specified in the federally approved waiver;

(d) the services do not supplant tasks that are customarily performed by legally responsible individuals; and

(e) the family member or legally responsible individual may not provide more than 40 hours of service in a seven-day period.

(7) Immediate family members include:

(a) a spouse; and

(b) a natural or adoptive parent of a minor child.

(8) A provider may also provide support to other family members in the recipient's household during hours of program reimbursed service if approved by the case management team or FM.

(9) The department adopts and incorporates by reference 42 CFR 441.301(c)(4), as amended January 16, 2014. A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Services, Senior & Long-Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11; AMD, 2024 MAR p. 612, Eff. 3/23/24; AMD, 2025 MAR, Notice No. 2025-523, Eff. 11/22/25.

Mont. Admin. R. 37.40.1408 Home and Community-Based Services for Elderly and Physically Disabled Persons: Enrollment

(1) A person in order to be considered by the department for enrollment in the program, must be determined by the department to qualify for enrollment in accordance with the criteria in this rule.

(2) A person is qualified to be considered for enrollment in the program if the person:

(a) meets one of the following criteria:

(i) is 65 years of age or older; or

(ii) is certified as disabled by the social security administration but does not have a primary diagnosis of mental retardation or serious mental illness.

(b) is Medicaid eligible;

(c) requires the level of care of a nursing facility as determined in accordance with the preadmission screening provided for in ARM 37.40.202, 37.40.205, 37.40.206, and 37.40.207; and

(d) has needs that can be met through the program.

(3) The department considers for an available opening for services those persons who, as determined by the department:

(a) are actively seeking services;

(b) are in need of the services available;

(d) have a projected total cost of service plan that is within the limits specified at ARM 37.40.1421.

(4) The department offers an available opening for services to the person, as determined by the department, who is most in need of the available services and most likely to benefit from the available services.

(5) Factors to be considered in the determinations of whether a person is in need of the available services and likely to benefit from those services and as to which person is most likely to benefit from the available services include, but are not limited to, the following:

(a) medical condition;

(b) degree of independent mobility;

(d) presence of problems with judgment;

(e) presence of a cognitive impairment;

(f) prior enrollment in the program;

(g) current institutionalization or risk of institutionalization;

(h) risk of physical or mental deterioration or death;

(i) willingness to live alone;

(j) adequacy of housing;

(k) need for adaptive aids or environmental modifications;

(l) need for 24-hour supervision;

(m) need of person's caregiver for relief;

(n) need, in order to receive services, of a waiver of the Medicaid deeming financial eligibility requirement;

(o) appropriateness for the person, given the person's current needs and risks, of services available through the program;

(p) status of current services being purchased otherwise for the person; and

(q) status of support from family, friends, and community.

(6) A person enrolled in the program may be removed from the program by the department. Bases for removal from the program, include, but are not limited to, the following:

(a) a determination by the case management team or program managers that the services, as provided for in the service plan, are no longer appropriate or effective in relation to the person's needs;

(b) the failure of the person to use the services as provided for in the service plan;

(c) the behaviors of the person place the person, caregivers or others at serious risk of harm or substantially impede the delivery of services as provided for in the service plan;

(d) the health of the person is deteriorating or in some other manner placing the person at serious risk of harm;

(e) a determination by the case management team or program managers that the service providers necessary to the delivery of services as provided for in the service plan are unavailable; and

(f) a determination that the total cost of service plan is not within the limits specified at ARM 37.40.1421.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-131, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1409 Home and Community Based Services for Elderly and Disabled Persons: Quality Assurance Reviews

(1) As used in this rule, the term "provider" means case management teams, independence advisors, and financial managers.

(2) The department will conduct comprehensive provider evaluations at least once every three years, to assure 1915(b) and 1915(c) waivers meet department and federal quality assurance requirements pursuant to 42 CFR 441.302.

(3) The department will conduct quality assurance reviews (QARs) on the provider's premises and/or through desk audits. Upon the department's request, providers must supply the documentation that the department determines is necessary to complete a QAR no later than 30 days following the request for documentation.

(4) The department will determine when reviews will take place. The department will assess compliance with the following service delivery standards:

(a) required documentation;

(b) service plan completeness;

(d) health and safety requirements;

(e) principles of charting;

(f) waitlist requirements;

(g) plan facilitator requirements; and

(h) financial accountability.

(5) The department will assess compliance with the following standards related to provider-prepared areas:

(a) administration and use of the member survey;

(b) case manager qualifications;

(d) serious occurrence reporting requirements; and

(e) quality improvement project reporting.

(6) The department will review a provider's case samples comprising at least 10 percent of Big Sky Waiver members, along with a 5 percent random sample of members admitted during the specific review period.

(7) Compliance requires that the provider meet all established standards in 86 percent of the cases reviewed, under both service delivery and provider-prepared standards.

(a) If compliance is below 86 percent in both areas, or if it is 50 percent or less in one or both areas, the next QAR will be scheduled within one year.

(b) If compliance is below 86 percent in one or two areas, but more than 50 percent in both areas, the next QAR will be scheduled within two years.

(8) Incidents of non-compliance identified through a quality assurance communication (QAC) require a remediation plan or recovery of HCBS funds. Any QACs must be responded to and resolved by a provider within 30 days.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 2025 MAR, Notice No. 37-1089, Eff. 1/11/25.

Mont. Admin. R. 37.40.1415 Home and Community Based Services for Elderly and Physically Disabled Persons: Reimbursement

(1) Services available through the program are reimbursed as specified in this rule.

(2) The following services are reimbursed as provided in (3):

(a) adult day health;

(b) adult residential care;

(d) community transition services;

(e) consultative clinical and therapeutic services;

(f) consumer-directed goods and services;

(g) dietetic services;

(h) environmental accessibility adaptations;

(i) family training and support;

(j) financial management;

(k) habilitation;

(l) health and wellness;

(m) homemaker chore services;

(n) homemaker;

(o) independence advisor;

(p) nonmedical transportation;

(q) nursing;

(r) nutrition services;

(s) pain and symptom management;

(t) personal emergency response systems;

(u) post-acute rehabilitation services;

(v) respite care;

(w) senior companion services;

(x) specialized child care for medically fragile children; and

(y) vehicle modifications.

(3) The services specified in (2) are, except as otherwise provided in (4), reimbursed at the lower of the following:

(a) the provider's usual and customary charge for the service; or

(b) the rate negotiated with the provider by the case management team up to the department's maximum allowable fee.

(4) The services specified in (2) are reimbursed as provided in (3) except that reimbursement for components of those services that are incorporated by specific cross reference from the general Medicaid program may only be reimbursed in accordance with the reimbursement methodology applicable to the component service as a service of the general Medicaid program.

(5) The following services are reimbursed in accordance with the referenced provisions governing reimbursement of those services through the general Medicaid program:

(a) personal assistance as provided at ARM 37.40.1105 and 37.40.1302;

(b) outpatient occupational therapy as provided at ARM 37.86.610;

(d) speech therapy as provided at ARM 37.86.610; and

(e) audiology as provided at ARM 37.86.705.

(6) Case management services are reimbursed, as established by contractual terms, on either a per diem or hourly rate.

(7) Respite care services provided by a nursing facility are reimbursed at the rate established for the facility in accordance with ARM Title 37, chapter 40, subchapter 3.

(8) Specialized medical equipment and supplies are reimbursed as follows:

(a) equipment and supplies which are reimbursable under ARM 37.86.1801, 37.86.1802, 37.86.1806, and 37.86.1807 shall be reimbursed as provided in ARM 37.86.1807;

(b) equipment and supplies which are not reimbursable under ARM 37.86.1801, 37.86.1802, 37.86.1806, and 37.86.1807 shall be reimbursed at the lower of the following:

(i) the provider's usual and customary charge for the item; or

(ii) the negotiated rate up to the department's maximum allowable fee.

(9) Reimbursement is not available for the provision of a service to a person that may be reimbursed through another program.

(10) No copayment is imposed on services provided through the program but recipients are responsible for copayment on other services reimbursed with Medicaid monies.

(11) Reimbursement is not available for the provision of services to other members of a recipient's household or family unless specifically provided for in these rules.

(12) Payment for the following services may be made to legally responsible individuals, if all program criteria in ARM 37.40.1407 are met:

(a) personal assistance;

(b) homemaker;

(d) specialized child care for medically fragile children;

(e) private duty nursing;

(f) transportation;

(g) respite;

(h) consumer-directed goods and services;

(i) homemaker chore;

(j) pain and symptom management;

(k) vehicle modifications; and

(l) environmental accessibility adaptations.

(13) When the Legislature funds a direct care wage initiative, waiver providers targeted by the initiative must report to the department, for a determined time period, actual hourly wage and benefit rates paid for all direct care workers or the lump sum payment amounts for all direct care workers that will receive the benefit of the increased funds. The reported data shall be used by the department for the purpose of tracking distribution of direct care wage funds to designated workers.

(a) The department will pay targeted waiver providers that submit an approved request to the department a lump sum payment in addition to the Medicaid reimbursement rate to be used only for wage and benefit increases or lump sum payments for direct care workers.

(b) To receive the direct care workers' lump sum payment, a targeted provider shall submit for approval a request form to the department stating how the direct care workers' lump sum payment will be spent to comply with all department requirements. The provider shall submit all of the information required on the form in order to continue to receive subsequent lump sum payment amounts.

(c) If these funds will be distributed in the form of a wage increase to direct care workers the form for wage and benefit increases will request information including, but not limited to:

(i) the number of category of each direct care worker that will receive the benefit of the increased funds;

(ii) the actual per hour rate of pay before benefits and before the direct care wage increase has been implemented for each worker that will receive the benefit of the increased funds;

(iii) the projected per hour rate of pay with benefits after the direct wage increase has been implemented;

(iv) the number of staff receiving a wage or benefit increase by category of worker, effective date of implementation of the increase in wage and benefit; and

(v) the number of projected hours to be worked in the budget period.

(d) If these funds will be used for the purpose of providing lump sum payments (i.e., bonus, stipend, or other payment types) to direct care workers the form will request information including, but not limited to:

(i) the number of category of each direct care worker that will receive the benefit of the increased funds;

(ii) the type and actual amount of lump sum payment to be provided for each worker that will receive the benefit of the lump sum funding;

(iii) the breakdown of the lump sum payment by the amount that represents benefits and the direct payment to workers by category of worker; and

(iv) the effective date of implementation of the lump sum benefit.

(e) A provider that does not submit a qualifying request for use of the funds distributed under (2), or does not include all of the information requested by the department, within the time established by the department, or a provider that does not wish to participate in this additional funding amount shall not be entitled to their share of the funds available for wage and benefit increases or lump sum payments for direct care workers.

(14) A provider that receives funds under this rule must maintain appropriate records documenting the expenditure of the funds. This documentation must be maintained and made available to authorize governmental entities and their agents to the same extent as other required records and documentation under applicable Medicaid record requirements, including but not limited to the provisions of ARM 37.40.345, 37.40.346, and 37.85.414.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2004 MAR p. 82, Eff. 1/1/04; AMD, 2011 MAR p. 1722, Eff. 8/26/11; AMD, 2025 MAR, Notice No. 2025-524, Eff. 11/22/25.

Mont. Admin. R. 37.40.1420 Home and Community-Based Services for Elderly and Physically Disabled Persons: Service Plans

(1) A service plan is a written plan of supports and interventions based on an assessment of the status and needs of a consumer. The service plan describes the needs of the consumer and the services available through the program and otherwise that are to be made available to the consumer in order to maintain the consumer at home and in the community.

(2) The services that a consumer may receive through the program and the amount, scope, and duration of those services must be specifically authorized in writing through an individual service plan.

(3) The service plan is initially developed upon the person's entry into the program. The plan must be reviewed and, if necessary, revised at intervals of at least six months beginning with the date of the initial service plan.

(4) The service plan is developed in conjunction with the consumer or the consumer's legal representative, with treating and other appropriate health care professionals and others who have knowledge of the consumer's needs.

(5) Each service plan must include the following:

(a) diagnosis, symptoms, complaints, and complications indicating the need for services;

(b) a description of the consumer's functional level;

(d) medication;

(e) treatments;

(f) restorative and rehabilitative services;

(g) activities;

(h) therapies;

(i) social services;

(j) diet;

(k) other special procedures recommended for the health and safety of the consumer to meet the objectives of the service plan;

(l) the specific services to be provided, the frequency of the services, and the type of provider to provide them;

(m) the projected annualized costs of each service; and

(n) names and signatures of all persons who have participated in developing the service plan (including the consumer, unless the consumer's inability to participate is documented) which will verify participation, agreement with the service plan, and acknowledgement of the confidential nature of the information presented and discussed.

(6) The consumer must be provided a copy of the service plan to the consumer.

(7) Service plan approval is based on:

(a) completeness of plan;

(b) consistency of plan with screening criteria; and

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1421 Home and Community-Based Services for Elderly and Physically Disabled Persons: Cost of Service Plan

(1) In order to maintain the program cost within the appropriated monies, the cost of service plans may be limited by the department collectively and individually.

(2) The total annual cost of services for each recipient, except as provided in (3), may not exceed a maximum amount set by the department based on the number of recipients and the amount of monies available to the program as authorized in appropriation by the Legislature.

(3) The total cost of services provided under a service plan for an individual may exceed the maximum amount set by the department if authorized by the department based on the department's determination that one or more of the following circumstances is applicable:

(a) the excess service need is short term and only a one time purchase is necessary;

(b) the excess service need is intensive services of 90 days or less which are necessary to:

(i) resolve a crisis situation which threatens the health and safety of the recipient;

(ii) stabilize the recipient following hospitalization or acute medical episode; or

(iii) prevent institutionalization during the absence of the normal caregiver;

(d) the recipient has long term needs that result in the maximum amount being exceeded in minor amounts at various times.

(4) The cost of services to be provided under a service plan is determined prior to implementation of the proposed plan of care and may be revised as necessary after implementation.

(5) A cost determination for the services provided under a service plan may be made at any time that there is a significant revision in the service plan.

(6) The provider reimbursement rate for a covered service for home and community-based services for elderly and physically disabled persons, except as otherwise provided in ARM 37.40.1415, is stated in the department's fee schedule adopted and effective at 37.85.105. These fees are calculated based on:

(a) the biennial Legislative appropriation; and

(b) the estimated demand for covered services during the biennium.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1713, Eff. 8/26/11.

Mont. Admin. R. 37.40.1422 Home and Community-Based Services for Elderly and Physically Disabled Persons: Community Transition Services, Requirements

(1) Community transition services is defined in ARM 37.40.1402.

(2) Allowable expenses are those necessary to enable a person to establish a basic household and may include:

(a) usual and customary security deposits that are required to obtain a lease on an apartment or home;

(b) essential household furnishings required, including furniture, window coverings, food preparation items, and bed/bath linens;

(d) usual and customary setup fees or deposits for utility or service access, including telephone, electricity, heating, and water;

(e) activities to assess need, arrange for and procure resources.

(3) Community transition services do not include monthly rental or mortgage expenses, food, regular utility charges, household appliances, or items that are intended for purely diversion/recreational purposes.

(4) Refunded security deposits must be paid to the department.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1423 Home and Community-Based Services for Elderly and Physically Disabled Persons: Financial Management, Requirements

(1) Financial management (FM) service is defined in ARM 37.40.1402.

(2) The financial manager acts as the common law employer (employer of record) and the consumer acts as the managing employer. Since the financial manager is the employer, this entity is responsible for all employee-related expenses and liability risks that may be incurred if a worker's compensation or unemployment claim is filed.

(3) On behalf of the consumer/personal representative the financial manager will:

(a) accept referral from the consumer/personal representative to process the employment packet;

(b) prepare and distribute an application package of information that is clear and easy for the potential employee to understand and follow;

(c) provide needed counseling and technical assistance regarding the role of the FM to consumer, their personal representatives, and others;

(d) process employment application package and documentation for prospective individual to be employed (as agency employee);

(e) complete criminal background checks on prospective consumer-referred worker and maintain results on file, if requested by the consumer;

(f) establish and maintain record for each individual employed and process all employment records;

(g) withhold, file, and deposit Federal Insurance Contributions Act (FICA), Federal Unemployment Tax Act (FUTA), and State Unemployment Tax Act (SUTA) taxes in accordance with Federal Internal Revenue Service (IRS), Federal Department of Labor (DOL), and state rules (if applicable);

(h) process all judgments, garnishments, tax levies or any related holds on a consumer's worker as may be required by local, state, or federal laws;

(i) generate and distribute IRS W-2s and 1099s, wage and tax statements and related documentation annually to all member-employed providers who meet the statutory threshold earnings, amounts during the tax year by January 31st;

(j) withhold, file, and deposit federal and state income taxes (if applicable) in accordance with federal IRS and state Department of Revenue Services rules and regulation;

(k) administer benefits for member-employed providers (if applicable);

(l) generate payroll checks in a timely and accurate manner, as approved in the consumer's self-direct spending plan, and in compliance with all federal and state regulations;

(m) develop a method of payment of invoices and monitoring expenditures against the self-direct spending plan for each consumer;

(n) receive, review, and process all invoices from individuals, vendors, or agencies providing consumer-directed goods or services as approved in the consumer's self-direct spending plan authorized by the division;

(o) process and pay non-labor-related invoices;

(p) generate utilization reports along with payroll reflecting accurate balances for a consumer/personal representative, independence advisor, the regional program officer (RPO), and the division;

(q) establish and maintain all consumer records with confidentiality, accuracy, and appropriate safeguards;

(r) respond to calls for consumer or their personal representatives and employees regarding issues such as withholdings and net payments, lost or late checks, reports, and other documentation;

(s) file claims through the Medicaid Management Information System (MMIS) for consumer-directed goods and services and prepare checks for individually hired workers; and

(t) generate service management and statistical information and reports.

(4) This is a mandatory service for consumer-direction.

(5) The fiscal manager provider must be certified by the department to provide the service.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1424 Home and Community-Based Services for Elderly and Physically Disabled Persons: Independence Advisor, Requirements

(1) Independence advisor (IA) is defined in ARM 37.40.1402.

(2) The IA may help consumers or their personal representatives:

(a) learn how to successfully direct services;

(b) develop a service plan;

(c) access waiver services, Medicaid State Plan services, and other needed medical, social, or educational services regardless of funding source;

(d) develop, implement, and monitor a monthly spending plan;

(e) identify risks and develop a plan to manage those risks;

(f) develop an individualized emergency backup plan;

(g) negotiate payments for necessary and allowable goods and services;

(h) work with the financial manager (FM) to track expenditures;

(i) monitor the provision of the services to ensure the consumer's health and welfare; and

(j) coordinate with the FM to ensure that consumers or personal representatives budget appropriately to meet their needs as defined in the service plan.

(3) This is a mandatory service for consumer-direction.

(4) An IA must be certified by the department to provide the service.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1425 Home and Community-Based Services for Elderly and Physically Disabled Persons: Consumer-Directed Goods and Services, Requirements

(1) Consumer directed goods and services is defined in ARM 37.40.1402.

(2) These items could include the purchase of appliances and vans, with or without modifications.

(3) These items or services must address an identified need in the consumer's service plan and must meet any or all of the following requirements:

(a) decrease the need for other Medicaid services;

(b) promote inclusion in the community;

(d) fulfill a medical, social, or functional need based on unique cultural approaches; or

(e) increase the person's safety in the community or home environment.

(4) Goods and services purchased must meet the following criteria:

(a) meet the consumer's identified needs and outcomes as outlined in their service plan;

(b) collectively must provide an alternative to institutional placement;

(d) be of sole benefit to the consumer.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1426 Home and Community-Based Services for Elderly and Physically Disabled Persons: Notice and Fair Hearing

(1) The department provides written notice to an applicant for a consumer of services when a determination is made by the department concerning:

(a) financial eligibility;

(b) level of care;

(d) termination of consumer's eligibility for the program.

(2) The department provides a consumer of services with notice ten working days before termination of services due to a determination of ineligibility.

(3) A person aggrieved by any adverse final determinations as listed in (1)(a) through (1)(d) or any adverse determinations regarding services in the service plan may request a fair hearing as provided in ARM 37.5.304, 37.5.307, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(4) Fair hearings will be conducted as provided for in ARM

37.5.304, 37.5.307, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1427 Home and Community-Based Services for Elderly and Physically Disabled Persons: Family Training and Support, Requirements

(1) Family training and support is defined in ARM 37.40.1402. Services include:

(a) general orientation about the child's disability; and

(b) training specific to the needs of the child and his or her family on how to best meet the child's needs.

(2) Providers of this service may:

(a) serve as consultants to families in terms of developmental stages and teaching activities that families can engage in with their child that help in the developmental process;

(b) collaborate with case managers and families to develop strategies for environmental modifications or adaptations that would be beneficial to the child;

(c) periodically assess the child, including conducting developmental assessments, in order to discover unmet needs, determine progress or lack of progress, and identify areas of strength that can be emphasized;

(d) provide emotional support to families, including active listening, problem solving;

(e) recommend resources within the community that could offer support;

(f) advocate for the family; and

(g) assist the family with transition and referral to special education.

(3) The provider of this service must be an employee of a Child and Family Services provider under contract with the Developmental Services Division.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1428 Home and Community-Based Services for Elderly and Physically Disabled Persons: Pain and Symptom Management, Requirements

(1) Pain and symptom management is defined in ARM 37.40.1402.

(2) Treatments include but are not limited to:

(a) acupuncture;

(b) reflexology;

(d) craniosacral therapy;

(e) hyperbaric oxygen therapy;

(f) mind-body therapies such as hypnosis and biofeedback;

(g) pain mitigation counseling/coaching;

(h) chiropractic therapy; and

(i) nursing services by a nurse specializing the pain and symptom management.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 2045, Eff. 8/26/11.

Mont. Admin. R. 37.40.1430 Home and Community-Based Services for Elderly and Physically Disabled Persons: Case Management, Requirements

(1) Case management is the planning for, arranging for, implementation of and monitoring of the delivery of services available through the program to a consumer.

(2) Case management services includes:

(a) developing a service plan for a consumer;

(b) monitoring and managing a service plan for a consumer;

(d) maximizing a consumer's efficient use of services and community resources such as family members, church members and friends;

(e) facilitating interaction among people working with a consumer;

(f) prior authorizing the provision of all services; and

(g) managing expenditures.

(3) The case management team consists of a registered nurse and a social worker.

(4) The case management team must:

(a) function as directed by the department;

(b) assure that services provided to consumers are of appropriate quality and cost effective;

(d) manage expenditures within the allocated monies; and

(e) meet the department's reporting requirements.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1431 Home and Community-Based Services for Elderly and Physically Disabled Persons: Homemaker Chore, Requirements

(1) Homemaker chore services is defined in ARM 37.40.1402. Services include:

(a) extensive cleaning beyond the scope of general household cleaning; and

(b) heavy cleaning such as:

(i) washing windows and walls;

(ii) yard care;

(iii) walkway maintenance;

(iv) minor home repairs; and

(v) firewood cutting, splitting, and stacking.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1435 Home and Community-Based Services for Elderly and Physically Disabled Persons: Adult Residential Care, Requirements

(1) Adult residential care services consist of the following categories: level 1 services, level 2 services, level 3 services, and group home services.

(2) Level 1 services are available in licensed adult foster care homes and licensed assisted living categories A, B, and C.

(3) Level 2 services are available in assisted living categories A, B, and C. Level 2 services consist of behavior management support services and include an enhanced rate to reimburse facilities for added supports for members who have disruptive behaviors associated with a medical diagnosis that occur four or more times per week.

(a) The following requirements apply to level 2 services:

(i) the services must be pre-authorized by the department;

(ii) the member must have received level 1 services for at least the past 30 days;

(iii) the facility must submit to the department a member-focused summary outlining the proposed plan of care to which the services will be applied;

(iv) the facility must provide documentation of past attempts to remedy the member's disruptive behavior that includes, at a minimum, the member's assisted living service plan, progress notes, charting, and any other applicable/relevant medical records;

(v) all staff providing direct services to members receiving level 2 services must receive eight hours of mandatory training annually that is specific to the needs and diagnosis of the member receiving support. Trainings must be documented, and training records must be available for inspection by the department upon request; and

(vi) all staff providing direct services to members receiving level 2 services must also receive eight hours of mandatory training annually, in the areas of traumatic brain injury, spectrum disorders, substance abuse, dementia/Alzheimer's, and other conditions which may be associated with behavioral issues. Trainings must be documented, and training records must be available for inspection by the department upon request.

(b) Level 2 services may be approved on a temporary or long-term basis depending on the individual member's circumstances and/or actual outcomes.

(c) Assisted living facilities providing specialized adult residential services and group homes are not eligible for the level 2 enhanced rate as reimbursement for behavioral support services is covered under the level 3 and group home rates.

(4) Level 3 services are specialized adult residential care services provided in licensed assisted living categories A, B, and C facilities that specialize in the care of individuals with brain injuries or other severe physical disabilities.

(5) Group home adult residential care services are provided in licensed community homes for persons with physical disabilities.

(6) Adult residential care services provided in a category B or C assisted living facility must be pre-authorized by the department.

(7) Adult residential care services must be provided using a person-centered planning process in accordance with 42 CFR 441.725, as amended May 10, 2024, which the department adopts and incorporates by reference. A copy of this federal regulation may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210 or by visiting https://www.ecfr.gov/.

(8) Adult residential care is a bundled service that includes:

(a) personal care services;

(b) homemaking;

(d) recreational activities;

(e) medication monitoring and management; and

(f) assistance in arranging for medical and non-medical transportation.

(9) Adult residential care must provide for 24-hour onsite response staff to meet members' scheduled and unscheduled needs.

(10) A recipient of adult residential care may not receive the following services through the program:

(a) personal assistance as specified at ARM 37.40.1447;

(b) homemaking services as specified at ARM 37.40.1450;

(d) respite care as specified at ARM 37.40.1451; and

(e) nutrition as specified in ARM 37.40.1476.

(11) Adult residential care facilities must be licensed by the state of Montana.

(12) A provider of adult residential care must report serious occurrences to the department in accordance with serious occurrence policy requirements.

(13) Provider owned or leased settings where Home and Community-Based services are furnished must be compliant with the Americans with Disabilities Act, 42 U.S.C. § 12101, et seq.

(14) The department may authorize retainer payments, billed at the facility provider rate when the member is absent from an adult residential care facility due to hospitalization, admission to a nursing facility, or vacation (absence from services), for a period not exceeding 30 days per service plan year subject to the following conditions:

(a) The facility may not bill Medicaid for services on days the member is absent from the facility unless retainer-day payments have been pre-authorized by the resident's case management team.

(b) The facility may bill for the date of admission to and discharge from a hospital or nursing facility.

(c) If the member is transferring from one residential care setting to another, the discharging facility may not bill for the day of transfer.

(d) Retainer payments may not be used while a member resides in the Montana State Hospital.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11; AMD, 2024 MAR p. 2273, Eff. 9/21/24.

Mont. Admin. R. 37.40.1436 Home and Community-Based Services for Elderly and Physically Disabled Persons: Community Supports Services, Requirements (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11; REP, 2025 MAR, Notice No. 2025-524, Eff. 11/22/25.

Mont. Admin. R. 37.40.1437 Home and Community-Based Services Treatment for Elderly and Physically Disabled Persons: Community Residential Rehabilitation, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; REP, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1438 Home and Community-Based Services for Elderly and Physically Disabled Persons: Supported Living, Requirements (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11; REP, 2025 MAR, Notice No. 2025-524, Eff. 11/22/25.

Mont. Admin. R. 37.40.1439 Home and Community-Based Services for Elderly and Physically Disabled Persons: Senior Companion Services, Requirements

(1) Senior companion services is defined in ARM 37.40.1402.

(2) The service includes:

(a) respite;

(b) socialization;

(d) homemaking.

(3) Providers of this service are Senior Companion Programs that are a part of Senior Corps.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1440 Home and Community-Based Services for Elderly and Physically Disabled Persons: Participation Direction

(1) Participant direction is defined in ARM 37.40.1402.

(2) Services may be directed by:

(a) an adult who has the capacity to self-direct;

(b) a legal representative of the member, including a parent, spouse, or legal guardian; or

(3) The person directing the services must:

(a) be 18 years of age or older;

(b) successfully complete required training for self-direction; and

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1441 Home and Community-Based Services for Elderly and Physically Disabled Persons: Health and Wellness, Requirements

(1) Health and wellness services is defined in ARM 37.40.1402.

(2) The service includes adaptive health, wellness, and therapeutic recreational services such as:

(a) hippotherapy;

(b) hydrotherapy;

(d) access to fitness and exercise facilities.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-402, MCA
History: NEW, 2011 MAR p. 2045, Eff. 8/26/11.

Mont. Admin. R. 37.40.1445 Home and Community-Based Services for Elderly and Physically Disabled Persons: Adult Day Health

(1) Adult day health is the provision of services to meet the health, social and habilitation needs of a recipient in settings outside the recipient's place of residence. An entity providing adult day health services must be licensed as provided at ARM 16.32.1001, et seq.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1446 Home and Community-Based Services for Elderly and Physically Disabled Persons: Post-Acute Rehabilitation Services, Requirements

(1) Post-acute rehabilitation is the provision of therapeutic intervention to a consumer with brain injury or other related disability in a residential or nonresidential setting. Post-acute rehabilitation assists in reducing the dependency of the consumer and in facilitating the integration of the consumer into the community.

(2) Post-acute rehabilitation may include:

(a) consultative clinical and therapeutic services as specified at ARM 37.40.1465;

(b) chemical dependency counseling as specified at ARM 37.40.1466;

(d) nutrition services as specified in ARM 37.40.1476;

(e) nonmedical transportation as specified at ARM 37.40.1488; and

(f) counseling.

(3) An entity providing post-acute rehabilitation services must be under the direction of an interdisciplinary team consisting of a licensed psychologist, a licensed neuropsychologist, a board-certified physiatrist, therapists, and other appropriate support staff.

(4) An entity providing post-acute rehabilitation services must be accredited or in the process of becoming accredited by the commission on accreditation of rehabilitation facilities (CARF) as a community reentry program for persons with brain injury.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1447 Home and Community-Based Services for Elderly and Physically Disabled Persons: Personal Assistance, Requirements

(1) Personal assistance is the provision of an array of personal care and other services to a recipient for the purpose of meeting personal needs in the home and the community.

(2) Personal assistance services includes the provision of the following services:

(a) personal care services as specified at ARM 37.40.1101(1) through (5) and 37.40.1301, 37.40.1302, 37.40.1305, 37.40.1306, 37.40.1307 and 37.40.1308;

(b) homemaking services as specified at ARM 37.40.1450;

(d) nonmedical transportation as specified at ARM 37.40.1488.

(3) Personal assistance services do not include any skilled services that require professional medical training except as allowed in ARM 37.40.1301, 37.40.1302, 37.40.1305, 37.40.1306, 37.40.1307 and 37.40.1308.

(4) The requirements for the delivery of personal care services specified at ARM 37.40.1101, 37.40.1102, 37.40.1105, 37.40.1106, 37.40.1301, 37.40.1302, 37.40.1305, 37.40.1306, 37.40.1307, 37.40.1308 and 37.40.1315 govern the provision of personal assistance services.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1448 Home and Community-Based Services for Elderly and Physically Disabled Persons: Habilitation, Requirements

(1) Habilitation is the provision of intervention services designed for assisting a consumer to acquire, retain, and improve the self-help, socialization, and adaptive skills necessary to reside successfully at home and in the community.

(2) Habilitation services may include:

(a) residential habilitation;

(b) day habilitation;

(d) supported employment.

(3) Residential habilitation is habilitation provided in a licensed group home for persons with physical disabilities or a specialized licensed adult residential care facility.

(4) Day habilitation is habilitation provided in a day service setting.

(5) Prevocational services are habilitative activities that foster employability for a consumer who is not expected to join the general work force or participate in a transitional sheltered workshop within a year by preparing the consumer for paid or unpaid work. Prevocational services include teaching compliance, attendance, task completion, problem solving and safety.

(6) Supported employment is intensive ongoing support to assist a consumer who is unlikely to obtain competitive employment in performing work activities in a variety of settings, particularly work sites where nondisabled persons are employed. Supported employment service includes supervision, training, and other activities needed to sustain paid work by a consumer.

(7) An entity inclusive of its staff, providing habilitation services must be qualified generally to provide the services and specifically to meet each consumer's defined habilitation needs.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1449 Home and Community-Based Services for Elderly and Physically Disabled Persons: Specially Trained Attendant Care, Requirements

(1) Specially trained attendant care is an option under personal assistance that provides supportive services to a consumer residing in their own residence.

(2) Specially trained attendant care services may include:

(a) personal assistance services directed at fostering the consumer's ability to achieve independence in instrumental activities of daily living such as homemaking, personal hygiene, money management, transportation, housing, and the use of community resources;

(b) services that assist consumers in acquiring, retaining, and improving self-help, socialization, and adaptive skills to reside successfully in the community;

(d) personal care services as specified at ARM 37.40.1101(1) through (5), 37.40.1301, 37.40.1302, 37.40.1305, 37.40.1306, 37.40.1307, and 37.40.1308; and

(e) continuous and extensive nursing services.

(3) A person providing specially trained attendant care must be an employee of a Medicaid enrolled personal assistance provider, trained in accordance with the department's training requirements by the provider and others to deliver the services that meet the specific needs of the consumer.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1450 Home and Community-Based Services for Elderly and Physically Disabled Persons: Homemaking, Requirements

(1) Homemaking is the provision of general household activities or chore services to a recipient when the recipient is unable to manage the recipient's home or care for self or others in the home, or when another who is regularly responsible for these responsibilities is absent.

(2) Homemaking may include:

(a) household management services consisting of assistance with those activities necessary for maintaining and operating a home and may include assisting the recipient in finding and relocating into other housing;

(b) social restorative services consisting of assistance which further a recipient's involvement with activities and other persons; and

(c) teaching services consisting of activities which improve a recipient's or family's skills in household management and social functioning.

(3) Homemaking services do not include the provision of personal care as specified at ARM 37.40.1101 and 37.40.1302.

(4) A person providing homemaking services must be:

(a) physically and mentally able to perform the duties required; and

(b) literate and able to follow written orders.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1451 Home and Community-Based Services for Elderly and Physically Disabled Persons: Respite Care, Requirements

(1) Respite care is the provision of supportive care to a consumer so as to relieve those unpaid persons normally caring for the consumer from that responsibility.

(2) Respite care services may be provided only on a short term basis, such as part of a day, weekends, or vacation periods.

(3) Respite care services may be provided in a consumer's place of residence or through placement in another private residence or other related community setting, a hospital, a nursing facility or a therapeutic camp.

(4) A person providing respite care services must be:

(a) physically and mentally qualified to provide this service to the consumer; and

(b) aware of emergency assistance systems.

(5) A person who provides respite care services to a consumer may be required to have the following when the consumer's needs so warrant:

(a) knowledge of the physical and mental conditions of the consumer;

(b) knowledge of common medications and related conditions of the consumer; and

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-141, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1452 Home and Community-Based Services for Elderly and Physically Disabled Persons: Specialized Child Care for Medically Fragile Children, Requirements

(1) Specialized child care for medically fragile children is the provision of day care, respite care, and other direct and supportive care to a consumer under 18 years of age who is medically fragile and who, due to medical and other needs, cannot be served through traditional child care settings.

(2) A person providing specialized child care for medically fragile children services must be:

(a) physically and mentally able to perform the duties;

(b) aware of emergency assistance systems; and

(3) A person providing specialized child care for medically fragile children services may be required, if appropriate to the circumstances of the consumer, to have:

(a) knowledge of the physical and mental conditions of the consumer;

(b) knowledge of the consumer's commonly needed medications and the conditions for which they are administered; and

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1460 Home and Community-Based Services for Elderly and Physically Disabled Persons: Outpatient Occupational Therapy, Requirements

(1) Outpatient occupational therapy services may include:

(a) occupational therapy services as specified at ARM 37.86.601; and

(b) services for habilitative or maintenance purposes.

(2) The requirements for the delivery of outpatient occupational therapy services provided at ARM 37.86.601, 37.86.605, 37.86.606 and 37.86.610, govern the provision of outpatient occupational therapy services.

(3) No visit limitation exists for maintenance therapy.

History

Authorizing statute(s): Sec. 53-2-201, 53-5-205, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-5-205, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1997 MAR p. 1269, Eff. 7/22/97; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1461 Home and Community-Based Services for Elderly and Physically Disabled Persons: Outpatient Physical Therapy, Requirements

(1) Outpatient physical therapy services may include:

(a) physical therapy services as specified at ARM 37.86.601; and

(b) services for habilitative or maintenance purposes.

(2) The requirements for the delivery of outpatient physical therapy services at ARM 37.86.601, 37.86.605, 37.86.606 and 37.86.610, govern the provision of outpatient physical therapy services.

(3) No visit limitation exists for maintenance therapy.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1997 MAR p. 1269, Eff. 7/22/97; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1462 Home and Community-Based Services for Elderly and Physically Disabled Persons: Speech Pathology and Audiology, Requirements

(1) Speech pathology and audiology services may include:

(a) speech therapy services as defined at ARM 37.86.601;

(b) audiology services as defined at ARM 37.86.702;

(d) screening and evaluation with respect to speech and hearing functions;

(e) comprehensive audiological assessment, as indicated by screening results, that include tests of puretone air and bone conduction, speech audiometry, and other procedures, as necessary, and the assessment of the use of visual cues;

(f) assessments of the use of amplification;

(g) provision for procurement, maintenance and replacement of hearing aids, as specified by a qualified audiologist;

(h) comprehensive speech and language evaluation, as indicated by screening results, including appraisal of articulation, voice, rhythm and language;

(i) participation in the continuing interdisciplinary evaluation for purposes of beginning, monitoring and following up on individualized habilitation programs; and

(j) treatment services as an extension of the evaluation process, that include:

(i) direct counseling with a recipient;

(ii) consultation with appropriate persons involved with a recipient for speech improvement and speech education activities; and

(iii) work with an appropriate recipient to develop specialized programs for developing communication skills in comprehension, including speech, reading, auditory training, hearing aid utilization and skills in expression, including improvement in articulation, voice, rhythm and language.

(2) The requirements for the delivery of speech therapy services at ARM 37.86.605 and 37.86.606 and for audiology services at ARM 37.86.701 and 37.86.702 govern the provision of speech pathology and audiology services.

(3) No visit limitation exists for maintenance therapy.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1997 MAR p. 1269, Eff. 7/22/97; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1463 Home and Community-Based Services for Elderly and Physically Disabled Persons: Respiratory Therapy, Requirements

(1) Respiratory therapy is the provision of direct respiratory treatment, ongoing assessment of respiratory and medical conditions, equipment monitoring and upkeep, pulmonary education and respiratory rehabilitation.

(2) A certified respiratory therapy technician, as defined by the national board for respiratory care, may assist under the direct supervision of a registered respiratory therapist or physician who is responsible for and participates in the recipient's treatment program.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1464 Home and Community-Based Services for Elderly and Physically Disabled Persons: Psycho-Social Consultation, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-141, 53-6-402, MCA
History: NEW, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1990 MAR p. 2184, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; REP, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1465 Home and Community-Based Services for Elderly and Physically Disabled Persons: Consultative Clinical and Therapeutic Services, Requirements

(1) These are services that assist unpaid and/or paid caregivers in carrying out individual service plans and are necessary to improve the individual's independence and inclusion in the community.

(2) Consultation activities are provided by professionals in psychiatry, psychology, neuro-psychology, physiatry, nursing, nutrition, behavior management, or occupational/speech/physical/recreational/therapy.

(3) The service may include:

(a) assessment;

(b) development of a home/community treatment plan;

(d) one-on-one consultation and support for paid and nonpaid caregivers.

(4) An entity, described in (2), inclusive of its staff providing consultative clinical and therapeutic services must be qualified generally to provide the services and specifically to meet each consumer's defined needs.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1466 Home and Community-Based Services for Elderly and Physically Disabled Persons: Chemical Dependency Counseling, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; REP, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1467 Home and Community-Based Services for Elderly and Physically Disabled Persons: Cognitive Rehabilitation, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00; REP, 2011 MAR p. 1722, Eff. 8/26/11.

Mont. Admin. R. 37.40.1475 Home and Community-Based Services for Elderly and Physically Disabled Persons: Dietetic Services, Requirements

(1) Dietetic services are the management of a person's nutritional needs.

(2) Dietetic services may include evaluation and monitoring of nutritional status, nutrition counseling, dietetic therapy, dietetic education and dietetic research necessary for the management of a recipient's nutritional needs.

(3) Dietetic services are limited to recipients whose disease or medical condition is caused by or complicated by diet or nutritional status.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1476 Home and Community-Based Services for Elderly and Physically Disabled Persons: Nutrition, Requirements

(1) Nutrition services are meals, congregate meals and home delivered meals as specified at ARM 37.41.302 including the meals on wheels program.

(2) The requirements for the delivery of nutrition services as specified at ARM 37.41.306 through 37.41.315 govern the provision of nutrition services.

(3) A full nutritional regimen of three meals a day may not be provided through this service.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1477 Home and Community-Based Services for Elderly and Physically Disabled Persons: Nursing, Requirements

(1) Nursing is the provision of individual and continuous nursing care.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1485 Home and Community-Based Services for Elderly and Physically Disabled Persons: Environmental Accessibility Adaptation, Requirements

(1) Environmental accessibility adaptations are modifications to a member's home, designed to maintain or improve the member's ability to remain at home.

(2) Environmental accessibility adaptation services may include:

(a) modifications to a personal vehicle that allow the member to be more independent;

(b) the installation of specialized electrical and plumbing systems to accommodate necessary medical equipment and supplies;

(d) facilitation of the ability of a caregiver or service provider to maintain a member at home.

(3) An environmental accessibility adaptation must:

(a) be functionally necessary and relate specifically to the member's disability;

(b) provide for the member's access to the home environment and increased independence and safety in the home;

(c) be reasonably expected to promote the member's functional ability or the ability of the caregiver to maintain the member at home; and

(d) be the most cost effective adaptation among the adaptations that are available to meet the member's needs; and

(e) meet applicable requirements of the Americans with Disabilities Act, 42 U.S.C. 12101, et seq. and the 2010 ADA Standards for Accessible Design. The department adopts and incorporates by reference the 2010 ADA Standards for Accessible Design, which set forth minimum standards for newly designed and constructed or altered state and local government facilities and public accommodations used by individuals with disabilities. The standards may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210 or by visiting https://www.ada.gov/law-and-regs/design-standards/2010-stds/.

(4) All requests for environmental accessibility adaptations must include an estimate or bid from a licensed contractor. Environmental accessibility adaptations anticipated to exceed $5,000 in cost must include at least two estimates or bids from licensed contractors, unless prior authorization is received from the department.

(5) Environmental accessibility adaptations must be installed by a licensed contractor.

(6) Environmental accessibility adaptation services do not include:

(a) general housing maintenance, including but not limited to plumbing, heating systems, or appliance repair; or

(b) measures to facilitate leisure time activities.

(7) The department may require review and approval by a consultant for certain types of environmental accessibility adaptations.

(8) A member may receive any environmental accessibility adaptation only once unless the department specifically authorizes the repurchase of an adaptation.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-402, MCA
History: NEW, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2025 MAR, 37-1086, Eff. 4/26/25.

Mont. Admin. R. 37.40.1486 Home and Community-Based Services for Elderly and Physically Disabled Persons: Personal Emergency Response Systems, Requirements

(1) A personal emergency response system is an electronic device or mechanical system used to summon assistance in an emergency situation.

(2) A personal emergency response system must be connected to a local emergency response unit with the capacity to activate emergency medical personnel.

(3) The provision of a personal emergency response system as a service does not include the purchase, installation or routine monthly charges of a telephone.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-141 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1487 Home and Community-Based Services for Elderly and Physically Disabled Persons: Specialized Medical Equipment and Supplies, Requirements

(1) Specialized medical equipment and supplies is the provision of items of medical equipment and supplies to a recipient for the purpose of maintaining and improving the recipient's ability to reside at home and to function in the community.

(2) The provision of medical equipment and supplies services may include:

(a) the provision of consultation regarding the appropriateness of the equipment or supplies; and

(b) the provision of supplies and care necessary to maintain a service animal.

(3) Specialized medical equipment and supplies must:

(a) be functionally necessary and relate specifically to the recipient's disability;

(b) substantively meet the recipient's needs for accessibility, independence, health, or safety;

(c) be likely to improve the recipient's functional ability or the ability of a caregiver or service provider to maintain the recipient in the recipient's home; and

(d) be the most cost effective item that can meet the needs of the recipient.

(4) Any particular item of medical equipment or supplies, except for an item or supply necessary to maintain a service animal, is limited to a one time purchase unless otherwise authorized by the department in writing.

(5) Specialized medical equipment and supplies services do not include:

(a) items used for leisure and recreational purposes only;

(b) items of clothing;

(d) educational items including computers, software, and books unless such items are purchased in conjunction with an environmental control unit.

(6) A service animal is an animal trained to undertake particular tasks on behalf of a recipient that the recipient can not perform and that are necessary to meet the recipient's needs for accessibility, independence, health, or safety.

(7) A service animal does not include any of the following:

(a) pets, companion animals, and social therapy animals;

(b) guard dogs, rescue dogs, sled dogs, tracking dogs, or any other animal not specifically designated as a service animal; or

(8) Supplies necessary for the performance of a service animal may include, but are not limited to, leashes, harness, backpack, and mobility cart when the supplies are specifically related to the performance of the service animal to meet the specific needs of the recipient. Supplies do not include food to maintain the service animals.

(9) Care necessary to the health and maintenance of a service animal may include, but is not limited to, veterinarian care, transportation for veterinarian care, license, registration, and where the recipient or recipient's primary care giver is unable to perform it, grooming.

(10) Certain items of medical equipment or supplies for short term use, as specified by the department, may be leased or rented instead of purchased.

(11) The department may require a consultation prior to the purchase of certain equipment and supplies.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-6-402, MCA
History: NEW, 2000 MAR p. 2023, Eff. 7/28/00.

Mont. Admin. R. 37.40.1488 Home and Community-Based Services for Elderly and Physically Disabled Persons: Nonmedical Transportation, Requirements

(1) Nonmedical transportation is the provision to a consumer of transportation through common carrier or private vehicle for access to social or other nonmedical activities.

(2) Nonmedical transportation services are provided only after volunteer transportation services, or transportation services funded by other programs, have been exhausted.

(3) Nonmedical transportation providers must provide proof of:

(a) a valid Montana driver's license;

(b) adequate automobile insurance; and

(4) Nonmedical transportation services must be provided by the most cost effective mode.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-141, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11.

Subchapter 37.40.15 Pediatric Complex Care Assistant Services

Mont. Admin. R. 37.40.1501 Pediatric Complex Care Assistant Services, Requirements

(1) To qualify for Pediatric Complex Care Assistant (PCCA) services, an individual must be a Medicaid member under 21 years of age.

(2) PCCA services must be provided in accordance with the requirements of 37-2-603, MCA. The services are limited to those provided for under the statute and in ARM 24.160.501.

(3) PCCA services must not replace Private Duty Nursing Services or supplant other services the member is receiving, but a member may receive PCCA services, Personal Care Assistant services, and/or Private Duty Nursing services under a person-centered care plan.

(4) PCCA services may only be provided by licensed pediatric complex care assistants employed by a Medicaid-enrolled PCCA provider agency and selected by the member or their authorized representative.

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 2025 MAR, Notice No. 2025-53, Eff. 9/27/25.

Mont. Admin. R. 37.40.1502 Pediatric Complex Care Assistant Services, Provider Requirements and Enrollment

(1) Pediatric Complex Care Assistant (PCCA) service provider agencies must be enrolled Medicaid providers.

(2) PCCA service provider agencies must be a business entity formed or registered to do business under Montana law.

(3) PCCA services must be prior-authorized by the department or the department's designee.

(4) PCCA service provider agencies must provide documentation to the department verifying the PCCA’s certification training and current licensure.

(5) PCCA service provider agencies must use an electronic visit verification (EVV) system to electronically document the delivery of services and submit claims.

(a) In accordance with 42 U.S.C. 1396b(l), the EVV system must capture the following data elements:

(i) the type of service performed;

(ii) the member receiving the service;

(iii) the date of the service;

(iv) the location of the service delivery;

(v) the individual providing the service; and

(vi) the time the service begins and ends.

(b) The use of EVV is required for all members utilizing PCCA services, including members for whom services are provided by a live-in caregiver.

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 2025 MAR, Notice No. 2025-53, Eff. 9/27/25.

Mont. Admin. R. 37.40.1503 Pediatric Complex Care Assistant Services, Reimbursement

(1) Pediatric Complex Care Assistant (PCCA) services may not exceed 24 hours, or 96 units, in a single day for an individual.

(2) The rate for PCCA services is the lesser of:

(a) $10.78 per 15-minute unit of service, which equates to $43.12 per hour of service provided; or

(b) the provider’s usual and customary charge.

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 2025 MAR, Notice No. 2025-53, Eff. 9/27/25.

Chapter 37.41 Aging Services

Subchapter 37.41.1 Area Agencies on Aging

Mont. Admin. R. 37.41.101 Purpose

(1) The purpose of the department's State Unit on Aging within the Senior and Long Term Care Division is to develop and administer the State Plan on Aging in accordance with the requirements of the Older Americans Act, Pub. L. No. 89-73 (1965), as amended and codified at 42 U.S.C. § 3001 et seq. The State Plan on Aging encompasses a comprehensive and coordinated service delivery system addressing the needs of older adults in the state.

(2) The State Unit on Aging performs the following functions:

(a) serves as the central authority, coordinating services in the state related to the Older Americans Act, including the coordination and oversight of area agencies and service providers;

(b) acts as the primary advocate for older adults in the state, in an effort to ensure their rights, dignity, and quality of life;

(c) provides guidance and direction to area agencies and service providers in developing and implementing effective and efficient service delivery systems that meet the diverse needs of older adults throughout the state; and

(d) works collaboratively with federal, state, and local partners to ensure the successful implementation and administration of aging services, including the Senior Farmers' Market Nutrition Program and Nutrition Services.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1094, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.102 Definitions

In addition to the definitions contained in 52-3-401, MCA, the following definitions apply to this subchapter:

(1) "Administration for Community Living/Administration on Aging" means the agency within the U.S. Department of Health and Human Services that is responsible for administering the provisions of the Older Americans Act.

(2) "Area agency" means the agency designated by the department in a planning and service area to develop and administer an area plan for a comprehensive and coordinated system of services for older adults.

(3) "Area plan" means the document submitted by an area agency to the department in order to receive subgrants or contracts from funds allocated under the Older Americans Act.

(4) "Community focal point" means a place or mobile unit in a community or neighborhood designated by an area agency for the collocation and coordination of services to older adults.

(5) "Comprehensive and coordinated system" means a system for providing necessary supportive services, including nutrition services, in a manner designed to:

(a) facilitate accessibility to, and utilization of, supportive and nutrition services provided within the geographic area served by such system by any public or private agency or organization;

(b) develop and make the most efficient use of supportive and nutrition services in meeting the needs of older adults;

(d) encourage and support public and private entities in assisting older adults to meet their service needs on a voluntary basis.

(6) "Nutrition services" means congregate and home-delivered meals, nutrition education, and nutrition counseling.

(7) "Older adult" means any person 60 years of age or older.

(8) "Service provider" means an individual, agency, or organization awarded a subgrant or contract from the department or an area agency to provide services under the state plan or an area plan.

(9) "Supportive services" means services such as:

(a) transporting older adults to and from community facilities and resources;

(b) escorting older adults unable to use conventional means of transportation;

(d) informing older adults of the opportunities and services available and referring them to the proper service provider;

(e) community services including education, information and referral, health, legal, advocacy, program development, counseling, health screening, residential repair and renovation, recreation, and acquisition of multipurpose senior centers;

(f) home services such as home health, homemaker, and home chore; and

(g) services in care-providing facilities such as placement, counseling, complaint, and grievance resolution.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-401, MCA
History: NEW, 1980 MAR p. 1094, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.107 Designation of Planning and Service Areas

(1) The department may designate as a planning and service area:

(a) any unit of general-purpose local government; or

(b) any district or combination of districts.

(2) The department shall designate and fix the number of planning and service areas in accordance with applicable federal and state law, including 52-3-405, MCA.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-405, MCA
History: NEW, 1980 MAR p. 1096, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.108 Designation of Area Agencies

(1) In accordance with applicable provisions of section 305 of the Older Americans Act, 42 U.S.C. § 3025, the department may designate an entity as an area agency in a planning and service area after considering the following factors:

(a) geographical distribution of older adults in Montana;

(b) incidence of need for supportive services, nutrition services, multipurpose senior centers, and legal assistance;

(c) distribution of older adults residing in such areas who have the greatest social or economic need, with particular attention to low-income older adults, including older low-income minority adults, older adults with limited English proficiency, and older adults residing in rural areas;

(d) distribution of Native American elders residing in such areas;

(e) distribution of resources available to provide such services or centers;

(f) boundaries of existing areas within the state drawn for the planning or administration of supportive-services programs; and

(g) location of units of general-purpose local government.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1096, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.109 Department Aging Services Hearing Procedures

(1) A designated area agency is entitled to a hearing if it is aggrieved by an adverse department:

(a) disapproving a plan or plan amendment submitted by the agency;

(b) disapproving an area plan for non-compliance with the requirements of the Older Americans Act; or

(2) A unit of general-purpose local government, district, or combination of districts is entitled to a hearing if it is aggrieved by a department action denying designation as a planning and service area.

(3) Hearings will be conducted in accordance with ARM 37.5.117.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1097, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.110 Functions of Area Agency

(1) Pursuant to the applicable provisions of section 306 of the Older Americans Act, 42 U.S.C. § 3026, each designated area agency shall:

(a) develop and administer a four-year area plan for a comprehensive and coordinated delivery system within a planning and service area;

(b) assess the area agency's incidence of need for supportive services, nutrition services, multipurpose senior centers, and legal assistance for older adults with the greatest social and/or economic need in the area, with particular attention to those who are low-income, including minority individuals, those with limited English proficiency, and those residing in rural areas;

(c) enter into subgrants or contracts to provide all services under the area plan, except as provided under ARM 37.41.121;

(d) monitor and conduct quarterly performance evaluations of all service providers under the plan, and provide them with technical assistance as needed;

(e) coordinate the administration of its plan with other federal, state, and local resources;

(f) establish an advisory council pursuant to ARM 37.41.116;

(g) conduct targeted outreach efforts to identify and inform older adults about services available under the area plan;

(h) ensure that older adults in the planning and service area have access to information and referral services available under the area plan;

(i) divide the entire planning and service area into community service areas, and designate community focal points; and

(j) develop and publish a manual of methods used to establish priorities for services, and provide a copy of the manual to each service provider in the planning and service area.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1097, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.116 Area Agency Advisory Council

(1) Pursuant to applicable provisions of section 306 of the Older Americans Act, 42 U.S.C. § 3026, each area agency shall establish an advisory council to provide guidance and advice to the agency in the following areas:

(a) developing and administering the area plan and operations conducted under the plan;

(b) conducting public hearings or focus groups when needed, to gather input on aging services from older adults and community members;

(d) reviewing and providing comment on community policies and programs affecting older adults.

(2) The composition of the advisory council shall meet the requirements of 45 CFR § 1321.63(b). The department adopts and incorporates by reference 45 CFR § 1321.63(b), as amended February 14, 2023, which sets forth the composition requirements for advisory councils under the Older Americans Act. A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Service, Senior and Long Term Care Division, P.O. Box 4210, Helena, MT 59604-4210.

(3) The advisory council shall meet, at a minimum, twice each year.

(4) To promote transparency and community involvement, the area agency shall provide public notice of advisory council meetings at least three days prior to the meeting date. Notices shall be posted at local senior centers or congregate meal sites within the planning and service area.

(5) The area agency shall provide necessary staff and assistance to support the advisory council in fulfilling its responsibilities effectively.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1098, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.117 Area Plan Content

(1) An area plan shall:

(a) demonstrate how the area agency will meet functions required by ARM 37.41.110; and

(b) provide the services set forth in ARM 37.41.121.

(2) Area agency plans must meet the applicable requirements of section 306 of the Older Americans Act, 42 U.S.C. § 3026.

(3) The area agency shall:

(a) hold a public hearing or focus group meetings on the area plan and any amendments proposed to the area plan;

(b) provide at least 14-days' notice to older adults, public officials, and other interested parties of the times, dates, and locations of the public hearings or focus group meetings; and

(c) submit the area plan and amendments to the area advisory council for review and comment and to the department for approval.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1098, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.118 Area Plan Review (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-5-606, MCA
Implementing statute(s): 53-5-602, 53-5-604, MCA
History: NEW, 1980 MAR p. 1098, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; REP, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.119 Area Plan, Approval/Disapproval

(1) The department will approve an area plan and amendments meeting the requirements of this subchapter and the Older Americans Act.

(2) The department will terminate an area plan or area agency designation if the department finds:

(a) an area plan has not been timely submitted;

(b) an area plan is not approved; or

(c) the administration or provisions of an approved area plan no longer substantially comply with the requirements of the Older Americans Act.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1099, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.120 Area Plan, Amendment/Development

(1) An area agency shall amend the area plan if:

(a) newly enacted or amended state or federal law necessitates revision in order to comply with the law; or

(b) local law, organization, policy, or agency operations change and are no longer accurately reflected in the area plan.

(2) The area agency may use its Older Americans Act-funded subgrants and contracts only for activities under the approved area plan.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1099, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.121 Direct Provision of Services by an Area Agency

(1) The area agency shall primarily use subgrants or contracts with service providers to provide all services under the Older Americans Act unless the determines the area agency's direct provision of a service is necessary to ensure an adequate supply of the service, or no other agency is able or available to provide the service.

(2) The area agency may directly provide information and referral, outreach, advocacy, program development, coordination, individual needs assessment, and case management services if the department determines the area agency can perform the services more effectively and efficiently than any other agency in the planning and service area.

(3) The area agency may plan, coordinate, and provide services funded under other programs if:

(a) it does not use funds under the Older Americans Act for those services; and

(b) it continues to meet all area agency responsibilities.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1099, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.122 Withholding of Area Agency Funds

(1) The department may withhold payment to an area agency if it finds the area agency has failed to:

(a) substantially comply with federal or state law;

(b) submit required reports with the department; or

(2) Prior to making a final determination to withhold funds, the department will provide the agency with:

(a) written notice of the action to withhold funds;

(b) documentation of the need for such action; and

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1100, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.130 Service Continuation by Department

(1) If the department withholds funding under ARM 37.41.122, it shall notify the area agency and the Administration for Community Living/Administration on Aging about the action to withhold funds.

(2) The department may use the withheld funds to directly administer services within the service area served by the area agency for a period not to exceed 180 days. If the department determines the area agency has not taken corrective action, or if the department does not approve of the corrective action, the department may extend the time period to directly administer services by up to 90 days.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1100, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.131 Contributions for Services

(1) The area agency shall require each service provider under the area plan to:

(a) give information about the cost of services to each older adult receiving services;

(b) give each older adult an opportunity to contribute to part or all of the cost of the service;

(d) protect the privacy and confidentiality of each older adult with respect to the contribution or non-contribution;

(e) have appropriate procedures to safeguard and account for all contributions;

(f) use all contributions to expand the services for which payment was given;

(g) use all contributions for nutrition services to increase the number of meals served;

(h) not consider assets, savings, or other property owned by an older adult in determining whether cost-sharing is permitted;

(i) not deny any service for older adults based on their income or failure to make a cost-sharing payment when allowed, when funds are received under the Older Americans Act;

(j) determine eligibility of older adults to cost-share solely based on a confidential declaration of income, without requiring verification; and

(k) distribute written materials created by the department.

(2) The area agency may not allow any service provider to invoice for voluntary contributions.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-402, 52-3-404, MCA
History: NEW, 1980 MAR p. 1100, Eff. 3/28/80; READOPT, 1983 MAR p. 740, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.132 Provision of Congregate Nutrition Services

(1) An area agency may award nutrition services funds only to a nutrition services provider that:

(a) provides congregate nutrition services;

(b) provides home-delivered nutrition services directly or by contract;

(d) meets the relevant requirements of ARM 37.41.301 through 37.41.306.

(2) An area agency shall award funds to a nutrition services provider that has carried out its nutrition services activities with demonstrated effectiveness.

History

Authorizing statute(s): 52-3-406, MCA
Implementing statute(s): 52-3-101, 52-3-504, MCA
History: NEW, 1980 MAR p. 1101, Eff. 3/28/80; AMD, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.133 Food Distribution Ratios (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; REP, 2024 MAR p. 1884, Eff. 7/27/24.

Subchapter 37.41.2 Senior Farmers' Market Nutrition Program

Mont. Admin. R. 37.41.201 Senior Farmers' Market Nutrition Program (sfmnp): Purpose

(1) The purpose of this subchapter is to provide a framework under which the department administers the SFMNP enacted under Section 4402 of the Farm Security and Rural Investment Act of 2002, codified at 7 U.S.C. 3007, and operated by the United States Department of Agriculture under the authority granted to it through 7 CFR 249.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17.

Mont. Admin. R. 37.41.202 Senior Farmers' Market Nutrition Program (sfmnp): Definitions

In addition to the definitions contained in 52-3-502, MCA, the following definitions apply to this subchapter:

(1) "Adverse Action" means an action of the department:

(a) denying an application or agreement;

(b) terminating an agreement or application for failure to comply with program requirements; or

(2) "Agreement" means a written legal document or contract binding the farmer, participant, or local agency and the local agency or department to designated terms and conditions.

(3) "Application" means a written request submitted on a form provided by the department or local agencies indicating interest in participating in SFMNP.

(4) "Bulk purchase program" means a program model in which bulk quantities of certain produce items are purchased directly from authorized farmers by the local agency and are then equitably divided among and distributed directly to eligible SFMNP participants.

(5) "Coupon" means a voucher or other negotiable financial instrument by which benefits are issued under the SFMNP.

(6) "Disqualification" means the act of terminating the agreement of an authorized farmer, participant, or local agency for noncompliance with program requirements.

(7) "Eligible foods" means fresh, nutritious, unprocessed, unprepared, locally grown fruits, vegetables, honey, and herbs for human consumption.

(8) "Farmer" means an individual residing within Montana authorized by the department to sell eligible fruit and vegetables at a participating farmers' market to a participant at a farmers' market.

(9) "Local agency" means any nonprofit or local government agency that is contracted to certify an eligible participant, issue coupons, or arrange for distribution of eligible foods through a Bulk Purchase Program.

(10) "Locally grown" means grown in the state of Montana.

(11) "Participant" means a person or household who meets the eligibility requirements of the SFMNP and to whom coupons or bulk purchase have been issued.

(12) "Proxy" means an individual authorized by an eligible senior to act on the senior's behalf, including application for certification, receipt of SFMNP coupons, and use of SFMNP coupons at authorized outlets as long as the benefits are ultimately received by the eligible senior.

(13) "Senior" means an individual 60 years of age or older.

(14) "Senior Farmers' Market Nutrition Program (SFMNP)" means the Senior Farmers' Market Nutrition Program authorized by 7 U.S.C. § 3007 and regulations in 7 CFR Part 249.

(15) "Summer farmers' market" means an association of local farmers who assemble at a defined location for the purpose of selling their produce directly to consumers during the summer market season.

(16) "Violation" means an activity that is prohibited by participant, farmer, or local agency SFMNP agreement, 7 CFR Part 249, or this subchapter.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.205 Senior Farmers' Market Nutrition Program (sfmnp): Participant Eligibility and Benefits

(1) A participant will be considered eligible for the SFMNP if the following criteria are met:

(a) the participant is a senior defined in ARM 37.41.202;

(b) the participant income is at or below 185% of the annual federal poverty level;

(d) the participant submits a completed current year's application through the contracted local agency in their area; and

(e) the participant agrees to follow the terms and conditions of the signed participant application which then becomes the agreement.

(2) Acceptance into the SFMNP is based on meeting the eligibility criteria in (1)(a) through (e) and available funding.

(3) Eligible participants may designate a proxy to submit the application, shop at the farmers' market, or pick up their eligible foods from the contracted Bulk Purchase Program on their behalf, if the senior is unable to perform these actions. Eligible participants must submit a signed statement designating the individual as their authorized representative.

(4) The eligible participant may designate a proxy at any point during the program's period of operation.

(5) SFMNP funds are limited and benefits will be distributed on a first come first served basis. SFMNP coupons are subject to the following:

(a) SFMNP coupons are only valid from June 1 through the first week in November of each year;

(b) lost or stolen SFMNP coupons will not be replaced; and

(c) an eligible participant who does not receive SFMNP coupons due to lack of available funding is not entitled to an appeal or fair hearing.

(6) The participant who is denied or deemed ineligible for reasons other than those stated in (1)(a) through (c) and (5) has the right to appeal this action.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17.

Mont. Admin. R. 37.41.206 Senior Farmers' Market Nutrition Program (sfmnp): Farmer Eligibility, Participation, and Violations

(1) Only authorized farmers may accept SFMNP coupons in exchange for eligible foods.

(2) In order to be eligible for participation in the SFMNP, a farmer applicant must:

(a) complete or renew the farmer agreement provided by the

department;

(b) agree to follow the terms and conditions in the farmer agreement; and

(3) Approved farmer agreements are valid for three consecutive summer farmers' market seasons.

(4) An authorized farmer must comply with SFMNP requirements contained in the terms and conditions of the farmer agreement and in applicable provisions of 7 CFR § 249.10.

(5) A farmer is in violation of the SFMNP if the farmer fails to:

(a) comply with the SFMNP and terms and conditions of the farmer agreement; or

(b) participate in the initial and annual training on SFMNP provided by the department.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.207 Senior Farmers' Market Nutrition Program (sfmnp): Farmer Participation Requirements and Violations (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17; REP, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.208 Senior Farmers' Market Nutrition Program (sfmnp): Monitoring of Farmers

(1) The department will conduct monitoring reviews of the operations of randomly selected authorized farmers at the designated summer farmers' market locations. The annual monitoring review is conducted to determine:

(a) whether the farmer demonstrates ability to meet Montana SFMNP requirements, as evidenced by the on-site observations, interviews, and third party information during the current agreement; and

(b) whether patterns of participant use demonstrate compliance with the SFMNP.

(2) The on-site monitoring and reviews will include no less than one-tenth of the total currently authorized farmers to include farmers that are considered high-risk in accordance with 7 CFR 249.10. High risk is defined as:

(a) newly authorized farmers;

(b) farmers about whom the department has received participant or local agency complaints; and

(c) farmers who receive a proportionately high volume of coupons as compared to other farmers at the same summer market location.

(3) On-site or follow-up contact by means other than (2)(a) through (c) may

occur when warranted by incomplete information or complaint.

(4) The department may conduct unannounced on-site monitoring visits.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17.

Mont. Admin. R. 37.41.211 Senior Farmers' Market Nutrition Program (sfmnp): Farmer Disqualification and Sanctions

(1) Based upon outcome of the monitoring as defined in ARM 37.41.208, the department may take an adverse action against the farmer, including disqualification of the farmer from participation in the program.

(2) A written warning may be issued for a first violation of the following:

(a) noncompliance with SFMNP rules and procedures as outlined in the farmer agreement not specifically listed as a violation;

(b) refusal to accept valid coupons for eligible produce;

(d) charging participants a price for an item that is greater than that charged to nonparticipants;

(e) charging for items not received; or

(f) accepting coupons after the end of the summer market season.

(3) A second violation of (2)(a) through (f) may result in a 15-day suspension during the current market season.

(4) Suspension from the SFMNP for the remainder of the current market season may occur as a result of the following:

(a) subsequent or continued violations described in (2)(a) through (f);

(b) accepting SFMNP coupons for nonlocally grown produce;

(d) accepting coupons in exchange for cash;

(e) cashing coupons for a nonauthorized farmer;

(f) issuing cash change for purchases less than value of coupon; or

(g) participating in discriminatory practices as defined in the terms and conditions of the farmer agreement and in accordance with 7 CFR 249.7.

(5) A farmer will face immediate disqualification without reinstatement and liable to prosecution under applicable federal, state, or local laws if the farmer engages in illegal activity.

(6) When taking an adverse action involving a suspension against or disqualification of a farmer from the SFMNP, the department will provide the affected farmer with written notice not less than 15 days in advance of the pending action. The notice must include the reasons for the adverse action, the date of adverse action, and, except in cases of the expiration of the farmers' SFMNP agreement, the farmers' right to appeal as set forth in ARM 37.41.213.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17.

Mont. Admin. R. 37.41.212 Senior Farmers' Market Nutrition Program (sfmnp): Monitoring, Review, and Disqualification of Local Agencies

(1) The department will conduct on-site monitoring reviews of the qualifications of authorized local agencies. In conducting such reviews, the department will consider the program's history of prior program compliance. On-site review will be conducted to determine program compliance and may include:

(a) a file review of ten percent or more of completed participant applications;

(b) review of procedures for secure storage of coupons, participant agreements, and other documents with identifying information;

(2) When disqualifying a local agency under the SFMNP, the department will provide the local agency with written notice not less than 30 days in advance of the pending action. The notice must include an explanation of the reasons for disqualification, the date of disqualification, and, except in cases of the expiration of a local agency's agreement, the local agency's right to appeal as set forth in 7 CFR 249.16. The notice will ensure that the action is not in conflict with any existing written agreements between the department and the local agency.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17.

Mont. Admin. R. 37.41.213 Senior Farmers' Market Nutrition Program (sfmnp): Appeals by Participants, Farmers, and Local Agencies

(1) A participant who is denied participation or been disqualified from the program by the local agency may request a fair hearing before the department in accordance with ARM 37.41.214 and 7 CFR 249.16.

(2) Expiration of the participant application or disqualification of the application due to ineligibility as the result of age, income, or insufficient program funds as established by 7 CFR 249.6 is not subject to appeal.

(3) A local agency or farmer may request a fair hearing before the department if:

(a) they are denied participation;

(b) they are disqualified during the current valid written agreement; or

(4) Expiration of the agreement with a farmer or local agency is not subject to appeal.

(5) The issuance of notice of adverse action, the processing of fair hearing requests, and the conduct of such hearings will be in accordance with provisions set forth in ARM 37.41.214.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17.

Mont. Admin. R. 37.41.214 Senior Farmers' Market Nutrition Program (sfmnp): Fair Hearing Procedures

(1) A designated local agency, farmer, or participant is entitled to a hearing if they are aggrieved by an adverse department determination which:

(a) results in a denial of an application or agreement by the local or state agency; or

(b) results in a revocation or correction plan for failure to comply substantially with the requirements of the application or agreement.

(2) The hearing will be conducted according to the applicable provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): 52-1-103, 52-3-504, MCA
Implementing statute(s): 52-3-102, 52-3-505, MCA
History: NEW, 2017 MAR p. 606, Eff. 5/13/17.

Subchapter 37.41.3 Nutrition Services

Mont. Admin. R. 37.41.301 Nutrition Services, Eligibility

(1) Congregate nutrition services may be made available to:

(a) an older adult;

(b) the spouse of an older adult;

(c) persons with disabilities who live in housing facilities in which mainly older adults live and which also provide congregate nutrition services;

(d) persons providing volunteer services to a congregate nutrition service provider during meal hours.

(2) Nutrition providers must determine eligibility for nutrition services in accordance with the criteria in (1) and standard written procedures the provider has adopted.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 52-3-504, 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.302 Nutrition Services, Definitions

In addition to the definitions contained in 52-3-502, MCA, the following definitions apply to this subchapter:

(1) "Home-delivered meals" means those meals transported from a preparation site to persons in their residences and includes programs commonly known as Meals on Wheels.

(2) "Nutrition service provider" means a non-profit corporation or public agency providing, on a regular basis, congregate or home-delivered meals to elderly or other adult persons who, due to age or disabilities, are unable to provide themselves with regular meals.

(3) "Older adult" means any person 60 years of age or older.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 52-3-504, 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.306 Nutrition Services, Food Requirements

(1) The nutrition service provider shall ensure:

(a) the use of procedures that preserve nutritional value and food safety in the purchase and preparation of food and delivery of meals;

(b) the use of appropriate food containers and necessary utensils for individuals who are blind or who have a disability;

(d) hot transported food be at 140°F or above from time of final food preparation to completion of delivery;

(e) cold food be maintained at 40° F or below from time of initial service to completion of delivery; and

(f) all food transported to sites is considered "leftover," except unopened pre-packaged food, and food remaining at the meal site or main food preparation center is thrown away.

(2) Vitamins or mineral supplements shall not be provided by the nutrition service provider.

(3) Each meal served by the service provider shall contain at least one-third of the current recommended dietary allowance as established by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 52-3-504, 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.307 Nutrition Services, General Provider Requirements

(1) A nutrition service provider shall:

(a) accept and use any United States department of agriculture food made available to it;

(b) assure arrangement for the appropriate transportation, storage and use of the food;

(d) coordinate its activities with agencies responsible for administering the food stamp program;

(e) comply with all state and local sanitation and safety regulations applicable to food preparation, delivery, and serving; and

(f) provide persons with nutrition education information that promotes improved food selection, better eating habits and other health and nutrition related practices.

(2) If a nutrition service provider receives United States department of agriculture cash, the cash shall be spent only for buying food.

(3) Special meals for any persons who have health, religious or ethnic dietary needs shall be provided by the nutrition service provider unless the department exempts the provider from this requirement. Such exemption may be granted only when the foods and skills to provide a special diet are unavailable to the provider.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-402, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279.

Mont. Admin. R. 37.41.308 Congregate Nutrition Services, Provider Requirements

(1) The nutrition service provider shall:

(a) provide a hot or other appropriate meal in a congregate setting at least once a day, five or more days a week, except in a rural area where such frequency is not feasible and is approved by the department;

(b) provide services as close as possible in physical proximity to the majority of eligible older adults within the service area;

(d) provide supervision of all staff working in the preparation of food, ensuring adherence to proper hygiene techniques and practices in food handling preparation and service;

(e) provide training by qualified personnel in sanitation, food preparation, and portion control for all paid and volunteer staff who prepare, handle, and serve food;

(f) conduct menu reviews at least semi-annually, ensuring compliance with ARM 37.47.306(3) when a registered dietician changes the menus;

(g) use a qualified dietician or nutritionist to conduct menu analyses;

(h) maintain menus and menu analyses for three years for auditing purposes;

(i) provide nutrition education and other nutrition services, as appropriate, based on the needs of meal recipients;

(j) plan meal availability for older adults during weather-related emergencies and natural disasters, including public health emergencies; and

(k) conduct an annual intake and nutrition risk assessment of each participant.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 52-3-504, 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Mont. Admin. R. 37.41.315 Home-Delivered Nutrition Services, Provider Requirements

(1) Pursuant to section 336 of the Older Americans Act, 42 U.S.C. § 3030f, nutrition service providers who provide home-delivered meals shall:

(a) provide, on five or more days a week, except in a rural area where such frequency is not feasible and the department approves less frequency, at least one home-delivered meal, which may consist of hot, cold, frozen, dried, canned, or fresh foods, and, as appropriate, supplemental foods and any additional meals the provider elects to deliver;

(b) provide meals with a satisfactory storage life;

(c) provide nutrition education, nutrition counseling, and other nutrition services, as appropriate, based on the needs of meal recipients;

(d) notify appropriate officials for follow-up on any conditions or circumstances placing the older adult or the household in imminent danger;

(e) plan for availability of meals to older adults during weather-related emergencies and natural disasters, including public health emergencies; and

(f) complete at least annually an intake application for each recipient for re-evaluating the need to continue home-delivered meals.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 52-3-504, 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2279; AMD, 2024 MAR p. 1884, Eff. 7/27/24.

Chapter 37.43 Supplemental Security Income Payments

Subchapter 37.43.1 Supplemental Payments to Recipients of Supplemental Security Income

Mont. Admin. R. 37.43.101 Purpose

(1) A supplemental payment may be made by the state to recipients of supplemental security income for the aged, blind, or disabled under Title XVI of the Social Security Act of the United States as amended (42 USC 1300 et seq.) . The purpose of the supplemental payment is to enhance the recipient's ability to be as self-sufficient as possible and to be integrated into the social life of the community. The payment is intended to provide for the basic living needs of recipients who, due to social, physical and environmental factors, cannot currently live independent from special programs and facilities as defined in ARM 37.43.103.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-204, MCA
History: NEW, 1982 MAR p. 1281, Eff. 7/1/82; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2294.

Mont. Admin. R. 37.43.102 Individual Eligibility for State Supplement

(1) Aged, blind and disabled persons residing in Montana who were, for December, 1973, recipients of assistance or had filed an application and were otherwise eligible for assistance under a state plan approved by the federal government for Title I, X, XIV or XVI of the Social Security Act, are eligible for mandatory state supplemental payments as required by sections 211 and 212 of P.L. 93-66 and by P.L. 93-233.

(a) Eligibility for mandatory state supplemental payments is subject to the limitations of 20 CFR 416.2040 which describes limitations on eligibility. The department hereby adopts and incorporates by reference 20 CFR 416.2040. A copy of the incorporated regulation may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, P.O. Box 4210, Helena, Montana 59604-4210.

(b) The amount of mandatory state supplement to be provided is determined in accordance with 20 CFR 416.2050, 416.2055, 416.2060, 416.2065, 416.2070, 416.2085 and 416.2097 which are federal regulations governing payments under state supplemental programs. The department hereby adopts and incorporates by reference the above cited sections. A copy of the above cited regulations may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, P.O. Box 4210, Helena, Montana 59604-4210.

(2) Persons eligible for optional state supplemental payments are those persons who:

(a) are recipients of federal supplemental security income or who would be eligible to receive federal supplemental security income except for the amount of their income;

(b) reside in one of the facilities described in ARM 37.43.103;

(c) are not ineligible under the provisions of 20 CFR 411.2040 governing limitations on participation in state supplementation programs. The department hereby adopts and incorporates by reference the above cited section. Copies of 20 CFR 411.2040 can be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, P.O. Box 4210, Helena, Montana 59604-4210;

(d) are financially eligible as provided for in 20 CFR 416.2001, 416.2025 and 416.2047, the federal regulations governing financial eligibility for state supplemental payments. The department hereby adopts and incorporates by reference the above cited sections. Copies of the above cited sections can be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, P.O. Box 4210, Helena, Montana 59604-4210.

(3) The amount of optional state supplement to be provided is determined in accordance with 20 CFR 416.2025, 416.2030, 416.2045, 416.2095 and 416.2097, which are federal regulations governing state supplement benefit calculations. The department hereby adopts and incorporates by reference the above cited sections. Copies of the above cited sections can be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, P.O. Box 4210, Helena, Montana 59604-4210.

(4) Applications for optional state supplemental payments are made to the county welfare department. Determination of eligibility is made by the social worker based on residential status. Eligibility shall be redetermined annually.

(5) Financial eligibility and actual payment amount for each individual based on all resources available is determined by the social security administration.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-204, MCA
History: NEW, 1982 MAR p. 1281, Eff. 7/1/82; AMD, 1986 MAR p. 2014, Eff. 12/12/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1997 MAR p. 2294.

Mont. Admin. R. 37.43.103 Eligibility Based on Living Arrangement

(1) In order for an individual to receive a state supplement, that individual must be a resident of one of the residential types of service facilities specified and defined in this rule.

(a) Personal care facilities defined by 50-5-101 (19) (e) , 50-5-225 and 50-5-226 , MCA, and licensed by the department of public health and human services in accordance with 50-5-227 , MCA, and ARM 16.32.380 through 16.32.388 and which for the purposes of this rule the department of public health and human services determines:

(i) provide personal care to five or more persons;

(ii) provide 24 hour on-duty personal care services that include all of the following:

(A) three nutritious meals daily served in a family setting or separate dining area;

(B) washing and drying of personal clothes and linens with such frequency as to provide for proper hygiene;

(C) protective oversight of residents meaning enhancement of their ability to live in and be integrated into the community and includes recreational activities, social activities, and assurance that individual needs are met;

(D) transportation to medical, social, therapeutic, church and other activities;

(E) preparation of special diets if required by the physician; and

(F) assistance with personal daily living activities as needed, e.g., eating, dressing, shaving, hair care, bathing, and getting in and out of bed.

(iii) provide to the department of public health and human services information and documentation as requested to implement the supplemental payment.

(b) Community homes for the developmental disabled, defined in Title 53, chapter 20, part 3, MCA, and licensed in accordance with ARM Title 37, chapter 100, subchapter 3 by the department of public health and human services.

(c) Group homes for the mentally disabled licensed by the department of public health and human services as rooming houses or retirement homes, having services approved by the Montana department of corrections, and serving only mentally disabled individuals identified by a mental health professional.

(d) Community homes for the severely disabled defined and licensed in accordance with Title 53, chapter 19, part 1, MCA.

(e) Foster care homes defined in Title 53, chapter 5, part 3, MCA, or Title 11, chapter 5, part 3, MCA, and licensed in accordance with ARM Title 37, chapter 100, subchapter 1, or ARM Title 37, chapter 97, subchapter 1, by the department of public health and human services.

(f) Transitional living services to developmentally disabled approved by the department of public health and human services as an intermediate step between the group home and independent living which promotes movement out of the group home. The program consists of clients living in congregate apartments with a staff person usually living at the complex for supervision or at least 24 hour on call availability of assistance. Staff is provided to train and supervise the clients to help them develop their skills to a higher level in such areas of daily living as cooking, shopping, and cleaning.

History

Authorizing statute(s): Sec. 52-1-103 and 52-1-104, MCA
Implementing statute(s): Sec. 52-1-104, MCA
History: NEW, 1982 MAR p. 1281, Eff. 7/1/82; AMD, 1986 MAR p. 2014, Eff. 12/12/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 978, Eff. 5/27/88; TRANS, from DFS, 1997 MAR p. 2294.

Mont. Admin. R. 37.43.104 Payment Standards

(1) The department of public health and human services has set the following monthly maximum payment standards of state supplement per client for each of the five facilities listed in ARM 37.43.103:

(a) personal care facilities - $94.00;

(b) community homes for the developmentally disabled - $94.00;

(d) community homes for the severely disabled - $94.00;

(e) foster care homes - $52.75;

(f) transitional living services to developmentally disabled - $26.00.

(2) The payments will be administered by the federal social security administration according to a state-federal agreement.

(3) A recipient must receive for personal needs a minimum amount of $40 total from the state supplement and the federal supplemental security income per month.

(4) The payment standards in (1) are retroactively effective July 1, 1983.

History

Authorizing statute(s): Sec. 52-1-103 and 52-1-104, MCA
Implementing statute(s): Sec. 52-1-104, MCA
History: NEW, 1982 MAR p. 1281, Eff. 7/1/82; AMD, 1983 MAR p. 1269, Eff. 9/16/83; AMD, 1986 MAR p. 2014, Eff. 12/12/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 978, Eff. 5/27/88; TRANS, from DFS, 1997 MAR p. 2294.

Chapter 37.45 Veterans' Facilities

Subchapter 37.45.1 General Requirements

Mont. Admin. R. 37.45.101 Mission Statement

(1) The Montana veterans' home, located at Columbia Falls, is a state operated facility which provides a home for honorably discharged veterans of the armed forces of the United States and the spouses of honorably discharged veterans. The Montana veterans' home provides intermediate nursing care and domiciliary care. All admissions are by voluntary application. Residents of the Montana veterans home are assessed charges for their care according to their ability to pay.

History

Authorizing statute(s): Sec. 10-2-403, MCA
Implementing statute(s): Sec. 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Mont. Admin. R. 37.45.102 Definitions

(1) For the purpose of interpreting these rules, the following definitions apply:

(a) "Veteran" means a person who served in the active military service and who was discharged with an honorable discharge.

(b) "Spouse" means a person who is legally married to a veteran.

(c) "Surviving spouse" means a person who was legally married to a veteran, who is the widow or widower of that veteran and who has not remarried.

(d) "Applicant" means a veteran, a spouse, a surviving spouse, or a married couple, one member of which is a qualified veteran, who is seeking admission to the Montana veterans' home or for whom admission is sought by a court appointed legal guardian.

(e) "Intermediate nursing care" means the provision of nursing care services, health-related services and social services under the supervision of a licensed nurse to patients not requiring 24 hour nursing care.

(f) "Domiciliary care" means the provision of services and care which do not require nursing skills to residents needing some assistance in performing the activities of daily living.

History

Authorizing statute(s): Sec. 10-2-403, MCA
Implementing statute(s): Sec. 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Subchapter 37.45.2 Admission Procedures

Mont. Admin. R. 37.45.201 Admission Criteria

(1) Eligibility for admission to the Montana veterans' home is determined without regard to race, color, sex, culture, social origin or condition, political or religious ideas, or ability to pay for the cost of care.

(2) To be admitted to the Montana veterans' home, an applicant must:

(a) be a veteran, spouse, or surviving spouse;

(b) be 55 years of age or, if younger than 55, an invalid and/or unable to earn a livelihood;

(d) have the mental status necessary to function in a manner conducive to the safety and comfort of residents and staff.

History

Authorizing statute(s): Sec. 10-2-403, MCA
Implementing statute(s): Sec. 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Mont. Admin. R. 37.45.205 Application Procedures

(1) To be considered for admission, the following documents must be submitted by the applicant to the superintendent of the Montana veterans' home:

(a) a completed application form which includes a request for admission to either intermediate or domiciliary care;

(b) documentation of honorable discharge from the armed forces of the United States;

(d) a medical history, including the results of a comprehensive medical evaluation conducted no more than 60 days prior to the date of application.

History

Authorizing statute(s): 10-2-403, MCA
Implementing statute(s): 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Mont. Admin. R. 37.45.206 Application Materials

(1) Application forms are available from the Superintendent, Montana Veterans' Home, Columbia Falls, MT 59912.

History

Authorizing statute(s): Sec. 10-2-403, MCA
Implementing statute(s): Sec. 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Mont. Admin. R. 37.45.207 Admission Procedures

(1) The superintendent will review all application materials and determine the applicant's eligibility for admission.

(2) The superintendent will notify the applicant, in writing, of the decision regarding eligibility.

(3) The eligible applicant will be admitted immediately if there is a bed available which:

(a) provides the level of care required by the applicant; and

(b) is appropriate for a person of the applicant's sex.

(4) If there is no bed immediately available, the applicant will be placed on a waiting list for either intermediate care or domiciliary care.

(5) As beds become available, the Montana veterans' home will admit applicants from the waiting list on the basis of the date of notification of eligibility. In general, the earlier the determination of eligibility, the earlier the admission. However, veterans on the waiting lists will be given preference over spouses and surviving spouses.

(6) The superintendent may waive use of the waiting lists

as described in (5) above if:

(a) the location of an available bed requires that the next person admitted be of a particular sex; or

(b) there is an applicant whose current living conditions

require that he or she be admitted immediately.

(7) When two or more applicants have equal priority on the waiting list, the person with the longest documented Montana residence will be admitted first.

History

Authorizing statute(s): Sec. 10-2-403, MCA
Implementing statute(s): Sec. 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Subchapter 37.45.3 Discharge Procedures

Mont. Admin. R. 37.45.301 Discharge

(1) Residents of the Montana veterans' home will be discharged upon request of the resident or his or her legal guardian. The superintendent may discharge a resident for serious violations of the Montana veterans' home rules and regulations.

History

Authorizing statute(s): 10-2-403, MCA
Implementing statute(s): 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Subchapter 37.45.5 Appeal Procedures

Mont. Admin. R. 37.45.501 Appeal Procedure

(1) Applicants who are denied admission may appeal that decision by submitting, in writing, their reasons for appealing the decision to the Director of the Department of Public Health and Human Services, 111 N. Sanders, P.O. Box 4210, Helena, Montana 59604-4210, within 30 days of the denial of admission.

(2) The director will respond to the appeal, in writing, within 30 days of receipt of the appeal.

History

Authorizing statute(s): Sec. 10-2-403, MCA
Implementing statute(s): Sec. 10-2-403, MCA
History: NEW, 1985 MAR p. 374, Eff. 4/26/85; TRANS, from DOC, 1998 MAR p. 1748.

Chapter 37.47 Protective Services

Subchapter 37.47.1 Adult Protective Services

Mont. Admin. R. 37.47.101 Adult Protective Services: Purpose

(1) Adult Protective Services (APS) investigates allegations of abuse, sexual abuse, neglect, or exploitation of vulnerable adults.

(2) APS does not provide direct support or personal care services but may refer individuals to state and local providers offering services aimed at reducing risk and addressing concerns related to adult maltreatment.

History

Authorizing statute(s): 52-3-205, 52-3-802, MCA
Implementing statute(s): 52-3-205, 52-3-804, MCA
History: NEW, 1978 MAR p. 206, Eff. 2/25/79; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 657; AMD, 2019 MAR p. 344, Eff. 3/30/19; AMD, Notice No. 2025-168, Eff. 5/10/25.

Mont. Admin. R. 37.47.102 Adult Protective Services: Definitions

As used in this subchapter, the following definitions apply:

(1) “Adult maltreatment” has the meaning provided in 45 CFR 1324.401.

(2) "Department" means the Department of Public Health and Human Services, as defined in 2-15-2201, MCA.

(3) "Non-voluntary services" means emergency protective services provided under court order to a vulnerable adult.

(4) "Protective services" has the meaning provided in 52-3-202, MCA.

(5) "Voluntary services" means protective services requested or accepted by a vulnerable adult.

(6) "Vulnerable adult" has the meaning provided in 52-3-803, MCA.

(7) "Ward" means an incapacitated person for whom a guardian has been appointed by a court of competent jurisdiction.

History

Authorizing statute(s): 52-3-205, 52-3-802, MCA
Implementing statute(s): 52-3-205, 52-3-804, MCA
History: NEW, 1978 MAR p. 206, Eff. 2/25/78; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 657; AMD, 2019 MAR p. 344, Eff. 3/30/19; AMD, Notice No. 2025-168, Eff. 5/10/25.

Mont. Admin. R. 37.47.106 Adult Protective Services: Available Services

(1) Adult protective services will be provided when necessary to any vulnerable adult.

(2) Voluntary services include:

(a) identifying vulnerable adults needing protective services through reports received;

(b) investigating reports of adult maltreatment and identifying the extent and types of services needed;

(i) behavioral health services for the vulnerable adult and family;

(ii) appropriate alternative living arrangements or protective placements;

(iii) support services from available persons or agencies;

(iv) medical health related services; or

(v) legal services.

(3) Non-voluntary services may include any voluntary service under (2) and any other services ordered by the court through guardianship proceedings.

(4) Adult protective services will be provided when necessary, without regard to income, to any vulnerable adult.

(5) Services are available to Montana residents or to any vulnerable adult located in the state of Montana.

History

Authorizing statute(s): 52-3-205, 52-3-802, MCA
Implementing statute(s): 52-3-205, 52-3-804, MCA
History: NEW, 1978 MAR p. 206, Eff. 2/25/78; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 657; AMD, 2019 MAR p. 344, Eff. 3/30/19; AMD, Notice No. 2025-168, Eff. 5/10/25.

Mont. Admin. R. 37.47.107 Adult Protective Services, Eligibility (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 52-3-205, 52-3-802, MCA
Implementing statute(s): 52-3-205, 52-3-804, MCA
History: NEW, 1979 MAR p. 1705, Eff. 12/28/79; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 657; AMD, 2019 MAR p. 344, Eff. 3/30/19; REP, Notice No. 2025-168, Eff. 5/10/25.

Mont. Admin. R. 37.47.111 Adult Protective Services: Obtaining Services

(1) Unless directed otherwise by the APS bureau chief, the Adult Protective Services regional office near where the vulnerable adult resides or is found will investigate reports of adult maltreatment and make referrals to state and local providers if appropriate.

(2) Referrals for service may be accepted by the vulnerable adult on their own behalf or by an authorized alternate decision-maker, such as a person who holds the vulnerable adult’s power of attorney or has been appointed as guardian to the vulnerable adult.

(3) A report of adult maltreatment may be written, electronic, or oral.

(a) All reports must be made through the Adult Protective Services (APS) Intake. This can be by phone or the online reporting portal, and may be made anonymously.

(b) If a person calls, visits, or writes to a department office other than the APS Intake to report adult maltreatment, that department office shall refer the person or written communication to the APS Intake.

History

Authorizing statute(s): 52-3-205, 52-3-802, MCA
Implementing statute(s): 52-3-205, 52-3-804, MCA
History: NEW, 1978 MAR p. 206, Eff. 2/25/78; AMD, 1979 MAR p. 1705, Eff. 12/28/79; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 657; AMD, 2019 MAR p. 344, Eff. 3/30/19; AMD, Notice No. 2025-168, Eff. 5/10/25.

Subchapter 37.47.3 Child Protective Services

Mont. Admin. R. 37.47.301 Child Protective Services: Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 2-4-201, 41-3-208 and 52-2-111, MCA
Implementing statute(s): Sec. 41-3-102, 41-3-201, 41-3-202 and 41-3-302, MCA
History: NEW, 1994 MAR p. 2431, Eff. 8/26/94; TRANS, from DFS, 1998 MAR p. 657; AMD, 2004 MAR p. 1793, Eff. 8/6/04; REP, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.47.302 Centralized Intake Bureau

(1) The centralized intake (CI) bureau is established within the department and is responsible for the operation of the statewide centralized intake system which receives all reports of suspected child abuse, neglect or abandonment statewide from both mandatory and discretionary reporters 24 hours a day, seven days a week.

(2) The department operates a child abuse hotline within the CI bureau to receive and screen incoming communications.

(3) All reports of child abuse or neglect must be made through the child abuse hotline. If a person calls, visits or writes a department office other than the child abuse hotline to report child abuse or neglect, that department office shall refer the person or written communication to the hotline.

History

Authorizing statute(s): Sec. 2-4-201 and 41-3-208, MCA
Implementing statute(s): Sec. 41-3-102, 41-3-201, 41-3-202 and 41-3-302, MCA
History: NEW, 2004 MAR p. 1793, Eff. 8/6/04.

Mont. Admin. R. 37.47.303 Child Abuse Hotline: Report and Screening of Information

(1) When the child abuse hotline receives an incoming communication, the CI specialist will:

(a) ask the caller's identity:

(i) if the caller does not wish to self-identify, the CI specialist shall also accept an anonymous call;

(b) use standardized questions to screen the communication and determine:

(i) the type of child abuse or neglect alleged;

(ii) the level of response required; and

(iii) how the report will be classified;

(d) enter the report information into the protective service information system described at ARM 37.47.315.

(2) When the incoming communication received by the hotline contains an allegation of child abuse or neglect requiring investigation, the CI specialist shall transmit the report to a local office for a response pursuant to 41-3-202 , MCA.

(3) When an incoming communication received by the hotline results in a report alleging child abuse or neglect which indicates a child may be in immediate danger of serious harm, thus requiring an immediate response, the CI specialist will promptly contact the appropriate social worker in the field designated to receive those reports and verbally inform the field social worker of:

(a) the nature of the concerns;

(b) where the child or children of concern can be located; and

(4) Following verbal communication with the field social worker, the CI specialist shall promptly enter the report information into the protective service information system and transmit the report electronically to the department's local office.

(5) When an incoming communication received by the hotline does not contain an allegation of child abuse or neglect, but instead is classified as a request for services, as child protection information only, or a report regarding a licensee issue, the CI specialist shall also record that information.

History

Authorizing statute(s): Sec. 2-4-201 and 41-3-208, MCA
Implementing statute(s): Sec. 41-3-102, 41-3-201, 41-3-202 and 41-3-302, MCA
History: NEW, 2004 MAR p. 1793, Eff. 8/6/04.

Mont. Admin. R. 37.47.304 Child Protective Services: Investigations Regarding Persons Present in Licensed or Registered Facilities or in Assistance of Law Enforcement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 41-3-208 and 52-2-111, MCA
Implementing statute(s): Sec. 41-3-102, 41-3-202, 41-3-302, 41-3-1142 and 52-2-741, MCA
History: NEW, 1994 MAR p. 2431, Eff. 8/26/94; TRANS, from DFS, 1998 MAR p. 657; REP, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.47.305 Disqualifying Criminal Offense for Adults Residing in Potential Emergency Placement

(1) "Disqualifying criminal offenses" for adults residing in emergency placements are the same criminal offenses set forth for youth foster homes in ARM 37.51.216(1) and 45 CFR 1356.30.

History

Authorizing statute(s): 41-3-304, MCA
Implementing statute(s): 41-3-304, MCA
History: NEW, 2015 MAR p. 306, Eff. 3/27/15.

Mont. Admin. R. 37.47.308 Child Protection Specialist Certification

(1) All Child and Family Services Division employees who are employed in child-facing employment positions, including child protection specialist supervisors and child protection specialists, must maintain certification.

(2) All division employees in child-facing positions hired after October 1, 2021 must successfully complete the training requirements for initial certification in their first year of employment.

(3) Following the completion of the mandatory training requirements, the division employee in a child-facing position must obtain a passing score on a competency examination approved by the division administration. An overall score of 80% is required for passage of the competency examination.

(a) Any division employee in a child-facing position who does not obtain a passing score as outlined above, must meet with their direct supervisor and regional training staff to review all relevant materials prior to attempting the competency examination again.

(b) Any division employee in a child-facing position who does not obtain a passing score on the competency examination following a second attempt must meet with the regional administrator and the division training development supervisor to review all relevant materials prior to attempting the competency examination again.

(c) Following the third unsuccessful attempt to obtain a passing score on the competency examination, the progressive discipline process through the department's human resources office will be utilized.

(d) If an employee hired after October 1, 2021 resigns and returns to the division within one year, and prior to resignation had completed the required training, the employee may choose to take the competency examination without repeating the training program.

(e) Current employees who were hired prior to October 1, 2021 who have completed training within the first year of hire are not required to repeat the training.

(i) Current employees must complete and pass the competency examination by October 1, 2023.

(ii) If the employee does not pass the competency examination within two attempts, the employee must repeat the training program prior to the third attempt.

(4) To be a child protection specialist supervisor, an employee must obtain the child protection specialist certification.

(5) Each division employee in a child-facing position who successfully completes the initial certification process must complete twenty hours of training on an annual basis.

(a) Annual training topics must include the topics required by statute.

(b) Other annual training topics approved by the division include, but are not limited to:

(i) parent coaching and supportive visitation;

(ii) childhood trauma;

(iii) multidisciplinary/child protection team;

(iv) substance use disorders;

(v) engagement and communication with children;

(vi) engagement and communication with adults;

(vii) forensic interview training;

(viii) identification and support of commercial sexual exploitation; and

(ix) any other trainings approved by division administration.

(6) For purposes of this rule, "division" means the Child and Family Services Division.

History

Authorizing statute(s): 41-3-131, MCA
Implementing statute(s): 41-3-127, 41-3-129, 41-3-130, MCA
History: NEW, 2022 MAR p. 613, Eff. 4/30/22.

Mont. Admin. R. 37.47.309 Initial Child Protection Specialist Supervisory Training

(1) Child protection specialist supervisors are required to attend supervisory training. It is the responsibility of the division's training unit to develop, coordinate, implement, and track the completion of the initial supervisory training.

(2) All child protection specialist supervisors hired after July 1, 2021 must complete the initial supervisory training within the first year of employment as a child protection specialist supervisor.

(a) Training topics for child protection specialist supervisors include, but are not limited to:

(i) personnel management and supervision framework;

(ii) the division safety assessment model;

(iii) the division practice model; and

(iv) leadership in child welfare.

(3) Proof of successful completion of the required training hours must be provided to the division's training unit.

(4) For purposes of this rule, "division" means the Child and Family Services Division.

History

Authorizing statute(s): 52-2-111, MCA
Implementing statute(s): 52-2-111, MCA
History: NEW, 2022 MAR p. 613, Eff. 4/30/22.

Mont. Admin. R. 37.47.310 Annual Child Protection Specialist Supervisory Training

(1) Child protection specialist supervisors must complete annual child welfare supervisory training. It is the responsibility of the division's training unit to develop, coordinate, implement, and track the completion of these supervisory trainings on an annual basis.

(2) Child protection specialist supervisors must complete twenty hours of child welfare supervisory training annually and have the completion recorded and tracked by the division's training unit.

(3) Annual training topics for child protection specialist supervisors are based on topics relevant to the position.

(4) All supervisory trainings completed by child protection specialist supervisors must be approved by the division's administration. Proof of successful completion of supervisory trainings must be provided to the division's training unit.

(5) Twenty hours of child protection specialist supervisory training will count toward the twenty-hour child protection specialist recertification.

(6) For purposes of this rule, "division" means the Child and Family Services Division.

History

Authorizing statute(s): 52-2-111, MCA
Implementing statute(s): 52-2-111, MCA
History: NEW, 2022 MAR p. 613, Eff. 4/30/22.

Mont. Admin. R. 37.47.315 Child Protective Services: Information System Operation

(1) "Protective services information systems" means a collection of records in a central location of all reports relating to investigations of child abuse or neglect cases. The department is responsible for maintaining the protective services information system.

(2) All reports of the protective services information system are confidential.

(3) Misuse of the information by any employee of the department is grounds for immediate dismissal.

(4) Misuse of information by persons other than department employees shall be grounds for termination of the person's rights to such information.

(5) Periodic statistical reports will be compiled.

(6) Persons who are subjects of the reports have the right to examine the protective services information system material on their case in accordance with ARM Title 37, chapter 47, subchapter 6.

History

Authorizing statute(s): Sec. 41-3-208, MCA
Implementing statute(s): Sec. 41-3-202, MCA
History: NEW, Eff. 4/5/76; AMD, 1981 MAR p. 1112, Eff. 10/1/81; AMD, 1983 MAR p. 1838, Eff. 12/16/83; AMD, 1984 MAR p. 1412, Eff. 9/28/84; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1994 MAR p. 2431, Eff. 8/26/94; TRANS, from DFS, 1998 MAR p. 657; AMD, 2004 MAR p. 2409, Eff. 10/8/04.

Subchapter 37.47.6 Confidentiality of Case Records

Mont. Admin. R. 37.47.601 Protective Services: Purpose

(1) The rules of this subchapter govern the disclosure and amendment of case records containing reports of child abuse, neglect or exploitation, and identify a procedure to administratively challenge a substantiated report of child abuse, neglect, or exploitation.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 41-3-205, MCA
History: NEW, 1987 MAR p. 1980, Eff. 10/30/87; AMD, 1994 MAR p. 2433, Eff. 8/26/94; TRANS, from DFS, 1998 MAR p. 657; AMD, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2010 MAR p. 539, Eff. 2/26/10.

Mont. Admin. R. 37.47.602 Child Protective Services: Definitions

For purposes of this subchapter, the following definitions apply:

(1) "A person responsible for a child's welfare" means those persons specified in 41-3-102, MCA.

(2) "Case records" means any records maintained by the department relating to reports and investigations of child abuse, neglect, or exploitation. Photographs, video and audio recordings may also be included as part of the case record. The term does not include confidential reports or evaluations, such as psychological evaluations, provided to the department by other professionals, or licensing or registration files of providers licensed, registered, or certified by the department.

(3) "Child abuse or neglect" means that defined in 41-3-102, MCA, including the various definitions for the types of abuse, neglect, and exploitation.

(4) "Confidential information" means information in case records that is restricted by law from being disclosed.

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

(6) "Disclosure" means to release for inspection or copying or to make known or reveal in any manner any information contained in case records.

(7) "Founded report" means that, after an investigation, the department has determined by a preponderance of the evidence that the reported act of child abuse or neglect occurred.

(8) "Report of child abuse, neglect, or exploitation" means a referral alleging that a child may be abused, neglected, or exploited.

(9) "Subject" means the person responsible for a child's welfare who is the alleged perpetrator of the child abuse, neglect, or exploitation.

(10) "Substantiated report" means that, after an investigation, the department has determined by a preponderance of the evidence that the reported act of child abuse or neglect occurred, and that the subject of the report may be disclosed to the appropriate entities as a person that may pose a danger to children.

(11) "Unsubstantiated" means that, after an investigation, the department could not determine by the preponderance of the evidence that the reported abuse or neglect occurred.

History

Authorizing statute(s): 2-4-201, 41-3-208, 52-3-205, MCA
Implementing statute(s): 2-4-201, 41-3-102, 41-3-202, 41-3-205, 52-3-205, MCA
History: NEW, 1987 MAR p. 1980, Eff. 10/30/87; AMD, 1994 MAR p. 1290, Eff. 5/13/94; AMD, 1994 MAR p. 2433, Eff. 8/26/94; TRANS, from DFS, 1998 MAR p. 657; AMD, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2015 MAR p. 306, Eff. 7/1/15; AMD, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.47.607 Protective Services: Disclosure

(1) Case records may be disclosed to those individuals or entities referred to in the applicable provisions of 41-3-205, MCA.

(2) The department may prevent the disclosure of any portions of the case record if:

(a) the disclosure of the information is determined to be detrimental to the child or harmful to any person named in the records, in accordance with 41-3-205, MCA; or

(b) the disclosure is prohibited by:

(i) the federal Health Insurance Portability and Accountability Act (HIPAA) , found at 42 USC 1320d et seq., and associated federal regulations;

(ii) the Government Health Care Information Act found in Title 50, chapter 16, part 6, MCA; or

(iii) the Montana Criminal Justice Information Act found in Title 44, chapter 5, MCA.

(3) At no time shall the identity of the referral source making the initial referral or providing information in the course of the investigation be shared with the person or persons about whom the referral is made.

(4) Case records will be disclosed to employees if disclosure is necessary for the administration of programs designed to benefit the child deemed to be abused, neglected or exploited.

History

Authorizing statute(s): 41-3-208, MCA
Implementing statute(s): 41-3-205, MCA
History: NEW, 1987 MAR p. 1980, Eff. 10/30/87; AMD, 1992 MAR p. 2378, Eff. 10/30/92; AMD, 1994 MAR p. 2433, Eff. 8/26/94; TRANS, from DFS, 1998 MAR p. 657; AMD, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.47.608 Protective Services: Procedures

(1) Requests for disclosure must be in writing to the department.

(a) The department shall respond to a request for disclosure within 30 calendar days of the request.

(b) If the request for disclosure is denied, the department shall notify the person requesting the information in writing of the reasons for denial.

(2) Upon receiving a request for disclosure, the department shall determine if the person or entity who is requesting disclosure is authorized by statute or these rules to receive such information.

(a) Any person who is not authorized to receive the information shall be notified in writing that the information cannot legally be disclosed without a court order.

(b) If the person or entity requesting disclosure is authorized by statute or these rules to receive the requested information, the department may disclose the information to the requesting person or entity except as provided in ARM 37.47.607.

(i) The person or entity requesting the information may inspect the case records at the department offices and may request copies of any portion of the case record.

(ii) No fee will be charged for inspection. The department may charge a reasonable fee for the costs of copying the case records. No fee will be charged for copies of the case record that are provided to a parent, a guardian or a parent's or guardian's attorney.

(iii) If the information cannot be disclosed within 30 calendar days of receiving the request, the department shall notify the requesting person or entity in writing of the reason for the delay.

History

Authorizing statute(s): Sec. 41-3-208, MCA
Implementing statute(s): Sec. 41-3-205, MCA
History: NEW, 1987 MAR p. 1980, Eff. 10/30/87; AMD, 1992 MAR p. 2378, Eff. 10/30/92; TRANS, from DFS, 1998 MAR p. 657; AMD, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.47.609 Protective Services: Request for Review and Amendment of the Record

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 2-4-201, 41-3-208 and 52-3-205, MCA
Implementing statute(s): Sec. 2-4-201, 41-3-205 and 52-3-205, MCA
History: NEW, 1987 MAR p. 1980, Eff. 10/30/87; AMD, 1994 MAR p. 1290, Eff. 5/13/94; AMD, 1995 MAR p. 1423, Eff. 7/28/95; TRANS, from DFS, 1998 MAR p. 657; REP, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.47.610 Child Protective Services: Right to Fair Hearing to Contest Substantiated Reports

(1) The subject of a child abuse or neglect report that is determined by the department as substantiated pursuant to ARM 37.47.612 may request a fair hearing.

(2) The request for a fair hearing must be in writing and be sent within 30 days after the date of mailing of the department's initial notice of its substantiation determination. The request must be sent to the Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, MT 59604.

(3) Upon receipt of the request for a fair hearing, the department will conduct an informal review of the investigation including the entire case record.

(a) The informal review is limited to the records and documentation in the case record and any written material provided by the subject.

(b) If, after the informal review, the department determines that the results of the investigation are not substantiated, pursuant to ARM 37.47.612, the department will amend the finding to reflect that the report is unsubstantiated or founded. The subject will be notified of the decision.

(c) If, after the informal review, the department determines that the investigation should be upheld as substantiated, pursuant to ARM 37.47.612, the department will notify the department's Office of Fair Hearings so that a fair hearing may be scheduled.

(4) The fair hearing will be conducted pursuant to the procedures specified in ARM 37.5.304, 37.5.307, 37.5.313, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337, subject to the limitations specified in ARM 37.47.615.

(5) Hearsay statements of the child victim are admissible as evidence in the fair hearing on an investigation of child abuse or neglect report. The administrative law judge will determine the weight to give each child victim's hearsay statement. The factors to be considered in determining the weight of the child hearsay statement include:

(a) the attributes of the child making the hearsay statement;

(b) the witness relating the child's hearsay statement;

(d) any other factors that provide for the reliability of the child's statement.

(6) Hearsay statements of persons other than the child victim are admissible in accordance with Montana Rules of Evidence and relevant case law.

(7) The hearing officer's proposal for decision is subject to review under ARM 37.5.331.

(8) A fair hearing is not available for reports that are determined to be unsubstantiated or founded.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 2-4-612, 41-3-203, 41-3-204, MCA
History: NEW, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2010 MAR p. 539, Eff. 2/26/10; AMD, 2015 MAR p. 306, Eff. 7/1/15; AMD, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.47.611 Declaration of Purpose: Child Abuse and Neglect Investigations Determined as "substantiated"

(1) Section 41-3-205, MCA provides that the case records of investigations into child abuse and neglect are confidential.

(2) Section 41-3-205, MCA also provides that persons and entities carrying out background, employment-related, or volunteer-related activities on prospective employees or volunteers who may have unsupervised contact with children may request information from the department. The information that may be provided by the department to such a request is limited to confirmation that the department's Protective Services Information System has information that indicates the person may pose a risk to children.

(3) The purpose of ARM 37.47.611, 37.47.612, 37.47.616 and 37.47.617 is to provide a process for which information in a child abuse or neglect investigation may be relied upon by the department in determining that a person may pose a risk to children and can be disclosed pursuant to 41-3-205, MCA.

(4) It is the policy of the department that any report of child abuse or neglect that is determined as "substantiated" may be disclosed to persons or entities requesting background checks on potential employees or volunteers who may have unsupervised access to children.

(5) Substantiated reports may be relied upon by the department to deny a person a foster care license, day care license, or employment in any field where a person has or may have unsupervised contact with children.

(6) Nothing in this rule prohibits the department or its personnel from using the facts discovered during an investigation and the associated case record of a child abuse or neglect report investigation, as necessary, to support district court actions under Title 41 of the Montana Code Annotated or an administrative process of the department.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 41-3-102, 41-3-202, 41-3-205, MCA
History: NEW, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.47.612 When the Results of an Investigation of Reported Child Abuse and Neglect May Be Disclosed as to an Individual That May Pose a Risk to Children

(1) After any investigation of a reported child abuse or neglect has been completed and the safety assessment set forth in 41-3-202, MCA is completed, the investigating worker and the local supervisor must determine how to list the report and investigation in the Protective Information System provided by ARM 37.47.613.

(2) The results of the investigation must be listed in the Protective Information System as either unsubstantiated, founded, or substantiated as defined in ARM 37.47.602.

(3) In order for an investigation to be determined and listed as substantiated against the subject of the report, the investigating worker and the local supervisor must determine that the preponderance of the evidence supports a finding that:

(a) the reported abuse or neglect occurred;

(b) the subject was the perpetrator of the abuse or neglect; and

(c) the case file documents sufficient evidence under the totality of the circumstances to find that the subject may pose a risk to children.

(4) The factors considered in determining whether a subject in a child abuse or neglect report may pose a danger to children include but are not limited to:

(a) the nature of the substantiated abuse or neglect;

(b) any prior or subsequent child abuse or neglect reports or investigations involving the perpetrator;

(c) any prior or subsequent Youth in Need of Care adjudications in District Court where the perpetrator was determined as an abuser;

(d) any prior or subsequent criminal convictions for crimes against children; and

(e) the degree to which a child was impacted by any prior or subsequent reported abuse or neglect, or any prior or subsequent criminal convictions.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 41-3-102, 41-3-202, 41-3-205, MCA
History: NEW, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.47.613 Child Protective Services: Listing of Determination in the Protective Information System

(1) When the department determines that a report of child abuse or neglect is substantiated pursuant to ARM 37.47.612, the department will initially list its determination in its protective services information system provided in ARM 37.47.315 that the report's final determination is pending. The report will be pending for a period of 30 days from the date of the department's initial notice to the subject.

(2) If, after receiving the initial notice of the department's determination that the results of any child abuse and neglect investigation are substantiated, the subject does not request a fair hearing within the 30-day time period required by ARM 37.47.610(2), the department will list the report in its protective services information system as substantiated.

(3) If the subject requests a fair hearing pursuant to ARM 37.47.610(2), the department's determination will be listed as pending in its protective services information system until all administrative and judicial appeals have been decided.

(4) Reports of child abuse or neglect that are determined to be unsubstantiated will be listed in the department's protective services information system described in ARM 37.47.315, for a period of three years from the date of the report, unless the report is associated with a prior or subsequent report that is substantiated.

(5) Reports of child abuse or neglect that are determined to be substantiated will be listed in the department's protective services information system described in ARM 37.47.315 in perpetuity, subject to the confidentiality provisions of ARM 37.47.614.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 41-3-202, 41-3-204, MCA
History: NEW, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2010 MAR p. 539, Eff. 2/26/10; AMD, 2015 MAR p. 306, Eff. 7/1/15; AMD, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.47.614 Use of Determinations in Child Abuse or Neglect Report Investigations

(1) Findings, determinations, and associated case records on child abuse or neglect reports that are determined as unfounded, unsubstantiated, or founded cannot be disclosed to the following persons without either a valid court order or a signed release by the subject of the report:

(i) a parent, grandparent, aunt, uncle, brother, sister, or guardian;

(ii) foster and adoptive parents who are or may be providing care for a child.

(2) Child abuse or neglect reports that are determined to be unsubstantiated or founded cannot be solely relied upon by the department to deny a person a license to provide foster care, kinship care, or to be employed in a capacity where they have unsupervised access to children.

(3) Findings, determinations, and associated case records on child abuse or neglect reports that are determined to be substantiated are confidential, but may be disclosed pursuant to 41-3-205, MCA, and ARM 37.47.612.

(4) Child abuse or neglect reports that are determined to be substantiated may be used as a basis to deny a person a license to provide foster care, kinship care, or to be employed in a capacity where they have unsupervised contact with children.

(5) Nothing in this rule prohibits the department or its personnel from using the facts discovered during an investigation and the associated case record of a child abuse or neglect report investigation, as necessary, to support district court actions under Title 41 of the Montana Code Annotated or an administrative process of the department.

(6) All disclosures of information on findings, determinations, and associated case records on child abuse or neglect reports are subject to the specific restrictions provided in 41-3-205, MCA.

History

Authorizing statute(s): 41-3-205, 41-3-304, MCA
Implementing statute(s): 41-3-205, 41-3-304, MCA
History: NEW, 2015 MAR p. 306, Eff. 7/1/15; AMD, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.47.615 Child Protective Services: Exceptions to Right to Fair Hearing

(1) The subject of a substantiated report of child abuse, neglect, or exploitation is not entitled to a fair hearing if:

(a) the subject has been criminally convicted, as defined in 45-2-101(15), MCA, of an offense related to child abuse, neglect, or exploitation which contains the same facts as the substantiated report and involves the same child victim; or

(b) pursuant to 41-3-437(2) or 41-3-434, MCA, there has been a district court adjudication, or a stipulation by the parents, that the child in the substantiated report is a youth in need of care, as defined in 41-3-102, MCA; and

(i) the facts of the district court adjudication, or the allegations in the affidavit in the case of a stipulation, are the same as that of the substantiated report; and

(ii) the subject of the substantiated report is the perpetrator of the child abuse, neglect, or exploitation; or

(c) a court or administrative hearing officer has made any adjudication in a prior proceeding as to the factual findings of the child abuse, neglect, or exploitation contained in the substantiated report.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 41-3-205, MCA
History: NEW, 2004 MAR p. 2409, Eff. 10/8/04; AMD, 2015 MAR p. 306, Eff. 3/27/15.

Mont. Admin. R. 37.47.616 Effect of a Department Determination That an Investigation of Child Abuse and Neglect Is "substantiated"

(1) If after an investigation, fair hearing, or any appeal thereof, the department has determined that the results of an investigation are "substantiated," then the department may:

(a) disclose to any person or entity requesting a background check pursuant to 41-3-205, MCA, that the department has information that indicates that a person may pose a risk to children; and

(b) rely on the information to deny a foster care license pursuant to ARM 37.51.216 or a day care license pursuant to ARM 37.95.176.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 41-3-102, 41-3-202, 41-3-205, MCA
History: NEW, 2020 MAR p. 2434, Eff. 1/1/21.

Mont. Admin. R. 37.47.617 Child Abuse and Neglect Reports Determined as Substantiated Prior to January 1, 2021

(1) Any child abuse or neglect report or investigation that was determined by the department as substantiated prior to January 1, 2021, may be disclosed to the appropriate persons or entities pursuant to 41-3-205, MCA.

(2) No hearing is available for child abuse or neglect reports that are not determined as substantiated.

History

Authorizing statute(s): 2-4-201, 41-3-208, MCA
Implementing statute(s): 2-4-201, 41-3-102, 41-3-202, 41-3-205, MCA
History: NEW, 2020 MAR p. 2434, Eff. 1/1/21.

Subchapter 37.47.9 Home Attendant Services

Mont. Admin. R. 37.47.901 Home Attendant Services, Definition (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 3218; REP, Notice No. 2025-168, Eff. 5/10/25.

Mont. Admin. R. 37.47.904 Home Attendant Services, Eligibility (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 3218; REP, Notice No. 2025-168, Eff. 5/10/25.

Mont. Admin. R. 37.47.905 Home Attendant Services, Services Available (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 3218; REP, Notice No. 2025-168, Eff. 5/10/25.

Mont. Admin. R. 37.47.910 Termination of Home Attendant Services

(1) The recipient may request that home attendant services be discontinued or may request a change of home attendant. The social worker must act on this request.

(2) The department may, in its discretion and in accordance with these rules, terminate home attendant services to a recipient.

(a) The social worker must inform the recipient both in person and in writing of the decision to discontinue services and the reasons.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1983 MAR p. 863, Eff. 7/15/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 3218.

Authorizing statute(s): 40-2-402, MCA
Implementing statute(s): 40-2-401, MCA
History: NEW, 1979 MAR p. 813, Eff. 7/27/79; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 657; REP, 2025 MAR, 37-1095, Eff. 4/12/25.

Chapter 37.49 Iv-E Foster Care Services

Subchapter 37.49.1 General Requirements

Mont. Admin. R. 37.49.101 Iv-E Foster Care Eligibility: Definitions

For purposes of this subchapter, the following definitions apply:

(1) "Child" means a person who is under age 18 or who is age 18 or older if the person is a full-time student in a secondary school who is reasonably expected to obtain a secondary school diploma or its equivalent in or before the month of the person's 19th birthday.

(2) "Child care institution" means a private institution, or public institution which accommodates no more than 25 children, which is licensed or approved by the state to provide care for children who have been removed from the home of the children's parents or guardians by a voluntary agreement or by court order. The term does not include detention facilities, forestry camps, training schools, or any other facility operated primarily for the detention of children determined to be delinquent.

(3) "Child support rights" means a child's legal entitlement to cash assistance from a parent with whom the child does not live.

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

(5) "Dependent child" means a child as defined in this rule who is deprived of parental support or care due to any of the causes set forth in ARM 37.49.113, lives with a specified relative as provided in ARM 37.49.112 and lacks income and resources sufficient for the child's needs according to the assistance standards and resource limits set forth in ARM 37.49.407 and 37.49.501.

(6) "Earned income" means income information acquired by researching the data in the automated eligibility system maintained by the department, the automated wage and labor data base maintained by the Montana department of labor and industry and the automated income tax data base maintained by the Montana department of revenue. Income information may also be obtained from the child or parents.

(7) "TANF cash assistance" means assistance in the form of monthly cash payments provided to eligible families.

(8) "Filing unit" means the child for whom IV-E eligibility is being sought and the persons with whom the child lives whose income and resources are considered in determining the child's eligibility.

(9) "Foster home" means a home licensed by the state to provide care for a child or children who have been removed from the home of the child or children's parents or guardians by voluntary agreement or by court order.

(10) "IV-E foster care maintenance payments" means monthly cash payments made on behalf of a IV-E eligible child to cover the cost of (and the cost of providing) food, clothing, shelter, daily supervision, school supplies, a child's personal incidentals, liability insurance with respect to a child and reasonable travel for a child's visitation with family or other caretakers. Local travel associated with providing the items listed above is also an allowable expense. In the case of child care institutions, such term must include the reasonable costs of administration and operation of such institutions as are necessarily required to provide the items described above.

(11) "Gross monthly income" means all earned and unearned income received in the month being considered, except for income excluded under ARM 37.49.412 and 37.49.414. In stepparent household cases as described in ARM 37.49.201, gross monthly income includes any income of the stepparent deemed available to the spouse as unearned income as provided in ARM 37.49.406.

(12) "Kinship foster care" means a youth care facility in which substitute care is provided to one to six children or youth other than the kinship parent's own children, stepchildren or wards. The substitute care may be provided by any of the following:

(a) a member of the child's extended family;

(b) a member of the child's or family's tribe;

(d) the child's stepparents; or

(e) a person to whom the child, child's parents or family ascribe a family relationship and with whom the child has had a significant emotional tie that existed prior to the department's involvement with the child or family.

(13) "Married" means that a legally recognized marital relationship exists between two persons, regardless of whether the marriage was created ceremonially or by common law.

(14) "Medical support rights" means a child's legal entitlement to health insurance coverage and/or assistance in paying medical expenses from a parent with whom the child does not live.

(15) "Minor parent" means a person under the age of 18 who is the biological or adoptive parent of a dependent child who is in the care of the minor parent.

(16) "Month of eligibility" means the month in which either:

(a) the child's parent or legal guardian entered into a voluntary placement agreement in regard to the child; or

(b) the petition was filed which resulted in a judicial determination to the effect that it would be contrary to the welfare of the child to remain in the home and that reasonable efforts have been made to prevent or eliminate the need to remove the child from the home.

(17) "Net monthly income" means gross monthly income less any earned or unearned income excluded pursuant to ARM 37.49.412 and 37.49.414 and less any earned income disregarded in ARM 37.49.413.

(18) "Placing worker" means an individual who has the authority and responsibility to make decisions regarding the placement of a child who has been removed from the child's home by a voluntary agreement entered into by the child's parent or legal guardian or as a result of a judicial determination that removal from the home will serve the child's welfare. A placing worker may be an employee or agent of a governmental unit or other public agency who has a IV-E agreement with child and family services division.

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

(20) "Unearned income" means all income that is not earned income as defined in this rule and includes but is not limited to social security benefits, veteran's benefits or payments, worker's compensation payments, unemployment compensation payments, child support payments and dividends paid on capital investments.

(21) "Youth care facility" means a facility that is licensed by the department or by the appropriate licensing authority in another state and in which facility substitute care is provided to youth. The term includes youth foster homes, kinship foster homes, youth group homes, youth shelter care facilities, child care agencies, transitional living programs and youth assessment centers. Youth care facilities must meet the definition of a child care institution in order to receive IV-E foster care maintenance payments.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.102 Iv-E Foster Care Eligibility: General Requirements

(1) IV-E eligibility for a child who has been placed in substitute care shall be determined based on circumstances in the month of eligibility as defined in ARM 37.49.101.

(2) A child shall be determined IV-E eligible if:

(a) the child was placed in substitute care:

(i) pursuant to a voluntary placement agreement entered into by the child's parent or legal guardian; or

(ii) by an order issued by a court of competent jurisdiction pursuant to the provisions of Title 41, chapter 3, MCA;

(b) the state or tribe has legal responsibility for the child's care and placement in accordance with the requirements of the Title IV-E agreement between the tribe and the state;

(i) meets the requirements for IV-E eligibility as specified in ARM 37.49.101 through 37.49.502 in the month of eligibility; or

(ii) was living in the home of the legal custodial specified relative as provided in ARM 37.49.112 during any month in the six months immediately prior to the month of eligibility and would have met the requirements for IV-E eligibility as specified in ARM 37.49.101 through 37.49.502 during said month; and

(d) meets all other eligibility requirements of ARM 37.49.101 through ARM 37.49.502.

(3) If a child is determined to be IV-E eligible, eligibility continues as long as the child remains in state custody or jurisdiction until age 18, regardless of subsequent changes in the filing unit's income or resources. However, IV-E funds cannot be used for maintenance payments when:

(a) deprivation of parental support as defined in ARM 37.49.113 no longer exists; or

(b) the child is age 18 unless the child is a full-time student in a secondary school who is reasonably expected to obtain a secondary school diploma or its equivalent in or before the month of the child's 19th birthday.

(i) reasonable efforts to finalize the permanency plan have not been made within 12 months from the time the court determined that the child was subjected to abuse or neglect; or

(ii) 12 months after the first 60 days of the removal from the home, whichever comes first; or

(iii) from the time of the last permanency plan hearing or within 30 days of a determination that reasonable efforts to provide preservation or reunification services are not necessary;

(d) the child is not placed in a IV-E eligible and licensed foster care placement; or

(e) the child's income and/or resources exceed the limits specified in ARM 37.49.407 and 37.49.501.

(4) A child who is IV-E eligible and who meets the requirements of (3) may receive benefits consisting of:

(a) IV-E foster care medicaid coverage; and

(b) IV-E foster care maintenance payments.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.106 Iv-E Foster Care Eligibility: Residency

(1) In order for a child to be IV-E eligible, the parent or parents of the child must be residents of the state of Montana in the month of eligibility. There is no durational residency requirement for the child's parent or parents.

(2) After a child is determined to be IV-E eligible, eligibility shall not be lost due to a change in residence of the child and/or the child's parents, and the state of Montana shall pay the IV-E foster care maintenance payments for the child as long as the child is eligible for benefits. However, if the child is living or physically located in a state other than Montana after the month of eligibility, the state which shall be responsible for providing medicaid coverage for the child shall be determined in accordance with the residency provisions of 42 CFR 435.403, as amended through October 1, 1997, which are hereby adopted and incorporated by reference. A copy of this regulation may be obtained from the Department of Public Health and Human Services, Office of Legal Affairs, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Mont. Admin. R. 37.49.107 Iv-E Foster Care Eligibility: Citizenship

(1) As a condition of IV-E eligibility and to receive IV-E maintenance payments and/or medicaid, a child must be either a citizen of the United States, a person born in Samoa who is not a U.S. citizen, or a qualified alien as defined in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, P.L. 104-193, section 431(b) (1) through (6) .

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Mont. Admin. R. 37.49.108 Iv-E Foster Care Eligibility: Age

(1) As a condition of IV-E eligibility, a child must be:

(a) under the age of 18; or

(b) age 18 or older if the child is a full-time student in a secondary school who is reasonably expected to obtain a secondary school diploma or its equivalent in or before the month of the child's 19th birthday.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.112 Iv-E Foster Care Eligibility: Living with a Specified Relative

(1) As a condition of IV-E eligibility, a child who is removed from the custody of a parent or other relative must have been living with any relative who is related by blood, including half blood, or by marriage or adoption, and who is within the fifth degree of kinship to the child. At some time during the six months immediately prior to the month of eligibility, the child must have lived with the relative in a place of residence maintained as the relative's home.

(2) The specified relative with whom the child resided during the six months prior to the month of eligibility must be the child's parent, grandparent, great grandparent, great-great grandparent, great-great-great grandparent, sibling, uncle, aunt, great uncle, great aunt, great-great uncle, great-great aunt, first cousin, first cousin once removed, nephew, or niece. Steprelatives of the same degree of kinship are also considered to be within the required degree of kinship; for example, stepparent, stepgrandparent or stepsibling.

(3) A spouse of any of the relatives named in (1) or (2) is considered to be within the required degree of kinship, even after the marriage has been terminated by death or divorce.

(4) The child must be placed in foster care after being removed from the legal custody of a parent or other legal custodian. Removal may occur under the terms of an agreement providing for foster care placement signed by a person with legal custody of the child or as a result of a petition filed by the department, a tribe, another state agency or a licensed child placing agency seeking to declare the child a youth in need of care.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03; AMD, 2004 MAR p. 2292, Eff. 9/24/04.

Mont. Admin. R. 37.49.113 Iv-E Eligibility: Deprivation of Parental Support

(1) As a condition of IV-E eligibility, a child must be deprived of parental support in the month of eligibility due to:

(a) death of a parent or parents;

(b) continued absence of a parent or parents;

(d) unemployment of parent.

(2) A child is considered to be deprived of parental support due to the continued absence of a parent if the nature and duration of the absence is such as to either interrupt or terminate the parent’s functioning as a provider of maintenance, physical care, or guidance for the child.

(a) A parent who is absent solely due to the performance of active duty in the armed services of the United States as defined in 37 USC 101(3) is not considered to be absent.

(3) A child is considered to be deprived of parent support due to physical or mental incapacity if:

(a) the parent has a physical or mental defect, illness, or impairment which has been established through competent medical evidence;

(b) the incapacity is of such a debilitating nature as to reduce substantially or eliminate the parent’s ability to support or care for the child; and

(4) A child is considered to be deprived of parental support due to unemployment of the primary wage earner if the family’s income does not exceed the income standards provided in ARM 37.49.407 for a family of that size.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Subchapter 37.49.2 Household Eligibility

Mont. Admin. R. 37.49.201 Iv-E Foster Care Eligibility: Stepparent Households

(1) A stepparent household is one in which a parent who lives with the child or children for whom a IV-E eligibility determination is being made or sought is married to and living with a person who is not the natural or adoptive parent of at least one of the children for whom IV-E eligibility is being determined.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Mont. Admin. R. 37.49.204 Iv-E Foster Care Eligibility: Inclusion in the Filing Unit

(1) The child's IV-E eligibility is based on the total countable income and resources of all members of the filing unit in the month of eligibility.

(2) Except as provided in (3) below, the following individuals must be included in the child's filing unit:

(a) the child for whom IV-E eligibility is being determined;

(b) any natural or adoptive parent of the child with whom the child was living in that month; and

(c) any blood-related or adoptive brother or sister of the child with whom the child was living in that month, including half brothers or sisters.

(3) The following individuals are not included in the child's filing unit:

(a) individuals who are receiving supplemental security income (SSI) benefits;

(b) stepsiblings; and

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Subchapter 37.49.3 Child Support Eligibility Requirements

Mont. Admin. R. 37.49.301 Child and Medical Support Requirements

(1) Except as provided in (2) , in every case where a child is receiving IV-E foster care maintenance payments and/or medicaid benefits based on the absence of a parent from the home, the child's specified caretaker relative must:

(a) assign child and/or medical support rights to the department; and

(b) cooperate in establishing paternity and obtaining child and/or medical support.

(2) A specified caretaker relative is not required to cooperate in establishing paternity and obtaining child and/or medical support if good cause for refusing to do so is determined to exist in accordance with the provisions of 45 CFR 232.40 through 232.49, as amended through October 1, 1995. The department hereby adopts and incorporates by reference 45 CFR 232.40 through 232.49, as amended through October 1, 1995, pertaining to good cause for refusal to cooperate. Copies of 45 CFR 232.40 through 232.49, as amended through October 1, 1995, may be obtained from the Department of Public Health and Human Services, Office of Legal Affairs, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(3) In addition to requiring assignment of rights and cooperation as provided in (1) , the department may seek an order requiring the payment of child and/or medical support for the child receiving IV-E foster care benefits by either or both of the child's parents.

(4) A child who is otherwise IV-E eligible will not be denied eligibility because of the failure or refusal of the placing worker, child's parent, or specified caretaker relative to comply with the requirements of (1) (a) or (1) (b) of this rule.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-2-613 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Subchapter 37.49.4 Income

Mont. Admin. R. 37.49.401 Iv-E Eligibility: a Condition of Need Must Exist

(1) A child is not IV-E eligible unless the requirements in ARM 37.49.102 are met.

(2) After the initial determination of IV-E financial eligibility, the child is not eligible for IV-E benefits as specified in ARM 37.49.102(4) (a) and (b) unless:

(a) deprivation of parental support as defined in ARM 37.49.113 exists, and:

(i) the child is under 18 years of age; or

(ii) the youth is age 18 or a full-time student in a secondary school and is reasonably expected to obtain a secondary school diploma or its equivalent in or before the month of the child's 19th birthday; and

(b) a judicial determination that:

(i) reasonable efforts to finalize the permanency plan have been made within 12 months from the time the court determined that the child was subjected to abuse or neglect; or

(ii) 12 months after the first 60 days of the removal from the home, whichever comes first; or

(iii) from the time of the last permanency plan hearing, or within 30 days of a determination that reasonable efforts to provide preservation or reunification services are not necessary;

(d) the child has income and resources equal to or less than the applicable income and resource standards established in ARM 37.49.407 and 37.49.501.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-2-613 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.404 Iv-E Foster Care Eligibility: Income

(1) Income standards as set forth in ARM 37.49.407 are used to determine whether a child or children is IV-E eligible based on income. Two sets of income standards are used. They are as follows:

(a) the gross monthly income (GMI) standards, which specify the maximum level of gross monthly income a filing unit with a particular number of members may have to be IV-E eligible; and

(b) the net monthly income (NMI) standards, which specify the maximum level of net monthly income a filing unit with a particular number of members may have to be IV-E eligible.

(2) To determine the IV-E eligibility of a child or children, the filing unit's gross monthly income as defined in ARM 37.49.101 is compared to the applicable GMI standard, and, after specified exclusions and disregards specified in ARM 37.49.412, 37.49.413, and 37.49.414 are applied, it is compared to the applicable NMI standard. If the filing unit's gross monthly income exceeds the GMI standard or the filing unit's net monthly income exceeds the NMI standard, the child or children are not IV-E eligible.

(3) The GMI and NMI standards which are used for each comparison are chosen based on the number of the persons in the filing unit and whether the filing unit has a shelter obligation.

(a) A filing unit is considered to have a shelter obligation if a member of the filing unit is obligated to meet a portion of the shelter expenses of the filing unit's place of residence, such as rent, a payment under a contract to purchase a house or other place of residence, a mortgage payment, real property taxes, home owner's insurance, mobile home lot rent, or utilities such as heating fuel, water, or lights. A filing unit receiving a government rent or housing subsidy is considered to have a shelter obligation even if the filing unit's share of the rent or housing payment is $0.

(4) Income received or reasonably expected to be received in the month of eligibility is compared to the applicable GMI and NMI standards.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Mont. Admin. R. 37.49.405 Iv-E Foster Care Eligibility: Treatment of Income

(1) All available income of any required member of the filing unit is counted in determining IV-E eligibility, unless a specific provision elsewhere in this chapter provides that the income will be excluded, disregarded, or otherwise not counted.

(2) Income averaging may be used to determine monthly income if:

(a) income information is obtained for an annual or quarterly period of time. In such cases, the monthly income is calculated by dividing the total amount of income by the number of months the payment or payments are intended to cover; or

(b) income fluctuates significantly from month to month. An example would be an employee paid an hourly wage whose hours worked vary from month to month.

(3) Income tax refunds are not considered as either earned or unearned income but are considered a resource to the filing unit.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.406 Iv-E Eligibility: Deeming of Income

(1) The income of certain individuals who live with the filing unit but are not members of the filing unit is considered in determining IV-E eligibility. The income of such individuals is considered by means of a procedure known as "deeming" which is described in (3) .

(2) The income of the following individuals is deemed to be available to the filing unit:

(a) a stepparent, i.e., a person who is not the natural or adoptive parent of any child in the filing unit but is married to the parent of a child in the filing unit;

(b) a sponsor of an alien for the three years immediately following the alien's entry into the United States; and

(3) The following amounts are subtracted from the income of individuals whose income is required to be deemed, and the net amount obtained is counted as unearned income available to the filing unit, regardless of whether that amount is actually made available to the filing unit for its support and maintenance:

(a) a standard work expense of $90 is subtracted from the individual's earned income, if any;

(b) an amount of earned income, unearned income, or a combination of both which is equal to the net monthly income standard for a family consisting of the individual whose income is deemed and all persons who live with the individual and qualify as the individual's dependents for federal income tax purposes but are not included in the filing unit;

(c) actual verified amounts paid by the individual to persons who do not live with the individual but who qualify as dependents of the individual for federal income tax purposes; and

(d) actual verified amounts of alimony or child support paid by the individual to persons not living with the individual.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA, NEW, 1999 MAR p. 1514, Eff. 7/2/99
History: AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.407 Iv-E Foster Care Eligibility: Tables of Income Standards

(1) The following income standards will be used as provided in ARM 37.49.404 to determine IV-E eligibility:

(a)

GROSS MONTHLY INCOME STANDARDS

Number of Persons in Household | With Shelter Obligation Per Month | Without Shelter Obligation Per Month 1 | $ 616 | $ 224 2 | 823 | 361 3 | 1,032 | 496 4 | 1,241 | 629 5 | 1,449 | 751 6 | 1,658 | 868 7 | 1,867 | 984 8 | 2,074 | 1,093 9 | 2,176 | 1,195 10 | 2,276 | 1,295 11 | 2,364 | 1,382 12 | 2,451 | 1,469 13 | 2,529 | 1,547 14 | 2,601 | 1,621 15 | 2,673 | 1,693 16 | 2,736 | 1,756

NET MONTHLY INCOME STANDARDS

Number of Persons in Household | With Shelter Obligation Per Month | Without Shelter Obligation Per Month 1 | $ 333 | $ 121 2 | 445 | 195 3 | 558 | 268 4 | 671 | 340 5 | 783 | 406 6 | 896 | 469 7 | 1,009 | 532 8 | 1,121 | 591 9 | 1,176 | 646 10 | 1,230 | 700 11 | 1,278 | 747 12 | 1,325 | 794 13 | 1,367 | 836 14 | 1,406 | 876 15 | 1,445 | 915 16 | 1,479 | 949

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Mont. Admin. R. 37.49.412 Iv-E Foster Care Eligibility: Excluded Earned Income

(1) The following earned income is not counted when comparing the filing unit's gross monthly income to the applicable GMI standard:

(a) the earned income of a dependent child who is a full-time student;

(b) income received by a dependent child under section 503 of the Job Training Partnership Act (JTPA) of 1982, P.L. 97-300; and

(2) The following earned income is not counted when comparing the filing unit's net monthly income to the applicable NMI standard:

(a) the earned income of a dependent child who is a full-time student; and

(b) EITC advance payments and refunds.

(3) Income tax refunds are not considered as either earned or unearned income but are considered a resource to the filing unit.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 2574, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.413 Iv-E Foster Care Eligibility: Earned Income Disregards

(1) To determine the net monthly income which will be compared to the applicable NMI standard, the disregards set forth in (2) (a) and (b) below are subtracted from the total gross earned income of each member of the filing unit after the exclusions provided in ARM 37.49.412 have been applied.

(2) The following disregards will be applied in the order listed:

(a) a standard work expense disregard of $90 for each member of the filing unit who has earned income; and

(b) $30 plus 1/3 of the balance of earned income for each member of the filing unit who has earned income; and

(c) a dependent care disregard for payments made by a member of the filing unit for the care of a dependent child or incapacitated adult living in the same home as the filing unit, provided that:

(i) the amount disregarded may not exceed $175 per month per person for persons 2 years of age or older or $200 per month per child for children younger than 2 years of age;

(ii) the disregard applies only to payments for care during the time when the employed member of the filing unit is at the place of employment or en route between the place of employment and the site of the dependent care; and

(iii) only amounts paid or due for the month for which eligibility is being determined may be disregarded.

History

Authorizing statute(s): Sec. 52-2-111, 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 52-2-115, 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2000 MAR p. 3545, Eff. 12/22/00.

Mont. Admin. R. 37.49.414 Iv-E Foster Care Eligibility: Excluded Unearned Income

(1) The following unearned income is not counted when comparing the filing unit's gross monthly income and net monthly income to the applicable GMI and NMI standards:

(a) complementary assistance from other agencies and organizations which consists of:

(i) goods and services not intended to be covered by the TANF cash assistance grant; or

(ii) a supplement to TANF cash assistance payments for a different purpose;

(b) agent orange settlement payments;

(c) undergraduate student loans and grants for educational purposes such as Pell grants, supplemental educational opportunity grants, state student incentive grants, college work study, BIA assistance, veterans financial assistance or university year for action (UYA) ;

(d) low income energy assistance payments (LIEAP) ;

(e) the value of the food stamp coupon allotment;

(f) the value of U.S. department of agriculture donated foods;

(g) any benefits received under Title VII of the nutrition program for the elderly of the Older Americans Act of 1965 as amended;

(h) the value of supplemental food assistance received under the Child Nutrition Act of 1966 and the special food services program for children under the National School Lunch Act, P.L. 92-433 and P.L. 93-150;

(i) all monies awarded to Indian tribes by the Indian claims commission or court of claims as authorized by P.L. 92-254, 93-134, 94-114, and 94-540;

(j) payments received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970;

(k) any contribution made by relatives or others on behalf of the filing unit which is not directly available to the filing unit;

(l) the tax exempt portions of payments made pursuant to the Alaska Native Claims Settlement Act, P.L. 92-203;

(m) all payments under Title I of the Elementary and Secondary Education Act;

(n) incentive payments or reimbursement of training related expenses made to participants in the work component of the TANF program;

(o) payments for supportive services or reimbursement of out-of-pocket expenses made to individual volunteers serving as foster grandparents, senior health aides, or senior companions, and to persons serving in the service corps of the retired executives and active corps of executives and any other program under Titles II and III of P.L. 93-113;

(p) payments to individual volunteers in service to America (VISTA) volunteers under Title I of P.L. 93-113, pursuant to section 404(g) of that law;

(q) small nonrecurring gifts such as those for Christmas, birthdays, and graduation, up to $30 per member of the filing unit in any period of three consecutive calendar months; and

(r) monetary allowances for certain children of Vietnam veterans as described in Administration for Children and Families (ACF) issuance IM-03-02 dated May 8, 2003.

(2) Income tax refunds are not considered as either earned or unearned income but are considered a resource to the filing unit.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Subchapter 37.49.5 Resources

Mont. Admin. R. 37.49.501 Iv-E Foster Care Eligibility: Resource Limitation

(1) A child is not IV-E eligible if the equity value of combined countable resources of all members of the filing unit exceeds $10,000 in the month of eligibility.

(2) After the initial determination of eligibility, the child is not eligible for IV-E benefits as specified in ARM 37.49.102(4) (a) and (b) if the equity value of the child's countable resources exceeds $10,000.

(3) All real and personal property is counted in determining eligibility if any member of the filing unit has the legal right or actual ability to liquidate the property or the member's interest in the property for cash, unless it is a resource specifically excluded in ARM 37.49.502.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2000 MAR p. 3545, Eff. 12/22/00.

Mont. Admin. R. 37.49.502 Iv-E Foster Care Eligibility: Excluded Resources

(1) The following resources are not counted when determining IV-E eligibility:

(a) the home which is the usual residence of the filing unit;

(b) one motor vehicle which has an equity value of $1,500 or less. Any equity value in excess of $1,500 for the first vehicle and the entire equity value of any additional vehicle or vehicles is counted in determining eligibility;

(c) household furniture and goods, clothing and other personal effects, equipment or other items necessary to produce food, home produce for family use and consumption only, and other items of limited value essential for day-to-day use;

(d) tools and equipment essential for the self-employment of a member of the filing unit;

(e) one burial plot for each member of the filing unit;

(f) funds designated for the funeral, burial, and/or cremation expenses of members of the filing unit as follows:

(i) for each member of the filing unit, a sum of $1,500 or less designated for such expenses under an irrevocable agreement; or

(ii) for each member of the filing unit, an unlimited sum designated for such expenses under an irrevocable agreement;

(g) real property other than the usual residence of the filing unit, for a maximum of 6 months, if the family is making a good faith effort to sell the property;

(h) agent orange settlement payments;

(i) radiation exposure compensation payments;

(j) Maine Indian Claims Settlement Act of 1980 payments;

(k) restitution paid pursuant to the Civil Liberties Act of 1988 to individuals of Japanese ancestry who were interned and Aleuts who were relocated during world war II;

(l) major disaster and emergency assistance payments received pursuant to the Disaster Relief and Emergency Assistance Amendments of 1988;

(m) all funds in a business asset development account (BADA) , provided that if the business fails and any funds from the account are disbursed to a member of the filing unit, those funds shall be counted as a resource in the month they are disbursed and in each subsequent month until the funds are spent down;

(n) cash benefits paid under a fire or casualty insurance policy for 90 days after the date of receipt;

(o) the face value of any life insurance owned by any member of the filing unit, but not the cash value of such insurance;

(p) any funds in an escrow account established for a member of the filing unit who is participating in the housing and urban development (HUD) family self-sufficiency (FSS) program;

(q) settlement proceeds paid to a member of the filing unit in the factor VIII or IX concentrate blood products class action lawsuit, MDL 986, No. 93-C-7452, northern district of Illinois;

(r) funds in a family health account (FHA) ;

(s) any unspent portion of an earned income tax credit (EITC) advance payment or refund, in the first month after the month in which it is received; pursuant to ARM 37.49.412, EITC payments and refunds are excluded as earned income in the month of receipt;

(t) student financial assistance made for attendance costs under Title IV of the Higher Education Act or bureau of Indian affairs student assistance programs under the Higher Education Technical Amendments Act of 1987; and

(u) a loan which a member of the filing unit receives and has a legal obligation to repay pursuant to a written agreement signed by the member.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 2286, Eff. 7/2/99.

Subchapter 37.49.6 Eligibility Determinations

Mont. Admin. R. 37.49.601 Iv-E Foster Care Eligibility: Place of Application (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; REP, 2024 MAR p. 2023, Eff. 8/10/24.

Mont. Admin. R. 37.49.602 Iv-E Foster Care Eligibility: Periodic Redeterminations of Eligibility (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; REP, 2024 MAR p. 2023, Eff. 8/10/24.

Mont. Admin. R. 37.49.606 Iv-E Foster Care Eligibility: Safeguarding and Sharing Information

(1) Use and disclosure of information concerning applicants for or recipients of IV-E eligibility are restricted to purposes directly connected with the administration of the IV-E program, except as provided in 42 USC 671(a) (8) and (9) , as amended through July 16, 1996, which governs use and disclosure of information in the IV-E foster care program. The department hereby adopts and incorporates by reference 42 USC 671(a) (8) and (9) as amended through July 16, 1996. A copy of 42 USC 671(a) (8) and (9) as amended through July 16, 1996, may be obtained from the Department of Public Health and Human Services, Office of Legal Affairs, 111 North Sanders Street, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Subchapter 37.49.7 Termination and Hearing Rights

Mont. Admin. R. 37.49.701 Iv-E Foster Care Eligibility: Grounds for Termination of Benefits; Notice of Termination

(1) If a child is determined to be IV-E eligible, eligibility continues as long as the child remains in state or tribal custody or jurisdiction regardless of subsequent changes in the filing unit's income or resources. However, eligibility no longer exists when the child is age 18 unless the child is a full-time student in a secondary school who is reasonably expected to obtain a secondary school diploma or its equivalent in or before the month of their 19th birthday and is under the jurisdiction of a tribe whose code allows for foster care past the age of 18.

(2) When a child becomes ineligible for IV-E benefits, a written notice must be sent to the placing worker at least 10 days prior to the date on which the benefits will terminate, except as provided in (3) (a) through (c) (ii) . The notice must state that the benefits are being terminated, the reason for the termination, and the date on which the benefits will terminate. The notice must also contain information about the right to a fair hearing and to contact the department prior to the effective date of termination to discuss any disagreement or misunderstanding regarding eligibility.

(3) The department is not required to send notice 10 days prior to the date of termination but must send notice not later than the date of termination if:

(a) the department has information from a reliable source that the child has died;

(b) the child's whereabouts are unknown; or

(i) requests the termination of benefits for the child; or

(ii) contains information which indicates that the child is no longer eligible for benefits and also contains an acknowledgment that benefits for the child must be terminated as a result of that information.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99; AMD, 2003 MAR p. 1196, Eff. 6/13/03.

Mont. Admin. R. 37.49.704 Iv-E Foster Care Eligibility: Opportunity for Hearing

(1) The placing worker who does not agree with an adverse action of the department related to IV-E eligibility shall have the right to a hearing as provided in ARM 37.5.304, 37.5.307, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, 37.5.337, 37.5.503 and 37.5.505.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201 and 53-6-131, MCA
History: NEW, 1999 MAR p. 1514, Eff. 7/2/99.

Chapter 37.50 Foster Care Services and Guardianship Services

Subchapter 37.50.1 Foster Care General Requirements

Mont. Admin. R. 37.50.101 Definitions

The following definitions apply to the rules contained in this subchapter.

(1) "Daily rate" means the rate the department will pay to facilities for supervision and treatment services. The daily rate is a percentage of the model rate and is based upon the department's appropriation for foster care services.

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

(3) "Facility" means child care agencies and youth group homes as defined in ARM 37.97.102 and child placing agencies as defined in ARM 37.93.101.

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

(5) "Model rate" means the rate established by the department for the essential programmatic costs of the supervision and treatment services the department requires for each classification level.

(6) "Professional staff" means staff employed by the facility who have a bachelor's, master's degree or doctorate in social work, counseling, psychology or a related field.

(7) "Voluntary placement" means an out-of-home placement of a child by the department after the parents or guardians have requested the assistance of the agency and signed a voluntary placement agreement.

(8) "Voluntary placement agreement" means a written agreement between the department and the parents or guardians of a child which contains the consent of the parents or guardians to placement in foster care and the rights and obligations of the parents or guardians, and the department while the child is in placement.

(9) "Youth" means any person under the age of 18.

(10) "Youth care facility (YCF) " means a licensed facility in which foster care is provided and includes youth foster homes, youth group homes and child care agencies.

History

Authorizing statute(s): Sec. 41-3-1103 and 52-1-103, MCA
Implementing statute(s): Sec. 41-3-1103 and 52-1-103, MCA
History: NEW, 1988 MAR p. 2035, Eff. 7/29/88; AMD, 1995 MAR p. 2462, Eff. 11/23/95; AMD, 1996 MAR p. 458, Eff. 2/9/96; TRANS & AMD, from DFS, 1998 MAR p. 488, Eff. 2/13/98.

Mont. Admin. R. 37.50.105 General Requirements

(1) The department may place a child in substitute care pursuant to:

(a) a court order;

(b) emergency protective services as authorized by 41-3-301 , MCA;

(d) other lawful authority.

(2) Children who meet the criteria set forth in (1) , will be evaluated by the department to determine the accessible, available and appropriate type of placement.

History

Authorizing statute(s): Sec. 41-3-1103 and 52-1-103, MCA
Implementing statute(s): Sec. 41-3-1103, 41-3-1122 and 52-1-103, MCA
History: NEW, 1988 MAR p. 2035, Eff. 7/29/88; AMD, 1996 MAR p. 458, Eff. 2/9/96; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.106 Voluntary Placement

(1) Voluntary placement should not exceed 6 months in duration.

(2) Voluntary placement agreements will generally not be accepted if:

(a) the child requests placement to avoid being held responsible for the child's behavior or because of conflicts with the parents or guardians; or

(b) the parents or guardians request placement because of behavior problems of the child or conflict with the child;

(c) In cases where requests for voluntary placement agreements are denied, the department will make appropriate referrals for services for the family to address these problems.

(3) The department will generally accept voluntary placement agreements only if:

(a) the child is in danger of being abused or neglected;

(b) the parents or guardians, as a result of unavoidable circumstances, are temporarily absent from the home, and no other placement alternatives are available;

(d) the parents or guardians are worried about their hostile, abusive or neglectful feelings toward their child and are willing to voluntarily seek the assistance or services necessary to assure the child can be returned to them as soon as possible.

(4) If any of the following conditions exist, voluntary placement agreements will generally not be substituted for appropriate legal action to protect the child:

(a) the parents or guardians have severely abused or neglected the child;

(b) the parents or guardians have abused or neglected the child and department services have been offered and previously refused or were previously accepted but have been unsuccessful;

(d) the parents or guardians by their words or actions have indicated a desire to relinquish their parental rights or abandon the child.

History

Authorizing statute(s): Sec. 41-3-1103 and 52-1-103, MCA
Implementing statute(s): Sec. 41-3-1103, 41-3-1122 and 52-1-103, MCA
History: NEW, 1988 MAR p. 2035, Eff. 7/29/88; AMD, 1996 MAR p. 458, Eff. 2/9/96; TRANS, from DFS, 1998 MAR p. 488.

Subchapter 37.50.3 Foster Care Maintenance Payments

Mont. Admin. R. 37.50.301 Foster Care Maintenance Payments

(1) If the child is found eligible for substitute care placement and foster care maintenance payments, the department shall make payment to the licensed youth care facility where the child is placed according to the rate established by the department for such facilities.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-302 and 41-3-1103, MCA
History: NEW, 1984 MAR p. 1412, Eff. 9/28/84; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.305 Foster Care Overpayments and Underpayments

(1) The department is entitled to promptly recover the amount of any foster care overpayment made to a foster care provider. Recovery will be accomplished by the provider making payment of the overpayment within 30 days of notification of the overpayment. If the provider fails to repay the overpayment within 30 days, the department may reduce future foster care maintenance payments until the overpayment is recovered in full.

(2) Where an underpayment of foster care maintenance payments is made it will be corrected by increasing the payment for the following month to cover the underpayment.

(3) The provider shall promptly notify the department of any overpayment or underpayment.

History

Authorizing statute(s): Sec. 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-1103, MCA
History: NEW, 1988 MAR p. 825, Eff. 4/29/88; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.306 Foster Care Right to Fair Hearing

(1) Any person aggrieved by an adverse department determination denying foster care maintenance payments or demanding recovery of a foster care overpayment may request a hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): Sec. 2-4-201 and 41-3-1103, MCA
Implementing statute(s): Sec. 41-3-302 and 41-3-1103, MCA
History: NEW, 1984 MAR p. 1412, Eff. 9/28/84; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 825, Eff. 4/29/88; AMD, 1988 MAR p. 1254, Eff. 6/24/88; AMD, 1995 MAR p. 1424, Eff. 7/28/95; TRANS, from DFS, 1998 MAR p. 488; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.50.310 Foster Care Payments to Facilities

(1) The department shall make payments to facilities for the care of youths who have been approved by the department for placement into the facility. The rate of payment shall be based upon the classification of the facility according to ARM 37.50.315.

(2) Facilities in the state of Montana must be licensed by the department or responsible tribal authority, and must have a current contract with the department to be eligible for payments for foster care from the department.

History

Authorizing statute(s): Sec. 41-3-1103 and 52-1-103, MCA
Implementing statute(s): Sec. 41-3-1103, 41-3-1122 and 52-1-103, MCA
History: NEW, 1989 MAR p. 20, Eff. 1/13/89; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.315 Foster Care Classification Model

(1) Each facility must be classified according to the department's classification model. The model identifies eight levels of supervision and three levels of treatment. A model rate has been assigned to each level of supervision and treatment.

(2) Each facility wishing to contract with the department must be classified according to ARM 37.50.316 to determine the daily rate the department would offer the facility for foster care services provided by the facility. The daily rate will be a percentage of the model rate for the facility's classification. The department may pay less than the daily rate if the facility requests less than the daily rate.

(3) There are eight levels of supervision in the classification model:

(a) In Level I the facility provides the basic living needs of the youth, including shelter, food, transportation and clothing by placing the youth in community family therapeutic foster homes. Trained foster home parents provide a skilled role model to carry out the implementation of the community based treatment plan for the youth. The facility provides supervision based upon an assessment of the youth's needs and a specific written case plan that is monitored to determine its effectiveness in reducing the need for this level of supervision.

(b) In Level II the facility provides the basic living needs of the youth, including shelter, food, transportation and clothing. In addition to the provision of these basic needs, the facility employs paid caretakers who provide day-to-day supervision of the youth in a family-like setting. This level of supervision does not require individual assessment of the youth and/or the development of treatment plans to determine structured activities or provide the day-to-day care and guidance of the youth.

(c) In Level III the facility provides the basic living needs of the youth, employs caretakers who provide the day-to-day supervision of the youth in a family-like setting, and a paid director to coordinate the facility's operations.

(d) In Level IV the facility provides the basic living needs of the youth and employs shift staff who provides 24-hour structured supervision of the youth and administrative personnel. This level of supervision utilizes planned structured supervision by trained staff. The facility provides activities and supervision based upon an assessment of the youth's needs and a specific written case plan that is monitored to determine its effectiveness in reducing the need for structured supervision.

(e) In Level V the facility provides the basic living needs of the youth, and employs shift staff who provides 24-hour intensive supervision with backup staff available. The facility also employs administrative personnel. The facility provides constant control of the youth by highly trained staff in a planned treatment environment. This level of supervision requires individual assessment of the youth and the development, implementation and monitoring of an individual written treatment plan by professional staff.

(f) In Level VI the facility provides the basic living needs of the youth including food, shelter, transportation, and clothing. The department pays licensed providers for the treatment portion of the per diem payment for therapeutic youth group homes currently classified as Level VI under this subsection. Therefore, no level of treatment in (4) of this rule applies to therapeutic youth group homes. However, as a prerequisite to licensure under the department's licensing rules in ARM Title 37, chapter 97, therapeutic youth group homes must abide by the applicable child/staff ratios for all staff including but not limited to program managers and lead clinical staff persons. For the purpose of calculating the ratio to check for compliance under the licensing requirements, only full-time contracted or employed program managers and lead clinical staff persons, or the equivalent number of part-time program managers and lead clinical staff persons, may be counted as "one" program manager or lead clinical staff person. Full-time program manager or lead clinical staff person means a program manager or lead clinical staff person who normally works for the therapeutic youth group home 40 hours per week.

(g) In Level VII, a facility must be licensed as a child care agency-maternity home. A facility at this level provides the basic living needs of pregnant and parenting youth, including food, shelter, transportation, recreation, and clothing. The facility also provides the basic living needs of the child or children of the parenting youth, including food, shelter, baby formula, diapers, transportation, clothing, and access to day care services. Shift staff shall be employed to provide 24-hour intensive supervision in a home-like environment with back-up staff available. The facility may reduce the number of shift staff required for intensive supervision during hours in which the youth attend public school when a professional staff is on the premises who is able to perform all shift staff duties as necessary. In addition, the facility will employ a program manager who provides program oversight and the functions described in ARM 37.97.206(6), and administrative support personnel. Professional staff must be employed to provide counseling and case management services, to include:

(i) individual and group counseling designed to address the youth's mild delinquent, emotional, social, and behavior problems;

(ii) development, implementation, and monitoring of individualized written case plans for each youth;

(iii) to assist shift staff in the initial and ongoing assessment of the safety and well-being of each youth and child in residence; and

(iv) will assist shift staff in teaching skill-building techniques, parenting, and life management skills to parenting youth to facilitate the acceptable adjustment to a community or family setting.

(h) In Level VIII, a transitional living program for parents and children, a facility must be licensed as a child care agency-maternity home. A facility at this level provides the basic living needs of the parenting youth, age 16 to 21 years of age, including food, shelter, transportation, recreation, and clothing. The facility also provides the basic living needs of the child or children of the parenting youth, including food, shelter, baby formula, diapers, transportation, clothing, and access to day care services. The child of the parenting youth must be under the custody of the state or the parenting youth must be working with the state under a voluntary agreement under 41-3-302, MCA. Shift staff must be employed to provide 24-hour intensive supervision in a home-like environment with back-up staff available. In this level, therapeutic treatment of the parenting youth may be provided as an ancillary service. In addition, the facility will employ a program manager who provides program oversight and the functions described in ARM 37.97.206(6), and administrative support personnel. The facility must employ professional staff to:

(i) provide counseling and case management services with an emphasis on the relationship between the parenting youth and the child(ren) being the central focus;

(ii) assist shift staff in the initial and ongoing assessment of the safety and well-being of each parenting youth and child(ren) in residence; and

(iii) assist shift staff in teaching skill-building techniques, parenting, and life management skills to parenting youth to facilitate the acceptable adjustment to a community or family setting.

(4) There are three levels of treatment in the classification model:

(a) In basic treatment, professional staff employed by the facility provide structured individual and group therapeutic services designed to address the youth's mild delinquent, emotional, social, and behavior problems. Staff implements skill-building techniques to assist the youth in progressing toward an acceptable adjustment to his family, school, and community. This level of treatment requires more than the day-to-day supervision by caretakers.

(b) In intermediate treatment, trained shift staff under the supervision of professionals, perform assessments, develop and implement planned interventions designed to address an individual youth's serious delinquent, emotional, social, and behavior problems. Structured group and individual therapeutic services are provided according to the youth's written case plan.

(c) In intensive treatment, intensive group and individual therapeutic services are provided by the facility to youth experiencing severe delinquent, emotional, social, and behavior problems which prevent an acceptable adjustment to the youth's family, school, and community. Treatment strategies are based upon an individual assessment of the youth and are administered according to a written treatment plan developed by the facility's professional staff. Group, individual, and family therapy are provided by the facility's professional staff. The youth's medical and psychological needs are addressed in the youth's treatment plan and qualified, professional staff monitors the medical and psychological needs of the youth. All services are provided by the facility as part of the regular services provided.

(5) Facilities will be classified by the department according to the above criteria. Each level of supervision and treatment is assigned a model rate on the model rate matrix of the department. Each classified facility will be offered a daily rate, which is a percentage of the model rate assigned to facilities in that classification.

(6) The department adopts and incorporates by reference the department's model rate matrix, effective July 1, 2014. A copy of the model rate matrix of the department is available upon request from the Department of Public Health and Human Services, Child and Family Services Division, Operations and Fiscal Bureau, 1400 Broadway, P.O. Box 8005, Helena, MT 59604-8005. A copy may also be obtained at this web site: http://www.dphhs.mt.gov/cfsd/ . The department will review and revise its model rate matrix at least once every two years.

History

Authorizing statute(s): 41-3-1103, 52-1-103, 52-2-603, MCA
Implementing statute(s): 41-3-1103, 41-3-1122, 52-1-103, 52-2-611, MCA
History: NEW, 1989 MAR p. 20, Eff. 1/13/89; AMD, 1993 MAR p. 147, Eff. 1/29/93; AMD, 1993 MAR p. 1208, Eff. 6/11/93; AMD, 1995 MAR p. 1118, Eff. 7/1/95; AMD, 1997 MAR p. 1663, Eff. 9/23/97; TRANS, from DFS, 1998 MAR p. 488; AMD, 2002 MAR p. 1557, Eff. 5/31/02; AMD, 2015 MAR p. 24, Eff. 1/16/15.

Mont. Admin. R. 37.50.316 Foster Care Classification Procedures

(1) Effective January 15, 1989, all facilities providing foster care under contract to the department shall be classified according to the level of treatment and supervision provided. Any facility that does not have a contract with the department may request classification at any time.

(2) The department shall request information from the facility regarding treatment and supervision services provided, population served and staffing of the facility. The department may conduct an on site visit at any time for purposes of assessing the classification of the facility.

(3) Each facility classified will be offered a daily rate which the department will pay for each day of care provided to children approved by the department for placement in the facility. The daily rate will be a percentage of the model rate established by the department for the classification.

(4) If the facility disagrees with the classification assigned by the department, the facility may submit a request for informal reconsideration within 30 days of written notification of the classification level.

(a) The request must state with particularity the reasons the facility believes the classification is incorrect and must include any supporting documentation the facility wishes to submit.

(b) The request for reconsideration shall be submitted to the Department of Public Health and Human Services, Child and Family Services Division, Cogswell Building, 1400 Broadway, P.O. Box 8005, Helena, MT 59604-8005.

(5) The department shall conduct an informal reconsideration of the classification within 15 days of receipt of the request for reconsideration and shall submit a decision in writing as to whether the classification will be changed.

(6) If the facility is dissatisfied with the result of the informal reconsideration, it may request an informal hearing before a panel comprised of the director, the evaluation bureau chief and a representative from another facility.

(a) The request for an informal hearing must be submitted in writing within 10 days of the receipt of the results of the informal reconsideration.

(b) An informal hearing shall be held within 20 days of the receipt of the request for hearing.

(c) The panel will consider all matters relevant to the level of supervision and the level of treatment provided at the facility, and shall make a determination whether the facility has been properly classified according to the rules of the department.

(d) The decision of the panel shall be the final decision of the department.

(7) The facility's current classification shall remain in effect pending the outcome of any reconsideration or appeal.

(8) The provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA do not apply to informal reconsideration or hearing proceedings under this rule.

History

Authorizing statute(s): Sec. 41-3-1103, 52-1-103 and 52-2-603, MCA
Implementing statute(s): Sec. 41-3-1103, 41-3-1122, 52-1-103 and 52-2-611, MCA
History: NEW, 1989 MAR p. 20, Eff. 1/13/89; TRANS, from DFS, 1998 MAR p. 488; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.50.320 Foster Care Facility Contracts

(1) Facilities that have been classified may apply for a contract with the department on a form provided by the department.

(2) At least 30 days prior to the expiration of the contract, each facility wishing to contract with the department shall submit an application for a new contract.

(3) The department shall select contractors on the basis of the department's need for the services provided by the facility. The selection process may include information regarding the contractor's history of providing services to children. The selection process shall include:

(a) a review of the department's access to similar services currently provided in the state or region;

(b) an overview of the children placed by the department requiring these services;

(d) a determination regarding the appropriateness of the service for children placed by the department.

(4) Each facility shall retain its classification and daily rate until the expiration of the current contract, unless written consent is provided by the department. Any facility wishing to change its classification at the expiration of the contract or during a contract period must request reclassification in writing at least 90 days prior to the proposed effective date for the reclassification. The written request shall present the justification for the reclassification. The justification shall include a discussion of the financial impact on the department, the impact on the children currently placed at the facility, and the anticipated results of the change for the department and the facility, and the anticipated results of the change for the department and the facility. Upon receipt of a request for reclassification, the department will follow the procedures set forth in ARM 37.50.316 and 37.50.320 to reclassify and assign a daily rate to the facility.

History

Authorizing statute(s): Sec. 41-3-1103, 52-1-103 and 52-2-603, MCA
Implementing statute(s): Sec. 41-3-1103, 41-3-1122, 52-1-103, 52-2-603 and 52-2-611, MCA
History: NEW, 1989 MAR p. 20, Eff. 1/13/89; TRANS, from DFS, 1998 MAR p. 488; AMD, 2003 MAR p. 486, Eff. 3/14/03.

Subchapter 37.50.4 Foster Care Review Committee

Mont. Admin. R. 37.50.401 Foster Care Review Committee

(1) The committee will conduct a review of any child placed in a licensed family foster home, a child care agency, group home or treatment facility if the child is placed under the supervision of the department or placed by the department or the department pays for the care of the child.

(2) At least one committee shall be appointed in each judicial district in the state by the youth court judge in consultation with the department.

(3) The committee shall be composed of not less than five nor more than seven members including:

(a) a representative of the department;

(b) a representative of the youth court;

(c) someone knowledgeable in the needs of the children in foster care placements not employed by the youth court or department;

(d) a representative of a local school district;

(e) the foster parent of the child whose care is under review, if there is one. The foster parent's appointment is effective only for and during that review;

(f) if the child under review is an Indian, an Indian person or a person knowledgeable about Indian cultural and family matters who is appointed for that review only.

(4) Three of the five required committee members must be in attendance to constitute an official review.

(a) A chairperson shall be selected by the committee prior to each meeting.

(5) Except for initial reviews under this rule, there shall be a foster care committee review once every 6 months on each child who has been in foster care for a period of more than 6 months.

(6) The person responsible for the placement of a child should not be a committee member when the committee reviews that child's placement.

History

Authorizing statute(s): Sec. 41-3-1115, MCA
Implementing statute(s): Sec. 41-3-1115, MCA
History: NEW, 1982 MAR p. 609, Eff. 3/26/82; AMD, 1983 MAR p. 1550, Eff. 10/28/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1990 MAR p. 728, Eff. 4/3/90; AMD, 1995 MAR p. 281, Eff. 2/24/95; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.402 Subject of Foster Care Reviews

(1) Foster care reviews must specifically consider the following:

(a) Are the child, parents, foster parents receiving appropriate services designed to get the child home?

(b) Have reasonable efforts been made by the placing agency to return the child to his or her home?

(c) Can the child return home? If not, why not? What efforts must be made by the parents and agency before the child can return home?

(d) In the interim, is this placement the least restrictive, most appropriate and as close as possible to the parents' home so as to facilitate visitation?

(e) Does the child's treatment plan need to be modified?

(f) By what date may it be expected that the child will return home, be placed for adoption or other alternative permanent placement situation (i.e., permanent foster care or guardianship) ?

(g) To what extent have the parents visited the child, what attempts has the placing worker made to facilitate visitation, and any reason why visitation has not happened?

(2) The committee shall be provided with written information by the placing agency necessary to answer all questions found in (1) of this rule 10 days prior to their meeting date. Supporting documentation available for review at the committee meeting shall include:

(a) current social information;

(b) placement history;

(d) description of activities and observations of worker;

(e) court orders;

(f) available psychological and psychiatric information regarding the child/family;

(g) placement worker's recommendation for continued placement or return to the family.

History

Authorizing statute(s): Sec. 41-5-807, MCA
Implementing statute(s): Sec. 41-5-807, MCA
History: NEW, 1982 MAR p. 609, Eff. 3/26/82; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.405 Reports of Foster Care Review Committee

(1) The committee, after reviewing the information provided, shall submit a written report to the judge, the department and placing agency summarizing their findings and recommendations within 30 days of the review date. The report shall include:

(a) answers to questions in ARM 37.50.402;

(b) recommendations and reasons as to continuation or discontinuation of foster care;

(2) The following people may participate in foster care review meetings:

(a) committee members;

(b) placing workers and/or supervisor;

(d) child's guardian ad litem;

(e) other people as appropriate.

(3) Confidentiality of foster care review.

(a) All members of the committee and all persons present at committee meetings are bound by the confidentiality policies of the department and shall be informed of the confidentiality of any information discussed at the meeting. Members and persons present are required to keep all information about the subject individuals confidential.

(b) All reports or written records of the committee shall be kept confidential subject to the requirements of the department (except as provided elsewhere in this rule) .

History

Authorizing statute(s): Sec. 41-5-807, MCA
Implementing statute(s): Sec. 41-5-807, MCA
History: NEW, 1982 MAR p. 609, Eff. 3/26/82; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.410 Reduction of the Number of Children in Foster Care

(1) This rule sets the department's specific goal on the maximum number of children receiving assistance under Title IV-E of the Social Security Act (hereinafter referred to as IV-E children) who have been in foster care for 2 or more years.

(2) At the end of each fiscal year the department shall determine what percent of the total number of IV-E children in foster care are IV-E children who have been in foster care for 2 or more years. The department shall calculate the percentage by:

(a) determining the total number of IV-E children in foster care; and

(b) dividing the total number into the number of IV-E children who have been in foster care for 2 or more years.

(3) The department shall strive to reduce the percentage by 2% each fiscal year.

History

Authorizing statute(s): Sec. 41-3-1103, 52-1-103, 52-2-111, and 53-4-111, MCA
Implementing statute(s): Sec. 41-3-1103, 52-2-111, 53-4-111 and 53-4-304, MCA
History: NEW, 1982 MAR p. 874, Eff. 4/30/82; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1996 MAR p. 1388, Eff. 5/24/96; TRANS, from DFS, 1998 MAR p. 488.

Subchapter 37.50.5 Foster Care Support Services

Mont. Admin. R. 37.50.501 Foster Care Support Services, Purpose

(1) The purpose of this subchapter is to establish eligibility criteria for foster care support services. Payment for foster care support services may be made on behalf of foster children who require diapers, respite care, and other specific special services which are not available from other sources.

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1993 MAR p. 1505, Eff. 7/16/93; AMD, 1993 MAR p. 2528, Eff. 10/29/93; TRANS, from DFS, 1998 MAR p. 488; AMD, 2024 MAR p. 757, Eff. 4/13/24.

Mont. Admin. R. 37.50.502 Foster Care Support Services, Definitions

For the purposes of this subchapter, the following definitions apply:

(1) "Foster child" means any person under the age of 18 years, without regard to sex or emancipation, who has been placed in a licensed youth foster home.

(2) "Foster care support services" means a diaper allowance, respite care allowance, or other special need allowance paid on behalf of a foster child who has a documented need for such foster care support services.

(3) "Diaper allowance" means payments made on behalf of a foster child for diapers subject to the conditions and limitations set forth in ARM 37.50.505.

(4) "Supplemental services allowance" means payments made on behalf of a foster child who requires educationally related services or equipment which is not available from any other source. Special needs include any documented special requirements necessary for the foster child, subject to the conditions and limitations set forth in ARM 37.50.510.

(5) "Respite care allowance" means payments made on behalf of a foster child for assistance necessary to provide foster parents with relief from the daily care requirements of foster children whose mental or physical condition requires special or more intense care. Respite care allowances are subject to the conditions and limitations set forth in ARM 37.50.511.

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1993 MAR p. 1505, Eff. 7/16/93; AMD, 1993 MAR p. 2528, Eff. 10/29/93; TRANS, from DFS, 1998 MAR p. 488; AMD, 2024 MAR p. 757, Eff. 4/13/24.

Mont. Admin. R. 37.50.505 Foster Care Support Services, Diaper Allowance

(1) Any child under the age of 3 who is placed in a licensed foster home is eligible for a diaper allowance if:

(a) the child is expected to be in foster care for more than 30 days;

(b) the department is making foster care payments for the child; and

(2) The amount of the diaper allowance is $1.67 per day per eligible child.

History

Authorizing statute(s): 41-3-1103, 41-3-1142, 52-2-111, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 52-2-111, MCA
History: NEW, 1993 MAR p. 1505, Eff. 7/16/93; AMD, 1995 MAR p. 930, Eff. 5/26/95; TRANS, from DFS, 1998 MAR p. 488; AMD, 2024 MAR p. 757, Eff. 4/13/24.

Mont. Admin. R. 37.50.506 Foster Care Support Services, Clothing Allowance (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1991 MAR p. 1489, Eff. 8/16/91; AMD, 1993 MAR p. 1505, Eff. 7/16/93; TRANS, from DFS, 1998 MAR p. 488; REP, 2024 MAR p. 757, Eff. 4/13/24.

Mont. Admin. R. 37.50.510 Foster Care Support Services, Supplemental Services Allowance

(1) Any child placed in a licensed youth foster home is eligible for a supplemental services allowance if:

(a) the child is expected to be in foster care for more than 30 days;

(b) the department is making the foster care payments for the child;

(d) all other possible resources have been exhausted.

(2) A supplemental services allowance is available for any documented special need of a foster child necessary to the child's health and welfare, subject to the limitations set forth in this rule.

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1993 MAR p. 1505, Eff. 7/16/93; AMD, 1993 MAR p. 2528, Eff. 10/29/93; TRANS, from DFS, 1998 MAR p. 488; AMD, 2024 MAR p. 757, Eff. 4/13/24.

Mont. Admin. R. 37.50.511 Foster Care Support Services, Respite Care Allowance

(1) Any child placed in a licensed youth foster home is eligible for respite care allowance if:

(a) the child is expected to be in placement for more than 30 days;

(b) the department is making foster care payments for the child; and

(i) developmentally disabled and is either on a respite care waiting list or is otherwise not eligible for the respite care program of the developmental disabilities division; or

(ii) "medically demanding", e.g. non-ambulatory; or

(iii) suffering from severe emotional problems which are manifested in serious behavior problems.

(2) The amount of the respite care payment(s) shall not exceed:

(a) $20.16 per hour per child for up to 8 continuous hours;

(b) $161.28 per child for more than 8 hours and up to 24 hours.

(3) The amount of respite care payment(s) per child per year shall not exceed 111 hours for each placement.

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1993 MAR p. 1505, Eff. 7/16/93; TRANS, from DFS, 1998 MAR p. 488; AMD, 2024 MAR p. 757, Eff. 4/13/24.

Mont. Admin. R. 37.50.512 Foster Care Support Services, Respite Care Selection and Training

(1) For children eligible for respite care under ARM 37.50.511, foster parents may arrange for respite care services. The arrangement shall provide for respite care services from a qualified individual.

(2) Laws may require that foster parents fulfill employment obligations owed to respite care providers. Examples of laws which may apply are statutes and regulations imposing wage and overtime requirements on employers of domestic employees. The department has no role in imposing or exempting foster parents from the requirements. Nor does the department accept financial responsibility for payment which may result from imposition of employment-related requirements.

(3) Notwithstanding the disclaimer contained in (2) and the requirement for prior approval for all foster care support services under ARM 37.50.520, foster parents may be reimbursed for expenses arising from imposition of employment requirements. Examples of permissible reimbursements under this subsection include payment for social security contributions and/or payment in addition to the hourly/daily rate provided in ARM 37.50.511 as a result of wage and hour requirements.

(4) Foster parents regularly utilizing a respite care provider in their home may be denied reimbursement under (3) absent prior special approval from the regional administrator whose region is responsible for reimbursement of respite care for the child.

(5) The selection of the person to provide respite care is made by the foster parent. The foster parent shall consider the ability of the respite care provider to:

(a) meet the special needs of the foster child; and

(b) provide safe, developmentally appropriate care to the child.

(6) The foster parent provides any specific training which may be necessary to care for a particular child.

(7) A request for reimbursement for respite care services which includes information on the name and qualifications of the respite care provider must be made prior to the care being given.

(8) The department representative may deny the request for reimbursement if the foster parent fails to document that the respite care provider selected by the foster parent possesses the qualifications and ability to provide care for the foster child.

History

Authorizing statute(s): Sec. 41-3-1103, 41-3-1142, 41-3-1152 and 52-2-111, MCA
Implementing statute(s): Sec. 41-3-1103, 41-3-1142, 41-3-1151 and 52-2-111, MCA
History: NEW, 1993 MAR p. 3019, Eff. 12/24/93; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.520 Foster Care Support Services, Application Process

(1) Any foster parent may apply for foster care support services.

(2) All requests for foster care support services must be based upon need for the service as documented by the placing social worker.

(3) All applications for foster care support services must be approved by the department prior to obtaining or purchasing the support services.

History

Authorizing statute(s): Sec. 41-3-1103, 53-2-201 and 53-4-111, MCA
Implementing statute(s): Sec. 41-3-1103 and 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.521 Foster Care Support Services, Availability of Funds

(1) All of the foster care support services payments are contingent upon the availability of state funds appropriated for such services.

(2) The allowances may be reduced, denied or discontinued regardless of eligibility if there are insufficient available funds to pay for the foster care support services requested.

(3) When the entire amount of the annual appropriation for foster care support services has been exhausted, no more applications for foster care support services will be accepted.

History

Authorizing statute(s): Sec. 41-3-1103, 53-2-201 and 53-4-111, MCA
Implementing statute(s): Sec. 41-3-1103 and 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.525 Foster Care Support Services, Hearing

(1) Any person aggrieved by an adverse action of the department or its representatives regarding foster care support services may request a hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): Sec. 2-4-201, 41-3-1103, 52-2-111 and 53-4-111, MCA
Implementing statute(s): Sec. 41-3-1103, 52-2-111 and 53-4-111, MCA
History: NEW, 1985 MAR p. 1021, Eff. 7/26/85; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1988 MAR p. 1254, Eff. 6/24/88; TRANS, from DFS, 1998 MAR p. 488; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Subchapter 37.50.8 Children With Multiagency Service Needs

Mont. Admin. R. 37.50.801 Placement of Children with Multiagency Service Needs with Out-of-State Providers, Definitions

As used in this subchapter, the following definitions apply:

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

(2) "Placement by the department" means placement by the department of a child with multiagency service needs in the custody of the department or committed to the department pursuant to 41-3-403 , 41-3-404 , 41-3-406 , or 41-5-523 , MCA, with an out-of-state provider.

(3) "Out-of-state provider" means a residential treatment program that is an approved Montana medicaid provider of residential treatment or a program which is licensed in its state of residency to provide:

(a) shelter care;

(b) youth group home care;

(d) therapeutic foster care;

(e) residential treatment as a child care agency; or

(f) an equivalent of the care described in this section.

(4) "Child with multiagency service needs" means a child as defined in 52-2-301 , MCA.

History

Authorizing statute(s): Sec. 52-2-308, MCA
Implementing statute(s): Sec. 52-2-301, 52-2-302, 52-2-303, 52-2-304, 52-2-305, 52-2-306 and 52-2-307, MCA
History: NEW, 1994 MAR p. 1996, Eff. 7/22/94; TRANS, from DFS, 1998 MAR p. 488.

Mont. Admin. R. 37.50.804 Limitations on Placement of Children with Multiagency Service Needs with Out-of-State Providers

(1) Placement of children with multiagency service needs with out-of-state providers shall occur only according to the applicable provisions of the memorandum of understanding entered by the department, the department of social and rehabilitation services, the department of health and environmental services, the office of public instruction, the Montana board of crime control, and the department of corrections and human services, dated July 1, 1993.

(2) The department hereby adopts and incorporates the memorandum of understanding referred to in (1) which sets forth the responsibilities, objectives and funding necessary for the member departments to establish and maintain a coordinated service system. A copy of the memorandum of understanding may be obtained upon request to the Department of Public Health and Human Services, Child and Family Services Division, P.O. Box 8005, Helena, Montana 59604.

History

Authorizing statute(s): Sec. 52-2-308, MCA
Implementing statute(s): Sec. 52-2-301, 52-2-302, 52-2-303, 52-2-304, 52-2-305, 52-2-306 and 52-2-307, MCA
History: NEW, 1994 MAR p. 1996, Eff. 7/22/94; TRANS, from DFS, 1998 MAR p. 488.

Subchapter 37.50.9 Interstate Compact on the Placement of Children

Mont. Admin. R. 37.50.901 Interstate Compact on the Placement of Children

(1) The Department of Public Health and Human Services adopts and incorporates by reference the regulations adopted by the Association of Administrators of the Interstate Compact on the Placement of Children as amended through May 6, 2012. These regulations interpret the interstate compact on the placement of children and include clarifications of the applicability of the interstate compact on the placement of children with regard to the following:

(a) use of uniform forms;

(b) interstate relocation of family units;

(d) definitions and placement categories, applicability and exemptions;

(e) interstate placements of children in residential treatment facilities;

(f) the requirement of a central state office for all compact referrals;

(g) a six-month time limit on placement authorization;

(h) procedures for expedited placements;

(i) appropriate use of forms to change placement purposes;

(j) definition of a visit;

(k) applicability to guardianships;

(l) responsibility of states to supervise children; and

(m) private and independent adoptions.

(2) A copy of the regulations adopted by the Association of Administrators of the Interstate Compact on the Placement of Children as amended through May 6, 2012, can be obtained from the Department of Public Health and Human Services, Child and Family Services Division, 301 South Park Avenue, Room 568, P.O. Box 8005, Helena, MT 59604.

History

Authorizing statute(s): 52-2-111, MCA
Implementing statute(s): 41-4-101, 52-2-111, MCA and Art. VII, of ICPC
History: NEW, 1986 MAR p. 1602, Eff. 9/26/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1994 MAR p. 1294, Eff. 5/13/94; AMD, 1997 MAR p. 316, Eff. 2/11/97; TRANS, from DFS, 1998 MAR p. 488; AMD, 2001 p. 676, Eff. 4/27/01; AMD, 2011 MAR p. 106, Eff. 1/28/11; AMD, 2012 MAR p. 2493, Eff. 12/7/12.

Subchapter 37.50.11 Guardianship Services

Mont. Admin. R. 37.50.1101 Guardianship and Home Approval

(1) In order to be approved as a guardian pursuant to 41-3-444, MCA, the prospective guardian and the home of the prospective guardian must meet the requirements set forth for youth foster homes contained in ARM 37.51.210, 37.51.216, 37.51.301, 37.51.305, 37.51.306, 37.51.307, 37.51.310, 37.51.311, 37.51.601, 37.51.602, 37.51.608, 37.51.609, 37.51.801, 37.51.802, 37.51.805, 37.51.806, 37.51.810, 37.51.815, 37.51.820, 37.51.825, 37.51.826, 37.51.901, 37.51.902, 37.51.1001, 37.51.1401, 37.51.1404, and 37.51.1405.

(2) The child for whom guardianship is being considered must have resided with the prospective guardian for a minimum of six months.

(3) A written assessment of the prospective guardian and home of the prospective guardian must be completed. The assessment must include a determination that the prospective guardian and home of the prospective guardian meet the requirements of this rule. The assessment must demonstrate the appropriateness of the proposed guardian to become the legal custodian for a specific child. Factors to be considered in determining the appropriateness of the proposed guardian include the proposed guardian's knowledge of the child's history, including placement and history of trauma and the potential effect on the child's development and future functioning; understanding and acceptance of the continued role of the child's birth family; understanding and acceptance of the powers and duties of a guardian; and the desire of the prospective guardian to become the child's guardian.

(4) If the child for whom guardianship is being considered is 12 years of age or older, the child must be consulted regarding the plan for guardianship.

(5) The entry of a decree of guardianship terminates the custody of the department and the involvement of the department except to the extent necessary to administer any financial subsidy.

History

Authorizing statute(s): 52-2-603, MCA
Implementing statute(s): 41-3-444, 52-2-603, MCA
History: NEW, 2000 MAR p. 864, Eff. 3/31/00; AMD, 2014 MAR p. 976, Eff. 5/9/14.

Mont. Admin. R. 37.50.1102 State-Subsidized Guardianship

(1) A child is eligible to have state subsidized guardianship payments made on the child's behalf if the child has been adjudicated a youth in need of care pursuant to Title 41, chapter 3, part 4, MCA.

(2) Subsidized guardianship payments may be made to the guardian of an eligible child when:

(a) the child meets the guardianship criteria found in 41-3-444, MCA;

(b) the prospective guardian and guardian's home meet the requirements of ARM 37.50.1101;

(d) an agreement describing the terms and conditions of the guardianship subsidy has been negotiated by the department with the prospective guardian; and

(e) the prospective guardian and the department have signed an agreement describing the negotiated terms and conditions of the subsidy prior to the issuance of the guardianship decree.

(3) Monthly payments and medical coverage as provided under Montana Medicaid programs may be provided under a subsidized guardianship agreement. A child in a subsidized guardianship arrangement is not eligible for the foster care support services as provided for in ARM 37.50.501, 37.50.502, 37.50.505, 37.50.506, 37.50.510, 37.50.511, 37.50.512, 37.50.520, 37.50.521, and 37.50.525.

(4) The monthly payment must not exceed the family foster care maintenance payment for which the child is eligible at the time the guardianship is established.

(5) The subsidized guardianship agreement may be renegotiated at the request of either the guardian or the department.

(6) The subsidized guardianship agreement may be terminated if requested by or agreed to by the guardian.

(7) The subsidized guardianship agreement will be terminated:

(a) if the guardian resigns the guardianship;

(b) if the guardianship is revoked by the court;

(d) when the child reaches age 18.

(8) The subsidy may continue until the child reaches the age of 19 if the child is a full-time student in a secondary school and is reasonably expected to obtain a secondary-school diploma or its equivalent on or before the month of the child's 19th birthday.

History

Authorizing statute(s): 41-3-444, 52-2-603, MCA
Implementing statute(s): 41-3-444, 52-2-603, MCA
History: NEW, 2000 MAR p. 864, Eff. 3/31/00; AMD, 2014 MAR p. 976, Eff. 5/9/14.

Mont. Admin. R. 37.50.1103 Federally Subsidized Guardianship

(1) Under the Title IV-E State Plan, Guardianship Assistance Program, approved by the United States Department of Health and Human Services (HHS), the department is authorized to utilize federal funds to pay guardianship subsidy on behalf of children who meet the requirements established under the terms and conditions of the Title IV-E State Plan, Guardianship Assistance Program, July 16, 2013. The terms and conditions approved by the HHS and the department are adopted and incorporated by reference. Copies of the Title IV-E State Plan, Guardianship Assistance Program may be obtained on the department's web site at www.dphhs.mt.gov/cfsd/ or from the Department of Public Health and Human Services, Child and Family Services Division, P.O. Box 8005, Helena, MT 59620-8005.

(2) Federally subsidized guardianship payments may be made to the guardian of an eligible child when:

(a) the prospective guardian meets the definition of a "kinship guardian" as established in the Title IV-E State Plan, Guardianship Assistance Program terms and conditions;

(b) the requirements of ARM 37.51.1101 are met; and

(c) the requirements established under the Title IV-E State Plan, Guardianship Assistance Program terms and conditions and the requirements of ARM 37.50.1102(1) through (6) are met.

(3) Title IV-E nonrecurring costs that are directly related to obtaining legal guardianship may not exceed $2000.

(4) The subsidized guardianship agreement will be terminated:

(a) if the guardian resigns the guardianship;

(b) if the guardianship is revoked by the court;

(d) when the child reaches age 18.

History

Authorizing statute(s): 52-2-603, MCA
Implementing statute(s): 41-3-444, 52-2-603, MCA
History: NEW, 2000 MAR p. 864, Eff. 3/31/00; AMD, 2014 MAR p. 976, Eff. 5/9/14.

Mont. Admin. R. 37.50.1104 Guardianship Subsidy: Fair Hearing Procedures

(1) Any person aggrieved by a department determination denying, reducing, terminating, or failing to act upon a guardianship subsidy request within one year of the request may request a hearing as provided in ARM 37.5.304, 37.5.307, 37.5.313, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History

Authorizing statute(s): 2-4-201, 41-3-444, 52-2-603, MCA
Implementing statute(s): 41-3-444, 52-2-603, MCA
History: NEW, 2014 MAR p. 976, Eff. 5/9/14.

Subchapter 37.50.12 Child Welfare Prevention and Support Services

Mont. Admin. R. 37.50.1201 Provider Participation

(1) As a condition to contract with the Department of Public Health and Human Services (department), Child and Family Services Division, for Child Welfare Prevention and Support Services, including but not limited to prevention to both families, intervened on by the department, or at risk of entering the child welfare system, preservation, family support and reunification, a provider must:

(a) comply with applicable state and federal statutes, rules, and regulations;

(b) comply with applicable Montana statutes and rules governing licensure and certifications; and

(c) follow regulations and statutes governing programs the department has authority to administrate and distribute funds for, including:

(i) Federal Child Access and Visitation Grant Program funds from U.S. Department of Health and Human Services, Administration of Children and Families, Office of Child Support Enforcement established under section 391 of the Personal Responsibility and Work Opportunity Reconciliation Act (welfare reform) of 1996 (Pub. L. 104-193, 110 Stat. 2258), also known as title III, subtitle I Enhancing Responsibility and Opportunity for Nonresidential Parents, and Section 469B of the Social Security Act;

(ii) 1979 Title IV-B Social Security Act, Subpart 2;

(iii) Title IV-E Social Security Act; and

(iv) 1974 Child Abuse Prevention and Treatment Act (CAPTA).

History

Authorizing statute(s): 41-3-101, 41-3-131, 52-1-103, 52-2-111, MCA
Implementing statute(s): 2-4-201, 41-3-101, 41-3-302, 42-1-102, 52-1-103, 52-2-111, MCA
History: NEW, 2020 MAR p. 1528, Eff. 8/8/20.

Mont. Admin. R. 37.50.1202 Provider Enrollment and Agreements

(1) Providers entering into a Child Welfare Prevention and Support Services contract must:

(a) follow requirements listed in the contract;

(b) submit a narrative and service array menu;

(i) sanctions, suspensions, exclusions, or civil monetary penalties imposed against a provider, person, or entity with an ownership or control interest in a provider, or agent or managing employee of a provider by a Medicare program, a state Medicaid program, or other federal program(s); and

(ii) criminal charges brought against, and criminal convictions of, a provider, person, or entity with ownership or control interest in a provider, or agent or managing employee of a provider related to a person's or entity's involvement in a Medicare, Medicaid, or Title XX Services program.

(d) submit valid and current copies of certificates for employees licensed or trained in specific models and practices outlined in the Child Welfare Prevention and Support Services Matrix Payment Fee Schedule and Catalog;

(e) provide written assurance the provider understands and agrees they are solely responsible in maintaining sustainability of their program, and will comply with fidelity of well supported, supported, promising, and general practices (i.e., evidence-based, trauma focused, or evidence-informed models) listed in their service array menu in relation to the Child Welfare Prevention and Support Services Matrix Payment Fee Schedule and Catalog;

(f) implement and enforce, as internal company policy, mandatory reporting requirements of 41-3-201, MCA, requiring employees with knowledge of or reasonable cause to suspect child abuse or neglect, to report the matter promptly to the Department of Public Health and Human Services, Child and Family Services Division, Centralized Intake (CI) Bureau, at 1-866-820-5437 (toll-free); and

(g) provide employees, within the first week of hiring, written notification of mandatory reporting law and provider's policy and practice enforcing the law. The provider shall maintain written documentation bearing the employee's dated signature, acknowledging receipt of such written notification.

(2) An enrolled provider shall not retroactively change category of service for which a provider is enrolled and must submit a narrative and service array menu outlining new categories to the department's liaison.

(a) An approved change in service category will be effective on or after the effective date of required licenses and certifications.

(b) Change will apply to services provided on or after the effective date of change.

(3) The provider must provide the department's liaison 30 days' advance written notice of change in the provider's name, address, tax identification number, group practice arrangement, business organization, or ownership.

(4) The provider, whose services are covered by Title XVIII program (Medicare), shall meet certification standards of Medicare except as provided otherwise in these rules.

(5) The provider shall render services to children and families served in the same scope, quality, duration, and method of delivery as to the general public, unless specifically limited by these regulations.

(6) Department employees may make referrals for children or families coming to the attention of the department for prevention or support services.

(7) The department is not obligated to assign referrals to a provider, and the provider is not obligated to accept referrals offered by the department for assignment.

(8) The provider shall not discriminate provision of service to children and families served or in employment of persons on grounds of race, creed, religion, color, sex, national origin, political ideas, marital status, age, or disability.

(9) The Child Welfare Prevention and Support Services Scope of Work, Procedures, and Child Welfare Prevention and Support Services Matrix Payment Fee Schedule and Catalog are uploaded to the department's Child and Family Services Division website: https://dphhs.mt.gov/cfsd/titleivbavmatrix .

(a) Notice of changes made to documents will be provided via email to providers by the department's liaison.

(10) Approved enrollment is effective upon execution of contract.

History

Authorizing statute(s): 41-3-101, 41-3-131, 52-1-103, 52-2-111, MCA
Implementing statute(s): 2-4-201, 41-3-101, 41-3-302, 42-1-102, 52-1-103, 52-2-111, MCA
History: NEW, 2020 MAR p. 1528, Eff. 8/8/20.

Mont. Admin. R. 37.50.1203 Billing, Reimbursement, Claims Processing, and Payment

(1) The department will reimburse the provider for services provided in accordance with the Child Welfare Prevention and Support Services Matrix Fee Schedule and Catalog.

(2) The provider will comply with billing procedures set forth in the contract.

History

Authorizing statute(s): 41-3-101, 41-3-131, 52-1-103, 52-2-111, MCA
Implementing statute(s): 2-4-201, 41-3-101, 41-3-302, 42-1-102, 52-1-103, 52-2-111, MCA
History: NEW, 2020 MAR p. 1528, Eff. 8/8/20.

Mont. Admin. R. 37.50.1204 Provider Education

(1) Except where termination has been imposed, the department may, in its discretion, direct a sanctioned provider to participate in a provider education program as a condition of continuing services.

(2) At the discretion of the department, provider education programs may include:

(a) instruction in claim form completion;

(b) instruction on use of the Child Welfare Prevention and Support Services Rate Matrix Fee Schedule and Catalog;

(i) Federal Child Access and Visitation Grant Program;

(ii) Title IV-B Subpart 2;

(iii) Title IV-E Social Security; and

(iv) Child Abuse Prevention and Treatment Act (CAPTA).

(d) instructions on coding or billing issues; and

(e) other matters as determined by the department.

History

Authorizing statute(s): 41-3-101, 41-3-131, 52-1-103, 52-2-111, MCA
Implementing statute(s): 2-4-201, 41-3-101, 41-3-302, 42-1-102, 52-1-103, 52-2-111, MCA
History: NEW, 2020 MAR p. 1528, Eff. 8/8/20.

Chapter 37.51 Youth Foster Homes

Subchapter 37.51.1 General Requirements

Mont. Admin. R. 37.51.101 Youth Foster Homes: Purpose

(1) These rules establish licensing procedures and licensing requirements for youth foster homes, including therapeutic foster homes and kinship foster homes licensed by the department.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-112, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.102 Youth Foster Homes: Definitions

The following definitions apply to youth foster home licensing rules:

(1) "ACIP" means the Advisory Committee on Immunization Practices of the U.S. Public Health Service.

(2) "Crib" means full size crib, mini crib, or play pen which must meet the applicable requirements for full size baby cribs or non-full size baby cribs as specified by the U.S. Consumer Product Safety Commission.

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

(4) "DT vaccine" means a vaccine containing a combination of diphtheria and tetanus toxoids for pediatric use.

(5) "DTP vaccine" means a vaccine containing diphtheria and tetanus toxoids and pertussis (whooping cough) vaccine combined, including a vaccine referred to as DTaP, diphtheria, tetanus toxoid, and acellular pertussis vaccine combined.

(6) "Foster child" means a person under 18 years of age who has been placed in a youth foster home by the department, another state agency, a tribe, or a licensed child placing agency. A youth over the age of 18 may remain in foster care if still in secondary school.

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

(8) "Household member" means any person residing in the home at the time of an emergency placement or foster care license application or any person staying in an emergency placement home or a licensed foster home for more than two weeks.

(9) "Kinship foster home" means a youth foster home in which substitute care is provided by a member of the child's extended family, a member of the child's or family's tribe, the child's godparents, the child's stepparents if the child is placed with the stepparent by the department, or a person to whom the child, child's parents and family ascribe a family relationship and with whom the child has had a significant emotional tie that existed prior to the agency's involvement with the child or family.

(10) "MMR vaccine" means a live virus vaccine containing a combination of measles, mumps, and rubella vaccine.

(11) "PCV vaccine" means a vaccine containing pneumococcal conjugate vaccine.

(12) "Secondhand smoke" or "environmental tobacco smoke (ETS)" is a mixture of the smoke given off by the burning end of a cigarette, pipe, or cigar, and the smoke exhaled by smokers.

(13) "Serious incident" includes suicide attempts, use of physical force by a foster parent or any member of the foster parent's household, sexual contact with the child by anyone, emergency medical treatment, injury to a foster child that requires hospitalization, physical assault by the foster child, involvement with law enforcement by any member of the foster parent's household, including a foster child, or the death of a foster child.

(14) "Substitute care" or "foster care" means the full-time care of a child who is placed in a youth foster home by the department, another state agency, a tribe, or licensed child placing agency for the purpose of providing food, shelter, security and safety, guidance, direction, and, if necessary, treatment to children who are removed from or who are without the care and supervision of their parents or guardians.

(15) "Td vaccine" means a booster vaccine containing a combination of tetanus and diphtheria toxoids.

(16) "Tdap vaccine" means a booster vaccine containing a combination tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine.

(17) "Therapeutic foster home" means a youth foster home operating under the direction of the clinical staff of a licensed child placing agency when such agency has a contract with the department to provide therapeutic foster care services. A therapeutic foster home provides substitute care to only one child unless it is approved by the department to provide care for a second child needing therapeutic services. The therapeutic foster home may provide services to a foster child who does not need therapeutic services only as provided in ARM 37.51.603.

(18) "Youth foster home" or "foster home" means a youth care facility in which care is provided to a maximum of six children or youth residing in the home, other than the foster parents' own children, stepchildren, or wards.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-112, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2018 MAR p. 724, Eff. 6/1/18; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Subchapter 37.51.2 Licensure

Mont. Admin. R. 37.51.201 Youth Foster Homes: License Required

(1) Every youth foster home shall be licensed by the department or responsible tribal authority.

(2) Failure of a provider to obtain or renew a license while continuing to operate a youth foster home is a misdemeanor and shall be subject to the penalties provided in 52-2-623 , MCA.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.202 Youth Foster Homes: Licensing Procedures

(1) Upon receipt of a completed application packet for license or renewal of license and completion of a licensing assessment, the department shall determine whether the applicant meets all requirements for licensure as established in these rules. A completed packet consists of all items on the checklist required for initial licensure or renewal except for the home assessment.

(2) If the department determines that an application or accompanying information is incomplete or erroneous, the department shall notify the applicant in writing of the specific deficiencies or errors, and the applicant shall submit the required or corrected information within 60 days. The department may not issue a regular license or renew a license until it receives all required or corrected information.

(3) An applicant's or licensee's failure to provide information they are obligated to provide may result in the denial of the application or, if a license has been issued, may result in other negative licensing action.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.203 Youth Foster Homes: Licensure and Renewal

(1) The department may issue a youth foster home, kinship foster home, or therapeutic foster home license to any license applicant that the department determines meets all licensing requirements established by these rules. The initial license will expire one year from the date it is issued unless it is extended up to an additional 60 days pursuant to (4).

(2) The department may renew a youth foster home or kinship home license biennially on the expiration date of the initial year′s license if:

(a) the foster parents apply for renewal of the foster home license on a form available on the department's website prior to the expiration date of the current license; and

(b) following completion of a relicensing study, the department determines that the foster home continues to meet all licensing requirements established by these rules.

(3) The department may renew therapeutic foster care licenses annually on the expiration date of the previous year's license if:

(a) the foster parents apply for renewal of the foster home license on a form available on the department's website prior to the expiration date of the current license; and

(b) following completion of a relicensing study, the department determines that the foster home continues to meet all licensing requirements established by these rules.

(4) If the foster parent submits a completed application packet for renewal of a license prior to the expiration of the license and the department is unable to complete the relicensing study before the expiration of the license, and makes a determination that the home is in compliance with the licensing requirements before the expiration date of the previous year's license, the previous year's license will continue in effect for no more than 60 days while the department completes the relicensing study.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2019 MAR p. 1636, Eff. 4/28/18; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.207 Youth Foster Homes: Provisional Licensure

(1) The department may, at its discretion, issue a provisional license restricted for care of a specific child or children for any period up to six months to any license applicant for a youth foster home or kinship foster home that:

(a) meets all licensing requirements for fire safety;

(b) ensures all adult household members complete, sign, and submit a release of information form available on the department's website;

(d) passes a Montana child protection background check for all adult household members; and

(e) agrees in writing to comply fully with all licensing requirements established by these rules prior to the expiration of the provisional license.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.208 Youth Foster Homes: Restricted License

(1) The department may issue a license that is restricted to the care of a specific child or children.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.209 Youth Foster Homes: Dual License

(1) If an applicant for a foster home or kinship foster home is a licensed or registered day care provider, or if a licensee wishes to become a licensed or registered day care provider, their application must be approved by the licensing bureau chief or designee and the designee for the Early Childhood and Family Support Division–Child Care Licensing.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, 52-2-721, 52-2-722, 52-2-723, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.210 Youth Foster Homes: Granting Licensure Exceptions

(1) An applicant against whom child abuse or neglect has been substantiated may be denied a foster care license unless an exception is granted by the department after careful review of extenuating circumstances that justify the issuance of a restricted license.

(2) An applicant whose child has been in foster care may be denied a foster care license unless the department grants an exception because the circumstances that led to the provision of services and placement no longer exist. This does not include an applicant whose children were in foster care prior to being placed with the applicant for adoption.

(3) An applicant may not be newly licensed as a youth foster home if any one of the following has occurred within 12 months of the application unless an exception is granted by the appropriate resource family specialist supervisor:

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

(b) a marital separation or divorce of the applicants;

(d) the birth of a child to the applicants; or

(e) loss of employment by an applicant.

(4) If any event described in (3)(a) through (3) (e) occurs in a licensed foster home, the foster parents shall notify the licensing worker within 48 hours as required by ARM 37.51.602 and the licensing worker will reevaluate the home within 30 days to determine whether to recommend a change in the licensing status of the home.

(5) The department shall review the circumstances and the foster parents' ability to maintain safety and well-being for all children in the home when a foster home exceeds more than six children in the home.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.216 Youth Foster Homes: Negative Licensing Action

(1) The department, through written notice to the applicant, licensee, or potential emergency placement, will deny or revoke a license or emergency placement upon finding that the applicant, licensee, emergency placement, or any household member has a conviction for any of the following types of crimes:

(a) felony crimes involving violence, including homicide, felony partner-family member assault, rape, sexual assault, human trafficking, robbery, burglary, kidnapping, animal cruelty, arson and aggravated assault, or convictions requiring registration on a sexual or violent offender registry;

(b) felony and misdemeanor crimes against children such as child abuse or neglect, endangering the welfare of a child, incest, child sexual abuse, ritual abuse of a minor, child pornography, child prostitution, internet crimes involving children, and unlawful transactions with children;

(c) if within the previous five years, a felony conviction for a drug related offense, including the use, distribution, or possession of controlled substances, criminal possession of precursors to dangerous drugs, criminal manufacture of dangerous drugs, criminal possession, manufacture, or delivery of drug paraphernalia, or driving under the influence of alcohol or other drugs;

(d) if within the previous five years, a conviction for other crimes such as misdemeanor assault and battery, including misdemeanor partner-family member assault; or

(e) felony and misdemeanor crimes against older persons or developmentally disabled persons, including abuse, sexual abuse, neglect, or exploitation.

(2) The department, through written notice to the applicant or licensee, may deny, suspend, restrict, or revoke a license upon a finding that:

(a) the foster home is not in compliance with fire safety standards;

(b) the foster home, a foster parent, or any household member, is not in compliance with any other licensing requirements;

(c) a foster parent has made any material misrepresentations to the department, either negligent or intentional, including an omission of information the foster parent is obligated to disclose to the department, regarding any aspect of the foster home;

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

(e) a foster parent or other household member has been named as the perpetrator of child abuse or neglect in a substantiated report or their child has been placed in out of home care by the department;

(f) a foster parent failed to report an incident of suspected child abuse or neglect of any child to the department as required by 41-3-201, MCA, within 24 hours of receiving information pertaining to the incident;

(g) results of a psychological or medical examination provide reasonable grounds for the department to believe that the foster parent is not an appropriate caretaker for a child;

(h) a foster parent or anyone living in the foster home may pose any risk or threat to the safety or welfare of a child placed in the foster home; or

(i) a foster parent has failed to protect the health, welfare, or safety of a child or the foster home presents a threat to the health, welfare, or safety of a child.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 2-4-631, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2015 MAR p. 306, Eff. 3/27/15; AMD, 2021 MAR p. 1233, Eff. 9/25/21; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.217 Youth Foster Homes: Hearing Procedures

(1) Any applicant or licensee against whom the department takes negative licensing action regarding a youth foster home, kinship foster home, or therapeutic foster home license may request a fair hearing as provided in ARM 37.5.117, 37.5.304, 37.5.307, 37.5.313, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 2-4-102, 2-4-623, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.218 Youth Foster Homes: Removal of a Child

(1) The department, after providing the foster home with notice, may remove a child in the care or custody of the department from a foster home at any time it determines that another placement is more appropriate. The department may immediately remove any foster child if there is a need to protect the child from possible harm.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Subchapter 37.51.3 Youth Health Requirements

Mont. Admin. R. 37.51.301 Youth Foster Homes: General Requirements for Foster Parents and Other Household Members

(1) Foster parents must:

(a) be at least 18 years of age;

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

(d) be in good general health;

(e) be able to demonstrate the foster home has sufficient resources to meet the needs of their existing family, independent of foster care reimbursements;

(f) comply with state laws including those that relate to the possession or use of drugs, alcohol, tobacco, and firearms; and

(g) have lived together for at least 24 months unless an exception is granted.

(2) No person residing in or visiting the foster home may pose a risk or threat to the safety and well being of children in the home.

(3) A foster parent shall not provide exposure to sexual or violent language and behavior inappropriate to the foster child's age, including but not limited to visual or other media depictions, and music, while in the foster parent's home.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.305 Youth Foster Homes: Health Verification Requirements for Foster Parents and Other Household Members

(1) A personal statement of health form, available on the department's website, must be completed for each household member. The form(s) must be submitted to the department with the initial licensure application, any renewal application, and/or anytime there is a new household member.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.306 Youth Foster Homes: Immunization Requirements

(1) All children residing in the foster home, other than the foster child, shall be immunized against measles, rubella, mumps, poliomyelitis, diphtheria, pertussis, tetanus, varicella, hepatitis B, pneumococcal, and Haemophilus influenza type B according to the following schedule or have a religious or medical exemption:

(2) Hib and PCV vaccines are not required or recommended for children five years of age and older.

(3) Doses of MMR and varicella vaccines, to be acceptable under this rule, must be given no earlier than 12 months of age. A child who received a dose prior to 12 months of age must be revaccinated; however, vaccine doses given up to four days before the minimum interval or age are counted as valid. Live vaccines not administered at the same visit must be separated by at least four weeks.

(4) Vaccines immunizing against diphtheria, pertussis, and tetanus must be administered as follows:

(a) a child less than seven years of age must be administered four or more doses of DTP or DTaP vaccine, at least one dose of which must be given after the fourth birthday;

(b) DT vaccine administered to a child less than seven years of age is acceptable for purposes of this rule only if accompanied by a medical or religious exemption; and

(c) a child seven years old or older who has not completed the requirement in (1) must receive additional doses of Tdap vaccine or Td vaccine to become current in accordance with the ACIP schedule.

(5) The following are considered adequate documentation of vaccination for the purposes of this subchapter:

(a) a record from any local health department in the United States, signed by a local officer or nurse;

(b) a certificate signed by a local health officer or nurse;

(c) any official immunization record, if information has been recorded and signed by a physician, physician's designee, local health officer, or that officer's designee; or an official report from the statewide immunization information system, or a health care provider's medical record system;

(d) immunization recorded on a form approved by the U.S. government;

(e) any state's official parent-maintained immunization record;

(f) the international certificates of vaccination approved by the World Health Organization; or

(g) in the case of vaccine administrated outside of the United States, a record of the vaccination signed by an official of the principal public health agency of the country where the vaccination occurred.

(6) Vaccine administration data may not be filled out by a parent, guardian, or other person unless they are a health care provider, health department official, or person otherwise authorized to do so by this subchapter.

(7) The immunization information is to be kept on file in both the foster home and the licensing file.

(8) A child residing in the foster home, other than the foster child, is not required to have any immunizations which are medically contraindicated or contrary to the religious belief, observance, or practice of the child's custodial parent or legal guardian.

(a) A written and signed statement from a health care provider that an immunization otherwise required by (1) of this rule is medically contraindicated will exempt a child from those immunization requirements as deemed necessary by the physician. It is preferred, but not mandatory, that a health care provider's medical exemption be recorded on HES-101A, and medical exemption documentation must include:

(i) which specific immunization is contraindicated;

(ii) the period of time during which the immunization is contraindicated;

(iii) the reasons for the medical contraindication; and

(iv) when deemed necessary by a health care provider, the results of immunity testing. The tests must indicate serological evidence of immunity and must be performed by a CLIA approved laboratory.

(b) A notarized affidavit of exemption on religious grounds attesting that receipt of a vaccine or vaccines is contrary to an individual's religious belief, observance, or practice;

(i) the religious exemption affidavit will be prepared on a form provided by the department;

(ii) the form must be provided to the department prior to licensure; and

(iii) the original claim of the religious exemption must be kept by the department in the licensing record.

Total Immunizations Required, By Age

Age Number Doses - Vaccine Type

under 2 months old no vaccinations required

by 3 months of age 1 dose of polio vaccine

1 dose of DTP vaccine

1 dose of Hib vaccine

1 dose of Hep B vaccine

1 dose of PCV vaccine

by 5 months of age 2 doses of polio vaccine

2 doses of DTP vaccine

2 doses of Hib vaccine

2 doses of Hep B vaccine

2 doses of PCV vaccine

by 7 months of age 2 doses of polio vaccine

3 doses of DTP vaccine

*2 or 3 doses of Hib vaccine

2 doses of Hep B vaccine

3 doses of PCV vaccine

by 16 months of age 2 doses of polio vaccine

3 doses of DTP vaccine

1 dose of varicella vaccine

1 dose of MMR vaccine

*3 or 4 doses of Hib vaccine

2 doses of Hep B vaccine

*4 doses of PCV vaccine

by 19 months of age 1 dose of varicella vaccine

3 doses of polio vaccine

4 doses of DTP vaccine

1 dose of MMR vaccine

*3 or 4 doses of Hib vaccine

3 doses of Hep B vaccine

*4 doses of PCV vaccine

By 6 years of age 3 doses of polio vaccine, one given after the 4th birthday

4 doses of DTP vaccine, one given after the 4th birthday

2 doses of varicella vaccine

2 doses of MMR vaccine

3 doses of Hep B vaccine

By 12 years of age 3 doses of polio vaccine, one given after the 4th birthday

1 dose of Tdap vaccine

2 doses of varicella vaccine

2 doses of MMR vaccine

3 doses of Hep B vaccine

(*) varies depending on vaccine type used or the ACIP catch-up schedule.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, 52-2-735, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2018 MAR p. 191, Eff. 6/1/18; AMD, 2022 MAR p. 1884, Eff. 9/24/22.

Mont. Admin. R. 37.51.307 Youth Foster Homes: School Aged Child Immunization Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 20-5-403, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; REP, 2018 MAR p. 191, Eff. 6/1/18.

Mont. Admin. R. 37.51.310 Youth Foster Homes: Criminal Background Checks

(1) A satisfactory criminal background, motor vehicle, and child protective services check is required for each household member of the applicant, licensee, or emergency placement.

(2) If a new applicant or household member who has lived only in Montana cannot be successfully fingerprinted, or if two fingerprint cards cannot be successfully read by the Department of Justice (DOJ), a Montana name-based criminal records check will be used for applicants who have not lived in a state other than Montana.

(3) If an applicant or household member who has lived in states other than Montana cannot be successfully fingerprinted, or if two fingerprint cards cannot be successfully read by the DOJ, a federal name-based criminal records check will be completed by request from the DOJ.

(4) An annual name-based criminal records check for licensed foster parents and all adult household members is required for relicensure.

(5) A motor vehicle record check is required for all licensed drivers in the household for relicensure.

(6) A child protective services check will be requested from all states in which an applicant or any adult household member has lived for a minimum of the past five years.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2018 MAR p. 849, Eff. 4/28/18; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.311 Youth Foster Homes: Psychological and Medical Examinations

(1) The department may require a psychological evaluation or medical examination, and/or a signed authorization for release of medical or psychological records from:

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

(b) any currently licensed foster parent or any member of a currently licensed foster parent's household.

(2) The results of a psychological or medical examination may be considered in determining whether an applicant, licensee, or member of an applicant's or licensee's household meets licensing requirements and may be relied upon as a basis for negative licensing action.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Subchapter 37.51.6 Records

Mont. Admin. R. 37.51.601 Youth Foster Homes: Confidentiality of Records and Information

(1) All information in records maintained in a youth foster home and all personal information made available to a foster parent pertaining to an individual child and the child's family must be kept confidential unless a written court order authorizes the release of the information. The confidentiality requirement continues after the child is no longer in the home. The confidentiality requirement also applies to information a foster parent receives about foster children placed with other foster parents, whether the information is received in a support group setting or otherwise.

(2) All requests for records or information maintained by a youth foster home which pertain to an individual child or the child's family must be referred to the department or, if applicable, to the agency that placed the child. The department may authorize the release of information from the foster home; the foster home may not.

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

(4) Records pertaining to individual children residing in the home but not placed by or in the custody of the department are available to the department for the purposes of licensing or relicensing the youth foster home.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 41-3-205, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.602 Youth Foster Homes: Reports of Change in Composition of Foster Home

(1) Foster parents shall notify the department licensing worker or supervisor or the licensed child placing agency's licensing worker under whose jurisdiction the foster home operates, within 48 hours of:

(a) a death of a spouse or a child in the foster family;

(b) a marital separation or divorce of the foster parents;

(d) the birth of a child to the foster parents; or

(e) loss of employment by one of the foster parents.

(2) At least 30 days prior to moving, foster parents shall report a planned change of residence to the department licensing worker or supervisor or to the licensed child placing agency under whose jurisdiction the foster home operates. The licensing worker assigned to the family will evaluate the new residence for compliance as soon as possible but not more than ten working days after the move to the new residence.

(3) Foster parents shall provide notice to the department licensing worker or supervisor or the licensed child placing agency under whose jurisdiction the foster home operates:

(a) within one working day of any changes in household composition; and

(b) within 30 days of a change in employment.

(4) If a foster parent is unwilling or unable to care for a child who is placed in the foster parent's care, the foster home shall notify the child's placing worker or their supervisor immediately. The foster parent is not authorized to make arrangements for care of the child, except for respite care.

(5) A foster parent may not accept placement of any child, including foreign exchange students, Bureau of Indian Affairs placement, or tribal placement into the household without prior notice to, and prior approval by, the department or the licensed child placing agency under whose jurisdiction the foster home operates.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.603 Youth Foster Homes: Therapeutic Foster Homes

(1) Therapeutic foster parents must meet all requirements for regular foster parents set forth in this rule, the requirements set forth in ARM 37.37.101, et seq., and the additional requirements in this rule and ARM 37.51.1403.

(2) Therapeutic foster parents are in home treatment providers who, in addition to carrying out usual family foster parent responsibilities, implement treatment strategies and provide treatment interventions under the supervision of a therapeutic foster care agency's clinical staff according to the child's individual treatment plan.

(3) Therapeutic foster care requires the availability of 24 hour per day supervision to deliver therapeutic services as needed. Parenting skills must be sufficient to meet the level of therapeutic foster care being provided, including being adequate to address the needs of the emotionally disturbed youth in the areas of behavior management, supportive counseling, and implementation of the treatment interventions identified in the child's individual treatment plan.

(4) If child care arrangements are made for a child receiving therapeutic foster care for any reason, including to allow a foster parent to work or in order to provide socialization opportunities for the child, such arrangements must be approved by the child's treatment team to ensure they meet the therapeutic needs of the child.

(5) Therapeutic foster parents are members of the youth's treatment team and must participate in treatment team meetings.

(6) Therapeutic foster parents shall regularly document the youth's progress toward achievement of the individual treatment plan. This documentation must be put in writing and must be incorporated into the youth's case file within 30 days.

(7) The department, in conjunction with the licensed child placing agency under whose jurisdiction the foster home operates, may approve the placement of children who are not approved for therapeutic foster care services with youth receiving therapeutic foster care services when:

(a) placement in the therapeutic foster home will maintain an intact sibling group;

(b) placement in the therapeutic foster home will maintain a parent/child relationship when the parent is a youth who is receiving therapeutic foster care services;

(c) moving a child who was previously placed in the therapeutic foster home but is not receiving therapeutic foster care services is determined by the department to not be in the best interests of the child; or

(d) the department and the licensed child placing agency under whose jurisdiction the foster home operates determine that a kinship placement is appropriate and an exception is granted by the regional administrator and licensing bureau chief.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.607 Youth Foster Homes: Reports of Suspected Child Abuse or Neglect

(1) As required by 41-3-201 , MCA, foster parents shall report any incident of known or suspected child abuse or neglect of any child to the department's Centralized Intake Bureau at 1 (866) 820-5437. Foster parents shall make the report within 24 hours of receiving information concerning suspected child abuse or neglect.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 41-3-201, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.608 Youth Foster Homes: Reports of Serious Incidents and Threats

(1) Foster parents shall as soon as possible but in not more than 24 hours report any serious incident as defined in ARM 37.51.102(13) involving a foster child to the person or agency which placed the child and to the department licensing worker or the licensed child placing agency under whose jurisdiction the foster home operates.

(2) Foster parents shall complete a written incident report form, which is available on the department's website, regarding any serious incident involving any child in the home. A copy of the report shall be maintained at the foster home and a copy sent to the department licensing worker or the licensed child placing agency under whose jurisdiction the foster home operates the next working day.

(3) Foster parents shall as soon as possible but in not more than 24 hours report any foster child who has run away from home to the police and the department's Centralized Intake Bureau at 1 (866) 820-5437.

(4) Foster parents shall report disasters or emergencies which require evacuation of a foster home to the department's Centralized Intake Bureau at 1 (866) 820-5437.

(5) Foster parents shall report any threats to the health, welfare, or safety of a child at the time of the license application or, with respect to any threat that subsequently arises, within the next working day after becoming aware of the threat, to the placing worker and the department licensing worker or the licensed child placing agency under whose jurisdiction the foster home operates.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 2-4-631, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.609 Youth Foster Homes: Reports of Discipline Violations

(1) If a foster parent or other household member physically disciplines a foster child as described in ARM 37.51.826 or violates any other portion of that rule, the foster parent must notify the agency that placed the child and the department licensing worker or supervisor of the violation by the next working day. The foster parent must then complete a written report on a form provided by the department and must submit it to both the person or agency which placed the child and to the department licensing worker or supervisor within 48 hours of giving notice of the violation.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Subchapter 37.51.8 Youth Rights

Mont. Admin. R. 37.51.801 Youth Foster Homes: General Program Requirements

(1) A foster parent shall not accept more children than the number specified on the license, without prior approval of the department licensing worker or licensed child placing agency under whose jurisdiction the foster home operates.

(2) A foster parents shall arrange for appropriate child care for every child in foster care when the child is not being cared for by a foster parent and is not in school.

(3) A foster parent shall provide appropriate care including:

(a) regular, well balanced meals, an adequately maintained and furnished home, clothing, and supervision of child's health and dental care;

(b) personal care, supervision, and attention appropriate to each child's age, needs, and level of functioning.

(4) A foster parent will make careful and sensible parental decisions that maintain the health, safety, and best interests of a child while also encouraging the emotional and developmental growth of the child. A foster parent shall use this standard when determining whether to allow a child in foster care, under the responsibility of the state, to participate in extracurricular, enrichment, cultural, religious, and/or social activities.

(5) A foster parent shall teach each foster child age-appropriate personal care, hygiene, and grooming, and shall provide each child with the necessary supplies.

(6) Money earned by a child or received as a gift or allowance is the child's personal property and must be accounted for separately from foster home funds.

(7) A foster parent, in conjunction with the supervising worker, shall distinguish between tasks which children are expected to perform as part of living together, jobs to earn spending money, and jobs performed for vocational training.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.802 Youth Foster Homes: Cooperation of Foster Parents

(1) Foster parents shall cooperate with the placing agency, implement decisions made by the department regarding the child, and support the department's permanency plan for the child.

(2) Foster parents shall permit and encourage contact and visitation between the foster child and the child's birth or legal family, including parents and siblings, except in those cases where a restriction of contact and visitation is part of a court order or the written case plan.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.805 Youth Foster Homes: Child Education and Training

(1) The foster parents shall cooperate with the placing agency and, when appropriate, the birth or legal parents, in providing or arranging an age appropriate education, employment, or training program appropriate for each child that addresses the child's needs in the areas of social living, sex education, consumer education, career planning, and preparation for independent living.

(2) The foster parents shall assure that all children attend a public school unless otherwise approved by the department.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, 52-2-666, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.806 Youth Foster Homes: Child Religious and Cultural Expression

(1) Each child in foster care shall have the opportunity to voluntarily practice his religion. Foster parents shall allow each child to attend available religious services of the child's or birth parent's choice in the community and to visit with representatives of the child's faith.

(2) Foster parents shall respect the religious beliefs or practices of the children placed in their home.

(3) Each child shall be given the opportunity to identify with his own cultural heritage and shall be encouraged to do so.

(4) Participation or nonparticipation by the child in religious activities of the child or foster family shall not be used as a form of discipline.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, 52-2-666, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.810 Youth Foster Homes: Child Clothing

(1) A foster parent shall ensure that each foster child is supplied with his or her own clothing suitable to the child's age and size.

(2) Clothing must be comparable to the clothing of other children in the community.

(3) Children must be given appropriate choice in the selection of their clothing.

(4) Clothing or other possessions that came with the child from the child's home must not be disposed of without approval from the child's social worker.

(5) The child's current clothing and other possessions must be sent with the child to any subsequent placement, including a return to the child's home.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.815 Youth Foster Homes: Child Privacy Rights

(1) The foster parents shall allow privacy for the child and shall provide appropriate sleeping arrangements, separate storage space for clothing and personal articles, and a place to display the child's socially appropriate creative works and symbols of identity.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, 52-2-666, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.816 Youth Foster Homes: Sleeping Arrangements and Requirements

(1) Each foster child must sleep in a room designated as a bedroom that provides for privacy.

(2) Any room in which the child sleeps must have a window sufficiently large for an adult to enter or exit in an emergency.

(3) Children of the opposite sex who are five years of age or older may not share a bedroom.

(4) Children over 24 months of age may not routinely sleep in the same room with an adult unless approved by the department foster care licensing supervisor.

(5) A foster parent shall sleep within call of all foster children during the night or must use a baby monitor or other intercom system that will alert the foster parent to the child's call.

(6) A foster parent shall provide each child with their own bed, which must be at least 30 inches wide and of a length that is adequate for the child's height.

(7) A child under the age of four may be provided with a toddler bed that uses a standard crib mattress, is at least 28 inches wide, and is of a length adequate for the child's height.

(8) Children under age two must sleep in a crib, as defined in ARM 37.51.102(2).

(a) Foster parents shall comply with current safe sleep practices for all children under one year of age.

(9) Each bed or crib must have appropriate bedding.

(10) Bunk beds more than two bunks high are prohibited. If bunk beds are used, the upper bunk must have a guardrail. Upper bunks may not be used by children under eight years of age.

(11) A foster parent shall provide each child with space in a closet, locker, or dresser for storage of the child's clothing and personal belongings. This storage space must be located in the child's sleeping area.

(12) When placement in a kinship foster home is determined to be in a child's best interests, an exception to one or more provisions (other than (8)(a)) of this rule may be granted by the department after careful review of the circumstances.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.820 Youth Foster Homes: Youth Independent Living Program, Job Training, and Employment

(1) Foster parents shall cooperate with the department's independent living program staff and contractors to ensure that eligible youth in foster care are encouraged and assisted to access services and benefits offered under the department's Independent Living Program.

(2) Foster parents shall assist the placing agency, eligible youth in foster care, the Independent Living Program staff, and contractors in developing an appropriate transitional plan for each eligible youth in foster care aged 14 or older.

(3) Foster parents shall encourage and assist eligible youth in foster care to prepare for the transition from foster care to independent living.

(4) Foster parents shall assist the placing agency, eligible youth in foster care, the Independent Living Program staff, and contractors in developing the youth's job readiness skills and, when appropriate, assisting the youth in locating employment.

(5) Foster parents shall assist youth eligible youth in foster care in exploring postsecondary educational opportunities.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.825 Youth Foster Homes: Physical Care of Children

(1) Foster parents shall work with the placing agency to ensure that the foster child's medical needs are met.

(2) Every foster child must have an identified physician.

(3) Medical and dental care, including examinations and treatment, must be obtained for children as needed.

(4) Foster parents, in consultation with the placing agency, shall arrange for each child to have a complete Early Periodic Screening, Diagnosis, and Treatment (EPSDT) well child examination which includes a medical, dental, vision, and hearing screen within 30 days of placement in foster care. Subsequent examinations and treatment must be completed as recommended by the child's physician.

(5) Foster parents shall obtain psychiatric, psychological, and counseling services, including diagnosis and treatment, for each child as determined necessary by the placing agency.

(6) Foster parents shall keep the placing agency apprised of illnesses of each foster child that require medical attention and the results of examinations, tests, and treatment recommended for each child.

(7) All medication must be kept in the original containers labeled with the original prescription labels in a place inaccessible to children.

(8) All medication must be given as prescribed unless a licensed health care provider rescinds the prescription or otherwise modifies it. The foster parent will notify the child's case worker of any changes in medication.

(9) Foster parents shall work with the placing agency to ensure that each foster child is immunized in accordance with ARM 37.51.306.

(10) In an emergency, the foster parents shall make arrangements for emergency care at a nearby hospital, clinic, or doctor's office and, as soon as possible thereafter, notify the placing agency.

(11) Foster parents may not provide tobacco products in any form to children under the age of 18 who are placed in the foster home.

(12) Foster parents may not allow children placed in the foster home to be exposed to secondhand smoke in the foster parents' home or vehicle.

(13) Nothing in (11) or (12) is meant to interfere with traditional or Native American ceremonies involving the use of tobacco.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.826 Youth Foster Homes: Discipline

(1) Foster parents shall use discipline appropriate to the child's age and developmental level. The foster parents' approach to discipline must be positive.

(2) The foster parents shall not use spanking or other forms of physical punishment.

(3) The foster parents shall not use any other disciplinary technique which is humiliating, shaming, cruel, capricious, frightening, or otherwise damaging to a child.

(4) No child in care shall be subjected to any form of abuse.

(5) No child in care shall be subjected to verbal abuse, derogatory remarks about himself or members of his family, or threats to expel the child from the foster home.

(6) No child in care shall be deprived of meals, mail, or family visits as a method of discipline.

(7) Foster parents shall not punish children for bed wetting or any other toilet training issue.

(8) Children must not be placed in a locked room.

(9) Participation or nonparticipation by the child in religious activities of the child or the foster family shall not be used as a form of discipline.

(10) Medication or withholding of prescribed medication shall never be used to discipline or threaten children.

(11) If a foster parent or other household member is involved in any physical discipline of a foster child or any other violation of this rule, the foster parent must report the violation as required in ARM 37.51.609.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-102, 52-2-111, 52-2-112, 52-2-113, 52-2-115, 52-2-601, 52-2-603, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Subchapter 37.51.9 Safety Requirements

Mont. Admin. R. 37.51.901 Youth Foster Homes: Environmental and Safety Requirements

(1) The foster home and its premises must be comparable to other residences of the community and neighborhood in which it is located.

(2) The home must be built or manufactured for the purpose of full-time residency.

(3) Every interior door must be designed to permit the opening of the locked door from the outside in an emergency.

(4) Protective plugs must be installed on electrical outlets in all homes occupied by foster children under five years of age.

(5) The foster parents shall keep the home clean and in good repair and the premises free from objects, materials, and conditions that constitute a danger to the occupants.

(6) Foster parents shall protect any foster child from any environmental danger or other hazard on the foster care property that the foster parent is aware of and that could affect the health, welfare, or safety of children in care. The foster parent must notify the licensing worker of any existing concern.

(7) All foster homes must be equipped with, or provide access to, a landline or cellular telephone. Telephone numbers of the placing agency, hospital, police department, fire department, ambulance, and poison control center must be posted in a place visible to a child in placement.

(8) The foster home must have an adequate and safe sewage disposal system.

(9) If the home's water supply is not from a municipal system, a foster parent must arrange to, at a minimum, have a basic screen water test conducted at least annually through the Department of Public Health and Human Services, Public Health and Safety Division, Laboratory Services Bureau, Environmental Laboratory Section, Cogswell Building, 1400 Broadway, Room B-204, Helena, MT 59620 to ensure that the water supply remains safe for human consumption. Documentation of the test results must be provided to the licensing worker. If a home's water supply is obtained from an approved source, but the water is stored in a cistern, it is recommended that a basic screen water test be conducted each time the water is replaced and the results provided to the licensing worker.

(10) Children may not be knowingly exposed to unsafe levels of lead as determined by the Environmental Protection Agency.

(11) Cleaning materials, flammable liquids, detergents, aerosol products, and other poisonous and toxic materials must be kept in their original containers or be clearly labeled with both symbols and words indicating that the contents are hazardous. Such substances must be kept in a place inaccessible to children and shall be childproofed, if possible, and be used in such a way that will not contaminate play surfaces, food, food preparation areas, or constitute a hazard to the children.

(12) Any pet or animal present at the home with the foster parents' permission must not pose a threat to the safety or well-being of any child placed in the home.

(a) Any pet or animal present at the home with a foster parent's permission must be vaccinated in accordance with local laws.

(b) Documentation provided by a veterinarian verifying that any pet or animal belonging to a foster parent and present at the home is in good health must be provided to the department upon request.

(c) Foster parents are responsible for their negligent actions and for any resulting injuries that may be caused by any animal allowed in or around the foster home.

(13) Foster parents shall keep guns and ammunition in locked storage with guns stored separately from ammunition. Guns kept in vehicles must be locked in the glove compartment or gun rack, must be unloaded, and ammunition must be kept locked in a separate location in the vehicle.

(14) Any outdoor play area must be maintained hazard free. If any part of the play area is adjacent to a well, machinery, road, drainage ditch, holes, or other hazardous areas, the play area must be enclosed with fencing or natural barriers when preschool children are in placement to restrict the children from these areas.

(15) Outdoor equipment, such as climbing apparatus, slides, swings, and trampolines, must be anchored firmly and placed in a safe location. A responsible adult must be present and directly observing any activity of a foster child on a trampoline at all times.

(16) Foster parents shall make swimming and wading pools, swimming areas, and hot tubs inaccessible to children except when directly supervised by a responsible adult.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2021 MAR p. 1233, Eff. 9/25/21; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.902 Youth Foster Homes: Fire Safety Requirements

(1) Two unobstructed means of exit must exist from all sleeping areas occupied by foster children.

(2) Foster parents shall devise a written plan for everyone in the home to exit the home in emergencies and must teach the plan to children placed in the home.

(3) A working smoke detector that is properly maintained and regularly tested must be located in each bedroom and in the hallway leading to the bedroom with at least one smoke detector on each level of the foster home.

(4) Each foster home in which fuel burning heat or appliances are used must have at least one carbon monoxide detector installed in the home.

(5) Each foster home must have a workable portable fire extinguisher with a minimum rating of 2A10BC. Extinguishers must be readily accessible and shall be mounted.

(6) Portable unvented fuel-fired heating devices, such as portable kerosene or oil heaters, are not allowed.

(7) An extension cord may not be used as permanent wiring.

(8) All woodburning stoves, pellet stoves, and fireplace inserts must meet building codes for the installation and use of such stoves. If the department identifies a possible concern regarding safety of a wood stove or fireplace, the department may require the foster home to have an inspection conducted to certify that it meets applicable codes.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Subchapter 37.51.10 Transportation

Mont. Admin. R. 37.51.1001 Youth Foster Homes: Transportation

(1) Foster parents and any person transporting foster children with a foster parent's permission, must possess a valid driver's license and meet the minimum liability insurance coverage requirements set by state law.

(2) Vehicle doors must be locked whenever the vehicle is in motion.

(3) No vehicle shall begin moving until all children are seated and secured in age appropriate safety restraints that are to remain fastened at all times while the vehicle is in motion.

(4) Foster parents must request and receive written travel authorization before taking any child placed by the department:

(a) out of the county for more than 72 hours;

(b) out of the state for more than 72 hours; or

(5) Any travel that interferes with visitation, therapy, education, or other services provided to the foster child must receive prior approval.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Subchapter 37.51.14 Training Requirements

Mont. Admin. R. 37.51.1401 Youth Foster Homes: Required Training

(1) Each applicant shall attend the required preservice training of not less than eight hours prior to issuance of a regular license.

(2) The foster parents shall complete the resource parent online training within the first year of licensure. Verification of completion of the online training must be provided to the department.

(3) The foster parents must obtain a total of at least 15 hours of training annually for relicensure following the first year of licensure. Training must be documented on a form provided by the department.

(4) The department will provide the foster parents notice that documentation of the training requirements is due in the materials provided by the department for relicensure.

(a) If the foster parents fail to obtain the required training hours, the license will be restricted to the care of the children in the home at the time until such time as the required training hours have been successfully completed; or

(b) If there are no children in the foster home, the license will be deemed automatically suspended until such time as the required training hours have been successfully completed.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2018 MAR p. 849, Eff. 4/28/18.

Mont. Admin. R. 37.51.1404 Youth Foster Homes: Training Exceptions

(1) A written exception to the required preservice training must be approved prior to initial licensure.

(2) A written exception to the required 15 hours of annual training must be approved prior to a license being renewed.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Mont. Admin. R. 37.51.1405 Youth Foster Homes: Required Training Topics

(1) Annual training is intended to help the foster parents gain further understanding regarding such issues as child maltreatment, child growth and development, family dysfunction, permanency planning, emergency or long term medical needs of children, and age appropriate preparation of youth for independent living.

(2) Training must be provided or approved by the department and may include training on the following topics:

(a) separation and grieving;

(b) loss and attachment;

(d) positive parenting techniques;

(e) the department's and foster parents' roles and responsibilities;

(f) biological family rights and responsibilities;

(g) how and why children come into foster care;

(h) types and behaviors of children in foster care;

(i) placement process;

(j) confidentiality;

(k) sexual abuse;

(l) drugs and alcohol;

(m) interpersonal communications;

(n) foster parent insurance; and

(o) other topics approved by the department.

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06.

Mont. Admin. R. 37.51.1410 Youth Foster Homes: Required Training for Therapeutic Foster Homes

(1) Therapeutic foster parents shall each complete 30 hours of training before initial licensure.

(2) Each year thereafter, therapeutic foster parents shall complete a total of 30 hours of annual training, including a minimum of 15 hours of training directly related to:

(a) the special needs of youth with emotional disturbances receiving treatment for their emotional disturbance in a treatment family environment; and

(b) the use of nonphysical methods of controlling youth to assure the safety and protection of the youth and others.

(3) Each therapeutic foster parent in a two parent foster home must complete at least five hours of training directly related to (2)(a) and (b).

History

Authorizing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
Implementing statute(s): 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA
History: NEW, 2006 MAR p. 1395, Eff. 6/2/06; AMD, 2024 MAR p. 1390, Eff. 6/8/24.

Chapter 37.52 Adoptive Services

Subchapter 37.52.1 Child Adoption Services

Mont. Admin. R. 37.52.101 Procedures for Obtaining Services

(1) Any person eligible to adopt, pursuant to 40-8-106 , MCA, may apply to adopt by filling out an application which can be obtained at any child and family services division regional office.

History

Authorizing statute(s): Sec. 53-4-111, MCA
Implementing statute(s): Sec. 53-4-112 and 53-4-115, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659.

Mont. Admin. R. 37.52.104 Home Approval, Eligibility Requirements

(1) The department will not accept adoptive applicants who have current applications before any other licensed adoption agency.

(2) The department decides whether applicants will be studied and whether children will be placed. The department may limit adoptive intake according to the number and type of children available for adoption.

(3) Adoptive applicants must submit to the department a physical examination report as part of the adoption application.

(4) Adoptive applicants must have sufficient income to provide for an additional child or children.

(5) A social worker completes an adoptive home study and recommends the type of child for whom a family will be considered.

(6) The department notifies the applicant when the home is approved for an adoptive placement.

(7) The adoptive home must be re-evaluated after 1 year if a child has not been placed in the home.

(8) At the time of placement, the adoptive family must sign an adoptive placement agreement.

History

Authorizing statute(s): Sec. 52-1-103 and 53-4-111, MCA
Implementing statute(s): Sec. 53-4-112 and 53-4-115, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 979, Eff. 5/27/88; TRANS, from DFS, 1998 MAR p. 659.

Mont. Admin. R. 37.52.110 Adoptive Home Approval

The department provides the following services:

(1) counsel the family regarding an appropriate placement for them;

(2) help the family to understand the adoptive process;

(3) counsel the family regarding possible adjustment problems;

(4) counsel the family regarding telling the child about adoption and handling questions which may come up in the future;

(5) advise the adoptive family that the department may provide services if problems arise after an adoption is completed;

(6) provide information regarding other agencies and resources and make referrals; and

(7) help the family to accept the department's decision.

History

Authorizing statute(s): Sec. 53-4-111, MCA
Implementing statute(s): Sec. 53-4-112 and 53-4-115, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659.

Mont. Admin. R. 37.52.115 Adoptive Placement Eligibility Requirements

(1) Parental rights must be terminated and custody with the right to place for adoption must be given to the department by a court of competent jurisdiction.

(2) The parent or parents may voluntarily relinquish a child for adoption by an affidavit of waiver and consent to adoption, in triplicate, before a notary public. The form may be obtained at any local county welfare office. This affidavit may not be signed prior to the birth of a child.

(3) The legal father of a child must also sign waivers to be relinquished for adoptive placement. If the child is born within 10 months of a divorce, the former husband must sign waivers.

(4) If paternity has been admitted or legally established, the unwed father must also sign waivers.

(5) The child must be able to accept and adjust to adoptive placement.

(6) The child must have a pre-adoptive physical examination.

History

Authorizing statute(s): Sec. 53-4-111, MCA
Implementing statute(s): Sec. 53-4-112 and 53-4-115, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659.

Mont. Admin. R. 37.52.120 Adoptive Placement Services Provided

The department will:

(1) prepare a social study on children considered for adoption;

(2) counsel children considered for adoption;

(3) arrange for pre-placement visits with the family selected for placement;

(4) assist the family in formal adoption proceedings;

(5) supervise the adoptive placement; and

(6) counsel the family and child if the adoption is disrupted.

History

Authorizing statute(s): Sec. 53-4-111, MCA
Implementing statute(s): Sec. 53-4-112 and 53-4-115, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659.

Mont. Admin. R. 37.52.125 Child Placement, Procedures for Obtaining Services

(1) A social worker may recommend adoptive placement for a child who is eligible for adoption and appears to be placeable by reason of age, adjustment and family situation.

(2) Another licensed agency or a court could recommend adoptive placement of a child. Referral may be in person, in writing or by telephone.

History

Authorizing statute(s): Sec. 53-4-111, MCA
Implementing statute(s): Sec. 53-4-112 and 53-4-115, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659.

Subchapter 37.52.2 Adoption Assistance

Mont. Admin. R. 37.52.201 Purpose (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-304, MCA
Implementing statute(s): 53-4-302, MCA
History: NEW, Eff. 8/4/73; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659; REP, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.202 Definitions

The following definitions apply to the rules contained in this subchapter:

(1) “Adoption assistance” means the financial and/or medical assistance and/or non-recurring expenses and/or other services provided under an adoption assistance agreement. At a minimum, adoption assistance must include Medicaid coverage for the adopted child and reimbursement of non-recurring adoption expenses.

(2) “Adoption assistance agreement” means a written document between the department and the pre-adoptive parent(s) which is signed by all parties on the date of or prior to the final decree of adoption. The agreement is a written, binding agreement which specifies the amount, duration, and scope of any payments, services, and assistance to be provided under such agreement.

(3) “Child with special needs” means a child who is a dependent of the department, a Montana federally recognized tribe which has entered into a Title IV-E agreement with the department, or a private licensed adoption agency, and meets at least one of the following criteria:

(a) diagnosed as having a physical, mental, or emotional disability;

(b) recognized to be at high risk of developing a physical, mental, or emotional disability;

(d) six years of age or older; or

(e) a member of a sibling group to be placed together for adoption.

(4) “Congregate care” means a therapeutic group home, group home, or shelter care facility fully licensed by the department.

(5) “Independent adoption” means an adoption completed independent of involvement by the department, a Montana tribal social services agency, or a licensed child placing agency. Independent adoptions are not eligible for adoption assistance unless one of the following criteria are met:

(a) the child meets the eligibility criteria for Social Security Income (SSI); or

(b) the child being adopted received adoption assistance in a previous adoption and continues to be a child with special needs.

(6) “Non-recurring adoption expenses” means reasonable and necessary legal fees and costs. This term includes court costs, attorney fees, and other expenses which are directly related to the legal adoption of a child with special needs and which are not incurred in violation of state or federal law.

(7) “Private adoption” means an adoption completed through a private licensed child placing agency.

(8) “Private licensed child placing agency” means an agency as defined in ARM 37.93.101.

(9) “Reasonable efforts to place without adoption assistance” means the department must determine that in each case a reasonable, but unsuccessful, effort to place the child with appropriate pre-adoptive parents without providing adoption assistance, has been made.

(a) The department staff must ask the pre-adoptive parent(s) whether they are willing to adopt without receiving assistance. The pre-adoptive parent(s) must indicate whether they can adopt the child without assistance, and the department staff must document the pre-adoptive parents’ response in the child’s case record.

(b) The department must establish reasonable efforts to place without adoption assistance except where it would be against the best interests of the child because of such factors as the existence of significant emotional ties with pre-adoptive parent(s) while in the care of such parent(s) as a foster child. Any exception to reasonable efforts to place without adoption assistance must be documented in the child’s case record.

(10) “Tribal adoption” means an adoption established by a tribal court and the tribe has a Title IV-E agreement with the department. This can include adoptions without termination of parental rights if allowed under the tribal code.

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-104, MCA
History: NEW, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.203 Adoption Assistance Agreement Required

(1) An adoption assistance agreement is negotiated between the pre-adoptive parents and the department. The agreement must:

(a) be negotiated and executed by the date of or prior to the date of the finalized adoption decree;

(b) indicate the terms and duration; and

(2) The agreement covers non-recurring adoption expenses, monthly cash payments, social services, and medical care as provided under federal or state Medicaid programs.

(3) The department is prohibited from using a means test when determining the amount, scope, and duration of the adoption assistance agreement. The agreement must be negotiated taking into consideration the circumstances of the adoptive parents and the needs of the child.

(4) The monthly cash assistance cannot exceed ten dollars less, per month, than the prevailing foster care rate at the time the adoption is finalized.

(5) As a condition of receiving adoption assistance, the adoptive parent(s) must ensure the child is:

(a) enrolled in school, if the child is age seven and above;

(b) enrolled in an authorized independent study program; or

(c) home-schooled consistent with the law of the state or other jurisdiction in which the school, program, or home is located during the entire time the adoption assistance agreement is in place.

(6) If the pre-adoptive parents and the department are unable to reach an agreement on the terms or amounts of the adoption assistance agreement during the negotiation process, or if the pre-adoptive parents are denied adoption assistance the pre-adoptive parents may request a review of the determination by the Child and Family Services Division administrator.

(7) If adoption assistance is denied by the Child and Family Services Division administrator, then the pre-adoptive parents may request a fair hearing.

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-108, MCA
History: NEW, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.204 Eligibility Requirements (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-304, MCA
Implementing statute(s): 53-4-304, MCA
History: NEW, Eff. 8/4/73; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659; REP, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.205 Application of Prospective Adoptive Family (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-304, MCA
Implementing statute(s): 53-4-308, MCA
History: NEW, Eff. 8/4/73; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659; REP, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.206 Amount and Determination of Subsidy (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-304, MCA
Implementing statute(s): 53-4-310, MCA
History: NEW, Eff. 8/4/73; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659; REP, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.207 Renegotiation

(1) The adoptive parents may request the department renegotiate the amount of the monthly payment in the adoption assistance agreement if:

(a) there has been a change in the family’s circumstances; or

(b) a higher foster care rate would have been paid on behalf of the child if the child had still been in foster care.

(2) The renegotiated adoption assistance payment cannot exceed ten dollars less, per month, than the amount the child would have received if the child had been in foster care.

(3) The adoptive parents may request the department renegotiate the adoption assistance agreement to extend beyond the child’s 18th birthday if the child continues to meet special needs criteria and has not graduated high school or completed their authorized independent study program by age 18; however, the child is expected to graduate or complete the authorized independent study program on or before their 19th birthday.

(4) The adoptive parents may request that the adoption assistance agreement be extended until the child is 21 years of age if the child has a mental or physical disability and remains in an educational program that warrants continuation of the agreement. The department has sole discretion to approve a request to extend adoption assistance until age 21.

(5) If adoption assistance agreements are extended beyond the child’s 18th birthday, then the family may request the amount of the monthly payment be renegotiated in accordance with (1) and (2).

(6) If adoptive parents want to renegotiate the amount of the monthly payment or the length of the adoption assistance, they must contact the Child and Family Services Division (CFSD) Adoption Negotiations Program manager.

(7) The adoptive parents may request a review of the determination by the CFSD administrator if the parent(s) and the department are unable to reach an agreement on the terms or amounts of the adoption assistance agreement during the renegotiation process.

(8) If adoption assistance renegotiation is denied by the CFSD administrator, the adoptive parents may request a fair hearing.

(9) The effective date of a renegotiated agreement will be the earlier of:

(a) the first day of the month following the renegotiated agreement being signed by the department and the adoptive family both parties;

(b) the first day of the month following the date the family requests a review by the CFSD administrator; or

(10) Payments will not be approved retroactively for more than six months from the date of the request for renegotiation of the adoption assistance agreement.

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-108, MCA
History: NEW, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.208 Termination of the Adoption Assistance

(1) Once the adoption assistance agreement is in place, the agreement may be terminated under any of the following:

(a) the conclusion of the term of the agreement;

(b) the adoptive parents provide the department a written request to discontinue the agreement;

(d) the death of the parent(s) of the child (one in a single parent family and both in a two-parent family);

(e) the agency determines that the child is no longer receiving any support from the adoptive parent(s);

(i) “Support” means various forms of financial support. Payments for family therapy, tuition, clothing, maintenance of special equipment in the home, or services for the child’s special needs are acceptable forms of financial support.

(ii) The department may continue providing adoption assistance if it determines that the parent is providing some form of financial support to the child even in situations where the child is placed in some form of out-of-home care;

(f) The department determines that the adoptive parent(s) are no longer legally responsible for support of the child. Parents are considered no longer legally responsible for support of the child when any of the following occur:

(i) parental rights have been terminated voluntarily or involuntarily;

(ii) the minor is emancipated;

(iii) the minor marries; or

(iv) the minor enlists in the military.

(2) Adoptive parents are required to inform the department of circumstances that would make them ineligible to continue to receive adoption assistance.

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-108, MCA
History: NEW, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.209 Eligibility Requirements

(1) Pre-adoptive parents adopting a child from the custody of the department or through a private licensed child placing agency must meet the pre-placement provisions of 42-3-204, MCA, or the department cannot enter into an adoption assistance agreement.

(2) Pre-adoptive parents adopting a child, who is under the jurisdiction of a federally recognized Montana tribal court, and the tribe has a Title IV-E agreement with the department, must do so in accordance with the tribe’s established standards for approving adoptive placements. The tribal standards may differ from the pre-placement provisions of 42-3-204, MCA, but they must, at minimum, meet the provisions of SSA Title IV-E, Sec. 471(a)(20)(A). If these federal provisions are not met, the department cannot enter into an adoption assistance agreement.

(3) In addition to pre-adoptive requirements in (1) and (2), the child being adopted must meet the following eligibility requirements:

(a) as required in the Social Security Act, Title IV-E, Sec. 473(a)(1)(A), all adoptions of children consented to by the department, tribal adoptions, and private adoptions are eligible to receive adoption assistance if the department has determined all the following:

(i) the child is a child with special needs; and

(ii) the child meets the adoption assistance eligibility criteria in the Social Security Act, Title IV-E, Sec. 473(2)(A), which specifically require:

(A) that the child was removed from their home as a result of a judicial determination; and

(B) the initial court order sanctioning the child’s removal contains language to the effect that it is contrary to the child’s welfare to remain in their home.

(4) In addition to (3), a child is also eligible for adoption assistance if either of the following criteria are met:

(a) the child meets the eligibility criteria for Social Security Income (SSI); or

(b) the child being adopted received adoption assistance in a previous adoption and continues to be a child with special needs.

(5) At the discretion of the department and based upon the availability of funding, a child, certified as a child with special needs, adopted from the custody of the department may be eligible for adoption assistance without meeting the criteria in (3) or (4).

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-107, MCA
History: NEW, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.210 Review of Subsidy Payment (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-107, 42-10-108, 42-10-109, MCA
History: NEW, Eff. 8/4/73; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659; AMD, 2009 MAR p. 417, Eff. 4/17/09; REP, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.211 Determination Review by Child and Family Services Division Administrator and Fair Hearing Requests

(1) If program staff determine that a child or family is ineligible for adoption assistance or deny a request for adoption assistance, the decision will be sent to the Child and Family Services Division (CFSD) administrator for review.

(2) The CFSD administrator’s review is limited to reviewing whether the program staff’s determination was made in accordance with the pertinent federal and state requirements. The pertinent federal and state requirements will be found in the following documents:

(a) Social Security Act - Title IV-E;

(b) Title 45 of the Code of Federal Regulation;

(d) Title 42, chapter 10, MCA; and

(e) ARM Title 37, chapter 52.

(3) Circumstances that may result in the CFSD administrator overturning the program staff’s determination that the child or family is ineligible for adoption assistance include:

(a) the child and adoptive family meet all requirements necessary to receive an adoption assistance agreement but adoption was finalized in state or tribal court prior to the assistance agreement being signed by the department and the adoptive family;

(b) the denial of adoption assistance was based on a means test of the adoptive family; or

(c) there was an erroneous determination by the department regarding the child’s or adoptive family’s ineligibility for adoption assistance.

(4) After reviewing the specifics of the case and the pertinent federal and state requirements, the CFSD administrator will provide their decision in writing to the program staff.

(a) If the CFSD administrator determines the program staff’s determination to deny adoption assistance was made in error, then the program staff will be instructed to negotiate and enter into an adoption assistance agreement with the family.

(b) If the CFSD administrator concurs with the program staff’s determination that the child or adoptive family were not eligible for adoption assistance, then the adoptive family will be notified in writing of the decision.

(i) The denial notification provided to the family must include the reasons for the denial and that the denial was reviewed and upheld by the CFSD administrator.

(ii) The notice must also describe the adoptive parent’s right to request a fair hearing.

(5) If a post finalization fair hearing determines that a child has been wrongly denied adoption assistance, the department may complete a negotiation with the adoptive family and provide retroactive adoption assistance payments.

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-108, MCA
History: NEW, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.212 Suspension of Adoption Assistance

(1) The department may suspend adoption assistance payments if it cannot establish or cannot contact the adoptive parents to establish that the adoptive parent is:

(a) providing any support to the adopted child;

(b) legally responsible for the support of an adopted child under age 18; or

(2) Adoption assistance payments can only be suspended if the signed adoption assistance agreement contains language outlining the circumstances under which the department may suspend adoption assistance payments.

(3) The department must provide adequate notice to the parent prior to suspending adoption assistance payments. Adequate notice includes:

(a) the department must send via certified mail, notification of intent to suspend adoption assistance payment, at least ten working days before the department intends to suspend payments;

(b) the notice must specify that the agency intends to suspend payments, the reason for the intended suspension, and the statutory basis for the intended suspension;

(c) the notice must provide the specific steps the adoptive family must take to reinstate adoption assistance payments; and

(d) the notice must describe the adoptive parent’s right to request a fair hearing and that payments will continue through the fair hearing process.

(4) Medicaid will not be suspended during the period in which the adoption assistance payment is suspended.

(5) The suspension of the adoption assistance agreement has no impact on the legal relationship between the parent and child.

History

Authorizing statute(s): 42-10-104, MCA
Implementing statute(s): 42-10-108, MCA
History: NEW, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.214 Post Placement (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-304, MCA
Implementing statute(s): 53-4-311, MCA
History: NEW, Eff. 8/4/73; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659; REP, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Mont. Admin. R. 37.52.220 Other Agencies (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-304, MCA
Implementing statute(s): 53-4-304, MCA
History: NEW, Eff. 8/4/73; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 659; REP, 2026 MAR, Notice No. 2025-6, Eff. 1/24/26.

Chapter 37.55 End Stage Renal Disease (esrd)

Subchapter 37.55.1 General Requirements

Mont. Admin. R. 37.55.101 Definitions

(1) "Claimant" means a person applying for assistance from the ESRD.

(2) "End stage renal disease" means severe kidney disease or kidney failure which is irreversible and permanent, and which requires dialysis or kidney transplantation to control uremia and maintain life.

(3) "EOB" means an explanation of benefit form.

(4) "ESRD" means the end-stage renal disease program administered by the department pursuant to chapter 692 of the 1983 session laws.

(5) "Family unit" means the individuals who are dependent upon a common primary source of financial support, including, but not limited to:

(a) the claimant,

(b) the claimant's spouse,

(d) when the claimant is under 18 years of age, the claimant's natural or adoptive parents and the claimant's siblings living with them.

(6) "Third party" means a public or private agency which is or may be liable to pay all or part of the medical costs of a claimant, including, but not limited to, medicare (Title XVIII of the Social Security Act) , medicaid (Title XIX of the Social Security Act) , a county fund for the medically needy, private insurance (including group health, private health, or family health carried by an absent parent, if applicable) , the veteran's administration, CHAMPUS (civilian health and medical program of the uniformed services) , the Indian health service of the U.S. public health service, and the rehabilitative services of the department of public health and human services.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Subchapter 37.55.2 Benefits and Application

Mont. Admin. R. 37.55.201 Application Procedures

(1) A new applicant must:

(a) submit an application to the department in writing on the form and in the manner prescribed by the department together with all income information and documentation supporting eligibility; and

(b) ensure that the application's witness and certification of economic need statements are signed prior to submission of the application.

(2) Application forms may be obtained from the department.

(3) Upon receipt, an application will be reviewed by the department to determine if it is complete. If it is not complete, the department will request the information lacking.

(4) The department will notify a claimant of the approval or denial of his application as soon as possible after the department receives either it or all the information needed to complete it.

(5) The claimant must provide the department with a new written application for the continuation of program benefits at the end of the period during which the claimant is entitled to benefits, as determined in ARM 37.55.202. If the department receives the new application and can verify continued eligibility before the current benefit period expires, benefits shall continue uninterrupted provided funding is available.

(6) Upon being determined eligible, the claimant will receive an ESRD identification card and identification number which may be referred to by vendors in the billing process. In order to be valid, the card must be signed on the reverse side by the claimant and countersigned by a person authorized to sign for the ESRD.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Mont. Admin. R. 37.55.202 Time Period for Benefits

(1) An approved application entitles the claimant to ESRD benefits, to the extent the ESRD appropriation allows, for the following periods:

(a) for July 1 to June 30 of each fiscal year. Benefits shall begin in the month following receipt of and approval of the claimant's application. Retroactive benefits are not available;

(b) if a claimant's application is originally denied, or the claimant's circumstances change in such a way as to impact eligibility during any fiscal year, the claimant may submit a new application and the department will reconsider its eligibility determination.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Mont. Admin. R. 37.55.206 Notice of End of Esrd Benefits

(1) Whenever it appears that the ESRD appropriation for the fiscal year in question will be used up before the end of that fiscal year, the department will provide a news release to each major wire service serving Montana announcing the imminent cessation of benefits and individual notice of the cessation to each person approved for ESRD participation and to each renal dialysis center within Montana.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Subchapter 37.55.3 Eligibility

Mont. Admin. R. 37.55.301 Non-Financial Eligibility Requirements

(1) In order to participate in ESRD, the claimant applying for benefits must:

(a) have medical verification of end-stage renal disease from a licensed physician who is board eligible or certified in nephrology or a related specialty;

(b) be on dialysis or have received a kidney transplant;

(d) participate in medicare part A and part B or have written documentation from the social security administration that the claimant is not eligible for social security benefits

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Mont. Admin. R. 37.55.303 Financial Eligibility Requirements

(1) In order to participate in ESRD, the claimant must take all reasonable steps necessary to apply for and exhaust any and all third party benefits, other than ESRD, to which the claimant is or may be entitled.

(2) If costs of treatment for end stage renal disease remain unpaid after the claimant has exhausted all other third party benefits, ESRD will pay the following benefits, provided funds are available:

(a) for claimants whose family unit's income is 200% of federal poverty level or less, ESRD will pay the claimant's unpaid costs for treatment of end stage renal disease or $1000 per month, whichever is less, except the ESRD will not pay medicaid copayments or medicaid deductibles for the claimant;

(b) for claimants whose family unit's income is between 200% and 300% of federal poverty level, ESRD will prorate the available benefits by determining the percentage of income over 200% of federal poverty level and applying that percentage to the benefit cap of $1000 per month except the ESRD will not pay medicaid copayments or medicaid deductibles for the claimant;

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Subchapter 37.55.5 Services and Supplies

Mont. Admin. R. 37.55.501 Eligible Services and Supplies: General

(1) The department, to the extent of its appropriation for ESRD, will pay for the costs listed in ARM 37.55.502 for approved ESRD-eligible individuals only if each service or supply is directly related to end stage renal disease, medically necessary, ordered by a physician, and provided after the time the individual's application has been approved by the department.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Mont. Admin. R. 37.55.502 Eligible Services and Supplies

(1) ESRD will pay for the cost of each of the following services and supplies which remains after all available third-party benefits have been utilized to pay for them:

(a) For home or center dialysis:

(i) insertion and maintenance of access site;

(ii) physician and hospital service for maintenance of home dialysis;

(iii) the following medications, not exceeding a 30-day supply:

(A) hepatitis vaccine;

(B) gamma globulin;

(D) hyperphosphatemia (phosphate binder) drugs;

(E) hypocalcemia drugs;

(F) vitamins, iron, and/or folic acid;

(G) vitamin D preparations;

(H) hypertensive drugs;

(I) diuretics;

(J) antibiotics for peritonitis associated with peritoneal dialysis.

(b) For home dialysis patients only:

(i) training the patient to implement and maintain home dialysis (excluding room, board, and travel expenses) ;

(ii) modification of existing plumbing and wiring, at the cost represented by the lowest of three bids submitted to the department, or, if three bidding sources are not reasonably available to the patient, the lowest of those bids available;

(iii) for those patients choosing to let a facility provide and maintain dialysis supplies and equipment (medicare method I) , the charge per run by that facility;

(iv) for those patients choosing to obtain and maintain their own home dialysis supplies and equipment (medicare method II) :

(A) rental and/or purchase of dialysis machine and supplies;

(B) repairs to dialysis equipment.

(i) preliminary medical work-up for donor/donee match for a dialysis patient who is otherwise program-eligible;

(ii) in the case of a cadaveric transplant, if ESRD is notified within 72 hours after the patient is admitted to a hospital for the transplant, transportation of the patient to and from the site where the transplant takes place, at the least expensive commercial rate available for the trip on the day of transplant; the above notification must be by the physician or social worker at either the transplant center or the dialysis facility;

(iii) physician and hospital care related to transplant surgery;

(iv) the following medications not exceeding a 30-day supply:

(A) immunosuppressants;

(B) steroids;

(D) diuretics.

(v) medical follow-up services which are directly related to maintenance or monitoring of the transplanted kidney.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Mont. Admin. R. 37.55.505 Non-Eligible Services

(1) The cost of the following services and supplies is not eligible for payment from ESRD:

(a) attendant or back-up person;

(b) drugs not specifically listed in ARM 37.55.502 as eligible medications;

(d) out-of-state dialysis care unless the care is directly related to a kidney transplant or a medical referral has been made by the patient's managing Montana nephrologist;

(e) any transportation for living related donor;

(f) services provided which are not related to kidney condition, e.g., epistaxis, otitis media, diabetes, eye examinations, and heart evaluations;

(g) medicare premiums;

(h) hospital in-patient care of over 60 days unless specifically justified as ESRD-related (e.g., not due to chronic debilitating disease other than renal disease) ;

(i) access-site surgery prior to initiation of dialysis treatments; and

(j) medicaid copayments or medicaid deductibles.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Subchapter 37.55.7 Claims Procedures and Payments

Mont. Admin. R. 37.55.701 Documentation of Claims

(1) A claim for ESRD reimbursement, in order to be reimbursable, must contain, or be accompanied by, the documentation required by this rule.

(2) Each claim for any reimbursable service or supply must contain:

(a) the patient's name and address; and

(b) the provider's federal tax identification number.

(3) A physician service claim must be:

(a) submitted and itemized on a completed universal health insurance claim form approved by the American medical association's council on medical services; and

(b) have a completed medicare EOB and an EOB from any private insurance which the patient might have which covers the service in question attached.

(4) A hospital service claim (inpatient or outpatient) must be:

(a) submitted on the universal hospital insurance form approved by the health insurance association of America and accepted for hospital use by the American hospital association; and

(b) have an itemized statement, medicare EOB, and an EOB from any private insurance which the patient might have which covers the service in question attached.

(5) A claim for dialysis supplies must have an itemized statement from the supplier, proper invoice numbers, medicare EOB's and the EOB's from any private insurance which the patient might have which covers purchase of the supplies in question attached.

(6) A drug/pharmacy claim must be submitted on the medicaid MA-5 form or, in the case of a hospital pharmacy, the MA-5 form or the appropriate medicare form.

(7) A claim for any ESRD-eligible service or supply other than one of those listed in (2) through (5) above must be submitted with an itemized statement or bill, plus a medicare EOB.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Mont. Admin. R. 37.55.702 Conditions of Claim Payment

(1) Payment of a claim will be made only when the amount payable by ESRD exceeds $20.

(2) Payment will be made, subject to (5) below, directly to the provider for that portion of the cost of eligible services or supplies which does not exceed either the amount allowed by medicare for the particular service or supply or the actual costs, whichever is less.

(3) Payment will be made only after all other reasonably available sources of payment, such as medicare or private insurance, have either paid in part or denied payment for the services or supplies.

(4) Payments for drugs will be made, subject to (5) below, only to the extent that the charges do not exceed the average wholesale price specified in the drug topics redbook for the specific drug. The department hereby adopts and incorporates by reference the most current version of the "Annual Pharmacists' Reference", referred to as the drug topics redbook which contains the average wholesale prices for most commercially available drugs. A copy of the drug topics redbook may be obtained from Drug Oradell, New York 07649. The average wholesale price for drugs used to treat end stage renal disease may be obtained from the Department of Public Health and Human Services, Health Policy and Services Division, ESRD Program, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(5) Benefit payments may not exceed $1000 per month per eligible claimant.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; AMD, 1991 MAR p. 1004, Eff. 6/28/91; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Mont. Admin. R. 37.55.705 Priority of Payment

(1) To the extent of the ESRD appropriation for a given fiscal year, bills received by the department during that fiscal year will be paid according to the date ESRD receives them, the first bills received being the first paid.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.

Subchapter 37.55.10 Hearing and Appeal Procedures

Mont. Admin. R. 37.55.1001 Right to Reconsideration of Adverse End Stage Renal Disease Program Decision

(1) Any claimant who is aggrieved by an adverse department end stage renal disease (ESRD) action on an application may, upon request, have an informal reconsideration in accordance with the procedures prescribed for informal reconsiderations in ARM 37.5.311. The informal reconsideration is not subject to the contested case provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA or, except as provided in this rule, the provisions of 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA
Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA
History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 2000 MAR p. 1653, Eff. 6/30/00; TRANS & AMD, from DHES 2000 MAR p. 1660, Eff 6/30/00.

Chapter 37.57 Maternal and Child Health

Subchapter 37.57.1 Handicapped Children's Services Program

Mont. Admin. R. 37.57.101 Purpose of Rules

(1) The purpose of the children's special health services program rules is to provide treatment and enabling services for children and youth with special health care needs.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; TRANS, from DHES, 2001 MAR p. 398; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.102 Definitions

Unless otherwise indicated, the following definitions apply throughout this subchapter:

(1) "Applicant" means a child or youth with special health care needs (CYSHCN) who has applied or whose parent or guardian has applied on the child's behalf to receive children's special health service (CSHS) financial assistance from the department.

(2) "Child or Youth with Special Health Care Needs" (CYSHCN) means a child or youth, under the age of 22, who has or is at increased risk for chronic physical, developmental, behavioral, or emotional condition and who also requires health and related services of a type or amount beyond that required by children generally.

(3) "Client" means a CYSHCN who is eligible to receive CSHS financial assistance as determined by the department under this subchapter.

(4) "CSHS" means the children's special health services program of the department, authorized by 50-1-202, MCA, that serves children and youth with special health care needs.

(5) "Department" means the Montana Department of Public Health and Human Services.

(6) "Disability" or "disabling condition" means a chronic physical, developmental, behavioral or emotional condition requiring health and related services of a type or amount beyond that required by children generally.

(7) "Disabled" means having any physical defect or characteristic, congenital or acquired, that prevents or restricts normal growth or capacity for activity.

(8) "Eligibility year" means the federal fiscal year in which a CYSHCN receives CSHS direct payment financial assistance.

(9) "Enabling services" means nonclinical services that enable individuals to access health care and improve health outcomes. Enabling services include, but are not limited to: case management, care coordination, referrals, home visiting, respite care, specialized daycare or preschool, translation/interpretation, transportation, eligibility assistance, health education for individuals or families, and outreach.

(10) "Family" means a group of related or non-related individuals who are living together as a single economic unit.

(11) "Federal fiscal year" means the period beginning October 1 and ending the following September 30.

(12) "Financial Assistance" means payment by the department for CSHS-authorized treatment and enabling services for a CYSHCN eligible for the CSHS program.

(13) "HMK" means Healthy Montana Kids (Children's Health Insurance Program or CHIP) insurance plan administered by the department.

(14) "HMK Plus" means Healthy Montana Kids Plus (children's Medicaid) plan administered by the department.

(15) "Initial diagnosis and evaluation" means taking a medical history and performing a physical examination, medical procedures, laboratory tests, hearing and other diagnostic tests, or other procedures necessary for the diagnosis of a condition.

(16) "Poverty income guidelines" means the poverty income guidelines published in 2018 in the Federal Register by the U.S. Department of Health and Human Services. The department adopts and incorporates by reference the federal poverty guidelines that establish income thresholds according to family unit size for purposes of determining eligibility for government assistance or services and that are published in the January 2018, Federal Register. A copy of the 2018 poverty guidelines may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Children's Special Health Services Program, 1400 Broadway, Rm A-116, Helena, MT 59620, telephone (406) 444-3617.

(17) "Program" means the department's children's special health services program for a CYSHCN, authorized by 50-1-202, MCA.

(18) "Provider" means a supplier of medical care or services, enabling services, interventions, medical appliances, prescribed medications, formula or foods, and consultations.

(19) "Risk category" means any condition of a child or youth's life which qualifies them as being at an increased risk for chronic physical, development, behavioral, or emotional condition, further qualifying them as a CYSHCN. This may include but is not limited to: living in poverty, in the foster care or Child Protective Services system, having a parent with a disabling condition, multiple adverse childhood experiences, or homelessness.

(20) "Services" means enabling or treatment services covered by the rule.

(21) "Special Health Care Need" means a chronic condition that requires

health and related services of a type or amount beyond that generally required by children.

(22) "Third-party payer" means a public or private entity that is or may be liable to pay all or part of the medical costs for a client.

(23) "Treatment" means medical, corrective, and/or surgical intervention to alleviate a disabling condition or as recommended by a provider based on a CYSHCN's risk category, including for initial testing and diagnosis. This includes medications and medical equipment.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; AMD, 2013 MAR p. 1449, Eff. 8/9/13; AMD, 2014 MAR p. 977, Eff. 5/9/14; AMD, 2015 MAR p. 2148, Eff. 12/11/15; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.105 General Requirements for Cshs Financial Assistance

(1) In order to receive CSHS financial assistance for a particular benefit a CYSHCN must meet the eligibility requirements of ARM 37.57.106.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.106 Eligibility for Cshs Financial Assistance

(1) Eligibility criteria for CSHS financial assistance are:

(a) an individual under the age of 22 who meets the definition of a child or youth with special health care needs (CYSHCN);

(b) a resident of the state of Montana and either a U.S. citizen or a qualified alien as defined under federal statute; and

(c) in need of a treatment or enabling services related to their disabling condition or risk category, which is recommended by a medical professional, where an out-of-pocket expense would be the responsibility of the family and no other means of payment is available to cover the out-of-pocket expenses.

(2) Family income must be verified to determine eligibility. CSHS will request documentation of income from the applicant.

(a) Family income may include one or more of the following:

(i) the income of both parents if the child resides with both parents;

(ii) the income of the parent with whom the child resides the majority of the year, including any child support received for the child, if the child resides with one parent in a single parent household;

(iii) if the parent with whom the child resides the majority of the year has remarried, the stepparent's income is imputed to the parent's income with whom the child resides the majority of the year; and

(iv) the income of individuals under the age of 19 who live in the home but do not attend school is imputed to the parent with whom the child resides the majority of the year.

(b) Family income does not include:

(i) money received from assets drawn down such as withdrawals from a savings account, an annuity, or for the sale of a house or car;

(ii) gifts, loans, one-time insurance payments, or lump sum compensation for an injury;

(iii) the first $2,000 of an enrolled tribal member's per capita payment; or

(iv) the first $2,000 of an enrolled tribal member's tribal land income.

(i) $1,440 per year for each family member whose earned income is counted;

(ii) $2,400 per year, regardless of the actual expense amount, for each individual for whom dependent care is paid out-of-pocket and the care is provided so a parent can work, look for work, or attend school; and

(iii) out-of-pocket expenses for health insurance premiums.

(d) A family whose income, less any out-of-pocket expenses for health insurance premiums, care expenses for children, disabled or elderly adults while adults are working, and earned income disregards is at or less than 300% of the federal poverty income guidelines and one of the following:

(i) ineligible for HMK Plus or HMK;

(ii) eligible for HMK Plus or HMK, but in need of services or financial assistance that are not covered by HMK Plus or HMK, or determined inaccessible but are covered by CSHS; or

(iii) potentially eligible for HMK Plus or HMK from information provided on the application, the family will be referred to the county office of public assistance for HMK Plus or HMK eligibility determination.

(3) Eligibility for program financial assistance will be determined within 30 days of receipt of the application by the department.

(4) Eligibility begins on the date an application is received by CSHS and continues for the duration of the federal fiscal year in which the application is received unless the age of the CYSHCN precludes them from participation or the CYSHCN no longer resides in Montana. Services provided up to six months prior to the date of eligibility are reimbursable by CSHS.

(5) A new or renewal application for a subsequent year must be submitted to the department in order for the department to determine if eligibility is to continue and must be completed and approved before any CSHS financial assistance in a subsequent year may be provided.

(6) A CYSHCN attending an interdisciplinary team pediatric specialty clinic funded by CSHS does not need to apply for financial assistance to cover the cost of clinic visits.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1991 MAR p. 1723, Eff. 9/13/91; AMD, 1992 MAR p. 919, Eff. 5/1/92; AMD, 1993 MAR p. 1933, Eff. 8/13/93; AMD, 1994 MAR p. 1836, Eff. 7/8/94; AMD, 1995 MAR p. 1804, Eff. 9/15/95; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; AMD, 2013 MAR p. 1449, Eff. 8/9/13; AMD, 2015 MAR p. 2148, Eff. 12/11/15; AMD, 2018 MAR p. 847, Eff. 4/28/18; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.109 Application Procedure for Cshs Financial Assistance

(1) A person who desires CSHS financial assistance for a CYSHCN must submit a completed CSHS financial assistance application, along with required supporting documents. This application is available by contacting CSHS at 1-800-762-9891 or visiting www.cshs.mt.gov .

(2) If the department notifies the applicant that the application is incomplete, the requested missing information must be received by CSHS within six weeks from the date of notification; otherwise the application will be considered inactive. If the requested information is subsequently received and the CYSHCN is found to be eligible, the eligibility year will begin on the date the additional requested information is received.

(3) If the CYSHCN is determined ineligible, the department will send the applicant a written notice stating the reasons for ineligibility and explaining how an informal reconsideration of its determination may be obtained pursuant to ARM 37.57.112.

(4) When the CYSHCN is determined eligible, the department will send the applicant a written notice specifying which services are eligible for CSHS financial assistance and the term of eligibility.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; AMD, 2000 MAR p. 1653, Eff. 6/30/00; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.110 Conditions and Services for Cshs Financial Assistance

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; AMD, 1994 MAR p. 1836, Eff. 7/8/94; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; REP, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.111 Payment Limits and Requirements

(1) The department will provide financial assistance for a CSHS-eligible CYSHCN with a covered condition:

(a) if the benefit is not covered by another payment source, with the exception of the Indian health service (IHS), which is a payer of last resort;

(b) if the department has sufficient federal funds to provide the benefit;

(d) for a CYSHCN under age three, CSHS will pay after the early intervention program, part C, of the disabilities services division; and

(e) after all third parties, if any, have paid the provider, in which case the department pays any balance remaining for services to the lower of the health care coverage allowed amount or the CSHS allowed amount for the services in question.

(2) When possible, CSHS will pay providers directly for CSHS-eligible services and will not reimburse clients. Clients may be reimbursed if the services were rendered prior to eligibility and proper documentation is provided as requested by CSHS.

(3) The department will pay eligible providers after the department receives a signed authorization, claim form, or invoice, and requested documentation that the care has been provided.

(4) Any individual who erroneously or improperly receives payment from the department must promptly refund that payment to the department.

(5) A provider who accepts the CSHS level of payment for covered services may not seek additional payment from a CSHS client or their family.

(6) The department will pay up to the following limits for orthodontia care:

(a) Orthodontia may only be covered for CYSHCN who have a medical condition with orthodontic implications. This may include but is not limited to: cleft/craniofacial anomalies, facial deformities, speech impediments, Treacher-Collins Syndrome, Marfan Syndrome, or Craniosynostosis.

(7) For services to a CSHS client, a provider will be paid 85% of the actual submitted charge. If the CSHS client has third-party coverage, the department will pay the remaining balance for services to the lower of the health care coverage allowed amount or the CSHS allowed amount of the approved services.

(8) In addition to the above, the department will pay:

(a) the lesser of either the actual charge for drugs and other prescribed supplies, or the wholesale price cited, less 15%, plus a dispensing fee on the Medicaid point-of-sale system;

(b) 85% of the cost of durable medical equipment to the appropriate amount when allowing financial assistance, or to the maximum amount set by the program for the federal fiscal year;

(c) 85% of the cost of specialized formula and foods and prescriptive or nonprescriptive medications prescribed by a physician for inborn errors of metabolism; and

(d) 85% of the cost of syringes and disposable medical equipment for the treatment of covered conditions.

(9) A CYSHCN who attends interdisciplinary pediatric specialty clinics, supported by CSHS, is not responsible for copays, deductibles, or coinsurance, nor will they be balance-billed.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; AMD, 1994 MAR p. 1836, Eff. 7/8/94; AMD, 1999 MAR p. 2879, Eff. 12/17/99; TRANS, from DHES, 2001 MAR, p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; AMD, 2013 MAR p. 1449, Eff. 8/9/13; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.112 Informal Reconsideration Procedure

(1) A CYSHCN who has been denied eligibility for CSHS, a provider who has been denied reimbursement for services or covered benefits, or anyone who is otherwise adversely affected by denial for CSHS financial assistance may have informal reconsideration. The party requesting such a reconsideration must do so within 60 days after notice of the adverse action in question has been placed in the mail or otherwise communicated to the aggrieved party.

(2) A request for a reconsideration, in order to be considered, must be in writing, include refutation of the department's findings, and be postmarked no later than the 60th day after notice of the adverse action referred to in (1) was given.

(3) If the department receives a request for an informal reconsideration, it will conduct the reconsideration within 30 days after the date the request is received unless both the requestor and the department agree to a later date.

(4) An informal reconsideration will be conducted in accordance with the procedures prescribed for informal reconsideration in ARM 37.5.311, with the exceptions noted in (1) and (5). Such informal reconsideration is not subject to the provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA, or, except as provided in this rule, the provisions of ARM 37.5.304, 37.5.307, 37.5.310, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

(5) In addition to the procedures specified in ARM 37.5.311, an applicant shall be provided an opportunity to appear and present evidence and arguments in person.

(6) The decision by the department after an informal reconsideration is final.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; AMD, 2000 MAR p. 1653, Eff. 6/30/00; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.117 Cshs Providers Receiving Cshs Funds: Requirements

(1) In order to be a CSHS provider for a CSHS client, a provider must meet the following requirements:

(a) A physician or surgeon must:

(i) be currently licensed by the state of Montana pursuant to Title 37, chapter 3, MCA, or currently licensed to practice medicine in the state in which they reside;

(ii) provide the department, upon request, with adequate documentation of credentials needed to prove program eligibility.

(b) An orthodontist must:

(i) be currently licensed as a dentist in the state of Montana or the state of residence;

(ii) have completed two years of graduate or post-graduate orthodontic training recognized by the council of dental education of the American dental association or the American orthodontic association; and

(iii) limit their practice to the area of orthodontics.

(i) be currently licensed as a dentist by the state of Montana or the state of residence; and

(ii) have completed a minimum of two academic years of a graduate or post-graduate pediatric dentistry program accredited by the council on dental accreditation of the American dental association.

(d) A hospital must be accredited by the joint commission of accreditation of healthcare organizations and be currently licensed and certified by the department, if in-state, or by the state in which it is located, if out-of-state.

(e) Any provider other than those listed in (1)(a) through (1)(d) must be certified and/or licensed by the appropriate Montana authority, or if Montana has no certification or licensure requirements for the provider, be certified by a nationally recognized professional organization in the provider's area of expertise.

(2) A provider must immediately supply the department with requested reports to permit effective evaluation of claims.

(3) A provider must accept CSHS level of payment for services and may not seek additional payment from a CSHS client or family.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; AMD, 2018 MAR p. 1733, Eff. 8/25/18.

Mont. Admin. R. 37.57.118 Program Records

(1) The department will retain specialty clinic participants case files of CSHS services provided for a client for a period of five years after the child reaches the age of 18 as set forth in the Montana Secretary of State records retention schedule, records series title "Specialty Clinic Participant Case Files."

(2) Prior to destroying specialty clinic participant case files, the department will advertise that the case files may be obtained by those to whom they pertain by publishing a notice in Montana's major newspapers once per week for three consecutive weeks.

(3) Case files remaining unclaimed for three months after the public notice described in (2) is completed will be destroyed after the department receives the approval of the state records committee required by 2-6-212, MCA.

(4) The department will retain CSHS financial assistance case files for five years from the last service date, as set forth in the Montana Secretary of State records retention schedule, records series title "Financial Assistance Case Files."

(5) The financial assistance case files will be destroyed after the program receives approval from the state records committee required under 2-6-212, MCA.

(6) The department will retain CSHS clinic billing files for five calendar years as set forth in the Montana Secretary of State records retention schedule, record series title "Clinic Billing Reimbursement Records."

(7) Clinic billing files will be destroyed after the program receives approval from the state records committee required under 2-6-212, MCA.

(8) The department will retain all electronic data as set forth in the Montana Secretary of State records retention schedule, records series title "CHRIS Files."

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; AMD, 2013 MAR p. 1449, Eff. 8/9/13.

Mont. Admin. R. 37.57.125 Advisory Committee

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202, MCA
History: NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; AMD, 1994 MAR p. 1836, Eff. 7/8/94; TRANS, from DHES, 2001 MAR p. 398; REP, 2003 MAR p. 1637, Eff. 8/1/03.

Subchapter 37.57.3 Infant Screening Tests and Eye Treatment

Mont. Admin. R. 37.57.301 Definitions

As used in this subchapter, the following definitions apply:

(1) "Health care facility" means a hospital or other facility licensed by or located in the state of Montana for the purpose of providing health care services, and which provides primary health care services for newborns at birth.

(2) "Newborn" means an infant in the first 28 days of life.

(3) "Newborn screening tests" are screening tests, procedures, or both for the following conditions:

(a) Acylcarnitine Disorders:

(i) Fatty Acid Oxidation Disorders:

(A) Carnitine uptake defect;

(B) Long-chain L-3-OH acyl-CoA dehydrogenase deficiency;

(D) Trifunctional protein deficiency; and

(E) Very long-chain acyl-CoA dehydrogenase deficiency;

(ii) Organic Acidemia Disorders:

(A) 3-hydroxy-3-methylglutaryl-CoA lyase deficiency;

(B) 3-Methylcrotonyl-CoA carboxylase deficiency;

(D) Glutaric acidemia type I;

(E) Isovaleric acidemia;

(F) Methylmalonic acidemia (Cbl A,B);

(G) Methylmalonic acidemia (mutase deficiency);

(H) Multiple carboxylase deficiency; and

(I) Propionic acidemia;

(b) Amino Acid Disorders:

(i) Argininosuccinic acidemia;

(ii) Citrullinemia type 1;

(iii) Homocystinuria;

(iv) Maple syrup urine disease;

(v) Classic Phenylketonuria; and

(vi) Tyrosinemia type I;

(d) Classical galactosemia;

(e) Congenital adrenal hyperplasia;

(f) Primary congenital hypothyroidism;

(g) Cystic fibrosis;

(h) Hemoglobinopathies, including:

(i) Hb S/β -thalassemia;

(ii) Hb SC disease; and

(iii) Hb SS disease; and

(i) Critical congenital heart disease, including:

(i) hypoplastic left heart syndrome;

(ii) pulmonary atresia;

(iii) tetralogy of Fallot;

(iv) total anomalous pulmonary venous return;

(v) transposition of the great arteries;

(vi) tricuspid atresia;

(vii) truncus arteriosus;

(j) Severe combined immunodeficiency disease;

(k) Spinal muscular atrophy (SMA);

(l) X-linked adrenoleukodystrophy (X-ALD); and

(m) Pompe disease.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1298, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14; AMD, 2015 MAR p. 828, Eff. 7/1/15; AMD, 2021 MAR p. 184, Eff. 3/1/21; AMD, 2024 MAR p. 2025, Eff. 9/1/24; AMD, 2026 MAR, Notice No. 2025-156, Eff. 2/1/26.

Mont. Admin. R. 37.57.304 Newborns Hospitalized for Neonatal Intensive Care

(1) If a newborn is hospitalized for neonatal intensive care, a specimen of its blood must be taken for testing prior to nonrespiratory treatment and no later than 48 hours of age, unless medically contraindicated, in which case the specimen must be taken as soon as the infant's medical condition permits.

(2) In the event that the initial screening blood specimen is taken at less than 24 hours of age, another screening specimen must be taken after 48 hours of age, and no later than 7 days of age.

(3) In the event that the newborn stays in a health care facility past 7 days of age, an additional screening blood specimen must be taken either at the time of discharge if the stay is less than one month, or at one month of age if the stay is one month or longer.

(4) Hospitals providing neonatal intensive care are responsible for developing and implementing a protocol to ensure a newborn hospitalized for neonatal intensive care receives screening for critical congenital heart disease.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1298, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.305 Newborns Other Than Those Hospitalized for Neonatal Intensive Care

(1) For newborns not requiring neonatal intensive care, the required blood specimen must be taken between 24 and 48 hours of age.

(2) In the event the newborn is discharged from a health care facility prior to 24 hours of age, the blood specimen must be taken immediately before discharge and, in addition:

(a) another specimen must be taken and submitted to the department's laboratory between the second and seventh day of the newborn's life; and

(b) the health care facility must:

(i) explain the reasons why it is of utmost importance to return for these tests; and

(ii) ensure that the parent or legal guardian of the newborn signs a statement assuming responsibility to cause a specimen to again be taken between the second and seventh day of life of the newborn and to submit it to the department for testing.

(3) For newborns not requiring neonatal intensive care, a pulse oximetry screening for CCHD must be completed per the department's recommended protocol prior to discharge and after 24 hours of age and screening results reported to the department as required by this subchapter.

(4) In the event the newborn is discharged from a health care facility prior to 24 hours of age, pulse oximetry screening must be completed immediately before discharge and the health care facility must:

(a) provide education to the newborn's family on the implications of screening prior to 24 hours of age;

(b) provide information on the optimal timing of a repeat screening and a location where repeat screening can be done; and

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1537, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.306 Transfer of Newborn Infant

(1) In the event of transfer of a newborn from one health care facility to another, or from a place of birth that is not a health care facility to a health care facility, a screening blood specimen must be taken and submitted by the receiving health care facility.

(2) A receiving health care facility must take specimens as necessary for follow-up tests as required by this subchapter.

(3) In the event of a transfer of a newborn from one health care facility to another, or from a place of birth that is not a health care facility to a health care facility, pulse oximetry screening for CCHD must be completed after 24 hours of age by the receiving health care facility and screening results reported to the department as required by this subchapter.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1298, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.307 Infant Born Outside Health Care Facility

(1) When an infant is born outside of a health care facility and is not subsequently transferred to a health care facility for initial newborn care, it is the responsibility of one of the persons designated in 50-15-221(4)(a), (b), and (c), MCA, in the order of priority indicated therein, to cause the blood specimen to be taken and submitted, and to cause pulse oximetry screening to be performed as required by this subchapter.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1298, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.308 Newborn Eye Treatment

(1) A physician, nurse-midwife, or any other person who assists at the birth of any newborn must, within the time limit stated in (3), instill or have instilled into each conjunctival sac of the newborn, erythromycin (0.5%) ophthalmic ointment or drops from single-use tubes or ampules.

(2) A prophylactic agent referred to in (1) above may not be flushed from a newborn's eyes after instillation.

(3) The prophylactic agent must be administered to a newborn within one hour after its birth unless it is physically impossible to obtain the agent within that time, in which case the agent must be administered as soon as possible.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2001 MAR p. 398; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.315 Transfusion: When Blood Specimen Taken

(1) If a newborn needs a transfusion, blood specimens for the tests required by this subchapter must be taken before the transfusion takes place unless medically contraindicated.

(2) If the newborn is transfused prior to collection of the initial newborn screening specimen, a screening specimen must be taken 90 to 120 days after the last transfusion to screen for classical galactosemia and hemoglobinopathies. This specimen is in addition to those required elsewhere in this chapter.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: NEW, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1298, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.316 Reporting Screening Results

(1) If screening results on an infant's blood specimen are within the expected or normal range the department will report the results to the submitter of the specimen and, in addition, to the infant's healthcare provider(s) upon request.

(2) If the infant's blood specimen is of unsatisfactory quality for testing, the department will notify the submitter of the need for collection of an additional specimen. The submitter must ensure collection of this specimen in a timely manner within three days of notification.

(3) If screening results on an infant's blood specimen are outside the expected or normal range:

(a) the department will report results to the submitter of the specimen and to the healthcare provider(s) for the infant. Recommendations for follow-up actions contained in the report are determined by the department;

(b) the provider(s) will ensure that all repeat screening, confirmatory testing, or both, as recommended, is collected and submitted to the department or an approved laboratory within 48 hours or as clinically appropriate;

(c) if a referral to a contracted specialist is made by the department, the specialist will ensure that all confirmatory testing results and final diagnosis are reported to the department within one week of the determination of the final diagnosis.

(4) An approved laboratory for confirmatory testing following out-of-range blood screening results includes any state or territorial health department laboratory and any laboratory within their jurisdictions which is approved by them, a U.S. public health service laboratory, a laboratory operated by the U.S. Armed Forces or Veteran's Administration, a Canadian provincial public health laboratory, and any laboratory licensed under the provisions of the Clinical Laboratories Improvement Act of 1967, as amended.

(5) Each person in charge of any health care facility and each person responsible under ARM 37.57.307 for a birth occurring outside a health care facility must report to the department regarding pulse oximetry screening per department guidelines.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1298, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.320 Responsibilities of Registrar of Birth: Administrator of Health Care Facility

(1) Each person in charge of any health care facility and each person responsible under ARM 37.57.307 for a birth occurring outside a health care facility must:

(a) ensure that a blood specimen is taken from each newborn for which the health care facility or person is responsible, in conformity with this subchapter, for the purpose of performing newborn screening tests;

(b) be certain that the specimen to be forwarded to the laboratory is adequate for testing purposes;

(c) within 24 hours after the taking of the specimen, cause such specimen to be forwarded to the department's laboratory by either courier or first-class mail or its equivalent;

(d) record in the newborn's medical record the date of taking of the test specimen and the results of the tests performed when reported by the department;

(e) ensure that pulse oximetry is performed per the department's recommended protocol for the purpose of performing newborn screening for CCHD as follows:

(i) ensure that the screening is performed on equipment that has been approved by the FDA for use on newborns and is motion tolerant;

(ii) ensure that screening is performed by licensed staff who have been trained on the screening procedure and protocol;

(iii) record in the newborn's medical record the date, time, and screening results;

(iv) ensure that the pulse oximetry screening results are reported to DPHHS as required by this subchapter;

(v) ensure that a policy and procedure is in place for immediate follow-up of a failed CCHD screen; and

(f) use educational materials provided by the department and must provide education to the newborn's family on the following:

(i) the conditions that may be detected through bloodspot screening and pulse oximetry screening;

(ii) the importance of newborn screening tests to detect potentially life- threatening conditions;

(iii) the process for collecting bloodspot screening and conducting pulse oximetry screening; and

(iv) after hearing all the benefits of newborn screening and the risks involved in refusing testing, a parent/legal guardian may refuse either of the above screenings. In that case, the parent/legal guardian must sign a waiver for the newborn's medical record in which they accept responsibility for adverse consequences. A copy of this waiver must be provided to the department.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Mont. Admin. R. 37.57.321 State Laboratory

(1) Only those newborn screening blood tests performed by the department laboratory or a laboratory approved by the department meet the requirements of 50-19-201, 50-19-202, 50-19-203, and 50-19-204, MCA.

(2) Dried blood specimens remaining after newborn screening test completion are the property of the department laboratory and will be stored for one calendar year prior to destruction. Any dried blood specimens sent to a laboratory approved by the department for testing will be destroyed after one year by the approved laboratory. An exception is made for screening specimens with results that are out of range which may be kept for quality improvement and new method development within the laboratory. These specimens may be stored by the laboratory for an indefinite period of time.

History

Authorizing statute(s): 50-19-202, MCA
Implementing statute(s): 50-19-203, MCA
History: Eff. 12/31/72; AMD, Eff. 5/6/74; AMD, 1985 MAR p. 1612, Eff. 11/1/85; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1298, Eff. 7/1/03; AMD, 2008 MAR p. 44, Eff. 1/18/08; AMD, 2014 MAR p. 1411, Eff. 7/1/14.

Subchapter 37.57.4 Newborn Hearing Screening and Assessment

Mont. Admin. R. 37.57.401 Definitions

(1) "Health care provider" means a person licensed in the state of Montana to provide health care services to pregnant women and/or newborn infants and who is the primary health care provider in attendance at the birth of a newborn infant born outside of a hospital or health care facility. The term includes direct-entry midwives.

(2) "Hospital or health care facility that provides obstetric services" means any hospital or health care facility licensed by or operating in the state of Montana that routinely provides or holds itself out as providing obstetric services, without regard for the number of births actually occurring in that hospital or health care facility on an annual basis.

(3) "Newborn" means any infant from birth through 28 days of age.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-402, 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Mont. Admin. R. 37.57.403 Newborn Hearing Screening Education

(1) Each licensed hospital and health care facility shall provide education to the parents of any newborn born in the hospital or health care facility or transferred to the hospital or health care facility from the newborn's place of birth, unless the newborn has previously been provided a hearing screening test by a hospital or health care facility from which the newborn was transferred, on:

(a) hearing loss;

(b) the importance of early hearing screening; and

(2) Each licensed health care provider in attendance at any birth outside of a hospital or health care facility shall provide education to the newborn's parents on:

(a) hearing loss;

(b) the importance of early hearing screening; and

(3) Each hospital, health care facility, and health care provider required to provide newborn hearing screening education shall comply with education protocols developed by the department and shall use educational materials provided by the department. Protocols and educational materials may be obtained from the Department of Public Health and Human Services, Newborn Screening Program, Children's Special Health Services Section, Family and Community Health Bureau, P.O. Box 202951, Helena, Montana 59620-2951.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Mont. Admin. R. 37.57.406 Newborn Hearing Screening - Referrals for Newborns Born Outside of Hospitals or Health Care Facilities

(1) Each health care provider who is required to provide newborn hearing screening education shall also provide referral information to the parents of any newborn who was born outside of a hospital or health care facility. The referral information shall identify the hospitals, health care facilities, and other health care providers in the region that are able to provide hearing screenings for newborns.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Mont. Admin. R. 37.57.407 Newborn Hearing Screening Protocols - Hospitals and Health Care Facilities

(1) Each licensed hospital or health care facility that provides obstetric services shall establish a newborn hearing screening program in order to ensure that a hearing screening is provided for each newborn born in the hospital or health care facility or transferred to the hospital or health care facility from the newborn's place of birth, unless the newborn was previously provided a hearing test by a hospital or health care facility from which the newborn was transferred.

(a) An initial hearing screening must be performed prior to the infant's discharge from the hospital or health care facility.

(b) If the results of the initial hearing screening were inconclusive or indicated a possible hearing loss, a second screening must be performed prior to the newborn's discharge from the hospital or health care facility, if possible. If a second hearing screening cannot be performed prior to the infant's discharge from the hospital, the hospital or health care facility must, prior to the discharge, work with the newborn's parents to schedule a second hearing screening for the newborn. The second screening shall be scheduled at the hospital or health care facility from which the newborn is being discharged. It shall be scheduled to occur within 30 days of the newborn's birth.

(2) Each hospital or health care facility shall use equipment designed to perform hearing screenings that utilizes either otoacoustic emissions (OAE) or auditory brainstem response (ABR) technology. Hearing screening equipment shall be maintained, calibrated, and used in strict conformance with manufacturers' guidelines.

(3) Newborn hearing screening shall be performed by staff members who are properly trained to conduct and interpret the tests and shall be performed in strict conformity with the testing protocols set by the equipment manufacturer.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-402, 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Mont. Admin. R. 37.57.410 Reporting Newborn Hearing Screening Results - Parents - Primary Care Providers

(1) The hospital or health care facility shall document all hearing screening results in the newborn's chart and shall provide the hearing screening results to the parents of the newborn on the newborn's Report Card form. If the newborn hearing screening indicates a possible hearing loss, the written notification of results to the newborn's parents must include a recommendation for an audiological assessment.

(2) The hospital or health care facility shall also provide the newborn's primary care provider with written notification of the results of the newborn hearing screening. If the newborn hearing screening indicates a possible hearing loss, the written notification of results sent to the newborn's primary care provider must include a recommendation for an audiological assessment.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Mont. Admin. R. 37.57.413 Reporting to the Department Regarding Newborn Hearing Screening and Education

(1) Each hospital and health care facility required to provide newborn hearing screenings must make a report to the department each month using the department's designated reporting software regarding newborn hearing screenings.

(2) Each hospital and health care facility shall enter the following information by the 15th day of each month for each newborn born in or transferred to the hospital or health care facility during the preceding month:

(a) the newborn's full name, date of birth, gender, mother's maiden name, and the location of the newborn's birth;

(b) that the education protocol and educational materials developed by the department on newborn hearing screening were provided to the parents of the newborn;

(c) whether the facility did or did not provide a complete hearing screening to the newborn as required in ARM 37.57.407;

(d) for any newborns not fully screened, a statement of any reason(s) the newborn has not been not fully screened;

(e) if the newborn was provided an initial screening prior to discharge, and the results of that screening indicated possible hearing loss, the date scheduled for the follow-up hearing screening;

(f) all of the newborn's hearing screening results; and

(g) contact information for the newborn's primary care provider if the initial or follow-up hearing screening(s) indicated possible hearing loss.

(3) If a newborn was discharged from a hospital or health care facility after an initial screening that indicated a possible hearing loss, the hospital or health care facility shall file an updated screening report regarding the newborn's hearing screening status by the 15th day of the month immediately following the appointment date set for the second screening.

(4) By the 15th day of each month, each hospital and health care facility shall provide the department a signed facsimile copy of any completed parent refusal form for each baby born in the previous month who did not receive newborn hearing screening or who did not have complete hearing screening because the parent refused the initial or follow-up screening. The refusal form used by the hospital or health care facility must contain at minimum the content of the "Parental Attestation of Refusal of Newborn Hearing Screening" form distributed as a suggested template by the department.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Mont. Admin. R. 37.57.414 Health Care Providers - Reporting to the Department Regarding Education and Referral Information

(1) Each licensed health care provider in attendance at any birth occurring outside a hospital or health care facility shall file a report with the department that documents:

(a) the newborn's full name, date of birth, gender, mother's maiden name, and the location of the newborn's birth;

(b) that the education protocol and educational materials developed by the department on newborn hearing screening were provided to the parents of the newborn;

(c) that referral information has been provided to the newborn's parents which identifies the hospitals, health care facilities, and other health care providers in the area that are able to provide hearing screenings for newborns.

(d) that the newborn's primary care provider, if other than the health care provider attending the birth, has been notified that newborn hearing screening has been provided to the newborn's parents.

(2) The report shall be made to the department by the 15th day of each month for the babies delivered in the previous month on a form available from the Department of Public Health and Human Services, Newborn Screening Program, Children's Special Health Services Section, Family and Community Health Bureau.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Mont. Admin. R. 37.57.415 Audiologists - Reporting of Audiological Assessments to Department - Parental Consent for Referral to the Montana School for the Deaf and Blind

(1) Each licensed audiologist to whom an infant is referred for audiological assessment following a newborn hearing screening shall file a report with the department each month regarding the results of the infant's audiological assessment. The report shall be filed using the department's designated reporting software. The audiologist shall enter and report the following information by the 15th day of each month for each infant assessed during the previous month:

(a) the newborn's full name, date of birth, gender, mother's maiden name, and the location of the newborn's birth;

(b) the name and address of the hospital or health care facility in which the baby was born or transferred to or the name and address of the health care provider attending the birth;

(2) Each licensed audiologist to whom an infant is referred for audiological assessment following newborn hearing screening shall request written authorization from the infant's parents for the audiologist to provide the infant's identifying information and test results to the department for subsequent referral for intervention services to the Montana School for the Deaf and Blind.

(a) Authorization shall be obtained on authorization forms approved and provided by the department.

(b) The audiologist shall submit a copy of the signed authorization form to the department by facsimile or as a scanned electronic attachment within three days of the date it is signed.

History

Authorizing statute(s): 53-19-402, MCA
Implementing statute(s): 53-19-404, MCA
History: NEW, 2008 MAR p. 171, Eff. 2/1/08.

Subchapter 37.57.10 Block Grant Funds

Mont. Admin. R. 37.57.1001 Maternal and Child Health Block Grant: Standards for Receipt of Funds

(1) In order for any county or other local entity to receive federal maternal and child health (MCH) block grant funding from the department, that entity must contractually agree to the following:

(a) MCH block grant funds will be used solely for providing health services to mothers and children.

(b) No MCH block grant funds will be used to supplant local funds that would be otherwise available.

(c) MCH block grant funds will be used solely for the core maternal and child health services listed in (2) below, unless the contractor has proved to the department prior to entering into the contract that all core services have already been provided for or, through a formal needs assessment process meeting the requirements of (3) below, that the contractor has shown there is no need for the particular core service not being provided. If there is such an exception made to provision of all of the core services, the exception must be specifically set out in the contract.

(d) For every $4 of MCH block grant funding it spends, it must expend $3 from other non-federal funding sources to provide the services required of it by the contract.

(e) If the contractor has a medicaid billing mechanism in place, it will bill medicaid for services provided under the contract that qualify for medicaid reimbursement; and if a medicaid billing mechanism is not in place, the contractor will work with department staff to establish such a mechanism or to determine the feasibility of medicaid billing by the contractor, and will utilize the mechanism once it is established.

(f) No more than 10% of the funds available under the contract may be used for administration of the contract, i.e., for services that do not directly contribute to the delivery of direct services to clients; examples of administrative costs are those for bookkeeping, legal aid, and supervision by persons who are not health professionals.

(g) If the contractor conducted maternal and child health programs during the state fiscal year prior to that in which the contract is to be performed, the contractor must maintain during the term of the contract at least the same level of effort as it provided for those programs during prior fiscal year.

(h) Any grant-related income (for example, income from fees charged or donations) accruing to the contractor from activities funded, in whole or in part, under the contract will be used only to pay for the allowable costs of providing the services described in the contract, during the term of the contract or within one year thereafter. Careful documentation

of the use of grant-related income must be maintained.

(2) Core maternal and child health services are the following, when provided to pregnant women, non-pregnant women of childbearing age, infants younger than one year of age, children and adolescents 18 years of age or younger, or children with special health care needs:

(a) population based individual services, such as immunizations, public health education, and screening for health problems;

(b) enabling and non-health support services, such as outreach and referral, that ensure that persons are informed about and referred to other services and programs which they need or for which they may be eligible;

(c) direct health services, including but not limited to public health nursing, home visiting, school health services, nutrition services, health care coordination, preventive and primary care, and other specific health services meeting the specific requirements or needs of the above target groups; and

(d) addressing public health infrastructure needs, including but not limited to assessment of local health problems, health program development, augmentation of service capacity, evaluation and management, and quality assurance.

(3) In order to use MCH block grant funds for services other than the core services listed in (2) above, a contractor must use a formal needs assessment process that includes developing a broad-based and local working group composed of representatives of health professionals, educators, consumers, social services providers, business leaders, and others interested in the health needs of the groups named in (2) above, and with that group, analyzing available statistics and utilizing consensus decision-making to determine the extent to which the objectives are met that are contained in Healthy People 2000 National Health Promotion and Disease Prevention Objectives, published by the U.S. department of health and human services.

(4) In distributing MCH block grant funds, the department will give priority to the counties, regions, and communities with the least resources, the largest proportion of underserved families, and the most serious maternal and child health problems, and will determine who should have priority by utilizing objective health indicators, including, at a minimum, the following:

(a) the number of children in poverty;

(b) the number of women of childbearing age; and

(5) The calculations required by (4) above must be based on 1990 census data, updated by projections made by the census and economic information center of the state department of commerce.

(6) The department hereby adopts and incorporates by reference Healthy People 2000 National Health Promotion and Disease Prevention Objectives (DPHHS Publication No. 91-50213) , published by the U.S. department of health and human services, September, 1990, and which contains a national strategy for significantly improving the nation's health through the 1990s, and addresses prevention of major chronic illness, injuries, and infectious diseases. A copy of Healthy People 2000 may be obtained from the department's Family Health Bureau, Cogswell Building, P.O. Box 202951, Helena, MT 59620-2951 (phone: 406-444-4743 ) .

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202, MCA
History: Ch. 593, L. 1995; NEW, 1996 MAR p. 2184, Eff. 8/9/96; TRANS, from DHES, 2001 MAR p. 398.

Chapter 37.59 Special Supplemental Nutrition Program for Women, Infants and Children (wic)

Subchapter 37.59.1 General Program Administration

Mont. Admin. R. 37.59.101 Purpose of Rules

(1) The purpose of the rules in subchapters 1 and 2 is to provide a clear procedural framework under which the department administers the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program), which is sponsored by the Food and Nutrition Service (FNS) of the United States Department of Agriculture (USDA) and which has been administered in Montana by the department since approximately 1974.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13.

Mont. Admin. R. 37.59.102 Definitions

Unless otherwise indicated, the following definitions apply throughout this chapter:

(1) "Administrative and program services costs" means those direct and indirect costs, exclusive of food costs, as defined in 7 CFR 246.14(c), which the department determines to be necessary to support local agency program operations. Administrative and program services costs include: the costs of program administration, start-up, monitoring, auditing, the development of and accountability for food delivery systems, nutrition and breastfeeding education, outreach, certification, information technology, and developing and printing food benefits.

(2) "Affirmative action plan" means that portion of the department plan which describes how the program will be initiated and expanded within the department's jurisdiction in accordance with 7 CFR 246.4(a).

(3) "Breastfeeding women" means women up to one year postpartum who are breastfeeding their infants.

(4) "Caseload" means the number of persons certified by the local agencies, eligible and participating in the WIC Program at any point in time. Persons certified eligible but wait-listed are not considered to be participating in the WIC Program, and therefore are not included when the department assigns caseload limits or tallying caseload being carried at a point in time.

(5) "Categorical eligibility" means persons who meet the definitions of pregnant women, breastfeeding women, postpartum women, infants, or children.

(6) "Certification" means the application of criteria and procedures to assess and document each applicant's eligibility for the program.

(7) "Children" means persons who have had their first birthday but have not yet attained their fifth birthday.

(8) "Clinic" means a facility where applicants are certified.

(9) "Competent professional authority (CPA)" means an individual on the staff of the local agency authorized to determine nutritional risk and prescribe supplemental foods. The following persons are the only persons the department may authorize to serve as a CPA: physicians, nutritionists (bachelor's or master's degree in nutritional sciences, community nutrition, clinical nutrition, dietetics, public health nutrition, or home economics with emphasis in nutrition), dietitians, registered nurses, physician's assistants (certified by the National Commission on Certification of Physician's Assistants, or certified by the state medical certifying authority), or state or local medically trained health officials. This definition also applies to an individual who is not on the staff of the local agency but who is qualified to provide data upon which nutritional risk determinations are made by a CPA on the staff of the local agency.

(10) "Days" means calendar days.

(11) "Disqualification" means the act of ending the program participation of a participant, authorized retailer, authorized farmer, or local agency, whether as a punitive sanction or for administrative reasons.

(12) "Dual participation" means simultaneous participation in the program in more than one WIC clinic.

(13) "Dyad" means a breastfeeding woman and the infant to whom she is providing breast milk who are participating on WIC.

(14) "Fair hearing" means the procedure through which an individual may appeal a department or local decision which results in denial of program participation, or suspension or termination from the program.

(15) "Family" means a group of related or non-related individuals living together as one economic unit and whose production of income and consumption of goods and services are shared. Residents of a homeless facility or an institution will not be considered as members of a single family. Students who are temporarily away at school may be counted as members of the family.

(16) "Farmer" means an individual authorized by the state agency to sell eligible fruits and vegetables to participants at a farmers' market or roadside stand. Individuals who exclusively sell produce grown by someone else, such as wholesale distributors, cannot be authorized.

(17) "Food costs" means the costs of supplemental foods, determined in accordance with 7 CFR 246.14(b).

(18) "Food delivery system" means the method used by the department and local agencies to provide supplemental foods to participants.

(19) "Food benefit" means a voucher, check, coupon, or electronic benefit transfer which is used by a participant to obtain supplemental foods.

(20) "Food package" means supplemental foods prescribed by a CPA for a WIC participant to meet demonstrated nutritional needs.

(21) "Health services" means ongoing, routine pediatric and obstetric care (such as infant and child care and prenatal and postpartum examinations) or referral for treatment.

(22) "Infants" means persons under one year of age.

(23) "Initial visit" means the first time a person visits a WIC clinic to request program benefits, whether by an in-person inquiry or by telephone.

(24) "Local agency" means:

(a) a public or private, nonprofit health or human service agency which provides health services, either directly or through contract, in accordance with 7 CFR 246.5;

(b) an Indian health service unit;

(c) an Indian tribe, band, or group recognized by the United States Department of the Interior which operates a health clinic or is provided health services by an Indian health service unit; or

(d) an intertribal council or group that is an authorized representative of Indian tribes, bands, or groups recognized by the United States Department of the Interior, which operates a health clinic or is provided health services by an Indian health service unit.

(25) "Members of populations" means persons with a common special nutritional need who do not necessarily reside in a specific geographic area, such as off-reservation Indians or migrant farmworkers and their families.

(26) "Migrant farmworker" means an individual whose principal employment is in agriculture on a seasonal basis, and who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode.

(27) "Monthly participation" means a total number of participants actually receiving benefits in any month, and the breastfeeding dyad member who does not receive food benefits while the other member does.

(28) "Nonprofit agency" means a private agency which is exempt from income tax under the Internal Revenue Code of 1954, as amended.

(29) "Nutrition counseling" means individualized professional guidance to assist a person in adjusting their daily food consumption to meet their health needs.

(30) "Nutrition education" means individual or group education sessions and the provision of information and educational materials designed to improve health status, achieve positive change in dietary habits, and emphasize relationships between nutrition and health, all in keeping with the individual's personal, cultural, and socioeconomic preferences.

(31) "Nutrition services" means nutrition intervention planned for and provided to a participant, such as assessment of nutritional health status, counseling, provision of nutrition information, prescription of a food package, referral to other health, financial, or social services, and evaluation of change in behavior and nutritional health status.

(32) "Nutritional risk" means:

(a) detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric measurements;

(b) their documented nutritionally related medical conditions;

(d) conditions that directly affect the nutritional health of a person; or

(e) conditions that predispose persons to inadequate nutritional patterns or nutritionally related medical conditions.

(33) "Nutritionist" means a professional who meets the academic and experience requirements described in 37-25-102, MCA.

(34) "Participants" means pregnant women, breastfeeding women, postpartum women, infants, and children who are receiving supplemental foods or food benefits under the program, and the breastfeeding dyad member who does not receive food benefits while the other member does.

(35) "Participation" means the number of persons who have received supplemental foods or food benefits during a reporting period, and the breastfeeding dyad member who does not receive food benefits while the other member does.

(36) "Postpartum women" means women up to six months after termination of pregnancy.

(37) "Potential participants" means persons not certified on WIC but who are applying for WIC services, or who have been determined by some statistical means to be eligible for WIC services.

(38) "Poverty income guidelines" means the poverty income guidelines prescribed by the United States Department of Health and Human Services (DHHS). These guidelines are adjusted annually by DHHS, with each annual adjustment effective July 1 of each year. The poverty income guidelines prescribed by the DHHS are used for the Montana WIC Program.

(39) "Pregnant women" means women who have one or more embryos or fetuses in utero.

(40) "Priority system" means the ranking applied to persons on a waiting list to ensure that those at highest nutritional risk are the first ones chosen to fill vacancies.

(41) "Program" means the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), authorized by section 17 of the Child Nutrition Act of 1966, as amended.

(42) "Reallocation" means the process by which the United States Department of Agriculture (USDA) monies are moved from one state agency which is spending at a lower rate and given to another state agency that is able to spend the money more rapidly due to larger caseloads and a similar process used by the department among local agencies.

(43) "Registered dietitian (RD)" means a professional who meets the academic and experience requirements described in 37-25-302, MCA.

(44) "Retail purchase system" means a system in which the participant obtains WIC foods through an authorized retailer or farmer.

(45) "Retailer" means an entity that, through a signed agreement with the state agency, provides WIC foods in exchange for WIC benefits. Each individual retailer must be contracted separately.

(46) "Satellite" means a WIC clinic operated by the WIC agency which has primary administrative responsibility for a program and contracts directly with the department. A satellite differs from a site in that it is located outside the defined project area, i.e., county or reservation.

(47) "Site" means a single clinic offering services to WIC participants within a defined project area that may contain more than one clinic.

(48) "Staffing pattern" means the recommended ratio of WIC staff to the number of participants served.

(49) "State plan" means the "2014 State Plan for Montana's Special Supplemental Nutrition Program for Women, Infants and Children (WIC)", a plan of program operation and administration that describes the manner in which the department intends to implement and operate all aspects of program administration within its jurisdiction in accordance with 7 CFR 246.4.

(50) "Supplemental foods" means those foods containing nutrients determined by nutritional research to be lacking in the diets of pregnant, breastfeeding, and postpartum women, infants, and children, and foods that promote the health of the population served by the WIC Program as indicated by relevant nutrition science, public health concerns, and cultural eating patterns as prescribed by the United States Secretary of Agriculture in 7 CFR 246.10.

(51) "Waiting list" means a list of applicants waiting to be accepted in the WIC Program when vacancies occur.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; AMD, 1990 MAR p. 227, Eff. 1/26/90; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.105 Incorporations by Reference

(1) This chapter of ARM Title 37 establishes a state WIC Program which is essentially the equivalent of the federal WIC Program.

(2) Where the department has adopted a federal regulation by reference, the following applies:

(a) References in the federal regulations to "Administrator" or "Regional Administrator," or the like, should be read to mean "department."

(b) Where the department incorporates by reference a subpart of a federal regulation, both the subpart and its constituent sections and subsections are also incorporated by reference.

(3) The department adopts and incorporates by reference the following:

(a) the poverty income guidelines as published under the "Annual Update on the HHS Poverty Guidelines" 78 Federal Register 16, pp 5182-5183, January 24, 2013;

(b) section 17 of the Child Nutrition Act of 1966, 42 U.S.C. 1771, et seq., as amended and reauthorized in 2010; and

(c) the "2014 State Plan for Montana's Special Supplemental Nutrition Program for Women, Infants and Children (WIC)" which is a comprehensive summary of applicable federal regulations, procedures, and forms used by the department.

(4) All material which is incorporated by reference may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), P.O. Box 202951, Helena, MT 59620-2951. Interested persons seeking a copy of the CFR may address their requests directly to: Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; AMD, 1990 MAR p. 227, Eff. 1/26/90; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.109 Program Administration and Guidance

(1) As the state agency to which the United States Department of Agriculture (USDA) has delegated the administration of the WIC Program, the department is responsible for the effective and efficient administration of the program in accordance with the USDA program regulations set forth in 7 CFR Part 246, USDA's regulations governing the WIC Program; 7 CFR Part 15, subparts A and C, USDA's regulations governing nondiscrimination; and 7 CFR Part 3015, USDA's regulations governing the administration of grants.

(2) In addition to the documents referred to in (1), the department, as the state agency to which the USDA has delegated administration of the WIC Program, also receives numerous policies, forms, guidelines, and instructions from the USDA Food and Nutrition Service (FNS) issued under the FNS directives management system. The department has assembled such policies, forms, guidelines, instructions, and the state forms and guidelines required by such directives, into the state plan which is distributed to each participating local agency and is to be followed by each local agency in administering the program.

(3) The department adopts and incorporates by reference the following:

(a) 7 CFR Part 246, which are USDA regulations governing the WIC Program, edition date January 1, 2013 and may be obtained at www.fns.usda.gov/wic/lawsandregulations/wicregulations-7cfr246.pdf ;

(b) 7 CFR Part 15, subparts A and C, which are USDA regulations governing nondiscrimination, edition date January 1, 2013 and may be obtained at www.law.cornell.edu/cfr/text/7/part-15/subpart-A and www.law.cornell.edu/cfr/text/7/part-15/subpart-C ;

(c) 7 CFR Part 3015, which are USDA regulations governing the administration of grants, edition date January 1, 2013 and may be obtained at www.law.cornell.edu/cfr/text/7/3015 ; and

(d) the "2014 State Plan for Montana's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)."

(e) Copies of these materials may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants, & Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; AMD, 1990 MAR p. 227, Eff. 1/26/90; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.110 Nutrition Services Standards

(1) Local agency staff will provide participants with nutrition services developed and defined in the state plan, including the following:

(a) a complete nutrition assessment including hematological and anthropometric measures as indicated;

(b) CPA-identified nutrition risk code(s);

(d) CPA-developed care plan to include documentation of participant goals, frequency of follow up, referrals, and plan for future education needs;

(e) breastfeeding education, promotion, and support for participants as appropriate; and

(f) at least four nutrition education contacts per annual certification or two education contacts per six-month certification, to be offered approximately every quarter.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; AMD, 1990 MAR p. 227, Eff. 1/26/90; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Subchapter 37.59.2 Local Agency Eligibility and Participation

Mont. Admin. R. 37.59.201 Selection of Local Agencies

(1) In selecting new local agencies, the department will apply the criteria in 7 CFR 246.5(a) through (f) together with the following criteria:

(a) whether the program is located to be accessible to participants;

(b) whether the program exhibits sufficient financial integrity and solvency to assure its ability to continue program operations; and

(c) whether there are documented, written procedures for making referrals to and coordinating with the following services and programs which are operating in the service area of the local agency: prenatal care, immunizations, postnatal care, family planning, well-child services, early periodic screening and development testing, schools, dental screening, private physicians, health maintenance organizations, hospitals, expanded food and nutrition education program, community relief agencies, USDA Supplemental Nutrition Assistance Program (SNAP), Children's Special Health Care Services, and maternal and child health services.

(2) The department adopts and incorporates by reference 7 CFR 246.5(a) through (f), which is a federal agency rule setting forth requirements and procedures for local agency selection and the expansion, reduction, and disqualification of participating local agencies. Copies of 7 CFR 246.5(a) through (f) may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants & Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.202 Agreements with Local Agencies

(1) The department adopts and incorporates by reference 7 CFR 246.6, which is a federal agency rule setting forth terms and requirements for agreements between the department and local agencies. Copies of 7 CFR 246.6 may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants & Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.203 Periodic Review and Disqualification of Local Agencies

(1) The department will conduct periodic reviews of the qualifications of authorized local agencies under its jurisdiction. In conducting such reviews, the department will consider the program's history of prior program performance and the factors listed in (2). Based upon the results of such reviews, the department may make appropriate adjustments among the participating local agencies, including the disqualification of a local agency when the department determines that another local agency can operate the program more effectively and efficiently. The department must implement the procedures established in (3) when disqualifying a local agency.

(2) The department may disqualify a local agency upon consideration of:

(a) noncompliance with program rules;

(b) sufficiency of department funds to support the continued operation of all its existing local agencies at their current participation level;

(c) whether, following a review of local agency credentials in accordance with (4), another local agency can operate the program more effectively and efficiently;

(d) the availability of other community resources to participants and the cost efficiency and cost effectiveness of the local agency in terms of both food and administrative and program services costs;

(e) the percentages of participants in each priority level being served by the local agency and the percentage of need being met in each participant category;

(f) the relative position of the area or special population served by the local agency in the affirmative action plan;

(g) the local agency's place in the priority system established in 7 CFR 246.5(d)(1); or

(h) the capability of another local agency or agencies to accept the local agency's participants.

(3) When disqualifying a local agency under the program, the department must:

(a) make every effort to transfer affected participants to another local agency without disruption of benefits;

(b) provide the affected local agency with written notice not less than 60 days in advance of the pending action; the notice must include an explanation of the reasons for disqualification, the date of disqualification, and, except in cases of the expiration of a local agency's agreement, the local agency's right to appeal as set forth in 7 CFR 246.18; and

(c) ensure that the action is not in conflict with any existing written agreements between the department and the local agency.

(4) The department adopts and incorporates by reference the following:

(a) 7 CFR 246.18, which is a federal agency rule setting forth the notice and hearing procedures for local agencies, retailers, and farmers who are denied participation or are disqualified from the program; and

(b) 7 CFR 246.5(d)(1), which is a federal agency rule setting forth the priority system for selection of local agencies.

(c) Copies of 7 CFR 246.18 and 7 CFR 246.5(d)(1) may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants & Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Subchapter 37.59.3 Retailer and Farmer Eligibility and Participation

Mont. Admin. R. 37.59.301 Requirements for State Agency Selection of Retailers and Farmers

(1) In selecting retailers to participate in the program, the state WIC agency will apply the requirements of 7 CFR 246.12(e) through (v), and the following criteria:

(a) whether the place of the retailer's business is permanent; no stores on wheels may be allowed;

(b) whether the retailer stocks and maintains appropriate quantities of authorized WIC foods;

(d) whether the retailer has been disqualified from the USDA SNAP;

(e) whether the retailer has a valid, current business license from each appropriate Montana state agency, as may be required by law.

(2) In selecting farmers to participate in the program, the state agency will apply the requirements of 7 CFR 246.12(v):

(a) The farmer must grow farm-direct approved fruits and vegetables themselves and may sell only locally grown produce as part of their farm-direct participation.

(b) The farmer will agree to sell only the eligible, locally grown foods in exchange for Montana WIC benefits.

(d) Farmers must have and maintain a positive compliance history with any and all USDA FNS programs in which they are participating or have participated.

(3) The department adopts and incorporates by reference the following:

(a) 7 CFR 246.12(e) through (v), which is a federal agency rule setting forth the authorization of retailers and farmers; requirements for agreements; periodic review of qualifications; guidelines for training; monitoring; participant, retailer, and farmer complaints and sanctions; requirements for control and reconciliation of food benefits; and payment to retailers and farmers.

(b) Copies of 7 CFR 246.12(e) through (o) may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants & Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.302 Agreements with Retailers and Farmers

(1) The department adopts and incorporates by reference 7 CFR 246.12(h) and (v), which is a federal agency rule setting forth terms and requirements for agreements between the department and retailers and farmers. Copies of this document may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants, & Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.303 Periodic Review and Disqualification of Retailers and Farmers

(1) The department (or local agency in consultation with the department), before re-authorization, will conduct periodic reviews of the operations of participating retailers and farmers, as described in the state plan, and will consider the following:

(a) a review of local agency monitoring reports;

(b) results of one or more on site visits;

(d) on site follow-up to (a) when warranted by incomplete information or complaint;

(e) whether the retailer or farmer demonstrates ability to meet Montana WIC Program requirements, as evidenced by performance during the current agreement; and

(f) whether patterns of participant use demonstrate compliance with the program.

(2) Based upon such review, the department may take an adverse action, other than a warning letter, against the retailer or farmer, including disqualification of the retailer or farmer from participation in the program.

(3) When taking an adverse action, other than a warning letter, against a retailer or farmer, including disqualification of a retailer or farmer from the program, the department must provide the affected retailer or farmer with written notice not less than 15 days in advance of the pending action. The notice must include the reasons for the adverse action, the date of adverse action, and, except in cases of the expiration of the retailer's or farmer's WIC agreement, the retailer's or farmer's right to appeal as set forth in 7 CFR 246.18.

(4) The department adopts and incorporates by reference the following:

(a) the "2014 State Plan for Montana's Special Supplemental Nutrition Program for Women, Infants and Children (WIC)", a comprehensive summary of applicable federal regulations, procedures, and forms used by the department; and

(b) 7 CFR 246.18, which is a federal agency rule setting forth the notice and hearing procedures for local agencies, retailers, and farmers who are denied participation or are disqualified from the program.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; AMD, 1990 MAR p. 227, Eff. 1/26/90; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Subchapter 37.59.4 Appeal Procedures

Mont. Admin. R. 37.59.401 Appeals by Program Participants

(1) An individual who has been denied participation or been disqualified from the program by the local agency may request a fair hearing by contacting either the local agency or the department no later than 60 days after the local agency's adverse action has been communicated to the individual.

(2) The processing of such requests and the conduct of such hearing is in accordance with 7 CFR 246.9 and applicable sections of the state plan.

(3) The department incorporates by reference the following:

(a) 7 CFR 246.9, which is a federal agency rule setting forth fair hearing procedures for individuals who are denied participation or disqualified from the program; and

(b) the fair hearing requirements of the state plan.

(c) Copies of the above documents may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; AMD, 1990 MAR p. 227, Eff. 1/26/90; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Mont. Admin. R. 37.59.402 Appeals by Local Agencies, Retailers, and Farmers

(1) A local agency, retailer, or farmer which is denied participation or, during the course of a contract or agreement, is disqualified or its participation is otherwise adversely affected may request a fair hearing before the department. Expiration of a contract or agreement with a retailer, farmer, or local agency is not subject to appeal.

(2) The issuance of notice of adverse action, the processing of fair hearing requests, and the conduct of such hearings are in accordance with the provisions of 7 CFR 246.18 and applicable sections of the state plan.

(3) The department adopts and incorporates by reference the following:

(b) the fair hearing requirements for local agencies, retailers, and farmers set forth in the state plan.

(c) Copies of 7 CFR 246.18 and the local agency and retailer and farmer fair hearing provisions of the state plan may be obtained from the Department of Public Health and Human Services, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1988 MAR p. 1528, Eff. 7/15/88; AMD, 1990 MAR p. 227, Eff. 1/26/90; TRANS, from DHES, 2001 MAR p. 982; AMD, 2013 MAR p. 1852, Eff. 10/18/13

Chapter 37.62 Child Support Services

Subchapter 37.62.1 Child Support Guidelines

Mont. Admin. R. 37.62.101 Authority, Policy and Purpose

(1) These guidelines are promulgated under the authority of 40-5-209 , MCA, for the purpose of establishing a standard to be used by the district courts, child support enforcement agencies, attorneys and parents in determining child support obligations.

(2) These guidelines are based on the principle that it is the first priority of parents to meet the needs of the child according to the financial ability of the parents. In a dissolution of marriage or when parents have never been married, a child's standard of living should not, to the degree possible, be adversely affected because a child's parents are not living in the same household.

(3) These guidelines are structured to determine child support on an annual basis. Payment will be made in equal monthly installments.

(4) As required by 40-4-204 , 40-5-226 and 40-6-116 , MCA, these guidelines apply to contested, non-contested and default proceedings to establish or modify support orders.

History

Authorizing statute(s): Sec. 40-5-203, MCA
Implementing statute(s): Sec. 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98.

Mont. Admin. R. 37.62.102 Rebuttable Presumption

(1) The guidelines create a presumption of the adequacy and reasonableness of child support awards. However, every case must be determined on its own merits and circumstances and the presumption may be rebutted by evidence that a child's needs are or are not being met.

(2) At the request of one of the parties and upon consideration of the factors set out in the guidelines and in 40-4-204, 40-4-208, and 40-6-116, MCA, the final outcome of the guidelines calculation, or "bottom line", may be rebutted and a variance from the guidelines final amount may be granted. Any consideration of a variance from the guidelines must take into account the best interests of the child.

(3) The support order may vary from the bottom line in a particular case only if the decree, separation order, or support order contains a specific written finding showing justification that application of the guidelines would be unjust or inappropriate, based upon evidence sufficient to rebut the presumption.

(4) Findings that rebut and vary the bottom line must include a statement of the amount of support that would have been ordered under the guidelines without the variance.

(5) Child support may vary from the bottom line based on a stipulation or agreement of the parties only if the stipulation or agreement meets the following criteria:

(a) it is in writing, executed by the parties free of coercion;

(b) it contains specific justification as to why application of the guidelines is unjust or inappropriate;

(c) it contains a statement of the amount of support that would have been appropriate under the guidelines without the variance; and

(d) it has been approved by the court or in an administrative proceeding.

(6) A support order granting a variance from the bottom line, based upon the existence of a condition or the performance of an act, must provide that, upon termination of the circumstances which justify the variance, the support immediately reverts to the amount which would have been ordered under the guidelines without the variance.

(7) In contrast to the bottom-line presumption, the child support guidelines include a variety of presumptions affecting particular entries or lines in the calculation intended to customize support for a particular family. "Line-item" presumption refers to various provisions of the child support guidelines assuming specific fact patterns which occur in a majority of cases. If, in the case at issue, a parent can show that the facts in evidence are not consistent with the facts assumed, the facts in evidence are applied to the entry and result in a different but appropriate child support award. The entry based on the evidence rebuts the line-item presumption regarding the guideline provision. For example, ARM 37.62.110(1)(b)(ii) may allow a deduction from a parent's income for "an amount equal to one-half of the primary child support allowance as found in ARM 37.62.121 for the number of other children for whom no support order exists". The rule presumes the remaining half of the child's support is the responsibility of the other parent of the child, but if, in the case at issue, there is no other parent to share responsibility, the party ordinarily entitled to the one-half deduction is allowed the full deduction.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.103 Definitions

For purposes of this chapter, unless the context requires otherwise, the following definitions apply:

(1) "Actual income" is defined in ARM 37.62.105.

(2) "CSSD" means the Child Support Services Division of the Department of Public Health and Human Services.

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

(4) "Federal poverty guidelines" means the guidelines published by the U.S. Department of Health and Human Services under the authority of 42 USC 9902(2), which will be updated periodically in the Federal Register. Such updates will be adopted by amendment to these rules as appropriate.

(5) "Guidelines" means the administrative rules for establishment of child support as provided in ARM Title 37, chapter 62, subchapter 1, as promulgated in 40-5-209, MCA.

(6) "Imputed income" is defined in ARM 37.62.106.

(7) "Incarceration" means a parent is held in a correctional, detention, or treatment facility for more than 180 days.

(8) "Legal dependent" means natural born and adopted minor children, spouses, special needs adult children, household members covered by a conservatorship or guardianship, and parent's parents living in the household who are claimed on tax returns as legal dependents.

(9) "Long distance parenting" is defined in ARM 37.62.130.

(10) "Other child" means a child whom a parent is legally obligated to support but who is not the subject of the child support calculation. A step-child is not considered an other child.

(11) "Personal allowance" is defined in ARM 37.62.114.

(12) "Primary child support allowance" is defined in ARM 37.62.121.

(13) "SOLA" means standard of living adjustment.

(14) "Standard of living" includes the necessities, comforts and luxuries enjoyed by either parent, the child or both parents and the child, which are needed to maintain them in customary or proper community status or circumstances.

(15) "Transfer payment" is defined in ARM 37.62.134.

(16) "Underemployed" means employed less than full time, when full-time work is available in the community or the local trade area, and/or earning a wage that is less than the parent has earned in the past, or is qualified to earn, when higher paying jobs are available in the community or the local trade area, for which the parent is qualified.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12; AMD, 2017 MAR p. 2441, Eff. 12/23/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.105 Determination of Income for Child Support

(1) Income for child support includes actual income, imputed income as set forth in ARM 37.62.106, or any combination thereof which fairly reflects a parent's resources available for child support. Income can never be less than zero.

(a) Parents are presumed to be capable of earning income from full-time employment; full-time employment is presumed to be 40 hours per week but may be more or less depending upon the parent's profession and/or the employer's policies.

(b) The net value of a parent's assets may be considered for child support where, in a specific case, it would be inappropriate not to do so.

(2) Actual income includes:

(a) economic benefit from whatever source derived, except as excluded in (3) of this rule, and includes but is not limited to income from salaries, wages, tips, commissions, bonuses, earnings, profits, dividends, severance pay, pensions, periodic distributions from retirement plans, draws or advances against wages or salaries, interest, trust income, annuities, royalties, alimony or spousal maintenance, social security benefits, veteran's benefits, workers' compensation benefits, unemployment benefits, disability payments, earned income credit and all other government payments and benefits. Income also includes capital gains net of capital losses. To the extent the net gains result from recurring transactions, they may be averaged over a period of at least three years. If the net gains are attributable to a single event or year, they may be used to represent income over one or more years;

(b) gross receipts minus reasonable and necessary expenses required for the production of income for those parents who receive income or benefits as the result of an ownership interest in a business or who are self-employed. Specifically:

(i) straight line depreciation for vehicles, machinery, and other tangible assets may be deducted from income if the asset is required for the production of income. The party requesting such depreciation shall provide sufficient information to calculate the value and expected life of the asset. Internal Revenue Service rules apply to determine expected life of assets;

(ii) if expenses are not required for the production of income, the expenses are not allowable deductions; if business expenses include a personal component, such as personal use of business vehicles, only the business component is deductible;

(iii) a net loss in the operation of a business or farm may not offset other income. If a parent has more than one business and the businesses are related, however, the total losses of the businesses may be offset against (deducted from) the total profits. An artist, for example, whose principal income source is the sale of paintings in her gallery may also own a company that publishes calendars and other commercial uses of her paintings as a marketing tool. A loss in the operation of the publishing company may be offset against the profit in the gallery business because the two enterprises are related; and

(iv) investment losses outside the normal course of business may not reduce other income.

(c) the value of noncash benefits, including but not limited to in-kind compensation, personal use of vehicle, housing, payment of personal expenses, food, utilities, etc.;

(d) grants, scholarships, third-party contributions, and earned income received by parents engaged in a plan of economic self-improvement, including students. Financial subsidies or other payment intended to subsidize the parent's living expenses and not required to be repaid at some later date must be included in income for child support; and

(e) allowances for expenses, flat rate payments or per diem received, except as offset by actual expenses. Actual expenses may be considered only to the extent a party can produce receipts or other acceptable documentation. Reimbursement of actual employment expenses may not be considered income for purposes of these rules.

(3) Income for child support does not include:

(a) income attributable to subsequent spouses, domestic associates, and other persons who are part of the parent's household;

(b) means-tested veteran's benefits;

(c) means-tested public assistance benefits including but not limited to cash assistance programs funded under the federal temporary assistance to needy families (TANF) block grant;

(d) supplemental security income (SSI);

(e) supplemental nutrition assistance program (SNAP) benefits, formerly known as food stamps;

(f) child support payments received from other sources; and

(g) adoption subsidies paid by state or federal agencies, unless expenses of the subsidized child are included in the calculation.

(4) Income for child support does not include lump sum social security payments or social security benefits received by a child or on behalf of a child as the result of a parent's disability or the child's disability, whether or not the child is a child of the calculation. See ARM 37.62.144 for more information on Social Security benefits.

(5) If overtime is mandatory and the worker has no control over whether or not overtime is worked, the overtime earnings are included in income for child support. In the case of voluntary overtime earnings or earnings from a job that is in addition to a full-time job, and the earnings are expected to continue for the foreseeable future, the earnings are presumed to be available for child support and are included in the calculation subject to rebuttal of the presumption.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.106 Imputed Income for Child Support

(1) "Imputed income" means income not actually earned by a parent, but which is attributed to the parent based on the provisions of this rule. It is presumed that all parents are capable of working at least 40 hours per week at minimum wage, absent evidence to the contrary.

(2) It is appropriate to impute income to a parent, subject to the provisions of (6) of this rule, when the parent:

(a) is unemployed;

(b) is underemployed;

(d) has an unknown employment status; or

(e) is a student.

(3) In all cases where imputed income is appropriate, the amount is based on the following:

(a) the parent's residence and recent work and earnings history;

(b) the parent's occupational, educational, and professional qualifications;

(d) the parent's age, literacy, health, criminal record, record of seeking work, and other employment barriers;

(e) the availability of employers willing to hire the parent; and

(f) other relevant background factors.

(4) Imputed income may be in addition to actual income and may not necessarily reflect the same rate of pay as the actual income.

(5) Income is imputed according to a parent's status as a full- or part-time student, whose education or retraining will result, within a reasonable time, in an economic benefit to the child for whom the support obligation is determined, unless actual income is greater. If the student is:

(a) full-time, the parent's earning capacity is based on full-time employment for 13 weeks and approximately half of full-time employment for the remaining 39 weeks of a 12-month period; or

(b) part-time, the parent's earning capacity is based on full-time employment for a 12-month period.

(6) Income is not imputed if any of the following conditions exist:

(a) the reasonable and unreimbursed costs of child care for dependents in the parent's household would offset in whole or in substantial part, that parent's imputed income;

(b) a parent is physically or mentally disabled to the extent that the parent cannot earn income, or is incarcerated for more than 180 days;

(d) the parent has made diligent efforts to find and accept suitable work or to return to customary self-employment, to no avail; or

(e) the court or hearing officer makes a finding that other circumstances exist which make the imputation of income inequitable. However, the amount of imputed income shall be decreased only to the extent required to remove such inequity.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12; AMD, 2017 MAR p. 2441, Eff. 12/23/17; AMD, 2022 MAR p. 1878, Eff. 9/24/22.

Mont. Admin. R. 37.62.108 Income Verification/Determining Annual Income

(1) A parent must swear to the accuracy and authenticity of all financial information submitted for the purpose of calculating child support.

(2) Income of the parents must be documented. This may include pay stubs, employer statements, income tax returns, and profit and loss statements. If expenses are disputed, proof may be required.

(3) To the extent possible, income for child support and expenses should be annualized to avoid the possibility of skewed application of the guidelines based on temporary or seasonal conditions. Income and expenses may be annualized using one of the two following methods:

(a) seasonal employment or fluctuating income may be averaged over a period sufficient to accurately reflect the parent's earning ability. If a parent has been self-employed for three years or less, the profit and loss statements and income tax returns of the individual parent and the business entity for each of those years are required so that the average of the parent's self-employment income can be considered in the child support calculation. If the parent has been self-employed for more than three years, a minimum of the most recent three years' profit and loss statements and tax returns are required; or

(b) current income or expenses may be projected when a recent increase or decrease in income is expected to continue for the foreseeable future. For example, when a student graduates and obtains permanent employment, income should be projected at the new wage.

(4) Nothing in this rule shall be construed to require the use of any particular method of determining annual income if it does not accurately reflect a parent's resources available for child support.

(5) Income for child support may differ from a determination of income for tax purposes.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.110 Allowable Deductions from Parents' Income

(1) Allowable deductions from income include those required by law, those required as a condition of employment, and those necessary for the production of income. Allowable deductions may include:

(a) the amount of alimony or spousal maintenance which a parent is required to pay under a court or administrative order;

(b) for an "other child" as defined in ARM 37.62.103(9):

(i) the amount of child support due under existing court or administrative support orders; and

(ii) an amount equal to one-half of the primary child support allowance as found in ARM 37.62.121 for the number of other children for whom no support order exists and who:

(A) reside with the parent of the calculation; or

(B) do not reside with a parent of the calculation if a showing of ongoing support is made;

(c) the amount of any health insurance premium which either parent is required to pay under a court or administrative order for a child not of this calculation;

(d) the actual income tax liability based on tax returns. If no other information is available, use the federal and state income tax tables which show the amount of withholding for a single person with one exemption;

(e) the actual social security (FICA plus Medicare) paid;

(f) court ordered payments except as excluded under ARM 37.62.111;

(g) actual unreimbursed expenses incurred as a condition of employment such as uniforms, tools, safety equipment, union dues, license fees, business use of personal vehicle and other occupational and business expenses;

(h) actual mandatory contributions toward internal revenue service (IRS) approved retirement and deferred compensation plans. Mandatory contributions are fully deductible;

(i) one-half the amount of a parent's unreimbursed payments for an "other child" for extraordinary medical expenses and child care expenses necessary to allow the parent to work, less federal tax credits;

(j) extraordinary medical expenses incurred by a parent to maintain that parent's health or earning capacity which are not reimbursed by insurance, employer, or other entity;

(k) cost of tuition, books, and mandatory student fees for a parent who is a student as anticipated under ARM 37.62.106(5); and

(l) the current, annual interest on student loans, paid by a parent of the calculation for post-secondary education that has resulted in an economic benefit for the children of the calculation.

(2) Allowable deductions from income for child support differ from allowable deductions for tax purposes.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2598, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.111 Nonallowable Deductions from Income

(1) Deductions which are not allowable under these rules include:

(a) payroll deductions for the convenience of the parent, such as credit union payments and savings;

(b) imputed employment-related expenses, such as imputed child care;

(d) payments for satisfaction of judgments against a parent related to the purchase of property for the parent's personal use;

(e) bankruptcy payments except to the extent that they represent debts for expenses which would otherwise be deductible; or

(f) a stepchild and associated costs.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.114 Personal Allowance

(1) Personal allowance is an amount which reflects 1.3 multiplied by the federal poverty guideline for a one-person household. This amount is deducted when determining child support. Personal allowance is a contribution toward, but is not intended to meet the subsistence needs of parents.

(2) If a parent has legal dependents not capable of self-support and whose needs have not already been considered at ARM 37.62.110, the personal allowance may reflect the parent's responsibility by increasing the number in the household when consulting the federal poverty guideline.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.116 Income Available for Child Support

(1) Income available for support is determined by subtracting from each parent's income, the deductions allowed under ARM 37.62.110 and the amount of personal allowance determined under ARM 37.62.114 .

History

Authorizing statute(s): Sec. 40-5-203, MCA
Implementing statute(s): Sec. 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98.

Mont. Admin. R. 37.62.118 Total Income Available/Parental Share

(1) The parents' incomes available for child support are combined to determine the total income available for child support. Each income is divided by the total. The resulting factor determines each parent's share of the primary child support allowance under ARM 37.62.121 and supplements under ARM 37.62.123 .

(2) For any parent whose support obligation is determined according to the provisions of ARM 37.62.126 (1) (a) and (1) (b) , the amount of the minimum contribution is substituted for that parent's total income available for child support for the purpose of determining each parent's share of the primary child support allowance and supplements.

History

Authorizing statute(s): Sec. 40-5-203, MCA
Implementing statute(s): Sec. 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98.

Mont. Admin. R. 37.62.121 Primary Child Support Allowance

(1) Primary child support allowance is a standard amount to be applied toward a child's food, shelter, clothing and related needs and is not intended to meet the needs of a particular child. This allowance is .30 multiplied by the personal allowance found at ARM 37.62.114 for the first child. For the second and third children, the personal allowance is multiplied by .20 and added for each child. For four or more children, the personal allowance is multiplied by .10 and added for each additional child.

History

Authorizing statute(s): Sec. 40-5-203, MCA
Implementing statute(s): Sec. 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98.

Mont. Admin. R. 37.62.123 Supplements to Primary Child Support Allowance

(1) The primary child support allowance is supplemented by:

(a) reasonable child care costs incurred by a parent for children of the calculation as a prerequisite to employment. The child care expense is reduced by the federal dependent care tax credit;

(b) cost of health insurance coverage for the children of the calculation. Include only the actual cost of adding the children to an existing health insurance policy or the cost of a child-only policy;

(c) unreimbursed health care expenses for each child of the calculation that exceed $250 per year and are recurring and predictable; and

(d) other needs of the child as determined by the circumstances of the case.

(2) The total supplemental needs of the child are divided proportionately between the parents according to the parental share determined under ARM 37.62.118.

(3) Each parent will receive credit for the amount of the supplemental needs paid by that parent.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.124 Parenting Days

(1) The parenting plan, referenced in 40-4-234, MCA, provides for the child's residential schedule with the parents.

(2) When the child resides primarily with one parent and does not spend more than 110 days per year with the other parent, there is no adjustment to the transfer payment due. When at least one child spends more than 110 days per year with both parents, however, or when at least one child resides primarily with each parent, the transfer payment is adjusted according to ARM 37.62.134.

(3) A "day" is defined as the majority of a 24-hour calendar period in which the child is with or under the control of a parent. This assumes there is a correlation between time spent and resources expended for the care of the child. For purposes of this chapter, and unless otherwise agreed by the parents or specifically found by the court, the calendar period begins at midnight of the first day and ends at midnight of the second day. When the child is in the temporary care of a third party, such as in school or a day care facility, the parent who is the primary contact for the third party is the parent who has control of the child for the period of third-party care. If both parents are primary contacts for a third party, or if the parents are otherwise unable to agree on the total number of days for each parent, the number of disputed days may be totaled and divided equally between the parents.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.126 Minimum Support Obligation

(1) A specific minimum contribution toward child support should be ordered in all cases when the parent's income, after deductions, is less than or equal to the parent's personal allowance or the parent's calculated child support obligation is less than 12% of that parent's income after deductions.

(a) For parents whose income, as defined in ARM 37.62.105 and ARM 37.62.106, after deductions, as defined in ARM 37.62.110, is less than or equal to the parent's personal allowance, the minimum contribution is a portion of the income after deductions and is determined by applying the table in (3) as follows:

(i) divide the income after deductions by the personal allowance as defined in ARM 37.62.114 to determine the income ratio;

(ii) find the income ratio in Column A;

(iii) locate the corresponding minimum contribution multiplier in Column B; and

(iv) multiply the income after deductions by the minimum contribution multiplier. The result is the parent's minimum contribution.

(b) For parents whose income after deductions exceeds the personal allowance, the parent's minimum contribution is 12% of income after deductions.

(2) The minimum contributions under this rule are presumptive and may be rebutted by the circumstances of a particular case, provided there is an appropriate finding on the record.

(3) The table for determining the minimum support obligation of a parent whose income after deductions is less than or equal to the parent's personal allowance is as follows:

Column A "Income Ratio" | Column B "Minimum Contribution Multiplier" If the IR is in the range: .00 to .25 | The minimum contribution is: .00 If the IR is: | | The multiplier is: over: | but not over: | .25 | .31 | .01 .31 | .38 | .02 .38 | .45 | .03 .45 | .52 | .04 .52 | .59 | .05 .59 | .66 | .06 .66 | .73 | .07 .73 | .80 | .08 .80 | .87 | .09 .87 | .94 | .10 .94 | 1.00 | .11

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.128 Income Available for Standard of Living Adjustment (sola)

(1) The purpose of SOLA is to ensure that the child enjoys, to the extent possible, the standard of living commensurate with the parent's income. If a parent has income available after deducting the personal allowance and the parent's share of the child support allowance as supplemented, the remaining income is subject to SOLA.

(2) SOLA is calculated by subtracting from the parent's income available for support, as provided in ARM 37.62.116 the parent's share of the primary child support allowance under ARM 37.62.121 and supplements as provided in ARM 37.62.123 .

(3) If income is available for SOLA, multiply the income by the SOLA factor from the following table which corresponds to the number of children for whom support is being determined.

Number of Children | SOLA Factor 1 | .14 2 | .21 3 | .27 4 | .31 5 | .35 6 | .39 7 | .43 8 or more | .47

(4) Income available for SOLA may not be less than zero.

History

Authorizing statute(s): Sec. 40-5-203, MCA
Implementing statute(s): Sec. 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98.

Mont. Admin. R. 37.62.130 Long Distance Parenting Adjustment

(1) Long distance parenting is any travel by a parent or child to attain the goals of the parenting plan. A long distance parenting adjustment is allowed when travel by a parent or child exceeds 2,000 miles in a calendar year.

(2) The amount of income available for SOLA is reduced to the extent the actual annual expense of transportation for long distance parenting exceeds 2,000 miles multiplied by the current IRS business mileage rate (standard expense) . The reduction is determined separately for each parent.

(3) The reduction is calculated as follows:

(a) multiply the parent's annual mileage driven to exercise long-distance parenting by the current IRS business mileage rate;

(b) add the annual cost of transportation by means other than automobile;

(d) subtract any difference greater than zero from the parent's income available for SOLA.

(4) Expenses are limited to costs of transportation and do not include meals, lodging, or other costs.

(5) A long distance parenting adjustment may not reduce income available for SOLA below zero.

History

Authorizing statute(s): Sec. 40-5-203, MCA
Implementing statute(s): Sec. 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98.

Mont. Admin. R. 37.62.134 Total Support Amount and Transfer Payment

(1) A total support amount is determined for each parent, separately, and consists of:

(a) the parent's share of the primary child support allowance, with supplemental needs, if any, plus the parent's standard of living adjustment; or

(b) the parent's minimum support obligation determined under ARM 37.62.126.

(2) After determining each parent's obligation according to (1)(a) or (1)(b), above, each parent's obligation is allocated according to the number of days each child spends with each parent.

(a) If all the children of the calculation reside primarily with one parent and do not spend more than 110 days per year with the other parent, the annual transfer payment, defined as the net amount of child support one parent owes the other, is the same as the total, annual support amount owed by the nonresidential parent.

(i) To set the amount of each child's monthly transfer payment, divide the annual transfer payment by the number of children in the calculation. Then, divide each child's annual payment by 12 and round the result according to ARM 37.62.134(2)(a)(ii), following.

(ii) The monthly transfer payment per child is rounded to whole dollars as follows: round down to the next whole dollar amounts ending in $0.49 or less and round up for amounts ending in $0.50 or more. The total of the rounded per child amount is the total monthly transfer payment owed by one parent to the other and/or to a third party, and due to rounding, may vary from the monthly transfer payment shown in the calculation.

(b) If any child of the calculation spends in excess of 110 days per year with both parents or if one or more children reside primarily with one parent while one or more children reside primarily with the other parent, the allocation of each parent's total support amount is determined as follows:

(i) recalculate the needs of each child separately;

(ii) recombine each parent's total support amount for each child based upon that child's proportionate need;

(iii) allocate the parent's total support amount for each child by retaining the amount for time the child spends with the parent and owing to the other parent the amount for time the child spends with the other parent;

(iv) offset the amounts each parent owes the other by subtracting the lower obligation from the higher for each of the children. The remaining balance for each child is the annual transfer payment for that child and is entered in the column of the parent owing the balance; and

(v) to set the monthly transfer payment, divide the annual transfer payment for each child by 12 and round according to (2)(a)(ii).

(A) where the calculation includes only one child, the monthly transfer payment is the total amount due from one parent to the other; or

(B) where the calculation includes two or more children, the monthly transfer payment for each child is the amount entered for the child at (2)(b)(v). The monthly transfer payment for each child is entered in the column of the parent owing the payment. Each parent's column is totaled and the difference between mother's total and father's total is the final monthly transfer payment owed by the parent with the higher total.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.136 Transfer Payment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; REP, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.138 Payment of Monthly Support Amount in Combination Parenting Arrangements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; REP, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.140 Anticipated Changes

(1) To the extent possible, child support orders must address children's changing needs as they grow and mature in a way that minimizes the need for future modifications. If any material change in current circumstances is anticipated within 18 months, separate child support calculations must be completed.

(2) In the initial calculation, present circumstances should be included. In the subsequent calculation(s), appropriate anticipated changes should be calculated. The child support order should provide that the amount(s) from the subsequent calculations will take effect the month following the anticipated changes.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.142 Support Payable in Dollars

(1) The child support order is to be paid in U.S. dollars.

(2) Gifts, clothing, food, payment of expenses, etc., in lieu of dollars will not be allowed as a credit for payment of a child support obligation except by court or administrative order.

(3) Direct payments to the child, the parent or a third party will not be allowed as credit for payment of a child support obligation payable through the clerk of court, the Child Support Services Division or other entity specified in the court or administrative order.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.144 Social Security and Veterans Benefits

(1) Social security and veterans benefits which are based on the earning or service record of either parent shall be considered in establishing new support orders or modification of existing orders under the following conditions:

(a) benefits received by the parent on behalf of the minor child are not to be included in that parent's gross income;

(b) the parent's obligation is satisfied if the amount of the child's benefit received for a given month as a result of that parent's earning record is equal to or greater than the parent's child support obligation. Any benefit received by the child for a given month in excess of the child support obligation is not treated as an arrearage payment or as future support;

(c) the parent must pay the difference if the amount of the child's benefit for a given month is less than the parent's child support obligation. This amount is presumed to be paid if the child resides with that parent a majority of the time; and

(d) whenever either parent receives for the benefit of the child, a lump sum payment which represents an accumulation of monthly benefits:

(i) the lump sum payment should not be treated as income of the parent; and

(ii) the lump sum should be credited to that parent's child support obligation for each month a payment accumulated for the child's benefit.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2017 MAR p. 2441, Eff. 12/23/17.

Mont. Admin. R. 37.62.146 Modifications of Child Support Orders

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; REP, 2012 MAR p. 747, Eff. 7/1/12.

Mont. Admin. R. 37.62.148 Support Guidelines Tables/Forms

(1) The Child Support Services Division (CSSD) has developed a child support calculation worksheet. Copies of this worksheet may be obtained from the Department of Public Health and Human Services, Child Support Services Division, P.O. Box 202943, Helena, MT 59620 or any regional office. The worksheet is also available on the department's web site at www.dphhs.mt.gov/forms/ .

(2) Included for use with the worksheet are a financial affidavit, necessary tables, and information for completion of the guidelines calculation. To assure that these tables are current, the Child Support Services Division will republish the tables annually as soon as practical after release of information upon which tables are based. The tables will be identified by the year of publication or republication.

(3) The child support guidelines worksheets, or a replica of those forms with a similar format and containing the same information, must be used in all child support calculations under the guidelines and a copy must be attached to the support order.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-209, MCA
History: NEW, 1998 MAR p. 2066, Eff. 11/1/98; AMD, 2012 MAR p. 747, Eff. 7/1/12; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Subchapter 37.62.3 General Provisions

Mont. Admin. R. 37.62.301 Applicability of Rules

(1) The provisions of this chapter set forth the rules pertaining to administrative actions by the Child Support Services Division (CSSD) under Title IV-D of the Social Security Act, Title 40, chapter 5, MCA, and the applicable provisions of 17-4-105, MCA. Unless specifically provided, other department rules do not apply to CSSD actions, notwithstanding any statements of general applicability contained in the rules. The provisions of this chapter do not apply to actions by the department under other chapters.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-201, 40-5-202, 40-5-203, 40-5-205, 40-5-206, 40-5-207, 40-5-208, 40-5-209, 40-5-210, 40-5-213, 40-5-214, 40-5-221, 40-5-222, 40-5-224, 40-5-225, 40-5-226, 40-5-227, 40-5-231, 40-5-232, 40-5-233, 40-5-234, 40-5-235, 40-5-236, 40-5-237, 40-5-238, 40-5-242, 40-5-243, 40-5-244, 40-5-247, 40-5-248, 40-5-251, 40-5-252, 40-5-253, 40-5-254, 40-5-255, 40-5-256, 40-5-257, 40-5-261, 40-5-262, 40-5-263, 40-5-264, 40-5-271, 40-5-272, 40-5-401, 40-5-402, 40-5-403, 40-5-404, 40-5-411, 40-5-412, 40-5-413, 40-5-414, 40-5-415, 40-5-416, 40-5-417, 40-5-418, 40-5-421, 40-5-422, 40-5-423, 40-5-424, 40-5-431, 40-5-432, 40-5-433, 40-5-434, 40-5-443, 40-5-701, 40-5-702, 40-5-703, 40-5-704, 40-5-709, 40-5-710, 40-5-711, 40-5-712, 40-5-713, 40-5-801, 40-5-802, 40-5-803, 40-5-804, 40-5-805, 40-5-806, 40-5-807, 40-5-808, 40-5-809, 40-5-810, 40-5-811, 40-5-812, 40-5-813, 40-5-814, 40-5-815, 40-5-816, 40-5-817, 40-5-818, 40-5-819, 40-5-820, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-825, 40-5-901, 40-5-906, 40-5-907, 40-5-908, 40-5-909, 40-5-910, 40-5-911, 40-5-921, 40-5-922, 40-5-923, 40-5-924, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.303 Definitions

For the purposes of this chapter, unless the context requires otherwise, the following definitions apply:

(1) Insofar as they are not inconsistent with, or clarified by, the more specific definitions set forth in this chapter, the definitions set forth in 40-5-201, 40-5-403, 40-5-701, 40-5-801 and 40-5-901, MCA are adopted and incorporated by reference. Copies of 40-5-201, 40-5-403, 40-5-701, 40-5-801 and 40-5-901, MCA may be obtained from the Department of Public Health and Human Services, Child Support Services Division, P.O. Box 202943, Helena, MT 59620-2943.

(2) "ALJ" means a CSSD administrative law judge whose duties are defined in ARM 37.62.901.

(3) "Caseworker" means an employee of the CSSD who is authorized to initiate and participate in a contested case as provided in these rules and by CSSD policy and procedures.

(4) "Child support guidelines" means the administrative rules used to determine child support obligations as provided in ARM Title 37, chapter 62, subchapter 1.

(5) "Contested case" means a proceeding subsequent to service of a contested case notice under the Montana Administrative Procedure Act, the Uniform Interstate Family Support Act and the applicable provisions of Title 40, chapter 5, MCA and 17-4-105, MCA in which a determination of legal rights, duties and responsibilities is to be made after opportunity for hearing. This definition is not intended to include investigations made to determine if formal "contested case" proceedings should be instituted nor does it include proceedings related to the enforcement of support orders unless a statute provides for a hearing before the enforcement action may be taken.

(6) "Contested case notice" means a notice that initiates a contested case under the applicable sections of Title 40, chapter 5, MCA and 17-4-105, MCA and the Montana Administrative Procedure Act. Until a contested case notice is served on a party, there is no contested case and no corresponding right to an administrative hearing. Contested case notice does not apply to procedural notices such as a notice of hearing.

(7) "CSSD" means the Child Support Services Division, an agency within the Department of Public Health and Human Services charged with the responsibility of providing support enforcement services under Title IV-D of the Social Security Act.

(8) "Guidelines" means the child support guidelines defined at (4) of this rule.

(9) "OALJ" means the CSSD's office of the administrative law judge as described in ARM 37.62.901.

(10) "Party" is defined in ARM 37.62.913.

(11) "Presiding ALJ" means the ALJ assigned to a contested case when a party requests a hearing.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-201, 40-5-202, 40-5-203, 40-5-205, 40-5-206, 40-5-207, 40-5-208, 40-5-209, 40-5-210, 40-5-213, 40-5-214, 40-5-221, 40-5-222, 40-5-224, 40-5-225, 40-5-226, 40-5-227, 40-5-231, 40-5-232, 40-5-233, 40-5-234, 40-5-235, 40-5-236, 40-5-237, 40-5-238, 40-5-242, 40-5-243, 40-5-244, 40-5-247, 40-5-248, 40-5-251, 40-5-252, 40-5-253, 40-5-254, 40-5-255, 40-5-256, 40-5-257, 40-5-261, 40-5-262, 40-5-263, 40-5-264, 40-5-271, 40-5-272, 40-5-401, 40-5-402, 40-5-403, 40-5-404, 40-5-411, 40-5-412, 40-5-413, 40-5-414, 40-5-415, 40-5-416, 40-5-417, 40-5-418, 40-5-421, 40-5-422, 40-5-423, 40-5-424, 40-5-431, 40-5-432, 40-5-433, 40-5-434, 40-5-443, 40-5-701, 40-5-702, 40-5-703, 40-5-704, 40-5-709, 40-5-710, 40-5-711, 40-5-712, 40-5-713, 40-5-801, 40-5-802, 40-5-803, 40-5-804, 40-5-805, 40-5-806, 40-5-807, 40-5-808, 40-5-809, 40-5-810, 40-5-811, 40-5-812, 40-5-813, 40-5-814, 40-5-815, 40-5-816, 40-5-817, 40-5-818, 40-5-819, 40-5-820, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-825, 40-5-901, 40-5-906, 40-5-907, 40-5-908, 40-5-909, 40-5-910, 40-5-911, 40-5-921, 40-5-922, 40-5-923, 40-5-924, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.305 Telephone Communications

(1) Due to the need for maintaining confidentiality of records, it is essential that the CSSD confirm the identity of persons to whom information is provided. Because a telephone caller's identity cannot be verified, no telephone inquiries concerning confidential information will be accepted by the CSSD.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-203, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.307 Distribution of Collections

(1) Except as provided in (2) and (6), collections of support from all sources, including but not limited to the proceeds from writs of execution, support liens, state tax offsets, and lump sum settlements, will be distributed, to the extent the collection is sufficient, in the following sequence:

(a) to pay the current support obligation for the month in which the collection is made if current support has not previously been paid for that month to the obligee. However, if the obligee is a recipient of public assistance including Title IV-E foster care services, collections of current support shall be retained by the CSSD for subsequent allocation according to applicable state and federal statutes and regulations;

(b) to satisfy any arrears owed to the obligee, except when the obligee is a recipient of public assistance, including IV-E foster care services. When the obligee is a public assistance recipient, or if no arrears are owed to the obligee, collections in excess of current support shall first be applied to arrears owed to the state of Montana under 40-5-202, 40-5-221, and 53-2-613, MCA, before any funds are distributed to the obligee.

(d) to satisfy fines awarded under 40-5-208 or 40-5-226, MCA which are owed by the obligor.

(2) When the CSSD is collecting support arrears only, amounts shall be distributed to open CSSD cases according to (1)(b) through (1)(d).

(3) After a distribution of support collections to the obligee is determined appropriate but before actual distribution is made, the CSSD may intercept a portion of the collections, as authorized by ARM 37.62.501, to be applied towards recoupment of over-payments previously made to the obligee.

(4) When the CSSD is providing services to two or more obligees of the same obligor:

(a) a distribution of current support under (1)(a) which is less than the amount of current support due to all the obligees shall be prorated among the obligees based on the amount of current support due to each obligee;

(b) a collection of support arrears owed under (1)(b) shall be distributed equally among the obligor's cases, provided however, that the amount distributed shall not exceed the arrears owed; and

(c) until current support and arrears owed by an obligor under a support order are satisfied, there shall be no distribution made to an obligee in a case where there is no support order.

(5) Notwithstanding the provisions of (4) above:

(a) if a particular support collection is made through an order to withhold income, any amount distributed from that collection must be distributed only to the obligor's cases that currently have an order to withhold income in place;

(b) a support payment by personal check, money order or like form of payment which is made payable only to a particular obligee, will be distributed only to that obligee's case;

(c) a support collection resulting from a writ of execution or similar case-specific remedy must be distributed to the specific obligee's case;

(d) a support payment received by an obligee directly from the obligor and turned over to the CSSD for distribution under this section will not be distributed to any other obligee's case; and

(e) support collections made through a clerk of court or other public or private child support enforcement authority, who forwards the collection to the CSSD, shall be distributed only to the obligor's case designated by the clerk of court or other authority. If the forwarded collection fails to include a designated specific case, the distribution provisions of (4) will apply.

(6) Support collections resulting from federal tax offsets will be distributed only to those arrears certified to the tax authorities as past due. These collections shall be distributed, to the extent they are sufficient, first to satisfy any arrears owing to the state of Montana under 40-5-202, 40-5-221, and 53-2-613, MCA. If there is no past due support owed to the state of Montana, or to the extent the collection exceeds the amount owed to the state of Montana, the collection shall be distributed to arrears owed to the obligee. If arrears are owed in more than one case, the collection shall be distributed equally among the obligor's cases, provided that the amount distributed shall not exceed the arrears owed.

(7) Except as provided in (9) below, the CSSD shall not distribute collections or any part of collections towards future support, even though the obligor may so direct, until all appropriate distributions under (1) and, if appropriate, (4) are made first.

(8) In the absence of a support order, voluntary payments of support made by an obligor shall be distributed as follows:

(a) Whenever there is a written or oral agreement and the agreement specifies a support amount and the frequency of payment, payments shall be distributed as provided in (1); or

(b) If there is no agreement, the total amount received in a given month will be counted as that month's current support obligation.

(9) For purposes of determining distribution under this rule, the effective date of a support collection shall be known as the date of collection.

(a) For collections made under an order to withhold income, the date of collection is the day the CSSD receives the payment. However, if the support is withheld by the payor in a month when the payment is due, but the payment is received by the CSSD in a month other than the month when due, the date of withholding is the date specifically reported by the payor in documentation accompanying the payment;

(b) Except as provided in (9)(c), when a collection is received in the mail directly from the obligor, the date of collection is the date that the CSSD receives the payment;

(c) If a collection is received in the form of a post-dated check, the date of collection shall be the date of the check;

(d) In all other cases, the date of collection shall be the day the CSSD receives the collection;

(10) Under this rule, collections characteristic of past due support may be distributed the same as collections identified as current support. However, for purposes other than distribution, these collections will be accounted for as past due support.

(11) For the purposes of determining statutes of limitations, arrears, interest on arrears, collection remedies and similar uses, all support collections, without regard to date of distribution, will be applied to satisfy the oldest unpaid installment of support due under the support order.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 17-4-105, 40-5-202, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; AMD, 1996 MAR p. 1714, Eff. 6/21/96; AMD, 1998 MAR p. 2496, Eff. 10/1/98; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20; AMD, 2022 MAR p. 1878, Eff. 9/24/22.

Mont. Admin. R. 37.62.309 Independent Support Enforcement Contractor

(1) The CSSD as provided in 40-5-264, MCA, is authorized to enter into cooperative agreements with any person, firm, corporation, association, political subdivision or other department of the state for the purpose of carrying out its duties under state law and Title IV-D of the Social Security Act. Under such agreements the CSSD may designate independent support enforcement contractors whose powers and duties are defined by the terms of the contract.

(2) An independent support enforcement contractor shall be accountable publicly and to the CSSD, and shall comply with the terms and conditions of the contract, as well as with all applicable federal and state laws, regulations and rules, including policies and procedures of the CSSD for processing casework.

(3) The jurisdiction and authority of an independent support enforcement contractor shall be limited to the terms of the contract and in no event may such jurisdiction and authority exceed that of the CSSD unless otherwise provided by law.

(4) In any action taken by an independent support enforcement contractor under the contract, the independent support enforcement contractor will inform all parties, their counsel or other representative, and the court or administrative hearing officer that such action is being undertaken as an independent support enforcement contractor. On all documents and forms bearing the name of the CSSD the independent support enforcement contractor shall include a statement in bold type of the status of independent support enforcement contractor as an independent contractor.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-264, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Subchapter 37.62.5 Nonpublic Assistance Services

Mont. Admin. R. 37.62.501 Terms and Conditions

(1) Under 40-5-203, MCA, the CSSD will provide services to any obligee or obligor who files an application for services with the CSSD. If public assistance was previously paid to an obligee, the CSSD will continue to provide services to the obligee without need for an application. However, if the obligee refused or terminated continued services following the last payment of public assistance, the obligee must file an application. An application for services or an obligee's acceptance of continued services after termination of public assistance shall constitute the applicant's or obligee's agreement to the following terms and conditions.

(2) For the purposes of this rule, "customer" means any person or entity who applies for CSSD services or who is receiving CSSD services.

(3) To receive and to continue to receive CSSD services under 40-5-205, MCA, a customer must:

(a) pay any application fee and any other fee which may be charged under 40-5-210, MCA;

(b) provide original certified copies of all child support orders, modifications or child support orders, whether issued by a Montana court or agency or by an out-of-state court or agency;

(c) provide certified copies of all payment records if support was ordered to be paid through the clerk of court, central registry or other public entity. If support was ordered to be paid directly to the obligee, provide any records, receipts or other materials which document payments made or received;

(d) upon request of the CSSD, promptly provide any information, documents, statements, exhibits, and other materials which the CSSD, in its judgment, may determine relevant to the case or which the CSSD finds is a necessary predicate to taking any action in the case. The customer must promptly advise the CSSD of any later changes or additions to the information and materials previously provided to the CSSD;

(e) promptly advise the CSSD in writing of any change of address or status, or any new information about the customer or other parties in the case, including changes in physical custody of the child, or of any adoption proceedings;

(f) cooperate with the CSSD in appearing at the time and place requested for interviews, hearings, depositions, blood draws, and other called for appearances where the presence of the customer is necessary for preparing testimony and evidence, providing information, testifying as witness and similar case pertinent activities;

(g) to ensure accurate payment records, if the obligee is the customer, the customer must promptly turn over to the CSSD all child support payments received from the obligor. If the obligor is the customer, the customer must pay child support through the CSSD for subsequent distribution to the obligee;

(h) let the CSSD know immediately if the customer or any other party initiates any action, whether judicial, administrative or private, which competes with, is an alternative to, is inconsistent with, or which may in any way affect the action the CSSD is taking in the case;

(i) except for the information available through the CSSD's voice response unit (VRU) or the CSSD's online payment lookup web site, submit all requests for specific case information in writing to the CSSD. In making any request for information, the customer must provide sufficient information to identify the customer as the person or entity entitled to receive the information.

(4) The CSSD may collect any fees incurred and owing by a customer under 40-5-210, MCA, by offsetting the fees against any funds which may be distributable to the customer. However, if the amount being distributed is a current support payment, the offset will not exceed 10% of the payment.

(5) In some instances when the customer is the obligee, the customer may receive money to which the customer is not entitled. The CSSD may make a written demand for repayment of the money from the customer. The customer's silence or failure to respond to the written repayment demand within 10 days of the demand shall be considered the customer's consent to recoupment of the money from any child support collection made on the customer's behalf. Recoupment shall be made by offsetting 10% of any current child support collection and by offsetting any additional child support collection made in excess of the current support obligation. If a customer contests the repayment demand, the CSSD may file an action in the district court to establish and collect the amount.

(6) Because support orders are often expressed in terms other than in monthly payments and because they often provide for varying and inconsistent payment due dates, to simplify monitoring of payments and payment accounting, the CSSD may elect to annualize the obligations. When the obligation is annualized, the total support payments due for a 1 year period are divided into 12 equal monthly installments.

(7) A customer cannot specify which of the CSSD services that customer may want to receive. The CSSD will determine which services are appropriate and the timing and duration of those services in accordance with Title IV-D of the Social Security Act, and the regulations promulgated thereunder.

(8) CSSD staff attorneys assigned to a case represent the CSSD and no attorney-client relationship exists between the customer and the CSSD attorney. At any hearing or in any action undertaken by the CSSD, the customer may appear and be represented by independent counsel of the customer's own choice.

(9) When there are multiple or concurrent procedures and remedies, whether judicial or administrative, criminal or civil, federal or state, which may be applicable to the customer's case, the CSSD, at its sole discretion, will determine which procedure and remedy to apply, including the sequence and timing of concurrent or consecutive actions.

(a) In determining which procedure or remedy to apply to an individual case, the discretion of the CSSD will be guided by the totality of circumstances including the time and effort required, the resources of the CSSD, the interest of the public at large and the needs of the child.

(10) The CSSD may terminate services:

(a) upon the request of the customer unless the customer is an obligee and the child is receiving public assistance benefits;

(b) when the CSSD is unable to locate the customer within a 30 calendar day period despite attempts to make contact by phone and at least one certified letter to the customer's last known address;

(c) when the customer fails to provide any information, documents or other materials requested under (2) of this rule and the CSSD cannot take the next step in the case without the information, documents or materials;

(d) when the customer fails to cooperate with the CSSD and the customer's cooperation is necessary to the action initiated by the CSSD; and

(e) or any other reason consistent with Title IV-D of the Social Security Act and the federal regulations promulgated thereunder.

(11) The CSSD will notify the customer in writing 60 calendar days prior to termination of services under (8)(b) through (e) of this rule, of the CSSD's intent to terminate services. The CSSD will not terminate services if the customer, within the notice period, reestablishes contact with the CSSD, supplies the requested information, documents or materials or begins to cooperate with the CSSD, whichever is appropriate. The CSSD's decision to terminate services is final and not subject to protest except as may otherwise be provided by law.

(a) If CSSD services are terminated and if there is a change in circumstances which would permit the CSSD to reactivate prior terminated services or initiate new or additional services, the former customer can reinstate services by filing a subsequent application with the CSSD.

(12) The CSSD does not guarantee or warrant the results of services.

(13) If the customer is the obligee, the customer agrees that the value of CSSD services exceeds any interest that might have accrued on collections that are held pending proof of validity, confirmation of funds, or possible adjustments from joint federal tax offsets, and thereby waives that interest. Joint federal tax offsets may be held up to six months pursuant to federal law.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-203, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; AMD, 1996 MAR p. 1714, Eff. 6/21/96; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2017 MAR p. 2441, Eff. 12/23/17; AMD, 2020 MAR p. 966, 5/30/20.

Subchapter 37.62.7 Fee Schedule

Mont. Admin. R. 37.62.705 Fee Schedule

(1) As authorized by 40-5-210, MCA, the CSSD adopts the following schedule:

(a) for each person, including the child, submitted or resubmitted for paternity blood testing, at the contract rate;

(b) for other actual costs and actual expenses incurred by the CSSD in a judicial proceeding, as awarded by the court; and

(c) a fee of $25.00 shall be collected from each applicant for non-assistance related services. This fee shall be collected from the applicant at the time of application in the form of a personal check, electronic check, cashier's check, money order, credit card, or debit card.

(2) The fees in (1)(a) shall be assessed to the parent, whether the alleged father or the mother, whose denial of paternity necessitates the taking of paternity blood tests.

(3) Other fees assessed to the party or entity requesting the service are:

(a) for parent locate services, a fee of $10.00 if the social security number of the person to be located is provided to the CSSD, and $14.00 if the social security number of the person to be located is not provided; and

(b) for each intercept of federal or state payments, a standardized fee of $25.00 or actual costs if less than the standardized fee; federal or state payments include, but are not limited to, income tax refunds.

(4) In no case may a fee authorized under this rule be charged to or collected from a person while that person is a recipient of public assistance in Montana unless federal regulations pertaining to operation of the Title IV-D program allow the charging or collection of that fee. Fees will not be charged to individuals receiving a financial assistance cash grant under the federal TANF (Temporary Assistance to Needy Families) Block Grant in Montana.

(5) In no case may a fee authorized under this rule be charged to or collected from a foreign reciprocating country, or an obligee residing in a foreign country.

(6) Any fee provided for under this rule may be assessed in addition to any other fee allowed by the rule which may be applicable to the case.

History

Authorizing statute(s): 40-5-202, 40-5-210, MCA
Implementing statute(s): 40-5-210, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; AMD, 1996 MAR p. 1714, Eff. 6/21/96; AMD, 1998 MAR p. 1777, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20; AMD, 2024 MAR p. 2071, Eff. 8/24/24.

Mont. Admin. R. 37.62.707 Waiver or Deference of Fees

(1) The CSSD may not waive or defer any of the foregoing fees except to encourage expedient, informal dispositions.

History

Authorizing statute(s): 40-5-202, 40-5-210, MCA
Implementing statute(s): 40-5-210, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Subchapter 37.62.9 Hearing Procedures

Mont. Admin. R. 37.62.901 Organizational Structure

(1) Within the CSSD there is an independent hearings bureau. For the convenient classification and division of business, the hearings bureau is divided into two administrative units consisting of the administrative law judges (ALJs) and the office of the administrative law judge (OALJ).

(2) The ALJs are responsible for and preside over all hearings in CSSD contested cases.

(a) In addition to the powers and duties set forth in 2-4-611(3), MCA an ALJ has the power and duty to carry out, undertake or perform any task or action expressly or implicitly required of an ALJ under these rules including the general authority to regulate the conduct and course of contested cases.

(3) The OALJ is responsible for providing administrative and clerical support to the ALJs:

(a) maintaining all contested case hearing records;

(b) calendaring contested cases for hearing;

(d) setting hearing dates;

(e) tracking the progress of a case through the hearing process; and

(f) similar other activities.

History

Authorizing statute(s): 2-4-201, 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.903 Assignment of Cases to Alj, Disqualification and Substitution

(1) When a hearing is requested by a party to a contested case, the OALJ will allocate the case file to an ALJ. Except as provided in this rule, once a case is assigned to an ALJ, the case shall be the continuing responsibility of that ALJ until a final decision and order is entered and the time for judicial review has expired. If judicial review is filed, the ALJ will lose jurisdiction over the case and will regain jurisdiction only if the district court remands the case to the CSSD for further proceedings.

(2) The duties of an ALJ are interchangeable among the judges during the absence or disability of the presiding ALJ. An ALJ making an order for the presiding ALJ will be presumed to have acted with the consent of the presiding ALJ.

(3) A presiding ALJ may transfer a case to another ALJ who will then become the presiding ALJ. Notice of the transfer shall be provided to all parties if the transfer is made subsequent to an assignment notice filed under (5). As an exception to (6)(a), the substitute ALJ shall give the parties reasonable time, determined according to the circumstances of the case, to submit a motion for disqualification.

(4) For the purposes of (6), when a contested case is assigned to a presiding ALJ for hearing, the OALJ will notify the parties of the assignment. This notice will be included as part of the order setting a hearing date.

(5) An ALJ may make an order or give notice of recusal or self-disqualification at any time.

(6) A party may submit a motion for disqualification of a presiding ALJ as provided by 2-4-611(4), MCA. The motion shall be heard and determined by an ALJ other than the one named in the motion.

(a) Motions for disqualification of a presiding ALJ must be filed with the OALJ within 10 calendar days of the effective date of service of the order setting the matter for hearing. If the ALJ fails to rule on the motion before the day set for the hearing, or if the motion is not timely filed, the motion shall be considered denied.

(b) Except as may be provided by 2-4-701, MCA determinations of motions for disqualification are not subject to judicial review but may be considered as part of a judicial review of the final decision and order in a contested case.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.905 Uniformity, Consistency and Independence

(1) To achieve and maintain uniformity and consistency in determining contested cases, contested case decisions shall be guided by:

(a) applicable sections of the Montana Code Annotated;

(b) case law decisions of the Montana supreme court;

(d) precedent created by other ALJ final decisions and orders in contested cases where the facts are essentially the same; and

(e) to determine the nature, extent, amount or duration of a support order issued by a tribunal of another state, the statutory and case law of the issuing state and the federal Full Faith and Credit for Child Support Orders Act (28 USC 1738 B).

(2) When there is no statute, case law or administrative rule directly pertinent to a particular contested issue, or when the law is unsettled, and to the extent the following are of general applicability and do not conflict with the rules for ex parte communication, the ALJ's discretion shall be guided by:

(a) written CSSD policy directives; and

(b) the CSSD policy and procedures manual.

(3) Notwithstanding (2), each ALJ has independent authority to hear and decide contested cases. Under the unique circumstances of a particular case and upon a showing of facts or law sufficient to rebut application of a particular policy, an ALJ may depart from established CSSD policy. Any departure shall be supported by reasoned explanation.

(4) An ALJ presiding over a contested case does not have general powers of equity similar to those of the district courts. Consequently, except in those specific circumstances allowing such equitable relief as is defined by statute or case law, an ALJ may not depart from applicable law and rule to grant equitable relief to a party even when such relief may appear proper under the circumstances.

(5) During the course of a hearing, if a particular policy applicable under (2) will affect a certain matter at issue and if that issue is disputed, the ALJ will give the parties an opportunity to show cause why the policy is not applicable under the circumstances of that case.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.907 Ex Parte Communications

(1) Except as provided in (3) , or unless expressly authorized by any rule under this chapter, a presiding ALJ shall not initiate or participate in ex parte communications, directly or indirectly, with any party or with any person who has a direct or indirect interest in the outcome of the case.

(2) For the purpose of this rule, a prohibited ex parte communication is any oral or written information that could intentionally or unintentionally influence any issue in a pending case or that directly or indirectly furnishes, diminishes or modifies any evidence in the case without notice and opportunity for all parties to participate in the communication.

(3) A presiding ALJ may consult with and receive aid from OALJ staff or another ALJ concerning the merits of a contested case if those persons do not receive ex parte communications of a type that the presiding ALJ would be prohibited from receiving.

(4) A presiding ALJ may engage in communications concerning administrative or procedural matters when the communication is necessary under the circumstances and does not affect the substantive rights of a party.

(5) If the presiding ALJ receives an improper ex parte communication, any decision and order entered in that case must include the ALJ's reason for concluding that the communication did not prejudice the substantial rights of any party.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.909 Contested Case Proceedings, Answer or Response and Request for Hearing

(1) Contested cases are initiated by service of a notice as provided in the Montana Administrative Procedure Act, applicable sections of Title 40, chapter 5, MCA and 17-4-105, MCA. Absent service of such notice there is no contested case, no jurisdiction and no corresponding right to an administrative hearing.

(2) A person served with a contested case notice may request an administrative hearing as provided in (5). Except as provided in (3) and (4), no additional answer or responsive pleading to any contested case notice is required.

(3) When the contested case notice is to initiate income withholding proceedings under 40-5-412 and 40-5-414, MCA, any request for hearing must allege a mistake of fact. If a mistake of fact is not alleged, the request for hearing may be denied. Notwithstanding the omission of a mistake of fact, a person may be entitled to a hearing for the purpose of contesting the jurisdiction of the CSSD to withhold the person's income.

(4) When requesting a hearing, the person must include with the request a brief statement of any affirmative defense the party may have to the contested case notice.

(5) To request a hearing, the person must:

(a) make the request in writing; and

(b) within the time permitted by statute or these rules for requesting the hearing, file the request with the OALJ as provided in ARM 37.62.911.

(6) In addition to the provisions of (4) through (5)(b), the written request must include the name, mailing address and telephone number at which the person requesting the hearing can be reached for service of subsequent documents and orders.

(7) The CSSD will make hearing request forms consistent with this rule available for use by persons requesting a hearing. Except for a request for hearing that omits a mistake of fact required by (3), a timely request for hearing that is generally in compliance with this rule shall not be dismissed solely for failure to strictly satisfy the requirements of this rule.

(8) A request for hearing is not deemed made until a written request is actually received by the OALJ. The OALJ shall deny untimely requests for hearing.

(9) Informal contact with the CSSD or OALJ, whether written or oral, will not constitute a hearing request, and will not extend the time in which a hearing must be requested.

(10) The CSSD, as the party initiating a contested case proceeding, does not need to request a hearing. If no other party requests a hearing, a default decision and order may be entered. However, if no other party requests a hearing, the CSSD may at its discretion request a hearing.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.911 Filing and Proof of Service

(1) Whenever a rule or statute requires or permits a request for hearing, motion, brief, responsive answer or other document relating to the hearing to be filed with the department or the CSSD, the place of filing shall be the OALJ. The location, mailing address, email address, and fax number of the OALJ shall be provided on the contested case notice and on each order, subsequent notice or other document mailed by the OALJ to a party. Excluding legal holidays, the hours for filing papers are between 8:00 a.m. and 5:00 p.m., Monday through Friday. Any papers presented or delivered after 5:00 p.m. shall be stamped the next business day. All original papers shall be filed with the OALJ and not the ALJ.

(2) Facsimile (fax) filings and electronic filings may be accepted. If the fax or electronic copy is offered to prove a fact, the fax or electronic copy will be stamped "received" by the OALJ and the original document must be filed with the OALJ within 5 business days in order to be filed as of the received date of the fax or electronic copy. The fax or electronic copy and the original document must be identical, or the filing is void. If the original is not timely filed, the received fax or electronic copy shall be void except upon a finding of good cause by the ALJ.

(3) Filing with the OALJ is effective upon actual receipt at the OALJ and not upon mailing. Filing with the OALJ does not constitute service on the CSSD and service on the CSSD does not constitute a filing with the OALJ.

(4) Whenever service of a document is required by ARM 37.62.917, an original certificate of service shall be attached to each document filed under this rule including fax or electronic filings. The copies served on other parties or entities entitled to service shall also attach certificates of service. Certificates of service shall be affixed to the document and shall include the date the document was served, and the name of each party and entity served.

(5) Failure to provide a certificate of service does not affect the validity of service provided that service can be substantiated by other proof, if necessary.

(6) If the document presented for filing was prepared by an attorney representing a party, the attorney's name, complete mailing address and telephone number shall appear at the top, left-hand corner on the document's first page.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2017 MAR p. 2441, Eff. 12/23/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.913 Parties

(1) Except as provided in (3), a party includes any person served with a CSSD contested case notice.

(2) As the entity initiating the proceedings, the CSSD is automatically a party in all contested case proceedings. However, the CSSD, at its discretion, may limit its participation in the case. When the CSSD does participate as a party, it will do so through a CSSD caseworker or CSSD attorney as provided in ARM 37.62.915.

(3) An interested person who receives an informational copy of the contested case notice is not a party.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.915 Representation

(1) Any person appearing in a CSSD proceeding may, at the person's own expense, be accompanied, represented and advised by an attorney.

(a) To represent a party in a contested case, the attorney must be licensed to practice law in this state or be admitted pro hac vice.

(b) If the attorney files a notice of appearance or signs and files a request for hearing or other responsive pleading with the OALJ in that contested case action, the attorney shall be designated as the attorney of record and all further communication, mailings and notices made in that contested case action will be directed to the attorney. However, the OALJ will mail or deliver copies of all decisions and orders to both the party and the party's attorney. If there is no attorney of record, the OALJ, CSSD and other parties will make all communications directly to the party.

(c) An attorney of record may withdraw from a pending case, however the attorney shall give notice of the withdrawal to the OALJ, the CSSD and all other parties. Upon receipt of notice the OALJ, the CSSD and all other parties will redirect all subsequent communications to the party formerly represented by the attorney.

(d) Unless the attorney sooner withdraws and gives notice thereof, an attorney of record will continue as the attorney of record until the final decision and order is entered in the case.

(2) A party to a contested case may be accompanied, assisted and advised by a person who is not an attorney or who is an attorney not admitted to practice law in this state; however, that person may not represent the party during the hearing or give statements or make arguments on the party's behalf. The OALJ will direct all communications to the party.

(3) A party who chooses not to be represented by counsel and who represents himself or herself must substantially comply with the provisions of these rules. An ALJ may modify the strict application of these rules to an unrepresented party to the extent that strict application is not necessary to assure a fair hearing, and the modification does not affect the substantive rights of any other party.

(4) Through the use of pre-approved legal forms and written CSSD policies and procedures, and under the ultimate direction of and in consultation with a CSSD attorney, and consistent with rules 5.3 and 5.5 of the Montana Rules of Professional Conduct, a CSSD caseworker may initiate, appear in and participate in a contested case. A caseworker's assertion in a contested case notice is sufficient to constitute the caseworker's authority to participate in the case. When in a particular case a mailing, service, or other communication with the CSSD is required by these rules, the mailing, service, or other communication must be directed to the participating caseworker.

(5) At the discretion of the CSSD, a CSSD attorney may personally appear and taken an active role in a contested case at any phase of the proceedings. The CSSD attorney may also cease taking an active role at any time. When a CSSD attorney does appear in the case, the attorney will not need to file a notice of appearance or sign any pleading as provided in (1)(b). The CSSD attorney's appearance is sufficient to establish the attorney's authority to provide counsel and representation. When requested by a CSSD attorney appearing the case, all other parties shall direct all further communication, mailings and notices made in that case to the attorney.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271,40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.917 Service of Subsequent Notice, Motions, Briefs, and Other Papers

(1) After service of a contested case notice, all subsequent notices including amendments to a contested case notice, motions, briefs and other papers pertaining to a pending administrative action must be served on all parties. Service may be made by regular U.S. mail, postage prepaid, addressed to each party at:

(a) the mailing address provided by the party in the request for hearing or a subsequent mailing address provided by the party;

(b) the party's last known mailing address if no request for hearing was made, or if the request for hearing failed to include an address; or

(c) the address of the place where service of the original contested case notice was achieved, if the party's mailing address is not known to the CSSD.

(2) Proof of service must be attached to each document as provided by ARM 37.62.911.

(3) When the requirements of this rule are met, service by mail is complete upon mailing.

(4) Service on the CSSD does not constitute a filing with the OALJ and filing with the OALJ does not constitute service on the CSSD.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.919 Notice of Hearing, Scheduling Order and Location of Hearing

(1) If a request for hearing is timely and properly filed according to these rules, the OALJ shall assign the case to an ALJ and schedule a time, date and place for the conduct of the hearing. The OALJ shall serve a notice of hearing and scheduling order on all parties. In support enforcement, paternity establishment, and support order establishment cases where the obligee is not a party, the OALJ shall also send a copy of the notice of hearing to the obligee. In those instances, the obligee is not a party to those proceedings but may attend as a nonparty observer or witness.

(2) The notice of hearing and scheduling order shall:

(a) set the date, time and place for the hearing;

(b) set the date by which the witness and exhibit list must be filed with the OALJ and by which a copy of the list must be served on all other parties;

(c) set the date by which exhibits must be exchanged with other parties if exhibits are not served as attachments to the witness and exhibit list;

(d) set the date by which a party must request discovery or request subpoenas for the attendance of witnesses or the production of documents;

(e) inform the party that the hearing will initially be held by telephone conference;

(f) if the hearing is by telephone conference, inform the party that before the hearing record is closed, the party will have an opportunity, at the party's request or upon a showing that a party's case was prejudiced by the lack of an in-person hearing, to request a de novo in-person hearing;

(g) give the party directions for the conduct of telephone hearings;

(h) direct the party to provide a telephone number at which the party will be available for the hearing and further direct that if the party does not provide the number or fails to be at the number when called for the hearing, the ALJ may either enter the party's default or proceed with the hearing in absentia; and

(i) inform the party that if the party does not have a telephone available for a telephone hearing, at the party's request, a telephone will be made available to the party at the nearest regional CSSD office or at the public assistance office in the county where the party resides.

(3) The time of the hearing will be during the CSSD's regular business hours. The place of the hearing may be:

(a) for a telephone hearing, at the location of the telephone number provided by each party and, if applicable, the obligee; or

(b) for an in-person hearing, as provided in 40-5-231(3), MCA.

(4) The parties may agree to an in-person hearing in another location which is mutually convenient to all the parties and the CSSD.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.921 Motions

(1) Prior to entry of an order resolving a contested case notice, a party may seek relief in that case by means of an appropriate motion. Appropriate motions may include motions to dismiss, motions for summary judgment, motions for continuance and similar other motions.

(2) Motions shall state:

(a) the relief sought by the party;

(b) the grounds and authority supporting the motion; and

(3) All motions which assert factual matters not of record must be accompanied by affidavits or exhibits which show the facts that are the grounds for the proposed relief. The failure to provide affidavits or exhibits shall be deemed an admission that the asserted facts do not exist.

(4) Each motion must also be accompanied by a brief or memorandum of law showing the moving party's entitlement to relief.

(5) Upon receipt of a filed motion the ALJ will set a schedule for the other parties to file responses to the motion and to file answer or reply briefs or memorandums of law.

(6) The failure of a party to file a brief or memorandum of law may subject the motion to summary ruling, and failure of a moving party to file a brief in support of the motion may be treated as an admission the motion is without merit. The failure to file an answer brief may be treated as an admission the motion is well taken and should be granted. The filing of a reply brief by the moving party is optional.

(7) If the moving party wants the ALJ to take immediate action on a motion, the motion should state that opposing parties have been contacted and have no objection to the motion; the moving party should advise the OALJ of the contact and non-objection when filing the motion, so the motion can be immediately brought to the attention of the ALJ. All uncontested motions should be accompanied by a proposed order with sufficient copies for the OALJ to mail to all other parties. If another party objects to the motion or if there is no indication whether another party objects, the motion will be decided as provided in (5) , (6) and (8) .

(8) Unless the ALJ determines that oral argument would be beneficial to determination of the motion, oral arguments will not be permitted. Motions will be decided on the briefs and other papers submitted in support of the motion. Motions will be deemed submitted at the time set for filing the final brief.

(9) If the ALJ does not render a decision with regard to the motion before entering an order resolving the contested case notice, the motion shall be deemed denied.

(10) Nothing in this rule shall be construed to preclude the oral presentation of motions or objections related to evidence, motions for summary judgment or other matters arising at the hearing.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.923 Extensions of Time and Continuances

(1) Because CSSD contested cases must proceed on an expedited basis, requests for extensions of time and continuances are disfavored and shall not be routinely granted. Extensions of time and continuances will be granted only upon a showing of extraordinary circumstances beyond the party's control which will cause substantial prejudice to the party if the extension or continuance is not granted.

(2) A request for an extension of time may be filed with the OALJ at any time prior to the day an activity or time frame is set by order, rule or statute for completion. The request shall contain:

(a) a statement of the reason for the extension of time;

(b) a statement showing extraordinary circumstances beyond the party's control which will cause substantial prejudice to the party if the extension or continuance is not granted; and

(3) Uncontested requests for extensions of time or continuances which include the above statements may be granted by the OALJ. If the request is contested for any reason the request will be submitted to the ALJ for determination as if the request were a motion under ARM 37.62.919. If the ALJ does not render a decision on the request by the day the activity or time frame is due to be completed, the request shall be deemed denied.

(4) All uncontested requests for extensions of time or continuances must be accompanied by an appropriate proposed order with sufficient copies for the OALJ to mail to all parties.

(5) An order for extension of time to file papers, briefs and other materials will include a provision for extending the time for other parties to file and serve opposing briefs and reply briefs and other responding materials.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.925 Amendments

(1) A contested case notice may be amended by the CSSD at any time before an order is issued resolving the notice. Except when the notice is amended during hearing, the amended notice shall be served on all parties in accordance with ARM 37.62.917.

(a) Except as provided in (1)(c), a party who has responded to the contested case notice as provided in ARM 37.62.909 does not need to respond to or request a hearing on the amended notice.

(b) If a party did not respond to the original notice as provided in ARM 37.62.909, the party may respond to the amended notice within the time frames provided in the amended notice.

(c) If a party did respond to the original notice and the party's request for hearing was denied for any reason, the party may respond to the amended notice as provided in ARM 37.62.909 and request a new hearing with regard to the issues claimed in the amended notice.

(d) The response time shall be the same number of days as allowed by statute or rule for requesting a hearing on the original notice. The time for responding to an amended notice begins on the day after the amended notice is served.

(2) During a hearing a party may seek to offer evidence relating to new issues not raised in the contested case notice or in the party's response to the notice. With the express or implied consent of the parties, the contested case notice or response may be deemed amended to conform to evidence which is relevant and material to issues within the scope of the CSSD's authority.

(3) If a party objects to evidence offered at a hearing on grounds that the evidence is not within the issues raised by the contested case notice or the response to the notice, the ALJ may allow the notice or response to be amended upon a showing that the evidence is relevant and material to issues within the scope of the CSSD's authority. If the amendment causes a surprise element to be introduced during a hearing, the ALJ may recess or adjourn the hearing to enable the objecting party to meet, refute, or rebut such evidence and may also order the exchange of additional relevant information or exhibits. The hearing record shall remain open and the ALJ shall set a specific time and date for the hearing to be reconvened. When a hearing is reconvened, it will be for the limited purpose of allowing the objecting party to meet, refute or rebut the evidence submitted by surprise in the prior hearing. This remedy may be had in addition to, or in conjunction with, any other remedy provided by these rules.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.927 Evidence

(1) The evidence received and considered in CSSD contested cases shall conform to the common law, the statutory rules of evidence and the provisions of 2-4-612 , MCA.

(2) A presiding ALJ may receive any evidence offered by a party without ruling on its admissibility at the time it is offered. After the matter is submitted for decision, the ALJ will then consider and determine the admissibility and sufficiency of the evidence, giving due regard to its materiality, relevance, and trustworthiness. Evidence may be excluded even though no objection was raised at hearing. If the ALJ takes evidence under advisement and rules on its admissibility later, a party may object to the inclusion or exclusion of evidence under this rule by filing a motion to review the proposed order as provided for in ARM 37.62.951.

(3) This rule shall not be construed to prevent the ALJ from limiting cumulative, irrelevant or other inadmissible testimony or evidence during the hearing.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.929 Official Notice

(1) Official notice may be taken of:

(a) federal law, including the constitution of the United States, congressional acts, resolutions, records, journals, and committee reports, the decisions of federal courts and administrative agencies, executive orders and proclamations, and all rules, orders and notices published in the federal register;

(b) state law, including the constitution, acts of the legislature, resolutions, records, journals and committee reports, decisions of the administrative agencies of the state of Montana, executive orders and proclamations by the governor, and all rules, orders and notices published in the Montana administrative register;

(c) department and CSSD organization, including administration, officers, personnel, official publications and official acts of the department and the CSSD;

(d) any fact that could be judicially noticed in the district courts including generally recognized technical and scientific facts obtained from treatises of learned scholars and public documents to the extent allowed by the rules of evidence;

(e) the records of other CSSD proceedings;

(g) codes, regulations, standards, action transmittals, policy interpretation questions and information transmittals issued or adopted by a federal agency pursuant to Title IV-D of the Social Security Act;

(h) written CSSD policy directives;

(i) the CSSD policy and procedures manual;

(j) records, reports, statements, and data compilations in any form of a clerk of court, public office or state agency of this or any other state or federal agency which are part of the regularly conducted activities of that clerk of court, public office or state agency;

(k) payment histories originated by the CSSD or obtained from clerks of court, the child support agencies of other states or other public records sources, and CSSD-prepared abstracts of those histories including computerized data compilations; and

(l) child support guidelines worksheets and similar documents, completed CSSD case related forms, and other papers within the scope of the CSSD's technical knowledge as a body of experts and within the scope of its duties, responsibilities and jurisdiction.

(2) Officially noticed law may be admitted during a hearing without the necessity of foundation testimony or formal proof of the existence of the law. Officially noticed facts, if relevant to a determination of the matter at issue, may be admitted as evidence without the necessity of foundation testimony. A party is entitled upon timely request to an opportunity to rebut any facts officially noticed or to contest the application of an officially noticed law before the matter is resolved by a final decision or order of the ALJ. If official notice is taken during a hearing without prior notice, the request for opportunity to rebut or contest must be presented during that hearing. If official notice of facts or law is taken in a proposed written hearing decision and order without prior mention during the hearing or otherwise, the request for an opportunity to rebut or contest must be made within 20 days after the proposed decision is first issued as provided for in ARM 37.62.951.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.931 Presumptions

(1) The ALJ may apply the following presumptions when consistent with all surrounding facts and circumstances:

(a) the presumptions both conclusive and rebuttable which are set forth in Title 26, chapter 1, part 6, MCA and 40-5-234 , 40-6-105 and 40-6-201 , MCA and any other presumption created by law;

(b) that mail or other communications properly addressed and transmitted to the post office or other common carrier with all postage, tolls or charges properly prepaid, is or has been delivered to the addressee or consignee in the ordinary course of business; and

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.933 Investigative Subpoena

(1) The CSSD may issue an investigative subpoena whenever the CSSD has a right or duty to investigate any matter relating to the location of an obligor, the establishment of paternity and support orders, and the enforcement or modification of a support order. A contested case as defined in ARM 37.62.303 need not be initiated before an investigative subpoena is issued.

(2) The investigative subpoena is used to obtain information leading to the determination of an obligor or obligee's:

(a) prior and current residential and mailing addresses;

(b) social security number;

(d) real or personal property, including but not limited to, wages, salaries, earnings, tips, bonuses, profits, draws and advances against earnings, severance pay, trust income, pensions, workers compensation benefits, unemployment benefits, commissions, disability payments, distributions from retirement plans, alimony or spousal maintenance, contract proceeds, rents received, interest earned, royalties, dividends, accounts as defined by 40-5-924, MCA, loan applications made, and any other similar information, regardless of source, related to the obligor's or obligee's assets and liabilities as may be contained in the records and files of the subpoenaed person or entity.

(3) The investigative subpoena may be directed to, but not limited to, public utility companies, financial institutions as defined by 40-5-904, MCA, accountants and bookkeepers, cable television providers, unions, and payors as defined by 40-5-403, MCA.

(4) In addition to (3), when a person with a support order requests the CSSD to review that order for a possible modification, the CSSD may direct an investigative subpoena to a parent for the purpose of determining during the review process whether there is a sufficient change of circumstances to warrant commencement of formal modification proceedings.

(5) The investigative subpoena shall order the subpoenaed person or representative of the subpoenaed entity to appear before the CSSD at a set time and produce the requested information and, if necessary, to permit the pertinent parts of the record and files to be inspected and copied. By mutual agreement between the CSSD and the subpoenaed person or entity, the time, place and method for production of the information may be modified.

(6) The CSSD shall issue an investigative subpoena only when the person who is the subject of the investigation fails to voluntarily provide the information and the information is otherwise unavailable to the CSSD through less intrusive means.

(7) If the person or entity to whom an investigative subpoena is directed objects to the subpoena before the time specified for compliance with the subpoena, that person or entity may contact the OALJ in writing concerning the objection. The OALJ will refer the matter to an ALJ for resolution. After providing the parties with an opportunity to present argument, the ALJ may, in writing or at a hearing:

(a) sustain the subpoena;

(b) quash or modify the subpoena if it is unreasonable, or unduly burdensome; or

(8) Investigative subpoenas issued under this rule may be enforced as provided by 2-4-102(2) and 40-5-226(13), MCA.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.935 Hearing Subpoena and Subpoena Duces Tecum

(1) A hearing subpoena is issued in a contested case and directs a person to appear at a particular time and place to testify as a witness. A subpoena duces tecum may also require the person to produce any records, books, documents, or other materials under the person's control which may be relevant to facts at issue in the pending case.

(2) Any party to a contested case may request a hearing subpoena or subpoena duces tecum. Except as provided in (7) , a request for a subpoena must be made in writing to the OALJ. Such a request must be made within the time set by the ARM 37.62.919 scheduling order.

(3) A request for a subpoena must be accompanied by an affidavit which includes:

(a) the name and address of the witness or the person or entity having control over the material to be subpoenaed;

(b) a brief statement as to why the testimony of the witness or production of the subpoenaed material is reasonable, necessary and relevant to an issue of fact; and

(i) a short, plain statement identifying or specifying the information requested by the subpoena; and

(ii) a statement as to why the information cannot be reasonably obtained by other less intrusive means.

(4) A request for subpoena under this rule that is not timely or not accompanied by a supporting affidavit shall be denied by the OALJ.

(5) Upon receipt of a request meeting the requirements of this rule, the OALJ shall issue the subpoena and deliver it to the requesting party. The requesting party is responsible for having the subpoena served on the witness or the person or entity having control of the subpoenaed material. The requesting party is also responsible for the costs of service, the costs of witness fees and mileage if requested by the witness, and the costs of preparing, copying and transmitting documentary materials. The method of service of subpoenas and the provisions for witness fees and mileage shall be the same as required in district court civil actions.

(6) If the person to whom a subpoena is directed objects to the subpoena before the time specified for compliance with the subpoena, that person may contact the OALJ in writing concerning the objection. The OALJ will refer the matter to the presiding ALJ. After providing the parties with an opportunity to present argument, the ALJ may:

(a) sustain the subpoena;

(b) quash or modify the subpoena if it is unreasonable or requires evidence not relevant or material to any matter in issue; or

(7) Subpoenas issued under this rule may be enforced as provided by 2-4-102 (2) and 40-5-226 (13) , MCA.

(8) An order denying, quashing or modifying a subpoena is not a final agency decision for purposes of the judicial review but may be considered as part of the judicial review of the final decision and order in the contested case.

(9) Except for the enforcement provisions of (7) , this rule does not apply to genetic testing subpoenas issued under 40-5-233 , MCA.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.937 Other Discovery

(1) In addition to subpoenas, other methods of discovery shall be available to the parties prior to a contested case hearing. Discovery other than by subpoena is referred to in this rule as "other discovery". Parties may obtain other discovery by one or more of the following methods:

(a) depositions upon oral examination or written questions;

(b) interrogatories;

(d) request for admissions.

(2) Because CSSD contested case proceedings are heard on an expedited basis, other discovery may unreasonably delay the hearing. For this reason other discovery may not be had except upon request. A request for other discovery must be made according to and within the time set by the ARM 37.62.919 scheduling order. When other discovery is requested, the OALJ will convene a discovery conference by telephone with all parties. At the conference the OALJ will establish dates for the accelerated completion of each phase of other discovery. Time tables for other discovery set out in the Montana Rules of Civil Procedure may be substantially shortened.

(a) If a party objects to the schedule or scope of other discovery, the OALJ will refer the matter to an ALJ for resolution of the dispute and, if appropriate, the setting of a revised discovery schedule. The party seeking discovery has the burden of showing that the discovery is needed for the proper presentation of the party's case. The ALJ may order such other discovery as is deemed appropriate or may deny the request for other discovery.

(3) Without need for other discovery or subpoena, specific identifiable CSSD records that are relevant to a disputed material fact, upon request and payment of any necessary copying fees, may be made available to a party unless the requested records are expressly exempt or protected from disclosure by state or federal law.

(4) When other discovery or subpoenas cannot be effectively completed prior to a hearing because of shortened time tables or limitations on the scope of discovery, and the incompleteness causes a surprise element to be introduced during a hearing, the ALJ may order the exchange of additional relevant information or exhibits. The hearing record shall remain open until the time set for the exchange has passed; the ALJ may order the hearing to be reconvened within 10 days after the record is closed. When a hearing is reconvened, it will be for the limited purpose of taking further testimony, or to cross-examine with regard to the exchanged information or exhibits. This remedy may be had in addition to, or in conjunction with, any other remedy provided by these rules.

(5) When necessary to protect records that are confidential or exempt from disclosure by state or federal law, or to protect a party or person from undue annoyance, excessive embarrassment, oppression or undue burden or expense, upon motion by a party or by the person from whom other discovery is sought, the presiding ALJ may make any order including one or more of the following:

(a) that other discovery not be had;

(b) that the other discovery may be had only on specified terms and conditions;

(c) that other discovery be had only if the discovery is by a method other than that selected by the party seeking discovery;

(d) that certain matters should not be inquired into, or that the scope of other discovery be limited to certain matters; and

(e) that other discovery be conducted with no one present except persons designated by the ALJ.

(6) The product of other discovery or subpoena shall not be routinely filed with the OALJ. A party who makes a motion referring to or supported by the product of other discovery or subpoena must support the motion by copies or abstracts of the discovery relied upon. A party who seeks to introduce the product of discovery or subpoena as a part of the record must identify such documents in the witness and exhibit list provided for in ARM 37.62.939. The use of depositions at hearing or in lieu of testimony by a witness shall be governed by the Montana Rules of Civil Procedure. Where consideration of only a portion of a deposition is necessary the ALJ may order the preparation of excerpts to avoid a bulky record or consideration of irrelevant or prejudicial matter.

(7) The party requesting other discovery is responsible for preparing and making all arrangements for the conduct of the requested discovery. The requesting party is also responsible for the costs of serving the discovery on other parties, deposition costs, the preparation of transcripts of depositions, and the costs of preparing, copying and transmitting discovered materials.

(8) If a party or other person fails or refuses, without good reason, to be sworn or to answer or respond to a discovery request or subpoena, the ALJ, after directly ordering the party or person to obey the discovery request, may enter an appropriate order that:

(a) deems that the facts are established in accordance with the claim of the party seeking to establish such facts through the discovery process;

(b) refuses to allow the disobedient party to support or oppose designated claims or defenses, or prohibits that party from introducing designated matters in evidence;

(d) assesses sanctions under 40-5-226(14), MCA.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.939 Witness and Exhibit List and Exchange of Exhibits

(1) A party must prepare and file with the OALJ a witness and exhibit list when the party intends to present, use, or refer to at hearing:

(a) the testimony of any witness other than the party; or

(b) any exhibit or other documentary evidence.

(2) The witness and exhibit list must include:

(a) for each witness, including the party if the party intends to testify, the name, address and telephone number at which the witness can be reached for the hearing;

(b) a brief summary of the testimony to be given by each non-party witness;

(d) attached to the list, the original copy of each exhibit identified in the witness and exhibit list. If an original copy is not reasonably available, a clear photocopy of the original may be substituted for the original. Each attached exhibit must be numbered consistent with the list and, in addition, each exhibit must include some marking to identify the party offering the exhibit.

(3) Within the time set by the ARM 37.62.919 scheduling order the witness and exhibit list with attachments must be filed with the OALJ. Within the same time the party must also serve copies of the list and copies of the attached exhibits on all parties as provided by ARM 37.62.917. If a witness is to give testimony with regard to a particular exhibit, the party should deliver a copy of that exhibit to the witness within this same time.

(4) If a party fails without good reason to file a witness and exhibit list or fails to serve a copy of the list on another party as provided in this rule, the ALJ may prevent the witness from testifying at the hearing or may exclude the exhibit as evidence. Upon a showing of good reason, the ALJ may allow a late witness or exhibit. If a party objects to the late entry, the ALJ may, upon motion by the party, delay the hearing or final decision and order and reconvene the hearing at a later date to allow the moving party to adequately cross-examine or rebut the late witness's testimony or late exhibit.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.941 Prehearing Status Conference

(1) After a hearing is opened on the record and immediately preceding the presentation of evidence, the presiding ALJ shall conduct, on the record, a case status conference. The purpose of the conference is to:

(a) identify those facts which the parties agree to be true and which will require no proof during the hearing;

(b) identify those hearing exhibits which the parties agree may be entered without objection;

(d) identify and clarify those issues of fact or law, including possible defenses, that remain to be determined by the ALJ during the hearing;

(e) identify any unusual legal or evidentiary issues;

(f) identify and exclude any matter raised by a party that is outside the scope of the hearing or which the ALJ has no authority to determine; and

(g) address such other matters as will promote the orderly and prompt conduct of the hearing.

(2) Based on the information identified in (1) the ALJ shall issue an order directing the course of the hearing as specified in ARM 37.62.945.

(3) If the status conference demonstrates that there are no facts at issue, the ALJ may convert the status conference to a proceeding for summary disposition of the case.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.943 Burden of Proof and Standard of Proof

(1) In all hearings conducted under this chapter, the party proposing that a certain action be taken must prove the facts at issue by a preponderance of the evidence unless the substantive law provides a different burden or standard. A party asserting an affirmative defense has the burden of proving the existence of the defense.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.945 Procedure at Hearing

(1) The presiding ALJ shall direct the order of presentation of evidence and cross-examination and shall limit the scope of the hearing in conformity with the prehearing status conference.

(2) The ALJ may enter appropriate oral orders during the hearing to control the conduct of witnesses, the parties or their attorneys, including conduct which is disruptive or constitutes contempt of the ALJ or the administrative hearing process.

(3) The hearing may be continued with recesses as determined by the presiding ALJ.

(4) With the exception of matters limited by the prehearing status conference or excluded under ARM 37.62.937, to the extent necessary for full disclosure of relevant facts and issues, the presiding ALJ shall afford all parties the opportunity to respond, present evidence and argument, conduct cross-examination, and submit rebuttal evidence. Evidence that is incompetent, irrelevant, immaterial, or unduly repetitious may be excluded.

(5) Evidence may be presented through exhibits and testimony of the parties or other witnesses. Testimony may be given in narrative fashion by witnesses or by question and answer. All oral testimony must be under oath or by affirmation. The presiding ALJ may exclude witnesses from the hearing so that they cannot hear the testimony of other witnesses.

(a) Under the provisions of ARM 37.62.949, officially noticed facts and law may be admissible without requiring foundation testimony.

(6) When there are multiple parties in the case, after the opportunity provided for under (4), at the ALJ's discretion a party may be excused and allowed to withdraw from any remaining part of the hearing which is not specific to that party.

(7) During the course of the hearing the ALJ may:

(a) question the parties and their witnesses to elicit full disclosure of all pertinent facts; and

(b) inquire into any circumstance or other matter the ALJ may find pertinent and relevant.

(8) Only evidence that is offered and received during the hearing or submitted following the hearing with the permission of the presiding ALJ may be considered in rendering a decision.

(9) At the conclusion of a hearing, the presiding ALJ may leave the record open and may order or permit submission of additional evidence or post hearing briefs. The ALJ shall set a schedule for the exchange of such additional evidence or briefs. The record is considered closed either at the conclusion of the hearing or, if ordered or permitted, upon the due date for the submission of the materials. Evidence and other materials submitted after the due date or without permission of the presiding ALJ may be returned to the submitting party and may not be considered by the ALJ when deciding the case.

(10) The ALJ shall cause the hearing to be recorded at the CSSD's expense. The CSSD is not required to prepare a transcript at its own expense. Any interested person, at the person's expense, may request a typed transcription of the recording or may cause additional audio, video, or stenographic recordings to be made during the hearing if the making of additional recordings does not cause distraction or disruption.

(11) CSSD hearings are open to public observation, except for the parts that the presiding ALJ declares to be closed pursuant to a provision of law authorizing closure. If the hearing is conducted by telephone, the availability of public observation is satisfied by allowing interested persons to observe and listen to the hearing at the location of any one of the participants or to listen to or inspect the audio tape record or to inspect any transcript obtained by the CSSD.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.947 Interpreters

(1) Whenever a party or a witness is unable to understand or speak the English language, and the presiding ALJ determines that this inability may impair the substantial rights of any party to a fair hearing, the ALJ may adjourn the hearing and appoint ex parte an interpreter at the CSSD's expense. The hearing will be reconvened after an interpreter is obtained.

(2) Every person appointed as an interpreter under this rule, before entering upon his or her duties, shall take an oath or affirmation to give a true verbatim translation.

(3) Interpreters are subject to the rules of evidence relating to their qualifications as experts.

(4) No interpreter shall be appointed who has a personal interest in any matter at issue, or who is related to any party, or who has a personal or business relationship with any party.

(5) In addition to and not in substitution for an interpreter appointed by the ALJ, a person who is a party or witness may appear in any contested proceeding with the person's own interpreter at the person's expense. If the person's interpreter is to make translations on the record, (2) and (3) of this rule shall apply to the interpreter. The interpreter may be a relative of or may have a personal relationship with the party or witness, however, the relationship shall be noted in the record of the case.

(6) Interpreters for the hearing impaired shall be appointed as provided in 49-4-501 through 49-4-511 , MCA.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.949 Proposed Decision, Final Decision and Order

(1) Following the close of hearing and the receipt of post-hearing briefs and other evidence ordered by the ALJ, the presiding ALJ shall prepare a proposed decision and order. Copies of the proposed decision and order shall be served on each party as provided in ARM 37.62.917. A proposed decision and order is interim in effect and does not become a final CSSD decision and order except as provided in (2) of this rule and by ARM 37.62.951(6) .

(2) The parties shall have 20 days following service of the proposed decision and order to review the order. At the end of the 20 days, the presiding ALJ may enact the proposed decision and order as a final CSSD order unless a party, within the 20 day review period, files a motion to review the proposed order as provided by ARM 37.62.951. A decision and order that becomes final under this rule takes effect as to its terms on the date it is enacted. Copies of the final decision and order shall be delivered or mailed to each party, and to each party's attorney if any.

(3) Proposed and final decisions and orders must include findings of fact, conclusions of law and the policy reasons for the decision if the decision is based on an exercise of CSSD discretion as referenced in ARM 37.62.905(1) (b) .

(a) Findings of fact must be accompanied by a concise and explicit statement of each of the underlying facts in the record or officially noticed that support those findings.

(b) Each conclusion of law must be supported by cited authority or by a reasoned explanation.

(c) If a party attempted to or did rebut the applicability of any policy, fact or other material officially noticed under ARM 37.62.929, the order must include appropriate findings and conclusions.

(d) If the admissibility of an exhibit or other evidence was not ruled on during the hearing as provided by ARM 37.62.927, the order must contain a ruling on the evidence and state the reasons why the evidence was accepted or rejected.

(e) If a party submitted a motion under ARM 37.62.951, the final order must include a ruling, separately stated, on each issue raised, each finding of fact or ruling of law requested, each policy consideration raised or contested, and any other matter permitted by ARM 37.62.951 as a ground for revising a proposed order.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.951 Motion to Review Proposed Order

(1) Within 20 days after service of a proposed decision and order any party may file a motion to review the order.

(2) A motion to review must set out, with specificity, one or more of the following grounds upon which a proposed order may be reviewed:

(a) Through inadvertence or mistake, the ALJ overlooked an important fact presented at the hearing which could affect the decision;

(b) The ALJ considered some fact that is not in the hearing record;

(d) The ALJ failed to consider a law, a policy or other material under ARM 37.62.905 which the ALJ should have included as a matter of course;

(e) The ALJ inappropriately applied official notice to a fact or other material under ARM 37.62.929;

(f) When the admissibility of evidence was ruled upon after a matter was submitted for decision, the ALJ improperly accepted or rejected the evidence;

(g) New evidence was discovered or became accessible after the hearing was closed and that evidence was not reasonably available at the time of the hearing;

(h) The ALJ based the order on a mistake of fact or law; or

(i) There have been intervening changes in controlling law.

(3) A motion to review is not for the purpose of:

(a) allowing the parties to present the case under new theories;

(b) presenting arguments which the ALJ has already considered and rejected;

(d) rehearing the case on the merits.

(4) The motion must be considered by the same presiding ALJ who issued the proposed decision and order.

(5) The presiding ALJ may, upon the ALJ's own initiative and without need for a motion, initiate a review under this rule. The provisions of (6) then apply as if a timely motion to review had been made by a party.

(6) Upon receipt of a timely filed motion to review which specifies one or more of the grounds set out in (2), the presiding ALJ shall afford each party an opportunity to respond to the motion and, upon request, to present oral argument and submit written briefs on the matters raised by the motion. After considering the motion and the responses to the motion, the ALJ may affirm the proposed decision or correct, amend or modify it as necessary. If affirmed, the proposed order shall be enacted as a final CSSD order. The enacted order takes effect as to its terms on the date it is enacted. If corrected, amended or modified, the ALJ shall issue a revised decision and order that is consistent with the proposed order as corrected, amended or modified. The revised decision and order shall be effective as a final CSSD decision and order on the day it is signed by the ALJ. Copies of decisions and orders that become final under this rule shall be delivered or mailed to each party, and to each party's attorney if any.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.953 Bench Rulings

(1) In order to more promptly deliver decisions and orders following any hearing in a case, particularly when the hearing does not involve complex factual questions or unique questions of law, the ALJ may, at his or her discretion, issue a bench ruling following the close of testimony and the closing arguments of the parties.

(2) The ALJ will announce the decision or order orally to the parties, on the record, outlining the factual and legal reasons for the decision. Except as provided in (3) , the ALJ will prepare and issue a written decision or order within 20 days after the announcement of the bench ruling.

(3) A bench ruling which is to be a final disposition in a contested case shall be in lieu of the proposed order provided for in ARM 37.62.949. A party may move to review the bench ruling and the review may be conducted as provided in ARM 37.62.951, except the time for filing the motion shall be within 20 days after the announcement of the bench ruling. When the time for filing a motion to review has expired and no motion is filed or following resolution of a motion to review, the ALJ will prepare and issue a written final decision and order.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.955 Hearing Record

(1) The contested case hearing record shall include all the items required by 2-4-614(1) , MCA.

(2) Except for parts of the file admitted as evidence during the hearing, the CSSD case file maintained by the CSSD caseworker, including computerized and hard copy versions, is not a part of the hearing record.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.957 Clerical Errors and Effect of Correction

(1) Clerical mistakes, typographical errors, and errors in mathematical calculations in any decision or order in a contested case arising from oversight or omission may be corrected by the ALJ at any time upon the ALJ's own initiative or upon the motion of any party and after notice to all other parties and the opportunity for such other parties to object.

(2) The ALJ will decide a motion to correct clerical errors based on the contents of the administrative hearing record and without a hearing. No new evidence will be accepted or considered with regard to the motion.

(3) Unless the ALJ orders otherwise, a corrected decision and order relates to and is effective from the date of the original decision or order.

(4) A motion to correct clerical errors does not:

(a) stay the effect of a final decision and order pending determination of the motion; or

(b) extend the time for filing a petition for judicial review of a final decision and order.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.959 Informal Disposition and Consent Orders

(1) The parties to a contested case may informally resolve the case, any motion concerning the case, or any issue pending resolution in the case, by stipulation, agreed settlement, or consent order. Except as provided in (3) , all informal dispositions must be in writing and must be submitted to the presiding ALJ for review. The ALJ will review the matter for conformity with applicable law and for jurisdiction of the CSSD to enter an order or resolve the matter based on the informal disposition. Upon concurrence the ALJ will make any appropriate order based on the informal disposition including dismissing or vacating any pending hearing.

(2) If an informal disposition is reached at the hearing or just before, the parties may orally communicate the terms of the informal disposition to the presiding ALJ. As long as the terms of the informal disposition are stated on the record, there is no need to follow the oral communication with a written communication. The ALJ may vacate the hearing and enter an order adopting the terms of the informal disposition.

(3) Informal dispositions of any issue of fact or law in a matter set for hearing shall be made according to ARM 37.62.941.

History

Authorizing statute(s): 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.961 Rehearing or New Hearing

(1) After a final decision and order is issued, a motion or request for rehearing or new hearing on the merits of the contested case will not be considered. The filing of a motion or request for rehearing or new hearing does not extend the time for judicial review of the final decision and order. This rule does not abrogate the authority of a district court to remand the matter for a new hearing or additional hearing as the result of judicial review of a final decision and order.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.963 Computation of Time and Enlargement

(1) In computing any period of time for acts required by any of the rules in this chapter, the day of the act, event or default after which the designated period of time begins to run is not included. The last day of the period is the last day computed, unless it is a Saturday, Sunday or legal holiday. In that event, the period runs until the end of the next day which is not one of the aforementioned days. When the period of time prescribed or allowed is less than 11 days, intermediate Saturdays, Sundays and holidays are excluded in the computation. A half-day holiday will be considered as other days and not as a holiday.

(2) Whenever a party has a right or is required to do some act under these rules within a prescribed period after service of a notice, order or other paper upon the party, and the notice, order or other paper is served upon the party by regular mail, 3 calendar days shall be added to the prescribed period.

(3) Except for dates or prescribed times fixed by statute and not subject to modification, an ALJ, for good cause shown, may enlarge the time to perform an act if the request or motion for enlargement is made before the expiration of the prescribed period for the act. If the request or motion is made after the prescribed time has expired, enlargement may be allowed only upon a showing of excusable neglect in the failure to act. Requests or motions for enlargement of time must be made as provided in ARM 37.62.921.

History

Authorizing statute(s): Sec. 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825 and 40-5-906, MCA
Implementing statute(s): Sec. 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824 and 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00.

Mont. Admin. R. 37.62.965 Dismissal of Contested Case or Withdrawal of Hearing Request

(1) The CSSD or a CSSD staff attorney may ex parte dismiss a contested case proceeding at any time prior to entry of a final decision and order. A copy of the ex parte dismissal shall be served on all parties served with a contested case notice. The OALJ shall vacate any hearing that may be pending in the case. A dismissal under this rule is without prejudice and the CSSD may initiate a new contested case proceeding at any time.

(2) A party requesting a hearing may withdraw the request at any time prior to or during the hearing. Prior to the hearing the request must be withdrawn in writing; during the hearing the request may be withdrawn orally with the ALJ.

(a) If the reason for the dismissal or withdrawal is based on an agreement between the parties that settles the contested case, the dismissal or request to withdraw will be made according to ARM 37.62.959.

(b) Except as provided for in (2)(a), when the OALJ or the presiding ALJ receives a request to withdraw, the ALJ will vacate the hearing provided that no other party has also requested a hearing in the same case. If no other party has requested a hearing, before vacating the hearing the ALJ will give the other parties an opportunity to request a hearing. If no party accepts this opportunity, the ALJ will vacate the hearing and the matter will be resolved as a default of the pending contested case notice or, if applicable, by stipulation. If another party requests or has requested a hearing, the request to withdraw will be deemed denied; the contested case will proceed to hearing and to a final decision and order based on the testimony and arguments of the parties who appear and participate at the hearing.

(c) If a party who has requested a hearing fails to appear at a scheduled hearing, the presiding ALJ may, unless prohibited by a statute, deem the party's request for hearing to be withdrawn. When a request is deemed withdrawn, the ALJ will proceed as provided in (2)(b).

(d) When a scheduled hearing is vacated as a result of a failure in (2)(c), the ALJ, upon a showing of good cause by the requesting party, may revive the withdrawn hearing request and schedule a hearing. The request to revive must be made in writing within 10 days after the hearing was vacated and must explain in detail why the requesting party was unable to appear at a scheduled hearing.

(3) A scheduled hearing and a final decision and order may be vacated and dismissed at any time by the ALJ upon a showing that the CSSD did not or does not have jurisdiction over the subject matter of the hearing or the final decision and order.

History

Authorizing statute(s): 2-4-201, 17-4-105, 40-5-202, 40-5-262, 40-5-272, 40-5-273, 40-5-405, 40-5-713, 40-5-825, 40-5-906, MCA
Implementing statute(s): 2-4-201, 17-4-105, 40-5-157, 40-5-202, 40-5-208, 40-5-226, 40-5-233, 40-5-261, 40-5-271, 40-5-273, 40-5-414, 40-5-431, 40-5-703, 40-5-710, 40-5-821, 40-5-822, 40-5-823, 40-5-824, 40-5-906, MCA
History: NEW, 2000 MAR p. 3547, Eff. 12/22/00; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Subchapter 37.62.11 Income Withholding Procedures

Mont. Admin. R. 37.62.1101 Definitions

For the purposes of this subchapter, the following definitions apply:

(1) "Act" means the Child Support Enforcement Act, Title 40, chapter 5, part 4, MCA.

(2) "File or file with the department" for the purposes of 40-5-414(1), MCA, means that the request for hearing must be delivered to and received by the CSSD hearing office within the time specified by law.

(3) "Notice" means a notice of withholding issued pursuant to 40-5-413, MCA.

(4) "Order" means an order to withhold income issued pursuant to 40-5-415, MCA, and, where the context requires, also means an order to modify issued pursuant to 40-5-417, MCA.

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-401, 40-5-402, 40-5-403, 40-5-404, 40-5-405, 40-5-411, 40-5-412, 40-5-413, 40-5-414, 40-5-415, 40-5-416, 40-5-417, 40-5-418, 40-5-421, 40-5-422, 40-5-423, 40-5-424, 40-5-431, 40-5-432, 40-5-433, 40-5-434, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1103 Withholding Entity

(1) The CSSD is designated the "state disbursement unit" pursuant to 42 USC 666(b)(5).

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-401, 40-5-402, 40-5-403, 40-5-404, 40-5-405, 40-5-411, 40-5-412, 40-5-413, 40-5-414, 40-5-415, 40-5-416, 40-5-417, 40-5-418, 40-5-421, 40-5-422, 40-5-423, 40-5-424, 40-5-431, 40-5-432, 40-5-433, 40-5-434, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1105 Voluntary Withholding

(1) Notwithstanding the provisions of 40-5-412 (2), MCA, the CSSD may, at the request of the obligor, take steps to implement income withholding at any earlier time, in an amount determined in accordance with 40-5-416 , MCA.

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-401, 40-5-402, 40-5-403, 40-5-404, 40-5-405, 40-5-411, 40-5-412, 40-5-413, 40-5-414, 40-5-415, 40-5-416, 40-5-417, 40-5-418, 40-5-421, 40-5-422, 40-5-423, 40-5-424, 40-5-431, 40-5-432, 40-5-433, 40-5-434, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1107 Effect of Delay or Continuance

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-401, 40-5-402, 40-5-403, 40-5-404, 40-5-405, 40-5-411, 40-5-412, 40-5-413, 40-5-414, 40-5-415, 40-5-416, 40-5-417, 40-5-418, 40-5-421, 40-5-422, 40-5-423, 40-5-424, 40-5-431, 40-5-432, 40-5-433, 40-5-434, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; REP, 2017 MAR p. 135, Eff. 1/21/17.

Mont. Admin. R. 37.62.1109 Issues Determinable at Hearing

(1) The administrative hearing provided in the act is limited to the determination of whether income withholding, including the amounts to be withheld, is improper because of a mistake of fact. To accomplish this purpose, and to facilitate the speedy resolution of disputes relating to income withholding, the obligor must state in his hearing request a mistake of fact which constitutes grounds upon which the request is based. If the obligor fails to state such grounds, the department may deny the hearing because there is no issue upon which a hearing may be granted.

(2) For purposes of this section, a "mistake of fact" shall be defined to include the following:

(a) mistakes concerning the identity of the obligor;

(b) mistakes concerning the existence or amount of the support obligation;

(c) mistakes in the determination that delinquent support amounts owed are equal to or greater than one month's support; and

(d) mistakes in the computation of delinquent support amounts owed.

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-413, 40-5-414, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551.

Mont. Admin. R. 37.62.1111 Prompt Delivery of Withheld Amount

(1) For purposes of 40-5-421 (1), MCA, the term "promptly" as it relates to the delivery of withheld amounts shall be defined as being no more than ten days after the obligor's regularly scheduled payday.

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-421, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551.

Mont. Admin. R. 37.62.1113 Availability of Hardship Adjustments

(1) In certain circumstances, the amount of money required to be withheld to defray delinquent support amounts owed under the terms of the act may be temporarily reduced at the discretion of the CSSD. Such a "hardship adjustment" may be made upon a showing that extraordinary costs or expenses for special medical, dental, and mental health needs have been incurred by the obligor or the obligor's dependents; that these costs are actually being paid by the obligor; and that the obligor is not being reimbursed by insurance. A hardship adjustment may also be based upon special costs or expenses which are directly related to the obligor's ability to earn income available for withholding, and which, if not paid by the obligor, would result in a major loss of income. Further, a hardship adjustment may be considered if the total income of the obligor's household only minimally meets the subsistence level for food, housing, clothing, and other necessities as established by the United States poverty guidelines.

(2) Such exercise of discretion does not constitute a "contested case" under the terms of the Montana Administrative Procedure Act, nor does it represent a "mistake of fact" upon which a hearing may be granted.

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-416, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1115 Effect of Hardship Determination

(1) A pending hardship determination does not stay or delay hearings on, or implementation of, income withholding.

(2) A request for hardship determination may be made at any time, without regard to whether income withholding is pending or has been previously implemented.

(3) A hardship adjustment applies only to the amount to be withheld to defray accumulated interest, fees, if any, and delinquent support amounts owed. It does not affect the amount of the obligor's current support obligation.

(4) Whenever the CSSD has determined that a hardship adjustment is appropriate, it shall issue a withholding order, or a modification of an existing withholding order, which reflects the hardship adjustment. No order may be issued for the withholding of less than:

(a) the amount of current support plus the monthly hardship payment determined by the CSSD if the obligor owes an ongoing current support obligation; or

(b) the monthly hardship payment determined by the CSSD if the obligor's current support obligation has terminated.

(5) When the hardship adjustment ceases, the CSSD may, without further notice to the obligor, modify or amend the order to withhold the amount of delinquent support determined to be proper prior to the hardship adjustment.

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-416, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1117 Procedures for Determining Hardship Adjustments

(1) The CSSD will use the following procedures as a guideline for the exercise of its discretion in determining hardship adjustments:

(a) The review will determine if the obligor is eligible for a reduction of the amount which would normally be withheld to defray the support delinquency and interest, if any.

(b) The review will be conducted ex parte by the CSSD's regional office based on financial information provided by the obligor or obtained from other sources.

(c) The standard for review will be the application of a formula developed by the CSSD. The CSSD will, upon request, provide copies of the formula to any interested person.

(d) The CSSD will determine the length of time the hardship adjustment will continue. The hardship adjustment will terminate at the end of the determined period, or cessation of the hardship condition, whichever occurs first. In the event the hardship condition continues after the end of such period, it shall be the obligor's duty to request further review at that time.

(e) If the obligor disagrees with the CSSD's determination, a request may be made in writing for further review by the CSSD division administrator or designee.

(f) If a request for further review is received, the division administrator or designee will review the previous determination and make an independent determination based on all relevant considerations. The decision of the division administrator or designee will be final for all purposes.

(g) Only one request for a hardship review is available to the obligor for each claimed incident of hardship. Further review will not be granted except upon a showing of circumstances not existing at the time of the original determination.

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-416, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1119 Unclaimed Collections

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-405, MCA
Implementing statute(s): 40-5-401, 40-5-402, 40-5-403, 40-5-404, 40-5-405, 40-5-411, 40-5-412, 40-5-413, 40-5-414, 40-5-415, 40-5-416, 40-5-417, 40-5-418, 40-5-421, 40-5-422, 40-5-423, 40-5-424, 40-5-431, 40-5-432, 40-5-433, 40-5-434, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; REP, 2017 MAR p. 135, Eff. 1/21/17.

Mont. Admin. R. 37.62.1122 Determining Unenforceable Case Status

(1) This rule establishes the criteria which a IV-D case must satisfy to be categorized as unenforceable. All of the following criteria must be met:

(a) no payments have been posted to the case in the last 12 months, and payments are not expected to be posted in the immediate future;

(b) no payments from the federal offset program have been received during the past two years;

(d) if payments have been made in the past two years, collected by methods other than federal or state offset, those payments do not exceed $1,000.00;

(e) the CSSD has not identified any attachable financial institution accounts belonging to the obligor parent;

(f) the CSSD has not identified any executable assets belonging to the noncustodial parent;

(g) a credit bureau report accessed within the past six months indicates that income or asset information is unavailable; and

(h) in a case involving Title IV-E funds, all of the children of the case have been emancipated, or parental rights of the noncustodial parent have been terminated.

History

Authorizing statute(s): 40-5-203, MCA
Implementing statute(s): 40-5-203, MCA
History: NEW, 2007 MAR p. 118, Eff. 1/26/07; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Subchapter 37.62.13 Suspension of Licenses

Mont. Admin. R. 37.62.1301 Purpose Statement

(1) The purpose of this subchapter is to facilitate the implementation of the process to suspend licenses for nonsupport as provided in 40-5-701, et seq., MCA, or failure to comply with a subpoena or warrant, and establishing criteria for claiming hardship and requesting an immediate stay of suspension.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17.

Mont. Admin. R. 37.62.1303 Definitions

For the purposes of this subchapter, the following definitions apply:

(1) "CSSD" means the Child Support Services Division.

(2) "Financial hardship payment plan" means a plan offered to the obligor by the CSSD for agreement which provides for monthly support arrears payments by the obligor in a lesser amount than under a standard payment plan and which, upon approval by the CSSD office of the administrative law judge, stays further license suspension proceedings.

(3) "Resultant hardship" means a hardship an obligor may claim at the time of or after the license suspension hearing, based on the impact of a license suspension on the obligor, to legal dependents residing in obligor's household, to obligor's employees, or to persons, business or other entities served by the obligor.

(4) "Standard payment plan" means a plan offered to the obligor by the CSSD for agreement which provides for monthly support payments by the obligor and which, upon approval by the CSSD office of the administrative law judge, stays further license suspension proceedings.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-710 and 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1305 Criteria for Standard Payment Plan

(1) A standard payment plan agreement must contain, but is not limited to, the following:

(a) sufficient security to ensure compliance with the support order;

(b) an acknowledgment by the obligor of the amount of the unpaid support debt;

(c) the obligor's agreement to pay each month an amount which equals current support plus at least 1/24 or more of the arrears debt;

(d) voluntary or involuntary income withholding where applicable;

(e) the obligor's waiver of a right to assert the affirmative defense of the statute of limitations to the collection of the debt not barred by a statute of limitations at the time the notice of intent to suspend was issued;

(f) an agreement that entry into a standard payment plan does not reduce the arrears obligation but only the payments toward the arrears debt;

(g) an agreement that a standard plan does not limit the CSSD's right to pursue collection of the arrears by other means;

(h) an agreement that the obligor gives up his or her right to an administrative fair hearing; and

(i) an agreement that the obligor gives up his or her right to have a district court review the decision of the CSSD hearing officer.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-710, 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1307 Financial Hardship Payment Plan

(1) A financial hardship payment plan may temporarily reduce the monthly amount of money to be paid by the obligor toward delinquent support arrears amounts which would otherwise be due under the terms of a standard payment plan. All other requirements of a standard payment plan apply to a financial hardship payment plan.

(2) Circumstances justifying a financial hardship include, but are not limited to a showing of:

(a) extraordinary costs or expenses for special medical, dental, and mental health needs have been incurred by the obligor or the obligor's dependents; that these costs are actually being paid by the obligor; and that the obligor is not being reimbursed by insurance;

(b) special costs or expenses which are directly related to the obligor's ability to earn income available for direct payment or withholding, and which, if not paid, would result in a major loss of income. For example, if the obligor is a taxi driver who needs an operable vehicle to make money to pay support and the engine needs major repairs, a short term financial hardship payment plan may be appropriate; or

(c) total income of the obligor's household is below the United States poverty guidelines for an equivalent sized household.

History

Authorizing statute(s): Sec. 40-5-713, MCA
Implementing statute(s): Sec. 40-5-710 and 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551.

Mont. Admin. R. 37.62.1309 Effect of Financial Hardship Payment Plan Determination

(1) A pending financial hardship payment plan determination does not stay or delay hearings on, or implementation of, license suspension, absent a stay or continuance issued by the CSSD administrative hearing officer.

(2) A request for a financial hardship payment plan determination on each claimed incident of hardship may be made at any time, without regard to whether a license suspension proceeding is pending or has been previously implemented.

(3) A financial hardship payment plan applies only to the amount to be withheld to defray accumulated interest, fees, if any, and delinquent support amounts owed. It does not affect the amount of the obligor's current support obligation.

(4) Whenever the CSSD has determined that a financial hardship payment plan is appropriate, the CSSD hearing officer shall consider the financial hardship payment plan and either approve or disapprove the plan.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-710, 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1311 Procedures for Determining Financial Hardship Payment Plan Terms

(1) The CSSD will use the following procedures as a guideline for the exercise of its discretion in determining the payment terms of a financial hardship payment plan:

(a) the obligor must request a financial hardship determination in writing to the CSSD office issuing the notice of intent to suspend stating the reasons a hardship adjustment is appropriate. The CSSD will determine if the obligor is eligible for a reduction of the amount which would normally be paid or withheld, under a standard payment plan, to defray the support delinquency and interest and fees, if any;

(b) the standard for determining the amount of the monthly payment toward support debt under a financial hardship payment plan will take into consideration the gross income of the obligor and the United States poverty index promulgated each year by the United States office of management and budget;

(c) the CSSD will determine the length of time the financial hardship determination will continue, based on the information provided by the obligor. The financial hardship payment plan will terminate at the end of the determined period, cessation of the financial hardship condition, or upon modification of the obligor's current/future support obligation, whichever occurs first. In the event the financial hardship condition continues after the end of such period, it shall be the obligor's duty to request further review prior to the date of expiration;

(d) only one request for a financial hardship determination is available to the obligor for each claimed incident of financial hardship. Further review will not be granted except upon a showing of circumstances not existing at the time of the original determination; and

(e) if the obligor disagrees with the CSSD's financial hardship determination, the license suspension process will proceed to hearing, if the obligor has timely requested a hearing pursuant to the requirements of 40-5-703, MCA.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-710, 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 2441, Eff. 12/23/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1313 Procedures and Criteria for Resultant Hardship

(1) The obligor must make a written claim for a resultant hardship to the CSSD office of the administrative law judge. The obligor must mail a copy of claim to the CSSD office issuing the notice of intent to suspend.

(2) The burden is on the obligor to prove that the claimed resultant hardship is not merely an inconvenience to the obligor, but is a tangible circumstance that would endanger or otherwise result in irreparable harm to the obligor's household, employees, legal dependents or other persons, businesses or entities served by the obligor.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-710, 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1315 Stay of License Suspension

(1) A stay of a license suspension may be issued by the CSSD office of the administrative law judge at any time subsequent to receipt in the CSSD office of the administrative law judge of a written claim of resultant hardship or a written motion for a stay pending a financial hardship payment plan determination.

(2) The CSSD office of the administrative law judge may issue an immediate stay if the hearing officer determines a reasonable chance of irreparable harm exists if a stay is not issued prior to a hearing on the resultant hardship claim or motion for a stay.

(3) Only one request for stay is available to the obligor for each claimed incident of financial or resultant hardship.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-710, 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1317 Contested Case Hearing Procedures

(1) Except as otherwise provided in these rules or the authorizing statutes, administrative hearings shall be requested and conducted as provided in ARM Title 37, chapter 62, subchapter 9.

History

Authorizing statute(s): 40-5-713, MCA
Implementing statute(s): 40-5-703, 40-5-713, MCA
History: NEW, 1994 MAR p. 2447, Eff. 8/26/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17.

Subchapter 37.62.15 State Debt Offsets

Mont. Admin. R. 37.62.1501 Offset of State Tax Refunds and Other Payments for Debts Collected by Child Support Agency

(1) The CSSD will notify the Department of Revenue as provided for by 17-4-105, MCA, of any past due debt resulting from or relating to a child support obligation owing to or collected by the state under Title IV-D of the Social Security Act. The debt must have accrued through a written contract, court judgment, administrative order, or a distribution the recipient was not entitled to retain as described in 40-5-910, MCA, and shall be for a definite amount of money due and owing to or collected by the state under Title IV-D of the Social Security Act.

(2) If the tax refund exceeds the debt, the excess tax refund will be returned to the taxpayer by the Department of Revenue.

(3) All cases which have a past due debt resulting from or relating to a child support obligation owing to or collected by the state under Title IV-D of the Social Security Act will be referred to the Department of Revenue for debt offset.

History

Authorizing statute(s): 17-4-105, MCA
Implementing statute(s): 17-4-105, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1503 Notice of State Tax Refunds and Other Payments Offset for Debts Collected by Child Support Agency

(1) After the Department of Revenue gives written notice of a pending offset as provided by 17-4-105(2), MCA, and the taxpayer desires to contest the proposed offset, the taxpayer must request a hearing in accord with 17-4-105(4), MCA, and ARM 42.10.506 and 42.10.507 following the day the notice was mailed to the taxpayer.

History

Authorizing statute(s): 17-4-105, MCA
Implementing statute(s): 17-4-105, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17.

Mont. Admin. R. 37.62.1505 Offset of Joint Return

(1) If the refund or other payment to be offset is a joint return, the spouse who does not owe the obligation to be collected by the Title IV-D agency may object pursuant to the procedures set forth in ARM 42.15.326 through 42.15.329 to having his or her share of the refund applied against the child support obligation. Under those procedures, an adjustment will be made to the joint tax return reflecting that portion of the return by the Department of Revenue that is attributable to the taxpayer who owes the obligation and only that portion will be offset.

(2) Filing the "injured spouse statement" does not relieve the taxpayer who is liable for a past due debt resulting from or relating to a child support obligation payable to the state under Title IV-D of the Social Security Act from requesting a hearing under ARM 37.62.1503 if the taxpayer wishes to contest the offset procedure or to present defenses to the debt.

History

Authorizing statute(s): 17-4-105, MCA
Implementing statute(s): 17-4-105, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17.

Subchapter 37.62.17 Reports to Credit Reporting Agencies

Mont. Admin. R. 37.62.1701 Notice on Intent to Report

(1) The notice of intent to report a support debt to a consumer reporting agency required by 40-5-261, MCA, may be given by incorporating a statement of such intent in the notices generally served on obligors under 17-4-103, 40-5-208, 40-5-222, 40-5-225, 40-5-232, 40-5-413, 40-5-702, MCA, and 45 CFR 303.72 as amended.

History

Authorizing statute(s): 40-5-262, MCA
Implementing statute(s): 40-5-261, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17.

Mont. Admin. R. 37.62.1703 Electronic Reports

(1) For the purpose of reporting a support debt to a consumer reporting agency, upon a request by a consumer reporting agency, the CSSD may provide such information by electronic means.

History

Authorizing statute(s): 40-5-262, MCA
Implementing statute(s): 40-5-261, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1705 Amounts to Be Reported

(1) The CSSD will report to the consumer reporting agency only those support debts when:

(a) the amount of the debt retainable by the CSSD for the reimbursement of assigned public assistance expenditures is an amount equal to at least seven times the monthly current support; or

(b) the amount of the debt owing to an obligee is an amount equal to at least seven times the monthly current support.

(2) Reports will be provided to a consumer reporting agency only upon request of an agency with whom the CSSD has entered into an agreement which specifies the form and content of the reported information, and which imposes terms and conditions for the use of the information so as to protect its confidentiality.

History

Authorizing statute(s): 40-5-262, MCA
Implementing statute(s): 40-5-261, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1707 Contesting Accuracy of Reported Information

(1) After service of notice specified in ARM 37.62.1701 which contains a statement of intent to report a support debt to a consumer reporting agency, the obligor may contest the accuracy of the intended report during a hearing conducted pursuant to the notice.

(2) Except as provided in (3), at any time after a reinvestigation conducted by a consumer reporting agency, an obligor dissatisfied with the results of the reinvestigation may request an administrative hearing to contest the accuracy of the support debt. Except as provided in (3) no hearing shall be denied for lack of timely request.

(3) An obligor may not be granted a hearing to contest the accuracy of a support debt whenever the amount of the debt:

(a) has previously been determined by a court or administrative final decision and order; or

(b) was at issue under a notice served upon the obligor under 40-5-222, 40-5-223, 40-5-225, 40-5-232, 40-5-413, and 40-5-702, MCA, and the obligor either failed to timely request a hearing or failed to appear at a scheduled hearing.

History

Authorizing statute(s): 40-5-262, MCA
Implementing statute(s): 40-5-261, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2017 MAR p. 135, Eff. 1/21/17.

Subchapter 37.62.19 Medical Support Enforcement

Mont. Admin. R. 37.62.1901 Providing Information

(1) Whenever an obligor is required under 40-5-208, MCA to provide the CSSD with information regarding health or medical insurance coverage, the obligor shall provide the information within 20 days following the receipt of a written request from the CSSD. The information must be provided by a verified writing using a form provided by the CSSD or a form provided by the obligor which contains essentially the same information.

(2) The request for health or medical insurance coverage information shall be deemed continuing, and the obligor must report changes in the information to the CSSD within 20 days of the change.

(3) Failure to provide or update the information may result in the assessment of a monetary sanction under 40-5-208, MCA.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-208, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; AMD, 1991 MAR p. 135, Eff. 2/1/91; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1903 Notice to Obligor

(1) If the CSSD determines that an obligor failed to provide or maintain health or medical insurance coverage pursuant to statute or court or administrative order, or if the obligor fails to provide information concerning such coverage, or both, the CSSD may cause to be served upon the obligor, a notice of such failure. The notice shall include:

(a) names of the obligor, the obligee and the child;

(b) a description of the court or administrative order, or statute which created the obligation to obtain and maintain insurance coverage;

(d) an order commanding the obligor to appear and show cause why the amount assessed should not become final;

(e) a statement that the amount finally assessed will be subject to income withholding, warrant for distraint and other remedies available to the CSSD to collect the assessed amount; and

(f) a statement of possible defenses to the assessment of monetary sanctions.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-208, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.1905 Request for Hearing

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-208, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; TRANS, from SRS, 2000 MAR p. 3551; REP, 2017 MAR p. 135, Eff. 1/21/17.

Mont. Admin. R. 37.62.1907 Amount of Monetary Sanction

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-208, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; AMD, 1991 MAR p. 135, Eff. 2/1/91; TRANS, from SRS, 2000 MAR p. 3551; REP, 2017 MAR p. 135, Eff. 1/21/17.

Mont. Admin. R. 37.62.1909 Reasonable Cost of Health Insurance

(1) An individual insurance or a health benefit plan is presumed to be available to a parent at a reasonable cost if:

(a) the amount payable for individual insurance or health benefit plan premiums does not exceed 5% of that parent's gross income; or

(b) a health benefit plan is available through an employer or other group organization for which the premium is partially or entirely paid by the employer or other group organization.

(2) The presumption under (1) may be rebutted by clear and convincing evidence, and the tribunal has the discretion to:

(a) order individual insurance or health benefit plan coverage when the amount of the premium may be greater than the presumptive amount; or

(b) not order coverage when the amount of the premium is less than the presumptive amount.

History

Authorizing statute(s): Sec. 40-5-806 and 40-5-825, MCA
Implementing statute(s): Sec. 40-5-806 and 40-5-825, MCA
History: NEW, 2001 MAR p. 1646, Eff. 8/24/01; AMD, 2003 MAR p. 2304, Eff. 10/17/03.

Subchapter 37.62.21 Modification of Support Orders

Mont. Admin. R. 37.62.2101 Modification of Support Orders

(1) The CSSD may conduct a review for modification of a support order which it is enforcing upon a verified written application showing one or more of the criteria for review under 40-5-272, MCA.

(2) The party filing an application for a review may withdraw the application prior to service of the administrative notice described in 40-5-273, MCA without triggering the prohibitions of ARM 37.62.2103(2)(a).

(3) The CSSD may conduct a review for modification of a support order which it is enforcing upon receipt of documentation that the obligated parent will be incarcerated for more than 180 days. The results of this review may be abatement of any support due during the period of incarceration and for 60 days following the release from incarceration.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-226, MCA
History: NEW, 1990 MAR p. 1337, Eff. 7/13/90; AMD, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2017 MAR p. 2441, Eff. 12/23/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.2103 Availability of Review

(1) For purposes of 40-5-272(4)(a), MCA, a substantial change in circumstances includes, but is not limited to:

(a) an increase or decrease of at least 30% in a parent's income for child support, as defined by the Montana child support guidelines, ARM 37.62.105(1);

(b) the adoption, emancipation, or death of a child in households where more than one child are the subjects of the guideline calculation, if the existing order is not a per child amount;

(c) the movement of a child from one parent's home to the home of the other parent, with the intent that the move is permanent and is:

(i) evidenced by the written consent of the other parent;

(ii) ordered by a court of competent jurisdiction; or

(iii) demonstrated to have continued for 90 days prior to the request for review and modification;

(d) the development of special needs by a child, if those needs were not considered in the original order; or

(e) evidence that the original Montana order was set without reference to the child support guidelines.

(2) The CSSD will deny a request for review of a support order if any of the following conditions exist:

(a) less than 36 months have elapsed from the date that the existing support order was entered, an administrative hearing was granted under 40-5-277, MCA, or an order was issued which denied a modification because of the applicant's failure to meet one of the criteria described in 40-5-208(2)(b) or 40-5-272, MCA, and no substantial change of circumstances has occurred;

(b) the CSSD does not have an open IV-D case after the procedures in ARM 37.62.2107 have been completed;

(d) the address of a necessary party has not been verified;

(e) review and adjustment services are being provided by another IV-D agency;

(f) a modification or adjustment action is pending in another forum; or

(g) the support order will terminate within six months after the date the request for review is received by the CSSD.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.2105 Hearing on Denial of Review Request

(1) When a review is denied under ARM 37.62.2103, the parent requesting the review has the right to request a hearing on whether the review was properly denied. The request for hearing shall be made to the CSSD Office of the Administrative Law Judge, and must be received within 10 days after service of a notice denying the review request.

(2) The hearing shall be conducted in accordance with CSSD rules at ARM 37.62.901, et seq., except that the hearing is not a contested case hearing, and therefore no judicial review is available. The scope of the hearing is limited to the CSSD's decision rejecting the review request, and the order of the administrative law judge is not subject to ARM 37.62.949 regarding proposed orders.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.2107 Procedure for Terminating Review or Modification After Closure of Iv-D Case

(1) If a IV-D case is closed while a review application or modification action is pending, the CSSD will mail notice to the party who did not open the IV-D case and offer that party the opportunity to apply for support enforcement services.

(2) If a new IV-D referral or an application for support enforcement services is not received by the CSSD within 20 calendar days of the date the notice was received by the party, the modification notice will be dismissed or the review application denied.

(3) If a new IV-D referral or an application for support enforcement services is received by the CSSD within 20 calendar days of the date the notice was received by the party, the action will continue from the point at which the IV-D case was closed.

(4) No additional or duplicate fees for performing the administrative review and modification will be charged in a case re-opened under this rule.

(5) This rule does not apply when closure is the result of a good cause determination by the appropriate agency under 42 CFR 433.147 or 45 CFR 232.40 through 232.49 that support enforcement may not proceed without risk of harm to the child or caretaker relative.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, MCA
History: NEW, 1994 p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.2109 Choice of Law

(1) All reviews and modifications under this subchapter will be conducted using Montana law, rules, procedures and child support guidelines.

(2) Any disputes about the effect or interpretation of Montana law, rules or procedures shall, if possible, be resolved with reference to the interpretations of the courts of Montana.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551.

Mont. Admin. R. 37.62.2111 Time Frame Determinations

(1) For purposes of determining time frames in reviews and modifications conducted under this subchapter, the following provisions apply:

(a) a request for review is received when the CSSD has sufficient information to determine if review is available under ARM 37.62.2103; or

(b) the CSSD shall take no action on a review or modification while the procedures under ARM 37.62.2107 are being performed. The time provided for the performance of procedures under ARM 37.62.2107 shall not be counted in any determination of time frames.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.2113 Requests for Discovery

(1) Requests for discovery by parties in administrative modification cases must be received in the CSSD Office of the Administrative Law Judge on or before the 10th day after service of a Notice of Review of Child Support Order and Order to Produce Financial Information upon the party requesting discovery. The CSSD may request discovery by including a discovery order within its notice of proposed modification.

(2) Requests for discovery may be denied for untimeliness or for other good and reasonable cause.

(3) Except as otherwise provided in these rules or the authorizing statutes, discovery shall be conducted as provided in ARM Title 37, chapter 62, part 9.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202 and 40-5-273, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.2115 Settlement Conference

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; REP, 2006 MAR p. 574, Eff. 2/24/06.

Mont. Admin. R. 37.62.2117 Negligible Change

(1) If the difference between the existing total monthly support order and the proposed support obligation is less than 15%, the change may be considered negligible and the child support provisions of the existing support order need not be modified.

(2) Provisions in the existing order for the medical needs of the child may be modified even if the change in the child support amount is negligible. Where an existing support order does not contain a provision for the medical needs of the child, the order may be modified to include a medical support order even if the change in the child support amount is negligible.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06.

Mont. Admin. R. 37.62.2119 Modification Hearing

(1) A party may request a hearing on the Notice of Administrative Review.

(2) The request for hearing must be received in the office of the administrative law judge within 20 days after the Notice of Administrative Review is received by the party requesting a hearing.

(3) If no party timely requests a hearing, the administrative law judge may enter an order adopting the terms and provisions proposed in the notice, including the child support amount and the imposition or modification of a medical support order.

(4) After the modification hearing, the administrative law judge shall enter an order in accordance with 40-5-277, MCA.

(5) The order shall be effective the first day of the month following the issuance of the Notice of Proposed Modification, or as determined by a district court. If the modification result is a lowered child support obligation, all payments received during the pendency of the modification action shall be credited against the new obligation, and amounts exceeding the modified obligation shall be applied first to outstanding arrearages, fees, and fines. Any amount remaining after such credits shall be applied to future child support by reducing the amount of child support collected under the new order for no more than six months, or before the order terminates, whichever comes first. Parties may agree to an alternate schedule. No refunds shall be available from the CSSD.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-202, 40-5-272, 40-5-273, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2017 MAR p. 135, Eff. 1/21/17; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.62.2121 Additional Hearing Procedures

(1) To the extent they are not inconsistent with the provisions of this subchapter, the overall hearing procedures set forth in subchapter 9 of this chapter are applicable to administrative hearings under this subchapter.

History

Authorizing statute(s): 40-5-202, MCA
Implementing statute(s): 40-5-273, MCA
History: NEW, 1994 MAR p. 2011, Eff. 7/22/94; TRANS, from SRS, 2000 MAR p. 3551; AMD, 2006 MAR p. 574, Eff. 2/24/06; AMD, 2012 MAR p. 747, Eff. 7/1/12.

Chapter 37.66 Mental Health Inpatient Facilities

Subchapter 37.66.1 Admission Policy for Mental Health Inpatient Facilities

Mont. Admin. R. 37.66.101 Purpose

(1) The Montana mental health nursing care center, a licensed nursing care facility, provides long term care and treatment of persons with mental disorders. The primary function of the center is set forth in 53-21-411 , MCA. The center provides a secure unit for persons with alzheimer/dementia. This program provides for persons who do not require the intensity of treatment available at Montana state hospital.

History

Authorizing statute(s): Sec. 53-21-402 and 53-21-411, MCA
Implementing statute(s): Sec. 53-21-411, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; AMD, 1996 MAR p. 1391, Eff. 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.102 Definitions

(1) "Mental disorder" means impairment as defined in 53-21-102 , MCA.

(2) "Professional person" means a person as defined in 53-21-102 , MCA.

(3) "Center" means the Montana mental health nursing care center.

(4) "Superintendent" means the superintendent of the Montana mental health nursing care center.

History

Authorizing statute(s): Sec. 53-21-402 and 53-21-411, MCA
Implementing statute(s): Sec. 53-21-411, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; AMD, 1996 MAR p. 1391, Eff. 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.106 Admission Criteria

(1) Eligibility for admission to the Montana center is determined without regard to race, color, sex, culture, social origin or condition, political or religious ideas, or ability to pay for the cost of care.

(2) To be eligible for admission on a voluntary basis, a person must:

(a) be 18 years of age;

(b) be diagnosed as having a mental disorder;

(d) exhibit behaviors rendering the person unable to be served appropriately in the community of residence or in a less restrictive setting;

(e) not require acute medical hospital care;

(f) not require active psychiatric treatment as provided by Montana state hospital;

(g) not require the services of a full time psychiatrist;

(h) have received a mental health evaluation and recommendation for admission by a mental health professional person within 60 days prior to application;

(i) be admitted on a voluntary basis through application by the person, a legally appointed guardian or durable power of attorney providing for health care decisions; and

(j) complete a center application for admission.

(3) The following is required for an involuntarily committed person to be admitted to the center from Montana state hospital:

(a) meet voluntary criteria for admission in (2) (a) through (g) of this rule;

(b) notification of the patient, the patient's next of kin, and the Montana disabilities board of visitors pursuant to 53-21-414 , MCA.

(4) The final decision for admission remains with the superintendent of the center. Patients referred from Montana state hospital who meet the above criteria will be given priority for admission to the center.

History

Authorizing statute(s): Sec. 53-21-402 and 53-21-411, MCA
Implementing statute(s): Sec. 53-21-411 and 53-21-414, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; AMD, 1987 MAR p. 484, Eff. 5/1/87; AMD, 1996 MAR p. 1391, Eff. 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.107 Application Procedures

(1) To be considered for admission, the applicant, applicant's guardian, or person who has a power of attorney for the applicant, must submit to the superintendent of the center:

(a) a completed admissions packet; and

(b) a medical history including the comprehensive medical evaluation and recommendation of a mental health professional.

History

Authorizing statute(s): 53-21-402, 53-21-411, MCA
Implementing statute(s): 53-21-411, 53-21-414, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; AMD, 1996 MAR p. 1391, Eff. 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.108 Application Materials

(1) Application packets are available by writing to the superintendent of the Montana Mental Health Nursing Care Center, 800 Casino Creek Drive, Lewistown, Montana 59457.

History

Authorizing statute(s): Sec. 53-21-402 and 53-21-411, MCA
Implementing statute(s): Sec. 53-21-411 and 53-21-414, MCA
History: NEW, 1996 MAR p. 257, Eff. 2/28/86; AMD, 1996 MAR p. 1391, 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.109 Admissions Procedures

(1) The superintendent will review all application materials and determine the applicant's eligibility for admission.

(2) The superintendent will notify the applicant, in writing, of the decision regarding eligibility.

(3) The eligible applicant will be admitted when an appropriate bed is available.

(4) If there is no bed immediately available, the applicant will be placed on a waiting list.

(5) Except for priority admissions as described in ARM 37.66.106, the center will admit applicants from the waiting list on the basis of the date of determination of eligibility for admission as beds become available.

(6) The superintendent may waive the use of the waiting list if:

(a) the location of an available bed requires that the next person admitted be of a particular sex; or

(b) there is an applicant whose current living conditions require that he or she be admitted immediately.

(7) When two or more applicants have equal priority on the waiting list, the person with the longest documented Montana residence will be admitted first.

History

Authorizing statute(s): Sec. 53-21-402 and 53-21-411, MCA
Implementing statute(s): Sec. 53-21-411 and 53-21-414, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; AMD, 1996 MAR p. 1391, Eff. 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.115 Treatment

(1) Treatment provided at the center focuses on maintaining the resident's physical and mental functioning to the extent possible. Residents will be provided medical, nursing, dietary, recreation and social services through an individualized care plan for each resident. The center may utilize the services of the regional mental health center when individual residents might benefit from such services.

History

Authorizing statute(s): Sec. 53-21-411, MCA
Implementing statute(s): Sec. 53-21-411, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.120 Transfer and Discharge Criteria

(1) The superintendent may authorize the transfer of a center resident to a licensed hospital in a medical emergency without the resident's consent.

(2) The director of the department of public health and human services, may authorize the transfer of a center resident to Montana state hospital for a period not to exceed 10 days.

(3) Residents of the center may be voluntarily admitted to Montana state hospital pursuant to 53-21-111 , MCA, or involuntarily committed pursuant to 53-21-128 , MCA.

(4) If the patient is currently the subject of an involuntary commitment, the patient may be transferred to Montana state hospital after notification pursuant to 53-21-413 , MCA.

(5) A legally competent voluntary resident will be discharged from the center within 5 days following a written request from the resident. If guardianship or durable power of attorney for the health care of the resident has been established, the written request must be made by the guardian or power of attorney.

(6) The superintendent may also discharge a resident after making proper arrangements if:

(a) the resident consistently displays behavior which violates other residents= rights;

(b) the resident=s behavior poses a consistent and/or serious danger to other residents, staff or visitors;

(d) the resident is able to function in a setting requiring greater independence;

(e) the resident may be served in a less restrictive environment such as a non-specialized nursing home; or

(f) the resident poses a health danger to other residents.

History

Authorizing statute(s): Sec. 53-21-402, 53-21-411 and 53-21-413, MCA
Implementing statute(s): Sec. 53-21-112, 53-21-113, 53-21-412 and 53-21-413, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; AMD, 1996 MAR p. 1391, Eff. 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.130 Appeal Procedure

(1) Applicants who are denied admission, or residents who are involuntarily discharged may appeal by submitting, in writing, their reasons for appealing the decision to the director of the Department of Public Health and Human Services, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 prior to discharge or within 30 days of the denial of admission.

(2) The director will respond to the appeal, in writing, within 30 days of receipt of the appeal.

(3) Pending appeal of an involuntary discharge, the patient may be transferred pursuant to ARM 37.66.120 or allowed to remain at the center until the final decision of the director.

History

Authorizing statute(s): 53-21-402, 53-21-411, MCA
Implementing statute(s): 53-21-411, MCA
History: NEW, 1986 MAR p. 257, Eff. 2/28/86; AMD, 1996 MAR p. 1391, Eff. 5/24/96; TRANS, from DOC, 1998 MAR p. 1505.

Subchapter 37.66.2 Documentation for Admission to Montana State Hospital

Mont. Admin. R. 37.66.201 Definitions

(1) "Court of Competent Jurisdiction" means a court having authority over the subject matter of civil commitment for treatment of a mental disorder and personal jurisdiction over the patient. In Montana, courts of competent jurisdiction are:

(a) state district courts, for all persons found within the state except members of an Indian tribe as described in (b); and

(b) tribal courts in Montana, for a tribal member physically located within the boundaries of the tribal member's reservation of enrollment at the time of commitment.

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

(3) "MSH" means Montana State Hospital.

(4) "Professional Person" means a professional person as defined in 53-21-102, MCA.

(5) "Superintendent" means the superintendent of Montana State Hospital.

History

Authorizing statute(s): 53-1-603, 53-21-601, MCA
Implementing statute(s): 53-1-601, 53-21-101, 53-21-601, MCA
History: NEW, 2012 MAR p. 2379, Eff. 1/1/13.

Mont. Admin. R. 37.66.203 Preadmission Documentation: Civil

(1) Before taking any of the actions listed in (a) through (e), a professional person must contact MSH by calling the main MSH switchboard at (406) 693-7000 to speak to the person responsible for admissions, and provide information and records as requested by MSH, including both physical and psychiatric medical information, sufficient to evaluate the immediate treatment needs and appropriate placement of the patient and whether alternative, less restrictive and medically appropriate facilities are available. Actions triggering this requirement are:

(a) authorizing an emergency detention at MSH under 53-21-129, MCA;

(b) requesting a 10-day transfer to MSH under 53-21-130, MCA;

(d) requesting the county attorney to file a petition for involuntary civil commitment to MSH under Title 53, chapter 21, MCA; or

(e) filing or requesting tribal authorities to file a petition for involuntary civil commitment to MSH under applicable tribal law.

History

Authorizing statute(s): 53-1-603, 53-21-601, MCA
Implementing statute(s): 53-1-601, 53-21-101, 53-21-601, MCA
History: NEW, 2012 MAR p. 2379, Eff. 1/1/13.

Mont. Admin. R. 37.66.205 Preadmission Documentation: Forensic

(1) Before admitting a criminal defendant committed under any provision of Title 46, chapter 14, MCA, MSH must collect information and records, including both physical and psychiatric medical information, sufficient to evaluate the immediate treatment needs of the patient, and consult with outpatient providers and criminal justice authorities to coordinate patient care during the admission process.

History

Authorizing statute(s): 53-1-603, 53-21-601, MCA
Implementing statute(s): 53-1-601, 53-21-101, 53-21-601, MCA
History: NEW, 2012 MAR p. 2379, Eff. 1/1/13.

Mont. Admin. R. 37.66.207 Documentation of Legal Authority to Admit - Preliminary Documentation by Fax

(1) MSH may not admit any person for evaluation, custody, care, or treatment without having received documentation that the admission is voluntary or that other legal authority exists to admit the person.

(2) Documentation of legal authority to admit consists of:

(a) for voluntarily admission, an original signed and witnessed application for voluntary admission as provided in 53-21-111, MCA, and ARM 37.66.306;

(b) for emergency detention to the next regular business day, an original signed statement from a professional person after evaluation of the person pursuant to 53-21-129, MCA, that the person appears to have a mental disorder and that an emergency situation exists because any person is in imminent danger of death or bodily harm from the activity of the person;

(c) for ten-day interinstitutional transfer, an original written request for transfer from another DPHHS institution or the Department of Corrections pursuant to 53-21-130, MCA, which has been accepted in writing by the superintendent;

(d) for court-ordered detention, a certified copy of an order from a court of competent jurisdiction that authorizes the detention of the person to receive treatment for a mental disorder on a temporary basis until a hearing is held on a petition for civil commitment;

(e) for civil commitment, a certified copy of an order from a court of competent jurisdiction that authorizes the detention of the person to receive treatment for a mental disorder; or

(f) for forensic commitment, a certified copy of an order from a court having jurisdiction of criminal proceedings, committing the person under the provisions of Title 46, chapter 14, MCA, for evaluation, custody, care, or treatment.

(3) MSH may receive preliminary documentation by fax, if:

(a) the quality is sufficient to determine that the documentation meets the requirements of this rule except for the requirement of certification of a court order;

(b) MSH is familiar with the sender, and has no reason to believe the documentation is not authentic or has been altered; and

(c) the sender confirms that the required signed or certified documentation of legal authority will be mailed or otherwise delivered so as to arrive at MSH before 4:30 p.m. on the fifth business day after the date of the fax. The address for mailed documentation is: Admissions Office, Montana State Hospital, P.O. Box 300, Warm Springs, MT 59756.

History

Authorizing statute(s): 53-1-603, 53-21-601, MCA
Implementing statute(s): 53-1-601, 53-21-101, 53-21-601, MCA
History: NEW, 2012 MAR p. 2379, Eff. 1/1/13.

Subchapter 37.66.3 Voluntary Admissions To Montana State Hospital

Mont. Admin. R. 37.66.301 Voluntary Admission Procedure

(1) The purpose of this chapter is to assure that voluntary admissions to Montana state hospital comply with the procedure established by 53-21-111 and 53-1-203 , MCA to assure that persons are not admitted to Montana state hospital if adequate treatment is available to them in the mental health region, and to establish a procedure whereby persons may be refused admission if the requirements of 53-21-111 and 53-1-203 , MCA are not met.

History

Authorizing statute(s): Sec. 53-21-111 and 53-1-203, MCA
Implementing statute(s): Sec. 53-21-111 MCA
History: NEW, 1986 MAR p. 258, Eff. 2/28/86; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.302 Definitions

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

(2) "Professional person" means a medical doctor or a person who has been certified as a professional person by the department pursuant to 53-21-106 , MCA.

(3) "Hospital" means Montana state hospital, Warm Springs campus.

(4) "Superintendent" means the superintendent of Montana state hospital.

(5) "Region" means a mental health region as described in 53-21-204 , MCA.

(6) "Center" means a comprehensive community mental health center as described in 53-21-201 , MCA.

(7) "Director" means the person appointed by a regional mental health corporation board to administer a comprehensive mental health center.

(8) "Designee" means a person employed by the center, who is appointed by the director to act on his/her behalf for the purposes of this chapter.

(9) "Applicant" means a person at least 18 years of age who is seeking voluntary admission to Montana state hospital.

(10) "Community support program (CSP) " employee means a center staff person whose primary work responsibilities involve the region's provision of support services, including but not limited to, day treatment, case management, residential, and crisis services to adults with severe disabling mental illness.

History

Authorizing statute(s): Sec. 53-21-111 and 53-1-203, MCA
Implementing statute(s): Sec. 53-21-111, MCA
History: NEW, 1986 MAR p. 258, Eff. 2/28/86; AMD, 1992 MAR p. 2287, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.306 Screening Process

(1) Each region shall have a minimum of 6 voluntary admission screening designees to assure that an applicant's geographical location within the region does not prevent prompt completion of the screening process.

(a) The designees shall be appointed by the director and approved by the department.

(b) A list of authorized designees shall be provided to the hospital and to all professional persons within the region and the director shall keep the list current.

(c) The hospital shall maintain a current list of professional persons and a current list of authorized designees at appropriate locations within the hospital.

(2) The application for voluntary admission form and other forms used in the screening process will be developed and approved by the department.

(a) All necessary forms will be available through all community mental health centers including all satellite offices and service locations.

(b) The application for voluntary admission form must be completed by the applicant or by an interested person on behalf of the applicant and must be signed by the applicant in the presence of a witness.

(d) The mailing address of the witness shall be provided on the form to assure the authenticity of the applicant's signature.

(e) An applicant shall not be refused admission simply because the application for voluntary admission form is not totally complete as long as the applicant's signature and the signature of the witness are affixed.

History

Authorizing statute(s): Sec. 53-21-111, MCA
Implementing statute(s): Sec. 53-21-111, MCA
History: NEW, 1992 MAR p. 1483, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.312 Parameters for Voluntary Admission to Montana State Hospital

(1) Voluntary admissions to Montana state hospital will be appropriate only when Montana state hospital is the least restrictive and most appropriate placement available.

(2) Montana state hospital will be considered the least restrictive and most appropriate placement for an individual who:

(a) is violent and assaultive as a result of mental illness and is unable to be served in local inpatient facilities;

(b) is so suicidal as to require 1:1 attention over extended periods of time and is unable to be served in mental health center programs or local inpatient facilities;

(c) is so disorganized by mental illness that the individual is unable to appropriately care for a medical condition other than mental illness, which places the individual in a life threatening situation; or

(d) is suffering from an acute exacerbation of mental illness which renders the individual unable, even with intensive supports, to maintain a level of functioning which is sufficiently high so as to allow the individual to remain in the community, and which would predictably require more than 14 days of inpatient care to stabilize.

(3) All community options including but not limited to case management, crisis response and local inpatient care must be considered and ruled out before an admission to Montana state hospital can be deemed appropriate.

(4) Symptoms or behavior related to or resulting from certain conditions, including but not limited to mental retardation, traumatic brain injury and alcohol/drug dependency shall not alone constitute the basis for a voluntary admission to Montana state hospital.

History

Authorizing statute(s): Sec. 53-21-111, MCA
Implementing statute(s): Sec. 53-21-111, MCA
History: NEW, 1992 MAR p. 1483, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1505.

Mont. Admin. R. 37.66.316 Release of Confidential Records

(1) All information obtained and records prepared in the course of a state mental health facility providing service are confidential and privileged. Information and records may be disclosed to qualified personnel for the purpose of conducting scientific or genealogical research, but such personnel may not identify, directly or indirectly, any individual patient in any report of such research, or otherwise disclose patient identities in any manner.

(2) Consent of the patient is required in order to release information or records concerning an individual who is currently an inpatient or who has been discharged within the 12 previous months. In the case of a patient who has been adjudicated incapacitated, any consent which is required under these rules may be given by the guardian or other person authorized under state law to act in the patient's behalf. If a written consent is needed to disclose information identifying a deceased patient, that consent may be given by an executor, administrator, or other personal representative appointed under applicable state law. If there is no such appointment, the consent may be given by the patient's spouse, or, if none, by any responsible member of the patient's family.

(3) Patient identifying information may be disclosed for the purpose of conducting research if the department director or, for records in state archives, the state archivist, makes a determination that the recipient of the patient identifying information:

(a) is qualified to conduct the research, as determined from the recipient's application for authorization of confidentiality;

(b) signs an oath of confidentiality; and

(i) maintain copies of the patient identifying information in accordance with security requirements;

(ii) destroy or deposit with the state archives all copies of the patient identifying information upon completion of the research. All information deposited with the state archives will be subject to retention rules of that agency.

(4) An application for authorization of confidentiality for a research project must be approved by the department and shall include the following:

(a) The name and address of the individual primarily responsible for the conduct of the research and the sponsor or institution with which he or she is affiliated, if any. Any application from a person affiliated with an institution will be considered only if it contains or is accompanied by documentation of institutional approval. This documentation may consist of a written statement signed by a responsible official of the institution, such as a graduate student's advisor or department chair;

(b) The location of the research project and a description of the facilities available for conducting the research, including the name and address of any hospital, institution, etc. to be utilized in connection with the research;

(c) Summaries of the applicant's and any other personnel having major responsibilities in the research project appropriate training and experience;

(d) An outline of the research project, including a clear and concise statement of the purpose and rationale of the research project and the general research methods to be used;

(e) The date on which research will begin and the estimated date for completion of the project;

(f) An assurance that if an authorization of confidentiality is given it will not be represented as an endorsement of the research project or used to coerce individuals to participate in the research project.

(5) Security requirements shall include:

(a) Written records that are subject to these regulations must be maintained in a secure room, locked file cabinet, safe, or other similar container when not in use;

(b) Applicant must have a research protocol which has been reviewed by a group of at least two individuals knowledgeable in the field who are independent of the research project. Applicant must have a written statement that the protocol has been reviewed and it has been determined that the rights of the patients will be adequately protected and the risks in disclosing patient identifying information are outweighed by the potential benefits of the research;

History

Authorizing statute(s): 53-21-166, MCA
Implementing statute(s): 53-21-166, MCA
History: NEW, 1996 MAR p. 2187, Eff. 8/9/96; TRANS, from DOC, 1998 MAR p. 1505.

Chapter 37.70 Low Income Home Energy Assistance Program (liheap)

Subchapter 37.70.1 General Program Administration

Mont. Admin. R. 37.70.101 Safeguarding/Sharing Information

(1) Disclosing information about applicants for or recipients of low income home energy assistance is restricted to purposes directly connected with the administration of such aid. Such purposes include establishing eligibility, determining amount of assistance, and providing benefits to or on behalf of applicants and recipients.

(a) Proper requests for information from a government authority, a court, or a law enforcement agency will be honored and the information released along with a notification of the confidentiality of the information and the penalty for misuse of such information.

(b) Whenever possible, the department will attempt to obtain prior consent from the applicant or recipient to release information about the applicant or recipient. Notification will be provided after release of information in the following situations: emergency situations; cases where the information is released for legal and investigative actions concerning fraud; collection of support, and third party medical recovery.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Mont. Admin. R. 37.70.102 Role of the Local Contractor

(1) The department will contract with appropriate community-based organizations in the state to provide outreach and to receive and process applications for the low income home energy assistance and weatherization programs.

(a) In providing outreach, the local contractor performs specified activities designed to inform all potentially eligible households in the contract area of the existence of and the benefits available under the low income home energy assistance program.

(b) In receiving and processing applications, the local contractor determines household eligibility and benefit award under the rules contained in this chapter. An application for low income home energy assistance may also constitute an application for weatherization.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Mont. Admin. R. 37.70.106 Fair Hearings

(1) Any applicant/recipient who is aggrieved by an adverse department action as defined in ARM 37.5.304 may request a fair hearing as provided in ARM 37.5.307. Fair hearings and appeals of fair hearing decisions shall be conducted as provided in ARM 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331 and 37.5.334.

(2) It is the responsibility of the department through the local contractor to inform every applicant/recipient in writing at the time of application and at the time any action affects his benefits of the right to request a fair hearing.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2004 MAR p. 2818, Eff. 11/19/04.

Mont. Admin. R. 37.70.107 Referrals to the Office of Inspector General, Program Compliance Bureau

(1) The Office of Inspector General, Program Compliance Bureau (PCB), has the power and duty to:

(a) investigate matters relating to LIHEAP including applications, awards of benefits, and information received relating to an application;

(b) determine, based on the evidence gathered, whether an overpayment of benefits has occurred; and

(i) a false or misleading statement or a misrepresentation, concealment, or withholding of facts; or

(ii) any other action intended to mislead, misrepresent, conceal, or withhold facts.

(2) Local contractors must make reports of possible overpayments or fraud to the Department of Public Health and Human Services, Human and Community Services Division (HCSD), P.O. Box 202956, Helena, MT 59620-2956. HCSD will review cases to determine whether to make a referral to the PCB. The PCB may refer the matter to the Montana Department of Justice or the county attorney of the county in which the person resides for further action.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Mont. Admin. R. 37.70.110 Fraud/Transfer of Resources

(1) A person who knowingly obtains LIHEAP benefits to which he or she is not entitled by means of a purposely or knowingly false statement, representation, impersonation, or other fraudulent device is guilty of theft as provided in 45-6-301, MCA, and is ineligible for assistance for the entire current heating season.

(2) Resale or transfer of benefits to another person is expressly prohibited.

(3) Fuel vendors may not retain benefits of households who have discontinued service.

(4) Fuel assistance will not be granted to a person who has deprived himself or herself, directly or indirectly, of any resources for the purpose of qualifying for assistance. A person who has transferred resources or interest in resources within one year of application without receiving adequate consideration in money or money's worth will be presumed to have made such transfer for the purpose of qualifying for assistance.

(a) A person may submit evidence that he or she did not make the transfer of resources to qualify for LIHEAP benefits.

(b) It is the responsibility of the person to submit this evidence.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1990 MAR p. 1959, Eff. 10/26/90; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Mont. Admin. R. 37.70.115 Underpayments and Overpayments

(1) When it is discovered that an administrative error resulted in an underpayment of LIHEAP benefits, it may be corrected by increasing the benefit award to cover the underpayment.

(a) For purposes of determining financial eligibility, such retroactive corrective payments will not be considered as income.

(2) Except as provided in (3), current and future program year payments of LIHEAP benefits will be reduced the full amount of prior overpayments, unless the administrative cost of recouping the overpayment would exceed the amount of such overpayment.

(3) When it is discovered that the local contractor caused an overpayment of LIHEAP benefits, at the sole discretion of the department, the local contractor may be required to repay the entire overpayment to the department, rather than the overpayment being withheld from the household's future payments.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1985 MAR p. 1412, Eff. 9/27/85; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Subchapter 37.70.3 Application and Eligibility Determination

Mont. Admin. R. 37.70.301 Interviews Required and Content of Interviews

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1992 MAR p. 2201, Eff. 9/25/92; TRANS, from SRS, 1998 MAR p. 2059; REP, 2001 MAR p. 2037, Eff. 10/12/01.

Mont. Admin. R. 37.70.304 Applications to Be Voluntary

(1) Applications must be voluntary and initiated by the person in need, except an application may be made by a third party when the physical or mental condition of the person in need precludes his ability to make application himself.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2001 MAR p. 2037, Eff. 10/12/01.

Mont. Admin. R. 37.70.305 Application

(1) Except as provided in (4), a new application for LIHEAP benefits must be made for each new heating season and when a household moves to a different residence during the heating season.

(2) The application form may be submitted to the local contractor's office.

(3) An application for LIHEAP benefits must be filed during the heating season for which assistance is being sought, that is, between October 1 and April 30, except as provided in (4). If April 30 falls on a weekend or holiday observed by Montana state government, the local contractor must accept applications on the next business day after the weekend or holiday. However, at the option of the department, a household's application for certain types of deliverable heating fuel which are sold at lower prices during the summer months or for emergency services may be filed prior to October 1 of the heating season for which a household is seeking assistance. In the case of households who use other types of fuel and who are not seeking emergency services, the department may in its discretion accept applications prior to October 1.

(4) Publicly subsidized housing households whose energy costs are included as a fixed portion of their rent, or households that reside in publicly subsidized housing and have an obligation to pay a base-load electric bill, are not eligible for a regular LIHEAP benefit computed using the benefit matrices and multipliers in the LIHEAP Benefit Award Matrix and Table of Multipliers for the current heating season. However, these households are eligible for weatherization assistance as provided in ARM Title 37, chapter 71 and a modified LIHEAP benefit. The modified LIHEAP benefit is equal to five percent of the amount of a regular LIHEAP benefit computed using the benefit matrices and multipliers in ARM 37.70.601 or a minimum payment of $25, whichever is greater, paid to the household annually. Households determined eligible for the modified LIHEAP benefit whose economic and housing situation does not change are eligible for a period of five years.

(5) Households residing in publicly subsidized housing that move into nonsubsidized housing during the five-year eligibility period may reapply for a prorated benefit for the current heating season based on the household's new circumstances as provided in ARM 37.70.602. The household may file a new application for each subsequent heating season as long as the household lives in nonsubsidized housing, as provided in (1).

(6) Households residing in publicly subsidized housing that move to another publicly subsidized housing unit during the five-year eligibility period may file a new application for a modified LIHEAP benefit for another five-year period, which will run from the date of the new application, if the household's energy costs are included as a portion of its rent or if it has an obligation to pay a base-load electric bill.

(7) No household or any of its members will be discriminated against on the basis of race, color, religion, sex, culture, age, creed, marital status, physical or mental disability, political beliefs, or national origin. This includes discrimination which affects participation in LIHEAP and benefit amount.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1993 MAR p. 2437, Eff. 10/15/93; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2005 MAR p. 2078, Eff. 10/28/05; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 108, Eff. 1/13/18; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2021 MAR p. 1060, Eff. 10/1/21; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Mont. Admin. R. 37.70.310 Investigation of Eligibility

(1) Investigations of eligibility will include securing information from the person applying for or receiving benefits and such other investigation as may be determined necessary by the department.

(a) Each application for assistance will be promptly and thoroughly investigated by a staff member of the local contractor. If a case is picked for quality control review, the client must cooperate or be subject to reduced, suspended, or terminated benefits.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1989 MAR p. 1571, Eff. 10/13/89; TRANS, from SRS, 1998 MAR p. 2059.

Mont. Admin. R. 37.70.311 Procedures Followed in Processing Applications and Verifiable Eligibility Requirements

(1) The procedures for determining eligibility for LIHEAP benefits are as follows:

(a) The household files an application together with verification for determining financial eligibility and benefit award.

(b) After an application is filed, the local contractor may request any additional information or documentation needed to determine the household's eligibility, benefit amount, or both.

(c) If a household fails to provide information or documentation necessary for a determination of eligibility within 30 days of the date of the most recent request for additional information, the application will be denied.

(d) If an application is denied, the household may reapply for assistance.

(2) Eligibility requirements that must be verified include a social security number (SSN) for each household member and proof of U.S. citizenship, or proof of status as a qualified alien as defined in 8 U.S.C. § 1641(b). Other eligibility requirements that may be verified include:

(a) photo identification for each household member 18 years or older may be required if the SSN has not been verified;

(b) for members under age 18, a birth certificate will be accepted if the SSN has not been verified;

(c) current receipt of benefits under the Supplemental Nutrition Assistance Program (SNAP), supplemental security income, or cash assistance funded by temporary assistance for needy families (TANF);

(d) household income and resources;

(e) proof of the household's obligation to pay for the cost of heating its residence and type of primary heating fuel for the household's residence; and

(f) receipts to support paid eligible energy costs when a household seeks direct reimbursement for paid eligible energy costs as provided in ARM 37.70.607. Failure to provide receipts to the local contractor by June 20 or the end of the heating season, whichever is later, will result in forfeiture of any remaining benefits for that heating season.

(3) If the local contractor reasonably doubts the accuracy of information provided by the household, then the type of dwelling, number of bedrooms, primary heating fuel, and primary fuel vendor must also be verified.

(4) The local contractor may conduct an interview with household members in person or by telephone, if necessary, to determine eligibility. In cases where the local contractor considers an interview to be necessary and neither the local contractor's office nor a telephone is reasonably accessible to the household, the local contractor will conduct the interview at some place which is reasonably convenient for the household and the local contractor.

(5) After a household's eligibility and benefit amount have been determined by the local contractor, notice of the decision will be given to the household as provided in ARM 37.70.312.

(6) A household's eligibility and benefit amount will be determined based on the household's circumstances regarding the following on the date the application is filed:

(a) household income level;

(b) the household's dwelling type;

(d) the dwelling's primary heating fuel;

(e) the heating district in which the dwelling is located;

(f) verification of the identities and citizenship or qualified alien status of those residing in the household;

(g) the household's resources; and

(h) the percent of poverty based on the number of people in the household and total household income.

(7) Eligibility regarding income is based on the household's income for one month immediately preceding the month of application, which will be annualized using the Combined Healthcare Information and Montana Eligibility System (CHIMES).

(8) The household has the burden of proving that it meets all requirements for eligibility.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2005 MAR p. 1786, Eff. 9/23/05; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2023 MAR p. 480, Eff. 5/27/23; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.312 Notification of Eligibility

(1) An individual who applies for low income home energy assistance will be notified in writing whether the application has been approved or denied and, if the application is approved, of the benefit amount. If the application is denied, the notice shall state the reason for denial. A notice approving or denying an application shall advise the applicant of the right to a fair hearing as provided in ARM 37.5.307.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1989 MAR p. 1571, Eff. 10/13/89; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Mont. Admin. R. 37.70.318 Notice of Adverse Action

(1) Each person who receives assistance must be notified ten days in advance of any action that terminates or reduces his benefits. Notification must be in writing and contain information about the amount of decrease or the closure, the reason and legal basis for the action, and must advise the client of the date on which the action will take effect. The notice must inform the client of his right to a fair hearing.

(2) The local contractor may dispense with timely notice but must send adequate notice no later than the date of action in the following situations:

(a) recipient dies;

(b) recipient no longer wishes assistance;

(d) recipient fraudulently obtained benefits.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; TRANS, from SRS, 1998 MAR p. 2059.

Subchapter 37.70.4 Coverage and Conditions of Eligibility

Mont. Admin. R. 37.70.401 Definitions

(1) "Annual gross income" means all nonexcluded income including wages, salaries, commissions, tips, profits, interest or dividends, retirement pay, workers' compensation, unemployment compensation, social security retirement and disability payments, supplemental security income payments, veterans administration payments, cash public assistance benefits such as temporary assistance for needy families or tribal, state, or county general relief, and capital gains received by the members of the household for one month immediately preceding the month of application. Annual gross income will be calculated through the Combined Healthcare Information and Montana Eligibility System (CHIMES).

(a) For households with self-employment income, annual gross income means gross receipts for 12 months immediately preceding the month of application minus self-employment deductions for the same time period, which will be annualized.

(2) "Applicant" means a person 18 years or older or an emancipated minor, applying for LIHEAP benefits for all eligible household members in the household at the time of application. The applicant does not need to be an eligible member of the household.

(3) "Base-load electric" costs are the costs represented in a utility company's bill for electricity that powers lights, plug-in appliances, and domestic water heating.

(4) "Child" means a person who is under age 18 and not emancipated.

(5) "Deliverable heating fuel" means heating fuel that can be delivered to the customer and stored for later use, for example: propane, fuel oil, kerosene, wood, or coal.

(6) "Disabled individual household" means a household in which at least one person who has been determined disabled based on the criteria for disability provided in Title II or Title XVI of the Social Security Act resides.

(7) "Elderly" means a person who is 60 years or older.

(8) "Eligible energy costs" means costs of the various types of energy supplied by the household's fuel vendors. Energy delivered by the household's fuel vendors prior to October 1 is ineligible for payment in the current heating season, except in the sole discretion of the department. Deliverable heating fuel charges incurred from July 1 through April 30 are eligible for payment in the current heating season. Eligible energy costs include tank rental and replacing valves on portable propane tanks, off-route fees (for example, when a vendor goes off a normal route to get propane to a client), and re-light fees, but not deposits or fuel tank set up costs.

(9) "Eligible household member" is any person who is a U.S. citizen or qualified alien and is a member of a household that meets the LIHEAP eligibility requirements.

(10) "Emancipated minor" is any person under the age of 18 who has been released from parental care or custody, and granted legal rights and responsibilities as provided in 41-1-401 or 41-1-503, MCA, or by order of a court having jurisdiction.

(11) "Federal fiscal year (FFY)" means the period from October 1 of one calendar year through September 30 of the next calendar year. For example, federal fiscal year 2026 means the period from October 1, 2025, through September 30, 2026.

(12) "Gross receipts" applies to households with income from self-employment and means all income before any deductions, including any nonexcluded income not from self-employment, which was received by members of the household for 12 months immediately preceding the month of application. Annual net self-employment income may also be calculated based on federal income tax return for the calendar year immediately preceding the calendar year in which the application is filed.

(13) "Heating season" means the period from October 1 to April 30. For example, the 2025 heating season means the period from October 1, 2025, through April 30, 2026. The department may, in its sole discretion, extend the heating season beyond April 30. If the heating season is extended beyond April 30, LIHEAP benefits may be applied against energy costs incurred in the additional months of the heating season, but no applications for benefits may be filed after April 30 except as provided in ARM 37.70.305. If the department extends the end of the heating season beyond April 30, the department will notify the local contractor of the final date for reimbursement requests.

(14) "Household" means any individual or group of individuals who are living together as one economic unit for whom residential energy is customarily purchased together or who make undesignated payments for energy in the form of rent.

(a) Any foster child or foster adult who lives in the household at the time of application and for whom foster care payments are being made may be either included or excluded from the household. This option must be exercised by the household at the time of application and cannot be changed until a new application for the next heating season is made.

(b) An unborn child may not be counted as a member of the household.

(15) “Income averaging” is the process by which CHIMES calculates income. Income will be averaged either:

(a) Bimonthly, or twice monthly, meaning an individual is always paid two times per month, usually on set dates such as the 1st or 15th of each month (resulting in 24 paychecks per year); or

(b) Biweekly, meaning an individual is paid every other week throughout the year (resulting in 26 paychecks per year).

(16) "Incurment" means that portion of a medically needy person's income that exceeds the medically needy income standard for the size of the household.

(17) "Ineligible household member" is a person who is not a U.S. citizen or qualified alien who is a member of a household that meets the LIHEAP eligibility requirements. An ineligible household member of legal age may apply for LIHEAP benefits on behalf of eligible household members.

(18) "In-kind income" means goods, services, or other nonmonetary benefits, including meals, clothing, housing, or produce.

(19) "Institution of higher education" means a college, university, or vocational or technical school at the post-high school level.

(20) "Licensed group-living situation" means a facility that is licensed by the department and in which housing is provided in a home-like setting on a long term or permanent basis to individuals or households, including community homes for persons with developmental disabilities licensed under 53-20-305, MCA. It does not include community homes for persons with severe physical disabilities licensed under 52-4-203, MCA, or youth care facilities licensed under 52-2-622, MCA, shelters for homeless or abused individuals, halfway houses, nursing homes or convalescent centers, or other residential treatment facilities which provide shelter in an institutional setting.

(21) "Life-threatening" means conditions are present that may cause death or severe permanent damage to the health of one or more household members. Such conditions include:

(a) Household is without primary heat source of electric or natural gas service, or has less than 10% of a deliverable fuel (propane, wood, coal, fuel oil) and:

(i) has no secondary or alternate heat source; and

(ii) the outside temperature is below 32°F.

(b) Household whose members’ health and/or well-being would likely be endangered without the availability of their primary heat source or emergency cooling assistance. This condition may include those who suffer severe adverse effects from extreme temperature changes or exposure to extreme temperatures due to medical condition.

(c) Additional special circumstances that are considered on a case-by-case basis by LIHEAP specialists at sub-contracting local agencies.

(22) "Local contractor" means a community-based organization with which the department has contracted to provide outreach and to receive and process applications for LIHEAP and the weatherization assistance program.

(23) "Medically needy" means a person or family otherwise eligible for Montana Medicaid (medical assistance) but whose income exceeds medically needy income levels. A medically needy household may or may not have an incurment.

(24) "Member receiving supplemental security income (SSI), or temporary assistance for needy families (TANF)-funded cash assistance" means any member of a household whose needs are included in the SSI, TANF-funded cash assistance, or any person whose income and resources are considered in determining eligibility for those programs.

(25) "Mobile home" means a singlewide or doublewide trailer, mobile home, or manufactured home.

(26) "Modified LIHEAP benefit" means the amount paid to eligible households who reside in publicly subsidized housing and whose energy costs are included as a fixed portion of their rent or who have an obligation to pay a base-load electric bill. The modified LIHEAP benefit is equal to five percent of the amount of a regular LIHEAP benefit computed using the benefit matrices and multipliers in the LIHEAP Benefit Award Matrix and Table of Multipliers for the current heating season or a minimum payment of $25, whichever is greater, paid to the household annually. Households determined eligible for the publicly subsidized housing modified LIHEAP benefit, whose economic and housing situation does not change, are income eligible for a period of five years.

(27) "Monthly gross income" means all nonexcluded income, including wages, salaries, commissions, tips, profits, interest or dividends, retirement pay, workers' compensation, unemployment compensation, social security retirement and disability payments, supplemental security income payments, veterans administration payments, cash public assistance benefits such as TANF or tribal, state, or county general relief, and capital gains, received by the members of the household in a calendar month.

(a) For households with self-employment income, monthly gross income means monthly gross receipts minus self-employment deductions.

(28) "Monthly gross receipts" applies to households with income from self-employment and means all income before any deductions, including any nonexcluded income not from self-employment, received by members of the household in a calendar month.

(29) "Multi-family unit" means a building which contains two or more shelter or rental units for living purposes. For purposes of the program, a duplex and a home with a basement apartment are considered multi-family units.

(30) "Nonrecurring lump sum payment" means a sum of money paid at one time rather than in two or more separate payments.

(31) "Nontraditional dwelling unit" means dwelling units that include mobile shelters and other structures not designed for year-round human habitation. A nontraditional dwelling unit includes recreational vehicles (RVs), campers, and other structures such as storage sheds, garages, yurts, utility trailers, storage containers, and railroad cars.

(32) "Paid eligible energy costs" means heating costs paid:

(a) in the form of rent;

(b) to a fuel account not in a household member's name; or

(c) to another party during the heating season for the dwelling in which the household resides at the time of application.

(33) "Publicly subsidized housing" means government-sponsored economic assistance aimed towards providing affordable housing for persons in need.

(34) "Qualified alien" means an alien who, at the time of submitting a LIHEAP application, is a qualified alien as defined by 8 U.S.C. § 1641(b).

(35) "Self-employment deductions" means all costs, excluding depreciation costs, necessary for the creation of any income from self-employment. As an alternative, the local contractor may, at the request of the household, deduct 40 percent from the annual gross receipts for self-employment deductions.

(36) "Shelters" mean a dwelling unit or units whose principal purpose is to house on a temporary basis individuals who may or may not be related to one another, including homeless people, people living in student housing, or other individuals seeking short-term or nonpermanent living situations.

(37) "Single elderly household" means a household consisting of one person only, who is 60 years or older.

(38) "Single family unit" means a building which contains a single residence or rental unit for living purposes.

(39) "State fiscal year" means the period from July 1 of one calendar year through June 30 of the next calendar year. For example, state fiscal year 2026 means the period from July 1, 2025, through June 30, 2026.

(40) "Traditional dwelling unit" means a residential housing structure, including a mobile home or a modular home when permanently connected to the required utilities (including plumbing, heating, and electrical systems contained therein) and designed to be used as a permanent residence.

(41) "U.S. Department of Health and Human Services Poverty Guidelines" means the poverty guidelines computed annually and published each year in the Federal Register by the U.S. Department of Health and Human Services.

(42) "Valid loan" means a person's lawful promise to repay a monetary sum received from a source outside the household, including private individuals and commercial institutions, which must be repaid at a future date. Unless otherwise provided in law, the loan may be oral or written.

(43) "Vendor payment" means a monetary payment made on behalf of the household by a person who is not a member of the household to a third party outside the household such as a creditor of the household or vendor of services or goods to the household.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1987 MAR p. 2245, Eff. 12/11/87; AMD, 1988 MAR p. 2042, Eff. 10/1/88; AMD, 1989 MAR p. 1571, Eff. 10/13/89; AMD, 1992 MAR p. 2201, Eff. 9/25/92; AMD, 1993 MAR p. 1113, Eff. 5/28/93; AMD, 1993 MAR p. 2437, Eff. 10/15/93; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2007 MAR p. 1948, Eff. 11/22/07; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 108, Eff. 1/13/18; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2021 MAR p. 1060, Eff. 10/1/21; AMD, 2023 MAR p. 480, Eff. 5/27/23; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.402 General Eligibility Requirements, Eligibility Requirements for Certain Types of Individuals and Households

(1) Households that are obligated to pay for fuel to heat their homes are eligible for LIHEAP benefits.

(2) Except as provided elsewhere in this rule, households which consist solely of members who are eligible for and receiving SNAP, SSI, or TANF-funded cash assistance are automatically financially eligible for LIHEAP benefits.

(3) Households which consist of members receiving SNAP, SSI, or TANF-funded cash assistance, and other individuals whose income and resources were not considered in determining eligibility for SNAP, SSI, or TANF-funded cash assistance are not automatically eligible for LIHEAP benefits but must meet the financial requirements set forth in this rule.

(4) Individuals living in shelters, including recipients of SNAP, SSI, or TANF-funded cash assistance, are not eligible for LIHEAP benefits. Individuals living in licensed group-living situations as defined in ARM 37.70.401 may be eligible if they meet all other requirements for eligibility. Individuals living in licensed group-living situations which are not group-living situations as defined in ARM 37.70.401 are not eligible for LIHEAP benefits.

(5) Households that are eligible for or that have received LIHEAP benefits through a tribal program funded by the U.S. Department of Health and Human Services may not receive LIHEAP benefits from the department for the same heating season, unless the household changes residence during the heating season and the household is no longer eligible for tribal LIHEAP benefits; in that case, the household may apply for a prorated LIHEAP benefit based on the household's new circumstances as provided in ARM 37.70.602.

(6) Residents of publicly subsidized housing whose energy costs are included as a fixed portion of their rent or who reside in publicly subsidized housing and have an obligation to pay a base-load electric bill are not eligible for a regular LIHEAP benefit computed using the benefit matrices and multipliers in the LIHEAP Benefit Award Matrix and Table of Multipliers for the current heating season. However, these households are eligible for weatherization assistance as provided for in ARM Title 37, chapter 71 and a modified LIHEAP benefit. The modified LIHEAP benefit is equal to five percent of the amount of a regular LIHEAP benefit, or a minimum payment of $25, whichever is greater, paid to the household annually. Households determined eligible for the modified LIHEAP benefit whose economic and housing situation does not change are eligible for a period of five years.

(7) In households consisting of eligible and ineligible household members, the income of all will be counted for benefit calculation purposes. Only the eligible household members will be counted when counting the number of household members for benefit calculation purposes.

(8) Current and future benefits will be denied to any persons and households who refuse to submit social security numbers or proof of U.S. citizenship or proof of status as a qualified alien as defined in 8 U.S.C. § 1641(b), or whose social security numbers, proof of residency, or citizenship cannot be verified.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1986 MAR p. 1606, Eff. 9/26/86; AMD, 1987 MAR p. 1805, Eff. 10/16/87; AMD, 1989 MAR p. 1571, Eff. 10/13/89; AMD, 1992 MAR p. 2201, Eff. 9/25/92; AMD, 1993 MAR p. 2437, Eff. 10/15/93; AMD, 1996 MAR p. 2887, Eff. 10/25/96; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2007 MAR p. 1948, Eff. 11/22/07; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 108, Eff. 1/13/18; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2021 MAR p. 1060, Eff. 10/1/21; AMD, 2023 MAR p. 480, Eff. 5/27/23; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.406 Income Standards

(1) Households with up to eight members with annual gross income at or below 60 percent of the estimated state median are eligible for LIHEAP benefits on the basis of income. Households with nine or more members are eligible for LIHEAP benefits on the basis of income only if the household's annual gross income is at or below 150 percent of the U.S. Department of Health and Human Services' poverty guidelines for a household of that size. Households with annual gross income above the applicable income standard are ineligible for LIHEAP benefits, unless the household is automatically financially eligible for LIHEAP benefits as provided in ARM 37.70.402 because all members of the household are receiving SNAP, SSI, or TANF-funded cash assistance.

(2) The department adopts and incorporates by reference the department's Low Income Home Energy Assistance Program (LIHEAP) Table of Income Standards, 2025-2026 heating season. The LIHEAP table of income standards is located at the department's web site at https://dphhs.mt.gov/hcsd/energyassistance/ or a copy may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, P.O. Box 202956, Helena, MT 59620-2956.

(3) Households eligible for LIHEAP are also eligible for LIHEAP client education and outreach activities.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1986 MAR p. 1606, Eff. 9/26/86; AMD, 1987 MAR p. 1805, Eff. 10/16/87; AMD, 1988 MAR p. 2042, Eff. 10/1/88; AMD, 1989 MAR p. 1571, Eff. 10/13/89; AMD, 1990 MAR p. 1959, Eff. 10/26/90; AMD, 1991 MAR p. 1857, Eff. 10/1/91; AMD, 1992 MAR p. 2201, Eff. 9/25/92; AMD, 1993 MAR p. 2437, Eff. 10/15/93; AMD, 1994 MAR p. 2642, Eff. 9/23/94; AMD, 1995 MAR p. 2157, Eff. 10/13/95; AMD, 1996 MAR p. 2887, Eff. 10/25/96; AMD, 1997 MAR p. 2296, Eff. 12/16/97; TRANS, from SRS, 1998 MAR p. 2059; AMD, 1999 MAR p. 414, Eff. 3/12/99; AMD, 1999 MAR p. 2575, Eff. 11/5/99; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2005 MAR p. 2078, Eff. 10/28/05; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2007 MAR p. 1948, Eff. 11/22/07; AMD, 2011 MAR 108, Eff. 1/28/11; AMD, 2011 MAR p. 2419, Eff. 11/11/11; AMD, 2013 MAR p. 61, Eff. 1/18/13; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 108, Eff. 1/13/18; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2021 MAR p. 1060, Eff. 10/1/21; AMD, 2023 MAR p. 480, Eff. 5/27/23; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.407 Excluded Income

(1) The following types of unearned income are excluded or deducted when calculating income for LIHEAP eligibility:

(a) complementary assistance from other agencies and organizations which consists of goods and services not included in or duplicated by the low income home energy assistance benefit award;

(b) home produce utilized for household consumption;

(c) undergraduate student loans and grants for educational purposes made or insured under any program administered by the Commissioner of Education;

(d) extension of Old-Age, Survivors, and Disability Insurance (OASDI) benefits for 18 to 22 year olds who are full-time students;

(e) the value of the SNAP allotment;

(f) the value of U.S. Department of Agriculture donated foods;

(g) any benefits received under Title III of the Nutrition Program for the Elderly of the Older Americans Act of 1965 as amended;

(h) the value of supplemental food assistance received under the Child Nutrition Act of 1966, and the Special Food Services Program for Children under the National School Lunch Act (P.L. 92-433 and P.L. 93-150);

(i) all monies awarded to Indian tribes by the Indian Claims Commission or Court of Claims as authorized by P.L. 92-254, 93-134, 94-540, 95-433, 97-408, or other applicable awards as provided in public law;

(j) payments received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970;

(k) the tax-exempt portions of payments made pursuant to P.L. 92-203, the Alaska Native Claims Settlement Act;

(l) all payments under Title I of the Elementary and Secondary Education Act;

(m) all earnings, work incentive allowances, reimbursement of training related expenses, and other allowances and payments made to a participant in any program under the Workforce Investment Act of 1998;

(n) payment for supportive services or reimbursement of out-of-pocket expenses made to individual volunteers serving as senior health aides, or senior companions, and to persons serving in service corps of the retired executives and active corps of executives, and any other program under Titles II and III of P.L. 93-113;

(o) payments to individual volunteers under Title I (VISTA) of P.L. 93-113, pursuant to section 404(g) of that law;

(p) proceeds from sale of the family home if the household is living in the residence at the time of the sale;

(q) one-time insurance payments, compensation for injury, or payments from federal or state crime victim compensation programs;

(r) the entire amount of Veteran's Administration educational payments made to an applicant or recipient who is attending an institution of higher education, including amounts spent for expenses not directly related to the individual's school attendance;

(s) Veteran's Administration pension reimbursements for medical expenses;

(t) foster care payments received for a foster child or adult if the LIHEAP applicant has chosen to exclude the foster child or adult from the household; such payments are not excluded if the applicant has chosen to include the foster adult or child as a member of the household. Additionally, any foster care payments received one full month immediately preceding the month of application for a foster child or adult who is no longer living in the household at the time of application shall be excluded;

(u) in-kind income;

(v) valid loans, except that the funds received from valid loans are considered as a resource until the funds are spent;

(w) monetary gifts, except that funds received as a gift are considered as a resource until the funds are spent;

(x) nonrecurring lump sum payments, such as federal and state income tax refunds, one-time insurance payments or worker's compensation payments, and retroactive SSI or SSDI payments, but only to the extent that the payment does not constitute income or benefits for one full month immediately preceding the month of application. The funds received from a nonrecurring lump sum payment are considered as a resource until the funds are spent;

(y) vendor payments, except the following types of vendor payments:

(i) payments which are legally owed or otherwise payable to the household but are diverted by the provider of the payment to a third party for an expense or debt of the household;

(ii) federal, state, or tribal benefits payable directly to the household but are diverted to a third party or protective payee for an expense or debt of the household; and

(iii) rent or mortgage payments made to the household's landlord or mortgagee.

(z) payments under Public Law 101-426, Radiation Exposure Compensation Act, are excluded as income and as a resource to the household;

(aa) amounts paid to satisfy an incurment for the medically needy programs; and

(bb) proof of out-of-pocket health insurance premiums paid by a member of the household for a household member or members will reduce the income when supplied at the time of application or prior to application eligibility determination.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1986 MAR p. 1606, Eff. 9/26/86; AMD, 1987 MAR p. 1805, Eff. 10/16/87; AMD, 1988 MAR p. 2042, Eff. 10/1/88; AMD, 1990 MAR p. 1959, Eff. 10/26/90; AMD, 1991 MAR p. 1857, Eff. 10/1/91; AMD, 1992 MAR p. 2201, Eff. 9/25/92; AMD, 1993 MAR p. 2437, Eff. 10/15/93; AMD, 1994 MAR p. 2642, Eff. 9/23/94; AMD, 1995 MAR p. 2157, Eff. 10/13/95; AMD, 1996 MAR p. 2887, Eff. 10/25/96; AMD, 1997 MAR p. 504, Eff. 10/25/96; AMD, 1997 MAR p. 2296, Eff. 12/16/97; TRANS, from SRS, 1998 MAR p. 2059; AMD, 1999 MAR p. 414, Eff. 3/12/99; AMD, 1999 MAR p. 2575, Eff. 11/5/99; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2005 MAR p. 2078, Eff. 10/28/05; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2023 MAR p. 480, Eff. 5/27/23; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.408 Resources

(1) The following nonbusiness resources are counted in determining a household's eligibility:

(a) cash on hand;

(b) certificate of deposits;

(d) market value of stocks or bonds and/or other negotiable resources; and

(e) the equity value of real property which is not the family home.

(2) The equity value of the household's business assets is counted in determining eligibility. The household may have business assets the equity value of which does not exceed $25,000.

(3) The value of a primary residence and the proceeds from the sale of a primary residence are not included as a resource for 12 months from the date of sale.

(4) The department adopts and incorporates by reference the department's LIHEAP Table of Resource Standards, for the 2025-2026 heating season. The LIHEAP table of resource standards is located at https://dphhs.mt.gov/hcsd/energyassistance/ or a copy may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, P.O. Box 202956, Helena, MT 59620-2956.

(5) The dollar limitations on nonbusiness resources listed elsewhere in this rule will be adjusted annually by the department on July 1 by increasing each limitation by an amount equal to the limitation amount for the previous year, multiplied by the lesser of:

(a) the percentage increase in the consumer price index, all items, United States city average, for the most recent calendar year completed before the beginning of the year for which the determination is being made; or

(b) five percent.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1991 MAR p. 1857, Eff. 10/1/91; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2005 MAR p. 2078, Eff. 10/28/05; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2007 MAR p. 1948, Eff. 11/22/07; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2011 MAR p. 2419, Eff. 11/11/11; AMD, 2013 MAR p. 61, Eff. 1/18/13; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 108, Eff. 1/13/18; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2021 MAR p. 1060, Eff. 10/1/21; AMD, 2023 MAR p. 480, Eff. 5/27/23; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Subchapter 37.70.6 Need and Amount of Assistance

Mont. Admin. R. 37.70.601 Benefit Award

(1) The department adopts and incorporates by reference the department's LIHEAP Benefit Award Matrix and Table of Multipliers, for the 2025-2026 heating season. The LIHEAP Benefit Award Matrix is located at https://dphhs.mt.gov/hcsd/energyassistance/ or a copy may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620. These matrices are used to establish the benefit payable to an eligible household for a full heating season. The 2025-2026 benefit matrix will be used for the 2025-2026 heating season. The benefit varies by:

(a) household income level;

(b) type of primary heating fuel;

(d) the number of bedrooms in the dwelling;

(e) the heating district in which the household is located, to account for climatic differences across the state;

(f) verification of the identities and citizenship or qualified alien status of those residing in the household; and

(g) the household's resources.

(2) The benefit payable to an eligible household will be computed by multiplying the applicable amount in the table of base benefit levels found in the LIHEAP Benefit Award Matrix by the applicable matrix amount in the table of income/climatic adjustment multipliers found in the LIHEAP Benefit Award Matrix.

(3) Publicly subsidized households whose energy costs are included as a fixed portion of their rent, or who reside in publicly subsidized housing and have an out-of-pocket obligation to pay a base-load electric bill, are not eligible for a regular LIHEAP benefit computed using the benefit matrices and multipliers in the LIHEAP Benefit Award Matrix and Table of Multipliers. However, these households may be eligible for a modified LIHEAP benefit. The modified LIHEAP benefit is equal to five percent of the regular LIHEAP benefit computed using the benefit matrices and multipliers in the LIHEAP Benefit Award Matrix and Table of Multipliers, or a minimum payment of $25, whichever is greater, paid annually. Households determined eligible for the modified LIHEAP benefit whose economic and housing situation does not change are eligible for a period of five years.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1983 MAR p. 131, Eff. 2/11/83; AMD, 1983 MAR p. 1362, Eff. 9/30/83; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; EMERG, AMD, 1986 MAR p. 362, Eff. 3/14/86; AMD, 1986 MAR p. 1606, Eff. 9/26/86; AMD, 1987 MAR p. 1805, Eff. 10/16/87; AMD, 1988 MAR p. 2042, Eff. 10/1/88; AMD, 1989 MAR p. 1571, Eff. 10/13/89; AMD, 1990 MAR p. 2307, Eff. 10/26/90; AMD, 1991 MAR p. 1857, Eff. 10/1/91; AMD, 1992 MAR p. 2201, Eff. 9/25/92; AMD, 1993 MAR p. 2437, Eff. 10/15/93; AMD, 1994 MAR p. 2642, Eff. 9/23/94; AMD, 1995 MAR p. 2157, Eff. 10/13/95; AMD, 1996 MAR p. 2887, Eff. 10/25/96; AMD, 1997 MAR p. 2296, Eff. 12/16/97; TRANS, from SRS, 1998 MAR p. 2059; AMD, 1999 MAR p. 414, Eff. 3/12/99; AMD, 1999 MAR p. 2575, Eff. 11/5/99; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2001 MAR p. 401, Eff. 3/9/01; AMD, 2001 MAR p. 2037, Eff. 10/12/01; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2005 MAR p. 1786, Eff. 9/23/05; AMD, 2005 MAR p. 2078, Eff. 10/28/05; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2007 MAR p. 1948, Eff. 11/22/07; AMD, 2008 MAR p. 810, Eff. 4/25/08; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2011 MAR p. 2419, Eff. 11/11/11; AMD, 2013 MAR p. 61, Eff. 1/18/13; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 108, Eff. 1/13/18; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2021 MAR p. 1060, Eff. 10/1/21; AMD, 2022 MAR p. 1879, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.602 Benefit Awards: Miscellaneous

(1) Households found eligible may apply all or a portion of their benefit award for conversion (or fuel switch) to a less costly heating fuel, as determined by the department.

(2) Eligible households who convert to a less costly heating fuel must disclaim any right to additional program benefits for the current heating season regardless of change of address or any other circumstance except emergencies as defined in ARM 37.70.901.

(3) When an eligible household changes residence during the heating season, the household must file a new application. The household's benefit award will then be recomputed based on its new residence, and the new benefit will be prorated from the date the applicant becomes responsible for the heat costs at the new residence. Any unused portion of the original benefit award reverts to the department. When an eligible household changes its type of primary heating fuel during the heating season, the household is not required to file a new application but must have its benefit award recomputed based on the new type of fuel. The new benefit will be prorated from the date of the change of type of fuel. Any unused portion of the original benefit reverts to the department.

(4) Benefit awards will be prorated for households new to the state or not previously responsible for heating costs from the date of residency or responsibility for the remainder of the heating season. Benefits will also be prorated for households who live in an area served by tribal LIHEAP if the household moves from the service area during the heating season and applies for benefits through Montana LIHEAP. Such households are eligible for a prorated benefit for the remainder of the heating season from the date the household moved from the service area served by the tribal LIHEAP.

(5) When a household changes primary fuel vendors, any remaining LIHEAP attributable credit balance will be returned to the department by the original fuel vendor. The department may reissue the unused portion of the benefit award to the new fuel vendor or reimburse the household as provided in ARM 37.70.607.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1983 MAR p. 131, Eff. 2/11/83; AMD, 1983 MAR p. 1362, Eff. 9/30/83; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1986 MAR p. 1606, Eff. 9/26/86; AMD, 1993 MAR p. 2437, Eff. 10/15/93; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2005 MAR p. 2078, Eff. 10/28/05; AMD, 2007 MAR p. 1948, Eff. 11/22/07; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2023 MAR p. 480, Eff. 5/27/23; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.603 Reversion of Benefits

(1) If a beneficiary discontinues utility service or changes residence or fuel type, the balance of the fuel benefit will be returned to the department.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1984 MAR p. 1481, Eff. 10/12/84; TRANS, from SRS, 1998 MAR p. 2059.

Mont. Admin. R. 37.70.607 Amount and Method of Payment

(1) Eligible households directly billed for energy costs by the fuel vendor will be paid a benefit amount computed using the benefit matrices and multipliers in the Low Income Home Energy Assistance Program (LIHEAP) Benefit Award Matrix and Table of Multipliers and will be paid as follows:

(a) Reimbursement may, at the discretion of the department only, be made by check payable to the household for any eligible energy costs which have been paid by the household at the time of the benefit or adjusted award. Paid eligible energy costs claimed by the household must be supported by fuel receipts.

(b) The amount of the benefit or adjusted award remaining after the application of (1)(a) will be paid by check directly to the fuel vendor and will be applied by the fuel vendor against any unpaid, including any future, eligible energy costs of the household in accordance with the department-provided vendor application and contract. Any credit balance in excess of $250 attributable to the benefit or adjusted award after the end of the heating season must be returned to the department.

(c) Application for benefits for the current heating season will not be processed until the credit balances for each of the household's fuel vendors attributable to previous years' program awards total $250 or less. This does not apply if the department has extended the heating season and has allowed LIHEAP attributable credit balances to remain on the recipients' accounts until spent.

(d) All credit balances are presumed to be from previous program awards unless the household provides proof to the contrary.

(2) Eligible households that pay energy costs for heating their homes that are not billed directly by the fuel vendor because the fuel account is not in the name of a household member will be reimbursed for eligible energy costs paid by the household, provided that the amount paid to the household for the heating season does not exceed the benefit amount computed using the benefit matrices and multipliers in the LIHEAP Benefit Award Matrix and Table of Multipliers. Reimbursement will be made by check payable to the household. The household must provide receipts to document paid eligible energy costs claimed. The household must provide receipts to support the paid eligible energy costs to the local contractor by June 20 or the end of the heating season, whichever is later.

(3) For eligible households that have their energy costs included in their rental payments:

(a) The household will be paid a benefit computed monthly. For each month of the current heating season for which the household provides a paid rent receipt, the household will be reimbursed a prorated portion, determined by dividing one by the number of months in the heating season, of the benefit amount provided in ARM 37.70.601. However, the benefit paid to the household for any month must not exceed 50 percent of the rent paid for that month as evidenced by the rent receipt. Failure to provide rent receipts to the local contractor by June 20 or the end of the heating season, whichever is later, will result in the forfeiture of any benefits to which the household would otherwise be entitled.

(b) The benefit will be paid by check payable to the household.

(4) Benefits for eligible households using wood to heat their dwelling will be paid as follows:

(a) by payment to a wood vendor for purchases of wood;

(b) at the option of the local contractor, by payment directly to the household for future purchases of wood. Households which receive a direct payment will not be entitled to any additional benefits for the current heating season which the household might otherwise be entitled to receive due to moving to a different dwelling or other change in circumstances, except in an emergency as defined in ARM 37.70.901; or

(c) when the household provides receipts to verify that the household has purchased wood between July 1 and the end of the heating season of the current state fiscal year, by a payment directly to the household reimbursing the household for wood already purchased. Households which are reimbursed based on paid receipts do not lose their right to additional benefits for the current heating season as provided in (4)(b). Failure to provide receipts verifying wood purchases to the local contractor by June 20 or the end of the heating season, whichever is later, will result in the forfeiture of any benefits to which the household would otherwise be entitled.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1982 MAR p. 1771, Eff. 10/1/82; AMD, 1983 MAR p. 131, Eff. 2/11/83; AMD, 1984 MAR p. 1481, Eff. 10/12/84; AMD, 1985 MAR p. 1412, Eff. 9/27/85; AMD, 1986 MAR p. 2021, Eff. 12/12/86; AMD, 1987 MAR p. 1805, Eff. 10/16/87; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2004 MAR p. 1026, Eff. 4/23/04; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2005 MAR p. 1786, Eff. 9/23/05; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2018 MAR p. 108, Eff. 1/13/18; AMD, 2018 MAR p. 1886, Eff. 9/22/18; AMD, 2019 MAR p. 2383, Eff. 12/28/19; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2021 MAR p. 1060, Eff. 10/1/21; AMD, 2022 MAR p. 1879, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Mont. Admin. R. 37.70.608 Adjustment of Payments to Available Funds

(1) When funds are not available to serve all eligible households, the department may, at its option, take any or all of the following steps:

(a) reduce the maximum benefit amounts of the benefit award matrices;

(b) limit eligibility to only financially needy households with a member 60 years of age or older, or with a member who is disabled and receiving supplemental security income or social security income based on permanent and total disability; or

(2) If additional funds become available to serve eligible households, the department may, at its option, take any or all of the following steps:

(a) increase the maximum benefit amounts of the benefit award matrices;

(b) extend the duration of the current heating season beyond April 30;

(d) allow LIHEAP attributable credit balances in excess of $250 to remain on recipients’ accounts through the end of the heating season. Credits in excess of the maximum must be returned to the department; or

(e) extend the deadline to submit paid receipts to correspond with the end of the heating season.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1983 MAR p. 1362, Eff. 9/30/83; TRANS, from SRS, 1998 MAR p. 2059; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2005 MAR p. 1786, Eff. 9/23/05; AMD, 2022 MAR p. 1879, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-532, Eff. 5/23/26.

Subchapter 37.70.9 Emergency Assistance

Mont. Admin. R. 37.70.901 Emergency Assistance

(1) Emergency assistance under LIHEAP may be provided to an eligible household in the following circumstances only when such circumstances present an imminent threat to the health and safety of the household:

(a) the household's primary supply of energy is interrupted because of weather conditions and another supply or a different type of energy is necessary;

(b) weather or other forces outside the household's control damages the household's dwelling and causes the dwelling to suffer a severe loss of heat;

(c) hazardous or potentially hazardous conditions exist in the household's primary home water heating system, space heating systems, or safety modifications to the system are required;

(d) any other home energy-related conditions caused by severe weather conditions, fuel shortages, or acts of God; or

(e) the household has a documented medical need for home energy-related safety modifications.

(2) Eligibility requirements:

(a) A household eligible for LIHEAP that has an emergency as defined above is eligible for emergency assistance.

(b) A household that would be eligible for LIHEAP had the household applied and which has an emergency as defined in (1) is also eligible for emergency assistance.

(3) The household is responsible, at its own expense, for documenting that circumstances exist which present an imminent threat to the household as defined in (1)(a) through (e). The local contractor may, however, in its discretion and subject to the priorities and restrictions specified in its contract with the department, assist the household in identifying and documenting such circumstances, if the local contractor has the expertise and resources to do so.

(4) Emergency assistance payments may be made on behalf of the eligible household for actual costs necessary to alleviate the emergency. However, no emergency assistance payments will be made for costs which are the liability of a third party, unless the household assigns to the department in writing its rights to such third party payments.

(5) Subject to the provisions of (6), after a household has requested emergency assistance and provided proof that it is financially and otherwise eligible for such assistance, the local contractor must provide some form of assistance to resolve the emergency:

(a) within 48 hours after the request is made in all cases; and

(b) within 18 hours after the request is made if the emergency is life-threatening. Life-threatening is defined as any of the conditions of emergency specified in (1) that may cause death or severe permanent damage to the health of one or more household members.

(6) The time limits contained in (5)(a) and (b) do not apply in a geographical area affected by a disaster or emergency as designated in (6)(a) and (b), as long as the designation is in effect, if the secretary of the U.S. Department of Health and Human Services determines that the disaster or emergency makes compliance with the time limits impracticable. This exception to the time limit applies when:

(a) a natural disaster has been designated by the secretary of the U.S. Department of Health and Human Services; or

(b) a major disaster or emergency has been designated by the president under the Disaster Relief Act of 1974.

(7) The identification, removal, or abatement of asbestos is not an allowable use of emergency assistance funds.

(8) Emergency assistance funds may be used to replace a wood stove not approved by the Environmental protection agency (EPA) if the wood stove is the eligible household's primary source of heat and the household is eligible to receive a benefit award for wood during the heating season.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 1982 MAR p. 732, Eff. 4/16/82; AMD, 1997 MAR p. 2296, Eff. 12/16/97; TRANS, from SRS, 1998 MAR p. 2059; AMD, 1999 MAR p. 414, Eff. 3/12/99; AMD, 1999 MAR p. 2575, Eff. 11/5/99; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2004 MAR p. 2818, Eff. 11/19/04; AMD, 2011 MAR p. 108, Eff. 1/28/11; AMD, 2011 MAR p. 2419, Eff. 11/11/11; AMD, 2014 MAR p. 126, Eff. 1/17/14; AMD, 2015 MAR p. 2145, Eff. 12/11/15; AMD, 2020 MAR p. 1844, Eff. 10/10/20; AMD, 2023 MAR p. 480, Eff. 5/27/23.

Mont. Admin. R. 37.70.902 Supplemental Assistance

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1986 MAR p. 1606, Eff. 9/26/86; AMD, 1987 MAR p. 1805, Eff. 10/16/87; AMD, 1987 MAR p. 2245, Eff. 12/11/87; AMD, 1989 MAR p. 1571, Eff. 10/13/89; AMD, 1990 MAR p. 1959, Eff. 10/26/90; AMD, 1994 MAR p. 2642, Eff. 9/30/94; AMD, 1996 MAR p. 2887, Eff. 10/25/96; TRANS, from SRS, 1998 MAR p. 2059; AMD, 1999 MAR p. 2575, Eff. 11/5/99; AMD, 2000 MAR p. 2707, Eff. 10/6/00; REP, 2001 MAR p. 2037, Eff. 10/12/01.

Chapter 37.71 Low Income Weatherization Assistance Program (liwap)

Subchapter 37.71.1 General Program Administration

Mont. Admin. R. 37.71.101 Safeguarding/Sharing Information

(1) Disclosure of information concerning applicants for or recipients of weatherization assistance for low income persons is restricted to purposes directly connected with the administration of such aid. Such purposes include establishing eligibility, determining amount of assistance, and providing benefits to or on behalf of applicants and recipients.

(a) When information is released, such information will be accompanied with a notification of the confidentiality of the information and the penalty for misuse of such information. Whenever possible, the department will attempt to obtain prior consent from the applicant or recipient, except in emergency situations where notification will be given after the release of information and in cases where the information is released for legal and investigative actions concerning fraud, collection of support and third party medical recovery.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 90-4-201 and 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; TRANS, from SRS, 1998 MAR p. 2061.

Mont. Admin. R. 37.71.102 Role of the Local Contractor

(1) The department will contract with appropriate community-based organizations in the state to provide outreach, receive and process applications, and provide weatherization services for the low income weatherization assistance program. A local contractor may provide one or all of these functions as designated by the department.

(a) In providing outreach, the local contractor performs activities designed to inform potentially-eligible households of the existence of and the benefits available under the low income weatherization assistance program.

(b) In receiving and processing applications, the designated local contractor determines household eligibility under the rules contained in this chapter.

(c) The designated local contractor shall see that priority is given to identifying and providing weatherization assistance to the elderly, persons with a disability, and children using a computerized listing of households prioritized for service provided by the department and described in ARM 37.71.601. The computerized listing may be amended by the designated local contractor using the procedure described in ARM 37.71.601.

(2) The designated local contractor provides weatherization service for eligible low income persons according to the rules and regulations of the United States department of energy (DOE) as found in 10 CFR 440 and the provisions of the contract for weatherization for low income persons. The department hereby adopts and incorporates by reference 10 CFR 440 which sets forth the specifications, weatherization techniques and material standards for weatherizing low income dwellings. A copy of 10 CFR 440 may be obtained from the Department of Public Health and Human Services, P.O. Box 4210, 111 Sanders, Helena, Montana 59604.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1983 MAR p. 1377, Eff. 9/30/83; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2018 MAR p. 1885, Eff. 9/22/18.

Mont. Admin. R. 37.71.106 Fair Hearings

(1) Any person who is aggrieved by an adverse department action taken on his application, benefit status, form or condition of services, may request a fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

(2) It is the responsibility of the department through the designated local contractor to inform every applicant/ recipient in writing at the time of application and at the time any action affects his benefits of the right to request a fair hearing.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 90-4-201 and 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1983 MAR p. 1377, Eff. 9/30/83; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.71.107 Referrals to the Office of Inspector General, Program Compliance Bureau

(1) The Office of Inspector General, Program Compliance Bureau (PCB) will have the power and duty to conduct an investigation to determine, based on the evidence gathered, whether a person or household has committed a program violation as defined in ARM 37.71.110.

(2) Requests to investigate suspected program violations must be sent to the department's Intergovernmental Human Services Bureau (IHSB), 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620-2956. IHSB will review cases prior to referral to the PCB.

History

Authorizing statute(s): 53-2-201, 90-4-201, MCA
Implementing statute(s): 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2017 MAR p. 2197, Eff. 11/25/17; AMD, 2022 MAR p. 1874, Eff. 9/24/22.

Mont. Admin. R. 37.71.110 Weatherization Assistance Program Violations

(1) A person is guilty of a program violation if the person purposely or knowingly obtains weatherization assistance provided under Title 53, chapter 2, part 2, MCA, that the person is not entitled to receive, by means of:

(a) a knowingly false statement, representation, or impersonation; or

(b) a fraudulent scheme or device.

(2) If a person appears to have committed a program violation, the local contractor must report all facts of the matter to the Intergovernmental Human Services Bureau (IHSB) to determine if the case should be referred to the Office of Inspector General, Program Compliance Bureau (PCB). The PCB may refer the matter to the Department of Justice or the county attorney of the county in which the person resides for further action.

History

Authorizing statute(s): 53-2-201, 90-4-201, MCA
Implementing statute(s): 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2017 MAR p. 2197, Eff. 11/25/17; AMD, 2022 MAR p. 1874, Eff. 9/24/22.

Subchapter 37.71.3 Application and Eligibility Determination

Mont. Admin. R. 37.71.301 Notification of Eligibility Determination

(1) An individual who makes application for low income weatherization assistance will receive written notice of eligibility including priority for service. If the applicant is determined ineligible, notification shall include the reasons for nonapproval.

(2) Households determined eligible but not prioritized high enough to receive service must be redetermined for eligibility after one year from initial application except that redetermination may be made within a year if a reasonable suspicion of change of status occurs.

(3) Notification of eligibility shall contain the following language: "Because of limited funds, homes are weatherized on a priority basis with special consideration given to the elderly, persons with a disability, and children. Households will be notified when funds become available to weatherize the applicant's home. If not notified within one year, the applicant must reapply to be reassigned priority for service."

History

Authorizing statute(s): 53-2-201, 90-4-201, MCA
Implementing statute(s): 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1983 MAR p. 1377, Eff. 9/30/83; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2018 MAR p. 1885, Eff. 9/22/18.

Mont. Admin. R. 37.71.304 Notice of Adverse Action

(1) Each person determined eligible for weatherization assistance must be notified by the designated local contractor in advance of any action that terminates or reduces his benefits. Notification must be in writing and contain information about the amount of decrease or the closure, the reason and legal basis for the action, and must advise the client of the date on which the action will take effect. The notice must inform the client of his right to a fair hearing.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 90-4-201 and 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1983 MAR p. 1377, Eff. 9/30/83; TRANS, from SRS, 1998 MAR p. 2061.

Mont. Admin. R. 37.71.308 Application/Eligibility

(1) Elderly or handicapped persons residing in a community residential facility as defined at 76-2-411 , MCA need not apply for weatherization assistance as provided for in this subchapter. The department will determine their eligibility based on their living arrangement and the individual records available to the department. The department will provide a list of the eligible facilities to the designated local contractors.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 90-4-201 and 90-4-202, MCA
History: NEW, 1991 MAR p. 311, Eff. 3/15/91; TRANS, from SRS, 1998 MAR p. 2061.

Subchapter 37.71.4 Coverage and Conditions of Eligibility

Mont. Admin. R. 37.71.401 Low Income Weatherization Assistance Program, Definitions

(1) "Act of God" means an event caused solely by forces of nature without human involvement.

(2) "Child" means a person who is under age 18.

(3) "Disability" means the same as when the term is used in Social Security law purposes and is determined by the Federal Social Security Administration (SSA) under Title II or Title XVI of the Social Security Act. Verification of disability will be demonstrated by persons showing a supplemental security income disability card, Social Security disability check, or award letter.

(4) "Elderly" means a person who is 60 years of age or older.

(5) "Energy burden" means the percentage of a household's income which is allocated to energy costs for the household's dwelling. The energy burden is calculated by dividing the household's actual or estimated annual heating costs by the household's annual income.

(6) "Energy usage" means the amount of energy used over a given period. The annual energy usage is determined by using actual or estimated heating cost over a twelve-month period.

(7) "Weatherization related imminent threat to the health or safety of a household" means any adverse condition in a dwelling that:

(a) relates to a structure, appliance, system, or equipment that directly and significantly impacts the dwelling's energy usage or energy conservation, including but not limited to the dwelling's primary water heating and/or space heating systems; and

(b) creates a serious and immediate risk to the physical health or safety of residents of the dwelling.

(8) "Weatherization services" means improvements, repairs, or other modifications made to a dwelling for the purpose of reducing a household's energy usage.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1988 MAR p. 289, Eff. 2/12/88; AMD, 1993 MAR p. 1113, Eff. 5/28/93; AMD, 1998 MAR p. 1416, Eff. 5/29/98; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2008 MAR p. 1592, Eff. 8/1/08; AMD, 2016 MAR p. 1574, Eff. 9/3/16; AMD, 2018 MAR p. 1885, Eff. 9/22/18.

Mont. Admin. R. 37.71.404 Low Income Weatherization Assistance Program, Eligibility

(1) A household is eligible for the Low Income Weatherization Assistance Program (LIWAP) if:

(a) the household satisfies the financial requirements of (2)(a) or (b) of this rule; and

(b) the household's dwelling satisfies the nonfinancial requirements of ARM 37.71.601.

(2) A household is financially eligible for LIWAP if:

(a) the household is eligible for Low Income Home Energy Assistance Program (LIHEAP) for the current heating season; or

(b) the household is not eligible for LIHEAP for the current heating season because the household's countable income exceeds 150% of the federal poverty level (FPL), but:

(i) the household's countable income does not exceed 200% of the FPL; and

(ii) the household is otherwise eligible for LIHEAP.

(3) If a household has not applied for LIHEAP for the current heating season but wishes to receive weatherization services through LIWAP, the household must complete a LIHEAP application and comply with all requirements of ARM 37.70.305 and 37.70.311. The household is not required to accept LIHEAP benefits in order to receive weatherization services.

(4) In determining whether a household's countable income is at or below 200% of the FPL, the provisions of ARM 37.70.401, 37.70.406, and 37.70.407 will be applied.

(5) In determining whether a household is otherwise eligible for LIHEAP the provisions of ARM 37.70.110, 37.70.401, and 37.70.408 will be applied.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1988 MAR p. 289, Eff. 2/12/88; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2000 MAR p. 2707, Eff. 10/6/00; AMD, 2012 MAR p. 1529, Eff. 8/1/12; AMD, 2022 MAR p. 1874, Eff. 9/24/22.

Subchapter 37.71.6 Need and Amount of Assistance

Mont. Admin. R. 37.71.601 Eligibility for Weatherization Service: Priorities

(1) Except as provided in (1)(a), a dwelling is not eligible for weatherization services funded with U.S. Department of Energy (DOE) funds if the dwelling has been weatherized within the fifteen years following the date of the previous weatherization completion.

(a) Regardless of the time limitations imposed in (1), DOE funds may be used at any time to weatherize a dwelling that has been damaged by fire, flood, or act of God if the damage to weatherization materials will not be paid for by insurance.

(2) Except as provided in (2)(a), a dwelling is not eligible for weatherization services funded with NorthWestern Energy free weatherization (NWE) funds if the dwelling has been weatherized within the five years following the date of the previous weatherization completion.

(a) Regardless of the time limitations imposed in (2), NWE funds may be used at any time to weatherize a dwelling that has been damaged by fire, flood, or act of God if the damage to weatherization materials will not be paid for by insurance.

(3) Except as provided in (3)(a), a dwelling is not eligible for weatherization services funded with LIHEAP weatherization funds if the dwelling has been weatherized within the five years following the date of the previous weatherization completion.

(a) Regardless of the time limitations imposed in (3), LIHEAP funds may be used at any time to weatherize a dwelling that has been damaged by fire, flood, or act of God if the damage to weatherization materials will not be paid for by insurance.

(4) Community residential facilities as defined at 76-2-411, MCA, that are the residence for low income elderly individuals or individuals with a disability are eligible for weatherization services.

(5) In determining which eligible households will receive weatherization services, local agencies may prioritize households as follows:

(a) The highest priority is given to a household that has a primary heating source or primary water heater emergency. Emergency must be documented in the client file.

(b) Local agencies may then prioritize households with:

(i) an elderly household member (60 years of age or older);

(ii) a household member with a disability; or

(iii) a household member who is a child.

(c) Local agencies may give higher priority for weatherization services to households meeting two or more of the priority criteria listed in (b)(i) through (iii) than those households with just one.

(6) If there exists a weatherization-related imminent threat to the health or safety of an eligible household, the home may be given a higher priority than described in (5). It is the obligation of the household to provide proof of an imminent threat to the health or safety of the household to the local contractor. The local contractor must request that the department give the household's dwelling a higher priority.

(7) Weatherization will be scheduled to minimize travel and other nonproductive costs.

(a) If nonproductive costs are excessive, the scheduled home may be delayed for weatherization, but in no instance will the scheduled home be delayed longer than one year or the end of the contract period whichever comes first.

(8) Eligible homes scheduled to receive partial weatherization from any other agency may be prioritized higher to allow coordination and avoid duplication of weatherization services.

(9) If at least 66% of units in a multi-unit building, or 50% for duplexes and four-unit buildings, are eligible for weatherization, and one of the units is prioritized high enough to be scheduled for service, all of the units in the building, including units that are not eligible for weatherization, will be weatherized to avoid nonproductive costs.

(10) When a dwelling is prioritized high enough to be scheduled for weatherization work, the delivery of services will be deferred until a later date if providing the services would pose a threat to the health or safety of either the weatherization installers or any other person. In such cases, the delivery of services will be postponed until the conditions that pose a threat to health or safety have been resolved. The department adopts and incorporates by reference the department's 2025 Weatherization Policy Manual effective July 1 2025, which outlines the circumstances that justify a deferral of weatherization services. The Weatherization Policy Manual is located at the department's web site at http://dphhs.mt.gov/hcsd/energyassistance/ or a copy may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620-2956.

History

Authorizing statute(s): 53-2-201, 90-4-201, MCA
Implementing statute(s): 53-2-201, 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1982 MAR p. 2181, Eff. 12/31/82; AMD, 1983 MAR p. 1377, Eff. 9/30/83; AMD, 1988 MAR p. 289, Eff. 4/1/88; AMD, 1991 MAR p. 311, Eff. 3/15/91; AMD, 1993 MAR p. 1113, Eff. 5/28/93; AMD, 1996 MAR p. 1713, Eff. 6/21/96; AMD, 1998 MAR p. 1416, Eff. 5/29/98; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2007 MAR p. 974, Eff. 7/6/07; AMD, 2008 MAR p. 1592, Eff. 8/1/08; AMD, 2016 MAR p. 1574, Eff. 9/3/16; AMD, 2017 MAR p. 2197, Eff. 11/25/17; AMD, 2018 MAR p. 1885, Eff. 9/22/18; AMD, 2019 MAR p. 545, Eff. 7/1/19; AMD, 2021 MAR p. 621, Eff. 7/1/21; AMD, 2022 MAR p. 1874, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2025-527, Eff. 1/24/26.

Mont. Admin. R. 37.71.602 Determining Low Income Weatherization Assistance

(1) Weatherization assistance is available to eligible households in accordance with the prioritized measures as determined by the State's Computerized Energy Audit (CEA) system.

(2) Dwellings chosen to be weatherized must receive those measures determined to be cost effective as defined in 10 CFR 440, effective July 1, 2025. The department adopts and incorporates by reference 10 CFR 440, effective July 1, 2025. A copy of these federal regulations is available at https://www.ecfr.gov/current/title-10/chapter-II/subchapter-D/part-440 or may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620-2956.

(3) The department adopts and incorporates by reference the department's 2025 Weatherization Policy Manual and National Renewable Energy Laboratory (NREL) Standard Work Specifications effective July 1, 2022. The Weatherization Policy Manual is located at the department's web site at http://dphhs.mt.gov/hcsd/energyassistance or a copy may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620. The NREL Standard Work Specifications are located at the NREL web site at https://sws.nrel.gov/.

History

Authorizing statute(s): 53-2-201, 90-4-201, MCA
Implementing statute(s): 53-2-201, 90-4-201, 90-4-202, MCA
History: NEW, 1982 MAR p. 1309, Eff. 7/1/82; AMD, 1983 MAR p. 1377, Eff. 9/30/83; AMD, 1988 MAR p. 289, Eff. 2/12/88; AMD, 1990 MAR p. 1960, Eff. 10/26/90; AMD, 1993 MAR p. 1113, Eff. 5/28/93; TRANS, from SRS, 1998 MAR p. 2061; AMD, 2002 MAR p. 3635, Eff. 11/28/02; AMD, 2007 MAR p. 1948, Eff. 11/22/07; AMD, 2016 MAR p. 1574, Eff. 9/3/16; AMD, 2017 MAR p. 2197, Eff. 11/25/17; AMD, 2018 MAR p. 1885, Eff. 9/22/18; AMD, 2019 MAR p. 545, Eff. 7/1/19; AMD, 2021 MAR p. 621, Eff. 7/1/21; AMD, 2022 MAR p. 1874, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2025-527, Eff. 1/24/26.

Chapter 37.74 Refugee Assistance

Subchapter 37.74.1 General Administration and Assistance

Mont. Admin. R. 37.74.101 Definitions

(1) For the purpose of this chapter, the following definitions apply:

(a) Refugee means an individual who:

(i) is a national of Cambodia, Vietnam or Laos and entered the United States on or after April 8, 1975; or

(ii) is a national of Cuba or Haiti and is an entrant to the United States as verified by the immigration and naturalization service through INS form I-94;

(iii) is a national of any country granted refugee status in the United States as verified by the immigration and naturalization service through INS form I-94.

(b) Assistance unit means all individuals who live in the same household and whose needs, income and resources are considered in determining the amount of assistance payments. Such individuals living together may consist of an individual, a couple, an intact family, or a combination of family members, such as aunt, uncle, niece and nephew.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1982 MAR p. 1279, Eff. 7/1/82; TRANS, from SRS, 1998 MAR p. 2063.

Mont. Admin. R. 37.74.102 Refugee Cash Assistance

(1) Refugee cash assistance (RCA) shall be provided to a refugee who:

(a) is not eligible for other cash assistance programs such as AFDC, SSI, OAA, AB, APTD and AABD;

(b) meets the following immigration status and identification requirements;

(i) has parole status as a refugee or asylee under section 212(d) (5) of the Immigration and Nationality Act;

(ii) has been admitted as a conditional entrant under section 203(a) (7) of the Immigration and Nationality Act;

(iii) has been admitted as a refugee under section 207 of the Immigration and Nationality Act;

(iv) has been granted asylum under section 208 of the Immigration and Nationality Act;

(v) has been admitted with an immigration status that entitled the individual to refugee assistance prior to enactment of the Refugee Act of 1980, as specified by the director;

(vi) is a dependent child of and part of the same filing unit as individuals who meet immigration status requirements; or

(vii) has been admitted for permanent residence provided the individual previously held one of the statuses identified above.

(d) is not a full-time student in a college or university except where such enrollment is approved as part of an individual's state-approved employability plan; or

(e) meets all income and resource criteria of the AFDC program except that the $30 plus 1/3 disregard and the $30 disregard to earned income is not allowed. Refer to ARM 46.10.401 through 46.10.404 and 46.10.505 through 46.10.514.

(2) RCA may be provided to eligible refugees during the eight month period beginning with the month of entry to the United States.

(a) Date of entry is the date the individual entered the United States as certified by the immigration and naturalization services on INS form I-94 or INS form I-551.

(3) An exempt RCA recipient may volunteer to participate in employment services.

(4) A recipient of RCA who is not exempt under 45 CFR 400.76 must, except for good cause shown follow all requirements as in 45 CFR 400.75 "General Requirements".

(a) Good cause may exist for refusal to participate in employability services, accept employment, or voluntarily quit a job if:

(i) The assignments were not within the scope of the individual's employability plan.

(ii) The individual does not have the capabilities to perform the task on a regular basis. If claim is based on physical or mental impairment, verification by a physician or designee must be submitted.

(iii) The total daily commuting time normally exceeded 2 hours, not including transporting of a child to and from a child care facility.

(iv) Suitable child care is not available.

(v) Working conditions are poor. Risks to health safety exist.

(vi) Assignments are discriminatory in terms of age, sex, race, creed, color or national origin.

(vii) Wages offered are less than the state minimum wage or the daily hours of work exceed those customary to the occupation.

(viii) The job offered is vacant due to a strike, lockout, or other bona fide labor dispute or is in conflict with the conditions of existing union membership.

(5) An employable RCA recipient may not, without good cause, voluntarily quit employment or fail or refuse to meet the requirements of the agency's employment services. (45 CFR 400.75(a) ) .

(a) Mandatory participants will be terminated from assistance for failure or refusal to participate. (45 CFR 400.82.)

(b) Voluntary participants will be deregistered for 90 days. (45 CFR 400.82)

(6) Other AFDC requirements applicable to RCA recipients are stated in 45 CFR 233.31 through 233.37, and 235.10. The department adopts and incorporates by reference 45 CFR 233.31 through 233.37, and 235.10 (1989 edition) .

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1982 MAR p. 1279, Eff. 7/1/82; AMD, 1990 MAR p. 1961, Eff. 10/16/90; AMD, 1992 MAR p. 675, Eff. 3/27/92; TRANS, from SRS, 1998 MAR p. 2063.

Mont. Admin. R. 37.74.103 Refugee Medical Assistance

(1) Medical assistance will be provided to refugees who qualify under (2) or (3) for the eight month period beginning with the month of entry to the United States.

(2) Recipients of refugee cash assistance are categorically eligible for medical assistance.

(3) Refugees not receiving refugee cash assistance are eligible for refugee medical assistance provided they:

(a) are ineligible for medicaid but meet the financial eligibility requirements of the medically needy program as set forth in ARM 37.82.1106, 37.82.1107 and 37.82.1110;

(b) meet immigration status and identification requirements as set forth in ARM 37.74.102(b) (i) through (vii) or are the dependent children of, and part of the same filing unit as, individuals who meet these requirements;

(d) provide the name of the resettlement agency which resettled them; and

(e) are not full-time students in institutions of higher education, except when enrollment in such an institution is approved by the state as part of an individual employability plan.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1982 MAR p. 1279, Eff. 7/1/82; AMD, 1992 MAR p. 675, Eff. 3/27/92; TRANS, from SRS, 1998 MAR p. 2063.

Chapter 37.75 Child and Adult Care Food Program

Subchapter 37.75.1 General

Mont. Admin. R. 37.75.101 Definitions

For purposes of this chapter, the following definitions apply:

(1) "Active recruitment" means direct contact, initiated by a day care home sponsor, with a provider that is currently participating in the Child and Adult Care Food Program (CACFP) under a current CACFP Sponsor/Provider Agreement, for the purpose of enticing the provider to switch the provider's CACFP Sponsor/Provider Agreement to a different sponsor. Examples of such direct contact considered to be active recruitment include but are not limited to a contact made in person, by phone call, through e-mail, by fax, and through a mailing or through a newsletter that is invitational in content disseminated by a sponsor to one or more providers that it does not sponsor.

(2) "Adult day care center" means an adult day care center as defined in 7 CFR 226.2.

(3) "Advanced payment" means funds made available to an institution for its CACFP costs prior to the month in which such costs will be incurred.

(4) "Adverse action" means an action taken by the state CACFP in the administration of the CACFP having a negative impact on an institution.

(5) "Announced review" means an on site review that occurs after forewarning.

(6) "Authorized capacity" means the number of children that a licensed or approved child care center or registered day care home is able to have in care at any one time including overlap.

(7) "CACFP" means the Child and Adult Care Food Program as designated in section 17 of the National School Lunch Act as amended (codified at 42 USC 1766).

(8) "Center" means a child care center, an adult day care center, or an outside school hours care center. "Center" may also mean an emergency shelter, special after school snacks center, Head Start center, or proprietary center that enters into an agreement with the department to administer the CACFP in a specific area for a specific period of time.

(9) "Child care center" means any public or private nonprofit organization, or any proprietary center, licensed or approved to provide nonresidential child care services to enrolled children, primarily of preschool age, including but not limited to day care centers, settlement houses, neighborhood centers, Head Start centers, and organizations providing day care services for children with disabilities. Child care centers may participate in the CACFP as independent centers or under the auspices of a sponsor.

(10) "Combination food" means an entree with more than one CACFP required food component included in its ingredients.

(11) "Corrective action plan" means a plan indicating the actions to be taken by an institution or provider entity for the purpose of correcting a deficiency or addressing a problem.

(12) "Day care home" or "DCH" means a family or group day care home as those terms are defined in 52-2-703 , MCA, and is an organized nonresidential child care program for children enrolled in a private home registered or approved as a family or group day care home, and participating in the CACFP through a sponsor.

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

(14) "Elementary school" means any school serving children in grades K through 8.

(15) "Emergency shelter" means a public or private nonprofit organization whose primary purpose is to provide temporary shelter and food services to homeless families with children.

(16) "Institution" means a sponsor or child care center which enters into an agreement with the department to assume final administrative and financial responsibility for CACFP operations.

(17) "Licensing staff" means department personnel who enforce state laws and rules for the purpose of registering, licensing, and regulation of child care.

(18) "Outside school hours care center" has the meaning cited in 7 CFR 226.2.

(19) "Processed meats", for purposes of the CACFP, means hot dogs, salami, sausage, and food of this type, but does not include ground meats such as hamburger or cured meat such as ham.

(20) "Program" means the Child and Adult Care Food Program.

(21) "Proprietary center" means a qualifying child care center participating in the CACFP as a for-profit center that is:

(a) a proprietary Title XIX or Title XX center with at least 25% of enrolled or authorized capacity, whichever is less, that is paid from a state pooled funding source which includes federal Title XX funds; or

(b) a free and reduced price center with at least 25% of its enrollment or authorized capacity, whichever is less, that is in the free and reduced price reimbursement category.

(22) "Provider" means a person providing care in a family or group day care home.

(23) "School attendance area" means the specific geographical area whose student population is served by a specific elementary school.

(24) "Seriously deficient" means the status of an institution, center, or a day care home that has been determined to be seriously noncompliant in one or more aspects of its operation of the CACFP.

(25) "Sponsor" means an organization under contract with the department that assumes final administrative and financial responsibility for CACFP operations for facilities under its jurisdiction and meets the definition of sponsoring organization in 7 CFR 226.2, the federal definitions pertaining to CACFP.

(26) "Tiering" means categorizing the reimbursement rate for day care homes based on school designation, census block numbering area, and established criteria for income standards.

(27) "Title XIX" means Title XIX of the Federal Social Security Act.

(28) "Title XX" means Title XX of the Federal Social Security Act.

(29) "USDA" means the United States Department of Agriculture.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2004 MAR p. 577, Eff. 3/12/04; AMD, 2006 MAR p. 331, Eff. 2/10/06; AMD, 2009 MAR p. 88, Eff. 1/30/09.

Mont. Admin. R. 37.75.102 Civil Rights

(1) The CACFP is a federal program and all participants must comply with Title VI of the Civil Rights Act of 1964. The full description of participant responsibilities is set forth in the civil rights section of the CACFP Manual, and is adopted and incorporated by this reference. A copy of the CACFP Manual's civil rights section is available from the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson, P.O. Box 202925, Helena, MT 59620-2925.

(2) The federal CACFP requires the inclusion of the USDA nondiscrimination and equal opportunity statements as set forth in (2)(a) to be used in all informational materials disseminated to the public.

(a) "In accordance with federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability.

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue SW, Washington, DC 20250-9410, or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer."

(3) If the material is too small to permit the full statement to be included (e.g., brochures, coupons, electronic benefit cards, flyers, and other media of less than a page) the material must, at a minimum, include USDA's short nondiscrimination statement, as follows: "THIS INSTITUTION IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER."

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.103 Child and Adult Care Food Program (cacfp): Federal Regulations Adopted by Reference

(1) The CACFP shall be administered in accordance with the requirements of federal law governing the Child and Adult Care Food Program as set forth in Title 7 CFR part 226 (2005), which regulates all state child and adult care food programs. Title 7 CFR part 226 (2005) is adopted and incorporated as a part of these rules. A copy may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Child and Adult Care Food Program, P.O. Box 202925, 111 North Jackson Street, Fifth Floor, Helena, MT 59620-2925 or through the federal government website access at www.gpoaccess.gov/cfr/index.html .

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.105 Head Start Categorical Eligibility

(1) A Head Start institution that serves children whose families do not meet the low income criteria of Head Start for eligibility must use the Montana CACFP income eligibility form and income guidelines to determine the free, reduced, or paid reimbursement category for any such children.

(2) For CACFP documentation and eligibility purposes, the Head Start organization must maintain a list of Head Start participants eligible for free meal reimbursement. The list must include a statement certifying that the participant is enrolled in Head Start on the basis of Head Start income eligibility. This list must be signed each month by a head start official authorized to act on behalf of Head Start and must be retained on site and be readily available, or must be made available during the time of a review.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.108 Advances

(1) The department may, in its discretion, advance a payment. The amount of any advance payment will be based on the historical payment data for the specific institution. Any and all advance payments must be repaid to the department prior to the beginning of the next fiscal year.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.109 Audit Grants

(1) An institution may be eligible to receive a grant from the department for the purpose of reimbursing the institution for all or part of the CACFP portion of an audit. To qualify for a grant, an institution must meet the following minimum requirements:

(a) An audit must be a condition for participation or continued participation in the CACFP.

(b) The professional services of the auditor or auditors must be performed in accordance with all applicable state and federal laws, regulations, and policies relating to procurement of professional services.

(c) Complete and return the annual Audit Questionnaire and Grant Application to be provided by the department for the purpose of complying with the accounting and audit requirements of the federal Office of Management and Budget (OMB) Circular A-133, "Audits of States, Local Governments, and Nonprofit Organizations", and the provisions of OMB Circular A-122, "Cost Principles for Nonprofit Institutions", concerning the use of the funds provided by the contractual agreement.

(d) Prior to beginning an audit, the institution must submit to the department for approval:

(i) a completed request for partial reimbursement of audit expenses;

(ii) a signed copy of the audit proposal, including the proposed audit cost, the resume of the on site auditor or auditors, and certification that the audit will include tests of the CACFP in accordance with the current federal "Office of Management and Budget (OMB)" circular A-133 and the USDA OMB supplement for the "Catalog of Federal Domestic Assistance (CFDA)" 10.558, Child and Adult Care Food Program, dated March 2002; and

(iii) evidence the supervising auditor is a certified public accountant.

(e) Prior to beginning the audit, the institution must:

(i) provide a copy of the current state CACFP audit policy to the auditor engaged to perform the audit; and

(ii) obtain prior written approval for the audit from the department.

(f) The audit must be completed no later than nine months after the end of the fiscal year being audited.

(2) If an audit grant is awarded, the institution must submit to the department within 30 days following completion of the audit:

(a) two copies of the audit (including management letters referenced in the audit report);

(b) a copy of the final invoice from the auditor, documenting the cost of an OMB circular A-133 audit;

(d) an invoice on the institution's letterhead requesting reimbursement of the CACFP portion of the audit expense.

(3) The department may authorize a grant for up to the actual direct cost of auditing the program.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06; AMD, 2009 MAR p. 88, Eff. 1/30/09.

Subchapter 37.75.2 Sponsors

Mont. Admin. R. 37.75.201 Day Care Home Sponsors Service Areas

(1) The Montana CACFP sets geographical boundaries of operation for sponsors. Boundaries are set based on financial viability and need for services. Geographical boundaries follow county lines.

(2) In any area of the state where at least two day care home sponsors are currently available to all program participants, additional sponsor applications will not be accepted.

(3) If a provider would be more efficiently served by a sponsor in an adjacent service area, the service areas may be adjusted if this arrangement is by mutual consent between the affected sponsors, and prior written approval is obtained from the department after the department confirms that the provider would be more efficiently served by the adjacent service area sponsor.

(4) A prospective new sponsor must demonstrate to the department the need for the services to be provided by submitting a list of registered and operating day care home providers who are not presently served by a sponsor in the proposed geographical area. The department will then determine whether the existing sponsors are capable of providing CACFP services to the new providers on the list.

(5) An institution interested in becoming a day care home sponsor must be either a governmental or private nonprofit organization.

(6) Prior to completing an application, preliminary documentation must be submitted to and approved by the Montana CACFP that includes:

(a) a written request to become a sponsor with the name, physical address, and telephone number of the organization;

(b) articles of incorporation as a tax-exempt organization, in accordance with state law;

(c) documentation from the internal revenue service that the organization is a private nonprofit corporation, tax-exempt under the Internal Revenue Code of 1986;

(d) a statement that the institution has a board of directors;

(e) an organizational flowchart stating which personnel will administer the CACFP;

(f) certification that neither the organization nor any of its principals have ever been disqualified from participation in any publicly funded program or been convicted in the last seven years of any activity that indicated a lack of business integrity, including, but not limited to, fraud, embezzlement, theft, forgery, or bribery;

(g) documentation of financial viability that demonstrates the ability to withstand temporary interruptions in program payments and pay expenses that are not funded through the CACFP;

(h) documentation of administrative capability that reflects adequate staff to operate and administer the program, including the supervision and monitoring of participating facilities; and

(i) documentation of program accountability that includes financial management, recordkeeping, claim processing, and training systems that will be used.

(7) The application to become a new sponsor must include the following:

(a) written acknowledgment of receipt of the criteria for sponsors;

(b) a written sponsor proposal; and

(8) A prospective sponsor must complete the written proposal, orientation training, oral presentation, and Montana CACFP training and be approved for each requirement before the institution will be allowed to become a sponsor.

(9) In the event that a sponsor discontinues or is terminated and disqualified from participation in the CACFP, the department may facilitate moving providers to existing sponsors that are able to demonstrate the capability to serve the providers of the discontinuing or terminated sponsor. The department will notify all providers and sponsors in the event that a sponsor discontinues or is terminated from CACFP participation. If the department determines that the existing sponsors in a service area are unable to serve the providers, the department may facilitate moving providers to existing sponsors outside of the existing sponsor's service area.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.202 Tiering Changes

(1) A sponsor may only claim meals for purposes of reimbursement for its sponsored day care homes once per month for any one tier category.

(2) A change in tier status resulting from new data, such as census, income information, or elementary school information distributed to sponsors for use in evaluating tier status, is effective statewide the first day of the month during which the income information, census, or elementary school information is available to the sponsor.

(3) A day care home may submit a request for a tier change evaluation to its sponsor. If approved, the change will be effective as noted below:

(a) changes based on elementary school attendance area or census block are effective on the first of the month during which the evaluation request is received, except as provided in (3)(c);

(b) changes based on income fluctuations or relocation of the provider are effective on the first day of the month that the evaluation request is documented and verified; and

(c) a change made to correct a tiering error will be retroactive to the first day of the month in which the date of the error occurred.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06; AMD, 2009 MAR p. 88, Eff. 1/30/09.

Mont. Admin. R. 37.75.205 Provider Enrollment

(1) A new provider must have a current, valid registration to provide child care in order to participate in the CACFP. An existing provider may be working toward renewal of its registration and participate in the CACFP if assurance is obtained from licensing staff that they are approved and the registration is forthcoming.

(2) Each sponsor must do the following when enrolling a new day care home for participation in the CACFP:

(a) unless (3) applies, obtain licensing verification in the form of:

(i) a current, valid copy of the provider's registration to provide child care;

(ii) written documentation from licensing staff indicating the provider has submitted all required information and has been approved for registration;

(iii) a screen print from the Child Care Under the Big Sky System (CCUBS), showing that the provider is registered and the effective date of the registration; or

(iv) a screen print from the department's web site, www.childcare.mt.gov, under "Programs & Services, Find Child Care" showing that the provider is registered and the effective dates of the registration; and

(b) obtain written preapproval for participating from the Montana CACFP prior to performing a preapproval visit, and perform a preapproval visit at the day care home prior to allowing the day care home to participate in the CACFP. During the preapproval visit, the sponsor must:

(i) discuss CACFP benefits and verify that the proposed food service does not exceed the capability of the day care home;

(ii) train the provider regarding CACFP duties and responsibilities; and

(iii) discuss record keeping and documentation requirements, including but not limited to posting menus, meals to be served, and attendance records.

(3) If a registered day care home is approved by the sponsor during the preapproval visit, the CACFP sponsor/provider agreement must be completed, reviewed, and signed by the provider and the sponsor's representative. The effective date to begin CACFP participation is the date the CACFP sponsor/provider agreement is signed by both the provider and the sponsor's representative.

(4) If the location where care is provided by a day care home changes:

(a) the provider must notify the sponsor, and the provider may continue CACFP participation without interruption, provided:

(i) the sponsor performs a preapproval visit at the new address within 10 business days following the provider's first day of operation at the new location;

(ii) the new site is determined acceptable for CACFP participation; and

(iii) the new site is approved for child care by licensing staff;

(b) a Day Care Home Change in Information form must be completed and submitted to the sponsor; and

(5) If a sponsor misdates any document in order to manipulate or circumvent a rule, the sponsor will be placed under corrective action.

(6) A sponsor must not submit a claim for a provider who is not registered or in compliance with (2)(a).

(7) A provider must retain on file for the current and preceding three federal fiscal years copies of:

(a) the signed applications and agreements; and

(b) the notification of reasons and procedures for termination.

(8) A provider must retain the following information on file and have it readily available at the time of a review for the entire time the provider participates in the CACFP:

(a) a copy of the preapproval visit forms; and

(b) a copy of the current CACFP sponsor/provider agreement.

(9) If a provider moves or changes its legal name, a new sponsor/provider agreement must be completed and marked "CHANGE."

(10) If only meal times are changed, a Meal Time Change form must be completed and submitted to the sponsor with the current month's claim. Each Meal Time Change form becomes a part of the sponsor/provider agreement and is effective upon the date of receipt.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06; AMD, 2009 MAR p. 88, Eff. 1/30/09.

Mont. Admin. R. 37.75.206 Recruitment

(1) Day care home (DCH) sponsors are encouraged to recruit DCH providers to participate in the CACFP that are not currently participating and that have not participated in the CACFP through any sponsor within the last 30 days.

(2) A DCH sponsor may not engage in active recruitment as defined in ARM 37.75.101(1) of a provider that is participating in the CACFP under a current CACFP Sponsor/Provider Agreement with any other DCH sponsor.

(3) A sponsor that the Montana CACFP determines has engaged in active recruitment as defined in ARM 37.75.101(1) will be subject to disciplinary action.

(4) Suspected active recruitment violations, if reported, must be submitted to the Montana CACFP staff in writing for investigation.

(5) Corrective action will include the following:

(a) Upon first violation, the Montana CACFP will issue a letter of warning to the sponsor stating that a recruiting violation has occurred, and the sponsor is required to complete a corrective action plan.

(b) Upon a second violation, the Montana CACFP will issue notice to the sponsor warning that a second recruiting violation has occurred and indicate that the sponsor must complete a corrective action plan; and

(i) The sponsor will be restricted to recruiting only new providers who are not currently participating in the CACFP; and

(ii) The sponsor may not accept any DCH providers that are changing sponsors or enroll a provider if the provider has participated in the CACFP within the preceding six months.

(c) For subsequent violations, the Montana CACFP will issue written notice to the sponsor that the number of DCH providers served by the sponsor will be capped for a minimum of one year, and the sponsor will not be allowed to enroll any new providers or any providers changing sponsors without specific prior written approval from the Montana CACFP.

(6) Simultaneous active recruitment of multiple providers will be treated as a single violation.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06; AMD, 2009 MAR p. 88, Eff. 1/30/09.

Mont. Admin. R. 37.75.209 Sponsor Change by Provider

(1) A provider may be enrolled with only one CACFP sponsor at a time while participating in the CACFP.

(2) Each sponsor must supply a copy of this rule to all providers upon their enrollment in the CACFP.

(3) Except as provided in (5), a participating day care home may change its CACFP sponsor according to these guidelines:

(a) A provider may change from one sponsor to another sponsor one time per year, the change to be effective the first day of the month following the notice provided in (3)(b). One time per year means once during any 12 month period.

(b) To change sponsors, a provider must notify its current sponsor in writing of its intention to change to another sponsor on or before the final working day of the month prior to the month in which the change to a new sponsor is to be effective. The current sponsor must submit a copy of the written notification to the department.

(4) A provider who fails to give timely notification to its sponsor, as required by (3)(b), will continue to be under the current sponsor until the first day of the following month.

(5) If a provider's current sponsor has requested information from the provider, is otherwise investigating the provider, or has notified the provider that corrective action is necessary, the provider may not change sponsors until the provider has been restored to good standing for a minimum of one calendar month.

(6) A sponsor is not obligated to sponsor any particular provider.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06; AMD, 2009 MAR p. 88, Eff. 1/30/09.

Subchapter 37.75.3 Food Requirements

Mont. Admin. R. 37.75.301 Menu Evaluation

(1) CACFP institutions and providers must ensure that all meals and snacks claimed for reimbursement meet all federal and state minimum standards in accordance with 7 CFR 226.20.

(2) Each DCH sponsor must annually evaluate the menus of each day care home participating in the CACFP through their sponsorship. The menu evaluation shall include a review of menus served over the course of at least one month.

(3) All institutions must monitor, verify, document, and ensure that only meals and snacks that meet federal regulations and state minimum standards are claimed for reimbursement.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.302 Infant Meal Reimbursement

(1) All meal components required by the USDA infant meal pattern contained in 7 CFR 226.20 must be supplied by the provider or center, with the exception of breast milk, for a meal to be eligible for reimbursement.

(2) Except as provided in (6), meals containing breast milk served to infants may be claimed for reimbursement. Other required or optional meal components must be supplied by the provider or center. If the parent supplies any meal component other than breast milk, the meal may not be claimed for reimbursement.

(3) Meals containing only breast milk do not qualify for reimbursement if feeding is performed naturally by the mother.

(4) Except as provided in (6), infant formula must be supplied by the provider or center for the meal to be eligible for reimbursement. If parents provide infant formula, meals cannot be claimed.

(5) Except as provided in (6), a provider or center must supply an infant with iron-fortified formula or soy-based formula if recommended by the infant's parent or the infant's health care provider.

(6) If an infant requires a specialty formula such as Nutramigen, Pregestimil, Alimentum, and Lofenalac that is much more expensive or difficult to obtain than a regular infant formula, the provider or center may request that the parent pay the difference between a regular priced formula and the much higher priced formula. If the parents supply the specific formula, in lieu of receipt of cash, the provider or center may credit the parents for the value of the formula the provider or the center would have supplied. A written agreement signed by both the provider or center and the parents indicating how specialty formulas are to be provided must be kept and must be available for review by CACFP staff and auditors.

(7) Whole milk is not allowed as a meal component for an infant who is 12 months or less of age.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.303 Combination Foods

(1) Each day care center and day care home shall list components of combination foods on menus as required by the Montana CACFP. Combination foods include, but are not limited to, the following:

(a) chili (ground turkey/beans);

(b) chicken casserole (chicken/rice/broccoli); and

(c) tacos (soft tortilla/ground beef/cheese/lettuce, and tomato). The provider or center is responsible for ensuring that combination foods provide adequate amounts of the required meal components for the age group being served.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Subchapter 37.75.4 Records

Mont. Admin. R. 37.75.401 Sponsor and Facility Training and Training Records

(1) A center must provide annual staff training on CACFP requirements, including those related to nutrition education, meal services, and food safety.

(2) Each institution must provide free training to each facility it sponsors under the CACFP. Initial training for each facility must occur before any meal or snack is served for which CACFP reimbursement is claimed.

(3) Training sessions must be provided at least annually for each facility.

(4) An institution must document each training session by keeping on file:

(a) an agenda which lists the date, time, topic, and location of the training;

(b) the names of the training facilitator or facilitators;

(d) a copy of the certificate of completion for online training, signed by the sponsor's authorized representative.

(5) The following individuals must attend at least five hours per federal fiscal year of CACFP training provided by the department:

(a) one of the center's cooks; and

(b) the administrator, director, or nutrition coordinator.

(6) Each sponsor of day care homes must provide, free of charge, a minimum of four hours of training to the providers it sponsors concerning CACFP requirements, including those relating to nutrition education, meal service, and food safety. Two hours of the required training must cover CACFP administrative and regulatory issues. The training to be provided by the sponsor must be submitted to the department in a written training plan and must be approved by the department as part of its annual renewal packet and whenever the training content or method of providing the training changes. Sponsors shall provide the approved training frequently enough and in convenient locations so that providers have a reasonable opportunity to participate in the training.

(7) Each sponsor must retain on site all information relating to training provided by that sponsor for a period of at least the three prior federal fiscal years, plus the current federal fiscal year.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 5-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.402 Milk Purchase Records

(1) All reviews of centers performed by department staff and auditors under department contract will evaluate the milk purchase quantity documentation and compare it to the meals claimed that require a milk volume component.

(2) Notwithstanding any other applicable rule, if enough milk is not purchased and documented to meet the minimum meal component milk volume requirement, a corresponding meal reimbursement disallowance shall be made, in accordance with the milk volume requirements of 7 CFR 226.20.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.403 Recipes Required

(1) All program providers or centers must maintain documentation as to the creditability of baked goods as a bread/bread alternate.

(2) Each day care center or day care home shall maintain documentation of bread/bread alternate ingredients. Documentation may include a recipe, food label, or child nutrition (CN) label for the food item. This documentation is to be used to assess whether the primary ingredient (by weight) of the item is whole-grain and/or enriched flour and therefore creditable as a bread/bread alternate.

(3) Examples of recipes/food labels that should be kept on file include but are not limited to the following:

(a) banana/carrot/zucchini bread;

(b) brownies/bars;

(d) gingerbread; and

(e) granola bars.

(4) It is the responsibility of the provider or center to ensure that all items claimed as bread/bread alternates meet the criteria listed in the grains/breads section of "Crediting Foods in Child and Adult Care Food Program." The August 2001 edition of "Crediting Foods in the Child and Adult Care Food Program" is hereby adopted and incorporated by this reference. A copy of the grains/breads section of "Crediting Foods in Child and Adult Care Food Program" is available from the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson, P.O. Box 202925, Helena, MT 59620-2925.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03.

Subchapter 37.75.5 Reviews

Mont. Admin. R. 37.75.501 Reviews of Day Care Home Sponsors

(1) The department will conduct at least one review of each day care home sponsor during each period consisting of two federal fiscal years for sponsors with 100 or more homes. The department will conduct at least one review of each day care home sponsor during each period consisting of three federal fiscal years for a sponsor with fewer than 100 homes.

(2) The sponsor must ensure that all program records are available during any review. Program records include but are not limited to:

(a) documentation to substantiate that the procedures outlined in the sponsor's current management plan have been and are being followed; and

(b) documentation of claims processed and fiscal activity for the three preceding federal fiscal years, plus the current federal fiscal years.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.502 Reviews of Centers and Sponsors of Centers

(1) The department will conduct a minimum of one announced or unannounced review of each center or sponsor of centers in each three year period.

(2) Each institution must provide all CACFP records to the CACFP review team when the CACFP performs an announced or unannounced review. Records that must be on site and made available to the CACFP during a review include but are not limited to:

(a) monthly attendance records and sign in/out sheets;

(b) food receipts, by month of purchase;

(d) menu plan and food production records;

(e) completed income eligibility forms;

(f) menus;

(g) milk receipts, by month of purchase;

(h) monthly financial reports;

(i) staff training records;

(j) records of facility training performed by the sponsor;

(k) monitoring procedures if a sponsor of centers;

(l) monitor training records if a sponsor of centers;

(m) a copy of the center's license, if the facility or institution is required to be licensed; and

(n) a copy of the health and fire inspection if the center is self-certified.

(3) During an on site review, the CACFP will verify that:

(a) the center is conducting a nonprofit food service;

(b) for profit institutions are eligible to claim reimbursement for meals served;

(c) meals offered and provided to CACFP participants are documented on menu plan and food production records that meet minimum food component and portion size requirements;

(d) completed CACFP income eligibility forms are on site or made available to the CACFP during a review to document that the center is claiming the correct rate of reimbursement for the meals being claimed; and

(e) records are satisfactorily completed to demonstrate which children and meals are claimed each day by each center or sponsored facility.

(4) If a center or sponsor of centers submits a claim for reimbursement for any month, and does not have complete records on site during a review or make records available to the CACFP during a review, the following actions may be taken:

(a) meal reimbursement for the corresponding claim month may be disallowed;

(b) the amount of reimbursement for disallowed meals, as stated in a notice of overclaim from the CACFP, must be paid back to the CACFP;

(c) the meal disallowance total, as stated in a notice of action from the CACFP, is subject to an administrative review (appeal); and

(d) records that are not on site or made available during a review will not be considered by the CACFP when establishing the dollar amount for disallowed meals. An exception may be requested in writing by the institution and must be approved in writing by the CACFP.

(5) When meals are disallowed and an overclaim notice is received by an institution, the institution may request an exception to have records reviewed that were not on site or made available to the CACFP at the time of a review. The request must be submitted to the CACFP within 15 days of receipt of an overclaim notice.

(6) The CACFP will notify the institution of its decision to grant or deny an exception within 15 days of receipt of the request for an exception.

(a) All misclassified income eligibility forms must be corrected back to the date of the signature of the adult household member on the forms.

(7) Exceptions may be granted only for extreme circumstances, such as the accidental destruction of records, and solely at the discretion of the CACFP.

(8) Reimbursement for claims submitted after the date of review may be delayed up to 45 days from receipt of a complete and valid claim if the institution owes money to the CACFP.

(9) Additional corrective actions may be required as a result of missing records. The CACFP may request copies of various records for random months throughout the year to demonstrate compliance with those items as stated in (2), (3), and (4).

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Subchapter 37.75.6 Enforcement

Mont. Admin. R. 37.75.601 Administrative Reviews (appeals) and Fair Hearings

(1) Except as provided in (3), an institution may appeal an adverse administrative action through the department's Office of Fair Hearings pursuant to the procedures provided in ARM Title 37, chapter 5. Adverse administrative actions include:

(a) denial of the institution's application for participation;

(b) denial of an application submitted by a sponsor of centers on behalf of a facility;

(d) denial of an institution's application for start up funds;

(e) denial of an institution's application for advance payment;

(f) denial of all or part of an institution's claim for reimbursement, provided the claim was submitted in a timely manner;

(g) denial by the state agency to forward to Food and Nutrition Services (FNS) of the USDA an exception request by the institution for payment of a late claim or a request for an upward adjustment to a claim; or

(h) demand for the remittance of an overpayment against an institution.

(2) An institution must file a written request for an administrative review (appeal) within 15 calendar days of receiving notification of an adverse administrative action by providing the written request to the Department of Public Health and Human Services, Quality Assurance Division, Office of Fair Hearings, 2401 Colonial Drive, P.O. Box 202953, Helena MT 59620-2953.

(3) A day care home may only participate in the CACFP through a sponsor. A participating day care home may appeal through the department's Office of Fair Hearings when there is a determination to terminate the home's participation in the CACFP. All other adverse administrative actions taken against a day care home must be reviewed through the sponsor's internal review process.

(4) Decisions made by FNS pertaining to requests for exceptions to the claims submission deadlines are not subject to appeal through the state's administrative review (appeal) process.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.602 Corrective Action Plan

(1) An institution receiving notice that it is deficient in some aspect of the CACFP shall submit to the department a corrective action plan to correct the deficiency. The plan must be postmarked within 30 days of receipt of the deficiency notice provided by the department, or within such other timeframe as is set forth in the deficiency notice. Any institution that fails to submit a timely corrective action plan will be determined to be seriously deficient, or if the original notice stated the institution was seriously deficient, the institution may be subject to termination in accordance with the provisions set forth in 7 CFR 226.6.

(2) All corrective action plans are subject to review and approval by the department. If a corrective action plan is rejected by the department, a revised corrective action plan that addresses the deficiencies in the original plan must be submitted to the department no later than 15 calendar days from the date of receipt of the notice of rejection of the original plan. Any institution that fails to submit an amended corrective action plan within 15 calendar days of the receipt of the notice from the department shall be determined seriously deficient, and will be subject to termination from the program.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Mont. Admin. R. 37.75.603 Termination and Re-Enrollment of a Day Care Home Provider

(1) When a sponsor terminates a day care home provider for cause, the sponsor must send to the department a copy of the termination letter that is sent to the provider. Upon receipt of this notification, the terminated provider's name will be added to the state list of terminated providers, sent to all day care home sponsors, and included on the national disqualified list.

(2) If a terminated provider wants to return to program participation, the provider must demonstrate to the satisfaction of the Montana CACFP that they have fully and permanently corrected the serious deficiency.

(3) An institution or provider terminating operations with the CACFP while under corrective action will still be placed on the national disqualified list as well as the state disqualified list.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, MCA
History: NEW, 2003 MAR p. 981, Eff. 5/9/03; AMD, 2006 MAR p. 331, Eff. 2/10/06.

Chapter 37.76 Food and Nutrition Services

Subchapter 37.76.1 Food Stamp Program

Mont. Admin. R. 37.76.101 Food Stamp Program

(1) The department of public health and human services hereby adopts and incorporates by reference 7 CFR 271 through 275, as amended through December 31, 2001, which are the food stamp program regulations as adopted by the food and nutrition services, United States department of agriculture. These federal regulations set forth the food stamp program and include general information and definitions, requirements for participating state agencies, certification of eligible households, issuance and use of food coupons, performance reporting system and state agency liabilities and federal sanctions. A copy of 7 CFR 271 through 275, as amended through December 31, 2001, may be obtained from the Department of Public Health and Human Services, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

History

Authorizing statute(s): Sec. 53-2-201 and 53-4-212, MCA
Implementing statute(s): Sec. 53-2-201 and 53-2-306, MCA
History: NEW, 1979 MAR p. 805, Eff. 7/27/79; AMD, 1980 MAR p. 2592, Eff. 9/12/80; AMD, 1981 MAR p. 1974, Eff. 1/1/82; AMD, 1981 MAR p. 1731, Eff. 1/28/82; AMD, 1982 MAR p. 98, Eff. 4/1/82; AMD, 1982 MAR p. 1196, Eff. 6/18/82; AMD, 1982 MAR p. 1259, Eff. 7/1/82; AMD, 1982 MAR p. 1261, Eff. 7/1/82; AMD, 1982 MAR p. 1844, Eff. 10/15/82; AMD, 1983 MAR p. 125, Eff. 2/10/83; AMD, 1983 MAR p. 300, Eff. 4/15/83; AMD, 1983 MAR p. 634, Eff. 8/1/83; AMD, 1983 MAR p. 1244, Eff. 10/1/83; AMD, 1983 MAR p. 1713, Eff. 11/25/83; AMD, 1984 MAR p. 294, Eff. 3/19/84; AMD, 1984 MAR p. 1085, Eff. 7/26/84; AMD, 1984 MAR p. 1750, Eff. 11/29/84; AMD, 1984 MAR p. 1748, Eff. 1/2/85; AMD, 1987 MAR p. 152, Eff. 3/16/87; AMD, 1988 MAR p. 1706, Eff. 7/29/88; AMD, 1991 MAR p. 1020, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 3555; AMD, 2002 MAR p. 952, Eff. 3/29/02.

Mont. Admin. R. 37.76.102 Food Stamps, Definitions

(1) "Beginning month" means the first month for which the household is certified to receive food stamps. A beginning month cannot be any month which immediately follows a month in which the household was certified.

(2) "Budget month" means the calendar month from which the department uses income, household composition, and other financial information concerning the household to calculate the household's food stamp allotment for the corresponding benefit month.

(3) "Benefit month" means the calendar month for which the department issues a food stamp allotment.

(4) "Prospective budgeting" means the determination of a household's composition, income, and deductible expenses on the best estimate of income and circumstances which will exist in the benefit month.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201 and 53-2-306, MCA
History: NEW, 1982 MAR p. 2155, Eff. 12/17/82; AMD, 1983 MAR p. 1107, Eff. 8/12/83; AMD, 1995 MAR p. 2500, Eff. 11/23/95; TRANS, from SRS, 2000 MAR p. 3555.

Mont. Admin. R. 37.76.105 Federally-Donated Foods

(1) Distribution of federally-donated foods shall be as follows:

(a) during temporary emergency situations when the secretary of the U.S. department of agriculture determines that commercial channels of food distribution have been disrupted;

(b) for such period of time as the secretary determines necessary to effect an orderly transition in an area in which the distribution of federally-donated foods to households is being replaced by a food stamp program; or,

(2) No household shall participate in both the food stamp program and distribution of federally-donated foods under this rule.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-306, MCA
History: NEW, Eff. 11/4/74; TRANS, from SRS, 2000 MAR p. 3555.

Mont. Admin. R. 37.76.110 Food Stamps, Determining Eligibility for the Food Stamp Program

(1) Eligibility shall be determined on a prospective basis.

(2) Households anticipating changes in their circumstances which will make them ineligible shall be given written notice of denial or written notice of the closure of their certification.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201 and 53-2-306, MCA
History: NEW, 1982 MAR p. 2155, Eff. 12/17/82; AMD, 1983 MAR p. 1107, Eff. 8/12/83; AMD, 1984 MAR p. 993, Eff. 6/29/84; TRANS, from SRS, 2000 MAR p. 3555.

Mont. Admin. R. 37.76.111 Food Stamps, Determining Eligibility and Benefits

(1) All households shall have their eligibility and the amount of food stamps they are entitled to receive determined using prospective budgeting.

(2) Prospective budgeting means using the best estimate of income and other circumstances which will occur in a particular month to determine eligibility for that month and/or the amount of benefits for that month.

(3) Lease, royalty, and rental income which is received periodically but not on a monthly basis and which is expected to continue shall be determined based on the 12 month period immediately prior to the month of application. The projected income shall be prorated over the current 12 month period. Once a cycle of income proration is established, it shall remain in effect for one year. However, if any portion of the prior period's income is expected to stop in the current period, then this portion shall not be considered as income in the current period.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201 and 53-2-306, MCA
History: NEW, 1982 MAR p. 2155, Eff. 12/17/82; AMD, 1983 MAR p. 352, Eff. 4/29/83; AMD, 1983 MAR p. 1107, Eff. 8/12/83; AMD, 1984 MAR p. 993, Eff. 6/29/84; AMD, 1994 MAR p. 2543, Eff. 9/9/94; AMD, 1995 MAR p. 2500, Eff. 11/23/95; TRANS, from SRS, 2000 MAR p. 3555.

Mont. Admin. R. 37.76.112 Food Stamps, Determining When Eligibility Begins

(1) Eligibility starts with the date a household applies for benefits. However, when a new member joins a participating household the eligibility of the new member will begin the month after the presence of the new member is reported. If the presence of the new member will result in increased benefits to the household, increased benefits cannot be issued for the month in which the new member is reported. However, increased benefits shall be issued:

(a) effective with the month after the new member is reported; and

(b) if the new member is reported after the 20th of the month and it is too late to include the new member in the next month's issuance then a supplemental benefit for the new member will be issued by the 10th day of the next month.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201 and 53-2-306, MCA
History: NEW, 1984 MAR p. 1755, Eff. 11/30/84; TRANS, from SRS, 2000 MAR p. 3555.

Mont. Admin. R. 37.76.120 Food Stamps, Certification Periods

(1) Households who are eligible for benefits shall be given certification periods of from 6 to 12 months except:

(a) self-employed households may be certified for less than 6 months in order to conform with the time when information about self-employment is available; and

(b) households who do not have a fixed residence in the county may be certified for from 1 to 6 months.

History

Authorizing statute(s): Sec. 53-2-201 MCA
Implementing statute(s): Sec. 53-2-201 and 53-2-306 MCA
History: NEW, 1984 MAR p. 993, Eff. 6/29/84; TRANS, from SRS, 2000 MAR p. 3555.

Mont. Admin. R. 37.76.121 Food Stamp Employment and Training Program

(1) Participants in the food stamp employment and training program shall be reimbursed for costs of transportation or other costs that are reasonably necessary and directly related to participation in the program. The following reimbursement shall be provided to participants:

(a) Project work program:

(i) rates and types of reimbursement as found at ARM 46.25.731(6) .

(b) Job search project:

(i) transportation utilizing the least expensive means and not to exceed $10.00 per day at the rate of $.185 per mile when using a private automobile;

(ii) work clothing;

(iii) other costs not exceeding $15.00 per month may be spent to obtain necessary employment and training items such as school transcripts, birth certificates, driver's license and application fees;

(iv) reimbursements provided shall not exceed $25.00 per month per participant.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-306, MCA
History: NEW, 1987 MAR p. 330, Eff. 3/27/87; AMD, 1988 MAR p. 1706, Eff. 7/29/88; AMD, 1989 MAR p. 123, Eff. 1/13/89; TRANS, from SRS, 2000 MAR p. 3555.

Mont. Admin. R. 37.76.122 Food Stamps, Transfer of Resources

(1) Households which have knowingly transferred resources for less than fair market value for the purpose of qualifying or attempting to qualify for food stamps shall be disqualified from receiving food stamps for a period of time determined in accordance with (4) .

(a) This disqualification period shall apply only to transfers made in the 3-month period immediately preceding application or after the household is determined eligible for food stamps.

(b) There shall be no disqualification period if a transfer was made for a reason other than to qualify for food stamps, even if qualifying for food stamps was also one reason or the primary reason for the transfer.

(c) This transfer rule shall apply to transfers by any household member or by any ineligible alien or disqualified person whose resources are considered available to the household.

(2) Households applying for food stamps must provide to the department information regarding any resource which any household member or ineligible alien or disqualified person whose resources are considered available to the household has transferred within the 3-month period immediately preceding application. A household which has already been certified to receive food stamps must provide to the department information regarding any such transfer which occurs during their certification period.

(3) Eligibility for food stamps shall not be affected by the following transfers:

(a) transfers where fair market value or value near fair market value is received for the property;

(i) value within 5% of the fair market value shall be considered to be near fair market value;

(b) transfers which would not affect eligibility, including:

(i) transfers of excluded resources;

(ii) transfers of non-excluded resources that, when added to other non-excluded resources of the household, had a value at the time of transfer of less than the allowable resource limit; and

(iii) transfers between members of the household, including ineligible aliens or disqualified persons whose resources are considered available to the household.

(4) The length of the disqualification period shall be based on the amount by which the transferred resource, when added to the other non-excluded resources of the household, exceeds the allowable resource limit, in accordance with the following table:

Amount in Excess of Period of Disqualification

Resource Limit (months)

$0 to 249.99 .........................................................................................1

$250 to 999.99 .....................................................................................3

$1,000 to 2,999.99 ..............................................................................6

$3,000 to 4,999.99 ..............................................................................9

$5,000 or more ...................................................................................12

(5) Any transfer for less than fair market value or a value near fair market value which is not exempted by (3) (b) (i) through (iii) and which is made within the 3-month period immediately preceding application or after a determination of eligibility has been made shall raise a rebuttable presumption that the transfer was made for the purpose of qualifying for food stamps; provided, however, that this presumption shall not apply if the food stamp applicant or recipient states a reason for the transfer other than to qualify or continue to qualify for food stamps and supports the statement with clear and convincing evidence.

(a) Whenever the department determines that such a transfer has occurred, it shall send a written notice to the applicant or recipient prior to making a determination of eligibility or ineligibility explaining the household's right to rebut the presumption.

(b) The household shall have 10 days from the date of mailing of the written notice required by (5) (a) to provide the department with clear and convincing evidence that the transfer was for a reason other than to qualify or attempt to qualify for food stamps.

(c) The determination of whether a disqualifying transfer has occurred shall be based on all facts and circumstances known to the department, including:

(i) the reason stated by the applicant or recipient for the transfer;

(ii) the household's attempts, if any, to transfer the property at or near fair market value and/or the reason the household accepted less than fair market value;

(iii) evidence that the household did receive an amount of compensation equal to or near fair market value;

(d) The presence of one or more of the following factors, while not necessarily conclusive, may indicate that the property was transferred for some purpose other than to qualify or continue to qualify for food stamps:

(i) the occurrence or onset of an unexpected event or condition after the transfer which necessitates application for food stamps;

(ii) the transfer was ordered by a court of law based upon statute, regulation, a bona fide condition of settlement or other legal requirement;

(iii) the transfer occurred as a result of fraud, misrepresentation, or coercion perpetrated upon the person who transferred the property, provided that person has taken all reasonable steps, including legal action, to recover such property or obtain fair compensation for it.

(e) If the household fails to rebut the presumption as required in (5) (b) , the household shall be disqualified for a period of time in accordance with (4) .

(6) If the department determines that a disqualifying transfer has occurred, it shall send a written notice to the household as follows:

(a) A household already receiving food stamps at the time the transfer is discovered shall be sent a notice of adverse action explaining the reason for the disqualification and its length. The disqualification shall be effective with the first allotment to be issued after the notice of adverse action period has expired, unless the household has requested continuation of benefits pending a fair hearing.

(b) An applicant household shall be sent a denial of eligibility explaining the reason for the denial and the length of the disqualification. The disqualification shall begin in the month of application.

History

Authorizing statute(s): Sec. 53-2-201, MCA
Implementing statute(s): Sec. 53-2-201, MCA
History: NEW, 1991 MAR p. 1020, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 3555.

Subchapter 37.76.2 Food Distribution Program

Mont. Admin. R. 37.76.201 Plan of Operation

(1) The Food Distribution Program on Indian Reservations (FDPIR) will operate on the following Indian reservations at their option:

(a) Blackfeet;

(b) Flathead;

(d) Crow;

(e) Rocky Boy;

(f) Fort Belknap; and

(g) Fort Peck.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 50-49-102, 53-2-201, MCA
History: NEW, Eff. 11/4/74; TRANS, from SRS, 2000 MAR p. 3555; AMD, 2023 MAR p. 481, Eff. 5/27/23.

Mont. Admin. R. 37.76.202 General Eligibility Requirements

(1) Households that meet program eligibility requirements may be certified to participate in FDPIR for up to 12 months. Households in which all adult members are elderly or disabled may be certified to participate in FDPIR for up to 24 months. Households cannot participate in FDPIR and the USDA Supplemental Nutrition Assistance Program (SNAP) in the same month.

(a) Assistance households that consist solely of members who are eligible for and receiving Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI) shall be eligible to receive donated foods upon application for certification without further investigation other than to determine the number of household members and that all members have been considered in granting such aid.

(b) Non-assistance households means any household in which one or more members do not participate in a public assistance program. Eligibility of non-assistance households to participate in FDPIR is determined using 7 CFR § 253.6, 7 CFR § 253.7, as amended through November 25, 2022, and the Food and Nutrition Service (FNS) Handbook 501, updated June 2, 2022. Copies of 7 CFR § 253.6, 7 CFR § 253.7, and FNS Handbook 501 may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620-2956.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 50-49-102, 53-2-201, MCA
History: NEW, Eff. 11/4/74; TRANS, from SRS, 2000 MAR p. 3555; AMD, 2023 MAR p. 481, Eff. 5/27/23.

Mont. Admin. R. 37.76.203 Certification and Review

(1) Applicant household eligibility and certification is determined according to 7 CFR § 253.6, 7 CFR § 253.7, as amended through November 25, 2022, and the FNS Handbook 501, updated June 2, 2022. Copies of 7 CFR § 253.6, 7 CFR § 253.7, and the FNS Handbook 501 may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620-2956.

(2) Households not recertified at the end of the time period shall be terminated until reapplication and redetermination of eligibility is made.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 50-49-102, 53-2-201, MCA
History: NEW, Eff. 11/4/74; TRANS, from SRS, 2000 MAR p. 3555; AMD, 2023 MAR p. 481, Eff. 5/27/23.

Mont. Admin. R. 37.76.204 Forms Used for Food Distribution

(1) Forms may be obtained at the local county FDPIR offices and from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620-2956.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 50-49-102, 53-2-201, MCA
History: Eff. 11/4/74; TRANS, from SRS, 2000 MAR p. 3555; AMD, 2023 MAR p. 481, Eff. 5/27/23.

Mont. Admin. R. 37.76.205 Income Eligibility Standards

(1) Income eligibility standards for participation in the FDPIR are determined according to FNS Handbook 501, Exhibit M for the contiguous United States. The department adopts and incorporates by reference FNS Handbook 501, Exhibit M FDPIR Net Monthly Income Standards based on household size revised May of 2022. Copies of the FNS Handbook 501, Exhibit M may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Carter Drive, P.O. Box 202956, Helena, MT 59620-2956.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 50-49-102, 53-2-201, MCA
History: NEW, Eff. 11/4/74; TRANS, from SRS, 2000 MAR p. 3555; AMD, 2023 MAR p. 481, Eff. 5/27/23.

Mont. Admin. R. 37.76.206 Resource Limitation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-306, MCA
History: NEW, Eff. 11/4/74; TRANS, from SRS, 2000 MAR p. 3555; REP, 2023 MAR p. 481, Eff. 5/27/23.

Chapter 37.78 Temporary Assistance for Needy Families (tanf)

Subchapter 37.78.1 TANF General Provisions

Mont. Admin. R. 37.78.101 Temporary Assistance for Needy Families (tanf): Purpose

(1) These rules implement Montana's TANF program authorized under section 401 of the Social Security Act, 42 USC 601, et seq. The purpose of this project is to provide temporary assistance for needy families and to assist families in obtaining or advancing in their employment or finding alternatives to public assistance where employment is precluded by disability or other causes.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.102 Federal Regulations Adopted by Reference

(1) The TANF program shall be administered in accordance with the requirements of federal law governing temporary assistance for needy families as set forth in Title IV of the Social Security Act, 42 USC 601 through 619 (March 1, 2026).

(2) The TANF Policy Manual dated December 1, 2025, is adopted and incorporated by reference. A copy of the TANF Policy Manual is available for public viewing at each local Office of Public Assistance, and at the Department of Public Health and Human Services, Human and Community Services Division, 2021 N. Montana Avenue, P.O. Box 202925, Helena, MT 59620-2925. Manual and draft manual updates are also available on the department's web site at https://dphhs.mt.gov/hcsd/tanfpolicymanual.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 952, Eff. 3/29/02; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2003 MAR p. 1301, Eff. 7/1/03; AMD, 2004 MAR p. 200, Eff. 1/30/04; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2005 MAR p. 1591, Eff. 8/26/05; AMD, 2006 MAR p. 2415, Eff. 10/6/06; AMD, 2007 MAR p. 301, Eff. 3/9/07; AMD, 2007 MAR p. 976, Eff. 7/6/07; AMD, 2007 MAR p. 1818, Eff. 11/9/07; AMD, 2008 MAR p. 1154, Eff. 6/13/08; AMD, 2008 MAR p. 2501, Eff. 1/1/09; AMD, 2009 MAR p. 1020, Eff. 7/1/09; AMD, 2009 MAR p. 2380, Eff. 1/1/10; AMD, 2010 MAR p. 2215, Eff. 9/24/10; AMD, 2011 MAR p. 107, Eff. 1/28/11; AMD, 2011 MAR p. 1313, Eff. 7/15/11; AMD, 2011 MAR p. 2827, Eff. 1/1/12; AMD, 2012 MAR p. 1263, Eff. 6/22/12; AMD, 2013 MAR p. 60, Eff. 1/18/13; AMD, 2026 MAR, Notice No. 2026-529, Eff. 9/26/26.

Mont. Admin. R. 37.78.103 Temporary Assistance for Needy Families (tanf): Definitions

The following definitions apply to this chapter:

(1) "Allowable work activities" means all activities defined in federal regulation that are countable toward the calculation of the TANF work participation rate and used to meet federal participation requirements at 45 CFR 261.30. These activities are contained in the Family Investment Agreement/WoRC Employability Plan (FIA/EP) for individuals who are required to negotiate and comply with a FIA/EP as a condition of eligibility for TANF cash assistance. These allowable work activities are identified in ARM 37.78.807.

(2) "Assistance unit" means a minor child or children and all individuals who live with the child and are related to the child by blood, marriage, adoption, or by law if the child was conceived by artificial insemination, provided that the relationship is within the fifth degree of kinship as specified in the definition of caretaker relative in this rule and provided that the individual meets the eligibility requirements to have the individual's needs covered by Temporary Assistance for Needy Families (TANF).

(3) "Benefit month" means the calendar month for which benefits are issued.

(4) "Budget month" means the calendar month used to determine eligibility for TANF cash assistance and to calculate the amount of the cash assistance payment. Under the prospective budgeting method, the budget month and the benefit month are the same.

(5) "Caretaker relative" means a specified caretaker relative.

(6) "Case manager" means the person who provides guidance for a participant in the TANF Cash Assistance Employment and Training or Activity Program.

(7) "Case management" means the process of formulating and developing and maintaining a Family Investment Agreement/WoRC Employability Plan (FIA/EP) for a participant.

(8) "Child support rights" means a child's legal entitlement to cash assistance from a parent with whom the child does not live.

(9) "Community operating plan/annual agreement" means the document developed by the community advisory council for a particular county or counties which sets forth local decisions made in areas where community flexibility is allowed.

(10) "Community service" means structured programs and embedded activities in which TANF participants perform work for the direct benefit of the community under the auspices of public or nonprofit organizations.

(11) "Deemed income" means the portion of the income of a member of the assistance unit considered available as unearned income to the assistance unit, whether or not it is actually contributed to the assistance unit.

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

(13) "Domestic violence" means physical, sexual, and/or mental or emotional abuse of a member of the assistance unit by a person with whom that member lives or with whom that member has recently lived which is sufficiently severe to interfere with the TANF participant's ability to become employed or seek alternatives to public assistance.

(14) "Earned income" means all income, whether in cash or in kind, earned by an individual through wages, salary, commissions, tips, or any other profit from activity in which the individual is engaged, including but not limited to all amounts withheld or deducted for income or social security taxes, garnishments, attachments, income deductions or insurance premiums or any other withholdings.

(15) "Educational activities" means activities that include but are not limited to:

(a) independent GED preparation;

(b) basic and remedial education to provide participant with brushup skills as needed for employment;

(c) English proficiency for participants unable to understand, read, speak, or write well enough to allow employment commensurate with participant's employment goal;

(d) attending high school or alternative high schools; and

(e) attending GED preparation courses.

(16) "Eligibility case manager" means the person who determines eligibility for benefits, makes referrals to other resources, monitors the participants' progress and authorizes benefits.

(17) "Employability plan" means a written plan developed by the participant and the work readiness component (WoRC) case manager which sets forth services and activities intended to assist the participant in obtaining and retaining employment.

(18) "English as a second language (ESL)" means classroom training for persons with limited or no skills in English which provides them with sufficient command of the English language to compete in the labor market or to participate in training.

(19) "Equity value" means the market value of a resource minus the value of any enforceable mortgage, lien, encumbrance, or security interest.

(20) "Family Investment Agreement (FIA)/WoRC Employability Plan" means a written document designating the case management entity who will assist the family in working toward self-sufficiency.

(21) "Federal means-tested public benefit" means food stamp benefits funded by the U.S. Department of Agriculture pursuant to the Food Stamp Act of 1977 as amended, 7 USC 2026 et seq., cash assistance or any other benefits funded by the Temporary Assistance for Needy Families (TANF) Block Grant pursuant to Title IV of the Social Security Act, 42 USC 601 et seq., and medical assistance benefits funded by the Medicaid Program pursuant to Title XIX of the Social Security Act, 42 USC 1395 et seq.

(22) "Filing unit" includes:

(a) all individuals who are included in the child's assistance unit;

(b) all individuals who have the option of being included in the child's assistance unit, such as grandparents of the child, whether or not they choose to be included; and

(c) all persons, such as parents of the child, who would be required to be members of the child's assistance unit if they were not excluded from the assistance unit due for a reason such as lack of U.S. citizenship, receipt of SSI benefits, or the imposition of a sanction or disqualification.

(23) "General equivalency diploma (GED)" means a certificate provided to persons who pass standardized tests in place of a high school diploma.

(24) "Gross monthly income" means all earned and unearned income received except for excluded income as provided in ARM 37.78.415 and 37.78.416.

(25) "Group job search" means the provision of counseling, training, information, and peer support activities to employment and training participants in a group in order to give them guidance and support in obtaining employment.

(26) "Home" means the assistance unit's usual residence.

(27) "Incapacity" means a physical or mental defect, illness, or impairment diagnosed by a licensed physician or psychologist which is sufficiently serious as to eliminate or substantially reduce the parent's ability to obtain and retain employment for a period expected to last at least 30 days.

(28) "Indian country" means the land within the geographical boundaries of an Indian reservation.

(29) "Job development and placement" means creating or locating job openings and assisting employment and training participants in obtaining those positions.

(30) Job search and job readiness assistance means the act of seeking or obtaining employment, preparation to seek or obtain employment, including life skills training, and substance abuse treatment, mental health treatment, or rehabilitation activities.

(a) Such treatment or therapy must be determined to be necessary and certified by a qualified medical or mental health professional.

(31) "Job skills training directly related to employment" means training or education for job skills required by an employer to provide an individual with the ability to obtain employment or to advance or adapt to the changing demands of the workplace.

(32) "Lump sum payment" means any nonrecurring payment of earned or unearned income, including but not limited to:

(a) retroactive payments of social security disability or supplemental security income benefits or other benefits;

(b) payments in the nature of a windfall, such as an inheritance or lottery winnings; and

(c) insurance payments and personal injury and worker compensation awards, to the extent that the payment or award is not earmarked and used to compensate or reimburse the recipient for damages or expenses incurred due to an accident or injury, such as medical bills or replacement or repair of a resource.

(33) "Market value" means the price which a resource would bring if sold on the open market in the geographic area where the resource is located.

(34) "Medical support rights" means a child's legal entitlement to health insurance coverage and/or assistance with medical expenses from a parent with whom the child does not live.

(35) "Minor child" means a person under the age of 18 years, or older than 18 but less than 19 years if the person is a full-time student in a secondary school or an equivalent program who lives with a specified caretaker relative who meets the specifications set forth in ARM 37.78.207.

(36) "Nonfinancial assistance" means the programs funded, in part, with Temporary Assistance for Needy Families, as provided in 45 CFR 260.31(b). Nonfinancial assistance is also the collective term used for post employment training and education payments, post employment service payments, and work support payments.

(37) "On the job training" means training in the private or public sector that is given to a paid employee while he or she is engaged in productive work and that provides knowledge and skills essential to the full and adequate performance of the job.

(38) "Participant" means a person who is eligible for and receiving TANF benefits.

(39) "Participation hours" means the number of hours which a TANF cash assistance participant must perform allowable work activities as specified in the participant's Family Investment Agreement/WoRC Employability Plan.

(40) "Penalty period" means the period of time during which a participant is sanctioned.

(41) "Post-Employment Program" means the TANF Cash Assistance Program that is available to households which are losing eligibility for TANF cash assistance based on new or increased earned income of an individual currently receiving TANF cash assistance, but which will continue to receive a limited TANF cash assistance benefit through the "Post-Employment Program" for a period not to exceed three months.

(42) "Screening guide" means the tool by which the WoRC case manager in conjunction with the participant determines appropriate allowable work activities for the participant.

(43) "Single-parent household" means a household in which only one parent is included in the assistance unit.

(44) "Specified caretaker relative" means a person related to the minor child within the fifth degree of kinship by blood, marriage, or adoption who lives with the child.

(a) The caretaker relative must be the child's parent, grandparent, great grandparent, great-great grandparent, great-great-great grandparent, sibling, uncle, aunt, great uncle, great aunt, great-great uncle, great-great aunt, first cousin, first cousin once removed, nephew, niece, or step relative of the same degree of relationship; for example, stepparent, step grandparent, or step sibling, or half-brother or half-sister. The spouse of any person named in the immediately preceding sentence will be considered a caretaker relative, even after the marriage is terminated by death or divorce.

(45) "Stepparent" means an individual who is married to the minor child's parent by means of either a ceremonial or common law marriage.

(46) "Supportive services" means expenses and services necessary for a TANF Cash Assistance participant to participate in allowable work activities or accept a job.

(47) "Temporary Assistance for Needy Families (TANF)" means the collective term for all programs funded by the TANF grant. The term also is used to denote benefits provided in the form of financial assistance, nonfinancial assistance, child care payments, supportive services, or other services.

(48) "TANF Cash Assistance" is the term for the financial assistance program of TANF. The term also is used to denote supportive services provided to nonworking families who also receive TANF Cash Assistance.

(49) "TANF extended benefits" is the term for cash assistance issued to a household under the 20% hardship extension as allowed at 45 CFR 264.1(c).

(50) "TANF grant" means the monthly cash payment to the assistance unit.

(51) "Teen parent" means an unmarried person under the age of 18 who cares for his or her minor child.

(52) "Teenage parent" means a teen parent.

(53) "Training activities" means jobs skills training, job readiness activities, and job development and placement.

(54) "Tribal native employment works (NEW)" means an employment and training program operated by a federally recognized tribe or Alaskan native organization.

(55) "20% hardship extension" means a household is eligible to receive federal TANF benefits beyond 60 months on the basis of a hardship according to rules defined by the state. This is allowed at 45 CFR 264.1(c).

(56) "Two-parent household" means a household in which two parents reside, regardless of whether the two parents are parents of the same minor child or two or more different children, except that a household in which two parents reside is considered a single-parent household for work participation hours if one or both of the parents receives Supplemental Security Income (SSI) benefits or is incapacitated. For purposes of this definition, a biological or adoptive parent or a stepparent is considered a parent.

(57) "Unearned income" means all income which is not earned income as defined in this rule. It includes, but is not limited to, social security benefits, supplemental security income payments, veteran's benefits or payments, workers' compensation and unemployment compensation benefits, interest payments, dividends, and distributions from trusts or estates.

(58) "Unsubsidized employment" means full or part-time employment or self-employment in the public or private sector that is not subsidized by TANF or any other public program.

(59) "Valid loan" means a lender delivers a sum of money to a borrower pursuant to a written or oral agreement that the borrower will repay the sum in the future. The obligation to repay must be absolute and not contingent on the occurrence of an uncertain event.

(60) "Vocational educational training" means organized educational programs that are directly related to the preparation of individuals for employment in current or emerging occupations requiring training up to a baccalaureate or advanced degree.

(61) "WoRC employability plan" means a negotiated document listing allowable work activities, and mutual obligations of the WoRC program and the participant regarding the course of action leading to the individual's employment and the number of hours and the time limits within which such activities and obligations shall be performed.

(62) "Work-eligible individual" means an individual whose participation in allowable work activities contributes to determining whether the family counts in the calculation of the work participation rate. These individuals include:

(a) all adults receiving assistance;

(b) all minor children receiving assistance who are the head of a household;

(d) all nonrecipient or disqualified individuals who are a natural or biological parent of a minor child living in the household unless the nonrecipient or disqualified individual is:

(i) a minor parent who is not the head of a household or the spouse of the head of the household;

(ii) an ineligible alien; or

(iii) a recipient of Supplemental Security Income (SSI) benefits.

(63) "Work experience" means placement in a formal job site training experience that provides an individual with an opportunity to acquire the general skills, training, knowledge, and work habits necessary to obtain employment. All work experience placements have a detailed training plan. The main purpose of work experience is to improve the employability of those who cannot find unsubsidized employment.

(64) "Work readiness component (WoRC)" means the activities case management component of the TANF Cash Assistance Program.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 952, Eff. 3/29/02; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2007 MAR p. 47, Eff. 1/12/07; AMD, 2007 MAR p. 976, Eff. 7/6/07; AMD, 2008 MAR p. 1154, Eff. 6/13/08; AMD, 2009 MAR p. 1020, Eff. 7/1/09.

Mont. Admin. R. 37.78.106 Tanf: Safeguarding and Sharing Information

(1) Use of information concerning applicants for or participants in TANF is restricted to purposes directly connected with the administration of TANF and other federally assisted programs which provide assistance to individuals on the basis of need.

(2) The department may use or share confidential information concerning an applicant for or participant in TANF, without notice or permission of the person for the following purposes:

(a) administration of TANF or any of the other federal programs listed in (4);

(b) reporting of child abuse and neglect to an appropriate agency or authority or responding to a request for information from an appropriate agency or authority investigating child abuse or neglect;

(d) for other purposes authorized by law; or

(e) notification of an appropriate person, authority or other entity that an applicant or participant is making threats to harm himself or herself or to harm others, in order to prevent or lessen the threatened harm.

(3) Administration of a program includes the use of information by the program necessary for:

(a) establishing applicant eligibility;

(b) determining amount of assistance for recipient;

(d) conducting audits and similar activities; or

(e) any investigation, prosecution, or criminal or civil proceeding relating to the administration of the program.

(4) Other federal programs for which confidential applicant information may be used include the following:

(a) food stamps;

(b) Medicaid;

(d) federal old age assistance;

(e) federal aid to the blind;

(f) federal aid to the disabled;

(g) supplemental security income;

(h) social security;

(i) federally assisted child welfare services;

(j) federally assisted foster care;

(k) federally assisted adoption assistance;

(l) federally assisted weatherization;

(m) low income energy assistance;

(n) social services block grant;

(o) federally assisted work incentive;

(p) federally assisted child care assistance; or

(q) any other federal or federally assisted program providing assistance, in cash, in-kind or in services, directly to recipients on the basis of need.

(5) The department, without notice to or the permission of an applicant or participant, may release the current address of the person to a federal, state or local law enforcement officer, if the officer identifies the person and satisfactorily demonstrates:

(a) that the person is:

(i) a fugitive felon;

(ii) violating a condition of probation or parole; or

(iii) has information necessary for the officer to conduct the officer's official duties; and

(b) that locating and/or apprehending the person is within the official duties of the officer.

(6) The department, without prior permission of the applicant or participant, may within its discretion release confidential information necessary for the provision of emergency services to meet medical and other critical needs of the person. Notice of the release must be given as soon as possible to the person.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-105, 53-2-201, 53-2-211, 53-3-111, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2004 MAR p. 1482, Eff. 7/2/04.

Subchapter 37.78.2 TANF Cash Assistance: Eligibility

Mont. Admin. R. 37.78.201 Tanf Cash Assistance Time Limits

(1) A family is not eligible for TANF Cash Assistance if the family includes an adult who has received cash assistance in a program funded under the Temporary Assistance for Needy Families Block Grant in any state or states, including tribal programs, for 60 months or more, whether or not the months are consecutive, unless all adults in the filing unit qualify for TANF extended benefits. However, in calculating the number of months that an adult has received such assistance, the department shall not count any month when the person received assistance if during that month:

(a) the person was a minor child and was not the head of a household or married to the head of the household; or

(b) the person was an adult and lived within the exterior borders of an Indian reservation or an Alaskan native village where at least 50% of the adults were not employed.

(i) A person living within the exterior borders of an Indian reservation is considered to be living in Indian country.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, 53-4-603, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 952, Eff. 3/29/02.

Mont. Admin. R. 37.78.202 Tanf: Cash Assistance Extensions to Time Limits

(1) Benefits under the TANF Cash Assistance Programs are time limited as provided in ARM 37.78.201.

(2) Households may be eligible for TANF Cash Assistance when an adult household member has received 60 months of TANF Cash Assistance if each adult household member is in compliance with the Family Investment Agreement and each adult meets one of the following extension reason criteria:

(a) each adult household member is temporarily or permanently physically or mentally ill or physically or mentally incapacitated in a manner that prevents the household member from working;

(b) each adult household member is temporarily or permanently physically or mentally ill or physically or mentally incapacitated in a manner that prevents the household member from working as a result of domestic violence;

(c) each adult household member is required in the home full time as the primary caretaker of a person who is temporarily or permanently physically or mentally ill or physically or mentally incapacitated and no alternative care is available, and the person who needs care is either:

(i) a member of the filing unit; or

(ii) a person who would be a member of the filing unit if the person was eligible;

(d) the adult household member is presently attempting to resolve a current domestic violence situation.

(3) Each adult household member must submit an application for the extension of TANF Cash Assistance and all required proof showing the household members meets an extension criterion before an extension will be considered. An application for the extension of TANF Cash Assistance will not be considered complete if required proof is not attached. Required proof may include, but is not limited to: physician statements, medical records, police reports, professional assessments, and psychological evaluations.

(4) All completed applications for the extension of TANF Cash Assistance will be evaluated by the eligibility case manager, the local director and a central committee made up of Public Assistance Bureau administrative program staff or their designees. The central committee will make the final determination on whether an extension will be granted.

History

Authorizing statute(s): 53-2-201, 53-4-211, 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-212, 53-4-231, 53-4-601, 53-4-607, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 952, Eff. 3/29/02; AMD, 2007 MAR p. 976, Eff. 7/6/07.

Mont. Admin. R. 37.78.206 Tanf: General Eligibility Requirements

(1) Except as provided in (2)(e), an application for TANF Cash Assistance must be made on behalf of a minor child as defined in ARM 37.78.103.

(2) Subject to the restrictions set forth in ARM 37.78.220 and in (3), TANF Cash Assistance may be granted to the following classes of persons if they meet all other eligibility requirements:

(a) minor children as defined in ARM 37.78.103;

(b) specified caretaker relatives, as defined in ARM 37.78.103;

(d) minor children as defined in ARM 37.78.103 who live in the home of a minor child and who are the child's siblings by blood, marriage, or adoption, including half brothers and half sisters and stepsiblings;

(e) pregnant women who have no other eligible children living with them, provided that they shall be eligible for cash assistance payments beginning the third month prior to the month in which the child is expected to be born.

(3) The following are not eligible for TANF Cash Assistance:

(a) persons receiving Supplemental Security Income (SSI) benefits under Title XVI of the federal Social Security Act;

(b) all members of the specified caretaker relative's filing unit when a specified caretaker relative fails or refuses without good cause to comply with the requirements of ARM 37.78.215 regarding the assignment of child and medical support rights and cooperation in establishing paternity and obtaining child and medical support;

(c) a specified caretaker relative who fails to report the absence of a child, lasting more than 90 consecutive days as specified in ARM 37.78.207 by the end of the five-day period which begins with the date on which it becomes clear to the caretaker relative that the child will be absent for more than 90 consecutive days;

(d) teenage parents who are not living with their parent or parents, legal guardian, or other adult relative who would qualify to be a guardian of a minor child under Title 72, chapter 5, MCA, unless the teenage parent has been authorized to live in an alternative setting by the local office of public assistance living arrangement review committee because:

(i) the teenage parent has no parent, legal guardian, or other adult relative who would qualify to serve as a guardian who will allow the teenage parent to live in their home; or

(ii) the teenage parent is living independently because:

(A) physical, verbal, or emotional abuse or domestic violence exists in the home of any adult relative or guardian with whom the teenage parent could otherwise live;

(B) alcohol or drug abuse exists in the home of any adult relative or guardian with whom the teenage parent could otherwise live;

(D) any adult relative with whom the teenage parent could otherwise live is mentally ill; or

(E) it would be dangerous to the teenage parent's physical or emotional well being for any other reason to live with any adult relatives with whom the teenage parent could otherwise live.

(e) persons who are in violation of a condition of the individual's probation or parole imposed under state or federal law and persons fleeing to avoid being prosecuted for a felony or fleeing to avoid custody or confinement after conviction of a felony;

(i) a person is an ineligible fleeing felon if the crime involved is a felony in the jurisdiction where the crime occurred.

(f) persons who have intentionally misrepresented their place of residence in order to obtain TANF, Medicaid, or food stamps in two or more states simultaneously are ineligible for a period of ten years;

(g) all members of the assistance unit which includes an individual who was convicted after August 22, 1996, of any offense which is classified as a felony in the jurisdiction where the offense occurred and which has as an element the possession, use, or distribution of a controlled substance as defined in section 102(6) of the federal Controlled Substance Act, 21 USC 802(6) who is not in compliance with the conditions of supervision, whose sentence associated with the felony conviction has not been discharged or the individual is not actively participating in treatment, if required;

(h) all members of the assistance unit which includes an adult who has received assistance for 60 months or more, as prescribed in ARM 37.78.201;

(i) all members of the assistance unit which includes a specified caretaker relative who fails or refuses to comply with third party liability;

(j) all members of the assistance unit which includes a specified caretaker relative or minor child who fails or refuses to comply without good cause with eligibility requirements including providing information and verification needed to determine eligibility;

(i) refusal may occur verbally, in writing, or by not responding in any manner;

(k) all members of the assistance unit if any member of the assistance unit who is required by ARM 37.78.806 to participate in allowable work activities as defined in ARM 37.78.103 and 37.78.807 fails or refuses without good cause to negotiate and sign a Family Investment Agreement/WoRC Employability Plan (FIA/EP);

(l) all required members of the filing unit, or individuals who would have been a required member of the filing unit at the time of sanction, which includes an individual who is sanctioned for noncompliance in allowable work activities as defined in ARM 37.78.103 and 37.78.807 negotiated in the Family Investment Agreement/WoRC Employability Plan (FIA/EP) or sanctioned for failure to accept and maintain employment without good cause, if the sanction results in an ineligibility period as defined in ARM 37.78.506, with the following exceptions:

(i) minor children who are removed from the household by Child and Family Services and who are determined eligible for child only TANF in another household; or

(ii) minor children who are determined eligible for child only TANF in another household.

(m) an individual who is serving an intentional program violation as outlined in ARM 37.78.505;

(n) an individual who is incarcerated and does not meet the temporary absence criteria as outlined in ARM 37.78.207; and

(o) all required members of the filing unit if the filing unit includes an individual who has been sanctioned twice and the sanctioned individual has not completed an intensive case management meeting within the 30 day application time period.

(4) An application for nonfinancial assistance must be made on behalf of a child under the age of 18.

(5) Subject to the restrictions set forth in (6), nonfinancial assistance may be granted to the following classes of persons if they meet all other eligibility requirements for nonfinancial assistance:

(a) children under the age of 18 for whom application is made;

(b) specified caretaker relatives, as defined in ARM 37.78.103, of children described in (5)(a);

(c) stepparents of children under the age of 18 who live with the child for whom application is made and with the child's natural or adoptive parent;

(d) siblings, by blood, marriage, or adoption, who are under the age of 18, half brothers and half sisters and stepsiblings of a child, in (5)(a).

(6) The following are not eligible for nonfinancial assistance:

(a) all members of the assistance unit which includes a specified caretaker relative or minor child who fails or refuses to comply, without good cause, with eligibility requirements including providing information and verification needed to determine eligibility;

(i) refusal may occur verbally, in writing, or by not responding in any manner.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-231, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2007 MAR p. 47, Eff. 1/12/07; AMD, 2007 MAR p. 976, Eff. 7/6/07; AMD, 2008 MAR p. 172, Eff. 11/9/07; AMD, 2009 MAR p. 1020, Eff. 7/1/09.

Mont. Admin. R. 37.78.207 Tanf: Living with a Specified Relative

(1) To be eligible for TANF Cash Assistance a child for whom application is made must be living with an adult related to the child by blood, marriage, or adoption who is within the fifth degree of kinship to the child as set forth in ARM 37.78.103. The child and adult relative must live together in a place of residence maintained as their home.

(a) A child who is visiting a noncustodial parent or is living with a parent who has joint custody but with whom the child resides less than one-half the time is not considered to be living with that parent for purposes of this rule.

(b) If a child spends equal amounts of time with both parents, both parents must be included in the child's assistance unit.

(2) A child may still be considered to be living with a specified relative even though either the child or the caretaker relative is temporarily absent from the home, providing that the temporary absence does not exceed 90 consecutive days and subject to the following conditions:

(a) It must be intended that the absent child or caretaker relative return to the home within 90 days.

(b) The caretaker relative must continue to exercise responsibility for the care of the child despite the temporary absence and must plan to exercise such responsibility over the child when the reason for the absence ends.

(c) The needs of the child or the caretaker relative are included in determining the assistance unit's eligibility for and amount of cash assistance during the temporary absence.

(d) The caretaker relative cannot be temporarily absent due to incarceration.

(3) If the child or caretaker relative is temporarily absent from the home to receive medical treatment, the child is still considered to be living with a specified caretaker relative even if the absence exceeds 90 days, and without regard to the conditions set forth in (2)(a) and (b), provided the parent or caretaker relative is otherwise eligible.

(4) If the specified caretaker relative is temporarily absent from the home to complete a specific short-term training or employment, the child is still considered to be living with a specified caretaker relative even if the absence exceeds 90 days, provided the parent or specified caretaker relative continues to be otherwise eligible.

(5) If the child is attending a boarding school and is expected to return to the home of the specified caretaker relative at the end of the school term, the child is still considered to be living with the specified caretaker relative while away at school.

(6) To be eligible for nonfinancial assistance a child for whom application is made must be living with an adult related to the child by blood, marriage, or adoption who is within the fifth degree of kinship to the child as set forth in ARM 37.78.103.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 264, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2007 MAR p. 976, Eff. 7/6/07.

Mont. Admin. R. 37.78.208 Tanf: Inclusion in Assistance Unit

(1) Except as provided in (5), the child for whom application is made must be included in the assistance unit. The child's income and resources will be counted in determining eligibility and benefit amount and the child's needs will be included in the grant.

(2) Except as provided in (5), any minor child, as defined at ARM 37.78.103, who is related to the child described in (1) within the second degree of kinship or is a step relative within the same degree of kinship and who lives with the child and meets all other nonfinancial requirements for eligibility, including citizenship, must be included in the assistance unit. The minor child's income and resources will be counted in determining eligibility and benefit amount and the minor child's needs will be included in the grant.

(3) Except as provided in (5), the parent or parents of a minor child described in (1) or (2) who live with the child and meet all other nonfinancial requirements for eligibility, including citizenship, must be included in the assistance unit, regardless of whether the parents are married to each other. The parent's or parents' income and resources will be counted in determining eligibility and benefit amount and the parent's or parents' needs will be included in the grant.

(4) Except as provided in (5), the stepparent of a minor child described in (1) or (2) who lives with the child and the child's natural or adoptive parent must be included in the assistance unit if the stepparent meets all other nonfinancial requirements for eligibility including citizenship. The stepparent's income and resources will be counted in determining eligibility and benefit amount and the stepparent's needs will be included in the grant.

(a) A person who is married to the child's parent by means of either a ceremonial or common law marriage is a stepparent.

(5) The needs, income and resources of persons receiving Supplemental Security Income (SSI) payments under Title XVI of the Federal Social Security Act shall not be included in determining the need and amount of the assistance payment of TANF Cash Assistance for the period for which SSI benefits are received. The needs, income and resources of persons with respect to whom federal, state or local foster care payments are made shall not be included in determining need and amount of the assistance payment.

(6) New household members required to be included in the assistance unit will be added the month after the month in which the new member entered the household or is reported to be living in the household, whichever occurs later, with the exception of a newborn minor child. A newborn minor child who is required to be included in the assistance unit will be added the date of birth or adoption, provided the household reports the birth or adoption of the newborn minor child within ten days from the date of birth or adoption. If the household fails to report the birth or adoption of the newborn minor child within ten days from the date of birth or adoption, the newborn minor child will be added the month after the month in which the newborn minor child entered the household or is reported to be living in the household, whichever occurs later.

(7) For purposes of TANF nonfinancial assistance, all persons who are included in the filing unit are included in the assistance unit.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-2-613, 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2007 MAR p. 1818, Eff. 11/9/07.

Mont. Admin. R. 37.78.215 Tanf: Tanf Cash Assistance; Child Support Services Cooperation Requirements

(1) Except as provided in (2), in every TANF cash assistance case where one or both of the minor child's parents is absent from the home, the specified caretaker relative must:

(a) assign child and medical support rights, as defined in ARM 37.78.103, to the department; and

(b) cooperate in establishing paternity and obtaining child or medical support, or both, subject to the exception for good cause provided in (3)(a) through (f).

(2) In cases where there is only one adoptive parent or where the parental rights of the child's parents have been terminated by a court of competent jurisdiction, the applicant or recipient is not required to assign child or medical support rights or cooperate in establishing paternity or obtaining child support.

(3) The requirement of cooperation in establishing paternity and obtaining child support may be waived if good cause is shown. For purposes of this rule, good cause exists if one of the following circumstances exists, and as a result of that circumstance cooperation would be detrimental to the child:

(a) cooperation is likely to result in substantial danger, physical harm, undue harassment or severe mental anguish to the child or the caretaker relative;

(b) the child was conceived as a result of forcible rape or an incestuous relationship;

(d) legal proceedings for the adoption of the child are pending before a court of competent jurisdiction;

(e) the parental rights to the child have been terminated by a court of competent jurisdiction;

(f) the absent parent is listed on the Montana Department of Justice Sexual or Violent Offender Registry; or

(g) any other situation which makes cooperation with child support requirements detrimental to the child.

(4) A specified caretaker relative who claims to have good cause for refusing to cooperate must:

(a) provide evidence to substantiate the claim; or

(b) provide sufficient information to permit an investigation to determine whether good cause exists.

(5) Assistance will not be denied, delayed, or discontinued pending a determination of good cause for refusal to cooperate if the specified caretaker relative has complied with the requirements of (4). However, if it is ultimately determined that good cause does not exist and the recipient continues to refuse to cooperate, the department may recover amounts paid pending the determination of good cause.

(6) In cases where good cause has been found, a review must be held at each redetermination of eligibility to determine whether there has been any change in circumstances such that good cause no longer exists.

(7) The local Office of Public Assistance will promptly notify the Child Support Services Division of all cases in which it has been determined that there is good cause for refusal to cooperate in establishing paternity or obtaining child or medical support.

(8) A pregnant woman is required before the birth of her child to provide information about the father of her unborn child for the purpose of establishing paternity and obtaining child and medical support after the child's birth.

(9) When a parent or parents fail or refuse without good cause to assign child or medical support rights or to cooperate in establishing paternity or obtaining child or medical support, all household members will be ineligible for assistance.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2008 MAR p. 1154, Eff. 6/13/08; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.78.216 Tanf: Tanf Cash Assistance Fia/Worc Employability Plan (fia/Ep)

(1) The FIA/WoRC Employability Plan (FIA/EP) is a negotiated document listing eligibility requirements, allowable work activities as defined in ARM 37.78.103 and 37.78.807, and mutual obligations of the state and the participant regarding the course of action leading to the individual's employment and the number of hours and the time limits within which such activities and obligations shall be performed.

(a) The following individuals are required to negotiate and comply with a FIA/EP as a condition of eligibility in the TANF Cash Assistance Program or TANF Cash Assistance Post-Employment Program:

(i) natural or adoptive adult parents of a minor child in the household;

(ii) nonrecipient or disqualified individuals who are a natural or adoptive parent of a minor child in the household unless the nonrecipient or disqualified individual is:

(A) a minor parent who is not the head of a household or the spouse as a head of the household;

(B) an ineligible alien; or

(iii) adult spouse of a natural or adoptive parent of a minor child in the household;

(iv) adult specified caretaker relative who has requested to be included in the assistance unit;

(v) minor children age 16 or 17 not attending school full-time;

(vi) teen parents not living independently and not attending school full-time;

(vii) teen parents who have been approved to live independently; and

(viii) minor parents.

(b) A participant who is receiving extended benefits as specified in ARM 37.78.202 must enter into a FIA/EP. The FIA/EP activities for a participant who is eligible for TANF extended benefits will take into consideration any limitations which are the basis for the extension.

(c) The FIA/EP will be reviewed at least once every 12 months by the eligibility case manager and at least monthly by the WoRC case manager. They may also be renegotiated as needed or at the request of either the participant, the eligibility case manager, or the WoRC case manager.

(d) Once the FIA/EP is completed, it is signed by the participant, the eligibility case manager and the WoRC case manager. The participant receives a signed copy.

(e) Failure to perform the activities required in the FIA/EP and/or to provide verification and/or documentation of participation in the activities on a timely basis will result in sanctions in accordance with ARM 37.78.506, unless the individual is receiving TANF cash assistance through the Post-Employment Program, in which case failure will result in case closure.

(2) Because entering into a FIA/EP is a condition of eligibility for TANF Cash Assistance and the TANF Cash Assistance Post-Employment Program, failure or refusal without good cause to enter into a FIA/EP initially or to renegotiate and/or sign a new FIA/EP when requested will result in the denial of or termination of assistance for the entire assistance unit.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, 53-4-606, 53-4-608, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 952, Eff. 3/29/02; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2007 MAR p. 976, Eff. 7/6/07; AMD, 2008 MAR p. 1154, Eff. 6/13/08.

Mont. Admin. R. 37.78.220 Tanf: Eligibility, Citizenship Requirements

(1) Except as provided by this rule, only U.S. citizens and qualified aliens are eligible for TANF Cash Assistance.

(2) A qualified alien is a noncitizen who:

(a) was admitted to the U.S. as a refugee under section 207 of the Immigration and Nationality Act (INA) for only seven years from the date of entry;

(b) was granted asylum under section 208 of the INA for only seven years from the date of entry;

(d) was granted parole for at least one year under section 21(d)(5) of the INA;

(e) was granted conditional entry under immigration law in effect before April 1, 1980;

(f) is a Cuban/Haitian entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980, if entry occurred within the last seven years, including:

(i) any alien granted parole status as a Cuban/Haitian entrant; or

(ii) any alien granted any other special status for nationals of Cuba or Haiti; or

(iii) any alien who is a national of Cuba or Haiti and who:

(A) was paroled into the U.S., but has not acquired any other status; or

(B) is the subject of removal proceedings or has an application for asylum pending; and

(g) is an Amerasian immigrant who was admitted to the U.S. pursuant to section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988, if admitted within the last seven years, including any alien lawfully admitted for permanent residence if the alien was a resident of Vietnam on December 22, 1987 and if the alien was born in Vietnam after January 1, 1962 and before January 1, 1976; and

(i) was fathered by a U.S. citizen; or

(ii) is the spouse, child, natural mother, or who acted as the mother, father or next of kin to the alien described in (2)(g)(i), if accompanying or following the alien described in (2)(g)(i) to the U.S. and if admission is necessary to maintain family unity;

(h) is an American Indian born in Canada if at least 50% American Indian blood and considered lawfully admitted for permanent residence;

(i) is a member of a federally recognized Indian tribe under the Indian Self Determination and Education Assistance Act and considered lawfully admitted for permanent residence;

(j) is a battered spouse or child or a person who has been subjected to extreme cruelty in the U.S. pursuant to the requirements of 8 USC 1641(c), if:

(i) the applicant verifies that battery or extreme cruelty was inflicted on the applicant, applicant's child or the child applicant's parent by providing proof that a case was established by INS; and

(ii) there is a substantial connection between the abuse and the applicant's need for benefits; and

(iii) the applicant does not reside with the abuser;

(k) is lawfully admitted to the U.S. for permanent residence and:

(i) the alien entered the U.S. as a refugee within the last seven years and the alien's status has changed to "lawfully admitted for permanent residence"; or

(ii) the alien was granted asylum within the last seven years and the asylee's status has changed to "lawfully admitted for permanent residence"; or

(iii) the alien had deportation withheld under section 243(h) of the INA within the last seven years and the alien's status has changed to "lawfully admitted for permanent residence"; or

(iv) the alien was admitted as a Cuban/Haitian entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980 within the last seven years and the alien's status has changed to "lawfully admitted for permanent residence"; or

(v) the alien was admitted as an Amerasian immigrant under section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988 within the last seven years and the alien's status has changed to "lawfully admitted for permanent residence"; or

(vi) the alien entered the U.S. before August 22, 1996 and can be credited with 40 qualifying quarters of work, cumulated as defined in (4) and (5); or

(vii) the alien entered the U.S. on or after August 22, 1996 and has resided in the U.S. for five years and can be credited with 40 qualifying quarters of work, cumulated as defined in (4) and (5);

(l) is a veteran of the U.S. Armed Forces and who received an honorable discharge not because of alienage;

(m) is a Hmong or other Highland Lao veteran who fought on behalf of the U.S. Armed Forces during the Vietnam conflict;

(n) is on active duty in the U.S. Army, Navy, Air Force, Marine Corps or Coast Guard and who is not on active duty for training purposes;

(o) is the spouse of an alien veteran or an alien on active duty as described in (2)(l) through (n);

(p) is the unmarried child of an alien veteran or alien on active duty as described in (2)(l) through (n); or

(q) is a victim of a severe form of trafficking as determined by the U.S. Department of Health and Human Services for only seven years from the date of entry.

(3) Qualified aliens entering the U.S. on or after August 22, 1996 are not eligible for TANF cash assistance benefits for a period of five years from the date of entry unless they are:

(a) refugees;

(b) asylees;

(d) honorably discharged veterans or aliens on active duty in the U.S. Armed Forces, or the spouse and/or unmarried child of honorably discharged veterans or aliens on active duty;

(e) Cuban/Haitian entrants as defined in section 501(e) of the Refugee Assistance Act of 1980;

(f) Amerasian immigrants admitted to the U.S. pursuant to section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988;

(g) enrolled members of a federally-recognized Indian tribe under section 4(e) of the Indian Self Determination and Education Assistance Act; or

(h) a victim of a severe form of trafficking as determined by the U.S. Department of Health and Human Services.

(4) If the alien entered the U.S. before August 22, 1996 or five years have passed since the alien entered the U.S., the work quarter requirement may be met, subject to (5), by cumulating quarters worked by:

(a) the alien;

(b) the alien's living parents (including stepparents) if the quarters were earned while the alien was under age 18;

(c) the alien's deceased parents (including stepparents) if the quarters were earned while the alien was under age 18; or

(d) the alien's spouse if the quarters were earned during the marriage and if the alien is still married to that spouse or if the spouse is deceased.

(5) No work quarters may be credited for any period after December 31, 1996 if any of the persons listed in (4)(a) through (d) received any federal means-tested benefits during the period the work quarters were earned.

(6) An alien who meets all financial and nonfinancial eligibility criteria is eligible to receive TANF cash assistance benefits only for a period of seven years from the date INS designates the alien as one of the following and if the alien was:

(a) admitted to the U.S. as a refugee under section 207 of the INA; or

(b) granted asylum under section 208 of the INA; or

(d) admitted as a Cuban/Haitian entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980; or

(e) admitted as an Amerasian immigrant under section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988.

(7) A person must be a U.S. citizen to be eligible for nonfinancial assistance.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-231, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2009 MAR p. 1020, Eff. 7/1/09.

Mont. Admin. R. 37.78.221 Tanf: Residency

(1) There is no durational residency requirement for TANF. Any resident of Montana who meets all other eligibility requirements may receive TANF.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.222 Tanf: Tanf Cash Assistance; Denial of Benefits to Strikers

(1) Participation in a strike does not constitute good cause to leave, or to refuse to seek or accept, employment.

(2) TANF cash assistance benefits will be denied to any family for any month in which any caretaker relative with whom the dependent child is living is, on the last day of the month, participating in a strike.

(3) No individual's needs will be included in determining the amount of benefit payable for any month to a family if, on the last day of such month, the individual is participating in a strike.

(4) A strike is defined as a temporary concerted stoppage of work by a group of employees (not necessarily members of a union) to express a grievance, enforce a demand for changes in the conditions of employment, obtain recognition, or resolve a dispute with management. Also included in this definition is a work stoppage by reason of the expiration of a collective bargaining agreement.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.226 Tanf: Tanf Cash Assistance; Place of Application

(1) Applications for TANF cash assistance may be made in any Office of Public Assistance in Montana on behalf of a minor child. When conditions preclude a person from visiting the Office of Public Assistance to make application, he shall have an opportunity to make application at a mutually agreed place, through a home visit by the worker or by mail.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-233, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.227 Tanf: Investigation of Eligibility

(1) Investigations of eligibility will include securing information from the person applying for or receiving assistance and such other investigation as may be determined necessary by the department.

(2) If a case is selected for program compliance review for any program, the client must cooperate.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-233, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.228 Tanf: Tanf Cash Assistance; Initial Payment and Redetermination of Eligibility

(1) The initial assistance payment will be issued in a prorated amount which includes the day upon which application was made and the remaining days of that month if the following criteria are met:

(a) the assistance unit does not include an individual as defined in ARM 37.78.216 who is required to negotiate and comply with a FIA/EP as a condition of eligibility;

(b) the assistance unit includes an individual(s) as defined in ARM 37.78.216 who is required to negotiate and comply with a FIA/EP and the negotiation of the FIA/EP indicates the required individual(s) has been referred to a Tribal NEW program for case management; or

(c) the assistance unit includes an individual(s) as defined in ARM 37.78.216 who is required to negotiate and comply with a FIA/EP as a condition of eligibility, the individual(s) has been referred to the WoRC program for case management and the individual(s) has negotiated a WoRC Employability Plan within three working days from being referred to the WoRC program or has good cause as outlined in ARM 37.78.508 for failing to negotiate a WoRC employability plan within three working days of referral.

(2) The initial assistance payment will be issued in a prorated amount which includes the day upon which the individual(s) negotiated a WoRC Employability Plan and the remaining days of the month if the individual(s) who is required to negotiate and comply with a FIA/EP as defined in ARM 37.78.216 and who has been referred to the WoRC program for case management does not negotiate a WoRC Employability Plan within three working days from being referred to the WoRC program and does not have a good cause as defined in ARM 37.78.508 for failing to negotiate a WoRC Employability Plan within three working days of referral.

(3) If the assistance unit contains more than one individual who is required to negotiate and comply with a FIA/EP as defined in ARM 37.78.216, the initial assistance payment will be prorated based on the latter of the application date or the date that all required individuals have negotiated the FIA/EP.

(4) Periodic investigations will be made of all TANF participants to determine whether continuing eligibility to receive assistance exists, at least once every 12 months, but may be made at any time if circumstances require.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2007 MAR p. 976, Eff. 7/6/07.

Subchapter 37.78.4 TANF Cash Assistance: Resources

Mont. Admin. R. 37.78.401 Tanf: Tanf Cash Assistance; Resources

(1) This rule governs the treatment of resources for purposes of all benefits in the TANF cash assistance program.

(2) In determining eligibility for TANF cash assistance, the department will count the equity value as defined in ARM 37.78.103 of all resources available to any member of the filing unit, unless there is a specific provision for the exclusion of the resource elsewhere in this rule or in federal law. A resource is considered available if actually available or when the applicant or participant has a legal interest in the resource and the legal ability to make it available for support and maintenance. In the case of qualified aliens, as defined in ARM 37.78.220, the income and resources of the alien's sponsor and the alien's sponsor's spouse must be considered in determining the eligibility of the alien. A sponsor is any person over the age of 18 who petitions for admission of an alien under section 213 of the Immigration and Nationality Act.

(3) If the total value of the filing unit's countable resources exceeds $3,000, the filing unit is ineligible for assistance. Eligibility is determined on the basis of the countable resources as of the date of application and the first moment of the first day of each month for which ongoing assistance is being determined. If the filing unit's countable resources exceed the $3,000 resource limit on the first day of the month, the filing unit is ineligible for that entire month, even if the value of the filing unit's countable resources drops below $3,000 later in the month.

(4) The following resources are not counted in determining eligibility:

(a) the filing unit's home, which is the usual residence of the filing/assistance unit, regardless of its value;

(b) household goods, clothing, or other essential personal effects, equipment, or other essential day to day items of limited value;

(d) one burial space for each member of the filing unit and not more than $1,500 designated under a funeral agreement for burial arrangements for each member or irrevocable burial accounts or agreements;

(e) Agent Orange settlement payments;

(f) radiation exposure compensation payments;

(g) vehicles as follows:

(i) one vehicle regardless of its value; however, the equity in any additional vehicles must be counted as a currently available resource; and

(ii) all income-producing vehicles;

(h) Maine Indian Claims Settlement Act of 1980 payments;

(i) the cash value of life insurance policies;

(j) restitution made to individuals of Japanese ancestry who were interned during World War II as per the Civil Liberties Act of 1988;

(k) restitution made to Aleuts who were relocated during World War II as per the Civil Liberties Act of 1988;

(l) major disaster and emergency assistance as per the Disaster Relief and Emergency Assistance Amendments of 1988;

(m) student financial assistance for post-secondary education made for attendance costs under Title IV of the Higher Education Act or Bureau of Indian Affairs Student Assistance Programs as per the Higher Education Technical Amendment Act of 1987. The exclusion lasts only as long as the recipient of assistance is continuously attending an institution of higher education, excluding regular school breaks such as semester breaks or summer vacations;

(n) earned income tax credit (EITC) advance payments and refunds;

(o) trust fund or similar legal document which cannot be accessed by the grantor, beneficiary or trustee for the purpose of providing for the health, welfare, maintenance or daily needs of the beneficiary;

(p) annuities from which payments are being made;

(q) funds which have been prorated as income, during the period for which they have been prorated;

(r) governmental disaster payments designated for restoration of a home damaged in a disaster if the household is subject to legal sanction if funds are not used as intended;

(s) funds which are held in an escrow account during the household's participation in a department of housing and urban development family self-sufficiency program; or

(t) senior benefit payments received by the Crow elders as per the Crow Boundary Settlement Act of 1994.

(5) The exclusions in (4) do not apply when members of the filing unit no longer have a personal ownership interest in the resource.

(6) If an individual would be required by ARM 37.78.208 to be included in the assistance unit except that the individual is not eligible because they are not a U.S. citizen or qualified alien, or they are a parole probation violator, fleeing felon, a person who has committed an intentional program violation, or a convicted drug felon as stated in ARM 37.78.206(3)(f) through (h) and 37.78.505, the resources of that individual will be counted in determining the assistance unit's eligibility and grant amount even though the individual's needs are not included in the grant.

(7) State and federal income tax refunds are a countable resource in the month received.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, 53-4-606, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2009 MAR p. 1020, Eff. 7/1/09.

Mont. Admin. R. 37.78.402 Tanf: Treatment of Income

(1) This rule governs the treatment of income for purposes of the TANF program.

(2) All available income of any member of the filing unit is counted in determining eligibility and benefit amount for TANF cash assistance, unless a specific provision elsewhere in this chapter provides that the income will be excluded, disregarded, or otherwise not counted. Income is considered available both when actually available and when the applicant or participant has a legal interest in it and the legal ability to make the income available for support and maintenance.

(3) Eligibility and grant amount for TANF cash assistance is determined for each benefit month. The assistance unit's future eligibility with regard to income and grant amount is determined by prospectively evaluating the income expected to be received by members of the filing unit in the month of application and future months. The department estimates total income to be received by the filing unit in the future based on their current circumstances and available information about changes in their circumstances reasonably anticipated to occur in the future.

(4) Income averaging may be used to determine monthly income if:

(a) income is paid during one month but is intended to cover a period of time which is greater than one month. The monthly amount would be computed by dividing the payment amount by the number of months the payment is intended to cover. An example would be an employee who receives a paycheck during only nine months of the year but whose salary is considered to be for a 12 month period; or

(b) income fluctuates significantly from month to month. An example would be an employee paid an hourly wage rather than a set salary whose hours of work vary from month to month.

(5) In the case of earned income from self-employment, allowable business expenses are subtracted from gross receipts to arrive at gross income.

(a) Business expenses means costs directly related to the production of goods or the furnishing of services and without which the goods could not be produced or the services furnished. Allowable business expenses include the costs of materials, labor, tools, rental equipment, supplies, and utilities.

(b) Allowable business expenses do not include depreciation, entertainment expenses, personal work related expenses such as clothing or transportation to the site of employment, purchase of capital equipment, or payments on principal of loans for capital assets or durable goods.

(6) Income tax refunds are not treated as income but are considered a countable resource in the month received.

(7) If an individual would be required by ARM 37.78.208 to be included in the assistance unit except that the individual is not eligible because they are not a U.S. citizen or qualified alien, or they are a parole probation violator, fleeing felon, a person who has committed an intentional program violation, an individual who is sanctioned for noncompliance in allowable work activities as defined in ARM 37.78.103 and 37.78.807 or sanctioned for failure to accept and maintain employment without good cause, or an individual who has intentionally misrepresented their place of residence in order to obtain assistance simultaneously from two or more states, the income of that individual will be counted in determining the assistance unit's eligibility and grant amount even though the individual's needs are not included in the grant.

(8) All earned income of the adults included in the filing unit is counted in determining eligibility for TANF nonfinancial assistance.

(9) Eligibility for TANF nonfinancial assistance is determined by evaluating the earned income expected to be received by the adults included in the filing unit in the month of application. The department estimates the total income to be received by the filing unit based on their current circumstances.

(10) In the case of earned income from self-employment, allowable business expenses are subtracted from gross receipts to arrive at gross income.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2008 MAR p. 1154, Eff. 6/13/08.

Mont. Admin. R. 37.78.406 Tanf: Tanf Cash Assistance; Income Disregards and Income Deeming

(1) This rule governs income disregards and deeming for purposes of TANF cash assistance.

(2) When testing countable monthly income and determining the amount of the assistance payment, the following amounts are subtracted in the order listed from the earned income of each wage earner in the assistance unit after exclusions provided in ARM 37.78.415 and 37.78.416:

(a) $200 of monthly earnings for each wage earner, except in the case of individuals whose income is deemed as described in (3);

(b) 25% of the remaining earned income after the disregards in (2)(a) have been applied;

(c) the cost of care for each working member's minor child or incapacitated adult for hours when the member is working or in employment and training activities, not to exceed $200 per month per child or incapacitated adult, but only if the minor child or incapacitated adult lives in the same household and is either a member of the assistance unit or would be a member of the assistance unit except for the fact that the minor child or incapacitated adult is receiving supplemental security income benefits.

(i) The cost of care incurred for the minor child or incapacitated adult in the budget month will be deducted. The amount deducted shall not include amounts incurred in months other than the budget month or amounts previously used to determine eligibility and benefit amount.

(d) One hundred percent of the countable earned income of each wage earner when the household is eligible for the TANF Cash Assistance Post-Employment Program.

(3) The amount of any child support payments paid under court order by any member of the assistance unit to any individual not living in the household is subtracted from the income of the household, whether earned or unearned or both.

(4) Subject to the disregards in (5)(a) through (d), income of the following individuals must be deemed when determining eligibility:

(a) for qualified aliens, the income of the alien's sponsor;

(b) for a pregnant woman the income of her spouse or of the father of her unborn child if the father resides with her; and

(c) for a caretaker relative whose needs are included in the assistance unit's grant and who is not the natural or adoptive parent of the dependent child, the income of the caretaker relative's spouse.

(5) The following amounts shall be subtracted from the income of the individuals specified in (4)(a) through (c) whose income is deemed:

(a) a $90 standard work expense;

(b) an amount of income equal to the net monthly income standard for a family consisting of the individual and the individual's natural or adopted children, if such children are claimed as dependents for federal income tax purposes and are living in the same household as the individual, but are not included in the TANF cash assistance unit;

(c) actual verified amounts paid by the individual to others not living in the household who are claimed by the individual as dependents for federal income tax purposes; and

(d) actual verified amounts of child support paid by the individual to other persons not living in the household.

(6) Income of the individuals specified in (4)(a) through (c), less the disregards specified in (5)(a) through (d), must be counted as unearned income to the assistance unit whether or not such income is actually contributed to any member of the assistance unit.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2003 MAR p. 1301, Eff. 7/1/03; AMD, 2008 MAR p. 1154, Eff. 6/13/08.

Mont. Admin. R. 37.78.407 Tanf: Tanf Cash Assistance; Limits on Disregards

(1) The income disregards in ARM 37.78.406 are applicable without limit on the number of months they can be applied.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.415 Tanf: Tanf Cash Assistance; Excluded Earned Income

(1) This rule governs excluded earned income for purposes of TANF cash assistance.

(2) In testing gross monthly income and in determining the monthly grant, the following earned income is to be excluded:

(a) the earned income of a minor child as defined in ARM 37.78.103 who is attending elementary or high school;

(b) earned income tax credit (EITC) advance payments and refunds;

(c) payments to individuals in the Volunteers in Service to America program (VISTA) pursuant to Title I of P.L. 93-113, section 404(g);

(d) all Workforce Investment Act (WIA) work experience income;

(e) all work-study earnings or payments received by a postsecondary student, regardless of the payment source; and

(f) all earned income received by a temporary census employee.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2008 MAR p. 2501, Eff. 11/27/08.

Mont. Admin. R. 37.78.416 Tanf: Tanf Cash Assistance; Excluded Unearned Income

(1) This rule governs excluded unearned income for purposes of TANF cash assistance.

(2) In testing gross monthly income and in determining grant amount, the following unearned income shall be excluded:

(a) gifts of money up to $50 per gift per month for each participant;

(b) energy assistance payments based on financial need;

(c) restitution made to individuals of Japanese ancestry who were interned during World War II as per the Civil Liberties Act of 1988;

(d) restitution made to Aleuts who were relocated during World War II as per the Civil Liberties Act of 1988;

(e) major disaster and emergency assistance as per the federal Disaster Relief and Emergency Assistance Amendments of 1988;

(f) the following income of enrolled tribal members:

(i) judgment claims payments;

(ii) judgments derived from submarginal lands;

(iii) per capita payments not to exceed $2,000 per individual per payment;

(iv) interest earned on excluded funds; and

(v) up to $2,000 per year of income derived from leases or other uses of individually owned trust or restricted lands.

(g) complementary assistance from other agencies or organizations which provides or pays for goods or services not intended to be covered by TANF cash assistance;

(i) The cash assistance grant is intended to provide assistance for food, household supplies, personal care items, clothing, and shelter, including heating costs.

(h) undergraduate grants, loans, or scholarships for purposes directly related to the individual's attendance at an institution of higher education or postsecondary training;

(i) veterans administration educational payments are totally excluded if the recipient of the payment is attending an institution of higher education or postsecondary training;

(j) the value of a food stamp allotment or food commodities donated by the U.S. Department of Agriculture;

(k) any benefits received under Title VII of the Nutrition Program for the Elderly of the Older Americans Act of 1965 as amended;

(l) the value of supplemental food assistance received under the Child Nutrition Act of 1966 and under the National School Lunch Act, P.L. 92-433 and 93-150;

(m) payments received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970;

(n) vendor payments or other financial assistance provided to the assistance unit by persons not included in the assistance unit where no income is contributed directly to members of the assistance unit;

(o) interest paid on escrow accounts established under the HUD Family Self-Sufficiency (FSS) program;

(p) payments made under the Maine Indian Claims Settlement Act of 1980;

(q) radiation exposure claims payments;

(r) payments received under the Alaska Native Claims Settlement Act, P.L. 92-203;

(s) payments received under the Volunteers in Service to America program (VISTA) pursuant to Title I of P.L. 93-113, section 404(g);

(t) reimbursement made to a member of the assistance unit, including repayment of monies spent;

(u) supportive services payments to or for an assistance unit who is participating in WoRC, or any other TANF cash employment and training program;

(v) supplemental security income (SSI) payments received by a person who lives with the assistance unit, except that any portion of the SSI payment which is directly contributed to the assistance unit is not excluded;

(w) HUD Section 8 utility payments, regardless of whether the payee is a member of the assistance unit or someone else is the payee;

(x) money received pursuant to a valid loan as defined in ARM 37.78.103;

(y) emergency assistance payments provided under ARM 37.78.601 and 37.78.602;

(z) interest earned on countable resources; and

(aa) payments received by Crow elders under the Crow Boundary Settlement Act of 1994, P.L. 103-444.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2006 MAR p. 2415, Eff. 10/6/06; AMD, 2009 MAR p. 1020, Eff. 7/1/09.

Mont. Admin. R. 37.78.420 Assistance Standards; Tables; Methods of Computing Amount of Monthly Benefit Payment

(1) Income standards as set forth in this rule are used to determine whether need exists with respect to income for any person who applies for or receives TANF cash assistance or TANF Post-Employment Program benefits and to determine the benefit amount the assistance unit will receive if eligible. Four sets of assistance standards are used:

(a) The gross monthly income (GMI) standard sets the level of gross monthly income for each size assistance unit which cannot be exceeded if the assistance unit is to be eligible for TANF cash assistance.

(b) The net monthly income (NMI) standard is used to determine the GMI.

(c) The benefit standard sets the level of net countable income which cannot be exceeded if the assistance unit is to be eligible for assistance.

(d) The payment standard is used to determine the amount of the monthly cash payment in the TANF cash assistance program and is based on the size of the TANF cash assistance unit, unless the household is receiving benefits through the TANF Post-Employment Program. Payment standards in the Post-Employment Program are a set amount as defined in (4)(e). This amount is not based on household size. The household's net countable income is subtracted from the payment standard to determine the amount of the payment for the TANF cash assistance unit. This amount is prorated for the month of application if eligibility is for less than a full month.

(2) The income standards vary depending on the number of persons in the assistance unit.

(3) The assistance unit's GMI as defined in ARM 37.78.103 is compared to the applicable GMI standard, and after specified disregards, to the benefit standard. If the assistance unit's GMI exceeds the GMI standard, or their countable monthly income as defined in ARM 37.78.402 exceeds the benefit standard, the assistance unit is ineligible for assistance. Monthly income is compared to the full standard even if the eligibility is being determined for only part of the month.

(a) Eligibility for assistance and the amount of the monthly benefit payment a TANF cash assistance unit will receive is determined prospectively, that is, based on the department's best estimate of income and other circumstances which will exist in the benefit month.

(b) When comparing income to the income standards, income anticipated to be received in the benefit month is used.

(4) The GMI standards, NMI standards, and benefits standards are as follows:

(a) Gross monthly income standards are compared with the assistance unit's gross monthly income as defined in ARM 37.78.406.

GROSS MONTHLY INCOME STANDARDS (GMI) Number of Persons in Household | Gross Monthly Income (GMI) 1 | $859 2 | 1,162 3 | 1,465 4 | 1,768 5 | 2,070 6 | 2,373 7 | 2,676 8 | 2,979 9 | 3,282 10 | 3,585 11 | 3,887 12 | 4,190 13 | 4,493 14 | 4,796 15 | 5,099 16 | 5,402 17 | 5,704 18 | 6,007 19 | 6,310 20 | 6,613

(b) Net monthly income standards are used to compute gross monthly income standards (GMI).

NET MONTHLY INCOME STANDARDS (NMI) 1 | $464 2 | 628 3 | 792 4 | 955 5 | 1,119 6 | 1,283 7 | 1,446 8 | 1,610 9 | 1,774 10 | 1,938 11 | 2,101 12 | 2,265 13 | 2,429 14 | 2,592 15 | 2,756 16 | 2,920 17 | 3,083 18 | 3,247 19 | 3,411 20 | 3,575

BENEFITS STANDARDS 1 | $365 2 | 493 3 | 622 4 | 750 5 | 879 6 | 1,007 7 | 1,136 8 | 1,264 9 | 1,393 10 | 1,521 11 | 1,650 12 | 1,778 13 | 1,907 14 | 2,035 15 | 2,164 16 | 2,292 17 | 2,421 18 | 2,549 19 | 2,678 20 | 2,806

(d) The payment standards for TANF cash assistance are compared to the assistance unit’s net countable income as defined in ARM 37.78.406.

CASH ASSISTANCE PAYMENT STANDARDS

1 | $425 2 | 575 3 | 725 4 | 875 5 | 1,025 6 | 1,175 7 | 1,325 8 | 1,475 9 | 1,625 10 | 1,775 11 | 1,924 12 | 2,074 13 | 2,224 14 | 2,374 15 | 2,524 16 | 2,674 17 | 2,824 18 | 2,974 19 | 3,124 20 | 3,274

(e) The payment standards for the TANF Post-Employment Program are a set benefit amount, which is not based on household size:

(5) The adult's gross monthly earned income as defined in ARM 37.78.103 and ARM 37.78.406 is compared to the applicable GMI limit. If the assistance unit's GMI exceeds the GMI limit, the assistance unit is ineligible for assistance. Monthly income is compared to the full limit even if the eligibility is being determined for only part of the month. When comparing income to the income limits, income anticipated to be received in the benefit month is used.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-241, MCA
History: NEW, 1996 MAR p. 2194, Eff. 8/9/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2001 MAR p. 183, Eff. 1/26/01; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2003 p. 1645, Eff. 8/1/03; AMD, 2006 MAR p. 2415, Eff. 10/6/06; AMD, 2007 MAR p. 1818, Eff. 11/9/07; AMD, 2008 MAR p. 1154, Eff. 6/13/08; AMD, 2009 MAR p. 2380, Eff. 1/1/10; AMD, 2011 MAR p. 107, Eff. 1/28/11; AMD, 2026 MAR, Notice No. 2026-529, Eff. 9/26/26.

Mont. Admin. R. 37.78.421 Tanf: Tanf Cash Assistance; Lump Sum Payments

(1) This rule governs lump sum payments for purposes of TANF cash assistance.

(2) Lump sum payments are payments of a nonrecurring sum of earned or unearned income.

(3) The assistance unit may lose eligibility for one or more months if, when the lump sum payment is added to all other countable resources, the total exceeds the $3,000 resource limitation. The household will be ineligible as long as the total countable resources exceed the $3,000 resource limitation.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.423 Tanf: Tanf Cash Assistance; Protective Payee

(1) A protective payment plan shall be implemented when the caretaker relative has clearly demonstrated an inability or unwillingness to use the family's assistance payments to meet the basic needs of the minor children in the household, as determined by an employee of the division of the department which provides protective services to children.

(2) Selection of the protective payee will be made by the participant, or with the participant's participation and consent, to the extent possible. Selection of a protective payee may be made among relatives, friends of the family, the clergy, a community service group, a voluntary social service agency, or departmental staff. If it is in the best interest of the participant for a staff member of the Department of Public Health and Human Services to serve as protective payee, a staff member will be appointed. The selection of protective payees may not include:

(a) county commissioners;

(b) executive heads of the Department of Public Health and Human Services;

(d) special investigative or resource staff;

(e) staff handling fiscal processes;

(f) landlords;

(g) grocers or other vendors of goods or services dealing directly with the client.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.424 Tanf: Restrictions on Payments

(1) TANF program monthly payments are made directly to eligible persons for their own use except in cases of protective payees. TANF cash assistance payments are made either by check, direct deposit, or by placing benefits in an electronic benefit transfer (EBT) account. The check may not be mailed to the grantee in care of a creditor delivered through indirect representation. Payments may not be forwarded from one address to another.

(2) TANF payments, including but not limited to employment and training supportive services payments, are made directly to the participant, protective payee or vendor.

(3) The check may not be mailed to the grantee in care of a creditor or delivered through indirect representation.

(4) Payments may not be forwarded from one address to another.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.425 Tanf: Nonfinancial Assistance Payment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, 53-4-603, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2007 MAR p. 976, Eff. 7/6/07; AMD, 2007 MAR p. 1818, Eff. 11/9/07; REP, 2008 MAR p. 1154, Eff. 6/13/08.

Mont. Admin. R. 37.78.430 Tanf: Underpayments and Overpayments

(1) The department may recover the value of any TANF benefits paid to or on behalf of an assistance unit to which it was not entitled, regardless of whether the overpayment occurred due to an error by the department, a nonfraudulent action or omission by the TANF participant, or fraudulent action by the TANF participant.

(2) Recovery may be made from the filing unit which was overpaid, from any individual member of the assistance unit at the time when the overpayment occurred, or from any assistance unit which includes a person who was a member of the overpaid filing unit at the time when the overpayment occurred.

(3) Recovery of TANF cash assistance shall be made as follows:

(a) If an overpayment of benefits has occurred due to fraudulent action by a member of the filing unit, the sum which must be repaid is 125% of the amount of assistance to which the assistance unit was not entitled. Fraudulent action includes but is not limited to the making of an intentionally false statement or misrepresentation and the intentional withholding of information.

(b) If an overpayment of benefits has occurred due to department error or a nonfraudulent error by a member of the filing unit, the sum which may be recovered is 100% of the amount of assistance to which the assistance unit was not entitled.

(c) The department is entitled to recover an overpayment regardless of whether any or all of the members of the overpaid assistance unit are currently receiving assistance.

(i) In the case of an individual or assistance unit currently receiving assistance, the department may recover an overpayment by reducing the current cash assistance amount by 10% or $10 whichever is higher, and retaining the sum by which the cash assistance has been reduced to repay the overpayment. At the department's option, recovery may also be made by voluntary payments by a member of the overpaid assistance unit or any other legal means available to collect a debt, including the use of offset against any monies which the state of Montana owes or may owe to a member of the filing unit.

(ii) In the case of an individual or assistance unit currently receiving assistance, and the overpayment is due to the receipt of continued benefits pending a fair hearing regarding a sanction, which was ruled in favor of the department, the department may recover an overpayment by reducing the current cash assistance amount by 25% or $25 whichever is higher, and retaining the sum by which the cash assistance has been reduced to repay the overpayment. At the department's option, recovery may also be made by voluntary payments by a member of the overpaid assistance unit or any other legal means available to collect a debt, including the use of offset against any monies which the state of Montana owes or may owe to a member of the filing unit.

(iii) In the case of an individual or assistance unit currently receiving assistance, if the household was determined to have committed an Intentional Program Violation (IPV) the department may recover an overpayment by reducing the current cash assistance amount by 20% or $20, whichever is higher, and retaining the sum by which the cash assistance has been reduced to repay the overpayment. At the department's option, recovery may also be made by voluntary payments by a member of the overpaid assistance unit or any other legal means available to collect a debt, including the use of offset against any monies which the state of Montana owes or may owe to a member of the filing unit.

(iv) In the case of individuals who are not currently receiving assistance, recovery may be made by voluntary payments by a member of the overpaid assistance unit or any other legal means available to collect a debt, including the use of offset against any monies which the state of Montana owes or may owe to a member of the filing unit.

(4) When an assistance unit has been underpaid due to an error by the department or the participant or due to any other reason, the underpayment shall be corrected by issuing a supplemental payment in the amount by which the assistance unit was underpaid.

(a) For purposes of determining continued eligibility and amount of assistance, the additional amount paid to the assistance unit to correct an underpayment will not be considered as income or as a resource in the month it is paid nor in the following month.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-108, 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2007 MAR p. 976, Eff. 7/6/07; AMD, 2011 MAR p. 2827, Eff. 1/1/12.

Subchapter 37.78.5 TANF Cash Assistance: Program Violations and Sanctions

Mont. Admin. R. 37.78.505 Tanf: Tanf Cash Assistance; Intentional Program Violation and Disqualification Hearings

(1) An intentional program violation (IPV) is a willful action which consists of:

(a) a false or misleading statement or a misrepresentation, concealment, or withholding of facts; or

(b) any other action intended to mislead, misrepresent, conceal, or withhold facts.

(2) If a TANF participant appears to have committed an IPV as defined in (1), the department must initiate administrative disqualification hearing (ADH) procedures to determine if the person should be disqualified from receiving cash assistance.

(3) The individual subject to the ADH must be sent written notification and will be presented with the following:

(a) an explanation of the charges against the individual;

(b) the evidence which exists;

(d) the option to waive the right to an ADH by signing a written "waiver of right to administrative disqualification hearing"; and

(e) an explanation of the disqualification period and repayment obligation if the individual is found to have committed an IVP at an ADH or signs a waiver of the individual's right to an ADH.

(4) If the individual does not sign a waiver of the right to an ADH within ten days of the date of the written notification, ADH procedures shall be initiated and the individual alleged to have committed an IPV shall be sent a written notice of the hearing at least 30 days prior to the date of the hearing.

(a) The notice must contain:

(i) the date, time, and place of the hearing;

(ii) the charge(s) against the individual;

(iii) a summary of the evidence, and how and where the evidence can be examined;

(iv) a warning that the decision will be based solely on the information provided by the department if the individual fails to appear at the hearing;

(v) a statement that an individual who has received notice of the hearing but did not appear at the hearing shall have ten days from the date of the hearing to present good cause for the failure to appear in order to receive a new hearing;

(vi) a warning that a determination of intentional program violation will result in disqualification periods as set forth in (8)(b)(i) through (b)(iii) of this rule, and a statement of which penalty the department believes is applicable to the individual's case;

(vii) a listing of the individual's rights as set forth in (7) of this rule;

(viii) a statement that the hearing does not preclude the state or federal government from prosecuting the individual for the intentional program violation in a civil or criminal court action, or from collecting any over issuances;

(ix) if there is an individual or organization available which provides free legal representation, notice of the availability of that service; and

(x) notice of the individual's right to obtain a copy of the department's hearing procedures upon request.

(b) The hearing may be held if the notice is returned as undeliverable. However, if no proof of receipt of the notice is obtained, the hearing decision shall be set aside and a new hearing shall be held if the recipient claims good cause for failure to appear due to nonreceipt of the notice within 30 days after the date of written notice of the hearing decision and shows good cause as defined in ARM 37.78.508(4)(a) through (g)(i).

(5) If the participant or the participant's representative cannot be located or fails without good cause to appear at the hearing, the hearing shall be held, but the hearing officer must carefully consider the evidence and determine whether clear and convincing evidence exists that an intentional program violation was committed.

(a) The participant has 30 days as specified in (4)(b) to claim good cause for failure to appear based on nonreceipt of the notice. If the participant claims good cause for failure to appear based on any other cause or circumstance, the recipient must present the claim of good cause within five days of the date of the hearing.

(6) The ADH shall be conducted by an impartial individual appointed or employed by the department as a hearing officer who has not had previous involvement in the individual's case.

(7) An individual charged with an IPV has the right to:

(a) examine all documents and records to be used at the hearing at a reasonable time before the date of hearing as well as during the hearing;

(b) examine the contents of the individual's case file, provided that confidential information such as the name of persons who have anonymously disclosed information about the individual or information about a pending criminal investigation or action shall not be released to the individual and also cannot be offered into evidence at the hearing;

(8) After the ADH, the hearing officer shall issue a written decision to the participant and the department no later than 90 days after written notice is given to the participant of the hearing, unless the hearing has been postponed, in which case the 90-day period shall be extended for as many days as the hearing was postponed. If the written decision is adverse to the participant the decision will notify the participant of the right to appeal to the Board of Public Assistance.

(a) The participant is entitled to one postponement of the hearing if the request for postponement is made at least ten days in advance of the scheduled date of hearing. However, the hearing may not be postponed for more than a total of 30 days.

(b) The department may limit the number of postponements to one.

(9) If the hearing officer determines after an ADH has been held that the individual committed an IPV, the department must provide the individual with a written notice of disqualification prior to the commencement of the disqualification period. The notice must contain the following information:

(a) notice of the decision and the reason for the decision;

(b) the date the disqualification shall take effect; and

(10) If it is determined through an ADH that an individual committed an IPV or if the individual alleged to have committed an IPV signs a waiver of right to ADH, the period of disqualification shall be:

(a) for IPVs involving misrepresentation of the individual's residence to obtain TANF cash assistance benefits in two or more states simultaneously, ten years;

(b) for all other types of IPVs:

(i) 12 months for the first violation;

(ii) 24 months for the second violation; and

(iii) permanently for the third violation.

(11) Disqualification shall begin the first month which follows the date the individual receives written notice of disqualification. Once a disqualification has been imposed, the period of disqualification must continue uninterrupted until completed regardless of the eligibility of the disqualified individual's household.

(12) The determination by the hearing officer that an IPV has occurred cannot be reversed by a subsequent fair hearing decision relating to the same or a similar issue.

(13) During the disqualification period, the income and resources of the disqualified individual shall be counted in their entirety, but the disqualified individual shall not be included as a member of the assistance unit in determining the size of the assistance unit.

(14) During the disqualification period, the disqualified individual shall lose his or her portion of the monthly cash payment and/or any other TANF Cash Assistance benefits.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2011 MAR p. 2827, Eff. 1/1/12.

Mont. Admin. R. 37.78.506 Tanf: Tanf Cash Assistance; Sanctions

(1) If any member of the assistance unit fails or refuses without good cause as defined in ARM 37.78.508 to comply with an allowable work activity as defined in (8), or to provide verification and/or documentation of participation in the activities, a sanction will be imposed on the individual. The first sanction will result in the reduction of the monthly TANF Cash Assistance payment by an amount equal to one person's share of the payment for one month. The second sanction will result in case closure and the imposition of a one month ineligibility period against all individuals who are considered to be a TANF recipient in the household at the time of the sanction, all individuals who were required filing unit members at the time of the sanction or individuals who enter the household during the ineligibility period and who would have been a required filing unit member at the time of sanction. The third sanction will result in case closure and the imposition of a three month ineligibility period against all individuals who are considered to be a TANF recipient in the household at the time of the sanction, all individuals who were required filing unit members at the time of the sanction, or individuals who enter the household during the ineligibility period and who would have been a required filing unit member at the time of sanction. The fourth and subsequent sanctions will result in a six months ineligibility period against all individuals who are considered to be a TANF recipient in the household at the time of the sanction, all individuals who were required filing unit members at the time of the sanction, or individuals who enter the household during the ineligibility period and who would have been a required filing unit member at the time of sanction. The ineligibility period will follow the required filing unit members or individual(s) even if they move to another household and apply for benefits as part of that household, with the following exceptions:

(a) minor children who are removed from the household by Child and Family Services and who are determined eligible for child only TANF in another household; or

(b) minor children who are determined eligible for child only TANF in another household. This rule does not apply to households who are receiving TANF extended benefits as defined in ARM 37.78.202. The imposition of a sanction ends the currently negotiated FIA/WoRC Employability Plan the last day of the penalty month. A sanction is considered imposed even if a fair hearing is requested and continued benefits are issued.

(2) During the penalty period for the first sanction, the income and resources of a sanctioned individual will continue to be considered in determining eligibility and grant amount for the assistance unit.

(3) For TANF Cash Assistance program participants, the penalty period for the first sanction will count toward the time limits provided in ARM 37.78.201.

(4) A sanctioned individual who is required to negotiate and comply with a FIA/WoRC Employability Plan (FIA/EP) during the sanction penalty month must negotiate a FIA/EP, prior to the reduced benefits being issued to the household. These individuals are outlined in ARM 37.78.216. These individuals are outlined in ARM 37.78.216.

(5) A sanctioned individual who is not required to negotiate and comply with a FIA/EP during the sanction penalty month must negotiate and sign a new FIA/EP prior to the end of the sanction penalty period for the first sanction or the household's TANF cash assistance will terminate at the end of the sanction penalty period.

(6) The food stamp allotment for a sanctioned individual's household will not increase as a result of cash assistance sanctioning.

(7) During the penalty period, child care assistance will continue if:

(a) child care is necessary to allow the TANF Cash Assistance participant to perform allowable work activities, as defined in (8), which are required by the FIA/WoRC Employability Plan (FIA/EP); and

(b) the sanctioned individual participates in specified allowable work activities throughout the penalty period. If the sanctioned individual fails to comply with any allowable work activity during the penalty period, child care assistance will be discontinued and will not be reinstated during the penalty period even if the sanctioned individual begins to comply or participate.

(8) "Allowable work activities", as specified in (7)(a), means activities specified on the FIA/WoRC Employability Plan or in the tribal NEW plan which are directly intended to promote economic self-sufficiency. These allowable work activities are defined in ARM 37.78.103 and 37.78.807.

(9) If a sanctioned individual requests a hearing to challenge the sanction and receives continued benefits pending the hearing, the sanction will not be imposed until a final decision is obtained. If a final decision upholding the sanction is obtained, the assistance received during the penalty period pending the fair hearing will be considered an overpayment.

(10) If an individual who has been sanctioned twice applies for TANF cash assistance, that individual is required to complete an intensive case management meeting within 30 days of application for TANF, or the case will be denied for failing an eligibility requirement as outlined in ARM 37.78.206(3)(o).

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, 53-4-608, 53-4-717, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 952, Eff. 3/29/02; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2007 MAR p. 1818, Eff. 11/9/07; AMD, 2008 MAR p. 2501, Eff. 1/1/09; AMD, 2009 MAR p. 1020, Eff. 7/1/09.

Mont. Admin. R. 37.78.507 Tanf: Reporting Requirements

(1) All applicants for or participants in TANF Cash Assistance must report any change of address and any change in income, resources, household composition or other circumstances which may affect eligibility or benefit amount to the eligibility case manager as soon as possible, but in any event within ten calendar days after the applicant or participant has knowledge of the change.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, 53-4-601, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.508 Tanf: Tanf Cash Assistance; Good Cause

(1) A TANF Cash Assistance participant's failure to comply with employment and training activities, failure to comply with any requirement under a Family Investment Agreement/WoRC Employability Plan (FIA/EP), including providing verification of participation in employment and training activities outlined in the FIA/EP, or failure to accept and/or maintain employment shall not result in an adverse action, including sanctions, if good cause exists for the failure to comply or for the participant's actions. A TANF Cash Assistance participant's failure to provide financial or nonfinancial verification shall not result in an adverse action, including denial or closure of TANF benefits, if good cause exists for the participant's actions.

(2) The participant shall be given the opportunity to document good cause for failing to comply by providing and verifying information to the case manager regarding the alleged noncompliance and the reasons for the alleged failure to comply. If the information provided is not sufficient to prove good cause and it is determined the participant has failed to prove good cause for the noncompliance, appropriate adverse action will be taken, including the imposition of a sanction in accordance with ARM 37.78.506 if appropriate.

(3) Good cause for failure to complete employment and training activities or comply with FIA/EP activities is limited to the following verified circumstances:

(a) temporary severe illness or incapacity of the participant for the duration of the illness or incapacity;

(b) temporary severe illness or incapacity of another household member sufficiently serious to require the presence of the participant for the duration of the illness or incapacity;

(d) temporary inability to obtain necessary child care, through no fault of the participant;

(e) adverse weather conditions which make travel impossible or unreasonably dangerous;

(f) temporary lack of transportation in a case where the participant cannot reasonably be expected to walk or bicycle because of the distance or the participant's health or physical limitations;

(i) Transportation is considered to be available if the participant has the use of a private vehicle, has access to public transportation, or can ride with someone else, provided that a participant will not be required to accept a ride under circumstances which a reasonable person would consider dangerous or unsuitable.

(g) the individual is unable to comply due to a current domestic violence situation.

(4) Good cause for failure to accept employment or for voluntarily quitting a job or reducing earned income from employment is limited to the following verified circumstances:

(a) The wage is less than the state minimum wage.

(b) Temporary lack of transportation in a case where the participant cannot reasonably be expected to walk or bicycle to work because of the distance or the participant's health or physical limitations.

(c) Participant is temporarily unable to obtain necessary child care during employment hours, through no fault of the participant.

(d) Working conditions are unsuitable because of an unreasonable degree of risk to health or safety or lack of workers' compensation coverage.

(e) The participant is age 60 or older.

(f) The participant has a physical or mental impairment which prevents the participant from accepting or maintaining this employment, as determined by a qualified medical professional involved in the treatment of the individual. A qualified medical professional is defined as an individual who is currently licensed in the state of Montana and is practicing within their field of expertise.

(g) A temporary severe illness or incapacity of the participant for the duration of the illness/incapacity only.

(h) A temporary severe illness or incapacity of another household member sufficiently serious to require the presence of the participant, for the duration of the illness/incapacity only.

(i) The participant lacks the necessary work-related skills for the employment and cannot acquire such skills in time to obtain or retain the employment.

(j) The participant is unable to participate in employment due to a current domestic violence situation.

(5) Good cause for failure to provide financial or nonfinancial verification to

determine or continue eligibility is limited to the following:

(a) verified circumstances beyond the participant's control for failing to provide citizenship verification, birth certificate, kinship documentation, income, or resources; and

(b) participant must be making a good faith effort to obtain the required verification.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601 MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2007 MAR p. 1818, Eff. 11/9/07; AMD, 2012 MAR p. 1263, Eff. 6/22/12.

Subchapter 37.78.6 TANF Emergency Assistance

Mont. Admin. R. 37.78.601 Emergency Assistance

(1) Financial assistance and/or services may be authorized to meet the emergency needs of a child under the age of 21, who lives with a specified relative as defined in ARM 37.78.207 or who is under age 18 and has lived with a specified relative within the six months prior to the request date in a place of residence maintained by the relative as the child's home, in the following circumstances:

(a) where the emergency arises from an unforeseen event which was beyond the household's control, and which has caused or threatens to cause the destitution of the child; or

(b) where the emergency arises out of a situation identified by the department as involving abuse or neglect of the child.

(2) For purposes of this rule, household means the child whose needs are to be met by the emergency assistance and all other persons who live with the child and are related to the child by blood or marriage, as specified in ARM 37.78.207.

(3) Emergency assistance will be provided only if:

(a) the child and all household members are U.S. citizens or qualified aliens as defined in ARM 37.78.220.

(b) the emergency needs did not arise because the child or the child's caretaker relative refused without good cause to accept or maintain employment or training for employment;

(i) good cause for failure to accept or maintain employment or training for employment shall be determined in accordance with the provisions of ARM 37.78.508.

(d) the household has exhausted all other means available to meet the emergency need, including but not limited to all liquid resources of the household and any benefits or services for which the household is eligible.

(4) Emergency assistance may be authorized once only in any period of 12 consecutive months.

(5) Emergency assistance shall be provided in the form of cash payments directly to the household or protective payee or to the vendor of a necessary item or service.

(6) Emergency assistance shall not be provided to pay for the following:

(a) penalties, fines, and taxes, including but not limited to personal and real property taxes;

(b) insurance - home, auto, or life;

(d) mortgages;

(e) reimbursements for expenses already paid or money loaned to the household to pay expenses;

(f) rental, security, and/or utility deposits or any rental payment required to be paid in advance before the household takes possession;

(g) bills for services already received, including medical bills;

(h) bills more than 30 days past due, excepting the two most recent months of past due rent or utility bills if an eviction notice or utility cut-off notice is imminent and the cause of the eviction or utility shut-off was an unforeseen event. For purposes of this rule, "imminent" means likely to happen without delay as a result of unanticipated circumstances.

(i) legal fees, including but not limited to court costs and attorney fees;

(j) the purchase of a vehicle; or

(k) any travel expense that would be payable by any source including but not limited to Medicaid or TANF Cash Assistance supportive services.

(7) Emergency assistance may be provided to pay for home based services, substitute care or foster care if the department identifies a need for services to prevent the child's removal, expedite the return of the child to the home, or prevent the need for protective services for the child.

(8) Information will be provided and referrals will be made to meet the needs of the household for counseling, shelter, child care, legal services, homemaker services, or other services.

(9) A pregnant woman who has no children living with her is not eligible to receive emergency assistance to meet her own needs or the needs of her unborn child unless:

(a) she is in the last trimester of her pregnancy; and

(b) an employee of the department who provides protective services to children has determined that she is in need of emergency assistance.

(10) Receipt of emergency assistance does not count as using any month of time-limited TANF Cash Assistance.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 199, Eff. 1/28/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.602 Emergency Assistance Procedures Followed in Determining Eligibility

(1) A household member or an employee or agent of the department may make a request for emergency assistance.

(2) Eligibility requirements for emergency assistance must be verified and documented.

(3) To receive emergency assistance, an applicant must show:

(a) that a child who is under the age of 21 is living with a relative specified in ARM 37.78.207 or is under age 18 and has lived with a specified relative within six months of the date of the request in a place of residence maintained by the relative as the child's home; and

(b) that all requirements set forth in ARM 37.78.601 have been met.

(4) Emergency assistance may be provided in addition to but not as a substitute for basic needs assistance, including but not limited to TANF Cash Assistance, Tribal TANF Family Assistance or Bureau of Indian Affairs (BIA) General Assistance.

(5) The completed request for emergency assistance shall be submitted to the local Office of Public Assistance. The applicant shall be notified by the department of the approval or reasons for denial of the request for emergency assistance.

(6) There are no residency requirements for emergency assistance. Nonresidents, migrants and transients who otherwise meet the requirements of this part are eligible for emergency assistance.

(7) The department shall make a determination of eligibility for emergency assistance within five days after receiving the application and all verification required to support the application.

(8) An expedited administrative review of a denial of a request for emergency assistance will be available to applicants who request in writing such an expedited review within five working days of the date of the denial. Such a review will be held within five working days of the date the request is received by the local office. Requests not made in accordance with these provisions will be processed according to the department's standard fair hearing procedures.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; AMD, 2000 MAR p. 199, Eff. 1/28/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.606 Tanf: Tanf Cash Assistance; Needy Pregnant Woman

(1) Cash assistance payments shall be provided to an otherwise eligible pregnant woman with no other children receiving assistance when the fact of pregnancy has been verified by a physician or the physician's designee, beginning the third month prior to the month in which the child is expected to be born.

History

Authorizing statute(s): 53-2-201, 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, MCA
History: NEW, 1998 MAR p. 3284, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Subchapter 37.78.8 TANF Employment and Training

Mont. Admin. R. 37.78.801 Tanf Cash Assistance Employment and Training: Purpose

(1) These rules govern TANF cash assistance employment and training for persons who are participants in the TANF Cash Assistance Program and/or required to negotiate and comply with a FIA/WoRC Employability Plan (FIA/EP) as a condition of eligibility in the TANF Cash Assistance Programs as defined in ARM 37.78.216.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2007 MAR p. 976, Eff. 7/6/07.

Mont. Admin. R. 37.78.806 Tanf Cash Assistance Employment and Training: Participation

(1) All participants in the TANF Cash Assistance Program or the TANF Cash Assistance Post-Employment Program who are required to negotiate and comply with their FIA/WoRC Employability Plan (FIA/EP) as outlined in ARM 37.78.216 are required to participate in allowable work activities as defined in ARM 37.78.103 and 37.78.807 and as provided in these rules. The above-named individuals must participate in allowable work activities as indicated in the FIA/EP if they are referred to the WoRC program for case management, or as indicated in their tribal NEW plan if they are referred to the tribal NEW program for case management.

(2) Some TANF allowable work activities may differ from community to community based on available resources. Participants may be placed in any activities available in their community.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2007 MAR p. 976, Eff. 7/6/07; AMD, 2008 MAR p. 1154, Eff. 6/13/08.

Mont. Admin. R. 37.78.807 Tanf Cash Assistance Allowable Work Activities

(1) Participants in TANF Cash Assistance, regardless of whether they are members of a single-parent or two-parent family, may, in accordance with their WoRC employability plan, subject to availability in their community, participate in the following allowable work activities:

(a) paid employment or self employment. The hours counted for self employment beyond the first two months are the gross wages divided by minimum wage;

(b) work experience placement (WEX) as defined at ARM 37.78.103;

(c) job search as defined at ARM 37.78.103. Job search is limited for each participant in each federal fiscal year by federal rule;

(d) community service as defined at ARM 37.78.103;

(e) vocational educational training as defined at ARM 37.78.103. Vocational educational training is limited in a lifetime for each participant by Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Section 407;

(f) job skills training directly related to employment as defined at ARM 37.78.103. Job skills training related to employment is limited to ten hours per week per individual for single parent households and five hours per week per individual for two parent households; and

(g) educational activities as defined at ARM 37.78.103;

(i) Educational activities are not limited for individuals under the age of 20 who do not have a high school diploma or GED.

(ii) Educational activities are limited for individuals 20 years of age or older to ten hours per week per individual for single parent households and five hours per week per individual for two parent households.

(2) In addition, a limited number of participants in TANF cash assistance households may participate in Parents as Scholars as defined in ARM 37.78.812.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2006 MAR p. 1720, Eff. 10/6/06; AMD, 2007 MAR p. 976, Eff. 7/6/07.

Mont. Admin. R. 37.78.810 Tanf Cash Assistance Employment and Training: Work Experience Placement (wex)

(1) "Work experience" means placement in a formal job site training experience that provides an individual with an opportunity to acquire the general skills, training, knowledge, and work habits necessary to obtain employment. All work experience placements have a detailed training plan. The main purpose of work experience is to improve the employability of those who cannot find unsubsidized employment. Other specific purposes of the work experience placement component are to:

(a) provide meaningful training for participants with little or no work history;

(b) provide an avenue for participants to earn a current recommendation; and

(2) After consulting with the participant and review of the WEX site goals and training plan, the department shall determine what work experience training site will best suit the individualized needs of the participant and how many hours per week the participant shall be required to participate. However, participants may not be required to participate more than 40 hours per week in work experience component activities.

(3) A participant's assignment to a work experience component site is subject to the following requirements:

(a) the site must be in compliance with all applicable federal, state, or local health and safety standards;

(b) nondisplacement should be established; and

(4) A participant shall not be assigned to a site until the department and the sponsoring agency have entered into an agreement.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2004 MAR p. 1482, Eff. 7/2/04; AMD, 2007 MAR p. 47, Eff. 1/12/07.

Mont. Admin. R. 37.78.811 Tanf Cash Assistance Employment and Training: Participation Requirements for Educational Activities

(1) A teen parent who is under 18, who has not completed high school or its equivalent or any other teen student referred to TANF employment and training must participate in educational activities unless the case manager designates or approves another activity.

(2) The determination of the appropriateness of educational activities is based on:

(a) results of the participant's available educational assessment;

(b) the participant's social and psychological history;

(d) the employment goals of the participant specified in the employability plan.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.812 Tanf: Participation Criteria Under Parents as Scholars Program

(1) The department will allow a maximum of 25 TANF recipients to continue postsecondary education activities under the Parents as Scholars Program (PAS).

(2) Twenty-five slots will be available statewide. Slots will be awarded through an application process and regional lottery as described in the Temporary Assistance for Needy Families (TANF) policy manual, section 701-3(a). Once a slot has been awarded to a participant, the participant will be entitled to retain the slot as long as the participant continues to meet the PAS requirements outlined in (3).

(3) A TANF recipient is eligible to participate in PAS if the recipient:

(a) meets all basic eligibility requirements for TANF;

(b) is a full-time post secondary education student enrolled in an approved education program at least 12 credit hours each semester or 30 credit hours per year, or is a full-time high school student, General Equivalency Diploma (GED) student, or vocational training student as defined by the institution in which the participant is enrolled;

(d) does not have a baccalaureate degree or a certification in a field for which a degree or certificate was previously awarded;

(e) is enrolled full time in an approved educational program in a unit of the Montana university system as provided in 20-25-201, MCA, or any other accredited college in Montana, or enrolled online with an accredited college whose credits are transferable in their entirety to an approved educational program in Montana, or is enrolled in an accredited high school or training program approved by the department by rule;

(f) maintains a cumulative GPA of 2.0 on a 4.0 scale and provides verification of current GPA at the end of each semester as well as verification of registration for classes for the next semester with a minimum of 12 credits or is making satisfactory progress in accordance with the requirements of the institution the participant is attending;

(g) has developed a comprehensive plan for the completion of the course of study and the attainment of a degree or certificate, regardless of the number of months remaining on the individual's TANF time clock;

(h) has successfully completed 12 months of Short Term Training while on TANF and is in good standing with the educational program, unless enrolled as a full-time student in high school or a GED program; and

(i) maintains monthly face-to-face contact with the WoRC case manager and school counselor throughout the PAS participation period to ensure ongoing case management, compliance with FIA/EP requirements and satisfactory progress in educational activities outlined in the comprehensive plan.

History

Authorizing statute(s): 53-4-209, 53-4-212, MCA
Implementing statute(s): 53-4-209, 53-4-211, 53-4-601, MCA
History: NEW, 2006 MAR p. 2415, Eff. 10/6/06; AMD, 2011 MAR p. 2827, Eff. 12/23/11.

Mont. Admin. R. 37.78.817 Tanf Cash Assistance Employment and Training: Two-Parent Families Participation and Other Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; REP, 2004 MAR p. 1482, Eff. 7/2/04.

Mont. Admin. R. 37.78.825 Tanf Employment and Training: Post-Secondary Participation Criteria

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 1771, Eff. 6/28/02; REP, 2004 MAR p. 1482, Eff. 7/2/04.

Mont. Admin. R. 37.78.826 Tanf Cash Assistance Employment and Training: Requirements for Satisfactory Progress in Educational, Work, and Training Activities

(1) Satisfactory progress in educational activities must be made in accordance with the requirements of the institution the participant is attending.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2004 MAR p. 1482, Eff. 7/2/04.

Mont. Admin. R. 37.78.830 Tanf Employment and Training: Job Search

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; REP, 2004 MAR p. 1482, Eff. 7/2/04.

Mont. Admin. R. 37.78.831 Faim Employment and Training: on-the-Job Training (ojt)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; REP, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.832 Tanf Cash Assistance Employment and Training: Supportive Services

(1) Dependent upon available funding, money may be available to pay expenses that are, or may be, incurred in a benefit month, by a TANF cash assistance participant to comply with family investment agreement activities.

(2) Supportive services funds may not be used to pay for:

(a) any medical service or item; or

(b) fines of any type, including traffic, criminal, and library fines.

(3) Supportive services payments may be provided as appropriate by the case manager.

(4) Supportive services may be provided in the form of voucher payments.

(5) Supportive services may be provided only if they are necessary to comply with the family investment agreement or are necessary for the participant to accept or maintain employment.

(6) Supportive services will not be made if similar services are available through other programs.

(7) Supportive service payments will not exceed $1,250 per household per state fiscal year.

(8) Each participant is expected to cost share between 5% and 15% in expenses. This cost share can be through an actual outlay of cash or an in-kind contribution. Each community advisory council establishes guidelines for determining exceptions to the limits and cost share requirement.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; AMD, 2000 MAR p. 746, Eff. 3/17/00; TRANS, from SRS, 2000 MAR p. 3414; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2006 MAR p. 2415, Eff. 10/6/06.

Mont. Admin. R. 37.78.833 Tanf Cash Assistance Post-Employment Program

(1) Households who are losing eligibility for TANF cash assistance due to the receipt of new or increased earned income may be eligible for no more than three months of assistance under the TANF Cash Assistance Post-Employment Program if:

(a) the household is losing TANF cash assistance eligibility due to new or increased earnings from employment of an individual who is currently receiving TANF cash assistance and the new or increased earned income was:

(i) reported within ten calendar days of the participant's knowledge of the change;

(ii) verified within ten calendar days from the request for verification;

(b) no adult household member who is receiving TANF cash assistance benefits (coded "IN") or who has been disqualified (coded "DQ") has received TANF cash assistance post-employment benefits in the prior 12 months;

(d) the household is not currently receiving TANF cash assistance extended benefits; and

(e) the household meets all financial and nonfinancial eligibility for the TANF Cash Assistance Program including negotiating a Family Investment Agreement/Employability Plan (FIA/EP) as outlined in ARM 37.78.806 and 37.78.216.

(2) Earned income of the assistance unit is disregarded under the TANF Cash Assistance Post-Employment Program as outlined in ARM 37.78.406.

(3) All other income of the assistance unit is treated as outlined in ARM 37.78.402, 37.78.406, and 37.78.416.

(4) The Post-Employment Program is a time-limited program. Households that are eligible for this program may receive up to three months of benefits. Payment standards for the Post-Employment Program are outlined in ARM 37.78.420. For each month of assistance provided under the Post-Employment Program, the time clock of the individuals receiving assistance will increment as outlined in ARM 37.78.201. However, households may not exceed their 60-month time clock by receipt of a Post-Employment benefit.

(5) Households receiving benefits under the Post-Employment Program are considered TANF recipients and are therefore eligible to receive TANF child care assistance in order to participate in the allowable work activities as negotiated in their FIA/EP.

(6) Households receiving benefits under the Post-Employment Program are considered TANF recipients and are eligible to receive TANF supportive service payments as outlined in ARM 37.78.832.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-4-211, MCA
History: NEW, 2008 MAR p. 1154, Eff. 6/13/08; AMD, 2008 MAR p. 2501, Eff. 1/1/09.

Mont. Admin. R. 37.78.836 Faim Employment and Training: Good Cause

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; REP, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.837 Faim Employment and Training: Sanctions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 3414; REP, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.78.838 Faim Employment and Training: Fair Hearing Procedure

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA
History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; AMD, 2000 MAR p. 1653, Eff. 6/30/00; TRANS, from SRS, 2000 MAR p. 3414; REP, 2003 MAR p. 15, Eff. 1/17/03.

Authorizing statute(s): 53-2-201, 53-2-901, MCA
Implementing statute(s): 53-2-901, MCA
History: NEW, 1996 MAR p. 284, Eff. 1/26/96; TRANS, from SRS, 2000 MAR p. 3414; REP, 2022 MAR p. 1673, Eff. 8/6/22.

Chapter 37.79 Healthy Montana Kids (hmk)

Subchapter 37.79.1 General Provisions

Mont. Admin. R. 37.79.101 Healthy Montana Kids (hmk) Plan

(1) The rules in this chapter implement the Healthy Montana Kids Plan to provide comprehensive health care coverage to Montana residents who are 18 years of age or younger residing in households with a combined family income at or below 250% of the federal poverty level (FPL). There is no resource test, as that term is used in 53-6-113 and 53-6-131, MCA, to qualify to participate in the Healthy Montana Kids Plan.

(2) The Healthy Montana Kids Plan has two health care coverage groups, Healthy Montana Kids (HMK) and Healthy Montana Kids Plus (HMK Plus). The coverage group an applicant is eligible for is determined by the combined family income.

(a) Qualified residents residing in households with income at or below 250% of the FPL but greater than 133% of the FPL qualify for the HMK coverage group. The HMK coverage group is a public benefit program administered by the department through a third party administrator. HMK enrollees have health care coverage to the extent described in this chapter. HMK providers are members of a provider network reimbursed at rates agreed to by contract. The provisions of this chapter apply to HMK enrollees. The provisions of 42 USC § 139d(r)(5) regarding services provided for early and periodic screening, diagnosis and treatment (EPSDT) purposes do not apply to the HMK coverage group.

(b) Qualified residents residing in households with income at or below 133% of the FPL qualify for the HMK Plus coverage group. The HMK Plus coverage group is the term used to identify the Montana Medicaid program for Montana residents 18 years of age or younger. HMK Plus enrollees have health care coverage to the extent provided by Montana Medicaid. HMK Plus providers are reimbursed at Montana Medicaid rates. The provisions of this chapter and Title 37, chapters 82, 83, 85, 86, and 88 apply to HMK Plus.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, 53-4-1110, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.102 Definitions

As used in this subchapter, unless expressly provided otherwise, the following definitions apply:

(1) "Advanced practice registered nurse (APRN)" means a registered professional nurse who has completed educational requirements related to the nurse's specific practice role, in addition to basic nursing education, as specified by the Board of Nursing in ARM 24.159.1414.

(2) "Ambulance services" means all mileage, services, procedures, and supplies provided by a licensed ambulance provider.

(3) "Applicant" means an individual under the age of 19 years who applied for the HMK Plan benefits or whose parent or guardian applied for the HMK Plan benefits on the individual's behalf.

(4) "Benefits" means the services an enrollee is eligible to receive. The HMK coverage group benefits are stated in its Evidence of Coverage. All benefits are provided to an enrollee through the department.

(5) "Benefit year" means:

(a) for medical and mental health, the period from October 1 through September 30 for those enrolled in the HMK coverage group. If an individual is enrolled in the HMK coverage group after October 1, the benefit year is the period from the date of enrollment through the following September 30.

(b) for dental, the period from July 1 through June 30 for those enrolled in the HMK coverage group. If an individual is enrolled in the HMK coverage group after July 1, the benefit year is the period from the date of enrollment through the following June 30.

(6) "Children's Health Insurance Program (CHIP)" means the Children's Health Insurance Program described in this subchapter and administered by the department under Title 53, chapter 4, part 10, MCA and Title XXI of the Social Security Act.

(7) "Department" means the Montana Department of Public Health and Human Services.

(8) "Earned income" means payments received as compensation for work performed. Some examples are: bonus, wages, salaries, tips, commission, self-employment, military pay, and severance pay.

(9) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following:

(a) serious jeopardy to the health of the enrollee or the enrollee's unborn child;

(b) serious impairment of bodily function; or

(10) "Enrollee" means an individual who is eligible and enrolled in the HMK coverage group. The term "enrollee" and "member" are synonymous.

(11) "Enrollment partner" means an organization or individual approved by the department to assist in enrolling eligible children in the plan.

(12) "Eyeglasses" means corrective lens and/or frames prescribed by an ophthalmologist or by an optometrist to aid and improve vision.

(13) "Family span" means the 12 month period beginning the first day of the month after the department receives an application for HMK coverage group benefits and ending the last day of the 12th month. Although qualified for the HMK coverage group benefits, applicants placed on the waiting list may not be enrolled during the entire family span.

(14) "Federal poverty level (FPL)" means the poverty guidelines for 2013 for the 48 contiguous states and the District of Columbia as published under the "Annual Update on the HHS Poverty Guidelines" 78 Federal Register 16, pp 5182-5183, January 24, 2013.

(15) "Federally qualified health center (FQHC)" means an entity that is a federally qualified health center as defined in 42 USC 1396d(l)(2)(B) (2009 Supp.).

(16) "Guardian" means the custodial parent or a person granted legal guardianship of a child by court order, judgment, or decree.

(17) "Health coverage" means a program administered by the department or a disability insurance plan, referred to in 33-1-207(1)(b), MCA, that provides public health care coverage or private health insurance for children.

(18) "Healthy Montana Kids (HMK) Plan" means the two health care coverage groups, Healthy Montana Kids (HMK) and Healthy Montana Kids Plus (HMK Plus), which pay for covered health care services to qualified individuals until their 19th birthday. The HMK coverage group was formerly referred to as CHIP and the provisions of Title 53, chapter 4, part 10, MCA apply. The HMK Plus coverage group is also referred to as children's Medicaid and the provisions of Title 53, chapter 6, MCA apply.

(19) "Incarcerated" means living in a facility which would be termed a public institution under Medicaid regulations at 42 CFR 435.1009.

(20) "Income" or "family income" means the gross earned income, unearned income, and imputed income of the custodial parent. Regular, continuing, and intermittent sources of income will be annualized for purposes of determining the annual income level.

(21) "Initiative I-155" means the initiative passed by Montana voters in November, 2008, that enacted the HMK Plan Act.

(22) "Institution for mental disease (IMD)" means a facility which would be termed an institute for mental disease under Medicaid regulations at 42 CFR 435.1009.

(23) "Medically necessary" or "medically necessary covered services" means services and supplies which are necessary and appropriate for the diagnosis, prevention, or treatment of physical or mental conditions as described in this subchapter and that are not provided only as a convenience.

(24) "Member" means an individual who is eligible to receive HMK Plan benefits as determined by the department under this rule. An individual is not a member while on a waiting list or pending issuance of a hearing decision or during any period a hearing officer determines the individual was not eligible for the HMK coverage group benefits. The term "member" and "enrollee" are synonymous.

(25) "Mid-level practitioner" is defined at ARM 37.86.202.

(26) "Montana resident" means a U.S. citizen or qualified alien who declares himself or herself to be living in the state of Montana, including a migrant or other seasonal worker.

(27) "Outpatient prospective payment system (OPPS)" means the reimbursement method for federally qualified health centers (FQHCs) and Rural Health Centers (RHCs).

(28) "Outreach" means efforts which promote the Healthy Montana Kids Plan through a combination of traditional marketing methods, and social marketing. The department will develop and maintain an enrollment partner network to encourage, assist, and actively enroll children in the program.

(29) "Participating provider" means a health care professional or facility as defined at 33-36-103(19), MCA.

(30) "Presumptive eligibility (PE)" means a temporary period of HMK medical assistance not to exceed two consecutive calendar months in a 12-month period for uninsured children through the month of their 19th birthday, pending a decision of HMK Plan eligibility.

(31) "Qualified alien" means a person residing legally in the United States, as defined by federal immigration laws and regulations and in ARM 37.78.220.

(32) "Qualified entity (QE)" means a health care facility, individual, or other approved entity designated and trained by HMK to make a presumptive eligibility determination for a child on behalf of HMK.

(33) "Rural health clinic (RHC)" means a clinic determined by the secretary of the U.S. Department of Health and Human Service to meet the rural health clinic conditions of certification specified in 42 CFR, part 491, subpart A.

(34) "Serious emotional disturbance (SED)" means the criteria stated in ARM 37.87.303.

(35) "State employee" means a person, including the HMK applicant, employed on a permanent basis by the state of Montana.

(36) "Third party administrator (TPA)" means an entity with a certificate of registration to conduct business in Montana in accordance with 33-17-603, MCA, or an entity licensed as a health service corporation. The department may contract for TPA services including but not limited to claims processing, maintaining an adequate network of participating providers, coordination and continuation of care, health education, notices, quality assurance, reporting, case management services, and customer service.

(37) "Unearned income" means all payments received other than earned income. Some examples are: adoption subsidies, annuities, dividends, interest, social security benefits, disability, and unemployment insurance payments.

(38) "Waiting list" means a list of applicants who have been determined eligible for the HMK coverage group but who are not enrolled because funds are not available.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1103, 53-4-1104, 53-4-1105, 53-4-1108, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 1027, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2011 MAR p. 70, Eff. 1/1/11; AMD, 2011 MAR p. 1388, Eff. 7/29/11; AMD, 2013 MAR p. 214, Eff. 2/15/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1405, Eff. 7/1/14.

Mont. Admin. R. 37.79.106 Electronic Applications and Signatures

(1) The HMK Plan will accept electronic applications and signatures. Electronic signatures are allowed in compliance with the requirements of ARM Title 30, chapter 18, subchapters 106, 117, and 122 to the extent those provisions are not inconsistent with this subchapter.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.110 Process for Identifying and Approving Enrollment Partners

(1) The following entities are qualified to be enrollment partners:

(a) a licensed or certified health care provider;

(b) a school district;

(d) a government agency; and

(e) provider associations.

(2) The department will consider requests to act as an enrollment partner from other entities and approve requests on a case-by-case basis.

(3) A qualified entity becomes an enrollment partner by contacting the department and indicating an interest in becoming an enrollment partner. The department will notify the entity if it is accepted as an enrollment partner.

(4) The department will recruit, train, provide program materials, and provide ongoing technical assistance to HMK enrollment partners.

(5) Enrollment partners must attend and complete department-sponsored training. The training will address HMK policies and procedures, confidentiality requirements, step-by-step instructions on how to complete the HMK application, and details regarding acceptable documents for citizenship, identity, and income verification.

(6) Enrollment partners will distribute program materials and applications. They will provide assistance to families to complete the application and obtain required documentation. Enrollment partners will submit the completed application and documentation to the department. The department will conduct the eligibility determination process and enroll eligible children in the appropriate coverage group of the HMK Plan.

(7) The department will maintain a list of the names, addresses, and telephone numbers of its enrollment partners and publish the list on its web site.

(8) The department has the option of denying or discontinuing enrollment partner status.

History

Authorizing statute(s): 53-4-1105, MCA
Implementing statute(s): 53-4-1104, 53-4-1105, MCA
History: NEW, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.115 Active Enrollment Process

(1) The department will promote the HMK Plan through a combination of traditional marketing methods and social marketing. The department will develop and maintain an enrollment partner network to encourage, assist, and actively enroll children in the plan.

(2) An individual may apply for the HMK Plan coverage group, HMK, or HMK Plus at any time and, if qualified, will be enrolled in the appropriate program. The department will process applications based upon the date of receipt. The department will enroll eligible children in the appropriate HMK Plan group based upon the respective program guidelines. An application may be submitted to the HMK Plan office, or any county public assistance office, or an enrollment partner.

History

Authorizing statute(s): 53-4-1105, MCA
Implementing statute(s): 53-4-1104, 53-4-1105, MCA
History: NEW, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.117 Presumptive Eligibility

(1) A family applies for a period of presumptive eligibility (PE), defined as temporary enrollment in the HMK coverage group not to exceed two consecutive calendar months within a 12-month period, for all of their uninsured children less than 19 years of age.

(a) To apply for PE, a parent or guardian submits a PE application to a qualified entity (QE).

(i) The parent or guardian must complete the entire PE application and sign it as indicated.

(b) The QE makes a determination of PE based on self-declared information provided by the applicant on the PE application including family size, gross monthly income, citizenship, and residency.

(i) PE determinations are effective beginning the date a QE makes the determination through the earlier of:

(A) the last day of the month following the PE determination month; or

(B) the date the department makes an eligibility determination.

(ii) If the children are approved for PE, the QE provides the parent or guardian with an HMK Plan application and explains how to submit the application and all needed documentation to HMK.

(iii) If the child(ren) are determined ineligible for PE, the QE provides the parent or guardian with the specific reason for the PE denial.

(c) The parent or guardian is responsible for submitting a completed HMK application and all needed documentation to HMK no later than the last day of the month following the month of the PE determination.

(d) The department makes the HMK coverage group determination based on information provided on a completed HMK Plan application that includes documentation. If eligible, a child remains enrolled in the HMK Plan. If ineligible, the child is disenrolled.

(e) Presumptively eligible children receive the same benefits as all children in the HMK coverage group.

(f) Children may not have more than one PE period during a 12-month span. The 12-month span begins with the date a QE determines eligibility.

History

Authorizing statute(s): 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1004, 53-4-1102, 53-4-1103, 53-4-1104, 53-4-1105, 53-4-1108, MCA
History: NEW, 2011 MAR p. 70, Eff. 1/1/11.

Mont. Admin. R. 37.79.120 Movement Between Hmk and Hmk Plus

(1) The HMK Plan is available to all Montana residents who are 18 years of age or younger and live in households with a combined family income at or below 250% of the federal poverty level (FPL). The HMK Plan provides for two coverage groups, HMK and HMK Plus. The HMK coverage group is available to qualified residents who reside in households with a combined family income between 134% and 250% of the FPL. A waiting list may apply to this program. The HMK Plus coverage group is available to qualified residents who reside in households with a combined family income between 0 and 133% of the FPL.

(2) The HMK and HMK Plus coverage groups provide an eligible enrollee 12 months continuous coverage that begins on the first day of the month in which the application is received. ARM 37.79.503 states eligibility determination procedures for the HMK coverage group. ARM 37.82.204 states eligibility determination procedures for the HMK Plus coverage group.

History

Authorizing statute(s): 53-4-1105, MCA
Implementing statute(s): 53-4-1104, 53-4-1105, 53-4-1110, MCA
History: NEW, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.125 Point of Access

(1) The department developed a combined Healthy Montana Kids Plan application for the HMK and HMK Plus coverage groups.

(2) The department will accept and determine eligibility for all applications for children's health coverage provided by the HMK Plan. Applications may be submitted directly to the Healthy Montana Kids Plan office or any county office of public assistance (OPA) , or to an enrollment partner who will forward it to the Healthy Montana Kids Plan office. Department staff will coordinate eligibility determination activities to enroll eligible children in the appropriate HMK Plan coverage group.

History

Authorizing statute(s): 53-4-1105, MCA
Implementing statute(s): 53-4-1104, 53-4-1105, MCA
History: NEW, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.130 Transition

(1) On October 1, 2009, all children currently enrolled in the CHIP and the Medicaid children's programs will transition from CHIP and Medicaid to the HMK Plan.

(2) The second transition will take place when current CHIP enrollees from families with income between 100% and 133% of the FPL transition to the CHIP-funded Medicaid expansion program. The transition will occur at the time of annual reapplication during federal fiscal year 2010 (October 1, 2009 to September 30, 2010). Approximately 10,000 current CHIP enrollees will be affected by this transition. The staggered transition will occur throughout the year. A parent or guardian of an enrollee in the HMK coverage group may apply for the HMK Plus coverage at any time.

(a) For an eligible child in the HMK coverage group there is a 12-month family span.

History

Authorizing statute(s): 53-4-1105, MCA
Implementing statute(s): 53-4-1104, 53-4-1105, 53-4-1110, MCA
History: NEW, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.135 Prospective Payment System for Federally Qualified Health Center (fqhc) Reimbursement

(1) The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires states with separate or combined CHIP programs to pay federally qualified health centers (FQHCs) and rural health centers (RHCs) using the Medicaid outpatient prospective payment system (OPPS) as described in ARM 37.86.4413. The department adopts the Medicaid OPPS rate for children enrolled in the HMK coverage group.

History

Authorizing statute(s): 53-4-1105, MCA
Implementing statute(s): 53-4-1104, 53-4-1105, MCA
History: NEW, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 1539, Eff. 7/1/10.

Mont. Admin. R. 37.79.140 Outreach Efforts

(1) The department will promote the HMK Plan through a combination of traditional marketing methods, social marketing, the development and maintenance of an enrollment partner network and collaborative efforts with schools, advocacy groups, health care providers, and other community organizations to encourage, assist, and actively enroll children in the plan. All outreach will include the name HMK Plan on documents associated with the plan including, but not limited to advertising, brochures, applications, and membership cards.

History

Authorizing statute(s): 53-4-1105, MCA
Implementing statute(s): 53-4-1104, 53-4-1105, MCA
History: NEW, 2009 MAR p. 1673, Eff. 10/1/09.

Subchapter 37.79.2 Eligibility

Mont. Admin. R. 37.79.201 Eligibility

(1) An applicant may be eligible for covered services under the HMK coverage group if:

(a) the applicant is under 19 years of age, unless the applicant qualifies for postpartum continuous eligibility coverage as defined in ARM 37.82.102;

(b) the applicant's social security number is provided. Benefits will not be denied or delayed to an otherwise eligible applicant pending issuance of his or her social security number;

(c) the family of which the applicant is a member has annual family income, without regard to other family resources, at or below 261% of the federal poverty level (FPL);

(d) the applicant is a Montana resident;

(e) the applicant is a U.S. citizen or qualified alien as defined under federal statute;

(f) the applicant is not incarcerated;

(g) the applicant is not an inpatient in an institution for mental disease on the date of initial application or the date of any redetermination of eligibility; and

(h) the applicant does not have other creditable health insurance.

(2) An applicant who is eligible or potentially eligible for the HMK Plus coverage group as determined by the department is not eligible for the HMK coverage group.

(3) The department must verify an applicant's citizenship or qualified alien status.

(4) Family income must be verified to determine eligibility. The department will request documentation of income from the applicant and will access various electronic databases to verify income as needed.

(a) Family income may include one or more of the following:

(i) the income of both parents if the child resides with both parents;

(iii) if the parent with whom the child resides the majority of the year has remarried, the stepparent's income is imputed to the parent with whom the child resides the majority of the year;

(iv) the income of siblings under the age of 19 who live in the household is imputed to the parent with whom the child resides the majority of the year.

(b) Family income does not include:

(i) money received from assets drawn down such as withdrawals from a savings account;

(ii) gifts under the federal annual exclusion, loans, one-time insurance payments, or lump sum compensation for an injury;

(iii) the first $2,000 of an enrolled tribal member's per capita payment;

(iv) the first $2,000 of an enrolled tribal member's tribal land income;

(v) the interest earned on (4)(b)(iii) and (iv);

(vi) foster care income for any children; or

(vii) income of an individual with whom a child resides who has no legal obligation to support the child and does not claim the child as a dependent.

(5) Applicants eligible to receive services from the Indian Health Services (IHS) program administered by the United States Department of Health and Human Services are eligible for the HMK coverage group if they meet the criteria specified in this subchapter.

(6) Applicants who are losing HMK Plus coverage or who were denied HMK Plus coverage for a reason other than that the family withdrew their application or failed to comply with HMK Plus requirements are evaluated for HMK coverage group.

(7) Applicants and their parents or guardians must comply with the procedures specified by the department as necessary to obtain or access benefits.

(8) The HMK coverage group benefits do not start until the applicant is enrolled even though the applicant may have been determined eligible for the HMK coverage group prior to the date of enrollment.

(9) The HMK coverage group eligibility is redetermined within one year after the initial eligibility period, and annually thereafter. Prior eligibility for HMK does not guarantee continued eligibility or enrollment.

(10) The HMK coverage group eligibility and benefits are not an entitlement. If funding is insufficient, the department may reduce enrollment numbers or reduce eligibility to a lower percentage of the federal poverty level to limit the number of individuals who are eligible to participate.

(11) A determination of the HMK coverage group eligibility will be completed within 45 calendar days after receipt of a complete application.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 1027, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 1539, Eff. 7/1/10; AMD, 2010 MAR p. 2217, Eff. 10/1/10; AMD, 2013 MAR p. 214, Eff. 2/15/13; AMD, 2024 MAR p. 2021, Eff. 8/10/24.

Mont. Admin. R. 37.79.202 Nonqualifying Applicants

(1) Applicants determined by the department to be eligible for the HMK Plus coverage group are eligible to receive the HMK Plus coverage group benefits but not eligible to receive the HMK coverage group benefits.

(2) Applicants who are patients in an institution for mental diseases on the date of initial application or any redetermination of eligibility are not eligible for the HMK coverage group (42 CFR 457.310).

(3) Applicants who are incarcerated cannot be enrolled in the HMK coverage group.

(4) Applicants who are not eligible for HMK coverage group benefits because their family income exceeds the HMK coverage group income guideline for the family size will be referred to other health care programs for children, as appropriate.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10.

Mont. Admin. R. 37.79.206 Eligibility Redetermination, Notice of Changes

(1) Eligibility determinations will be effective for a period of 12 months unless one or more of the following changes occurs:

(a) the enrollee moves from the state of Montana;

(b) the enrollee moves, does not notify the department of the new address and the department is unable to locate the enrollee;

(d) the enrollee becomes an inmate of a public institution;

(e) the enrollee attains the age of 19 years;

(f) the enrollee dies; or

(g) the enrollee becomes eligible for HMK Plus.

(2) Parents or guardians must give notice within 30 days when the family moves or another change specified in (1) occurs.

(3) A prepopulated HMK renewal application with household composition and income information is mailed to each family a month prior to the end of the existing family span. If there are changes to household composition, annual income, or health insurance coverage the family must complete, sign, date, and return the renewal application by a specified date or benefits will terminate. If there are no changes to household composition, annual income, or health insurance coverage the family is not required to respond or fill out the renewal application and the children are redetermined as eligible and are enrolled in the program for a new 12-month span. If enrollment ends, a new application may be completed and, if the children are determined eligible, they may be placed on the waiting list if one exists.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.207 Termination of Eligibility and Guardian Liability

(1) The HMK coverage group eligibility terminates immediately upon:

(a) death of the enrollee; or

(b) incarceration of the enrollee.

(2) The HMK coverage group eligibility terminates at the end of the month the department becomes aware:

(a) the enrollee attains the age of 19 years;

(b) the enrollee is a beneficiary of other creditable health insurance;

(d) the enrollee wishes to disenroll;

(e) the enrollee moves out of Montana;

(f) the enrollee has moved without providing a new address and the department is unable to locate the enrollee; or

(g) information requested by the department to redetermine eligibility has not been received.

(3) Termination of eligibility, based on insufficient funding at the department may not be effective earlier than the end of the month notice of termination is given to the enrollee or the enrollee's parent or guardian. Disenrollment for provisions of (2), except for (2)(a), will be effective subject to ten-day notification per ARM 37.79.505.

(4) A parent or guardian is liable to the department and the department may collect from the parent or guardian the amount of actual payments to the TPA contractor or to providers for any benefits furnished to the enrollee because of an intentional misrepresentation or a failure to give notice of changes as required by this subchapter.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.208 Provisional Benefits, Determination of Eligibility, and Applications for Hmk

(1) Provisional HMK coverage group benefits may be extended to enrollees who would otherwise lose health care coverage while awaiting an HMK Plus determination. Provisional coverage may be extended to enrollees who:

(a) complete the HMK Plan renewal application process before their HMK coverage group benefits are scheduled to end;

(b) have been determined potentially eligible for HMK Plus coverage; and

(2) A determination of HMK Plan eligibility will be completed within 45 calendar days after receipt of a complete application.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.209 Eligibility Verification Reviews

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1004, MCA
History: NEW, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; REP, 2009 MAR p. 1673, Eff. 10/1/09.

Subchapter 37.79.3 Benefits

Mont. Admin. R. 37.79.301 Covered Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.302 Coverage Limitations

(1) There is no lifetime limit on the dollar value of benefits per enrollee.

(2) Pre-existing conditions of each enrollee are covered as of the effective date of enrollment if the condition would be otherwise covered.

(3) A newborn of an HMK coverage group enrollee shall have all medically necessary benefits covered by the HMK coverage group program for 31 days after the newborn's date of live birth. Coverage for the newborn shall begin the day of live birth, without regard to whether the newborn is hospitalized on the date of coverage.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10.

Mont. Admin. R. 37.79.303 Benefits Not Covered

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1005, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 1539, Eff. 7/1/10; AMD, 2010 MAR p. 2217, Eff. 10/1/10; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.304 Services Covered

(1) The department adopts and incorporates by reference the HMK Evidence of Coverage dated July 1, 2026, which is available on the department's web site at www.hmk.mt.gov.

(2) The HMK Evidence of Coverage describes the health care benefits available to an HMK coverage group enrollee if the service is medically necessary. Prior authorization may be required and copayments may apply.

History

Authorizing statute(s): 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1005, 53-4-1109, MCA
History: NEW, 2013 MAR p. 214, Eff. 2/15/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2013 MAR p. 1698, Eff. 10/1/13; AMD, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2015 MAR p. 762, Eff. 7/1/15; AMD, 2015 MAR p. 2292, Eff. 1/1/16; AMD, 2017 MAR p. 2286, Eff. 10/14/17; AMD, 2018 MAR p. 1609, Eff. 8/11/18; AMD, 2023 MAR p. 178, Eff. 2/25/23; AMD, 2024 MAR p. 2281, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2026-210, Eff. 7/25/26; AMD, 2026 MAR, Notice No. 2026-127, Eff. 9/26/26.

Mont. Admin. R. 37.79.307 Inpatient Hospital Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.308 Outpatient Hospital Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.309 Physician and Advanced Practice Registered Nurse Benefits, Limitations, and Exclusions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.312 Prescription Drug Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.313 Laboratory and Radiology Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.316 Mental Health Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 1027, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2010 MAR p. 1539, Eff. 7/1/10; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.317 Substance Use Disorder Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 1539, Eff. 7/1/10; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.321 Vision Benefits

(1) Vision benefits and medical eye care include:

(a) services for the medical treatment of diseases or injury to the eye;

(b) vision exams; and

(c) a dispensing fee for eyeglasses which are ordered from the department's contractor and provided by a licensed physician, opthamologist, optometrist or optician working within the scope of the profession.

History

Authorizing statute(s): Sec. 53-4-1009, MCA
Implementing statute(s): Sec. 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04.

Mont. Admin. R. 37.79.322 Eyeglass Benefits

(1) Eyeglasses shall be paid by the department through a single volume purchase contract.

(2) An enrollee is limited to one pair of eyeglasses per 365 day period unless additional pairs are necessary due to any of the following circumstances:

(a) cataract surgery;

(b) .50 diopter change in correction in sphere;

(d) .5 prism diopter change in vertical prism;

(e) .50 diopter change in the near reading power;

(f) a minimum of a 5 degree change in axis of any cylinder less than or equal to 3.00 diopters;

(g) a minimum of 3 degree change in axis of any cylinder greater than 3.00 diopters;

(h) any 1 prism diopter or more change in lateral prism; or

(i) the inability of the enrollee to wear bifocals because of a diagnosed medical condition.

(3) When the enrollee meets one or more of the conditions in (2) (a) through (2) (i) , the enrollee may be allowed two pairs of single vision eyeglasses per 365 day period.

(4) Contact lenses are not a covered benefit.

History

Authorizing statute(s): Sec. 53-4-1009, MCA
Implementing statute(s): Sec. 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 1027, Eff. 2/13/04.

Mont. Admin. R. 37.79.325 Audiology Benefits

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 1539, Eff. 7/1/10; REP, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.326 Dental Benefits

(1) Covered dental services are reimbursed at 85% of the billed charges. Providers may not balance bill the enrollee, parent, or guardian for the remaining 15% of the billed charges.

(2) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained in the American Dental Association Manual of Current Dental Terminology (CDT 2026).

(3) Effective July 1, 2026, only the dental procedures listed at http://dphhs.mt.gov/hmk are benefits of the HMK coverage group Dental Program.

(4) Providers must comply with all applicable state and federal statutes, rules and regulations, including the United States Code governing the HMK Plan and all applicable Montana statutes and rules governing licensure and certification.

(5) Providers must also comply with the requirements of ARM Title 37, chapter 85, subchapters 4 and 5 to the extent those provisions are not inconsistent with this subchapter.

(6) For purposes of applying the provisions of any Medicaid rule as required by this subchapter, references in the Medicaid rule to "Medicaid" or the "Montana Medicaid program" or similar references shall be deemed to apply to the HMK coverage group or the HMK Plus coverage group as the context permits.

History

Authorizing statute(s): 53-4-1004, 53-4-1005, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1005, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10; AMD, 2011 MAR p. 70, Eff. 1/1/11; AMD, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2015 MAR p. 2292, Eff. 1/1/16; AMD, 2017 MAR p. 1521, Eff. 9/9/17; AMD, 2018 MAR p. 1168, Eff. 7/1/18; AMD, 2019 MAR p. 546, Eff. 7/1/19; AMD, 2020 MAR p. 1531, Eff. 8/8/20; AMD, 2022 MAR p. 1077, Eff. 7/1/22; AMD, 2023 MAR p. 1025, Eff. 9/9/23; AMD, 2026 MAR, Notice No. 2026-127, Eff. 9/26/26.

Subchapter 37.79.5 Enrollment Provisions

Mont. Admin. R. 37.79.501 Cost Sharing Provisions

(1) Except as provided in (2) and (3), the parent or guardian of each HMK coverage group enrollee whose family income is greater than 100% of the federal poverty level must pay to the provider of service the following copayments not to exceed the cost of service:

(a) $25 per admission for inpatient hospital services including hospitalization for physical, mental, and substance abuse reasons;

(b) $5 per visit for emergency room services;

(c) $5 per visit for outpatient hospital visits including outpatient treatment for physical, mental, and substance abuse reasons; and

(d) $3 per visit for physician, APRN, PA, optometrist, audiologist, mental health professional, substance abuse counselor, or other covered health care provider services.

(2) No copayment will apply to:

(a) well baby or well child care, including age-appropriate immunizations;

(b) outpatient hospital visits for x-ray and laboratory services;

(d) families with at least one enrollee who is a Native American Indian or Native Alaskan;

(e) extended mental health services for children with a serious emotional disturbance; or

(f) pharmacy services.

(3) The total copayment for each family shall not exceed $215 per family per benefit year.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2013 MAR p. 214, Eff. 2/15/13; AMD, 2013 MAR p. 1698, Eff. 10/1/13.

Mont. Admin. R. 37.79.503 Enrollment

(1) The HMK coverage group will accept without restriction eligible applicants in the order in which they are received for enrollment until the maximum enrollment, at which time eligible applicants will be put on a waiting list and will be enrolled when spaces become available. Applicants come off the waiting list and are enrolled based on the date they were determined eligible.

(2) Except for a newborn child, a child's HMK enrollment begins the later of:

(a) the first day of the month an application is received so long as the child is determined to meet all eligibility criteria;

(b) the first day of the month the family reports a new child, who meets all HMK eligibility criteria, joined the family;

(d) the month funding is sufficient to enroll the applicant from the waiting list.

(3) A newborn will be enrolled effective:

(a) the date of birth when the child's birth is reported during the birth month;

(b) the date of birth when the birth is reported the following month, but within ten days of birth;

(d) the month funding is sufficient to enroll the applicant from the waiting list.

(4) The HMK coverage group will:

(a) provide each enrollee with a handbook of information about the program including a summary of benefits; and

(b) issue an appropriate identification card to each enrollee.

(5) For presumptively eligible children, enrollment begins the date the qualified entity (QE) determines eligibility and may not exceed two consecutive calendar months in a 12-month period.

(a) The QE will give the enrollee a copy of the signed presumptive eligibility (PE) determination to verify PE for service providers during the enrollment period.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1007, 53-4-1009, 53-4-1103, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2011 MAR p. 70, Eff. 1/1/11; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.504 Right to Choose Primary Care Provider

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; REP, 2008 MAR p. 49, Eff. 1/18/08.

Mont. Admin. R. 37.79.505 Disenrollment

(1) Participation in the HMK coverage group is voluntary and an enrollee may withdraw from the program at any time.

(a) HMK coverage group benefits may be terminated for good cause if the enrollee, parent, or guardian has violated rules adopted by the Montana Commissioner of Insurance for enrollment with an insurer.

(b) Good cause is defined as provided in Montana insurance law and rules and does not include an adverse change in health status.

(2) Disenrollment takes effect, at the earliest, the first day of the month after the department receives the request for disenrollment, but no later than the first day of the second calendar month after the request for disenrollment is received.

(a) The enrollee remains enrolled in the HMK coverage group and the HMK coverage group program is responsible for benefits covered under the contract until the effective date of disenrollment, which is the first day of a month.

(b) The department will disenroll a presumptively eligible child the earlier of:

(i) the last day of the month following the PE determination month; or

(ii) the date the department makes an eligibility determination.

(3) The department will disenroll an enrollee if the enrollee becomes ineligible.

(4) Notice of disenrollment will be mailed at least ten days prior to the time the proposed disenrollment or adverse action is to become effective.

(5) Notice is adequate if it includes:

(a) a statement of the proposed adverse action;

(b) the reason for the proposed adverse action;

(d) a statement of the claimant's right to a hearing;

(e) how to obtain a hearing;

(f) telephone number to call for additional information;

(g) the right to be represented by legal counsel, friend, relative, or other spokesperson;

(h) the availability of free legal assistance if such assistance is known to the department program manager involved in the denial of the claim;

(i) if applicable, whether or not benefits are to be continued and the liability of the claimant for benefits received pending hearing if the hearing decision is adverse; and

(j) any other information as specifically required by applicable law, including department rule.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1103, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2011 MAR p. 70, Eff. 1/1/11; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Subchapter 37.79.6 Services and Provider Requirements

Mont. Admin. R. 37.79.601 Contract for Services

(1) The department may contract as it determines appropriate and in conformity with state and federal procurement law for services to administer the HMK coverage group.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.602 Provision of Benefits

(1) The department may impose the following requirements in the provision of benefits:

(a) the use of certain types of providers to the extent allowed by law;

(b) prior authorization for benefits other than emergency services;

(d) denial of payment to a provider for benefits provided to an enrollee if the participation requirements in this rule are not met by the enrollee or the enrollee's parent, or guardian.

(2) An enrollee must use the HMK coverage group's TPA participating providers unless:

(a) the department authorizes a nonparticipating provider to provide a service; or

(b) the enrollee receives emergency services or emergency room screen.

(3) The TPA and participating providers must provide covered benefits as listed in this subchapter to enrollees in the same manner as those benefits are provided to any child who is not enrolled in the HMK Plan.

(4) The department will deny payment to any entity located outside of the United States (U.S.) for any items or services provided to an enrollee.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 48, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Mont. Admin. R. 37.79.605 Participating Providers

(1) The third party administrator must offer to federally qualified health centers (FQHCs), rural health clinics (RHCs), Title X family planning providers, Indian health services providers, tribal health providers, urban Indian centers, migrant health centers, and county public health departments terms and conditions that are at least as favorable as those offered to other providers.

(2) The department and the third party administrator will deny payment to a provider who is currently suspended or terminated by the Medicaid or the Medicare program in any state.

(3) Participating providers shall be licensed or certified in Montana or in the case of out-of-state providers, in the state in which they practice.

(4) Physicians, advanced practice registered nurses, and physician assistants shall either have admitting privileges to at least one general or critical shortage area hospital or shall have a mechanism in place to ensure hospitalization when appropriate.

(5) In addition to the cost sharing provisions outlined in ARM 37.79.501, participating providers may bill the enrollee, parent, or guardian for services provided to a HMK coverage group enrollee, which are not covered benefits.

(6) A third party administrator may not prohibit a participating provider from:

(a) discussing a treatment option with an enrollee, parent, or guardian; or

(b) advocating on behalf of an enrollee within the utilization review or grievance processes established by the third party administrator.

History

Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA
Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 1027, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09.

Mont. Admin. R. 37.79.606 Reimbursement of Third Party Administrator

(1) In consideration for all services rendered by a third party administrator under a contract with the department, the third party administrator will receive payment for services provided as agreed in the contract.

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08.

Mont. Admin. R. 37.79.607 Utilization Review and Quality Assurance

(1) The third party administrator shall have adequate staff and procedures to assure that health care provided to enrollees is medically necessary and appropriate.

(2) The third party administrator shall comply with and cooperate in any external quality review that may be implemented by the department or its designee. An external quality review may include participation in the design of the review, collection of data, and making data available to the department or its designee.

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08.

Subchapter 37.79.8 Hearing and Appeal Procedures

Mont. Admin. R. 37.79.801 Grievance and Appeal Procedures

(1) A third party administrator must have a written procedure, approved in writing by the department before implementation, for resolution of grievances or complaints brought by enrollees or their parents or guardians either individually or as a class. In a situation requiring urgent care or emergency care, the department may require the third party administrator to expedite resolution of a grievance within a time line established by the department.

(2) Except when the HMK coverage group eligibility has been denied, an enrollee, parent, or guardian must exhaust the third party administrator's grievance procedure before appeal of the matter may be made to the department.

(3) An applicant, parent, or guardian aggrieved by a denial, suspension, or termination of the HMK coverage group eligibility or an enrollee, parent, or guardian aggrieved by a final grievance decision of a third party administrator, including but not limited to a reduction or denial of benefits, may request a fair hearing in accordance with ARM 37.5.304, 37.5.307, 37.5.313, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(4) If a written request for hearing is not received by the department within 90 days after the date a notice of adverse action is mailed by the department or a final grievance decision is mailed by a third party administrator, the hearing officer may deny a hearing as provided in ARM 37.5.313.

(5) Continuation of HMK benefits during an appeal process will be applied as specified in ARM 37.5.316(3) through (15).

History

Authorizing statute(s): 53-4-1009, MCA
Implementing statute(s): 53-4-1003, MCA
History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10; AMD, 2013 MAR p. 214, Eff. 2/15/13.

Chapter 37.80 Child Care Assistance

Subchapter 37.80.1 General Requirements

Mont. Admin. R. 37.80.101 Purpose and General Limitations

(1) This chapter pertains to the Best Beginnings Program, which administers payment for child care services.

(2) Financial assistance may be available to pay a portion of a working parent's child care costs. Payment may only be made to:

(a) a licensed child care center;

(b) a registered group child care home;

(d) a provider of family, friend, or neighbor care as that term is defined at ARM 37.95.102; or

(e) a relative care provider.

(3) The Child Care Assistance Program will be administered in accordance with:

(a) the requirements of federal law governing the Child Care and Development Block Grant Act of 2014, codified at 42 USC 9858 et seq., and 45 CFR part 98, child care and development fund, adopted November 29, 2016; and

(b) the Montana Child Care Manual, dated June 1, 2020, adopted and incorporated by this reference. The manual contains the policies and procedures utilized in the implementation of the department's Child Care Assistance Program. A copy of the manual is available at each child care resource and referral agency; at the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson St., P.O. Box 202925, Helena, MT 59620-2925; and on the department's web site at www.childcare.mt.gov .

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-731, 53-2-201, 53-4-211, 53-4-601, 53-4-611, 53-4-612, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1997 MAR p. 578, Eff. 3/25/97; AMD, 1997 MAR p. 1920, Eff. 10/21/97; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1989, Eff. 5/31/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2006 MAR p. 2964, Eff. 12/8/06; AMD, 2008 MAR p. 174, Eff. 2/1/08; AMD, 2010 MAR p. 2216, Eff. 9/24/10; AMD, 2010 MAR p. 2743, Eff. 11/13/10; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2011 MAR p. 2295, Eff. 10/28/11; AMD, 2012 MAR p. 756, Eff. 1/27/12; AMD, 2012 MAR p. 1788, Eff. 9/7/12; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 590, Eff. 4/9/16; AMD, 2016 MAR p. 1711, Eff. 9/30/16; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2018 MAR p. 1283, Eff. 7/7/18; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.102 Definitions

As used in this chapter, the following definitions apply:

(1) "Authorization of services" means the span of time, number of hours per week, and schedule that an eligible child is approved for care at a particular provider's facility. In addition, it indicates the monthly payment amount that the family is approved to receive for the indicated child at the indicated facility. The authorization of services is used to create the authorization plan.

(2) "Authorization plan" means the document prepared by the department, or its agent, that states the amount of child care assistance to be paid and includes any additional information required by the department. This document is generated after the authorization of services has been created.

(3) "Child care" means care by a provider listed in ARM 37.80.101 for a child less than 13 years of age at the time of eligibility determination or a child with disabilities or special needs. The terms "child care" and "day care" have the same meaning and are used interchangeably in this subchapter.

(4) "Child care assistance" means a subsidy for child care that is paid to a child care provider on behalf of a parent or guardian.

(5) "Child care facility" means a place where a provider listed in ARM 37.80.101 is authorized under license or registration to provide child care.

(6) "Child care resource and referral agency (CCR&R agency)" or "resource and referral agency" means an agent of the department authorized to determine eligibility for benefits, process payment to providers, and carry out other functions as authorized by the department.

(7) "Child with disabilities" means a child with a disability as that term is used in 45 CFR Part 98.

(8) "Child with special needs" means a child who requires additional assistance because of an emotional or physical disability, a cognitive delay, or both that is verified by documentation from a medical professional.

(9) "Children from the same household" means children who are of the same sibling group.

(10) "Copayment" means the portion of child care expenses which the parent is responsible for paying in accordance with the sliding scale established in ARM 37.80.202.

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

(12) "Federal poverty guidelines (FPG)" or "Federal poverty level (FPL)" means the poverty guidelines published by the U.S. Department of Health and Human Services based on information compiled by the U.S. Bureau of the Census. Upon request, a copy of the guidelines is available from the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson St., P.O. Box 202952, Helena, MT 59620-2925.

(13) "Full-time child care" means care certified for over 30 hours per week on a regular basis.

(14) "Full-time field experience and class time" means 30 hours per week combined of field experience and class time accrued by a postsecondary education student.

(15) "Graduated eligibility" means graduated phaseout as that term is used in the Child Care and Development Block Grant Act of 2014 at 42 USC 9858c(c)(2)(N)(iv).

(16) "Household size" means the number of household members including the parents, as the term is defined in this chapter, and the children of the parents, but not including adults living in the household other than the parents, unless the income of such adults is counted in computing the household's monthly income under this chapter.

(17) "Infant/toddler" for payment purposes means a child from birth to through the end of the 35th month of age.

(18) "Intentional program violation (IPV)" means conduct by a parent or provider described in ARM 37.80.506.

(19) "Monthly income" means gross monthly income of the parent or parents residing with the child and the income of adults in the household who are included in the calculation of household size as provided in ARM 37.80.202. The income of a parent not residing with the child will be counted as monthly income under this chapter only in cases where such parent's income is available to support the household of the child. Any child support provided by a parent not residing with the child to the household of such child will be counted as monthly income, and such child support will be deemed to constitute the extent to which the nonresidential parent's income is available to the household. The following sources of income are the only sources that will not be counted in determining gross monthly income:

(a) educational loans, scholarships, and grants;

(b) earned income tax credit;

(d) independent living INC payments for youth;

(e) foster care support services;

(f) food stamp benefits;

(g) a minor's earned income, if attending high school or a GED-type program; and

(h) supplemental security income (SSI) payments.

(20) "Non-traditional hours of care" refers to the hours of care that fall outside of the traditional child care hours of 6 a.m. to 6 p.m. Monday through Friday.

(21) "Overpayment" means a payment of child care assistance to a parent or provider, by the department or its agent, that is more than the amount the parent or provider is properly authorized to receive by federal or state law. An overpayment may result from the intentional or unintentional action of a parent, guardian, provider, department, or department's agent.

(22) "Parent" or "parent or guardian" means:

(a) a biological or adoptive parent of a child;

(b) a foster parent;

(d) an individual acting in the place of a biological or adoptive parent, including a grandparent, stepparent, or other relative with whom the child lives; or

(e) an individual who is legally responsible for the child's welfare.

(23) "Part-time child care" means care authorized for 30 hours or under per week on a regular basis.

(24) "Preschool" means an educational program or school environment targeted to children at age four and up to kindergarten entry.

(25) "Preschool-age child" for payment purposes means a child from thirty-six months up to their sixth birthday.

(26) "Provider" means a licensee or registrant listed in ARM 37.80.101.

(27) "Provider Rate" means the amount of reimbursement the department will pay an enrolled provider for child care provided to an eligible, enrolled child.

(28) "Relative care" has the same meaning as "relative care" defined by the Child Care Licensing Program in ARM 37.95.102.

(29) "School-age child" for payment purposes means a child from six through the end of the 12th year of age.

(30) "Teen parent" means a parent who is attending high school, GED courses, or an equivalency program and has not yet attained the age of 20 years.

(31) "Training" means vocational or educational training meeting the requirements of this chapter.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 53-2-201, 53-4-211, 53-4-601, 53-4-611, 53-4-612, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1997 MAR p. 578, Eff. 3/25/97; AMD, 1997 MAR p. 1920, Eff. 10/21/97; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1989, Eff. 5/31/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2012 MAR p. 195, Eff. 1/27/12; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 1711, Eff. 9/30/16; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2018 MAR p. 1283, Eff. 7/7/18; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.103 Confidentiality

(1) Use and disclosure of information is allowed only for the following purposes:

(a) to administer child care assistance under this chapter;

(b) to determine eligibility and amount of assistance for any other needs-based federally funded public assistance program for low income persons;

(c) to report possible child abuse or neglect to the appropriate agency or authority or respond to requests for information from an appropriate agency or authority investigating possible child abuse or neglect;

(d) to assist the Child Support Services Division or any other agency or entity authorized to conduct child support enforcement activities;

(e) to provide the applicant or recipient's current address to a state or local law enforcement officer, if the officer documents that the person is a fugitive felon whose arrest is the responsibility of the officer; additionally, the officer must provide the name and social security number of the recipient by written request;

(f) to provide information necessary for emergency medical or other critical needs;

(g) to provide information relevant to a child care licensing investigation; and

(h) any other disclosure required by law.

(2) An applicant or recipient of child care assistance is entitled to information regarding the applicant or recipient's case upon request, except:

(a) when release of the information is prohibited by law; or

(b) when release of the information would impede law enforcement.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 53-2-211, MCA
History: NEW, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.80.104 Child Care Assistance Hearing Rights

(1) A parent who has applied for or is receiving child care assistance under this chapter and who is subject to any adverse action, as defined in ARM 37.5.304, by the department or the department's agent is entitled to a fair hearing in accordance with ARM 37.5.103.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-713, MCA
History: NEW, 2002 MAR p. 1553, Eff. 5/31/02.

Subchapter 37.80.2 Eligibility

Mont. Admin. R. 37.80.201 Nonfinancial Requirements for Eligibility and Priority for Assistance

(1) In addition to the income requirements of ARM 37.80.202, parents must work or attend school or vocational training to receive child care payments.

(a) With the exceptions in (2), a two parent household must work a total of 120 hours per month, but there is no minimum number of hours that each parent must work each month.

(b) A single parent must work a minimum of 60 hours each month or attend school or vocational training full-time. A single parent must be working a minimum of 40 hours each month if attending school or vocational training part-time.

(2) The monthly minimum hourly work requirement does not apply to:

(a) households receiving cash assistance funded by temporary assistance for needy families (TANF);

(b) households in which the parent is a teen parent, or both parents in a two-parent household are teen parents, attending high school or an equivalency program;

(d) households containing parents who are in a grace period, provided the parents:

(i) are actively seeking work;

(ii) have reported the change in circumstance in a timely manner in accordance with ARM 37.80.203; and

(iii) have been approved for a grace period;

(e) an individual parent with a severe disability who is not able to meet a minimum hourly work requirement and has a need for child care during work hours;

(f) a parent, in a two-parent household, who is severely disabled and unable to care for their child;

(g) parents who are homeless; and

(h) in unusual circumstances of verifiable medical, financial, and physical hardship, the Child Care Program manager or the chief of the Early Childhood Services Bureau may approve or continue eligibility.

(3) Child care assistance under this chapter for parents who are pursuing vocational training or education is subject to the following limitations and requirements:

(a) assistance is not available to parents seeking postsecondary education beyond the level of a bachelor's degree or its equivalent; and

(b) assistance is not available for education to a parent who has earned a degree within the past five years.

(4) If a parent of a child does not live with the child and is not paying child support under a child support order recognized by a Montana district court, the custodial parent must apply for and cooperate with child support services from the department's Child Support Services Division. The department determines cooperation with Child Support Services Division by maintaining an open case when a case can be established or by the parent providing all appropriate requested documentation to Child Support Services Division for them to open a child support case. A custodial parent who fails without good cause to apply for such services and to cooperate with the Child Support Services Division will be decertified for benefits under this chapter as of the date of such failure. Good cause is defined as specified in ARM 37.78.215.

(5) Due to limited funding for child care assistance, some households that meet all requirements for eligibility may not receive benefits. If there are insufficient funds to provide benefits to all eligible households, priority is as follows:

(a) a household receiving assistance funded by the TANF program when participating in employability activities that require child care;

(b) a household containing a child with special needs or a child with disabilities;

(c) a household headed by a teen parent when otherwise eligible for child care assistance under ARM 37.80.201 through 37.80.502;

(d) a household experiencing homelessness; and

(e) all other eligible non-TANF households.

(i) Non-TANF households are ranked by household income as a percentage of the Federal Poverty Guidelines (FPG). The household with the lowest percentage of income, relative to FPG, has the highest priority when funding becomes available.

(ii) If there are two or more Non-TANF households at the same percentage, the household whose application was received first has a higher priority.

(6) Under no circumstances may payment be made for child care provided by a parent or person acting in loco parentis of the child, even if such parent does not reside in the child's household. In addition, no payment under this chapter may be made for child care provided by any person who is included as a member of the same household as the child for purposes of determining eligibility for TANF cash assistance or child care assistance under this chapter.

(7) A household experiencing loss of work or cessation of attendance at a job training or education program may have child care benefits extended and the usual child care schedule continued for 90 calendar days or to the end of the 12 month eligibility period following the reported change, if the following conditions are met:

(a) the department has sufficient funds to provide extended child care benefits; and

(b) the household requests the extension within ten calendar days after the parent's last day of employment, job training, or education program.

(i) An unemployed parent or parents must actively seek new employment during the period of extended child care.

(8) Child care assistance is only available under this chapter for child care provided by:

(a) a licensed child care facility or registered provider under ARM 37.95.103 and ARM 37.95.106, excluding facilities licensed solely for drop-in, irregular, intermittent, and occasional care.

(9) During the hours school is in session, a licensed or registered child care provider is not eligible for child care assistance for a child six years of age or older on or before September 10 of the current year.

(10) A household experiencing homelessness may have child care benefits continued for 90 calendar days following the reported homeless status if the department has sufficient funds to provide extended child care benefits.

(11) A 12-month eligibility span is given for a Non-TANF or TANF family meeting all the eligibility requirements.

History

Authorizing statute(s): 40-4-234, 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 53-2-201, 53-4-211, 53-4-601, 53-4-611, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1997 MAR p. 578, Eff. 3/25/97; AMD, 1997 MAR p. 1920, Eff. 10/21/97; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 1999 MAR p. 2454, Eff. 10/22/99; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2002 MAR p. 3153, Eff. 11/15/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2008 MAR p. 174, Eff. 2/1/08; AMD, 2010 MAR p. 2743, Eff. 11/13/10; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2011 MAR p. 2295, Eff. 10/28/11; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 590, Eff. 4/9/16; AMD, 2016 MAR p. 1711, Eff. 9/30/16; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2018 MAR p. 1283, Eff. 7/7/18; AMD, 2020 MAR p. 966, Eff. 5/30/20; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.202 Financial Requirements for Eligibility; Payment for Child Care Services; Parent's Copayment

(1) Financial eligibility for child care assistance is based on a household's monthly income as defined in ARM 37.80.102. A household whose income is below 150% of the Federal Poverty Guideline (FPG) for a household of that size is eligible for child care assistance.

(2) At annual redetermination, a household not receiving temporary assistance for needy families (TANF), whose income exceeds 150% and is below 185% of the FPG for a household of its size is eligible for child care assistance under graduated eligibility. To qualify for graduated eligibility, the following apply:

(a) eligibility is given for a 12 month eligibility period; and

(b) all other non-TANF eligibility requirements must be met.

(3) A household that is not receiving TANF is presumed eligible to receive child care assistance for 30 calendar days while application information is verified.

(a) To qualify for presumptive eligibility, a household must:

(i) submit a complete application that states the household meets eligibility requirements;

(ii) authorize the release of information to the department; and

(iii) submit the name of the child care provider on the application sufficient to set up the authorization of services.

(b) An applicant who intentionally provides false information for the purpose of receiving child care assistance must repay the child care assistance and may be ineligible to participate in the program.

(4) A household with assets exceeding the threshold identified in 42 USC 9858n (4)(B) (2016) is not eligible for child care assistance.

(5) Parents eligible for assistance are responsible for paying a monthly copayment in the amount specified in the sliding fee scale table.

(a) In general, a household's copayment is a percentage of the household's gross monthly income, based on the household's gross monthly income as compared to the FPG for a household of that size. Generally, households with income which is a higher percentage of the FPG are required to pay a higher percentage of their gross monthly income as a copayment than households whose income is a smaller percentage of the FPG. All parents receiving TANF-funded cash assistance must pay the $10 minimum copayment amount as specified in the sliding fee scale, regardless of household size or income.

(b) In the event that the actual cost of child care for the month is less than the required copayment the parent is required to pay the actual cost of care rather than the specified copayment.

(c) Parents are solely responsible for paying the copayment to the child care provider. Parents who fail to make the required payment or make arrangements satisfactory to the provider are ineligible for child care assistance until the amount due has been paid or arrangements satisfactory to the provider have been made.

(d) Children in child care placements due to protective services provided by the department are not subject to a copayment.

(6) A household for purposes of determining eligibility and the parent's copayment, includes the following individuals:

(a) the child or children for whom child care is being provided;

(b) all persons who live in the same household as the child or children and who are the child's:

(i) parents or stepparents;

(ii) siblings, step-siblings, or half-siblings age 17 and younger;

(c) an adult who lives in the same household as the child or children and who is the child's legal guardian or who assumes all the responsibilities of the parent for the child; and

(d) parents residing outside of the child's home, provided the parents of the child are not separated or divorced.

(7) The parent may include or exclude as a household member any qualified person residing with the child. If the parent includes or excludes a person when eligibility is initially determined, he or she cannot subsequently choose a different option, unless the optional member leaves the household.

(8) The income of all persons counted in computing household size must be counted in the household's income.

(9) In determining a household's need for child care assistance, the work hours, school schedules, and ability to care for the child or children of each adult included in calculating household size are considered. The work hours and ability to care for the child or children of adults excluded in calculating household size are not considered.

(10) Persons providing child care services subsidized under this chapter are paid at the lesser of the provider's usual and customary rate or the rates specified in ARM 37.80.205. The portion of the total monthly payment that the department is required to pay is computed by subtracting the parent's monthly copayment from the total monthly payment due.

(11) Eligible households may receive child care assistance for each child in the household who meets the age requirement for child care contained in ARM 37.80.102 and whose care meets all other requirements of this chapter for payment.

(12) No child care assistance payments can be issued until an authorization plan has been created by the child care resource and referral agency.

(13) The child care authorization and corresponding authorization plan set limits for child care benefits. The authorization plan stays at the same level for the 12 month eligibility period and covers temporary changes defined in 45 CFR, 98.21(a)(2017).

(14) If an audit of the case shows that monies received fall under ARM 37.80.506(1)(a), (b), (c), and (d), a household that receives any amount of child care assistance to which the household was not entitled must repay all child care assistance to which the household was not entitled.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 53-2-201, 53-4-211, 53-4-212, 53-4-601, 53-4-611, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1993 MAR p. 541, Eff. 4/16/93; AMD, 1995 MAR p. 1325, Eff. 7/14/95; AMD, 1997 MAR p. 578, Eff. 3/25/97; AMD, 1997 MAR p. 1920, Eff. 10/21/97; TRANS & AMD, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 1999 MAR p. 1378, Eff. 6/18/99; AMD, 1999 MAR p. 2454, Eff. 10/22/99; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2002 MAR p. 2922, Eff. 10/18/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2006 MAR p. 2964, Eff. 12/8/06; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 590, Eff. 4/9/16; AMD, 2016 MAR p. 1711, Eff. 9/30/16; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.203 Requirement to Report Changes

(1) Applicants and recipients of child care assistance must report to the resource and referral agency administering their case any change in their child care provider within one business day of the change.

(2) Applicants and recipients of child care assistance must report by phone, email, written communication, or in person to the resource and referral agency administering their case any change in the following circumstances within ten calendar days from the date the change occurs:

(a) a change in work, training, or educational status;

(b) an increase in the household's monthly gross income above 85 percent of State Median Income (SMI); or

(3) Applicants and recipients of child care assistance may report any change to their circumstance at any time during the eligibility period.

(4) Changes that are required to be reported under this rule must be reported to the resource and referral agency administering the child care assistance case. A report to any other employee, contractor, or agent of the department does not satisfy the reporting requirements set forth in this rule.

(5) If an audit of the case shows that monies received fall under ARM 37.80.506(1)(a), (b), (c), and (d), a household that receives child care assistance to which the household was not entitled must repay the overpayment.

(6) When a circumstance change listed in (2) is reported to the child care resource and referral agency, the agency will follow-up with a written notification describing changes to the case.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, 53-2-108, 53-2-201, MCA
History: NEW, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2006 MAR p. 2964, Eff. 12/8/06; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 590, Eff. 4/9/16; AMD, 2018 MAR p. 457, Eff. 2/24/18.

Mont. Admin. R. 37.80.204 At-Home Infant Care

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 52-2-111, 52-2-704, 53-2-201, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, MCA
History: NEW, 2002 MAR p. 1553, Eff. 5/31/02; REP, 2003 MAR p. 1306, Eff. 7/1/03.

Mont. Admin. R. 37.80.205 Child Care Rates: Payment Requirements

(1) The department calculates provider rates based on market rate surveys required by the Child Care and Development Block Grant Act of 2014. A half-time day rate is calculated for five or less hours of care during a calendar day. A full-time day rate is calculated for more than five hours and up to 12 hours during a calendar day.

(2) Provider rates are listed on the Early Childhood Services Bureau website for each child care provider type.

(3) Child care authorization and corresponding authorization plans may authorize payment for extended care of more than 12 hours during a calendar day. When care is provided for more than 12 but less than 18 hours per day, the full-day rate multiplied by 1.25 will be paid. When the authorization and corresponding authorization plan specifies service exceeding 18 hours of care during a calendar day, the full-day rate multiplied by 1.5 will be paid.

(4) Providers are paid for actual attendance when the child is present if a child attends less than 85% of the authorized time listed on the authorization plan.

(5) Providers are paid the entire monthly amount listed on the authorization plan when a child attends at least 85% of the authorized time listed on the authorization plan.

(6) The provider rates in the Child Care Manual, section 1-4, are the maximum rates payable.

(7) The rate charged by a child care provider for children whose child care is paid for by the department cannot exceed the rate charged to private pay parents for the same service.

(8) The department has the discretion to adjust rates for children with special needs or disabilities.

(9) The department has the discretion to adjust rates for child care provided during non-traditional hours as defined in ARM 37.80.102.

(a) In order for an adjusted rate to be paid, the approved care must be provided for at least one hour between 6 p.m. to 6 a.m. Monday through Friday or after 6 p.m. Friday to 6 a.m. Monday.

(10) The department will only pay a fee for registering a child in a child care facility if the registration fee is charged to all who enroll in the facility.

(a) The payment will not exceed thirty dollars.

(b) The fee will be available to registered family, registered group, and licensed child care centers.

(11) When child care is provided in the child's home by a provider who does not live with the child, the state payment will be made to the parent. The parent is responsible to pay the provider, and failure to do so will result in the parent's ineligibility for child care assistance until the provider has been paid in full or the parent has made arrangements for payment which are satisfactory to the provider.

(12) Child care facilities must notify the child care resource and referral agency when a child is absent without explanation for five consecutive working days unless the child has been attached to a different provider. If the provider fails to notify the child care resource and referral agency when a child is absent without explanation for five consecutive working days, the department is not required to pay for any care from the date the child last attended the facility.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, MCA
History: NEW, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1989, Eff. 5/31/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2008 MAR p. 174, Eff. 2/1/08; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2012 MAR p. 195, Eff. 1/27/12; AMD, 2016 MAR p. 1711, Eff. 9/30/16; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2018 MAR p. 1283, Eff. 9/28/18; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.206 Absent Days

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, MCA
History: NEW, Eff. 4/5/76; AMD, 1985 MAR p. 945, Eff. 7/12/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1991 MAR p. 2261, Eff. 11/28/91; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 1999 MAR p. 2454, Eff. 10/22/99; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2008 MAR p. 174, Eff. 2/1/08; AMD, 2012 MAR p. 195, Eff. 1/27/12; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 1711, Eff. 9/30/16; AMD, 2018 MAR p. 1283, Eff. 7/7/18; REP, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.207 Best Beginnings Child Care Scholarship Preschool

(1) The Best Beginnings Child Care Scholarship will not reimburse child care services during preschool program hours at any of the following settings:

(a) public preschool settings, described in ARM 10.63.101;

(b) state funded preschool programs; or

(2) The Best Beginnings Child Care Scholarship will reimburse any licensed or registered child care provider for wraparound care, including before and after-school care, at the half-day rate.

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 52-2-713, 53-4-611, MCA
History: NEW, 2018 MAR p. 1283, Eff. 7/7/18.

Mont. Admin. R. 37.80.208 Care Provided in the Child's Home

(1) Child care assistance paid for care provided in a child's home must be approved by the department's Early Childhood Services Bureau.

(2) Subsidized care provided in a child's home can only be paid to approved Family, Friend, and Neighbor and relative care providers.

(3) One of the following criteria must be met to receive payment for subsidized care in a child's home:

(a) a child approved as a child with disabilities or a child with special needs;

(b) a child of a teen parent; or

History

Authorizing statute(s): 53-4-212, MCA
Implementing statute(s): 52-2-713, 53-4-611, MCA
History: NEW, 2018 MAR p. 1283, Eff. 7/7/18.

Subchapter 37.80.3 Provider Requirements

Mont. Admin. R. 37.80.301 Requirements for Child Care Facilities, Compliance with Existing Rules, Certification

(1) Child care facilities must be in compliance with the licensing and registration requirements ARM Title 37, chapter 95 to receive payment under this chapter. Loss of eligibility for funds under this chapter for failing to comply with child care facility licensing and registration requirements including group size and staff-to-child ratios, as well as program requirements, as stipulated in the Best Beginnings Child Care Scholarship Manual is in addition to other remedies available for such violations.

(2) The provider is responsible for informing parents who are receiving child care assistance under this chapter that the provider's license, or registration has been revoked or expired. The provider may not bill the household for payments denied by the department due to the provider's failure to comply with licensing, certification, or registration requirements.

(3) Child care providers must be certified or recognized by the department or its designated agent as eligible to receive payment under this chapter. All applicable forms must be completed and submitted for approval. Registered and licensed facilities are approved by the Child Care Licensing Program of the department's Quality Assurance Division. Facilities licensed or registered by other entities must be recognized by the Child Care Licensing Program of the department's Quality Assurance Division.

(4) A provider's eligibility to receive state payment under a state-assisted child care program may be terminated if:

(a) the provider willfully misrepresents services provided, as set out in ARM 37.80.316(4) or 37.80.502(6); or

(b) the provider refuses access to the child care setting and child records during business hours to the following personnel:

(i) employees or other agents of state or local government, investigating child care services, or child abuse or neglect;

(ii) child care resource and referral agency personnel; or

(iii) health, building, or fire officials investigating child care facility health and safety issues.

(5) All child care providers must maintain current sign-in/sign-out records for each child receiving child care assistance and utilize them as follows:

(a) Each time the child enters or leaves the provider's care, the parent or other individual authorized to deliver or pick up the child must initial or sign the sign-in/sign-out sheet. An electronic signature system may be used if it employs a unique and confidential identification process for individuals.

(b) Sign-in/sign-out records must indicate the child's name, the date, the hour, and the minute when the child enters and leaves the provider's care.

(c) The provider must make sign-in/sign-out records available to child care resource and referral agency staff and state and local government health, safety, or law enforcement representatives upon request.

(d) The provider must keep sign-in/sign-out records for five years beyond the date of attendance.

(e) Sign-in/sign-out records must be maintained on a daily, chronological basis that show the attendance of all children. If the provider maintains a sign-in/sign-out record by individual child or family, it does not meet the requirements of this rule.

(6) Providers must have a policy on preventing and reducing expulsion and suspension. The policy must include the following:

(a) reasons for expulsion;

(b) procedures for expulsion;

(d) the types of referrals the provider will make such as those to a community agency that could offer additional supports to the family.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1993 MAR p. 941, Eff. 7/1/93; AMD, 1997 MAR p. 578, Eff. 3/25/97; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2006 MAR p. 2964, Eff. 12/8/06; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 1711, Eff. 9/30/16; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2018 MAR p. 1283, Eff. 7/7/18.

Mont. Admin. R. 37.80.305 Legally Certified Providers: Introduction

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1997 MAR p. 578, Eff. 3/25/97; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2014 MAR p. 599, Eff. 3/28/14; REP, 2016 MAR p. 1711, Eff. 9/30/16.

Mont. Admin. R. 37.80.306 Legally Certified Providers: Certification Requirements and Procedures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1993 MAR p. 941, Eff. 7/1/93; AMD, 1994 MAR p. 958, Eff. 4/15/94; AMD, 1997 MAR p. 578, Eff. 3/25/97; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2012 MAR p. 195, Eff. 1/27/12; AMD, 2012 MAR p. 1788, Eff. 9/7/12; AMD, 2014 MAR p. 599, Eff. 3/28/14; REP, 2016 MAR p. 1711, Eff. 9/30/16.

Mont. Admin. R. 37.80.315 Rights and Responsibilities Agreement

(1) In addition to complying with all other certification requirements, providers must sign a rights and responsibilities agreement under this chapter, on the form provided by the department. Parents are provided a copy of the providers' rights and responsibilities.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1997 MAR p. 578, Eff. 3/25/97; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 1999 MAR p. 2454, Eff. 10/22/99; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2012 MAR p. 195, Eff. 1/27/12.

Mont. Admin. R. 37.80.316 Requirements and Procedures for Child Care Payments

(1) Except as provided in (2) and (3), the provider will receive payment for child care services when the care is provided outside the child's home.

(2) Payment will be made to the parent when a care giver, who does not live with the parent or child, provides child care in the child's home.

(3) Payment will be made to the provider when the provider participates in a tiered reimbursement program, as referenced in ARM 37.80.205(6). Tiered reimbursement programs are intended to benefit the higher quality child care provider.

(4) In the case of direct payment to the parents, the parents and/or the provider bear sole responsibility:

(a) for obtaining provider registration through ARM 37.95.103 prior to claiming payment for covered child care under this chapter; and

(b) for resolving disputes as to proper payment arising between the parent(s) and the provider.

(5) The provider must submit a claim for covered child care services on the billing form provided by the department. Except as provided in (4)(a), a completed billing form with all information and documentation necessary to process the claim must be received by the resource and referral agency of the department within 60 calendar days after the last day of the calendar month in which the service was provided. Timely filing of claims in accordance with the requirements of this rule is a prerequisite for payment. In addition:

(a) The claim must be for actual care provided by the provider designated on the child care authorization and corresponding authorization plan as defined in ARM 37.80.102 and subject to the limitations described in ARM 37.80.201(9). The provider may not bill for care subcontracted to another individual or facility.

(b) The claim must accurately reflect the child's time in and time out as indicated on the provider's sign-in/sign-out records.

(d) If the authorization and corresponding authorization plans are not completed until after the calendar month in which the child care is provided, the claim will be considered to be filed timely if a completed billing form with all information and documentation necessary to process the claim is received by the department or the entity designated by the department for this purpose within 60 days after the billing document is sent to the provider.

(e) If corrections or adjustments to a submitted claim are necessary, they must be received by the department or its designated entity within the 60 day period prescribed by this rule for timely filing of the claim.

(6) Once an invoice is submitted, invoices are processed within three business days by the child care resource and referral agency.

(7) In cases where payments are made directly to the parent, a parent who fails to pay the provider will be ineligible for further child care assistance until the provider has been paid in full or the parent has made arrangements for payment which are satisfactory to the provider.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-711, 52-2-713, MCA
History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1553, Eff. 5/31/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2018 MAR p. 1283; Eff. 7/7/18; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.317 Authorization of Services – Authorization Plans

(1) Child care assistance is provided for through an authorization of services and an authorization plan. The authorization of services and authorization plan include the following information:

(a) number of children authorized to receive child care assistance;

(b) number of hours per week authorized;

(d) name of the child care provider;

(e) amount of child care payment based on the number of hours per week authorized; and

(f) amount of monthly copayment that the parent must pay to the provider.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, MCA
History: NEW, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Subchapter 37.80.5 Termination of Services

Mont. Admin. R. 37.80.501 Termination of Child Care Assistance

(1) Child care assistance will be terminated if any of the following occurs:

(a) the household does not apply for redetermination;

(b) a parent has been given a grace period and does not meet the activity requirement or is not participating in the TANF funded case assistance program at the end of the grace period;

(c) the parent voluntarily makes a written request to the child care resource and referral agency worker that child care services be closed;

(d) a family moves outside of the state of Montana; or

(e) the child has had a span of more than five unexplained absences reported by the child care facility specified in the authorization and corresponding authorization plan and there is no indication that the child will be receiving care at that facility in the near future.

(2) When child care assistance is terminated due to the household's loss of eligibility, as specified in (1)(b), (c), (d), or (e), notice of termination must be sent to both the parent and the provider at least 15 calendar days prior to the effective date of termination, except for TANF cases in which a ten-calendar-day notice is required. No notice is required from the state when child care is terminated by the parent or provider, or for the other reasons specified in (1)(a).

(a) The notice sent to the parent must state the reason for the termination and must inform the parent of the right to a hearing as provided in ARM 37.80.104.

(b) The notice of termination sent to the provider must include the child's name, the parent's name, and the date of termination but must not disclose any confidential information about the parent or child.

(3) When the child care resource and referral agency denies an initial application for child care assistance, written notice must be sent to both the parent and the provider, but there is no requirement for advance notice of the denial.

(a) The notice to the parent shall include reasons for the denial and inform the parent of the right to a hearing as provided in ARM 37.80.104.

(b) The notice to the provider must include the child's name and the parent's name but must not disclose any confidential information about the parent or child.

(4) The department is obligated to the parent and/or the provider only to the extent specified in the authorization and corresponding authorization plan and the rules governing child care assistance. No agreement or arrangement between the parent and provider purporting to modify or terminate any provision of the authorization plan is binding on the department.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, MCA
History: NEW, Eff. 12/31/72; AMD, Eff. 4/5/76; AMD, 1981 MAR p. 1792, Eff. 12/18/81; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS & AMD, from DFS, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 1999 MAR p. 2454, Eff. 10/22/99; AMD, 2002 MAR p. 1989, Eff. 5/31/02; AMD, 2006 MAR p. 2964, Eff. 12/8/06; AMD, 2011 MAR p. 323, Eff. 3/11/11; AMD, 2018 MAR p. 457, Eff. 2/24/18; AMD, 2018 MAR p. 1283, Eff. 7/7/18; AMD, 2020 MAR p. 687, Eff. 6/1/20.

Mont. Admin. R. 37.80.502 Child Care Overpayment

(1) A child care provider or a parent who has reason to believe an overpayment or underpayment of child care assistance has occurred must notify the department within ten days.

(2) If an audit of the case shows monies received fall under ARM 37.80.506(1)(a), (b), (c), and (d), the department may recover the amount of any child care payment made to a child care provider or to a parent which is in excess of the amount to which the provider or parent was entitled.

(a) If an overpayment is due to an intentional program violation of the parent, the parent must repay the overpayment to the department.

(b) If an overpayment is due to any error, act, or omission of the provider, whether intentional or otherwise, the provider must repay the overpayment to the department.

(3) The parent must repay the overpayment to the department. Failure to be current on accounts will make the parent ineligible for child care assistance from the department.

(4) The provider must repay the overpayment to the department. Failure to be current on accounts will make the provider ineligible for child care assistance from the department.

(5) If an underpayment of child care payments occurs, the underpayment will be corrected by increasing the payment for the following month to cover the underpayment.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-713, MCA
History: NEW, 1998 MAR p. 3117, Eff. 11/20/98; AMD, 2002 MAR p. 1989, Eff. 5/31/02; AMD, 2003 MAR p. 1306, Eff. 7/1/03; AMD, 2005 MAR p. 1057, Eff. 7/1/05; AMD, 2012 MAR p. 195, Eff. 1/27/12; AMD, 2014 MAR p. 599, Eff. 3/28/14; AMD, 2016 MAR p. 590, Eff. 4/9/16; AMD, 2018 MAR p. 1283, Eff. 7/7/18.

Mont. Admin. R. 37.80.506 Intentional Program Violations

(1) An intentional program violation occurs when:

(a) a parent or guardian receives, or attempts to receive, child care assistance based on a false or misleading statement, misrepresentation, concealment, or withholding of relevant facts or information;

(b) a parent or guardian knowingly fails to comply with the requirements for receiving child care assistance;

(c) a provider receives, or attempts to receive, a child care assistance payment based on a false or misleading statement, misrepresentation, concealment, or withholding of relevant facts or information; or

(d) a parent, guardian, or provider knowingly fails to comply with the requirements of the Montana Child Care Act, this chapter, or ARM Title 37, chapter 95.

(2) The department will evaluate an intentional program violation on a case-by-case basis to determine whether to impose a sanction as provided in ARM 37.80.507.

(3) The department must impose sanctions for the following intentional program violations:

(a) providing false employment information, including concealing employment;

(b) providing false information regarding wages or other income;

(d) failing to disclose a criminal conviction as identified in ARM 37.80.306(3);

(e) claiming child care assistance for care provided by an ineligible provider;

(f) misrepresenting the amount of child care needed or used;

(g) falsifying sign-in/sign-out records; and

(h) attempts to undermine or circumvent program requirements designed to ensure child safety, including background checks, group sizes, and child-to-staff ratios.

(4) The department may sanction other intentional program violations based on the circumstances of the violation.

History

Authorizing statute(s): 52-2-704, 53-4-212 MCA
Implementing statute(s): 52-2-704, 52-2-713, MCA
History: NEW, 2014 MAR p. 599, Eff. 3/28/14.

Mont. Admin. R. 37.80.507 Intentional Program Violation Sanctions

(1) The department has the discretion, based on the circumstances of the violation, to determine the appropriate sanction for the first intentional program violation. The department may impose any of the following sanctions on a parent/guardian or provider for a first intentional program violation:

(a) issue the intentional program violation even if there is no overpayment due;

(b) require repayment of child care assistance payments related to the program violation; or

(c) require repayment of child care assistance payments related to the program violation and terminate the parent/guardian or provider, or both, from the Child Care Assistance Program.

(2) If a parent or guardian receives a second intentional program violation, the department will require the repayment of all child care assistance payments related to the violation and the parent will be terminated from the Child Care Assistance Program.

(3) If a provider receives a second intentional program violation, the department will require the repayment of all child care assistance payments related to the violation and may terminate the provider from the program, if appropriate.

(4) A notice of an intentional program violation is an adverse action of the department. The department will send timely notice of this adverse action, including fair hearing rights under ARM 37.80.104 and 37.5.103.

History

Authorizing statute(s): 52-2-704, 53-4-212 MCA
Implementing statute(s): 52-2-704, 52-2-713, MCA
History: NEW, 2014 MAR p. 599, Eff. 3/28/14.

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-704, 52-2-721, 53-4-212, MCA
History: NEW, 2005 MAR p. 1057, Eff. 7/1/05; REP, 2008 MAR p. 174, Eff. 2/1/08.

Chapter 37.81 Pharmacy Access Prescription Drug Benefit Program

Subchapter 37.81.1 General Provisions

Mont. Admin. R. 37.81.101 Big Sky Rx Program

(1) The rules in this chapter implement the Pharmacy Access Prescription Drug Benefit program established in 53-6-1004 , MCA. This program is referred to in these rules as the Big Sky Rx program.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06.

Mont. Admin. R. 37.81.104 Definitions

In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter:

(1) "Assets" mean cash or other resources that a person owns and could convert to cash to be used for his or her support and maintenance.

(2) "Closed" means an individual or case that was enrolled but is no longer receiving a benefit amount or was on a waiting list but is no longer on the waiting list.

(3) "Completed application" means the applicant has provided all required information to the department.

(4) "Contract" means an agreement between the department and a PDP provider for the provision of premium payments for enrollees of the program.

(5) "Countable income" means the amount of an applicant's income that is compared to the federal poverty level (FPL) to determine the applicant's FPL percentage.

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

(7) "Earned income" means salary, wages, and self-employment net earnings.

(8) "Eligible" means an applicant has met all the Big Sky Rx Program eligibility criteria stated in ARM 37.81.307.

(9) "Eligibility threshold" means Big Sky Rx Program income up to 200% of FPL.

(10) "Enrolled" means an eligible applicant enrolled in the program.

(11) "Extra help" means the federal program that assists with premiums, copayments, and deductibles for clients who meet the social security program's requirements. The program is sometimes referred to as Low Income Subsidy (LIS).

(12) "Family" means individuals residing together, related by blood, marriage, or adoption, and dependent on the household for at least one-half of their support.

(13) "Federal poverty level (FPL)" means the poverty income guidelines published annually in the Federal Register by the U.S. Department of Health and Human Services.

(14) "First in first served" means completed applications will be processed and eligible applicants enrolled based on the date the complete application is received by the department.

(15) "Income" or "family income" means salary, wage, self-employment net earnings, royalties, honoraria, social security benefits, veterans benefits, railroad benefits, pensions, workers compensation, alimony, net rental income, trust income, dividends, and interest.

(16) "Incomplete" means the application is missing information required by ARM 37.81.318.

(17) "Ineligible" means the individual or case does not meet the criteria for enrollment in the program.

(18) "Insurer" means an authorized insurer of the federal Medicare Part D Prescription Drug Plan (PDP).

(19) "Low income subsidy (LIS)" means the federal program that assists with premiums, copayments, and deductibles for clients who meet the social security program's requirements. The program is sometimes referred to as Extra Help.

(20) "Open" means a case or individual that is pending, currently enrolled, or eligible to receive the benefit amount but on a waiting list.

(21) "Pending" means the department is waiting to determine eligibility because the individual's application was incomplete.

(22) "Premium assistance" or "benefit amount" means the amount of money the department either pays monthly to an insurer for the provision of benefits for an enrollee or pays to an enrollee.

(23) "Prepopulated" means a computer generated document that includes information from the department's records to be verified by the applicant.

(24) "Prescription drug plan (PDP)" means the private insurance plans for federal prescription drug benefit for people with Medicare. The benefit was created by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), (42 USC 1302, 1395w-101 through 1395w-152, and 1395hh). It is implemented at 42 CFR, part 423.

(25) "Processing" means the application is matched against program criteria.

(26) "Program" means the Big Sky Rx Program administered by the department.

(27) "Qualified" means the applicant is a Montana resident with a family income at or below 200% of the FPL.

(28) "Renewal" means the process of verification to remain eligible for Big Sky Rx benefits.

(29) "Representative" means a person who the applicant has given permission to assist the applicant with program requirements by communicating with the program and receiving information from the department.

(30) "Residing" means living in Montana voluntarily with the intention of making a home here and not for a temporary purpose.

(31) "Temporary enrollment" means the three month enrollment allowed for those applicants that are only missing Social Security Extra Help determination.

(32) "Unearned income" means any income other than salary, wages, and earnings from self-employment.

(33) "Waiting list" means the list compiled by the department of applicants who are eligible for premium assistance but who are not enrolled in the Big Sky Rx Program because funds are not available to pay their program benefits.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2378, Eff. 1/1/10; AMD, 2019 MAR p. 60, Eff. 1/12/19.

Subchapter 37.81.3 Big Sky Rx Program

Mont. Admin. R. 37.81.301 Big Sky Rx Scope and Purpose

(1) On January 1, 2006, Medicare Prescription Drug Plans (PDPs) became available to people with Medicare. This is a voluntary federal program created by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) 42 USC 1302, 1395w-101 through 1395w-152, and 1395hh. It is referred to as "Medicare Part D" in these rules and implemented in 42 CFR part 423.

(2) An individual entitled to benefits under Medicare Part A or enrolled in Medicare Part B is eligible to enroll in a Medicare Part D PDP. An individual enrolled in a PDP is responsible for the premium and receives prescription drug coverage. There is also a federal premium subsidy called "Social Security Extra Help" for some individuals that assists in paying copayments, deductibles, and premiums.

(3) The purpose of Montana's Big Sky Rx Program is to pay a portion or all of the cost of the PDP premium for eligible Montana residents.

(4) The individual enrolled in Part D must choose and enroll in a federally approved PDP.

(5) The program does not provide assistance with selecting or enrolling in a PDP.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.304 Amount of the Big Sky Rx Benefit

(1) An applicant eligible for the Big Sky Rx PDP premium assistance may receive a benefit not to exceed $41.50 per month. The benefit amount will not exceed $41.50 regardless of the cost of the premium for the PDP the individual chooses.

(a) If a portion of the applicant's PDP premium is paid through the Extra Help Program, the Big Sky Rx Program will pay the applicant's portion of the PDP premium up to $41.50 per month.

(b) Big Sky Rx does not pay for the cost of an enrollee's drugs or the cost of an enrollee's deductible, coinsurance, or copayments.

(c) All expenditures are contingent on legislative appropriation. The amount of the monthly benefit, $41.50, extends the Social Security Extra Help benefit amount to Montana residents with income up to 200% FPL. The department's total expenditure for the program will be based on appropriation and the number of enrolled applicants.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2378, Eff. 1/1/10; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2011 MAR p. 2826, Eff. 1/1/12; AMD, 2012 MAR p. 2495, Eff. 1/1/13; AMD, 2013 MAR p. 2438, Eff. 1/1/14; AMD, 2014 MAR p. 3093, Eff. 1/1/15; AMD, 2016 MAR p. 21, Eff. 1/9/16; AMD, 2016 MAR p. 2434, Eff. 1/1/17; AMD, 2019 MAR p. 60, Eff. 1/12/19; AMD, 2020 MAR p. 94, Eff. 1/18/20; AMD, 2021 MAR p. 183, Eff. 2/13/21; AMD, 2021 MAR p. 1935, Eff. 1/1/22; AMD, 2024 MAR p. 1886, Eff. 7/27/24; AMD, 2025 MAR, Notice No. 2025-526, Eff. 11/8/25; AMD, 2026 MAR, Notice No. 2026-366, Eff. 4/25/26.

Mont. Admin. R. 37.81.307 Eligibility for Big Sky Rx

(1) An applicant must be eligible and enrolled in the program to receive premium assistance.

(2) To qualify the applicant must:

(a) be a resident of the state of Montana; and

(b) have a family income at or below 200% FPL.

(3) An applicant who meets the eligibility requirements for Social Security Extra Help as outlined in 42 CFR 423.773 (2007), which is adopted and incorporated by reference, must provide a determination from Social Security Extra Help.

(4) An individual who is receiving benefits for Medicaid is not eligible for the Big Sky Rx Program.

(5) An individual in a LIS program with full premium subsidy is not eligible.

(6) Eligibility determinations shall be effective for 12 months from the date of determination regardless of change in income or household size. This also applies to an applicant on the waiting list as provided in ARM 37.81.326.

(7) Enrollees in the program must comply with procedures specified by the PDP, the department, Extra Help, and Social Security (if applicable) to receive premium assistance.

(8) Program enrollment and eligibility will terminate at the end of the month in which any of the following events occur:

(a) the enrollee becomes Medicaid eligible;

(b) by income verification, the enrollee's income is found to exceed 200% of the FPL;

(d) the enrollee did not provide an Extra Help determination, if appropriate, or reapply for Extra Help;

(e) the enrollee dies;

(f) the enrollee is incarcerated; or

(g) the enrollee fails to provide information requested by the department.

(9) Termination of the benefit amount will be effective at the end of the month and a notice of termination will be mailed to the enrollee.

(10) Big Sky Rx eligibility and benefits are not an entitlement. If funding is insufficient, the department may reduce enrollment numbers or enrollment criteria to limit the number of individuals who are eligible to participate.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.310 Income and Family Size Criteria for Big Sky Rx

(1) Family income must be at or below 200% FPL to qualify for the program. Assets are not considered. Family income is the total of the applicant's income and the spouse's income if married and living together. For purposes of determining Big Sky Rx eligibility, the income items listed in this rule are included in family income.

(2) Earned income includes gross wages, net earnings from self-employment, payment for services performed in a sheltered workshop or work activities center, royalties, and honoraria.

(3) Unearned income includes Social Security benefits, veterans benefits, railroad benefits, public and private pensions, annuities, workers' compensation, alimony, child support, unemployment, income from a trust, net rental income, dividends, interest, and inheritances.

(4) Income tax refunds, assistance based on need funded by a state or local government, and small amounts of income received infrequently or irregularly are not counted. The income listed in (2) and (3) may also be decreased based on the adjustments stated in 20 CFR 416 to calculate income for purposes of Social Security Supplemental Income (SSI).

(5) The result of adding (2) and (3) and making any disregards of income provided for in (4) equals countable income.

(6) Compare countable income with household size to figure FPL.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2378, Eff. 1/1/10.

Mont. Admin. R. 37.81.314 Maximum Big Sky Rx Program Enrollment

(1) The department will enroll the number of participants it determines can be served based on the amount of appropriation.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06.

Mont. Admin. R. 37.81.318 Processing Big Sky Rx Participant Applications

(1) The department will process applications on a first in first served basis using the date the application is received by the department.

(a) The program will not enroll or pay benefits retroactively.

(b) Benefits will only be paid to eligible and enrolled individuals as of the first month following enrollment.

(2) Applications will be processed by the department and individuals will be notified in writing of their eligibility status as:

(a) ineligible;

(b) qualified but incomplete;

(d) eligible and enrolled; or

(e) eligible and on the waiting list for the Big Sky Rx Program.

(3) A completed application consists of:

(a) a signed Big Sky Rx application form with the following information:

(i) applicant's and spouse's (if applicable) name;

(ii) Social Security number;

(iii) Medicare number;

(iv) date of birth;

(v) gender;

(vi) home phone number;

(vii) mailing address;

(viii) family size;

(ix) family income;

(x) gross wages;

(xi) family assets;

(xii) disability or blind related work expense;

(xiii) name of applicants' PDP; and

(xiv) payment option of direct deposit or mail if applicant wishes to be paid directly.

(4) An applicant must sign the application and self-declare Montana residency and application for Big Sky Rx.

(5) An applicant must provide documentation of Medicare Part D PDP or Medicare advantage plan enrollment including documentation of Part D name, group number, and premium payment portion amount.

(6) An applicant who meets the eligibility requirements for Social Security Extra Help and is missing no other program requirement will receive a three month temporary enrollment. Within three months a temporary enrollee must provide documentation of a Social Security Extra Help determination. If no documentation is provided, the temporary enrollee will be disenrolled.

(7) An application is incomplete if it is missing any item listed in (3) through (6).

(8) Individuals not meeting the eligibility criteria in ARM 37.81.307 will be considered ineligible and mailed a program notice containing the reason for ineligibility. An individual may request an appeal, as provided in ARM 37.81.330. An individual may reapply for the program at any time.

(9) Qualified but incomplete applications will be marked "pending" until the applicant provides the PDP information and any missing application material.

(a) The applicant will be mailed a notice that the application is pending. The application will be held for 60 days from the application date. Following the 61st day, a notice will be mailed to the applicant as a reminder of the missing information.

(b) The application will remain "pended" until the information can be processed. If the information is still missing on the 91st day following the application date, the department will consider the applicant ineligible and the individual will be mailed a notice. The department will take no further action.

(10) Incomplete applications that are not otherwise qualified are considered "pending" by the department. These individuals will be mailed a notice of the missing information.

(a) A pended application will be held for 30 days waiting for missing information. If the missing information is received within the 30 days from the application date, the application will be processed.

(b) Following the 31st day the department will consider the application incomplete. The applicant becomes ineligible, and will be mailed a notice. The department will take no further action.

(11) Eligible individuals must meet all of the eligibility criteria in ARM 37.81.307. An eligible applicant will be enrolled in the program on a first in first served basis using the date the completed application is received by the department.

(12) Program enrollment starts the first day of the following month. Enrollees will be mailed an enrolled notice, including the approved premium benefit amount. The premium benefit amount will be paid to the PDP or the individual for the following month.

(13) If no premium assistance is available because of funding, eligible individuals will be placed on the department's waiting list. If funds become available, a notice will be sent and the applicant will be enrolled.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2378, Eff. 1/1/10.

Mont. Admin. R. 37.81.322 Big Sky Rx Application Renewal

(1) Sixty days prior to the end of the 12-month eligibility period, a prepopulated notice will automatically be generated and mailed to the client. This notice is generated based on the client's eligibility enrollment determination date.

(2) The client must review the information on the notice to ensure the information is accurate including, but not limited to, information about income, assets, dependent family members, and contact information.

(a) If the notice has incorrect information, the client must write the correct information on the notice and return the corrected notice to the department before the eligibility period ends.

(b) If the client has verified the information on the notice is correct, the client does not need to return it or take any other action.

(3) The department will process the enrollee's returned notice with corrected information as a renewal application in accordance with ARM 37.81.318.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2019 MAR p. 60, Eff. 1/12/19.

Mont. Admin. R. 37.81.326 Maintenance of a Waiting List for Those Determined Eligible for Big Sky Rx

(1) The department will process applications and will notify eligible individuals in writing of their program status.

(2) If no available program slot exists, the eligible individuals will not be enrolled and will be maintained on a waiting list until a slot becomes available.

(3) When slots are available, individuals will be notified in writing prior to the month of enrollment.

(4) The 12-month eligibility stated in ARM 37.81.307 applies.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06.

Mont. Admin. R. 37.81.330 Big Sky Rx Grievance and Appeal Procedures

(1) All decisions of the department related to the administration of the Big Sky Pharmacy Rx program are reviewable using the procedures stated at ARM 37.5.101, 37.5.304, 37.5.307, 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, and 37.5.334.

(2) An applicant contesting a denial, or an enrollee or guardian contesting a benefit or enrollment denial, benefit reduction, disenrollment, closure, or termination of Big Sky Rx may request a fair hearing.

(3) If a written request for hearing is not received by the department within 90 days of the mailing date of a notice of adverse action, the hearing officer may deny a hearing as provided in ARM 37.5.313.

History

Authorizing statute(s): 53-2-201, 53-6-1004, 53-6-1011, MCA
Implementing statute(s): 53-2-606, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06.

Mont. Admin. R. 37.81.334 Big Sky Rx Appeal Procedures

(1) Hearings to contest adverse department actions under the Big Sky Rx program, Title 53, chapter 6, part 10, MCA, are available to the extent granted by statute or rule in accordance with ARM 37.81.330.

History

Authorizing statute(s): 53-2-201, 53-6-1004, 53-6-1011, MCA
Implementing statute(s): 53-2-606, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06.

Mont. Admin. R. 37.81.338 Verification of Eligibility for Big Sky Rx

(1) A random sample of enrolled individuals will be required to participate in an eligibility verification review and provide documentation to verify the income as stated on the application.

(2) An individual will have 30 days from the date of the written request by the department to submit the required income documentation. The client will remain enrolled during the verification process.

(a) If the required documentation is not received by the department after 30 days, the enrolled individual will be disenrolled from the program the following month.

(b) An individual who provides income verification documentation after 30 will have the application reprocessed as if it is a new application.

(3) If verified income is over 200% FPL, the applicant will be disenrolled effective the last day of the month in which the determination was made and the client was notified.

(4) For purposes of this rule, necessary income documentation may include one or more of the following:

(a) state or federal income tax returns;

(b) pay stubs or other pay statements;

(d) self employment records documenting income and expenses;

(e) check copies;

(f) correspondence from an employer specifying a benefit;

(g) records of any government payor; or

(h) other appropriate, persuasive documentation may be accepted at the discretion of the department.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.342 Big Sky Rx Premium Payments

(1) Monthly premium payments will be made:

(a) to an insurer that has contracted with the department;

(b) directly to clients if:

(i) their monthly premium is deducted from their Social Security check;

(ii) they enroll in a PDP provided by an insurer that does not contract with the department; or

(iii) the client chooses to be paid directly.

(2) Direct monthly premium payments to enrollees will be made:

(a) through direct deposit; or

(b) by check only in the following circumstances:

(i) if there is no bank account; or

(ii) the enrollee has a permanent exemption with Social Security and still receiving Social Security benefits by check or by Direct Express debit card.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2013 MAR p. 2438, Eff. 1/1/14.

Mont. Admin. R. 37.81.346 Big Sky Rx Pdp Memorandum of Understanding (mou) and Business Associates Agreement (baa)

(1) An insurer receiving direct payment of all or part of a PDP premium from the state on behalf of an enrollee must enter into a Memorandum of Understanding (MOU) or Business Associates Agreement (BAA) with the department.

History

Authorizing statute(s): 53-2-201, 53-6-1004, MCA
Implementing statute(s): 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA
History: NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08.

Subchapter 37.81.10 Montana PharmAssist Program

Mont. Admin. R. 37.81.1001 Montana Pharmassist Program

(1) The rules in this chapter implement the Prescription Drug Consumer Information and Technical Assistance Program established in 53-6-1006, MCA. This program is referred to in these rules as the Montana PharmAssist Program.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.1002 Rule Definitions

In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter:

(1) "Application" means the form developed by the department to provide the program with client specific information.

(2) "Authorized client" means an applicant has met all the Montana PharmAssist authorization criteria stated in ARM 37.81.1009.

(3) "Chronic disease" means a condition or disease of long duration and generally slow progression that requires long term drug treatment such as cardiovascular disease, chronic respiratory disease, diabetes mellitus, arthritis, epilepsy, cancer, osteoporosis, depression, anxiety, bipolar disorder, or schizophrenia.

(4) "Client inventory form" means a form developed by the department to include pertinent client and health information.

(5) "Credentialed pharmacist" means a Montana licensed pharmacist in good standing who has completed the required initial training for the PharmAssist Program and has a current personal service contract with the department.

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

(7) "Eligible client" means an applicant has met all the Montana PharmAssist eligibility criteria stated in ARM 37.81.1009.

(8) "First in first served" means completed applications will be processed and eligible applicants will be referred to a pharmacist for services based upon the date received.

(9) "Personal service contract" means the contract between the department and the credentialed pharmacist.

(10) "PharmAssist patient packet" means an application, a signed Acknowledgement of Receipt of Notice of Privacy Practices, and a Client Inventory Form.

(11) "Qualified" means an applicant has met all the Montana PharmAssist qualification criteria stated in ARM 37.81.1009.

(12) "Residing" means living in Montana voluntarily with the intention of making a home in the state and not for a temporary purpose.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09.

Mont. Admin. R. 37.81.1005 Montana Pharmassist Scope and Purpose

(1) Beginning July 15, 2007, Montana residents may request applications for referral to a credentialed pharmacist for review of their medication regimens to address medication cost and the proper and prudent use of their medications. Clients who have applied and whose personal circumstances warrant a referral will be referred to a pharmacist for a drug regimen review and face-to-face interactions to identify therapeutic duplications and possible cost saving alternatives. The pharmacist will schedule and perform a face-to-face consultation and provide recommendations for the client to discuss with their prescriber. Upon completion, the client, their prescribers, and department representatives will receive a letter prepared by the pharmacist outlining the face-to-face discussion. The letter will include the pharmacist's recommendations for the possible alternatives available for the client. Clients are encouraged to discuss the pharmacist's recommendations with their prescribers prior to making any changes.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.1008 Amount of Pharmassist Benefit

(1) If eligible for Montana PharmAssist, a client may receive up to $200 of pharmacist services per 12 month period as outlined in the pharmacist's Personal Service Contract. Services will include an initial face-to-face consultation and may include follow-up services if warranted and approved by the department or its designee. All expenditures are contingent on available appropriations.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.1009 Eligibility for Montana Pharmassist

(1) An applicant must be qualified, eligible, and authorized to receive pharmacist services.

(2) To qualify, an applicant must have a chronic disease and either:

(a) take four or more medications; or

(b) have a condition or health issue determined by the screening pharmacist that provides an opportunity for benefit.

(3) To be eligible, an applicant must be residing in the state of Montana.

(4) To be authorized, an applicant must submit a completed PharmAssist Patient Packet, to include:

(a) an application;

(b) a signed Acknowledgement of Receipt of Notice of Privacy Practices; and

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.1012 Processing Montana Pharmassist Applications

(1) The department or its designee will process PharmAssist Patient Packets on a first in first served basis using the date the complete package is received.

(2) Authorized clients will be referred to a pharmacist for services.

(3) Applicants failing to meet criteria defined in ARM 37.81.1009 will be notified in writing.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.1013 Maintenance of a Waiting List for Those Determined Eligible for Montana Pharmassist

(1) The department will process PharmAssist Patient Packets and notify eligible individuals in writing if no available program slot exists, either due to lack of appropriations or credentialed pharmacists in their region.

(2) Eligible individuals will have their names maintained on a waiting list until program slots become available.

(3) When program slots become available, clients will be referred to a credentialed pharmacist for services on a first in first served basis.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08.

Mont. Admin. R. 37.81.1018 Montana Pharmassist

(1) To participate in the PharmAssist Program a pharmacist must be licensed by the state of Montana and complete initial training, which consists of a self-guided educational packet prepared by the department.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09.

Mont. Admin. R. 37.81.1020 Montana Pharmassist Grievance and Appeal

(1) All decisions of the department related to the administration of the Montana PharmAssist are reviewable using the procedures in ARM 37.5.101, 37.5.304, 37.5.307, 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, and 37.5.334.

(2) An aggrieved applicant may request a fair hearing in writing within 90 days. The request must be mailed to the Department of Public Health and Human Services, Quality Assurance Division, Office of Fair Hearings, P.O. Box 202953, Helena, MT 59620-2953.

(3) If a written request for hearing is received by the department more than 90 days after the mailing date of a notice of denial, the hearing officer must deny a hearing as provided in ARM 37.5.313.

History

Authorizing statute(s): 53-2-201, 53-6-1006, MCA
Implementing statute(s): 53-2-201, 53-6-1006, MCA
History: NEW, 2008 MAR p. 954, Eff. 5/9/08.

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, MCA
History: NEW, 2006 MAR p. 575, Eff. 2/24/06; REP, 2008 MAR p. 954, Eff. 5/9/08.

Chapter 37.82 Medicaid Eligibility

Subchapter 37.82.1 Medical Assistance

Mont. Admin. R. 37.82.101 Medical Assistance, Purpose, and Incorporation of Policy Manuals

(1) Subject to applicable state and federal laws, regulations and rules, the Montana Medicaid program pays for covered medically necessary services for persons determined eligible by the department or its agents.

(2) The department adopts and incorporates by reference the state policy manuals, namely the Family Medicaid Manual, dated January 1, 2010, and the Aged Blind Disabled (ABD) Medicaid Manual governing the administration of the Medicaid program dated July 1, 2011. The Family Medicaid Manual, the ABD Medicaid Manual, and the proposed manual updates are available for public viewing at each local Office of Public Assistance or at the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson Street, Fifth Floor, P.O. Box 202925, Helena, MT 59601-2925. The proposed manual updates are also available on the department's web site at www.dphhs.mt.gov/legalresources/proposedmanualchange.shtml.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, 53-6-141, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 476; AMD, 2002 MAR p. 1771, Eff. 6/28/02; AMD, 2003 MAR p. 15, Eff. 1/17/03; EMERG, AMD, 2003 MAR p. 652, Eff. 4/11/03; AMD, 2003 MAR p. 1301, Eff. 7/1/03; AMD, 2004 MAR p. 200, Eff. 1/30/04; AMD, 2005 MAR p. 163, Eff. 1/28/05; AMD, 2005 MAR p. 1591, Eff. 8/26/05; AMD, 2006 MAR p. 2411, Eff. 10/06/06; AMD, 2006 MAR p. 2417, Eff. 10/6/06; AMD, 2007 MAR p. 302, Eff. 3/9/07; AMD, 2007 MAR p. 2131, Eff. 1/1/08; AMD, 2008 MAR p. 1325, Eff. 7/1/08; AMD, 2009 MAR p. 2494, Eff. 1/1/10; AMD, 2011 MAR p. 1823, Eff. 9/9/11.

Mont. Admin. R. 37.82.102 Medical Assistance, Definitions

(1) "AABD" means aid to the aged, blind, and disabled under Title XVI of the Social Security Act.

(2) "AB" means Aid to the Blind under Title X of the Social Security Act.

(3) "AFDC" means Aid to Families with Dependent Children under Title IV-A of the Social Security Act.

(4) "Affiliates" means persons having an overt or covert relationship such that any one of them directly or indirectly controls or has the power to control another.

(5) "APTD" means aid to the permanently and totally disabled under Title XIV of the Social Security Act.

(6) "Categorically needy" means aged, blind or disabled individuals or families and children:

(a) who are otherwise eligible for Medicaid and who meet the financial eligibility requirements of section 1951 of the Social Security Act, SSI, or an optional state supplement; or

(b) whose categorical eligibility is otherwise provided for in ARM Title 37, chapter 82, subchapters 7, 9, 11, and 13.

(7) "Certification" means the process by which a governmental or nongovernmental agency or association evaluates and recognizes an individual, institution or educational program as meeting predetermined standards.

(8) "Department" means the Montana Department of Public Health and Human Services.

(9) "Designated review organization" means either the department or other entity, contracting with the department or designated by law to determine the medical necessity of medical services rendered to recipients of public assistance.

(10) "Electronic media claims" means claims submitted to the Montana Medicaid Program via magnetic tape or another acceptable electronic media approved by the department in accordance with ARM 37.85.406.

(11) "Emergency service" means inpatient and outpatient hospital services that are necessary to treat an emergency medical condition as defined in 42 CFR 489.24(b).

(12) "Families and children" refers to eligible members of families with dependent children who are financially eligible under family-related rules in subchapters 7, 11, and 13. In addition, this group includes individuals under 19 who are not dependent children but who are financially eligible under the above-cited subchapters. It does not include individuals under age 21 whose eligibility for Medicaid is based on the blindness or disability; for these individuals, the SSI-related rules in ARM Title 37, chapter 82, subchapters 9, 11, and 13 apply.

(13) "Family size", for SSI-related medically needy, means the number of eligible individuals and responsible relatives living in the same household unit. Ineligible persons living in the same household who are not responsible relatives are not counted when determining family size. For family-related medically needy, "family size" means the number of eligible individuals in the same household unit. Ineligible persons living in the same household, including ineligible responsible relatives, are not counted in determining family size.

(14) "Fiscal agent" means an organization which processes and pays provider claims on behalf of the department.

(15) "Grounds for sanctions" are fraudulent, abusive, or improper activities engaged in by providers of medical assistance services.

(16) "Intern" means a medical practitioner involved in a period of on-the-job training as part of a larger educational program.

(17) "License" means permission granted to an individual or organization by competent authority to engage in a practice, occupation or activity which would otherwise be unlawful. It is granted in the state where the practice, occupation or activity is carried out.

(18) "Medically necessary service" means a service or item reimbursable under the Montana Medicaid program, as provided in these rules:

(a) Which is reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions in a patient which:

(i) endanger life;

(ii) cause suffering or pain;

(iii) result in illness or infirmity;

(iv) threaten to cause or aggravate a handicap; or

(v) cause physical deformity or malfunction.

(b) A service or item is not medically necessary if there is another service or item for the recipient that is equally safe and effective and substantially less costly including, when appropriate, no treatment at all.

(c) Experimental services or services which are generally regarded by the medical profession as unacceptable treatment are not medically necessary for purposes of the Montana Medicaid program.

(i) Experimental services are procedures and items, including prescribed drugs, considered experimental or investigational by the U.S. Department of Health and Human Services, including the Medicare program, or the department's designated review organization or procedures and items approved by the U.S. Department of Health and Human Services for use only in controlled studies to determine the effectiveness of such services.

(d) With respect to abortion services reimbursable under the Montana Medicaid program, subsection (a) is limited by ARM 37.86.104(11).

(19) "Medically needy" means aged, blind or disabled individuals or families and children who are otherwise eligible for Medicaid and whose income is above the prescribed limits for the categorically needy but within the limits prescribed in ARM Title 37, chapter 82, subchapter 11.

(20) "Montana Medicaid Program" means the Montana Medical Assistance Program authorized by Title 53, chapter 6, MCA and Title XIX of the Federal Social Security Act.

(21) "OAA" means Old Age Assistance under Title I of the Social Security Act.

(22) "OASDI" means Old Age, Survivors, and Disability Insurance under Title II of the Social Security Act.

(23) "Optional state supplement" means a cash payment made by the department to an aged, blind or disabled individual.

(24) "Postpartum continuous eligibility coverage" means members who are currently enrolled in Healthy Montana Kids (HMK) or Medicaid may receive 12 months of continuous postpartum coverage, regardless of any changes in circumstances. The 12-month postpartum period begins on the last day of a member's pregnancy and extends through the end of the month in which the 12-month period ends.

(25) "Professional component" means the cost of professional services of the physician including examination of the patient, when indicated, performance and/or supervision of the procedure, interpretation and reporting of the examination and consultation of the referring physician. It does not include the cost of personnel, materials, equipment or other facilities.

(26) "Provider" means an individual, company, partnership, corporation, institution, facility, or other entity or business association that has enrolled or applied to enroll as a provider of services or items under the Montana Medicaid program.

(27) "Recipient overpayment" means an amount of public assistance paid to or on behalf of a recipient in excess of the amount that is proper.

(28) "Resident" means a medical practitioner involved in a prolonged period of on-the-job training which may either be part of a formal educational program or be undertaken separately after completion of a formal program, sometimes in fulfillment of a requirement for credentialing.

(29) "Services" means services, items and any other amounts reimbursable under the Montana Medicaid program.

(30) "SSI" means Supplemental Security Income under Title XVI of the Social Security Act.

(31) "Suspension of participation" means an exclusion from participation in the Medicaid Program for a specified period of time.

(32) "Suspension of payments" means the withholding of all payments due a provider pending the resolution of the matter in dispute between the provider and the department.

(33) "Technical component" means the cost of personnel, materials including visual contrast media and drugs, space, equipment and other facilities, but does not include the cost of radioisotopes.

(34) "Termination from participation" means an exclusion from participation in the Medicaid program.

(35) "Total value" means the combined value of the professional component and the technical component of physician services.

(36) "Withholding of payments" means a reduction or adjustment of the amounts paid to a provider on pending and subsequently submitted bills for purposes of offsetting overpayments previously made to the provider.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-106, 53-6-107, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1980 MAR p. 2978, Eff. 11/29/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 769, Eff. 7/31/81; AMD, 1982 MAR p. 105, Eff. 1/29/82; AMD, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1983 MAR p. 757, Eff. 7/1/83; AMD, 1983 MAR p. 1197, Eff. 8/26/83; AMD, 1985 MAR p. 248, Eff. 3/15/85; AMD, 1985 MAR p. 1409, Eff. 9/27/85; AMD, 1986 MAR p. 359, Eff. 3/14/86; AMD, 1986 MAR p. 1967, Eff. 12/1/86; AMD, 1987 MAR p. 894, Eff. 6/26/87; AMD, 1987 MAR p. 907, Eff. 7/1/87; AMD, 1988 MAR p. 753, Eff. 5/1/88; AMD, 1991 MAR p. 2049, Eff. 11/1/91; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1998 MAR p. 495, Eff. 2/13/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2003 MAR p. 15, Eff. 1/17/03; AMD, 2023 MAR p. 414, Eff. 5/1/23; AMD, 2024 MAR p. 2021, Eff. 8/10/24.

Subchapter 37.82.2 Application, Determination and Redetermination of Eligibility and Furnishing Assistance

Mont. Admin. R. 37.82.201 Application

(1) Opportunity to apply:

(a) Any individual wishing to do so will be afforded the opportunity to apply for medicaid without delay.

(2) Written application and place of application:

(a) The application must be submitted in writing:

(i) on the form and in the manner prescribed by the department of public health and human services; and

(ii) at the office of public assistance in the county of their choice.

(3) Assistance with application:

(a) An application will be accepted from a person acting responsibly on the behalf of a client who is:

(i) incompetent;

(ii) incapacitated; or

(iii) otherwise incapable of submitting the application himself.

(b) An individual or individuals of the applicant's choice may accompany, assist and represent the applicant in the application process.

(4) Automatic entitlement to medicaid:

(a) Except as provided for below, a separate application for medicaid will not be required from an individual if the individual receives:

(i) supplemental security income (SSI) ;

(ii) mandatory state supplement; or

(iii) optional state supplement.

(b) Recipients of SSI, mandatory state supplement and optional state supplement must provide on the form and in the manner prescribed by the department, information on third party liability as a further condition of eligibility.

(5) Availability of program information:

(a) The following information will be made available in the form of brochures, pamphlets and other appropriate printed materials, to all applicants and all other individuals who request it:

(i) the eligibility requirements;

(ii) available medicaid services;

(iii) the rights and responsibilities of the applicant/ recipient; and

(iv) the rules governing appeals of department decisions.

(6) Use of social security number (SSN) :

(a) In the Montana medicaid program, disclosure of or application for a social security number is mandatory. Medicaid may be denied to an otherwise eligible applicant for failure or refusal to disclose or apply for a SSN.

(b) Notwithstanding the above, under P.L. 98-369, Sec. 2651(c) (3) and 53-2-201 , MCA, the department will request, on the application, the SSN of each individual (including children) for whom medicaid services are requested.

(i) disclosure of or application for a SSN is mandatory;

(ii) the mandate for a SSN is made under the authority of P.L. 98-369, Sec. 2651(c) (3) and 53-2-201 , MCA; and

(iii) the SSN will be used only in the administration of the medicaid program.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-132 and 53-6-133, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1985 MAR p. 1574, Eff. 10/18/85; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2003 MAR p. 15, Eff. 1/17/03.

Mont. Admin. R. 37.82.204 Determination of Eligibility

(1) Timely determination of eligibility:

(a) Aid will be furnished in a timely manner to eligible persons and will conform to the following time standards:

(i) 90 days for applicants on the basis of disability; and

(ii) 45 days for all other applicants.

(b) These time standards cover the period from the date of application to the date the department mails or otherwise provides the applicant with a formal written notice of decision.

(c) Eligibility will be determined within the time standards except in cases of unusual circumstances which are caused by the claimant or which are beyond the department's control.

(d) The time standards will not be used:

(i) as a waiting period before determining and announcing eligibility; or

(ii) as a reason for denying eligibility because it has not been determined within the time standard.

(2) Denials or determinations of disability made by the U.S. social security administration (SSA) will be accepted by the department unless one of the following conditions exist:

(a) the individual has not applied to SSA for supplemental security income (SSI) cash benefits, or is found ineligible for SSI for a reason other than a disability;

(b) the individual has applied both to SSA for SSI and to the department for medicaid, but SSA has not made a disability determination within 90 days from the date of the individual's application for medicaid; or

(i) alleges a disabling condition different from, or in addition to that considered by SSA in making its determination; or alleges more than 12 months after the most recent SSA determination denying disability that his condition has changed or deteriorated since that SSA determination and further alleges a new period of disability which meets the durational requirements of the Social Security Act, and has not applied to SSA for a determination with respect to these allegations; or

(ii) alleges less than 12 months after the most recent SSA determination denying disability that his condition has changed or deteriorated since that SSA determination, alleges a new period of disability which meets the durational requirements of the Social Security Act and has applied to SSA for reconsideration or reopening of its disability decision and SSA refused to consider the new allegations.

(3) Determinations of disability will be made in accordance with the requirements applicable to disability determinations under the Supplemental Security Income Program specified in 20 CFR, part 416, subpart I (1993) . The department hereby adopts and incorporates by reference 20 CFR, part 416, subpart I (1993) . A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Developmental Disabilities Program, 111 Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(4) If the department bases its disability determination upon the decision made by the social security administration (SSA) the medicaid applicant is limited to appealing the decision through the SSA procedures for hearing and appeals. If the department makes a decision of disability on its own as set forth under the circumstances stated in (2) of this rule, the medicaid applicant has a right of appeal through the department's fair hearing process.

(5) Adequate notice:

(a) Each applicant will be sent a written notice of the department's decision on his application.

(b) If eligibility is denied, written notice will include the reasons for the action, the specific regulation or statute supporting the action, and an explanation of the applicant's right to request a hearing and will be mailed or otherwise provided to the applicant no later than date of denial.

(6) Disposal of applications:

(a) Each application will be disposed of by a finding of eligibility or ineligibility, unless:

(i) the applicant voluntarily withdraws his application;

(ii) the applicant dies and no one acting responsibly on his behalf requests in writing to have the application continued; or

(iii) the applicant cannot be located.

(b) Voluntary withholding of information that is mandatory for eligibility determination by the applicant will result in a finding of ineligibility.

(7) Effective date:

(a) Eligibility for medicaid will be effective as provided below, if the individual was or if he had applied would have been eligible for medicaid.

(i) "if he had applied" includes if someone had applied for him; also, the individual need not be alive when application for medicaid is made on his behalf.

(b) For coverage of aged, blind and disabled persons whose eligibility is related to the supplemental security income program, eligibility is granted for the month provided the resource eligibility criteria is met the first moment of the first day of that month and all other eligibility criteria are met for that month.

(c) For coverage of parents and children whose eligibility is related to the FAIM financial assistance program, eligibility is granted for the month if all eligibility criteria are met on the date of application and first day of subsequent month.

(d) For coverage of medically needy persons, eligibility begins:

(i) on the first of the month when the medically needy person pays the cost-share amount as defined in ARM 37.82.1107; or

(ii) when incurred remedial and medical expenses equal the required incurment as defined in ARM 37.82.1107 for the period.

(e) In no case will coverage be granted prior to the first day of the third month preceding the date of application.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, 53-6-132 and 53-6-133, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1985 MAR p. 181, Eff. 2/15/85; AMD, 1986 MAR p. 678, Eff. 4/25/86; AMD, 1993 MAR p. 1398, Eff. 7/1/93; AMD, 1994 MAR p. 36, Eff. 1/14/94; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.205 Redetermination of Eligibility

(1) Periodic redetermination of eligibility:

(a) where an individual has been determined eligible, eligibility will be reconsidered or redetermined:

(i) at the time required when the department has information obtained previously about anticipated changes in the individual's situation which might affect eligibility;

(ii) within 30 days after a report is obtained which indicates that changes in the individual's circumstances may affect the individual's eligibility; and

(iii) at least every six months if the client is categorically eligible related to FAIM financial assistance; or

(iv) at least every 12 months if the client is categorically eligible related to SSI.

(2) The department will provide recipients with timely and adequate notice of proposed action to terminate, discontinue or suspend their eligibility or to reduce or discontinue services they may receive under medicaid.

(a) Timely notice is as defined in ARM 37.5.505.

(3) In redetermining eligibility, the department will also review case records for the recipient's SSN or, in the case of families, each family member's SSN. If the case record does not contain the SSN's, the department will require them in accordance with ARM 37.82.201(6) .

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-142, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1986 MAR p. 678, Eff. 4/25/86; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.206 Furnishing Assistance

(1) The department will:

(a) furnish medicaid in a timely manner to recipients, as required by ARM 37.82.204(1) (a) , without any delay caused by the agency's administrative procedures;

(b) continue to furnish medicaid regularly to all eligible individuals;

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-132 and 53-6-133, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.207 Recipient Overpayments

(1) The department shall take reasonable and appropriate actions to recover each recipient overpayment, as defined in ARM 37.82.102, of medicaid benefits when the recipient overpayment is the result of the recipient's intentional or unintentional act or omission. The department shall also take reasonable and appropriate actions to recover overpayments that result from continued benefits which were paid pending the outcome of a fair hearing that is ultimately decided, at least in part, in the department's favor.

(2) The department shall not seek to recover a recipient overpayment, as defined in ARM 37.82.102, of medicaid benefits when the entire recipient overpayment is the result of an error made by the department.

(3) A recipient overpayment shall be calculated to include:

(a) the total amount of medicaid benefits paid to or on behalf of an ineligible recipient; or

(b) the difference between the amount of an accurately calculated monthly incurment and the amount of monthly incurment the recipient paid toward an incorrectly calculated incurment.

(4) The medicaid recipient and any other individual who has a legal obligation to support the medicaid recipient is liable to the department for any recipient overpayment sought to be recovered by the department. The department may use all legal means to recover the overpayment.

History

Authorizing statute(s): Sec. 53-2-201, 53-4-212 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-111, MCA
History: NEW, 2003 MAR p. 15, Eff. 1/17/03.

Subchapter 37.82.3 Modified Adjusted Gross Income (MAGI)

Mont. Admin. R. 37.82.301 Magi as the Measure of Income

(1) Effective January 1, 2014, except for members receiving aged, blind, or disabled benefits or benefits based on participation in a Medicaid home and community-based services waiver, a person's income must be determined in accordance with 42 U.S.C. 1396a(e)(14) (2015), which establishes modified adjusted gross income (MAGI) as the required measure of income.

(2) To create uniformity among the states for income disregards, federal regulation 42 CFR 435.603(d)(4) (2015) requires a state to subtract an amount equal to five percentage points of the current FPL to determine an individual's eligibility. This is implemented by increasing the maximum income to qualify for Medicaid from 133% to 138% of the current FPL.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16.

Subchapter 37.82.4 General Non-Financial And Financial Eligibility Requirements for the Categorically Needy and the Medically Needy

Mont. Admin. R. 37.82.401 Citizenship and Alienage

(1) As a condition of eligibility for Medicaid, an otherwise eligible individual must be:

(a) a citizen or national of the United States;

(b) granted status as lawfully admitted for permanent residence as an immigrant as defined by sections 1101(a)(15) and 1101(a)(20) of the Immigration and Nationality Act, excluding alien visitors, tourists, diplomats, and students who enter the United States temporarily;

(c) an alien granted status as a Cuban or Haitian entrant as defined in Section 501(e) of the Refugee Education Assistance Act of 1980; or

(d) an individual who is lawfully residing in the United States in accordance with the Compacts of Free Association between the United States and Micronesia, the Marshall Islands, and Palau, and as defined at 45 C.F.R. § 152.2.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2026 MAR, Notice No. 2026-84, Eff. 10/1/26.

Mont. Admin. R. 37.82.402 Residency

(1) For purposes of this rule, a person is considered incapable of indicating intent if:

(a) his I.Q. is 49 or less or he has a mental age of seven or less, based on standardized tests;

(b) he has been judged legally incompetent; or

(c) documentation acceptable to the department supports a finding that he is incapable of indicating intent. Acceptable documentation includes but is not limited to medical, psychological or psychiatric reports prepared by a qualified professional person.

(2) Medicaid will be provided to otherwise eligible residents of Montana. The documents used to verify that an applicant is a resident of this state include, but are not limited to, electronic data sources permitted by federal and state law, driver's license, state identification card, mortgage or rental agreement, post office records, utility bill, and wage stub.

(a) Noninstitutionalized individuals:

(i) An individual age 18 and over is a resident if he is living in Montana with the intent to remain permanently or for an indefinite period.

(A) there is no durational requirement for residency;

(B) residency is retained until abandoned; and

(C) temporary absences from Montana with intent to return when the purpose of the absence is accomplished does not interrupt continuity of residence.

(ii) An individual under age 19 living with a caretaker relative who qualifies as a resident of Montana under the criteria of this rule is also considered a resident of the state. Caretaker relative is as defined in ARM 46.10.302.

(iii) A blind or disabled individual under age 21 is considered a resident of Montana if he is living in the state.

(b) Individuals receiving an SSI state supplementary payment:

(i) Any individual receiving a state supplementary payment from Montana is considered a resident of Montana.

(ii) Any individual receiving a state supplementary payment from a state other than Montana is considered a resident of the state making the supplementary payment.

(i) An institutionalized individual who became incapable of indicating intent at or after age 18 is a resident of Montana if he was residing in the state when he first became incapable of indicating intent.

(ii) An individual under age 18 or an individual age 18 or older who became incapable of indicating intent before 18 is a resident of Montana if his parents or legal guardian resides in the state or, when the parents live in separate states and there is no legal guardian appointed, if the parent applying for Medicaid on his behalf resides in Montana.

(iii) Medicaid eligibility may not be denied to an institutionalized individual who did not establish residency in Montana prior to entering the institution.

(d) Out-of-state institutional placements:

(i) Any individual placed in an out-of-state institution by Montana continues to be a Montana resident.

(ii) Any individual placed in a Montana institution by another state continues to be a resident of the placing state.

(3) Montana has entered into an interstate residency agreement with certain other states. This agreement sets forth rules and procedures for resolving cases of disputed residency and takes precedence over the provisions above. A copy of the agreement and list of states involved in the agreement may be obtained from the Department of Public Health and Human Services, 111 Sanders, P.O. Box 4210, Helena, MT 59620-4210.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, 53-6-133, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476; AMD, 2020 MAR p. 925, Eff. 5/16/20.

Mont. Admin. R. 37.82.406 Applicant's Choice of Category

(1) A person who is eligible for more than one category of Medicaid eligibility will have eligibility determined for the category the person selects.

(2) A person who is eligible for Medicaid as a qualified Medicare beneficiary and under another Medicaid eligibility category may have eligibility determined under all categories for which the person may qualify.

(3) "Category" as used in this rule means aged, blind, disabled, families, and children or qualified Medicare beneficiary.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.407 Limitation on the Financial Responsibility of Relatives

(1) The income and resources of the following relatives are considered available to an individual in determining the individual's eligibility for Aged Blind Disabled (ABD) Medicaid:

(a) the spouse of the individual, except as provided in (3); and

(b) the biological or adoptive parent or parents or stepparent of the individual with whom the individual resides, if the individual is under the age of 18.

(2) The income and resources of the following relatives are considered available to an individual in determining the individual's eligibility for family Medicaid:

(a) the spouse of the individual, except as provided in (3);

(b) the biological or adoptive parent or parents or stepparent of the individual with whom the individual resides, if the individual is under the age of 19;

(c) for an individual applying for or receiving Medicaid under the child-under age six, child-age six to 19, child-medically needy or family-medically needy coverage groups only, the individual's siblings, half-siblings, or step siblings if the individual chooses to have such siblings included in the filing unit; and

(d) for an individual applying for or receiving Medicaid under any of the coverage groups described in 42 U.S.C. 1396r-6 and 42 U.S.C. 1396u-1, all siblings, half siblings, and step siblings of the individual with whom the individual resides, if the individual is under the age of 19. The individual does not have the option of excluding any such siblings from the filing unit.

(3) The following rules apply In the case of a married individual who is not living with his or her spouse:

(a) In determining the eligibility of an institutionalized spouse as defined in ARM 37.82.1330, resources of the institutionalized spouse's spouse, that is, of the community spouse as defined in ARM 37.82.1330, are considered available to the institutionalized spouse, and a resource assessment must be conducted as provided in ARM 37.82.1331, regardless of whether the institutionalized spouse and the community spouse live together or have ever lived together. In determining the eligibility of an institutionalized spouse the income of the community spouse will be considered as provided in 42 U.S.C. 1396r-5 pertaining to the treatment of income and resources for institutionalized spouses which is adopted and incorporated by reference.

(b) In determining the eligibility of any individual who is not an institutionalized spouse as defined in ARM 37.82.1330, the income and resources of the individual's spouse are considered available to the individual as long as the spouses live together. If the individual and the individual's spouse cease living together, the income and resources of the individual's spouse are not considered available to the individual unless actually contributed to the individual beginning in the first month after the month in which the individual and the individual's spouse ceased living together. If the individual and individual's spouse never lived together, the spouse's income and resources are not considered available to the individual unless actually contributed to the individual.

(4) Except as provided in (1), (2), and (3), the department may not consider the income or resources of any relative to be available to an individual in determining the individual's eligibility for Medicaid unless:

(a) the income or resource are actually contributed to the individual; or

(b) a relative makes a vendor payment on behalf of the individual and the vendor payment would be countable income to the individual as provided in the ABD Medicaid Manual or Family Medicaid Manual that is incorporated by reference in ARM 37.82.101.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-113, 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1996 MAR p. 284, Eff. 1/26/96; TRANS, from SRS, 2000 MAR p. 476; AMD, 2007 MAR p. 302, Eff. 3/9/07.

Mont. Admin. R. 37.82.415 Application for Other Benefits

(1) As a condition of eligibility, applicants and recipients must make every effort to obtain any benefits to which they are entitled, unless they can show good cause for not doing so. These benefits include, but are not limited to, veteran's compensation and pensions, OASDI benefits, railroad retirement benefits, and unemployment compensation.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.416 Assignment of Rights to Benefits, Cooperation with Child Support Services Requirements

(1) As a condition of eligibility for Medicaid, each legally able applicant and recipient must assign his rights to medical support or other third party payments to the department and must cooperate with the department in obtaining medical support or payments, except as provided in (4)(a) through (4)(e).

(2) Assignment method and rights assigned:

(a) Under 53-2-612 , MCA, the department has a lien upon all money paid by a third party or his insurer in satisfaction of a judgment or settlement arising from a recipient's claim for damages or compensation for personal injury, disease, illness, or disability. Under 53-2-613 , MCA, by signing the department-prescribed application form for Medicaid, an applicant for or recipient of Medicaid assigns to the department:

(i) his own rights to any medical care support under an order of a court or an administrative agency, and any third party payments for medical care; and

(ii) the rights of any other eligible individual in the family for whom he can legally make an assignment.

(b) Assignment of rights to benefits does not include assignment of rights to Medicare benefits.

(3) Cooperation in establishing paternity and obtaining support:

(a) The individual whose rights are assigned as provided in (2) must cooperate in:

(i) establishing paternity of a child born out of wedlock for whom he can legally assign rights; and

(ii) obtaining medical care support and payments for himself and any other individual for whom he can legally assign rights.

(b) As a part of cooperation, the department may require an individual to:

(i) appear at the state or county office to provide information or evidence relevant to the case;

(ii) appear as a witness at a court or other proceeding;

(iii) provide information, or attest to lack of information, under penalty of perjury;

(iv) pay to the department any support or medical care funds received that are covered by the assignment of rights; and

(v) take any other reasonable steps to assist in establishing paternity and securing medical support and payments.

(c) The department will waive the requirements in (a) and (b) if it determines that the individual has good cause for refusing to cooperate.

(i) With respect to establishing paternity of a child born out of wedlock or obtaining medical care support and payments for a child for whom the individual can legally assign rights, good cause is as defined in ARM 37.78.215.

(ii) With respect to obtaining medical care support and payments for an individual in any case not covered by (3)(c)(i), the department will waive cooperation if the department determines that cooperation is against the best interests of the individual or other person to whom Medicaid is being furnished, because it is anticipated that cooperation will result in reprisal against, and cause physical or emotional harm to, the individual or other person.

(d) The procedure for waiving cooperation is as provided in ARM 37.78.215.

(4) Individuals receiving medical assistance only in any of the following coverage groups are not required to assign their rights to medical support or cooperate with the Child Support Services Division in establishing paternity and obtaining medical support:

(a) automatic newborn assistance;

(b) poverty level child assistance;

(d) poverty six child assistance; and

(e) Ribicoff child assistance.

(5) Medicaid eligibility will be denied or terminated for any applicant or recipient who fails or refuses without good cause to comply with the requirements of this rule regarding assignment of rights and/or cooperation in establishing paternity and obtaining support.

(a) However, Medicaid will be provided to a minor child or other individual who cannot legally assign rights or cooperate, if that individual is otherwise eligible, despite the failure or refusal of the caretaker relative or any other individual to comply with the requirements of this rule.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-612, 53-2-613, 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1990 MAR p. 1609, Eff. 8/17/90; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.82.417 Transfer of Resources

(1) The following definitions apply to this subchapter:

(a) "Fair market value" means the amount of compensation at which property would change hands between a willing buyer and an unrelated seller, neither being under compulsion to buy or sell and both having reasonable knowledge of the relevant facts.

(b) "Compensation" means money, food, shelter, support, maintenance, services, or other valuable real or personal property, as further specified in (5), received by an individual in exchange for the transferred property.

(c) "Uncompensated value" means the difference between the property's fair market value at the time of the transfer less any outstanding encumbrances on the property and the fair market value of compensation received in exchange for the property.

(d) "Transfer of property" means any transfer or renunciation of a client's property. Transfers to joint tenancy or to tenancy in common are included in this definition. Transfers of or restrictions upon a client's right of access to or legal ability to dispose of property are also included in this definition, except as provided in (8)(b)(iv).

(e) "Incurred medical expenses" are those actually incurred medical expenses which are not subject to payment by a third party.

(f) "Undue hardship" means any one of the conditions specified in (8)(b)(i) through (8)(b)(v).

(g) "Client" means applicant for or recipient of Medicaid services or such a person at any time prior to application and, where the context allows, includes any person whose resources are considered by the department in determining eligibility of the applicant or recipient.

(h) "Property" means any full or proportionate right, title or interest in or to any real or personal property or property right.

(i) "Institutionalization" means admission to a nursing facility, admission to a medical institution at a level of care equivalent to nursing facility services, or commencement of services to the applicant or recipient under the Home and Community Based Waiver program.

(j) "Home" means the client's principal place of residence, including adjoining land and outbuildings;

(k) "Principal place of residence" means the property on which the individual, the individual's spouse, or a dependent child of the individual (including a dependent adult child) currently resides or has resided within the previous six months and the individual, the individual's spouse, or a dependent child of the individual intends to return to the property to reside within six months of absence in the event of a temporary absence. Only one property may qualify as an individual's principal place of residence.

(2) The client's home:

(a) is a countable resource; and

(b) will be considered an exempt resource so long as the client or a dependent child resides in the home and ownership is retained by the client.

(3) Property transfers made on or after July 1, 1988, are evaluated for only those clients applying for or receiving nursing facility services, services in a medical institution at a level of care equivalent to nursing facility services, or services under the Home and Community Based Waiver Program.

(4) For transfers made on or after July 1, 1988:

(a) A client is ineligible for the medical services specified in (3) for a period of time calculated in accordance with (4)(b)(i) and (ii) if, for the purpose of qualifying for medical assistance, the client has disposed of any resource, including his home, for less than fair market value within:

(i) 30 months immediately prior to institutionalization or at any time thereafter, in the case of a person who is receiving medical assistance on the date of institutionalization; or

(ii) 30 months immediately prior to the date of application for medical assistance or at any time after application, in the case of a person who is not receiving medical assistance on the date of institutionalization.

(b) The period of ineligibility will begin with the month in which the resources were transferred. The number of months in such period is equal to the lesser of:

(i) 30 months; or

(ii) the uncompensated value divided by Montana's statewide average private pay cost of nursing home services as determined by the department as of July 1 of the state fiscal year in which the transfer occurs.

(i) the property was transferred to a spouse or a blind or permanently and totally disabled child of the applicant or recipient;

(ii) the transferred property was the applicant's or recipient's home and was transferred to:

(A) the applicant's or recipient's spouse;

(B) a child of the applicant or recipient who is under age 21;

(D) a child of the applicant or recipient who resided in the home for at least two years prior to the client's institutionalization and who provided care which permitted the client to reside at home; or

(E) a sibling of the applicant or recipient who has equity interest in the home and resided in the home for at least one continuous year immediately preceding the client's institutionalization.

(iii) the property was transferred exclusively for a purpose other than to qualify for medical assistance; or

(iv) denial of eligibility would cause an undue hardship as defined in (1)(f).

(d) When a client, whether or not receiving medical assistance at the time of institutionalization, has disposed of any resource for less than fair market value within the periods of time described in (4)(a)(i) and (ii), it is presumed that the transfer was made for the purpose of qualifying for medical assistance, unless the client establishes by clear and convincing evidence that the transfer was exclusively for some other purpose.

(5) All property transfers made after December 19, 1989, by either the client or his spouse, will be evaluated as if the transfer was made by the client.

(6) For purposes of evaluating all transfers, regardless of date, the value of compensation received for transferred property is determined based upon the agreement and expectations of the parties at the time of the transfer. Compensation may be in the form of:

(a) cash, in the total amount paid or agreed to be paid in exchange for the resource, excluding interest;

(b) any valuable real or personal property which is valued according to its fair market value and which is exchanged for the property transferred;

(c) support and/or maintenance provided in accordance with a valid written contract entered into before the support and/or maintenance was rendered. The support and/or maintenance are valued at fair market value based upon the support and/or maintenance provided and the length of time for which the contract requires that it be provided;

(d) services provided in accordance with a valid written contract entered into before services were rendered. The services provided are valued at fair market value, considering the frequency and the duration of the services required by the contract;

(e) food valued at retail price; or

(f) shelter valued at fair market value.

(7) In all cases in which the department determines that an applicant or recipient has transferred resources to establish or maintain eligibility, regardless of the date of the transfer, the department must send a written notice to the individual, prior to a determination of eligibility or ineligibility, informing him that an uncompensated transfer of nonexcluded resources has been identified, stating the value of the property transferred, and explaining the individual's right to rebut the presumption that the transfer was made to qualify for assistance.

(8) For purposes of evaluating all transfers, regardless of date, the presumption that property was transferred to establish Medicaid eligibility shall apply unless the individual presents to the department, within 15 days of the department's mailing of notice, a rebuttal statement containing clear and convincing evidence that the property was transferred exclusively for some other reason. If the individual does not present a rebuttal statement as provided herein, the department shall deny or terminate eligibility.

(a) The individual's rebuttal statement must include, if applicable:

(i) the individual's reason for transferring the property;

(ii) the individual's attempts to transfer the property at fair market value;

(iii) the individual's representation and documentation that he did receive fair market value, if that is his belief and contention, or the individual's reasons for accepting less than fair market value for the property;

(iv) the individual's means of or plans for supporting himself after the transfer;

(v) the individual's relationship, if any, to the persons to whom the property was transferred; and

(vi) any relevant documentary evidence of the transfer or consideration received for the transfer including but not limited to legal documents, agreements, appraisals, and correspondence regarding the transfer of property.

(b) The determination of whether a transfer covered by this section has occurred will be based upon consideration of all facts and circumstances. The presence of one or more of the following or other factors, while not necessarily conclusive, may indicate that the property was transferred exclusively for some purpose other than establishing eligibility;

(i) The occurrence or onset after transfer of an unexpected event or condition which necessitates application for Medicaid benefits.

(ii) The occurrence after transfer of an unexpected loss of:

(A) other resources which would have precluded Medicaid eligibility; or

(B) income which would have precluded Medicaid eligibility.

(iii) If the property had been retained, the individual's total countable resources would have been below the general resource limit during each of the preceding 30 months.

(iv) The property transfer or restrictions upon the availability of the property to its owner were ordered by a court of law based upon an applicable statute, regulation, bona fide condition of settlement or other legal requirement and not at the request or suggestion of the client or the client's parent, child, guardian, attorney, or other legal representative.

(v) The individual was the victim of fraud, misrepresentation or coercion, and the transfer was based upon such fraud, misrepresentation or coercion, provided that the individual has taken any and all possible steps, including legal action, to recover such property or the equivalent thereof in damages.

(9) For purposes of evaluating all transfers, regardless of date, if the individual had some other purpose for transferring the property but establishing eligibility for public assistance was also a factor or foreseeable result of his decision to transfer, the presumption established in (4)(d) is not rebutted.

History

Authorizing statute(s): 53-2-201, 53-2-601, 53-6-113, MCA
Implementing statute(s): 53-2-601, 53-6-101, 53-6-113, 53-6-143, MCA
History: NEW, 1981 MAR p. 1979, Eff. 1/1/82; AMD, 1987 MAR p. 710, Eff. 5/29/87; AMD, 1990 MAR p. 124, Eff. 1/12/90; AMD, 1991 MAR p. 262, Eff. 3/1/91; TRANS, from SRS, 2000 MAR p. 476; EMERG, AMD, 2003 MAR p. 652, Eff. 4/11/03.

Mont. Admin. R. 37.82.418 Bona Fide Effort to Sell Non-Home Real Property

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, 53-6-141, 53-6-142, MCA
History: NEW, 1989 MAR p. 882, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 476; EMERG, REP, 2003 MAR p. 652, Eff. 4/11/03.

Mont. Admin. R. 37.82.422 Conditional Medical Assistance, Definitions

(1) Definitions for the purposes of conditional medical assistance include:

(a) "Nonliquid resource" is personal property which is not cash and which cannot be converted to cash within 20 workdays.

(b) "Liquid resource" is property which is cash or can be converted to cash within 20 workdays.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, MCA
History: NEW, 1991 MAR p. 1045, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.423 Conditional Medical Assistance, Eligibility

(1) Medicaid applicants may qualify for assistance conditioned on the sale, at current market value, of excess nonliquid resources.

(2) To be eligible for conditional assistance an applicant must:

(a) be categorically eligible by reason of being:

(i) age 65 or older;

(ii) blind; or

(iii) disabled;

(b) have or apply for a social security number;

(d) meet the residency requirements of ARM 37.82.402;

(e) have total countable resources which exceed the SSI-related resource standard of ARM 37.82.1110;

(f) not have countable liquid resources exceeding three times the appropriate federal supplemental security income monthly benefit payment standard at the time of application;

(g) make reasonable efforts to sell the resources as defined in (3) within the conditional assistance period specified in (4); and

(h) enter into a written agreement to use the net proceeds of the sale of the excess nonliquid resources to refund to the department conditional medical assistance payments paid on the applicant's behalf.

(3) "Reasonable efforts to sell" means:

(a) list the property for sale at market value or less with an agent; or

(b) begin advertising the property for sale at market value or less in at least one of the appropriate local media;

(d) begin conducting "open houses" or otherwise show the property to interested parties on a continuous basis; and

(e) attempt any other appropriate methods of sale.

(4) Conditional assistance may be provided to an eligible applicant for up to three months while attempting to dispose of excess personal property, and up to nine months while attempting to dispose of excess real property. An additional three months of conditional assistance may be provided to an applicant when the department determines that the sale of the resource has been prevented by circumstances beyond the applicant's control.

(5) The amount of conditional medical assistance to be refunded to the department is equal to the lesser of:

(a) balance of the net proceeds after an amount is deducted to raise the applicant's and spouse's, if any resources to the applicable resource limit; or

(b) total conditional medical assistance payments made on the applicant's and spouse's, if any, behalf.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, MCA
History: NEW, 1991 MAR p. 1045, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476; EMERG, AMD, 2003 MAR p. 652, Eff. 4/11/03.

Mont. Admin. R. 37.82.424 Health Plan Premium Payments

(1) "Group health plan" means any plan of an employer or any plan to which an employer contributes including a self-insured plan to provide health care, directly or otherwise, to the employer's employees, former employees, or the families of such employees, or former employees.

(2) "Individual health plan" means any plan to provide health care to an individual and/or his family which is not a plan of the individuals's employer or to which the individual's employer contributes.

(3) "Cost effective" means the amount paid for premiums, coinsurance, deductibles, and other cost sharing obligations under an individual or group health plan plus the additional departmental administrative costs is likely to be less than the department would pay out for Medicaid services for a Medicaid recipient, determined on an actuarial basis.

(a) Cost effective criteria may include assessment of medical diagnoses and health risk assessment.

(4) Payment of individual or group health premiums is a Medicaid benefit.

(5) The Department of Public Health and Human Services may pay premiums of an individual or group health plan which provides benefits not covered by Medicaid as long as it has determined that payment of the premiums will be cost effective.

(6) Coinsurance and deductibles will be paid for services covered by a health plan when these same services are provided by Medicaid. Payment amounts cannot exceed the reimbursement schedule set by Medicaid.

(a) Coinsurance and deductibles will not be paid for non-Medicaid eligible persons who are covered by the health plan.

(b) Coinsurance and deductibles will not be paid for persons who are eligible for Medicaid as COBRA continuation beneficiaries, as defined in ARM 46.12.3215.

(7) Payment of premiums may be made for a retroactive period up to three months if necessary to insure enrollment or continuation of enrollment.

(8) Payment of premiums may be in the form of direct payments to insurance companies or employers offering the health plan or direct reimbursement to the recipient or insured.

(9) Premiums for non-Medicaid recipients may be paid only if it is a condition of the enrollee's eligibility in the health plan to enroll family members, and if premium payments are cost effective.

(a) Ineligible family members may reside in a separate household.

(10) Medicaid payment of health plan premiums may begin as of the Medicaid eligibility effective date for:

(a) applicants who are already enrolled in a health plan; and

(b) applicants who have a waiting period before health plan coverage begins.

(i) Full Medicaid coverage is available to applicants during the waiting period.

(11) Health plans are treated as a third party resource in accordance with ARM 37.85.407.

History

Authorizing statute(s): 53-2-201, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-103, 53-6-131, MCA
History: NEW, 1991 MAR p. 1021, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.430 Cobra Continuation Beneficiaries, Application, and Eligibility for Medicaid

(1) A person is a COBRA continuation beneficiary eligible for Medicaid, if:

(a) the person meets the nonfinancial criteria in (2) of this rule;

(b) the person has countable resources which do not exceed twice the federal supplemental security income (SSI) resource limitation set forth at 42 USC 1382(a)(3)(A) and (B). The department hereby incorporates 42 USC 1382(a)(3)(A) and (B) as amended through April 1, 1991. Copies of 42 USC 1382(a)(3)(A) and (B), as amended through April 1, 1991, are available from the Department of Public Health and Human Services, Human and Community Services Division, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952;

(c) the person has countable income not in excess of 100% of the federal poverty income standard as defined by the Executive Office of Management and Budget (EOMB) and revised annually;

(d) the person is eligible for coverage under a group health plan provided by an employer with at least 75 employees pursuant to Title XXII of the Public Health Service Act, subsection 4980B of the Internal Revenue Code of 1986, or Title VI of the Employee Retirement Income Security Act (ERISA) of 1974 due to a qualifying event;

(i) a COBRA continuation coverage qualifying event is:

(A) death of the covered employee;

(B) termination or reduction of hours of the covered employee's employment;

(D) the covered employee becoming eligible for benefits under Medicare; or

(E) a dependent child ceases to be a dependent child under the applicable plan requirements.

(e) it is cost effective to pay the health plan premiums according to the definition of cost effective in (2) of ARM 37.82.424.

(2) The nonfinancial criteria for determining eligibility of a COBRA continuation beneficiary are that the person:

(a) has or takes the necessary steps to obtain a social security number;

(b) meets the citizenship or alienage requirements of ARM 37.82.401; and

(3) A person applying for and receiving Medicaid as a COBRA continuation beneficiary is subject to the following provisions:

(a) ARM 37.82.201 concerning application requirements;

(b) ARM 37.82.204 concerning determinations of eligibility;

(d) ARM 37.82.407 concerning limitation on the financial responsibility of relatives; and

(e) ARM 37.82.415 concerning application for other benefits.

(4) Medical assistance for a person eligible for Medicaid only as a COBRA continuation beneficiary shall be limited to payment of COBRA continuation premiums. The department will not pay coinsurance or deductibles under the group health plan or any other Medicaid benefits for a COBRA continuation beneficiary.

History

Authorizing statute(s): 53-2-201, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-103, 53-6-131, MCA
History: NEW, 1991 MAR p. 1021, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.431 Medicaid Estate Recoveries, Waiver of Recovery Based Upon Undue Hardship

(1) The department shall waive, in whole or in part, its claim under 53-6-167 , MCA, if the applicant demonstrates that recovery would result in an undue hardship to the applicant as provided in this rule.

(2) An applicant may request an undue hardship waiver of estate recovery by filing an application on the form prescribed by the department. Application forms may be obtained from and must be filed with the Department of Public Health and Human Services, Quality Assurance Division, Third Party Liability, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953. Application forms may also be obtained from county human services or welfare offices, but must be filed with the Quality Assurance Division office in Helena at the above address.

(a) The department may require the applicant to submit any information and documentation regarding the applicant's finances, property, employment, liabilities, expenses, and other matters relevant and necessary to determine whether an undue hardship would result from recovery.

(3) The persons entitled to apply for an undue hardship waiver as provided in this rule are:

(a) a person who has succeeded or would succeed to part or all of the decedent's assets but for recovery by the department, including a person who has received or would have received a beneficial interest in the assets but not legal title; or

(b) a person who was, for a substantial period of time during the decedent's lifetime and after the decedent's death remains, dependent upon the decedent's assets for food, shelter, or clothing.

(4) Department recovery will result in an undue hardship to the applicant if:

(a) The estate assets or property received by survival or distribution are part of a business, including a working farm or ranch, upon which the applicant was dependent for applicant's livelihood, during the decedent's lifetime recovery by the department would deprive the applicant of their sole means of livelihood, and the applicant has no other means of satisfying the department's claim;

(b) The applicant is an aged (age 65 or over), blind or disabled relative of the decedent who for one year or more before the decedent's death had been continuously and lawfully living in a residence owned by the decedent and continues to reside there, and who would have significant difficulty establishing an alternative living arrangement, obtaining financing (such as a home equity loan) to repay the department or arranging other means to repay the department;

(c) The applicant is a relative of the decedent who for one year or more before the decedent's death had been continuously and lawfully living in a residence owned by the decedent and continues to reside there, and who would have no means of providing or obtaining alternative shelter and there is no person legally responsible or assets otherwise available to provide the person shelter;

(d) Without recovery by the department, the applicant would receive or be permitted to retain property that the applicant transferred to the decedent for no consideration, as determined by clear and convincing evidence including appropriate title documents, agreements and other documentation; or

(e) The property that applicant would receive or be permitted to retain without recovery by the department is needed by the applicant to acquire necessities of life, such as food, shelter, clothing, or medical care and there are no other assets or means available to the applicant to satisfy in full or in part the department's claim.

(5) An undue hardship does not exist if:

(a) the decedent or applicant created the hardship by using estate planning, gifting or other methods to divert or shelter assets to avoid estate recovery; or

(b) The circumstances indicate that the hardship was created for purposes of avoiding or defeating recovery.

(6) The department may limit an undue hardship waiver to a partial or temporary waiver of recovery and/or may condition a waiver upon the applicant's agreement and provision of security for repayment in appropriate cases if the limited waiver would address reasonably the applicant's hardship.

(7) To the extent that there currently is, or later comes into existence, a conflict between the provisions of this rule and standards promulgated by the Secretary of the U.S. Department of Health and Human Services, the federal standards shall control.

(8) The department shall provide the applicant written notice of its determination on an application for an undue hardship waiver of estate recovery.

(9) An applicant aggrieved by an adverse determination on an application for an undue hardship waiver of estate recovery may assert a claim of entitlement to an undue hardship waiver as provided in 53-6-167 (7)(c), MCA rather than through an administrative review, fair hearing or contested case hearing under the Montana Administrative Procedure Act or the department's rules.

History

Authorizing statute(s): 53-6-167, 53-6-189, MCA
Implementing statute(s): 53-6-167, MCA
History: NEW, 1995 MAR p. 2837, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.435 Medicaid Real Property Lien, Notice and Right to Hearing

(1) At least 30 days prior to filing a lien under 53-6-171, MCA upon real property of a Medicaid applicant or recipient, the department must provide the applicant or recipient notice of its determination that applicant or recipient is permanently institutionalized and that none of the exceptions provided by 53-6-171, MCA or federal law apply. The notice must inform the applicant or recipient of the exceptions that would prevent imposition of a lien and of the right to a fair hearing as provided in (2).

(2) The applicant or recipient upon whose property the department proposes to impose a lien under 53-6-171, MCA is entitled to a fair hearing according to the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.318, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337. The applicant or recipient must request the hearing within 30 days of receipt of the notice required under (1).

(a) The hearing is limited to issues regarding imposition of the lien and may not address issues relating to recovery on the lien, undue hardship, spousal exemption, or similar issues.

(3) If a hearing is requested, the department may not file the lien until permitted to do so by order of the hearing officer or a court of law, which may be granted after a determination on the merits or before a determination on the merits upon a demonstration by the department that the lien is necessary to prevent the applicant, recipient or other person from disposing of the property to avoid the lien.

History

Authorizing statute(s): 2-4-201, 53-6-113, 53-6-189, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-171, 53-6-172, MCA
History: NEW, 1995 MAR p. 2837, Eff. 12/22/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2007 MAR p. 2132, Eff. 12/21/07.

Mont. Admin. R. 37.82.436 Medicaid Real Property Lien, Waiver of Lien Recovery Based Upon Undue Hardship

(1) The department shall waive, in whole or in part, its recovery upon a lien under 53-6-171 through 53-6-188 , MCA, if the applicant demonstrates that recovery would result in an undue hardship to the applicant.

(a) A waiver may be granted under this rule only to forego or prevent recovery under a lien previously imposed under 53-6-171 , MCA. A waiver may not be granted under this rule to forego or prevent imposition of a lien under 53-6-171 , MCA.

(2) An applicant may request an undue hardship waiver of lien recovery by filing an application on the form prescribed by the department. Application forms may be obtained from and must be filed with the Department of Public Health and Human Services, Quality Assurance Division, Third Party Liability, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953. Application forms may also be obtained from county human services or welfare offices, but must be filed with the Quality Assurance Division Office in Helena at the above address.

(3) The persons entitled to apply for an undue hardship waiver as provided in this rule are:

(a) a person who has succeeded or would succeed to part or all of the recipient's interest in the liened property but for recovery by the department, including a person who has received or would have received a beneficial interest in the liened property but not legal title; or

(b) a person who is dependent upon the liened property for shelter or if the recipient is deceased, was, for a substantial period of time during the recipient's lifetime and after the decedent's death remains dependent upon the liened property for shelter.

(4) Department recovery will result in an undue hardship to the applicant if:

(a) The liened property is part of a business, including a working farm or ranch, upon which the applicant was dependent for applicant's livelihood during the recipient's lifetime, lien recovery by the department would deprive the applicant of their sole means of livelihood, and the applicant has no other means of satisfying the department's claim;

(b) The applicant is an aged (age 65 or older), blind or disabled relative of the recipient who for one year or more before the recipient's death had been continuously and lawfully living in the liened property and continues to reside there, and who would have significant difficulty establishing an alternative living arrangement, obtaining financing (such as a home equity loan) to repay the department or arranging other means to repay the department;

(c) The applicant is a relative of the recipient who for one year or more before the recipient's death had been continuously and lawfully living in the liened property and continues to reside there, and who would have no means of providing or obtaining alternative shelter and there is no person legally responsible or assets otherwise available to provide the person shelter;

(d) Without lien recovery by the department, the applicant would receive or be permitted to retain liened property that the applicant transferred to the recipient for no consideration, as demonstrated by clear and convincing evidence, including appropriate title documents, agreements, and other documentation; or

(e) The liened property is needed by the applicant for shelter and there are no other assets or means available to the applicant to satisfy in full or in part the department's claim.

(5) An undue hardship does not exist if:

(a) the recipient or applicant created the hardship by using estate planning, gifting or other methods to divert or shelter assets to avoid estate recovery; or

(b) the circumstances indicate that the hardship was created for purposes of avoiding or defeating recovery.

(6) The department may limit an undue hardship waiver to a partial or temporary waiver of lien recovery and/or may condition a waiver upon the applicant's agreement and provision of security for repayment in appropriate cases if the limited waiver would address reasonably the applicant's hardship.

(8) The department shall provide the applicant written notice of its determination on an application for an undue hardship waiver of lien recovery.

(9) An applicant aggrieved by an adverse determination on an application for an undue hardship waiver of lien recovery may assert a claim of entitlement to an undue hardship waiver as provided in 53-6-180 (1)(c), MCA, rather than through an administrative review, fair hearing or contested case hearing under the Montana Administrative Procedure Act or the department's rules.

History

Authorizing statute(s): 53-6-180, 53-6-189, MCA
Implementing statute(s): 53-6-180, MCA
History: NEW, 1995 MAR p. 2837, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.437 Medicaid Real Property Lien, Spouse's Limited Recovery Exemption

(1) The department shall provide to the recipient's surviving spouse an exemption from recovery on a lien under 53-6-171 , MCA to the extent and under the conditions specified in 53-6-182 , MCA, according to the procedures and requirements specified in this rule.

(a) An exemption may be granted under this rule only to forego, prevent or reduce a recovery under a lien previously imposed under 53-6-171 , MCA. An exemption may not be granted under this rule to forego or prevent imposition of a lien under 53-6-171 , MCA.

(2) A recipient's spouse may request the exemption by filing an application on the form prescribed by the department. Application forms may be obtained from and must be filed with the Department of Public Health and Human Services, Quality Assurance Division, Lien Recoveries, 2401 Colonial Drive, Helena, P.O. Box 202953, Helena MT 59620-2953. Application forms may also be obtained from county human services or welfare offices, but must be filed with the Quality Assurance Division Office in Helena at the above address.

(a) The department may require the applicant to submit any information and documentation regarding the applicant's finances, property, employment, liabilities, expenses, fair market value of assets, and other matters relevant and necessary to determine entitlement to and the amount of any exemption under this rule.

(3) The department must provide the applicant notice of its determination on an application for the spousal exemption. The notice must inform the applicant of the right to a fair hearing as provided in (4).

(4) An applicant aggrieved by the department's determination on an application for a spousal exemption under this rule is entitled to a fair hearing according to the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.318, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337. The applicant or recipient must request the hearing within 30 days of receipt of the notice required under (3).

(5) If a hearing is requested, the department may, subject to order of the hearing officer or a court having jurisdiction of the matter, take action to preserve the security of the lien but may not take further action to recover upon the lien until permitted to do so by order of the hearing officer or a court of law, which may be granted after a determination on the merits or before a determination on the merits upon a demonstration by the department that the lien is necessary to prevent the applicant or another party from disposing of the property to avoid the lien.

History

Authorizing statute(s): 2-4-201, 53-6-182, 53-6-189, MCA
Implementing statute(s): 2-4-201, 53-6-182, MCA
History: NEW, 1995 MAR p. 2837, Eff. 12/22/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.82.438 Medicaid Real Property Lien, Release of Lien After Recipient's Return Home

(1) If a recipient upon whose real property the department has imposed a lien under 53-6-171 , MCA has been discharged from the facility and has returned home, the department shall upon written request file a release of the lien in the clerk and recorder's office.

(2) The written request must contain the name and social security number of the recipient and must be accompanied by a copy of the legal description of the property subject to the lien.

(3) The department may require reasonable documentation or verification that the recipient has been discharged from the facility and returned home.

History

Authorizing statute(s): 53-6-189, MCA
Implementing statute(s): 53-6-174, MCA
History: NEW, 1995 MAR p. 2837, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 476.

Subchapter 37.82.7 Eligibility Requirements for the Noninstitutionalized Categorically Needy: AFDC-Related Families and Children

Mont. Admin. R. 37.82.701 Groups Covered, Noninstitutionalized Families and Children

(1) Medicaid will be provided to:

(a) Individuals under age 19 who currently reside in Montana and are receiving foster care, guardianship, or adoption assistance under Title IV-E of the Social Security Act, whether or not such assistance originated in Montana. Eligibility requirements for Title IV-E foster care and adoption assistance are found in ARM 37.50.101, 37.50.105, 37.50.106, and 45 CFR part 233.

(b) Individuals who have been receiving assistance in the nonmedically needy family Medicaid program and whose assistance is terminated because of earned income. These individuals may continue to receive Medicaid for any or all of the 6 calendar months immediately following the month in which nonmedically needy family Medicaid is last received, providing:

(i) in cases where assistance was terminated due to earned income, a member of the assistance unit continues to be employed during the 6 months; however, eligibility may continue even though no member of the assistance unit is employed if there was a good cause as defined in the family-related Medicaid Manual, section 1508-1, as incorporated by reference in ARM 37.82.101, for the termination or loss of employment;

(ii) they received nonmedically needy family Medicaid for three of the six months immediately prior to the month they became ineligible for nonmedically needy family Medicaid coverage; and

(iii) there continues to be an eligible child in the assistance unit. This coverage group is known as the "family-transitional."

(c) Individuals under age 19 who live with a specified caretaker relative as defined in the family-related Medicaid manual, section 201-1, as incorporated by reference in ARM 37.82.101, and who meet all other eligibility requirements.

(d) A pregnant woman whose pregnancy has been verified and whose family income and resources meet the requirements listed in ARM 37.82.1106, 37.82.1107, and 37.82.1110. This coverage group is known as the "qualified pregnant woman group." The unborn child shall be considered an additional member of the filing unit for purposes of determining eligibility.

(e) A pregnant woman whose pregnancy has been verified, whose family income does not exceed 157% of the federal poverty guidelines. This coverage group is known as the "pregnancy group."

(i) The unborn child shall be considered an additional member of the filing unit for purposes of determining eligibility.

(ii) Newborn children are continuously eligible through the month of their first birthday, provided they continue to reside in Montana. This coverage group is known as the "child-newborn group."

(f) A pregnant woman during a period of presumptive eligibility.

(i) Presumptive eligibility is established by submission of an application by the applicant on the form specified by the department, to a qualified presumptive eligibility provider, verification of pregnancy and a determination by the qualified presumptive eligibility provider that applicant's household income and resources do not exceed the income and resource standards specified in (1)(e).

(A) A qualified presumptive eligibility provider is an entity which meets the requirements specified in section 3570 of the state Medicaid Manual, published by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services and who is enrolled with the department as a qualified presumptive eligibility provider under the presumptive eligibility program. Section 3570 of the state Medicaid Manual is adopted and incorporated by this reference. A copy of the manual section may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson St., P.O. Box 202925, Helena, MT 59620-2925.

(B) Presumptive eligibility determinations shall be effective through the earlier of the date the department makes a determination of eligibility or ineligibility based upon a Medicaid application, or the last day of the month following the month of the presumptive eligibility determination, if no Medicaid application is filed within such period. An individual is limited to one presumptive eligibility period per pregnancy.

(C) The applicant or recipient shall be entitled to a fair hearing with respect to a determination by the department based upon a Medicaid application.

(ii) During a period of presumptive eligibility, a pregnant woman is limited to ambulatory prenatal care services covered under the Montana Medicaid program. Such services may be provided by any Medicaid provider eligible to receive Medicaid reimbursement for such services under applicable law and regulations.

(g) A pregnant woman who becomes ineligible for Medicaid due solely to increased income and whose countable resources do not exceed $3,000 and whose pregnancy is disclosed to the department prior to the effective date of Medicaid closure. This coverage group is known as the "continuous pregnant woman group." Eligibility shall be continuous without lapse in Medicaid eligibility from the prior Medicaid eligibility and shall terminate on the last day of the month in which the 12-month postpartum period ends.

(h) A child who has not yet reached age 19, whose family income does not exceed 143% of the federal poverty guidelines. This coverage group is known as the "Healthy Montana Kids (HMK) Plus" group. Children determined eligible under the Healthy Montana Kids Plus program will receive up to 12 months of continuous coverage.

(i) Individuals under the age of 21 who are receiving foster care or subsidized adoption payments through child welfare services. These individuals must have full or partial financial responsibility assumed by public agencies and must have been placed in foster homes, private institutions, or private homes by a nonprofit agency.

(j) A child of a minor custodial parent when the custodial parent is living in the child's grandparent's home and the grandparent's income is the sole reason rendering the child ineligible for nonmedically needy family Medicaid.

(k) Needy caretaker relatives as defined in the family-related Medicaid Manual, section 201-1, as incorporated by reference in ARM 37.82.101, who have in their care an individual under age 19 who is eligible for Medicaid, and whose countable income does not exceed the state's family Medicaid standards as defined in the family-related Medicaid Manual, section 002.

(l) A child through the month of the child's 19th birthday, who lives in a household whose income exceeds the categorically needy standards and resources do not exceed the resource standards specified in ARM 37.82.1106, 37.82.1107, and 37.82.1110. This coverage group is known as the "family medically needy group."

(m) Individuals, under the age of 65 who have been screened through the Montana Breast and Cervical Health Program who:

(i) have been diagnosed with cancer or precancer of the breast or cervix;

(ii) do not have creditable coverage to pay for their cancer/precancer treatment;

(iii) have countable income that does not exceed 250% of the federal poverty level at the time of screening and enrollment into the Montana Breast and Cervical Health Program; and

(iv) are not eligible for any other nonmedically needy Medicaid coverage group. This coverage group is known as "breast and cervical cancer treatment."

(n) Families who, due to receipt of new or increased spousal support, lose eligibility for nonmedically needy family Medicaid. To be eligible the family must:

(i) receive new or increased spousal support in an amount great enough to cause their nonmedically needy family Medicaid eligibility to end; and

(ii) have received nonmedically needy family Medicaid in Montana for three of six months prior to the closure of nonmedically needy family Medicaid. The coverage will continue for four consecutive months. This program is known as the "family-extended group."

(o) Women ages 19 through 44, who have not been otherwise determined eligible for Medicaid under this title, who are able to become pregnant but are not now pregnant, whose household income does not exceed 211% of the federal poverty level. Services are limited to those family planning services defined at ARM 37.86.1707 and not covered by third party health coverage. This program is limited to 4,000 women at any given time and is known as Plan First. Plan First will not pay any copay or deductible required by a member's third party health coverage.

(2) Medicaid will continue until the last day of the month in which the 12-month postpartum period ends for pregnant women as long as the pregnant woman was eligible for and receiving Medicaid on the date pregnancy ends.

(3) Medicaid may be provided for up to three months prior to the date of application for individuals listed in (1)(a), (1)(c), (1)(d), (1)(g), (1)(h), (1)(i), (1)(j), (1)(k), (1)(l), and (1)(m) if all financial and nonfinancial eligibility criteria are met as of the date medical services were received in each of those months.

History

Authorizing statute(s): 53-4-212, 53-4-1105, 53-6-113, MCA
Implementing statute(s): 53-4-231, 53-4-1104, 53-4-1105, 53-6-101, 53-6-131, 53-6-134, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1984 MAR p. 1478, Eff. 10/12/84; AMD, 1985 MAR p. 500, Eff. 5/17/85; AMD, 1986 MAR p. 1604, Eff. 9/26/86; AMD, 1987 MAR p. 1655, Eff. 9/25/87; AMD, 1989 MAR p. 883, Eff. 7/1/89; AMD, 1990 MAR p. 541, Eff. 4/1/90; AMD, 1990 MAR p. 542, Eff. 4/1/90; AMD, 1991 MAR p. 516, Eff. 4/26/91; AMD, 1991 MAR p. 1046, Eff. 6/28/91; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2002 MAR p. 1773, Eff. 6/28/02; AMD, 2006 MAR p. 2418, Eff. 10/6/06; AMD, 2007 MAR p. 302, Eff. 3/9/07; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2009 MAR p. 2494, Eff. 1/1/10; AMD, 2012 MAR p. 757, Eff. 5/1/12; AMD, 2014 MAR p. 2166, Eff. 9/19/14; AMD, 2018 MAR p. 2240, Eff. 11/3/18; AMD, 2024 MAR p. 2021, Eff. 8/10/24; AMD, 2024 MAR p. 2284, Eff. 9/21/24.

Mont. Admin. R. 37.82.702 Nonfinancial Requirements, Noninstitutionalized Faim Financial Assistance Related Families and Children

(1) Individuals eligible for FAIM financial assistance are presumed to have met the nonfinancial requirements of the Medicaid program.

(2) For individuals under 19 who are not eligible for foster care or adoption assistance under Title IV-E or do not qualify as dependent children, the nonfinancial requirements for Medicaid under this subchapter are as provided in ARM 37.82.701(3).

History

Authorizing statute(s): 53-4-211, 53-4-212, 53-4-231, 53-6-113, MCA
Implementing statute(s): 53-4-211, 53-4-212, 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1991 MAR p. 1734, Eff. 9/13/91; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.703 Financial Requirements, Noninstitutionalized Faim Financial Assistance Related Families and Children

(1) Individuals eligible for FAIM financial assistance are presumed to have met all the financial requirements for Medicaid eligibility.

(2) Notwithstanding the above and in accordance with ARM 37.82.701(1)(d), for purposes of this coverage group:

(a) the increase in OASDI benefits on July 1, 1972 will be excluded from unearned income; and

(b) ineligibility for FAIM financial assistance on the basis of the gross monthly income test found in ARM 37.78.420 will not preclude continued Medicaid coverage under ARM 37.82.701(1)(c).

(3) For individuals under 19 who are not eligible for foster care or adoption assistance under Title IV-E or do not qualify as dependent children, the FAIM financial requirements which are set forth in ARM 37.78.401, 37.78.402, 37.78.406, 37.78.407, and 37.78.420 will be used to determine whether:

(a) the individual in his placement is eligible with respect to resources;

(b) the individual in his placement is eligible with respect to gross and net income and with respect to the applicable benefit standards.

(i) because the individual is not living with his parent, parental income will be considered only when actually contributed; and

(ii) applicable standards are the child only standards.

(4) In determining Medicaid eligibility, an unborn child is considered a family member.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-4-231, 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1987 MAR p. 1655, Eff. 9/25/87; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.704 Three Month Retroactive Coverage, Noninstitutionalized Faim Financial Assistance Related Families and Children

(1) Three month retroactive coverage will be provided to individuals determined eligible for Medicaid under this subchapter if:

(a) they received medical services during any of the three months prior to application;

(b) they are determined eligible for Medicaid on the 1st day of the month in the month or months medical services were received.

(c) Eligibility in the retroactive period will be determined in accordance with this subchapter, except that eligibility with respect to income will be determined using actual income received in the month or months of service.

(2) Under (1), Medicaid will pay only unpaid bills for services:

(a) incurred in the retroactive period;

(b) provided for in chapters 82, 83, 85, 86 and 88; and

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.710 Resource Exclusions: Family Medicaid for Noninstitutionalized Categorically Needy Children and Families

(1) In determining eligibility for noninstitutionalized categorically needy children and families under the family Medicaid coverage groups in regard to the factor of resources, no exclusions will be applied to any property that is not owned by a member of the filing or assistance unit. No exclusion will be applied to any property that is owned or held by any entity, including but not limited to a trust or corporation, limited liability company, or any other legal entity, instrument, device, or arrangement of any kind, under which a member of the filing or assistance unit does not own the property.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 2008 MAR p. 1325, Eff. 7/1/08.

Subchapter 37.82.9 Eligibility Requirements for the Non-Institutionalized Categorically Needy: SSI-Related Individuals and Couples

Mont. Admin. R. 37.82.901 Groups Covered, Non-Institutionalized Ssi-Related Individuals and Couples

(1) Medicaid will be provided to:

(a) Aged, blind or disabled individuals or couples receiving SSI, including:

(i) those receiving SSI pending final determination of blindness or disability;

(ii) those receiving SSI under an agreement with the social security administration to dispose of resources that exceed the SSI dollar limits on resources; and

(iii) those deemed to be receiving SSI under the special SSI eligibility status granted by the social security administration to certain severely impaired individuals who work.

(b) Aged, blind or disabled individuals or couples receiving mandatory state supplements.

(c) Aged, blind or disabled individuals or couples receiving only a state supplementary payment (but no SSI payment) under the optional state supplementary program established in ARM 37.43.101 through 37.43.104.

(2) Medicaid will also be provided to aged, blind or disabled individuals or couples who are not receiving SSI. This coverage is limited to:

(a) Individuals who would be eligible for SSI had they applied.

(b) Individuals who, in August 1972, were eligible for OASDI and who were also receiving OAA, AB, APTD, or AABD or would have been receiving such cash assistance had they applied, providing:

(i) they meet all current SSI non-financial requirements identified as applicable to medicaid eligibility in ARM 37.82.902;

(ii) they meet all current SSI resource limitations identified as applicable to medicaid eligibility in ARM 37.82.903; and

(iii) they would currently be eligible for an SSI payment if the increase in OASDI benefits on July 1, 1972 had not raised individual or couple income over the SSI income standards identified as applicable to medicaid eligibility in ARM 37.82.903.

(c) Individuals who are receiving OASDI and were receiving SSI but became ineligible due solely to a cost-of-living increase in OASDI paid under section 215(i) of the Social Security Act after April 1977, providing they would still be eligible for SSI if such increases were excluded from income.

(d) Individuals who would currently be eligible for an SSI payment if the January 1, 1984, increase in social security retirement benefits for disabled widows or widowers had not raised the individual income over the SSI income standards identified as applicable to medicaid eligibility in ARM 37.82.903.

(e) Widow(er)s who no longer receive SSI benefits or state supplemental payments as a result of becoming entitled to and receiving Title II benefits. Coverage is limited to individuals who are:

(i) between the ages of 60 and 65;

(ii) eligible for and receiving early widow(er) 's benefits from social security;

(iii) ineligible for SSI benefits or state supplemental payments due to receipt of social security early widow(er) 's benefits; and

(iv) not entitled to medicare Part A (hospital insurance) .

(3) Medicaid will also be provided to aged, blind or disabled individuals or couples who are not receiving a state supplementary payment under the optional state supplementary program. This coverage is limited to:

(a) Individuals who, in August 1972, were eligible for OASDI and who were also receiving OAA, AB, APTD, or AABD or would have been receiving such cash assistance had they applied, providing:

(i) they meet all current optional state supplementary program non-financial requirements identified as applicable to medicaid eligibility in ARM 37.82.902;

(ii) they meet all current optional state supplementary program resource limitations identified as applicable to medicaid eligibility in ARM 37.82.903; and

(iii) they would currently be eligible for a state supplementary payment if the increase in OASDI benefits on July 1, 1972 had not raised individual or couple income over the optional state supplementary program income standards identified as applicable to medicaid eligibility in ARM 37.82.903.

(b) Individuals who are receiving OASDI and were receiving a state supplementary payment under the optional state supplementary program but became ineligible due solely to a cost-of-living increase in OASDI paid under section 215(i) of the Social Security Act after April 1977, providing they would still be eligible for a state supplementary payment if such increases were excluded from income.

(4) Finally, medicaid will be provided to individuals who were eligible for medicaid in December 1973. This coverage is limited to:

(a) Individuals who in December 1973 were eligible for medicaid as an essential spouse of a recipient of OAA, AB, APTD, or AABD, providing:

(i) the spouse has continued to live with and be essential to the well being of the former recipient of OAA, AB, APTD, or AABD;

(ii) the former recipient of OAA, AB, APTD, or AABD continues to meet the December 1973 eligibility requirements; and

(iii) the spouse continues to meet the December 1973 requirements for having his needs included in computing the cash payment available in December 1973.

(b) Individuals who meet all current SSI non-financial and financial requirements identified as applicable to medicaid eligibility in ARM 37.82.902 and 37.82.903 except the blindness or disability criteria, providing:

(i) they were eligible for medicaid in December 1973 as blind or disabled; and

(ii) for each consecutive month after December 1973, they continue to meet not only the December 1973 blindness or disability criteria, but also all other December 1973 eligibility criteria.

(5) Medicaid will be provided to a disabled widow, disabled widower or disabled surviving divorced spouse who loses supplemental security income benefits or state supplemental payments and therefore medicaid eligibility because the person is determined to be eligible for social security, if the person meets the following criteria:

(a) The person was eligible for supplemental security income or state supplemental payments the month before the person began receiving social security benefits;

(b) The person would continue receiving supplemental security income or state supplemental payments if the person's social security benefit was not counted as income; and

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1987 MAR p. 208, Eff. 2/27/87; AMD, 1988 MAR p. 2231, Eff. 10/14/88; AMD, 1991 MAR p. 1049, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.902 Non-Financial Requirements, Non-Institutionalized Ssi-Related Individuals and Couples

(1) Aged, blind or disabled individuals or couples receiving SSI, mandatory state supplements, or only a state supplementary payment under the optional state supplementary program are presumed to have met the non-financial requirements for medicaid eligibility.

(2) For individuals and couples under the heading aged, blind or disabled individuals or couples who are not receiving SSI, the SSI non-financial requirements which are set forth in 20 CFR Part 416, Subparts H and I, will be used to determine whether an individual is aged, blind or disabled. 20 CFR Part 416, Subpart H, contains the SSI criteria for determining age, and 20 CFR Part 416, Subpart I, contains the SSI criteria for determining blindness and disability. The department hereby adopts and incorporates by reference 20 CFR Part 416, Subparts H and I. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

(3) For individuals and couples under the heading aged, blind or disabled individuals or couples who are not receiving a state supplementary payment under the optional state supplementary program, the optional state supplementary program non-financial requirements set forth in ARM 37.43.101 through 37.43.104 will be used to determine whether an individual is aged, blind or disabled and is certified as requiring the services covered by the state supplementary payment.

(4) For individuals under the heading individuals who were eligible for medicaid in December 1973, the December 1973 OAA, AB, APTD, or AABD non-financial requirement will be used to determine whether an individual continues to be a medicaid eligible essential spouse, as provided in ARM 37.82.901(4) (a) , or may be considered blind or disabled in spite of SSI criteria, as provided in ARM 37.82.902(4) (b) . A copy of the December 1973 OAA, AB, APTD, and AABD non-financial requirements may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.903 Financial Requirements, Non-Institutionalized Ssi-Related Individuals and Couples

(2) For individuals and couples under the heading aged, blind or disabled individuals or couples who are not receiving SSI, the SSI financial requirements which are set forth in 20 CFR Part 416, Subparts J, K and L, will be used to determine whether an individual or couple is eligible with respect to resources and with respect to income. 20 CFR Part 416, Subpart J, contains the SSI criteria for evaluating family relationships; 20 CFR Part 416, Subpart K, for evaluating income, including the income of financially responsible relatives; and 20 CFR Part 416, Subpart L, for evaluating resources, including the resources of financially responsible relatives. The department hereby adopts and incorporates by reference 20 CFR Part 416, Subparts J, K and L. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

(a) Notwithstanding the above and in accordance with ARM 37.82.901(2) (b) , (c) , (d) and (e) for purposes of this coverage group:

(i) the increase in OASDI benefits on July 1, 1972, will be excluded from unearned income;

(ii) any cost-of-living increases in OASDI paid under section 215(i) of the Social Security Act after April 1977 will be excluded from unearned income; and

(iii) the January 1, 1984, increase in social security disabled widow's and widower's benefits caused by an elimination factor for individuals who became entitled to said benefits before age 60 will be excluded from unearned income; and

(iv) Title II early widow(er) 's benefits for individuals who meet eligibility criteria at ARM 37.82.901(2) (e) will be excluded from unearned income.

(b) In addition, aged, blind or disabled individuals who would be institutionalized solely because of the income and resources requirements relating to financially responsible relatives will be exempt from those requirements and such individuals will have their eligibility determined on the basis of their own income and resources if the department approves such an exemption. The administrative mechanism for approval of this exemption shall consist of:

(i) The department shall review individual cases.

(ii) The department will accept applications for exemption only from department long term care specialists, and developmental disabilities division area office staff, who must recommend that the income and resources requirements relating to financially responsible relatives not be applied in the particular case.

(iii) The application must justify the exemption by showing that:

(A) The economic burden on the financially responsible relative for the care of the individual is the sole reason that institutionalization of the individual is being pursued. The burden on the financially responsible relative of personally providing care to the individual is not a factor.

(B) Enabling the applicant to be eligible for medicaid on the basis of his own income and resources will result in an individual plan of care for home and community-based services which is feasible and cost-effective as provided in ARM 37.40.1421.

(c) For a disabled widow, disabled widower or disabled surviving divorced spouse receiving social security benefits who is eligible for medicaid as provided in ARM 37.82.901 the social security benefits are excluded from countable income.

(3) For individuals and couples under the heading aged, blind or disabled individuals or couples who are not receiving a state supplementary payment under the optional state supplementary program, the optional state supplementary program financial requirements set forth in ARM 37.43.101 through 37.43.104 will be used to determine whether an individual or couple is eligible with respect to resources and with respect to income.

(a) Notwithstanding the above and in accordance with ARM 37.82.901(3) (a) and (b) , for purposes of this coverage group:

(i) the increase in OASDI benefits on July 1, 1972 will be excluded from unearned income; and

(ii) any cost-of-living increases in OASDI paid under section 215(i) of the Social Security Act after April 1977 will be excluded from unearned income.

(4) For individuals under the heading individuals who were eligible for medicaid in December 1973, the December 1973 OAA, AB, APTD, or AABD financial requirements will be used to determine whether the individual continues to be eligible with respect to December 1973 medicaid financial criteria. A copy of the December 1973 OAA, AB, APTD, and AABD financial requirements may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

(a) When individuals under this heading must also meet current medicaid financial requirements, as provided in ARM 37.82.901(4) (b) , the SSI financial requirements identified in (2) above apply.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-131 and 53-6-402, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1983 MAR p. 1079, Eff. 8/15/83; AMD, 1987 MAR p. 208, Eff. 2/27/87; AMD, 1988 MAR p. 2231, Eff. 10/14/88; AMD, 1991 MAR p. 1049, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.904 Three Month Retroactive Coverage, Non-Institutionalized Ssi-Related Individuals and Couples

(1) Three month retroactive coverage will be provided to individuals determined eligible for medicaid under this subchapter if:

(a) they received medical services during any of the three months prior to application;

(b) they are determined eligible for medicaid in the month or months medical services were received.

(2) Under (1) , medicaid will pay only unpaid bills for service:

(a) incurred in the retroactive period;

(b) provided for in this chapter; and

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.910 Resource Exclusions: Aged, Blind, and Disabled Medicaid for Noninstitutionalized Individuals and Couples

(1) In determining eligibility for noninstitutionalized categorically needy individuals and couples under the aged, blind, and disabled Medicaid coverage groups in regard to the factor of resources, no exclusions will be applied to any property that is not owned by a member of the filing or assistance unit. No exclusion will be applied to any property that is owned or held by any entity, including but not limited to a trust or corporation, limited liability company, or any other legal entity, instrument, device, or arrangement of any kind, under which a member of the filing or assistance unit does not own the property.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 2008 MAR p. 1325, Eff. 7/1/08.

Subchapter 37.82.10 Medicaid for Workers With Disabilities

Mont. Admin. R. 37.82.1002 Medicaid for Workers with Disabilities: Definitions

The following definitions apply to this subchapter:

(1) "Employed" means engaged in work for which the individual receives or seeks to receive income, either as an employee or as a self-employed person. An individual is considered to be employed only if Medicare and social security taxes are withheld from the income received for the work or, in the case of a self-employed individual, if the individual pays Medicare and social security taxes on any income received for the work.

(2) "Family" means the individual applying for or receiving Medicaid and any relative or relatives who reside with the individual and whose income and resources are deemed available to the individual pursuant to the supplemental security income (SSI) regulations in 20 CFR, part 416, subparts K and L, as amended through May 17, 2010, which are adopted and incorporated by reference. 20 CFR part 416, subpart K, contains the SSI criteria for evaluating income, including the income of financially responsible relatives. 20 CFR, part 416, subpart L, contains the SSI criteria for evaluating resources, including the resources of financially responsible relatives. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson Street, 5th Floor, P.O. Box 202925, Helena, MT 59620-2925.

(3) "Gross income" means an individual's income before any deductions or disregards provided in 20 CFR, part 416, subpart K, are subtracted.

(4) "Income" has the meaning provided in 20 CFR, part 416.1102 and 416.1103 as amended through May 17, 2010.

(5) "Indian" means any person who is a member of an Indian tribe.

(6) "Indian tribe" means any Indian tribe, band, nation, or other organized group or community, including any Alaskan native village or group or regional or village corporation as defined in or established pursuant to the Alaskan Native Claims Settlement Act, 43 USCS section 1601 et seq., that is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians.

(7) "Retirement or pension fund or plan" means a fund or plan specifically established and earmarked for the sole purpose of providing financial resources for a person who is retired from gainful employment or who is no longer employed by a particular employer. Examples of a retirement or pension fund or plan are 457 plans, conventional 401(k) plans, SIMPLE 401(k) plans, employer-based defined benefit plans, Public Employee Retirement System (PERS) accounts for Montana state employees, thrift savings plan accounts for federal employees, section 403(b) plans, section 501(c)(18) plans, Keogh plans, individual retirement accounts (IRAs), Roth IRAs, SIMPLE IRAs, simplified employee pension (SEP) plans, employee profit sharing plans, and cash balance plans.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, 53-6-195, MCA
History: NEW, 2010 MAR p. 2733, Eff. 11/27/10.

Mont. Admin. R. 37.82.1003 Medicaid for Workers with Disabilities: Applicable Law

(1) Except as specifically provided in this subchapter or in the Aged Blind Disabled (ABD) Medicaid Manual adopted and incorporated by reference in ARM 37.82.101, the Medicaid for Workers with Disabilities program shall be administered in accordance with Title XIX of the Social Security Act, 42 USC 1396, et seq. and ARM Title 37, chapter 5, chapter 82, subchapters 1, 2, and 4, chapter 85, chapter 86, chapter 87, chapter 88, and chapter 90.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, 53-6-195, MCA
History: NEW, 2010 MAR p. 2733, Eff. 11/27/10.

Mont. Admin. R. 37.82.1004 Medicaid for Workers with Disabilities: General Eligibility Criteria

(1) An individual is eligible for benefits through the Medicaid for Workers with Disabilities program if the individual:

(a) is employed;

(b) has a disability as defined in 42 USC 1382c, except that the criteria that the individual must be unable to engage in substantial gainful activity does not apply;

(d) pays a cost-share amount as specified in ARM 37.82.1007; and

(e) satisfies all other eligibility requirements specified in the authorities cited in ARM 37.82.1003.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, 53-6-195, MCA
History: NEW, 2010 MAR p. 2733, Eff. 11/27/10.

Mont. Admin. R. 37.82.1005 Medicaid for Workers with Disabilities: Income

(1) An individual is eligible for benefits through the Medicaid for Workers with Disabilities program in regard to income if the individual's net family income is less than 250% of the 2011 U.S. Department of Health and Human Services poverty level for a family of that size.

(2) The individual's net family income will be determined using the income provisions of the supplemental security income (SSI) regulations at 20 CFR, part 416, subpart K, as amended through May 17, 2010, and of the Aged Blind Disabled (ABD) Medicaid Manual adopted and incorporated by reference in ARM 37.82.101. 20 CFR, part 416, subpart K, which contains the SSI criteria for evaluating income, including the income of financially responsible relatives, is adopted and incorporated by reference. In case of a conflict between a provision of 20 CFR, part 416, subpart K, and a provision of the ABD Medicaid Manual, the provision of the Medicaid Manual shall apply. The ABD Medicaid Manual is available for public viewing at each local office of public assistance or at the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson Street, 5th Floor, P.O. Box 202925, Helena, MT 59620-2925.

History

Authorizing statute(s): 53-6-113, 53-6-195, MCA
Implementing statute(s): 53-6-101, 53-6-131, 53-6-195, MCA
History: NEW, 2010 MAR p. 2733, Eff. 11/27/10; AMD, 2011 MAR p. 1823, Eff. 9/9/11.

Mont. Admin. R. 37.82.1006 Medicaid for Workers with Disabilities: Resources

(1) An individual is eligible in regard to resources if the individual's resources, including any resources of relatives deemed to be available to the individual pursuant to the supplemental security income (SSI) regulations at 20 CFR, part 416, subpart L, as amended through May 17, 2010, have a value of $8,000 or less. 20 CFR, part 416, subpart L, which contains the SSI criteria for evaluating resources, including the resources of financially responsible relatives, is adopted and incorporated by reference. A married individual who resides with his or her spouse is eligible in regard to resources if the resources of the individual and his or her spouse, including any resources of relatives deemed to be available to the individual pursuant to 20 CFR, part 416, subpart L, have a value of $12,000 or less.

(2) Except as provided in (3) below, the individual's resources will be determined using the resource provisions of SSI regulations at 20 CFR, part 416, subpart L, and of the ABD Medicaid Manual adopted by reference in ARM 37.82.101. In case of a conflict between a provision of 20 CFR, part 416, subpart L, and a provision of the ABD Medicaid Manual, the provision of the Medicaid Manual shall apply.

(3) Funds in a retirement or pension fund or plan are excluded as a resource.

History

Authorizing statute(s): 53-6-113, 53-6-195, MCA
Implementing statute(s): 53-6-131, 53-6-195, MCA
History: NEW, 2010 MAR p. 2733, Eff. 11/27/10.

Mont. Admin. R. 37.82.1007 Medicaid for Workers with Disabilities: Cost Share Fees

(1) Except as provided in (2) below, an otherwise eligible individual must make a monthly cost share fee in accordance with the table in (3) below, as a condition of eligibility for benefits under the Medicaid for Workers with Disabilities program. The payment is based on the gross income of the individual only, not the individual's family income. The amount of the payment varies depending on what percentage of the federal poverty level for a family of one the individual's gross income represents.

(2) Indians are not required to pay any cost share fee regardless of their income.

(3) The amount of an individual's cost share fee will be determined using the following table:

Gross Income as a percentage of federal poverty level (FPL) | Monthly gross income dollar amount | Monthly payment Up to 100% | $01.00 to $903 | $35 Over 100% to 150% | $903.01 to $1,354 | $67 Over 150% to 200% | $1,354.01 to $1,805 | $100 Over 200% to 250% | $1805.01 to $2,256 | $135

History

Authorizing statute(s): 53-6-113, 53-6-195, MCA
Implementing statute(s): 53-6-131, 53-6-195, MCA
History: NEW, 2010 MAR p. 2733, Eff. 11/27/10.

Subchapter 37.82.11 Eligibility Requirements for the Non-Institutionalized Medically Needy

Mont. Admin. R. 37.82.1101 Individuals Covered, Non-Institutionalized Medically Needy

(1) Medicaid under this subchapter will be provided to the following individuals who would be receiving FAIM financial assistance if their income had not exceeded the income standards found in ARM 37.78.420 provided they are also eligible under ARM 37.82.1102 , 37.82.1106 , 37.82.1107 and 37.82.1110 :

(a) pregnant women whose pregnancy has been verified;

(b) individuals who are under the age of 18 or are age 18 and a full-time student in a secondary school and can reasonably be expected to obtain a secondary school diploma or its equivalent in or before the month of their 19th birthday;

(c) a child born on or after October 1, 1983, through the month of their 19th birthday whose family income and resources meet the requirements listed in ARM 37.78.401 and 37.82.1106 ;

(d) individuals under age 19 who are ineligible for medicaid under ARM 37.82.701 ; and

(e) individuals in a FAIM financial assistance lump sum period of ineligibility.

(2) This group does not include individuals whose cash assistance is terminated solely because of increased income from employment and who, under ARM 37.82.701 , are receiving continued medicaid coverage. However, this group may be eligible when the medicaid coverage terminates.

(3) This group does not include coverage for the caretaker relative, as defined in ARM 46.10.403.

(4) Medicaid under this subchapter will also be provided to the following groups of non-institutionalized SSI-related individuals and couples:

(a) Individuals who would be receiving SSI if their income had not exceeded the current SSI income standards.

(i) This group does not include aged, blind or disabled individuals or couples receiving mandatory state supplements or only a state supplementary payment (but no SSI payment) under the optional state supplementary program established in ARM 37.43.101 through 37.43.104 . Under subchapter 9, these individuals are eligible for medicaid on the basis of income standards higher than the current SSI income standards. However, this group does include such individuals when increased income causes ineligibility for such supplementary payments. At this juncture, for the purposes of medicaid under the present subchapter, any income used to meet needs previously met by the supplementary payment is not excluded from income.

(ii) This group does not include individuals who are currently ineligible for SSI or only a state supplementary payment under the optional state supplementary program because the increase in OASDI benefits they received on July 1, 1972, raised individual or couple income over the current SSI or optional state supplementary program income standards. These individuals, under ARM 37.82.901 (2) (b) and (3) (a) and 37.82.903 (2) and (3) , have their July 1, 1972, increase in OASDI benefits excluded from unearned income and are determined eligible for medicaid under subchapter 9. However, this group does include such individuals when, after excluding the July 1, 1972 increase in OASDI benefits, other income causes ineligibility for medicaid under subchapter 9. At this juncture, for the purposes of medicaid under the present subchapter, the July 1, 1972, increase in OASDI benefits is no longer excluded from but is counted as unearned income.

(iii) This group does not include individuals who are currently ineligible for SSI or only a state supplementary payment under the optional state supplementary program solely due to a cost-of-living increase in OASDI paid under section 215 (i) of the Social Security Act after April, 1977. These individuals, under ARM 37.82.901 (2) (c) and (3) (b) and 37.82.903 (2) and (3) , have such increases excluded from unearned income and are determined eligible for medicaid under subchapter 9. However, this group does include such individuals when, after excluding such increases, other income causes ineligibility for medicaid under Chapter 85, subchapter 20. At this juncture, for the purposes of medicaid under the present subchapter, cost-of-living increases in OASDI paid under section 215(i) of the Social Security Act after April, 1977, are no longer excluded from but are counted as unearned income.

(iv) This group does not include individuals who in December, 1973, were eligible for medicaid as an essential spouse of a recipient of OAA, AB, APTD, or AABD. These individuals are eligible for medicaid under subchapter 9 if the provisions of ARM 37.82.901 (4) (a) , 37.82.902 (4) , and 37.82.903 (4) are met. When medicaid under subchapter 9 is lost, such individuals must qualify for medicaid under the present subchapter in their own right. Medicaid under the present subchapter does not provide for coverage of an essential person.

(v) This group does not include individuals who would be eligible for SSI had they applied. These individuals are not relevant to medicaid under this subchapter.

(b) Individuals who, under ARM 37.82.901 (4) (b) and 37.82.903 (4) , would be eligible for medicaid under subchapter 9, on the basis of December, 1973, blindness or disability criteria, if their income had not exceeded the income standards specified in ARM 37.82.903 (4) .

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1991 MAR p. 265, Eff. 3/1/91; AMD, 1991 MAR p. 1046, Eff. 6/28/91; AMD, 1993 MAR p. 1398, Eff. 7/1/93; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1102 Non-Financial Requirements, Non- Institutionalized Medically Needy

(1) Except as provided in (2) , for groups covered under ARM 37.82.1101 (1) , the AFDC nonfinancial requirements which are set forth in ARM 46.10.301 through 46.10.307, 46.10.320 and 46.10.321 will be used to determine whether:

(a) an individual under age 19 is considered a dependent child because he is deprived of parental support or care;

(b) an individual is an eligible member of a family with a dependent child; and

(c) notwithstanding the above and in accordance with ARM 37.82.1101 (1) (c) , (d) , and (e) , the school attendance requirement found in ARM 46.10.301 and the JOBS participation requirements found in ARM 46.10.805 through 46.10.847 do not apply to this coverage group.

(2) In the case of individuals under 21 who are ineligible for medicaid under ARM 37.82.701 (1) (b) (iii) and (3) , the nonfinancial requirements for medicaid under this subchapter are as provided in ARM 37.82.701 (3) .

(3) Except as provided in (4) , for groups under non-institutionalized SSI-related individuals and couples, the SSI nonfinancial requirements which are set forth in 20 CFR, part 416, subparts H and I, will be used to determine whether an individual is aged, blind or disabled.

(a) 20 CFR part 416, subpart H, contains the SSI criteria for determining age.

(b) 20 CFR part 416, subpart I, contains the SSI criteria for determining blindness and disability.

(c) The department hereby adopts and incorporates by reference 20 CFR part 416, subparts H and I. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

(4) For individuals who, under ARM 37.82.1101 (2) (b) , may meet the December 1973 blindness or disability criteria instead of the current SSI criteria, see ARM 37.82.902 (4) for these.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1991 MAR p. 265, Eff. 3/1/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1106 Medically Needy Income Standards

(1) To be eligible for medically needy assistance, SSI and family-related institutionalized and non-institutionalized recipients must meet:

(a) non-financial criteria of ARM 37.82.1102 ;

(b) resource criteria of ARM 37.82.1110 ; and

(2) Medically needy recipients must participate in cost sharing as provided for in ARM 37.85.204 .

(3) The adjusted income for individuals and families is compared to the following table to determine medically needy assistance eligibility.

(a) Since families who are not residing in an institution are assumed to have a shelter obligation, an amount for shelter obligation is included in each level.

(b) Institutionalized recipients must also meet the income criteria of ARM 37.82.1320 .

MEDICALLY NEEDY INCOME LEVELS

FOR SSI and FAMILY-RELATED

INDIVIDUALS AND FAMILIES

Family Size | | One Month Net Income Level 1 | | $ 525 2 | | 525 3 | | 658 4 | | 792 5 | | 925 6 | | 1,058 7 | | 1,192 8 | | 1,317 9 | | 1,383 10 | | 1,450 11 | | 1,508 12 | | 1,558 13 | | 1,608 14 | | 1,658 15 | | 1,700 16 | | 1,742

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, 53-6-131 and 53-6-141, MCA
History: NEW, 1981 MAR p. 769, Eff. 7/31/81; AMD, 1982 MAR p. 105, Eff. 1/29/82; AMD, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1982 MAR p. 1280, Eff. 7/1/82; AMD, 1983 MAR p. 757, Eff. 7/1/83; EMERG, AMD, 1983 MAR p. 1933, Eff. 1/1/84; AMD, 1984 MAR p. 328, Eff. 2/17/84; AMD, 1985 MAR p. 181, Eff. 2/15/85; AMD, 1985 MAR p. 1027, Eff. 7/26/85; AMD, 1985 MAR p. 2051, Eff. 12/27/85; AMD, 1987 MAR p. 163, Eff. 2/14/87; AMD, 1987 MAR p. 1346, Eff. 8/14/87; AMD, 1987 MAR p. 2172, Eff. 11/28/87; AMD, 1987 MAR p. 2397, Eff. 1/1/88; AMD, 1989 MAR p. 232, Eff. 1/27/89; AMD, 1990 MAR p. 853, Eff. 4/27/90; AMD, 1990 MAR p. 1334, Eff. 7/13/90; AMD, 1991 MAR p. 265, Eff. 3/1/91; AMD, 1991 MAR p. 1050, Eff. 6/28/91; AMD, 1992 MAR p. 1405, Eff. 7/1/92; AMD, 1992 MAR p. 2398, Eff. 10/30/92; AMD, 1993 MAR p. 1398, Eff. 7/1/93; AMD, 1994 MAR p. 1750, Eff. 7/1/94; AMD, 1995 MAR p. 1246, Eff. 7/1/95; AMD, 1997 MAR p. 502, Eff. 3/11/97; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2002 MAR p. 1773, Eff. 6/28/02.

Mont. Admin. R. 37.82.1107 Income Eligibility, Noninstitutionalized Medically Needy

(1) Medically needy income eligibility for non-institutionalized and family-related persons will be computed using a one month prospective budget period.

(a) For groups covered under ARM 37.82.1101 (1)(a) through (1)(e), monthly countable income will be determined using family-related medicaid income requirements, in particular those with respect to prospective budgeting and earned income disregards, set forth in the Family Medicaid Program Policy Manual, sections 601-1 and 602-1.

(i) In the case of individuals whose income must be deemed when determining eligibility, the family-related medicaid income requirements contained in the Family Medicaid Program Policy Manual, section 603-1 will be used.

(ii) In the case of individuals under age 21 who reside in an inpatient psychiatric facility, only income which belongs to the individual or which is actually contributed to the individual will be used to determine eligibility.

(b) For groups covered under ARM 37.82.1101 (4)(a) and (b), countable income will be determined using the SSI income requirements set forth in 20 CFR, part 416, subpart K, as amended through January 1, 2022, which contains the SSI criteria for evaluating income, including the income of financially responsible relatives. The department adopts and incorporates by reference 20 CFR, part 416, subpart K, as amended through January 1, 2022. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, 1500 E. 6th Ave., P.O. Box 202925, Helena, MT 59620-2925.

(i) The exemption from the income requirements relating to financially responsible relatives as described at ARM 37.82.903 (2)(b) applies to individuals applying as medically needy.

(2) When an otherwise eligible family, individual or couple covered under ARM 37.82.1101 has countable income equal to or less than the applicable medically needy income level, the family, individual or couple is eligible for medicaid without an incurment of medical expenses.

(3) When an otherwise eligible individual or family covered under ARM 37.82.1101 has countable income which exceeds the medically needy income level, the individual or family will become eligible:

(a) on the first day of the month if the individual or family pays the cost-share amount for the month in cash to the department, eligibility begins on the first day of the month. The cost-share amount is equal to the difference between the individual's or family's countable income and the medically needy income level for that household size;

(i) Medical expenses may be used to reduce the cost-share amount. The only medical expenses which may be used are:

(A) expenses incurred by:

(I) eligible or ineligible individuals who are considered members of the household for family-medicaid; or

(II) eligible individuals or the eligible individual's spouse if there was income deemed from the spouse to the eligible individual for SSI related medicaid.

(B) expenses which are not the liability of a third party other than another public program of the state of Montana;

(C) expenses which have not been used to meet a prior incurment or used to reduce the cost-share amount in a prior period;

(D) expenses incurred by the individual or family or financially responsible relatives for necessary medical and remedial services that are recognized under state law but are not Montana medicaid covered services; or

(b) after a medical expense incurment is satisfied. The incurment is equal to the difference between the countable income and the medically needy income limit for the family size, less a living allowance deduction of $269. The living allowance deduction will adjust each year with the annual Social Security Cost of Living Adjustment (COLA). Eligibility will extend to the end of the budget period. The only medical expenses which may be used to meet the incurment requirement are:

(i) expenses incurred by:

(A) eligible or ineligible individuals who are considered members of the household for family-related medicaid; or

(B) eligible individuals or the eligible individual's spouse if there was income deemed from the spouse to the eligible individual for SSI related medicaid.

(ii) expenses which are not the liability of a third party other than another public program of the state of Montana or any of its political subdivisions;

(iii) expenses which have not been used to meet a prior incurment requirement;

(iv) expenses will be deducted in the following order:

(A) medicare and other health insurance premiums, deductibles, or coinsurance charges;

(B) expenses for necessary medical and remedial services that are recognized under Montana law but are not provided for under this chapter;

(v) for the retroactive budget period:

(A) paid and unpaid expenses incurred during the retroactive budget period; and

(B) paid or unpaid bills incurred in the three months immediately prior to the retroactive budget period.

(vi) for the prospective budget period:

(A) paid and unpaid expenses incurred during the three months immediately preceding the prospective budget period;

(B) paid and unpaid expenses incurred during the prospective budget period.

(4) Medicaid will pay only unpaid medical expenses:

(a) incurred by an eligible individual in the retroactive or prospective budget period;

(b) which have never been used to meet an incurment requirement;

(d) for which no third party payment is available.

(5) An unborn child is considered a family member when determining medicaid eligibility.

(6) A medically needy individual or family who paid the cost-share obligation but did not incur medical expenses equal to that cost-share obligation may request a refund of funds which exceed the provider billed charges.

History

Authorizing statute(s): 53-2-201, 53-4-212, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-4-231, 53-6-101, 53-6-131, 53-6-402, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1983 MAR p. 1079, Eff. 8/15/83; AMD, 1986 MAR p. 678, Eff. 4/25/86; AMD, 1987 MAR p. 1655, Eff. 9/25/87; AMD, 1991 MAR p. 265, Eff. 3/1/91; AMD, 1993 MAR p. 1398, Eff. 7/1/93; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2000 MAR p. 746, Eff. 3/17/00; AMD, 2002 MAR p. 1773, Eff. 6/28/02; AMD, 2022 MAR p. 1887, Eff. 9/24/22.

Mont. Admin. R. 37.82.1110 Resource Standards, Non-Institutionalized Medically Needy

(1) Except as provided in (2) for households receiving assistance in the FAIM project, the medically needy resource limitations are:

(2) For households receiving assistance in the FAIM project, the medically needy resource limitation is $3,000 regardless of the number of members in the household.

(3) To establish resource eligibility for the medically needy program:

(a) FAIM financial assistance related individuals and families will have resources evaluated according to ARM 37.78.401 . The value of the resources must not exceed the resource limit under (1) as of the date of application to be eligible for any part of the month.

(b) SSI related individuals will have resources evaluated according to 20 CFR part 416, subpart L, as amended through April 1, 1990. The department hereby adopts and incorporates by reference 20 CFR, part 416, subpart L, as amended through April 1, 1990. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952. SSI-related applicants must be within the applicable resource limit under (1) on the first moment of the first day of the coverage month.

(4) The exemption from the resource requirements relating to financially responsible relatives as described at ARM 37.82.903 (2 ) ( b) applies to individuals applying as medically needy.

Family

Size

1 $2,000

2 3,000

( a ) One hundred dollars will be added to the two person standard for each additional family member.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-131 and 53-6-402, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 678, Eff. 4/25/86; AMD, 1991 MAR p. 265, Eff. 3/1/91; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1111 Three Month Retroactive Coverage, Non-Institutionalized Medically Needy

(1) The retroactive period may include any or all of the three months immediately preceding the month of application.

(2) To be eligible for retroactive medically needy coverage, during each month of the retroactive period, SSI and AFDC-related persons and families must meet:

(a) non-financial criteria of ARM 37.82.1102 ;

(b) resource criteria of ARM 37.82.1110 as of the first day of the month; and

(c) income criteria of ARM 37.82.1107 except that income will be determined using actual income received in the retroactive period.

(3) Medical expenses incurred during the retroactive period will be paid according to ARM 37.82.1107 (4) .

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1991 MAR p. 265, Eff. 3/1/91; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1116 Resource Exclusions: Medically Needy Coverage for Noninstitutionalized Individuals, Couples, and Families

(1) In determining eligibility for noninstitutionalized medically needy individuals, couples, and families under the family Medicaid and aged, blind, and disabled Medicaid coverage groups in regard to the factor of resources, no exclusions will be applied to any property that is not owned by a member of the filing or assistance unit. No exclusion will be applied to any property that is owned or held by any entity, including but not limited to a trust or corporation, limited liability company, or any other legal entity, instrument, device, or arrangement of any kind, under which a member of the filing or assistance unit does not own the property.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 2008 MAR p. 1325, Eff. 7/1/08.

Subchapter 37.82.13 Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy

Mont. Admin. R. 37.82.1301 Definitions Relating to Institutional Status

(1) As used in this subchapter:

(a) "Active treatment in institutions for the mentally retarded" requires the following:

(i) The individual's regular participation, in accordance with an individual plan of care, in professionally developed and supervised activities, experiences, or therapies.

(ii) An individual written plan of care that sets forth measurable goals or objectives stated in terms of desirable behavior and that prescribes an integrated program of activities, experiences or therapies necessary for the individual to reach those goals or objectives. The overall purpose of the plan is to help the individual function at the greatest physical, intellectual, social, or vocational level he can presently or potentially achieve.

(iii) An interdisciplinary professional evaluation that:

(A) is completed for a recipient, before admission to the institution but not more than three months before, and for an individual applying for medicaid after admission, before the institution requests payment;

(B) consists of complete medical, social and psychological diagnosis and evaluations and an evaluation of the individual's need for institutional care; and

(C) is made by a physician, a social worker and other professionals, at least one of whom is a qualified mental retardation professional.

(iv) Reevaluation medically, socially and psychologically at least annually by the staff involved in carrying out the resident's individual plan of care. This must include review of the individual's progress toward meeting the plan objectives, the appropriateness of the individual plan of care, assessment of his continuing need for institutional care, and consideration of alternate methods of care.

(v) An individual postinstitutional plan, as part of the individual plan of care, developed before discharge by a qualified mental retardation professional and other appropriate professionals. This must include provision for appropriate services, protective supervision, and other follow-up services in the resident's new environment.

(b) "In an institution" refers to an individual who is admitted to live there and receive treatment or services provided there that are appropriate to his requirements.

(c) "Inmate of a public institution" means a person who is living in a public institution. An individual is not considered an inmate if:

(i) he is in a public educational or vocational training institution for purposes of securing education or vocational training; or

(ii) he is in a public institution for a temporary period pending other arrangements appropriate to his needs.

(d) "Inpatient" means a patient who has been admitted to a medical institution on recommendation of a physician or dentist and is receiving room board, and professional services in the institution on a continuous 24-hour-a-day basis.

(e) "Institution" means an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor.

(f) "Institution for mental diseases" means an institution that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. Whether an institution is an institution for mental diseases is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such. An institution for the mentally retarded is not an institution for mental diseases.

(g) "Institution for the mentally retarded or persons with related conditions" means an institution (or distinct part of an institution) that:

(i) is primarily for the diagnosis, treatment, or rehabilitation of the mentally retarded or persons with related conditions; and

(ii) provides, in a protected residential setting, ongoing evaluation, planning, 24-hour supervision, coordination, and integration of health or rehabilitative services to help each individual function at his greatest ability.

(h) "Institution for tuberculosis" means an institution that is primarily engaged in providing diagnosis, treatment or care of persons with tuberculosis, including medical attention, nursing care, and related services. Whether an institution is an institution for tuberculosis is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of tuberculosis, whether or not it is licensed as such.

(i) "Medical institution" means an institution that:

(i) is organized to provide medical care, including nursing and convalescent care;

(ii) has the necessary professional personnel, equipment, and facilities to manage the medical, nursing, and other health needs of patients on a continuing basis in accordance with accepted standards;

(iii) is certified under Montana law to provide medical care; and

(iv) is staffed by professional personnel who are responsible to the institution for professional medical and nursing services. The services must include adequate and continual medical care and supervision by a physician; registered nurse or licensed practical nurse supervision and services and nurses' aid services, sufficient to meet nursing care needs; and a physician's guidance on the professional aspects of operating the institution.

(j) "Patient" means an individual who is receiving needed professional services that are directed by a licensed practitioner of the healing arts toward maintenance, improvement, or protection of health, or lessening of illness, disability or pain.

(k) "Persons with related conditions" means individuals who have epilepsy, cerebral palsy, or other developmental disabilities.

(l) "Public institution" means an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. The term "public institution" does not include a medical institution as defined above, an intermediate care facility as defined in chapter 40, subchapter 3, or a publicly operated community residence that serves no more than 16 residents, as defined below.

(m) "Publicly operated community residence that serves no more than 16 residents" means:

(i) It is the responsibility of a governmental unit, or a governmental unit exercises administrative control over it.

(ii) It has been designed or has been changed to serve no more than 16 residents and it is serving no more than 16.

(iii) It provides some services beyond food and shelter such as social services, help with personal living activities, or training in socialization and life skills. Occasional medical or remedial care may also be provided.

(iv) A publicly operated community residence does not include the following facilities, even though they accommodate 16 or fewer residents:

(A) residential facilities located on the grounds of, or immediately adjacent to, any large institution or multiple purpose complex;

(B) educational or vocational training institutions that primarily provide an approved, accredited, or recognized program to individuals residing there;

(C) correctional or holding facilities for individuals who are prisoners, have been arrested or detained pending disposition of charges, or are held under court order as material witnesses or juveniles;

(D) hospitals, skilled nursing facilities, and intermediate care facilities.

(n) "Resident of an intermediate care facility" is an individual who is:

(i) in need of and receiving professional services to maintain, improve, or protect health or lessen disability or pain under the direction of a practitioner of the healing arts;

(ii) admitted to an intermediate care facility in accordance with chapter 40, subchapter 1;

(iii) under care and supervision 24-hours-a-day; and

(iv) if he is in an institution for the mentally retarded, receiving active treatment as defined above.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1305 Groups Covered, Afdc-Related Institutionalized Individuals

(1) Medicaid will be provided to the following AFDC-related institutionalized individuals under the heading categorically needy:

(a) Individuals under age 21 in intermediate care facilities, including in intermediate care facilities for the mentally retarded.

(b) Individuals under age 21 receiving active treatment as inpatients in psychiatric facilities or programs provided that the youth is in the custody of the department or has been committed to the department by district court pursuant to 41-3-403 , 41-3-404 , 41-3-406 or 41-5-523 , MCA.

(2) Medicaid will also be provided to the following AFDC-related institutionalized individuals under the heading medically needy:

(a) individuals described in (1) (a) and (1) (b) who are ineligible for coverage as categorically needy because of excess income.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1993 MAR p. 1399, Eff. 6/25/93; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1306 Groups Covered, Ssi-Related Institutionalized Individuals

(1) Medicaid will be provided to the following SSI-related institutionalized individuals under the heading categorically needy:

(a) Individuals receiving SSI on the basis of the SSI income standard for institutionalized individuals.

(b) Individuals in medical institutions and intermediate care facilities who are ineligible for SSI because the SSI income standard for institutionalized individuals is lower than the SSI income standard for noninstitutionalized individuals.

(c) Individuals who were eligible for medicaid in December, 1973, as inpatients of medical institutions or residents of intermediate care facilities, if, for each consecutive month after December, 1973, they:

(i) continue to meet the December, 1973, eligibility requirements;

(ii) remain institutionalized; and

(iii) continue to need institutional care.

(2) Medicaid will also be provided to the following SSI-related institutionalized individuals under the heading medically needy:

(a) individuals described in (1) (b) who are ineligible for coverage as categorically needy because of excess income.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1310 Non-Financial Requirements, Afdc-Related Institutionalized Individuals

(1) Individuals under age 19 who continue to receive AFDC even though they are in a medical institution or intermediate care facility are presumed to have met the non-financial requirements for medicaid eligibility.

(2) For individuals under age 21 in intermediate care facilities, including intermediate care facilities for the mentally retarded, or receiving treatment in psychiatric facilities or programs pursuant to the requirements of ARM 37.82.1305(1) (b) , the nonfinancial requirements for medicaid under this subchapter, whether as categorically needy or medically needy, consist of the age requirement and applicable service requirements.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1993 MAR p. 1399, Eff. 6/25/93; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1311 Non-Financial Requirements, Ssi-Related Institutionalized Individuals

(1) Individuals receiving SSI on the basis of the SSI income standard for institutionalized individuals are presumed to have met the nonfinancial requirements for medicaid eligibility.

(2) For individuals in medical institutions and intermediate care facilities who are ineligible for SSI because the SSI income standard for institutionalized individuals is lower than the SSI income standard for noninstitutionalized individuals, the nonfinancial requirements for medicaid under this subchapter, whether as categorically needy or medically needy, are the SSI nonfinancial requirements which are set forth in 20 CFR, Part 416, subparts H and I. These will be used to determine whether an individual is aged, blind, or disabled. 20 CFR, Part 416, subpart H, contains the SSI criteria for determining age, and 20 CFR, Part 416, subpart I, contains the SSI criteria for determining blindness and disability. The department hereby adopts and incorporates 20 CFR, Part 416, subparts H and I. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

(3) For individuals who were eligible for medicaid in December, 1973, as inpatients of medical institutions or residents of intermediate care facilities, the nonfinancial requirements for medicaid under this subchapter are the December, 1973 OAA, AB, APTD, or AABD nonfinancial requirements. A copy of the December, 1973 OAA, AB, APTD, and AABD nonfinancial requirements may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1312 Financial Requirements, Afdc-Related Institutionalized Individuals

(1) Individuals under age 19 who continue to receive AFDC even though they are in a medical institution or intermediate care facility are presumed to have met the financial requirements for medicaid eligibility.

(2) For individuals under age 21 in intermediate care facilities, including intermediate care facilities for the mentally retarded, or receiving treatment in psychiatric facilities or programs pursuant to the requirements of ARM 37.82.1305(1) (b) , the financial requirements for medicaid under this subchapter as categorically needy are the AFDC financial requirements which are set forth in ARM 46.10.401 through 46.10.406 and 46.10.505 through 46.10.514. These will be used to determine whether:

(a) the individual in his placement is eligible with respect to resources;

(b) the individual in his placement is eligible with respect to gross and net income and with respect to the applicable benefit standards.

(i) because the individual is not living with his parent, parental income will be considered only when actually contributed; and

(ii) applicable standards are the child only standards.

(3) For individuals under age 21 in intermediate care facilities, including intermediate care facilities for the mentally retarded, or receiving treatment in psychiatric facilities or programs pursuant to the requirements of ARM 37.82.1305(1) (b) who are ineligible under (2) because of excess income, the financial requirements for medicaid under this subchapter as medically needy are the medically needy financial requirements for noninstitutionalized AFDC-related families and children which are set forth in subchapter 11. The financial provisions of this subchapter which apply to individuals under 21 who are ineligible for medicaid under ARM 37.82.701(1) (b) (iii) and (3) apply identically to the above described individuals under 21.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1993 MAR p. 1399, Eff. 6/25/93; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1313 Financial Requirements, Ssi-Related Institutionalized Individuals

(1) Individuals receiving SSI on the basis of the SSI income standard for institutionalized individuals are presumed to have met the financial requirements for medicaid eligibility.

(3) For individuals in medical institutions and intermediate care facilities who are ineligible under (2) because of excess income, the financial requirements for medicaid under this subchapter as medically needy are the medically needy financial requirements for noninstitutionalized SSI-related individuals and couples which are set forth in subchapter 11. The financial provisions of this subchapter which apply to the individual living in his own home apply identically to the above described individual.

(4) For individuals who were eligible for medicaid in December, 1973, as inpatients of medical institutions or residents of intermediate care facilities, the financial requirements for medicaid under this subchapter are the December, 1973 OAA, AB, APTD, or AABD financial requirements. A copy of the December, 1973, OAA, AB, APTD, and AABD financial requirements may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1320 Post-Eligibility Application of Patient Income to Cost of Care

(1) After the nonfinancial and resource eligibility criteria are met, the income of individuals in a residential medical institution will be applied toward the cost of care as provided in this section. This provision applies to all covered groups in this subchapter, except:

(a) individuals under age 19 who continue to receive AFDC even though they are in a medical institution or intermediate care facility, as provided in ARM 37.82.1305(1)(a); and

(b) individuals receiving supplemental security income on the basis of the supplemental security income standard for institutional individuals, as provided in ARM 37.82.1306(1)(a).

(2) Amounts will be deducted from a single individual's gross income in the following order to determine the amount applicable toward his cost of care:

(a) up to $65 of gross earned income;

(b) a personal needs allowance of $50;

(d) medical or remedial care expenses of the institutionalized individual as defined in (8).

(3) During any month in which an institutionalized spouse is in the institution, no income of the community spouse may be deemed available to the institutionalized spouse except as specifically provided in this section.

(a) In determining whether any income, including income from a trust or from any other source, is income of the institutionalized or community spouse after the institutionalized spouse has been determined eligible for medical assistance, the following rules shall apply regardless of state law regarding the division of marital property to the contrary:

(i) income from a trust or other written agreement shall be considered available according to the terms of the trust or agreement; or

(ii) if there is no trust or written agreement making provision for distribution of income, the income shall be considered available according to the manner in which it is distributed.

(b) The rules in (3) shall not apply, unless otherwise made applicable under state or federal law, to determinations of an individual's interest in any income or resource under any public assistance or medical assistance program to individuals who are not institutionalized or community spouses.

(4) The following amounts will be deducted monthly in the following order from the gross income of an institutionalized spouse to determine the amount applicable toward the cost of care:

(a) up to $65 of gross earned income;

(b) $50 personal needs allowance for the institutionalized spouse;

(d) a family allowance for each family member equal to one-third of the difference between the basic needs standard, as determined under (9)(b)(i)(A) through (C) of this rule, and the family member's gross monthly income;

(e) incurred medical or remedial care expenses of the institutionalized spouse as defined in (8); and

(f) Regardless of any other provision of this section, the community spouse's monthly income allowance as defined in (9) of this rule shall not be less than the amount of any monthly support which an institutionalized spouse has been ordered by a court to pay to the community spouse.

(5) The institutionalized spouse or his representative is responsible to report to the department any changes to his own and the community spouse's income within ten days of the change.

(6) Unless the institutionalized spouse specifically objects, a community spouse monthly income allowance will be deducted from the institutionalized spouse's monthly income and must be provided to the community spouse.

(7) The home maintenance allowance for purposes of (2)(c) of this rule shall consist of:

(a) the medically needy income level for one as defined in ARM 37.82.1106 if the client:

(i) entered the facility from a community living arrangement after the first day of the month; or

(ii) leaves the facility into a community living arrangement on or before the last day of the month; and

(b) for a maximum of six months, the medically needy income level for one as defined in ARM 37.82.1106 when a physician certifies that the individual is likely to return to the home within six months.

(8) Medical or remedial care expenses of the institutionalized individual for purposes of (2)(d) and (4)(e) of this rule include:

(a) Medicare and other health insurance premiums, deductibles or coinsurance;

(b) for three months or until paid in full, whichever comes first, medical or remedial care expenses which:

(i) were incurred during the three months immediately prior to application for Medicaid coverage of institutional care or were incurred more than three months immediately prior to application for Medicaid coverage of institutional care if actual payments are currently being made on the expenses, and only in the amount of the payment currently being made;

(ii) were unpaid at the time of application for Medicaid coverage of institutional care;

(iii) are recognized and regulated by state law as medical services, supplies, or equipment;

(iv) are not payable by Medicaid or a third party; and

(v) are expenses that have not been applied to another month's incurment or post-eligibility treatment of income.

(c) no deduction is allowed for medical and remedial care expenses that were incurred during a penalty period imposed due to an uncompensated transfer of assets.

(9) A monthly income allowance for the community spouse for purposes of (4)(c) of this rule shall consist of the lesser of:

(a) $1,500 minus the community spouse's own gross monthly income. Effective January 1 of each calendar year after 1989 the $1,500 limit will increase by a percentage equal to the increase in the consumer price index for all urban consumers which occurred between September of the calendar year for which the increase is being made and September of the preceding year; or

(b) the total of:

(i) a basic needs standard which is equal to:

(A) 1/12 of 122% of the federal poverty level for a family unit of two persons effective through June 30, 1991;

(B) 1/12 of 133% of the federal poverty level for a family unit of two persons from July 1, 1991 through June 30, 1992;

(ii) shelter expenses as defined in ARM 37.82.1330 which exceed 30% of the amount determined under (9)(b)(i); minus

(iii) the amount of gross monthly income otherwise available to the community spouse, without regard to the community spouse's monthly income allowance.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1990 MAR p. 543, Eff. 3/16/90; AMD, 1991 MAR p. 54, Eff. 1/18/91; AMD, 1992 MAR p. 673, Eff. 3/27/92; TRANS, from SRS, 2000 MAR p. 476; AMD, 2011 MAR p. 1823, Eff. 9/9/11.

Mont. Admin. R. 37.82.1321 Prohibited Coverage

(1) Medicaid will not be provided to:

(a) an individual who is an inmate of a public institution;

(b) an individual who is a patient under age 65 in an institution for tuberculosis or mental disease except as an inpatient receiving active treatment in a psychiatric facility or program.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1982 MAR p. 729, Eff. 4/16/82; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1322 Resource Exclusions: Family Medicaid and Aged, Blind, and Disabled Medicaid for Institutionalized Categorically Needy and Medically Needy Individuals, Couples, and Families

(1) In determining eligibility for categorically needy and medically needy institutionalized individuals, couples, and families under the family Medicaid and aged, blind, and disabled Medicaid coverage groups in regard to the factor of resources, no exclusions will be applied to any property that is not owned by a member of the filing or assistance unit. No exclusion will be applied to any property that is owned or held by any entity, including but not limited to a trust or corporation, limited liability company, or any other legal entity, instrument, device, or arrangement of any kind, under which a member of the filing or assistance unit does not own the property.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-131, MCA
History: NEW, 2008 MAR p. 1487, Eff. 7/1/08.

Mont. Admin. R. 37.82.1330 Institutionalized Spouse, Definitions

(1) The following definitions apply with respect to ARM 37.82.1320, 37.82.1321, 37.82.1330, 37.82.1331, and 37.82.1336 through 37.82.1338.

(a) "Community spouse" is the member of the married couple who continues to reside in the community after the institutionalization of the other spouse.

(b) "Community spouse resource allowance" means the amount of the couple's combined countable resources which are transferrable to the community spouse, as determined under ARM 37.82.1336.

(c) "Continuous period of institutionalization" means at least 30 consecutive days of institutionalization without a break in care.

(d) "Countable resources" are those resources defined as countable in ARM 37.82.903(2) .

(e) "Dependent" means only minor or dependent children, dependent parents, or dependent siblings of the institutionalized or community spouse who are residing with the community spouse and are recognized as dependents for federal income tax purposes.

(f) "Institutionalization" means admission to a medical institution.

(g) "Institutionalized spouse" means an individual who:

(i) is in a medical institution or nursing facility;

(ii) is married to a spouse who is not in a medical institution or nursing facility; and

(iii) is likely to meet conditions (i) and (ii) of this definition for at least 30 consecutive days.

(h) "Medical institution" means an institution organized to provide medical care and includes, but is not limited to, hospitals and nursing facilities.

(i) "Shelter expenses" means the following expenses for the community spouse's principal residence:

(i) the monthly amount of rent or mortgage payment, including principal and interest;

(ii) real estate taxes on the community spouse's principal residence;

(iii) homeowners insurance on the community spouse's principal residence;

(iv) any required condominium or cooperative maintenance charge on the community spouse's principal residence; and

(v) a monthly standard utility allowance (SUA) available only to households which incur central heating or central cooling costs separate from rent or mortgage. The SUA shall be $225 and includes the cost of heating or cooling, water, sewerage, garbage and trash collections, cooking fuel, electricity not used to heat or cool the residence, and the basic service fee for a telephone.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1991 MAR p. 54, Eff. 1/18/91; AMD, 1992 MAR p. 673, Eff. 3/27/92; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1331 Institutionalized Spouse, Resource Assessments

(1) A resource assessment is available to any married individual who:

(a) entered a medical institution on or after October 1, 1989;

(b) is likely to remain in the institution for at least 30 consecutive days; and

(2) Only one resource assessment per lifetime is available to each institutionalized spouse. The resource assessment is based on the couple's countable resources at the beginning of the first period of continuous institutionalization beginning after September 30, 1989.

(3) An institutionalized spouse, community spouse or a representative for either spouse may request a resource assessment based on the married couple's combined countable resources, whether owned individually or jointly, as of the first moment of the month of institutionalization.

(4) The individual requesting the assessment must provide all relevant documentation and/or verification required by the department within 45 days of the assessment request date.

(5) The department will complete a resource assessment within 45 days of:

(a) the assessment request date, unless documentation or verification is delayed due to a third party; or

(b) documentation or verification receipt when the individual requesting the resource assessment does not provide necessary information in a timely manner.

(6) When the resource assessment is complete the department will provide written notice to both spouses including:

(a) the amount of the combined countable resources at the beginning of the most recent continuous period of institutionalization;

(b) the method used to compute the community spouse's resource allowance ARM 37.82.1336(2) ; and

(7) The resource assessment is appealable through a fair hearing by either spouse after the institutionalized spouse applies for medicaid benefits, and the hearing must be held within 30 days of the date it is requested.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1991 MAR p. 54, Eff. 1/18/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1336 Institutionalized Spouse, Resource Eligibility Determination

(1) The institutionalized spouse is resource eligible when the institutionalized spouse and community spouse's combined countable resources are less than or equal to the community spouse's resource allowance in (2) plus the supplemental security income (SSI) resource limitation for one person as defined in ARM 37.82.1110.

(2) The community spouse resource allowance is the greatest of the following:

(a) one-half, but no more than $60,000, of the couple's combined countable resources. Effective January 1 of each calendar year after 1989, the $60,000 limit shall increase by the same percentage increase in the consumer price index as adopted by the federal government for all urban consumers which occurred between September 1988 and the September before the calendar year involved;

(b) Montana's standard community spouse resource allowance of $12,000. Effective January 1 of each calendar year after 1989, the $12,000 limit shall increase by the same percentage increase in the consumer price index as adopted by the federal government for all urban consumers which occurred between September 1988 and the September before the calendar year involved;

(d) an amount designated by a department hearings officer.

(3) The community spouse resource allowance must be revised when inaccurate information was used to calculate the resource allowance.

(4) After the month in which the institutionalized spouse is determined eligible for medicaid, no resources of the community spouse shall be deemed available to the institutionalized spouse as long as the institutionalized spouse remains continuously institutionalized.

(5) Eligibility will not be denied an institutionalized spouse whose resources exceed the supplemental security income resource limit for one when denial of eligibility will create an undue hardship or when the conditions of assignment of support rights described in 42 U.S.C. 1396r-5(c) (3) (A) and (B) (sub 1990 edition) are met. The department hereby adopts and incorporates 42 U.S.C. 1396r-5(c) (3) (A) and (B) (sub 1990 edition) by reference. Copies may be obtained through the Department of Public Health and Human Services, Operations and Technologies Division, Institutional Reimbursement, 111 Sanders, P.O. Box 6429, Helena, MT 59604-6429.

(6) Unless specifically refused by the institutionalized spouse, a portion or all of his resources may be used to ensure adequate resources are available to meet the community spouse resource allowance.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1991 MAR p. 54, Eff. 1/18/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1337 Institutionalized Spouse, Receipt of Additional Resources

(1) When additional resources are received by an institutionalized spouse after the initial eligibility determination and receipt of such resources would cause ineligibility for the institutionalized spouse, the resources will be exempt as countable resources for 90 days from receipt if:

(a) the institutionalized spouse intends to transfer the new resources to the community spouse;

(b) receipt of the additional resources is reported within ten days of receipt; and

(c) a written statement of the intent to transfer the resources to the community spouse is made by the institutionalized spouse.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1991 MAR p. 54, Eff. 1/18/91; TRANS, from SRS, 2000 MAR p. 476.

Mont. Admin. R. 37.82.1338 Institutionalized Spouse, Transfer of Resources to Community Spouse

(1) Within 90 days of the initial eligibility determination or court order, or within any time period specifically required under the court order, an institutionalized spouse must irrevocably transfer resources:

(a) to or for the sole benefit of the community spouse resources which constitute the community spouse's resource allowance; or

(b) to or for the sole benefit of the community spouse or a family member, if such transfer is pursuant to a court order.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-131, MCA
History: NEW, 1991 MAR p. 54, Eff. 1/18/91; TRANS, from SRS, 2000 MAR p. 476.

Chapter 37.83 Medicaid for Certain Medicare Beneficiaries and Others

Subchapter 37.83.2 Eligibility Requirements for Qualified Medicare Beneficiaries

Mont. Admin. R. 37.83.201 Qualified Medicare Beneficiaries, Application and Eligibility for Medicaid

(1) A person is a qualified medicare beneficiary eligible for medicaid, as provided for in Title 37, chapter 83, subchapter 8, if the person:

(a) is entitled to medicare Part A benefits as provided for in 42 USC 1395c et seq.;

(b) meets the nonfinancial criteria in (3) of this rule;

(c) has countable resources not in excess of two times the resource limitation applicable to the federal supplemental security income (SSI) resource limitation at 42 USC 1382a. The department hereby incorporates 42 USC 1382a as amended through April 1, 1989, which sets forth the resource limitation applicable to the federal (SSI) program. Copies of 42 USC 1382a, as amended through April 1, 1989, are available from the Department of Public Health and Human Services, Human and Community Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951; and

(d) has countable income as determined in accordance with this section;

(i) countable income may not exceed:

(A) 100% of the federal poverty income standard for state fiscal year 1991 and 1992;

(B) 110% of the federal poverty income standard for state fiscal year 1993 and 1994; and

(2) When determining countable income, cost of living increases to the client's Title II social security benefits beginning with December of the previous year through the month after the official federal poverty standards are published shall be excluded.

(3) The non-financial criteria for determining eligibility of a medicaid qualified medicare beneficiary are that the person:

(a) is categorically eligible under the federal social security act as being:

(i) age 65 or older,

(ii) blind, or

(iii) disabled;

(b) has a social security number;

(d) meets the residency requirements of ARM 37.82.402.

(4) A person in applying for and receiving medicaid as a qualified medicare beneficiary is subject to the following provisions:

(a) ARM 37.85.407 concerning third party liability;

(b) ARM 37.82.201 concerning application requirements;

(c) ARM 37.82.204 concerning determinations of eligibility, except as to the effective date provided for at ARM 37.83.202;

(d) ARM 37.82.205 concerning redetermination;

(e) ARM 37.82.407 concerning limitation on the financial responsibility of relatives;

(f) ARM 37.82.415 concerning application for other benefits; and

(g) ARM 37.82.416 concerning assignment of rights to benefits.

(5) Countable income and resources will be determined using SSI criteria incorporated by reference in ARM 37.82.903 (2) .

(6) No retroactive coverage is available to a person for medicaid services provided to the person as a qualified medicare beneficiary. If otherwise eligible for medicaid under another category, a person may receive retroactive coverage for medicaid services received through that other eligibility.

(7) A person receiving medicaid as a qualified medicare beneficiary must report within 10 days any changes in circumstances that may affect eligibility.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1990 MAR p. 1336, Eff. 7/13/90; AMD, 1992 MAR p. 674, Eff. 3/27/92; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.202 Qualified Medicare Beneficiaries, Effective Date of Eligibility

(1) A person is eligible for the receipt of medicaid benefits at the beginning of the following month after the department determines that the person is a qualified medicare beneficiary.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.

Subchapter 37.83.4 Medicaid for Qualified Disabled Working Individuals

Mont. Admin. R. 37.83.401 Qualified Disabled Working Individuals, Application and Eligibility for Medicaid

(1) A qualified disabled working individual (QDWI) is an individual:

(a) who is entitled to enroll in hospital insurance benefits (medicare Part A) under 42 USC 1395i-2a because he lost premium-free Part A medicare coverage due solely to excess earned income from substantial gainful activity;

(b) meets the non-financial criteria in (2) of this rule;

(c) whose income does not exceed 200% of the official federal poverty guideline as defined by the executive office of management and budget; and

(d) whose resources do not exceed twice the supplemental security income (SSI) resource limit set forth at 42 USC 1382 (a) (3) (A) and (B) (1990 edition) .

(2) The non-financial criteria for determining eligibility of a qualified disabled working individual are that the person:

(a) has not attained the age of 65;

(b) is blind or disabled as defined in 42 USC 416(i) (1) (1990 edition) .

(d) meets the citizenship or alienage requirements of ARM 37.82.401; and

(e) meets the residency requirements of ARM 37.82.402.

(3) A person in applying for and receiving medicaid as a qualified disabled working individual is subject to the following provisions:

(a) ARM 37.85.407 concerning third party liability;

(b) ARM 37.82.201 concerning application requirements;

(d) ARM 37.82.205 concerning redetermination ;

(e) ARM 37.82.407 concerning limitation on the financial responsibility of relatives;

(f) ARM 37.82.415 concerning application for other benefits; and

(g) ARM 37.82.416 concerning assignment of rights to benefits.

(4) Countable income and resources will be determined using SSI criteria incorporated by reference in ARM 37.82.903(2) .

(5) A person receiving medicaid as a qualified disabled working individual must report within 10 days any changes in circumstances that may affect eligibility.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1991 MAR p. 1052, Eff. 7/1/91; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.402 Qualified Disabled Working Individuals, Effective Date of Eligibility

(1) A person is eligible for QDWI benefits as of the date that all eligibility criteria set forth in ARM 37.83.401 are met and he is enrolled in medicare Part A under 42 USC 1395i-2a.

(2) Retroactive coverage is available for up to 3 months prior to date of application.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1991 MAR p. 1052, Eff. 7/1/91; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.406 Qualified Disabled Working Individuals, Medicaid Benefits

(1) Medicaid benefits for a qualified disabled working individual are limited to payment of the monthly medicare hospital insurance (Part A) premium.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1991 MAR p. 1052, Eff. 7/1/91; TRANS, from SRS, 2000 p. 197.

Subchapter 37.83.5 Specified Low Income Medicare Beneficiaries

Mont. Admin. R. 37.83.501 Specified Low Income Medicare Beneficiaries, Application and Eligibility for Medicaid

(1) A person is a specified low income medicare beneficiary eligible for medicaid as provided in (7) of this rule if the person:

(a) is entitled to medicare Part A benefits as provided in 42 USC 1395c et seq.;

(b) meets the nonfinancial criteria in (3) of this rule;

(c) has countable resources not in excess of two times the resource limitation applicable to the federal supplemental security income (SSI) resource limitation at 42 USC 1382a; and

(d) has countable income as determined in accordance with this section;

(i) countable income may not be less than 100% of the federal poverty income standard nor more than:

(A) 110% of the federal poverty income standard for calendar year 1993; and

(B) 120% of the federal poverty income standard beginning January 1, 1994.

(2) When determining countable income, cost of living increases to the client's Title II social security benefits shall be excluded from December of each year through the month after the official federal poverty standards are published.

(3) The non-financial criteria for determining eligibility of a medicaid specified low income medicare beneficiary are that the person:

(a) is categorically eligible under the federal Social Security Act as being:

(i) age 65 or older;

(ii) blind; or

(iii) disabled;

(b) has a social security number;

(d) meets the residency requirements of ARM 37.82.402.

(4) A person in applying for and receiving medicaid as a specified low income medicare beneficiary is subject to the following provisions:

(a) ARM 37.82.201 concerning application requirements;

(b) ARM 37.82.204 concerning determinations of eligibility;

(d) ARM 37.82.407 concerning limitation on the financial responsibility of relatives.

(5) Countable income and resources will be determined using SSI criteria incorporated by reference in ARM 37.82.903 (2) .

(6) A person receiving medicaid as a specified low income medicare beneficiary must report within 10 days any changes in circumstances that may affect eligibility.

(7) Medicaid coverage for a person eligible for medicaid only as a specified low income beneficiary shall be limited to payment of medicare Part B premiums.

(8) A specified low income medicare beneficiary may be eligible for retroactive coverage for any or all of the 3 months immediately preceding the month of application, if the applicant met all of the financial and non-financial criteria set forth in (1) (a) through (5) of this rule in that month.

History

Authorizing statute(s): Sec. 53-2-201, 53-6-111 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1993 MAR p. 1542, Eff. 7/16/93; TRANS, from SRS, 2000 MAR p. 197.

Subchapter 37.83.8 Requirements for Qualified Medicare Beneficiaries

Mont. Admin. R. 37.83.801 Medicaid Coverage for Qualified Medicare Beneficiaries

(1) ARM Title 37, chapter 83 implements medicaid coverage, as provided for in Section 301 of the Medicare Catastrophic Coverage Act of 1988 and House Bills 452 and 453 of the 51st Montana legislature for the costs of medicare Parts A and B insurance premiums, deductibles, and coinsurance for persons who are categorically entitled to medicaid and meet certain financial and other criteria.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.802 Qualified Medicare Beneficiaries, Definitions

(1) "Assignment" means an agreement between the medicare carrier and a medicare provider under which the carrier makes payment to the provider rather than the recipient, and the provider agrees to accept the medicare allowable rate as payment in full.

(2) "Carrier" means the private insurance company contracted with by the United States health care financing administration to process medicare Part B claims and issue payments to physicians and other providers or to recipients.

(3) "Chiropractic services" means the manipulation of the spine by a licensed chiropractor to correct a subluxation. Chiropractic services do not include x-rays or other diagnostic or therapeutic services provided by a licensed chiropractor.

(4) "Coinsurance" means an amount of medical and other costs incurred by an eligible person that are the financial responsibility of that person rather than of the medicare Parts A or B insurance. The amount of coinsurance is the difference between the medicare allowable rate and the actual medicare payment.

(5) "Copayment" means a cost sharing fee imposed upon a qualified medicare beneficiary recipient for a medical service paid for by medicaid.

(6) "Customary charge" means the charge most frequently used by the provider for the service or item.

(7) "Deductible" means a set amount of medical and other costs designated by medicare as the person's financial responsibility. Medicare coverage begins with costs in excess of the deductibles.

(8) "Department" means the department of public health and human services as provided for at 2-15-2201 , MCA.

(9) "Full medicaid" means medicaid coverage other than that provided to qualified medicare beneficiaries.

(10) "Hospice care" are those services providing pain relief, symptom management, respite care, and support services to terminally ill persons.

(11) "Intermediary" means the private insurance company contracted with by the United States health care financing administration to make coverage and payment decisions on services covered by medicare Part A insurance in hospitals, skilled nursing facilities, home health agencies and hospices.

(12) "Medicare allowable rate" means the reasonable charge for the medical service reimbursable under medicare Part B.

(13) "Medicare" means the health insurance programs under Title XVIII of the Social Security Act.

(14) "Medicare Part A insurance" means the insurance program under medicare that covers inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care.

(15) "Medicare Part B insurance" means the insurance program under medicare that covers outpatient hospital services, physician services, home health care services, and other medical services not covered by medicare Part A insurance.

(16) "Premiums" means the monthly amounts that are charged for a person to receive medicare Part B insurance coverage and that may be charged for a person to receive medicare Part A coverage when the person is not eligible for premium-free coverage.

(17) "Prevailing charge" means a level equal to at least three-fourths of the average of all the charges for the same service billed by all the physicians or suppliers in the state.

(18) "Qualified medicare beneficiary" means a person eligible for the program provided for in Title 37, chapter 83.

(19) "Respite care" is a short term inpatient hospital stay necessary to temporarily relieve the person who regularly provides hospice care to a person.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01.

Mont. Admin. R. 37.83.805 Qualified Medicare Beneficiaries, General Requirements

(1) A qualified medicare beneficiary is subject to the requirements in the following rules:

(a) ARM 37.86.5303 concerning prior approval and restrictions on provider; and

(b) ARM 37.82.206 concerning the provisions of assistance.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, 53-6-113, 53-6-116 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197; AMD, 2004 MAR p. 1624, Eff. 7/23/04.

Mont. Admin. R. 37.83.810 Qualified Medicare Beneficiaries, Payment of Medicare Premiums

(1) Medicaid will cover the medicare Part B insurance premium for a qualified medicare beneficiary.

(2) Medicaid will cover the medicare Part A insurance premium for a qualified medicare beneficiary who is not eligible for premium-free medicare Part A insurance coverage.

(3) The department will enroll all qualified medicare beneficiaries in medicare Part B insurance. Persons who are not eligible for premium free medicare Part A insurance, will not be enrolled by the department in medicare Part A insurance. Those persons must enroll themselves through the United States social security administration.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.811 Qualified Medicare Beneficiaries, Coverage of Deductibles and Coinsurance for Medicare Services Also Covered by Full Medicaid

(1) For a qualified medicare beneficiary, medicaid will participate in the deductibles and coinsurance for the following medicare services also covered by medicaid:

(a) inpatient hospital services;

(b) outpatient hospital services;

(d) skilled nursing home care;

(e) hospice care;

(f) outpatient physical therapy services;

(g) outpatient speech therapy services;

(h) outpatient occupational therapy services;

(i) prosthetic devices, durable medical equipment and medical supplies;

(j) physician services, including laboratory and x-ray services; and

(k) dental services which are oral surgery services.

(2) Medicaid requirements governing the services in (1) are found in Title 37, chapters 40, 82 and 86 of the Administrative Rules of Montana (ARM) . Medicare requirements prevail when medicare requirements as to the availability and delivery of services differ from those for medicaid.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01.

Mont. Admin. R. 37.83.812 Qualified Medicare Beneficiaries, Payment for Chiropractic Services as Medicare Services Not Covered by Full Medicaid

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; REP, 2010 MAR p. 2986, Eff. 1/1/11.

Mont. Admin. R. 37.83.820 Qualified Medicare Beneficiaries, Free Choice of Providers

(1) Any qualified medicare beneficiary may obtain services from any institution, agency, pharmacy, or practitioner licensed and qualified to perform such services and participating under the medicaid program, unless the department restricts the person's access to services as provided for in ARM 37.86.5303.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, 53-6-113, 53-6-116 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197; AMD, 2004 MAR p. 1624, Eff. 7/23/04.

Mont. Admin. R. 37.83.821 Qualified Medicare Beneficiaries, Provider Requirements

(1) As a condition of participation in the Montana medicaid program, including the qualified medicare beneficiary program, all providers of service shall abide by all applicable state and federal statutes and regulations, including but not limited to federal regulations and statutes found in Title 42 of the United States Code and the Code of Federal Regulations governing the medicaid program, and all pertinent Montana statutes and rules governing licensure and certification.

(2) In addition to the requirements provided in these rules, a provider of services to a medicaid qualified medicare beneficiary must comply with the requirements in the following rules:

(a) ARM 37.85.402 concerning provider requirements, participation and service delivery;

(b) ARM 37.85.406(1) concerning billing requirements;

(c) ARM 37.85.406(2) concerning prompt payment of claims and prompt recovery of all payments erroneously or improperly made to a provider;

(d) ARM 37.85.406(3) and (4) concerning reimbursement requirements, payment in full and retroactive payment increases;

(e) ARM 37.85.406(5) , (6) and (7) concerning direct provider payments, payment rates for out of state providers and governmental billing of medicaid;

(f) ARM 37.85.407 concerning third party liability;

(g) ARM 37.85.414 concerning record keeping, record disclosure and audits; and

(h) ARM 37.85.501 concerning sanctions.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.822 Qualified Medicare Beneficiaries, Provider Choice of Participation and Other Rights

(1) A provider may choose to provide services to a person either as a private pay client or as a medicaid client. A medicaid client is a person who is medicaid eligible either as a qualified medicare beneficiary or as a qualified medicare beneficiary who is also eligible under another medicaid category.

(2) A provider has the rights set forth in ARM 37.85.411, concerning the exercise of professional judgment, management of business affairs and a provider's right to appeal an administrative decision.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.825 Qualified Medicare Beneficiaries, Payments to Providers

(1) Payments for services provided to medicaid qualified medicare beneficiaries may only be made to a provider. A provider in order to receive payments must be enrolled in the medicaid program.

(a) Medicaid payment will be made to the provider even when the provider for medicare purposes has not accepted assignment.

(2) Payment in full, except as otherwise provided in (2) (a) below, for services provided to medicaid qualified medicare beneficiaries, is the medicaid payment as determined under ARM 37.83.811, 37.83.812 and 37.85.406 plus the qualified medicare beneficiary's copayment as provided for in ARM 37.83.826. A provider may not collect any amount from the person which is in excess of payment in full even if that payment is less than the medicare insurance deductibles and coinsurance. Where a person is eligible for medicaid under both medicaid qualified medicare beneficiary and another medicaid category, a provider must accept the medicaid payment as payment in full.

(a) Where a provider does not accept medicare assignment and the person receiving medicaid services is medicaid eligible only as a qualified medicare beneficiary, the provider may bill the person for that portion of the service cost that is the difference between medicare's allowable rate and the provider's charge. A provider who does not accept medicare assignment must inform a person receiving services that this portion may be billed to the person.

(3) Subject to the requirements of this rule, the Montana medicaid program pays the lowest of the following for qualified medicare beneficiary services:

(a) the provider's usual and customary charge for the service; or

(b) the appropriate medicaid allowed amount as provided in ARM 37.85.406(18) .

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01.

Mont. Admin. R. 37.83.826 Qualified Medicare Beneficiaries, Copayments

(1) A qualified medicare beneficiary is responsible for copayments to the same extent as a medicaid recipient under the provisions of ARM 37.85.204.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1997 MAR p. 820, Eff. 5/6/97; AMD, 1997 MAR p. 1208, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.830 Qualified Medicare Beneficiaries, Billing

(1) The requirements for billing medicaid are as follows:

(a) Claims for qualified medicare beneficiaries must be submitted to medicare first.

(i) Claims for medicare Part A insurance services must be submitted to the medicare Part A insurance intermediary for medicare payment and then submitted to medicaid on the appropriate claim form with the medicare explanation of medical benefits (EOMB) attached for payment of the deductibles and coinsurance.

(ii) Claims for medicare Part B insurance services must be submitted to the medicare Part B insurance carrier for medicare payment and then submitted to medicaid on the appropriate claim form with the medicare explanation of medical benefits (EOMB) attached for payment of the deductibles and coinsurance. The Part B carrier may, under an agreement with the department, submit the claims by electronic media to medicaid for payment of the deductibles and coinsurance.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.

Mont. Admin. R. 37.83.831 Qualified Medicare Beneficiaries, Determination of Medical Necessity

(1) For services to qualified medicare beneficiaries, medicaid may accept medicare's determination of medical necessity for services which require approval prior to service delivery or review prior to payment. Medicaid may also accept medicare's determination of whether a medical procedure is experimental or not.

(2) The department will only pay for medically necessary, non-experimental services, as established in ARM 37.82.102(2) and ARM 37.85.410.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.

Chapter 37.84 Medicaid Expansion

Subchapter 37.84.1 Montana Health and Economic Livelihood Partnership (HELP) Program

Mont. Admin. R. 37.84.101 Help Act: Purpose

(1) The purpose of this subchapter is to implement the Montana Health and Economic Livelihood Partnership Act (HELP Act) enacted by the 64th Montana Legislature, Ch. 368, L. 2015 MT, and House Bill 658 enacted by the 66th Montana Legislature, Ch. 21, L. 2019 MT.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1306, 53-6-1307, 53-6-1308, 53-6-1309, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; AMD, 2020 MAR p. 2438, Eff. 1/1/21.

Mont. Admin. R. 37.84.102 Definitions

(1) "American Indian and Alaska Native” means a person who:

(a) is an Indian or an Urban Indian as defined in paragraphs (13) or (28) of section 4 of the Indian Health Care Improvement Act;

(b) is a California Indian as described in section 809(a) of the Indian Health Care Improvement Act; or

(c) has otherwise been determined eligible as an Indian for the Indian Health Service under U.S. Health and Human Services regulations.

(2) “Caregiver” means a parent, guardian, relative, or family caregiver of either a dependent child who is 13 years of age or younger or a disabled individual. “Family caregiver” has the same meaning as defined in section 2 of the RAISE Family Caregivers Act, Pub. L. No. 115-119.

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

(4) "Federal poverty level” or “FPL” means the income level published each year by the United States Department of Health and Human Services to determine poverty guidelines.

(5) "Health and Economic Livelihood Partnership program" or “HELP program” means a Medicaid coverage program for persons as authorized at Title 53, chapter 6, part 13, MCA, 42 U.S.C. 1315, 42 U.S.C. 1396d(y), and other applicable state and federal authorities for those persons who are eligible for the HELP program as authorized under 42 U.S.C. 1396a(a)(10)(A)(i)(VIII).

(6) "Medicaid alternative benefit plan" means the health services offered to HELP program participants, which are identical to regular Medicaid benefits.

(7) "Medically frail" means a person who has special medical needs, including an individual:

(a) who is blind or disabled as defined in section 1614 of the Social Security Act;

(b) with a substance use disorder;

(d) with a physical, intellectual, or developmental disability that significantly impairs their ability to perform one or more activities of daily living; or

(e) with a serious or complex medical condition.

(8) "Member" means an individual enrolled in Montana Medicaid under 53-6-131, MCA, or receiving Medicaid-funded services under 53-6-1304, MCA.

(9) "Modified adjusted gross income" or “MAGI” means income determined in accordance with 42 U.S.C. 1396a(e)(14) and 42 CFR 435.603.

(10) "Participant" means a HELP program member whose MAGI is at or below 138% of the federal poverty level.

(11) “Work program” means:

(a) a program under Title I of the Workforce Innovation and Opportunity Act, Pub. L. No. 113-128;

(b) a program under section 236 of the Trade Act of 1974, Pub. L. No. 93-618;

(c) a program of employment and training operated or supervised by a state or political subdivision of a state that meets standards approved by the governor of the state, including a program under section 6, subsection (d)(4) of the Food and Nutrition Act of 2008, other than a supervised job search program or job search training program;

(d) a program of employment and training for veterans operated by the United States Department of Labor or the United States Department of Veterans Affairs, and approved by the relevant department secretary; or

(e) a workforce partnership under section 6, subsection (d)(4)(N), of the Food and Nutrition Act of 2008.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1304, 53-6-1305, 53-6-1306, 53-6-1307, 53-6-1308, 53-6-1309, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; AMD, 2017 MAR p. 2326, Eff. 1/1/18; AMD, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.103 Help Act: Eligibility for Coverage

(1) An individual qualifies for Medicaid coverage under the HELP Program if the person is a Montana resident who meets the eligibility criteria for Medicaid coverage as authorized at 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) (2015) and 42 C.F.R. 435.119.

(2) HELP Program coverage, as specified in (1), is inclusive of a person who is 19 through 64 years of age, has a modified adjusted gross income at or below 138% of FPL as appropriate to the household size, and is not:

(a) pregnant at the time of enrollment;

(b) entitled to or enrolled in Medicare; or

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-1304, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; AMD, 2020 MAR p. 2438, Eff. 1/1/21.

Mont. Admin. R. 37.84.106 Help Act: Benefits

(1) Coverage for a person in the HELP Program is provided through the Medicaid Alternative Benefit Plan.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; AMD, 2017 MAR p. 2326, Eff. 1/1/18; AMD, 2020 MAR p. 2438, Eff. 1/1/21.

Mont. Admin. R. 37.84.107 Help Act: Premiums (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-1307, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; AMD, 2017 MAR p. 2326, Eff. 1/1/18; AMD, 2020 MAR p. 2438, Eff. 1/1/21; REP, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.108 Help Act: Help Plan Copayments

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1305, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-1306, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; REP, 2017 MAR p. 2326, Eff. 1/1/18.

Mont. Admin. R. 37.84.109 Help Act: Help Plan Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1305, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-1305, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; REP, 2017 MAR p. 2326, Eff. 1/1/18.

Mont. Admin. R. 37.84.112 Help Act: Help Plan Provider Qualifications

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1305, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1305, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; REP, 2017 MAR p. 2326, Eff. 1/1/18.

Mont. Admin. R. 37.84.115 Help Act: Help Plan Grievance and Appeal Process

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1305, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1305, MCA
History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; REP, 2017 MAR p. 2326, Eff. 1/1/18.

Mont. Admin. R. 37.84.116 Community Engagement Activity Participation: Requirements and Reporting

(1) Participants must complete at least 80 hours of community engagement activities each month, unless the participant qualifies for an exemption. The participant is required to report on their community engagement activities. The required 80 hours may be made up of a combination of activities described in ARM 37.84.118.

(2) Participants do not have to complete the community engagement requirements if they meet one of the exemptions as described in ARM 37.84.120.

(3) Participants may report their community engagement hours or request an exemption online, by phone, or by mail.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.117 Community Engagement Activity Participation: Data Review and Verification

(1) The department shall make reasonable efforts to use electronic data to verify if participants are meeting the community engagement requirements or if they are exempt.

(2) The department will only ask for documentation or verification from a participant if it cannot verify compliance or exemption using electronic data.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.118 Community Engagement Activity Participation: Qualifying Activities, Data Review, and Verification on Application

(1) Time spent in the following activities may count toward the 80-hour community engagement requirement in ARM 37.84.116:

(a) work, including employment that meets at least one of these conditions:

(i) the participant earns at least the amount equal to the federal minimum wage multiplied by 80 hours each month;

(ii) the participant works at least 80 hours each month, even if they earn less than the minimum wage; or

(iii) for seasonal workers as defined in 26 U.S.C. 45R(d)(5) their average monthly income for the past six months is at least the minimum wage multiplied by 80 hours;

(b) community service;

(d) enrollment in an educational program at half-time status or greater, which includes:

(i) an educational program offered by an institution of higher education as defined in section 101 of the Higher Education Act of 1965, Pub. L. No. 89-329; or

(ii) a program of career and technical education as defined in section 3 of the Carl D. Perkins Career and Technical Education Improvement Act of 2006, Pub. L. No. 109-270; or

(e) any combination of the activities described in (1)(a) through (d).

(2) On application of initial or renewed eligibility for the HELP program, the department will review electronic data sources to determine if a participant meets the community engagement activity participation requirement. If the department cannot verify community engagement activity participation through a data review, the participant may submit documentation to show they meet the requirement.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.119 Help Act: Community Engagement Activity Participation: Income-Based Exemption (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; REP, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.120 Community Engagement Activity Participation: Standard Exemptions, Data Review, and Verification

(1) A participant is exempt from the community engagement activity participation requirements for a given month if, during part or all of that month, they are:

(a) an individual described in section 1902(a)(10)(A)(i)(IX) of the Social Security Act;

(b) an American Indian or Alaska Native as defined in ARM 37.84.102;

(d) a veteran with a disability rated as total under 38 U.S.C. 1155;

(e) medically frail as defined in ARM 37.84.102;

(f) compliant with the work requirements of the Temporary Assistance for Needy Families program;

(g) a member of a household that receives Supplemental Nutrition Assistance Program benefits under the Food and Nutrition Act of 2008 and are not exempt from a related work requirement;

(h) participating in a drug addiction or alcoholic treatment and rehabilitation program as defined in section 3(h) of the Food and Nutrition Act of 2008;

(i) an inmate of a public institution or an individual who was previously an inmate of a public institution at any point during the three-month period ending on the first day of the month that is being reported on;

(j) either under the age of 19 or over the age of 64;

(k) entitled to, or enrolled in, Medicare Part A or enrolled in Medicare Part B;

(l) described in an eligibility group listed in subsection (I) through (VII) of section 1902(a)(10)(A)(i) of the Social Security Act;

(m) pregnant or entitled to postpartum medical assistance under subsections (5) or (16) of 42 U.S.C. 1396a(e).

(2) On application of initial or renewed eligibility for the HELP program, the department will review electronic data sources to identify an exemption under this rule. If the department cannot identify an exemption through a data review, the participant may submit documentation to show they meet an exemption under this rule.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.121 Community Engagement Activity Participation: Short-Term Hardship Events

(1) A participant may request that the department deem the participant to have demonstrated community engagement during a month when the participant experiences a short-term hardship event.

(2) For the purposes of (1), a short-term hardship event includes the following:

(a) the participant receives inpatient hospital services, nursing facility services, services in an intermediate care facility for individuals with intellectual disabilities, inpatient psychiatric hospital services, or other services of similar acuity as determined appropriate by the U.S. Secretary of Health and Human Services;

(b) the participant resides in a county:

(i) in which there exists an emergency or disaster declared by the President of the United States pursuant to the National Emergencies Act or the Robert T. Stafford Disaster Relief and Emergency Assistance Act;

(ii) that, subject to a request from the Montana Department of Public Health and Human Services to the U.S. Secretary of Health and Human Services, has an unemployment rate that is at or above the lesser of eight percent or one and one-half times the national unemployment rate; or

(c) the participant, or the participant’s dependent, must travel outside of their community for an extended period of time to receive medical services necessary to treat a serious or complex medical condition as described in 42 U.S.C. 1396a(xx)(9)(A)(ii)(V)(ee) that are not available within their community of residence.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.122 Community Engagement Activity Participation: Noncompliance Sanctions

(1) A participant who does not qualify for an exemption in ARM 37.84.120 or who does not report at least 80 hours of community engagement activities for the months that they are reporting on will have 30 days after receiving a notice of noncompliance to become compliant. In order to become compliant, a participant must submit documentation reporting on activities completed during the months in which the participant was noncompliant.

(2) If a participant does not provide verification of compliance within 30 days of receiving a notice of noncompliance, they will face disenrollment or denial of their application.

(3) The participant may reapply and may regain coverage if the department determines that the participant:

(a) qualifies for an exemption;

(b) has followed the community engagement requirements; or

(4) Before coverage is terminated, the department will send written notice explaining the upcoming termination and how the participant can become compliant prior to termination.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Mont. Admin. R. 37.84.123 Community Engagement Activity Participation: Audit Requirements

(1) Cases will be audited in accordance with the audit requirements of section 1903(u)(1) of the Social Security Act and the Medicaid Eligibility Quality Control program requirements described in Title 42, part 431, subpart P, of the Code of Federal Regulations.

History

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA
Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA
History: NEW, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.

Chapter 37.85 General Medicaid Services

Subchapter 37.85.1 Montana Medicaid Provider Fee Schedules

Mont. Admin. R. 37.85.104 Effective Dates of Provider Fee Schedules for Montana Non-Medicaid Services

(1) The department adopts and incorporates by reference the fee schedule for the following programs within the Behavioral Health and Developmental Disabilities Division on the dates stated:

(a) Mental health crisis services, as provided in ARM 37.88.101, is effective July 1, 2025.

(b) Goal 189, as provided in ARM 37.89.201, is effective July 1, 2023.

(d) Substance use disorder services provider reimbursement, as provided in ARM 37.27.905, is effective July 1, 2025.

(2) Copies of the department's current fee schedules are posted at http://medicaidprovider.mt.gov. A description of the method for setting the reimbursement rate and the administrative rules applicable to the covered services are published in the chapter or subchapter of this title regarding that service.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1402, Eff. 7/1/14; AMD, 2015 MAR p. 822, Eff. 7/1/15; AMD, 2015 MAR p. 1911, Eff. 10/30/15; AMD, 2016 MAR p. 1058, Eff. 7/1/16; AMD, 2016 MAR p. 2431, Eff. 1/1/17; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 1116, Eff. 7/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2020 MAR p. 1158, Eff. 7/1/20; AMD, 2021 MAR p. 1324, Eff. 10/9/21; AMD, 2022 MAR p. 1078, Eff. 7/1/22; AMD, 2022 MAR p. 1914, Eff. 9/24/22; AMD, 2023 MAR p. 181, Eff. 2/25/23; AMD, 2023 MAR p. 1025, Eff. 9/9/23; AMD, 2024 MAR p, 2269, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26.

Mont. Admin. R. 37.85.105 Effective Dates, Conversion Factors, Policy Adjusters, and Cost-to-Charge Ratios of Montana Medicaid Provider Fee Schedules

(1) The Montana Medicaid Program establishes provider reimbursement rates for medically necessary, covered services based on the estimated demand for services and the legislative appropriation and federal matching funds. Provider reimbursement rates are stated in fee schedules for covered services applicable to the identified Medicaid program. New rates are established by revising the identified program's fee schedule and adopting the new fees as of the stated effective date of the schedule. Copies of the department's current fee schedules are posted at http://medicaidprovider.mt.gov. A description of the method for setting the reimbursement rate and the administrative rules applicable to the covered service are published in the chapter or subchapter of this title regarding that service. The department will make periodic updates, as necessary, to the fee schedules noted in this rule to include new procedure codes and applicable rates and to remove terminated procedure codes.

(2) The department adopts and incorporates by reference, the resource-based relative value scale (RBRVS) reimbursement methodology for specific providers as described in ARM 37.85.212 on the date stated.

(a) Resource-based relative value scale (RBRVS) means the version of the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services and published at 90 Federal Register 49266 (Nov. 5, 2025), effective January 1, 2026, which is adopted and incorporated by reference. Procedure codes created after January 1, 2026, will be reimbursed using the relative value units from the Medicare Physician Fee Schedule in place at the time the procedure code is created.

(b) Fee schedules are effective July 1, 2026. The fee schedules are applicable to claims for services that are provided on or after the effective date; prior fee schedules remain applicable to claims for services provided prior to that date.

(i) The conversion factor for physician services is $46.95. The conversion factor for allied services is $28.75. The conversion factor for mental health services is $21.48. The conversion factor for anesthesia services is $33.93.

(c) Policy adjustors are effective July 1, 2023. The maternity policy adjustor is 100%. The family planning policy adjustor is 105%. The psychological testing policy adjustor is 200%. The psychological testing policy adjustor applies only to psychologists.

(d) The BCBA/BCBA-D services policy adjuster is 115.8%, effective July 1, 2021.

(e) The payment-to-charge ratio is effective July 1, 2026, and is 47.70% of the provider's usual and customary charges.

(f) The specific percentages for modifiers adopted by the department are effective July 1, 2016.

(g) Psychiatrists receive a 112% provider rate of reimbursement adjustment to the reimbursement of physicians effective July 1, 2016.

(h) Midlevel practitioners receive a 90% provider rate of reimbursement adjustment to the reimbursement of physicians for those services described in ARM 37.86.205(5)(b), effective July 1, 2016.

(i) Optometric services receive a 110.59% provider rate of reimbursement adjustment to the reimbursement for allied services, as provided in ARM 37.85.105(2), effective July 1, 2026.

(j) Reimbursement for physician-administered drugs described in ARM 37.86.105 is determined pursuant to 42 U.S.C. 1395w-3a.

(k) Reimbursement for vaccines described at ARM 37.86.105 is effective July 1, 2020.

(3) The department adopts, and incorporates by reference, the fee schedule for the following programs within the Health Resources Division, on the date stated.

(a) The inpatient hospital services fee schedule and inpatient hospital base fee schedule rates including:

(i) the APR-DRG fee schedule for inpatient hospitals, as provided in ARM 37.86.2907, effective July 1, 2026; and

(ii) the Montana Medicaid APR-DRG relative weight values, average national length of stay (ALOS), outlier thresholds, and APR grouper version 43.0, contained in the APR-DRG Table of Weights and Thresholds, effective July 1, 2026. The department adopts and incorporates by reference the APR-DRG Table of Weights and Thresholds effective July 1, 2026.

(b) The outpatient hospital services fee schedules including:

(i) the Outpatient Prospective Payment System (OPPS) fee schedule as published by the CMS in 90 Federal Register 53448 (Nov. 25, 2025), effective January 1, 2026, and reviewed annually by CMS, as required in 42 CFR 419.50 and as updated by the department;

(ii) the conversion factor for outpatient services on or after July 1, 2025 is $62.54;

(iii) the Medicaid statewide average outpatient cost-to-charge ratio is 48.59%; and

(iv) the bundled composite rate of $290.32 for services provided in an outpatient maintenance dialysis clinic effective on or after July 1, 2025.

(d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in 2026 resulting in a dental conversion factor of $39.52 and fee schedule is effective July 1, 2026.

(e) The Dental and Denturist Program Provider Manual, as provided in ARM 37.86.1006, is effective July 1, 2026.

(f) The outpatient drugs reimbursement dispensing fees range as provided in ARM 37.86.1105(3)(b), is effective July 1, 2026:

(i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $4.25 and the maximum is $17.52;

(ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $4.25 and the maximum is $15.17; or

(iii) for pharmacies with prescription volume greater than or equal to 70,000, the minimum is $4.25 and the maximum is $12.83.

(g) The outpatient drugs reimbursement compound drug dispensing fee range, as provided in ARM 37.86.1105(5), will be $12.50, $17.50, or $22.50, based on the level of effort required by the pharmacist, effective July 1, 2013.

(h) The outpatient drugs reimbursement vaccine administration fee, as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $17.37 for each additional vaccine administered on the same date of service, effective July 1, 2026.

(i) The outpatient drugs reimbursement, unit dose prescriptions fee as provided in ARM 37.86.1105(10), will be $0.75 per pharmacy-packaged unit dose medication, effective November 1, 2013.

(j) The home infusion therapy services fee schedule, as provided in ARM 37.86.1506, is effective July 1, 2025.

(k) The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective July 1, 2025. Pursuant to 2-4-307(9), MCA, future updates to this fee schedule to conform with updates made by the Centers for Medicare & Medicaid Services to its Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule are incorporated by reference without additional rulemaking.

(l) The nutrition services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2025.

(m) The children's special health services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2019.

(n) The orientation and mobility specialist services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2025.

(o) The transportation and per diem fee schedule, as provided in ARM 37.86.2405, is effective July 1, 2025.

(p) The specialized nonemergency medical transportation fee schedule, as provided in ARM 37.86.2505, is effective July 1, 2025.

(q) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective July 1, 2025.

(r) The audiology fee schedule, as provided in ARM 37.86.705, is effective July 1, 2026.

(s) The therapy fee schedules for occupational therapists, physical therapists, and speech therapists, as provided in ARM 37.86.610, are effective July 1, 2026.

(t) The optometric services fee schedule, as provided in ARM 37.86.2005, is effective July 1, 2026.

(u) The chiropractic fee schedule, as provided in ARM 37.85.212(2), is effective July 1, 2026.

(v) The lab and imaging services fee schedule, as provided in ARM 37.85.212(2) and 37.86.3007, is effective July 1, 2026.

(w) The Targeted Case Management for Children and Youth with Special Health Care Needs fee schedule, as provided in ARM 37.86.3910, is effective July 1, 2025.

(x) The Targeted Case Management for High-Risk Pregnant Women fee schedule, as provided in ARM 37.86.3415, is effective July 1, 2025.

(y) The mobile imaging services fee schedule, as provided in ARM 37.85.212, is effective July 1, 2026.

(z) The licensed direct-entry midwife fee schedule, as provided in ARM 37.85.212, is effective July 1, 2026.

(aa) The private duty nursing services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2025.

(4) The department adopts and incorporates by reference, the fee schedule for the following programs within the Senior and Long-Term Care Division on the date stated:

(a) The Big Sky Waiver home and community-based services for elderly and physically disabled persons fee schedule, as provided in ARM 37.40.1421, is effective July 1, 2026.

(b) The home health services fee schedule, as provided in ARM 37.40.705, is effective July 1, 2026.

(d) The self-directed personal care services fee schedule, as provided in ARM 37.40.1135, is effective July 1, 2026.

(e) The community first choice services fee schedule, as provided in ARM 37.40.1026, is effective July 1, 2026.

(5) The department adopts and incorporates by reference, the fee schedule for the following programs within the Behavioral Health and Developmental Disabilities Division on the date stated:

(a) The mental health center services for adults fee schedule, as provided in ARM 37.88.907, is effective July 1, 2025.

(b) The home and community-based services for adults with severe disabling mental illness fee schedule, as provided in ARM 37.90.408, is effective July 1, 2025.

(6) For the Behavioral Health and Developmental Disabilities Division, the department adopts and incorporates by reference the Medicaid youth mental health services fee schedule, as provided in ARM 37.87.901, effective May 9, 2026.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA
History: NEW, 2011 MAR p. 1713, Eff. 8/26/11; AMD, 2013 MAR p. 686, Eff. 4/26/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2013 MAR p. 2151, Eff. 11/15/13; AMD, 2014 MAR p. 506, Eff. 3/14/14; AMD, 2014 MAR p. 1402, Eff. 7/1/14; AMD, 2014 MAR p. 2168, Eff. 9/19/14; AMD, 2015 MAR p. 26, Eff. 1/16/15; AMD, 2015 MAR p. 822, Eff. 7/1/15; AMD, 2015 MAR p. 1911, Eff. 10/30/15; AMD, 2016 MAR p. 151, Eff. 1/23/16; AMD, 2016 MAR p. 1058, Eff. 7/1/16; AMD, 2016 MAR p. 1462, Eff. 10/1/16; AMD, 2016 MAR p. 2431, Eff. 1/1/17; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2017 MAR p. 2443, Eff. 1/1/18; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 1116, Eff. 7/1/18; AMD, 2018 MAR p. 1612, Eff. 8/11/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 343, Eff. 4/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2019 MAR p. 2252, Eff. 12/7/19; AMD, 2020 MAR p. 91, Eff. 1/18/20; AMD, 2020 MAR p. 1158, Eff. 7/1/20; AMD, 2020 MAR p. 1740, Eff. 10/1/20; AMD, 2021 MAR p. 180, Eff. 2/13/21; AMD, 2021 MAR p. 1324, Eff. 10/9/21; AMD, 2021 MAR p. 1683, Eff. 11/20/21; AMD, 2021 MAR p. 1927, Eff. 12/24/21; AMD, 2022 MAR p. 241, Eff. 2/12/22; AMD, 2022 MAR p. 695, Eff. 5/14/22; AMD, 2022 MAR p. 1078, Eff. 7/1/22; AMD, 2022 MAR p. 1914, Eff. 9/24/22; AMD, 2023 MAR p. 181, Eff. 2/25/23; AMD, 2023 MAR p. 482, Eff. 5/27/23; AMD, 2023 MAR p. 1563, Eff. 9/9/23; AMD, 2024 MAR p. 615, Eff. 3/23/24; AMD, 2024 MAR p. 2269, Eff. 9/21/24; AMD, 2025 MAR, Notice No. 37-1104, Eff. 3/8/25; AMD, 2025 MAR, Notice No. 37-1110, Eff. 6/7/25; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26; AMD, 2026 MAR, Notice No. 2026-127, Eff. 9/26/26.

Mont. Admin. R. 37.85.106 Medicaid Behavioral Health Targeted Case Management Fee Schedule

(2) The Department of Public Health and Human Services (department) adopts and incorporates by reference the Medicaid Behavioral Health Targeted Case Management Fee Schedule effective October 1, 2025, for the following programs within the Behavioral Health and Developmental Disabilities Division:

(a) Targeted Case Management Services (TCM) for Youth with Serious Emotional Disturbance (SED), as provided in ARM 37.87.901;

(b) TCM for Substance Use Disorders (SUD), as provided in ARM 37.27.905;

(d) TCM for Adults with Serious Mental Illness or SUD, exiting state-operated secure facilities, as provided in ARM 37.90.501; and

(e) TCM for post-adjudicated youth offenders exiting state-operated secure facilities, up to age 21 or former foster care, up to age 26, and as provided in ARM 37.90.501.

(3) Copies of the department's current fee schedules are posted at https://medicaidprovider.mt.gov.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 2305, Eff. 1/1/18; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2020 MAR p. 691, Eff. 4/18/20; AMD, 2020 MAR p. 1158, Eff. 7/1/20; AMD, 2021 MAR p. 1324, Eff. 10/9/21; AMD, 2022 MAR p. 1078, Eff. 7/1/22; AMD, 2023 MAR p. 1025, Eff. 9/9/23; AMD, 2024 MAR p. 2269, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26; AMD, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.

Subchapter 37.85.2 Miscellaneous

Mont. Admin. R. 37.85.201 Selection of Provider

(1) Except as otherwise provided in ARM Title 37, chapters 40, 80, 82, 83, 85, 86, 88 any individual eligible for medical assistance may obtain the services available from any institution, agency, pharmacy, or practitioner, qualified to perform such services and participating under the program, including an organization which provides these services or arranges for their availability on a prepayment basis.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-116, 53-6-132, MCA
History: NEW, Eff. 11/4/74; AMD, Eff. 11/3/75; AMD, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.204 Member Requirements, Cost Sharing

(1) Effective for claims paid on or after January 1, 2020, members covered under Medicaid or Medicaid Expansion will not be assessed a copayment, as defined in ARM 37.84.102, for any covered service.

(2) The total of Medicaid or Medicaid Expansion cost share, as defined in ARM 37.84.102, incurred by a Medicaid or Medicaid Expansion household may not exceed an aggregate limit of five percent of the family's income applied quarterly. There may not be further cost sharing applied to the household members in a quarter once a household has met the quarterly aggregate cap.

(3) Providers may directly charge members only for the following services if the member signs an Advanced Beneficiary Notice for the specific service prior to the service being provided:

(a) noncovered services;

(b) experimental services;

(d) services performed in an inappropriate setting;

(e) services that are not medically necessary;

(f) investigational services; or

(g) dental treatment expenses that exceed the annual dental treatment cap.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, 53-6-141, MCA
History: NEW, 1983 MAR p. 1197, Eff. 8/26/83; AMD, 1986 MAR p. 677, Eff. 4/25/86; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1994 MAR p. 686, Eff. 4/1/94; AMD, 1995 MAR p. 1159, Eff. 7/1/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1208, Eff. 7/8/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479; AMD, 2002 MAR p. 797, Eff. 3/15/02; EMERG, AMD, 2002 MAR p. 3156, Eff. 11/15/02; AMD, 2016 MAR p. 829, Eff. 5/7/16; AMD, 2017 MAR p. 100, Eff. 1/7/17; AMD, 2017 MAR p. 2326, Eff. 1/1/18; AMD, 2020 MAR p. 95, Eff. 1/18/20.

Mont. Admin. R. 37.85.205 Recipient Restriction of Access to Medical Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-104, MCA
History: NEW, 1979 MAR p. 1122, Eff. 9/28/79; AMD, 1983 MAR p. 354, Eff. 4/29/83; AMD, 1985 MAR p. 249, Eff. 3/15/85; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; REP, 2004 MAR p. 1624, Eff. 7/23/04.

Mont. Admin. R. 37.85.206 Services Provided

(1) Except as otherwise provided in this rule, the following medical or remedial care and services are available to all persons who are eligible for Medicaid benefits under this chapter, including deceased persons, categorically related, who would have been eligible had death not prevented them from applying.

(a) inpatient hospital services;

(b) outpatient hospital services;

(d) nursing facility services;

(e) early and periodic screening, diagnosis and treatment services;

(f) physician's services;

(g) podiatry services;

(h) outpatient physical therapy services;

(i) speech therapy, audiology and hearing aid services;

(j) outpatient occupational therapy services;

(k) home health care services;

(l) personal care services in a member's home;

(m) home dialysis services;

(n) private duty nursing services;

(o) clinic services;

(p) dental services;

(q) outpatient drugs;

(r) durable medical equipment, prosthetic devices, and medical supplies;

(s) eyeglasses and optometric services;

(t) transportation and per diem;

(u) ambulance services;

(v) specialized nonemergency transportation;

(w) family planning services;

(x) home and community services;

(y) mid-level practitioner services;

(z) hospice services;

(aa) licensed psychologist services;

(bb) licensed clinical social worker services;

(cc) licensed professional counselor services;

(dd) inpatient psychiatric services;

(ee) mental health center services;

(ff) case management services;

(gg) institutions for mental diseases for persons aged 65 and over;

(hh) payment of premiums, co-insurance, deductibles, and other cost sharing obligations under an individual or group health plan in accordance with the provisions of ARM 37.82.424;

(ii) diabetes and cardiovascular disease prevention services;

(jj) habilitative services;

(kk) rehabilitative services; and

(ll) pediatric complex care assistant services.

(2) Only those medical or remedial care and services also covered by Medicare are available to a person who is eligible for Medicaid benefits as a qualified Medicare beneficiary under ARM 37.83.201 and 37.83.202.

(3) State plan Medicaid benefits are available for members who are Medicaid-covered through the Waiver for Additional Services and Populations (WASP) Medicaid 1115 Waiver as approved by the Centers for Medicare and Medicaid Services (CMS).

(a) A person may receive coverage through the WASP Medicaid 1115 Waiver if the person is 18 or older, has severe disabling mental illnesses (SDMI), would qualify for or be enrolled in the state-financed mental health services plan (MHSP) or the WASP Medicaid 1115 Waiver but is otherwise ineligible for Medicaid benefits, and either:

(i) the person's income is 0 to 138% of the federal poverty level and the person is eligible for or is enrolled in Medicare; or

(ii) the person's income is 139 to 150% of the federal poverty level whether Medicare-eligible or not.

(b) A person determined categorically eligible for Medicaid as aged, blind, or disabled (ABD) in accordance with ARM 37.82.901 through 37.82.903 is not subject to the annual dental treatment limit incorporated under ARM 37.86.1006. The monies expended for treatment costs exceeding the limit are covered through the WASP Medicaid 1115 Waiver.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-103, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA
History: NEW, 1980 MAR p. 1789, Eff. 6/27/80; AMD, 1986 MAR p. 677, Eff. 4/25/86; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1988 MAR p. 2228, Eff. 10/14/88; AMD, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1991 MAR p. 1021, Eff. 6/28/91; AMD, 1992 MAR p. 1401, Eff. 6/26/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1997 MAR p. 898, Eff. 3/25/97; AMD, 1999 MAR p. 1806, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479; AMD, 2009 MAR p. 2379, Eff. 1/1/10; AMD, 2012 MAR p. 1671, Eff. 8/24/12; AMD, 2016 MAR p. 829, Eff. 5/7/16; AMD, 2025 MAR, Notice No. 2025-53, Eff. 9/27/25; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26.

Mont. Admin. R. 37.85.207 Services Not Provided by the Medicaid Program

(1) Items or medical services not specifically included within these rules as covered benefits of the Montana Medicaid program are not reimbursable.

(2) The following medical and nonmedical services are explicitly excluded from the Montana Medicaid program, except for those services specifically available, as listed in ARM 37.40.1406, 37.90.402, and Title 37, chapter 34, subchapter 9 to persons eligible for home and community-based services; and except for those Medicare covered services, as listed in ARM 37.83.812 to qualified Medicare beneficiaries for whom the Montana Medicaid program pays the Medicare premiums, deductible, and coinsurance:

(a) chiropractic services;

(b) acupuncture services;

(d) dietician services;

(e) physical therapy aide services, except as provided in ARM 37.86.601, 37.86.605, 37.86.606, and 37.86.610;

(f) surgical technicians who are not physicians or mid-level practitioners;

(g) nutritional services;

(h) masseur or masseuse services;

(i) dietary supplements;

(j) homemaker services;

(k) telephone service in home, remodeling of home, plumbing service, car repair, and/or modification of automobile;

(l) delivery services not provided in a licensed health care facility or nationally accredited birthing center, except as set forth below in (i) and (ii) of this subsection. Delivery services means services necessary to protect the health and safety of the woman and fetus from the onset of labor through delivery. The following circumstances are an exception to the exclusion set forth in this subsection:

(i) delivery services occurring as an emergency service, as defined in ARM 37.82.102; and

(ii) a planned home birth attended by a licensed nurse midwife or licensed direct-entry midwife, provided the circumstances of the delivery comply with the standards and requirements in ARM 24.111.617 and ARM 24.159.1477;

(m) treatment services for infertility, including sterilization reversals;

(n) experimental services;

(o) all invasive medical procedures undertaken for the purpose of weight reduction such as gastric bypass, gastric banding, or bariatric surgery, including all revisions; and

(p) circumcisions not authorized by the department as medically necessary.

(3) Medical services furnished to Medicaid eligible recipients who are absent from the state are excluded from the Montana Medicaid program except for those medical services provided when:

(a) there is a medical emergency and the recipient's health would be endangered if he were required to travel to Montana to obtain the medical services;

(b) the recipient travels to another state because the department finds the required medical services are not available in Montana; or it is determined by the department that it is general practice for recipients in a particular locality to use medical resources in another state;

(c) the recipient or his representative can demonstrate to the satisfaction of the department that out-of-state medical services and all related expenses will be less costly than in-state services; or

(d) the recipient is a child residing in another state for whom Montana makes adoption assistance or foster care maintenance payments.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-103, 53-6-116, 53-6-131, 53-6-141, 53-6-402, MCA
History: NEW, 1980 MAR p. 1793, Eff. 6/27/80; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1985 MAR p. 250, Eff. 3/15/85; AMD, 1986 MAR p. 677, Eff. 4/25/86; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1988 MAR p. 1255, Eff. 7/1/88; AMD, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1992 MAR p. 1401, Eff. 6/26/92; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2007 MAR p. 1680, Eff. 10/26/07; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2024 MAR p. 2278, Eff. 9/21/24.

Mont. Admin. R. 37.85.212 Resource Based Relative Value Scale (rbrvs) Reimbursement for Specified Provider Types

(1) For purposes of this rule, the following definitions apply:

(a) "Anesthesia units" means time and base units used to compute reimbursement under RBRVS for anesthesia services. Base units are those units as defined by the Medicare program. Time units are 15-minute intervals during which anesthesia is provided.

(b) "Conversion factor" means a dollar amount by which the relative value units, or the anesthesia units for anesthesia services, are multiplied in order to establish the RBRVS fee for a service. The effective date and conversion factor amounts are adopted at ARM 37.85.105(2). There are four conversion factor categories:

(i) physician services, which applies to the following health care professionals listed in (2): physicians, mid-level practitioners, podiatrists, public health clinics, independent diagnostic testing facilities (IDTF), mobile imaging/portable X-ray providers, qualified Medicare beneficiary (QMB) and early and periodic screening, diagnostic and treatment (EPSDT) chiropractors, laboratory and x-ray services, family planning clinics, and dentists providing medical services;

(ii) allied services, which applies to the following health care professionals listed in (2): physical therapists, occupational therapists, speech therapists, optometrists, opticians, audiologists, school-based services, licensed direct-entry midwives, and EPSDT orientation and mobility specialists;

(iii) mental health services, which applies to the following health care professionals listed in (2): licensed psychologists, licensed clinical social workers, and licensed professional counselors; and

(iv) anesthesia services, which applies to anesthesia services.

(c) "Conversion factor category" means the four categories of providers for purposes of calculating Medicaid fees. The categories are physician services, allied services, mental health services, and anesthesia services.

(d) "Policy adjustor" means a factor by which the product of the relative value units and the conversion factor is multiplied to increase or decrease the fees paid by Medicaid for certain categories of services.

(e) "Provider rate of reimbursement adjustment" means the change to the RBRVS fee calculated for a procedure based on the health care professional delivering the service.

(f) "Rate variable" means a multiplier in the rate equation, such as a policy adjustor, a provider rate of reimbursement, or pricing modifier, that changes the RBRVS rate for a procedure or service.

(g) "RBRVS fee" for a covered procedure means the amount calculated by multiplying the relative value units (or the anesthesia units for anesthesia services) for the procedure by the appropriate conversion factor. If applicable, a rate variable may be applied to the RBRVS fee to calculate the Montana Medicaid fee for the procedure.

(h) "Relative value unit (RVU)" means a numerical value assigned in the resource based relative value scale to each procedure code used to bill for services provided by a health care provider. The relative value unit assigned to a particular code expresses the relative effort and expense expended by a provider in providing one service as compared with another service.

(i) "Resource-based relative value scale (RBRVS)" means the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services. The effective date and citation for the RBRVS is adopted at ARM 37.85.105(2).

(2) Services provided by the following health care professionals will be reimbursed in accordance with the RBRVS methodology set forth in (3):

(a) physicians;

(b) mid-level practitioners;

(d) physical therapists;

(e) occupational therapists;

(f) speech therapists;

(g) audiologists;

(h) optometrists;

(i) opticians;

(j) public health clinics;

(k) licensed psychologists;

(l) licensed clinical social workers;

(m) licensed professional counselors;

(n) dentists providing medical services;

(o) laboratory and x-ray services;

(p) independent diagnostic testing facilities (IDTF);

(q) school-based services;

(r) QMB and EPSDT chiropractors;

(s) family planning clinics;

(t) anesthesia services;

(u) licensed direct-entry midwives;

(v) EPSDT orientation and mobility specialists;

(w) mobile imaging/portable x-ray providers; and

(x) BCBA/BCBA-D.

(3) The RBRVS fee for a covered service is calculated by multiplying the RVUs determined in accordance with (7) by the conversion factor. The RBRVS fee may also be multiplied by a rate variable to calculate the fee paid by Medicaid.

(4) The conversion factor for physician services is calculated as stated in 53-6-124 and 53-6-125, MCA. The conversion factor for allied services, mental health services, and anesthesia services is calculated as follows:

(a) The total RVUs for the prior period is calculated as the sum of the product of the RVUs for a procedure code multiplied by the number of times the procedure code was paid in a prior period.

(b) The total RVUs for the prior period is multiplied by the projected change in utilization to estimate utilization during the appropriation period.

(c) The Montana Legislature's appropriation for the period is divided by the estimated utilization for the period to calculate the conversion factor.

(d) The RVU assigned to each procedure code is multiplied by the appropriate conversion factor to calculate the RBRVS fee for a particular procedure code.

(5) Policy adjustors will be used to accomplish targeted funding allocations. The effective date and amounts are as provided in ARM 37.85.105(2).

(6) All conversion factors may be adjusted, pursuant to 17-7-140, MCA, to ensure that the expenditure of appropriations does not exceed available revenue.

(7) The RVUs for services are adopted from the Medicare Physician Fee Schedule described in (1).

(8) Subject to the provisions of (8)(a), when billed with a modifier, payment for procedures established under the provisions of (7) is a percentage of the rate established for the procedures.

(a) The methodology to determine the specific percent for each modifier is as follows:

(i) The department obtains information from Medicare and other third party payers regarding the comparative value utilized for payment of procedures billed with modifiers.

(ii) The department establishes a specific percentage for each modifier based upon the purpose of the modifier, the comparative value of the modified service and the medical insurance industry trend of reimbursement for the modifier.

(iii) The department's list of the specific percents for the modifiers used by Medicaid is adopted and incorporated by reference. A copy of the list is available on the department's web site at: https://medicaidprovider.mt.gov/manuals/physicianrelatedservicesmanual. The effective date and amounts are as provided in ARM 37.85.105(2).

(9) In applying the RBRVS methodology set forth in this rule, Medicaid reimburses in accordance with Medicare's policy on the bundling of services, as set forth in the Medicare Physician Fee Schedule adopted by CMS and published in the Federal Register annually, whereby payment for certain services constitutes payment for certain other services which are considered to be included in those services.

(10) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained in the Federal Health Care Administration's Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers, and HCPCS is available in provider manuals located on the department's web site at: https://medicaidprovider.mt.gov/.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-125, MCA
History: NEW, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 984, Eff. 6/8/01; EMERG, AMD, 2002 MAR p. 797, Eff. 3/15/02; AMD, 2002 MAR p. 1775, Eff. 6/28/02; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2002 MAR p. 3637, Eff. 12/27/02; EMERG, AMD, 2003 MAR p. 1311, Eff. 7/1/03; AMD, 2004 MAR p. 1488, Eff. 7/2/04; AMD, 2005 MAR p. 974, Eff. 7/1/05; AMD, 2006 MAR p. 1422, Eff. 6/2/06; AMD, 2007 MAR p. 1339, Eff. 10/1/07; AMD, 2008 MAR p. 1155, Eff. 7/1/08; AMD, 2009 MAR p. 1012, Eff. 7/1/09; AMD, 2010 MAR p. 1540, Eff. 7/1/10; AMD, 2011 MAR p. 1700, Eff. 8/26/11; AMD, 2012 MAR p. 1266, Eff. 6/22/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1407, Eff. 7/1/14; AMD, 2016 MAR p. 2435, Eff. 1/1/17; AMD, 2017 MAR p. 1522, Eff. 9/9/17; AMD, 2024 MAR p. 2269, Eff. 9/21/24.

Mont. Admin. R. 37.85.213 In-Training Mental Health Professional Services Billing Medicaid

(1) To bill and receive reimbursement for services rendered by an in-training mental health professional, a provider must be a licensed mental health center or meet the criteria outlined in this rule.

(2) For the purposes of this rule:

(a) "Face-to-face" has the meaning provided in ARM 24.219.301.

(b) "In-training mental health professional" refers to an individual providing in-training mental health professional services, as that term is defined in this rule.

(i) has completed all academic requirements for licensure as a psychological resident (as defined in ARM 24.189.301(8)), licensed clinical social worker, licensed professional counselor, or licensed marriage and family therapist;

(ii) is under the supervision of a licensed mental health professional approved by the candidate's licensing board;

(iii) is in the process of completing the supervised experience requirement for licensure, in accordance with ARM Title 24, chapter 189 or 219; and

(iv) has an approved supervision plan through the candidate's licensing board.

(3) The provider's practice setting must:

(a) provide medication management;

(b) provide outpatient mental health services; and

(i) the service is available 24 hours a day, seven days a week;

(ii) an answering service or unlicensed employees may answer calls and transfer calls to individuals trained to respond to crisis calls;

(iii) written policies and procedures that include:

(A) training requirements for individuals responding to crisis calls;

(B) a policy requiring a mental health professional to be on-site for consultation and backup for unlicensed individuals receiving crisis calls; and

(d) employ or contract with a licensed health care professional who is licensed to prescribe medication for mental health/behavioral health disorders;

(e) employ or contract with the licensed mental health professional who is approved by the candidate's licensing board to serve as supervisor to the candidate; and

(f) have at least one licensed mental health professional on-site or available for face-to-face supervision of the candidate when the supervisor is not available.

(4) The supervisor must provide face-to-face supervision of the licensure candidate in accordance with the licensure board's approved supervision plan and as needed. The designated supervisor must be a supervisor of record with the candidate's licensing board and have assumed responsibility for the candidate's continued training and for services provided by the candidate.

(5) The provider must provide professional liability insurance for the candidate's professional services.

(6) An in-training mental health professional may not engage in independent practice.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2024 MAR p. 2014, Eff. 8/10/24.

Mont. Admin. R. 37.85.219 Mobile Imaging/Portable X-Ray Supplier

(1) Any provider that is enrolled in the federal Medicare program as a Mobile Imaging Provider/Portable X-Ray Supplier may also enroll in the Montana Medicaid program as a Mobile Imaging Provider/Portable X-Ray Supplier.

(2) A Mobile Imaging Provider/Portable X-Ray Supplier enrolled in the Montana Medicaid program is governed by 42 CFR 486.100, 486.102, 486.104, 486.106, 486.108, and 486.110. The department adopts and incorporates by reference 42 CFR 486.100, 486.102, 486.104, 486.106, 486.108, and 486.110. Copies of 42 CFR 486.100, 486.102, 486.104, 486.106, 486.108, and 486.110 are available upon request from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(3) In addition to 42 CFR 486.100, 486.102, 486.104, 486.106, 486.108, and 486.110, a Mobile Imaging Provider/Portable X-Ray Supplier enrolled in the Montana Medicaid program must comply with all rules generally applicable to Medicaid providers.

(4) A Mobile Imaging Provider/Portable X-Ray Supplier must be reimbursed for diagnostic services performed under ARM 37.85.406 and 37.86.105.

(5) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted by reference at ARM 37.86.101, set forth meanings of terms commonly used by the Montana Medicaid program in implementation of the program's Mobile Imaging Provider/Portable X-Ray Supplier fee schedule.

(6) The Physician-Related Services Manual governing the administration of the Mobile Imaging Provider/Portable X-Ray Supplier program adopted at ARM 37.86.101 applies to a Mobile Imaging Provider/Portable X-Ray Supplier.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-125, MCA
History: NEW, 2016 MAR p. 2435, Eff. 1/1/17.

Mont. Admin. R. 37.85.220 Independent Diagnostic Testing Facilities

(1) Any facility that is enrolled in the federal Medicare program as an independent diagnostic testing facility (IDTF) may also enroll in the Montana Medicaid program as an IDTF.

(2) IDTFs enrolled in the Montana Medicaid program shall be governed by 42 CFR 410.32 and 410.33. The department hereby adopts and incorporates by reference 42 CFR 410.32 and 410.33 (2001). Copies of 42 CFR 410.32 and 410.33 (2001) are available upon request from the Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(3) In addition to 42 CFR 410.32 and 410.33, IDTFs enrolled in the Montana Medicaid program shall comply with all rules generally applicable to Medicaid providers.

(4) An IDTF shall be reimbursed for diagnostic services performed pursuant to this rule in accordance with ARM 37.85.406 and 37.86.105.

(5) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted at ARM 37.86.101 set forth meanings of terms commonly used by the Montana Medicaid program in implementation of the program's IDTF fee schedule.

(6) The Physician-Related Services Manual governing the administration of the IDTF program adopted at ARM 37.86.101 applies to independent diagnostic testing facilities.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-111, MCA
History: NEW, 2002 MAR p. 797, Eff. 3/15/02; AMD, 2012 MAR p. 2625, Eff. 1/1/13.

Mont. Admin. R. 37.85.221 Medicaid Overpayment Auditor Evaluation Hearings; Recovery Audit Contractor (rac) Program

(1) Within one year after the establishment of the contract auditor, and each subsequent year, the department will announce auditor evaluation hearing meetings via the department's website at www.dphhs.mt.gov and the State of Montana's public calendaring system. The meetings will provide an opportunity for the Medicaid provider community and the department to discuss appropriate conduct and determinations by contract auditors. The evaluation meetings' information will be published no less than 30 calendar days in advance of any annual meeting.

History

Authorizing statute(s): 53-6-1409, MCA
Implementing statute(s): 53-6-111, 53-6-1409, MCA
History: NEW, 2018 MAR p. 1166, Eff. 6/23/18.

Subchapter 37.85.4 Provider Requirements

Mont. Admin. R. 37.85.401 Provider Participation

(1) As a condition of participation in the Montana Medicaid program all providers must comply with all applicable state and federal statutes, rules and regulations, including but not limited to federal regulations and statutes found in Title 42 of the Code of Federal Regulations and the United States Code governing the Medicaid Program and all applicable Montana statutes and rules governing licensure and certification.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1491, Eff. 5/16/80; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.402 Provider Enrollment and Agreements

(1) Providers must enroll in the Montana Medicaid program for each category of services to be provided. As a condition of granting enrollment approval or of allowing continuing enrollment, the department may require the provider to:

(a) complete and submit an enrollment application or form;

(b) complete and submit agreements or other forms applicable to the provider's category of service;

(c) provide information and documentation regarding ownership and control of the provider entity and regarding the provider's ownership interest or control rights in other providers that bill Medicaid;

(d) provide information and documentation regarding:

(i) any sanctions, suspensions, exclusions or civil monetary penalties imposed by the Medicare program, any state Medicaid program or other federal program against the provider, a person or entity with an ownership or control interest in the provider or an agent or managing employee of the provider; and

(ii) any criminal charges brought against and any criminal convictions of the provider, a person or entity with an ownership or control interest in the provider or an agent or managing employee of the provider related to that person's or entity's involvement in Medicare, Medicaid, or the Title XX Services program; and

(e) submit documentation and information demonstrating compliance with participation requirements applicable to the provider's category of service.

(2) Providers shall provide the department's fiscal agent with 30 days advance written notice of any change in the provider's name, address, tax identification number, group practice arrangement, business organization or ownership.

(a) An enrolled provider is not entitled to change retroactively the category of service for which the provider is enrolled, but must enroll prospectively in the new program category. The change in service category will be effective only upon approval of a completed enrollment application for the new service category and on or after the effective date of all required licenses and certifications. The change will apply only to services provided on or after the effective date of the enrollment change.

(3) Except as provided in (2)(a), an approved enrollment is effective on the later of:

(a) one year prior to the date the completed enrollment application is received by the department's fiscal agent; or

(b) the date as of which all required licenses and certifications are effective.

(4) Providers, whose services are covered by the Title XVIII program (Medicare), shall meet the certification standards of Medicare except as provided otherwise in these rules.

(5) Providers shall render services to an eligible Medicaid recipient in the same scope, quality, duration and method of delivery as to the general public, unless specifically limited by these regulations.

(a) No provider may deny services to any recipient because of the recipient's inability to pay a copayment in ARM 37.83.826 or in ARM 37.85.204.

(6) Providers shall not discriminate illegally in the provision of service to eligible Medicaid recipients or in employment of persons on the grounds of race, creed, religion, color, sex, national origin, political ideas, marital status, age, or disability. Providers shall comply with the Civil Rights Act of 1964 (42 USC 2000d, et seq.), The Age Discrimination Act of 1975 (42 USC 6101, et seq.), The Americans With Disabilities Act of 1990 (42 USC 12101, et seq.), section 504 of the Rehabilitation Act of 1973 (29 USC 794), and the applicable provisions of Title 49, MCA, as amended and all regulations and rules implementing the statutes.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA
History: NEW, 1980 MAR p. 1491, Eff. 5/16/80; AMD, 1983 MAR p. 1197, Eff. 8/26/83; AMD, 1987 MAR p. 900, Eff. 6/30/87; AMD, 1987 MAR p. 1116, Eff. 7/17/87; AMD, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.403 Icd Clinical Modification (cm) and Procedural Coding System (pcs) Services

(1) The department adopts and incorporates by reference the Diagnosis coding practice of International Classification of Diseases (ICD) published by the World Health Organization. The ICD is used as a health care classification system for diseases and health conditions.

(a) For dates of service on or before September 30, 2015, the ICD edition being utilized will be the ninth revision (ICD-9) to code the diagnosis of services.

(b) For dates of service October 1, 2015 and thereafter the ICD edition being utilized will be the tenth revision (ICD-10) to code the diagnosis of services. ICD-10 consists of the following codes sets:

(i) ICD-Clinical Modification (CM); and

(ii) ICD-Procedure Coding System (PCS).

(c) For inpatient claims with a discharge date on or after October 1, 2015, the tenth revision (ICD-10) must be utilized.

(d) Outpatient claims with dates of service that span the utilization dates must be split based on date of service in order to utilize the appropriate edition as noted in (a) and (b).

(e) Per 45 CFR 162.1002, ICD-10 will replace ICD-9 for dates of service October 1, 2015 and after. A copy of the ICD codes may be obtained at http://www.medicalcodingbooks.com/ .

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2014 MAR p. 507, Eff. 3/14/14; AMD, 2014 MAR p. 3074, Eff. 12/25/14.

Mont. Admin. R. 37.85.405 Electronic Visit Verification Requirements

(1) Montana Medicaid providers that provide home and community-based services subject to federal Electronic Visit Verification (EVV) requirements must ensure an EVV system is used to electronically document the delivery of EVV services and submit claims.

(2) Each EVV visit transaction must contain the following data elements, as required by section 12006 of the 21st Century Cures Act, Pub. L. No. 114-225 (Dec. 13, 2016), as codified at 42 U.S.C. 1396b(l)(l) & (5)(A), for:

(a) the type of service provided;

(b) the name of the member who received the service;

(d) the date of the service;

(e) the time the service began and ended; and

(f) the location, including the address, at which the service was provided.

(3) In addition to the requirements listed in (2), the department may request additional information deemed necessary to ensure the accurate payment of a claim for services.

(4) EVV is a requirement for all members utilizing home and community-based services subject to federal EVV requirements, including those who have a live-in caregiver.

History

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-2-201, 53-6-113, MCA
History: NEW, 2025 MAR, Notice No. 2025-523, Eff. 11/22/25.

Mont. Admin. R. 37.85.406 Billing, Reimbursement, Claims Processing, and Payment

(1) Providers must submit clean claims to Medicaid within the latest of:

(a) 12 months from the latest of:

(i) the date of service;

(ii) the date retroactive eligibility is determined; or

(iii) the date disability was determined;

(b) six months from the date on the Medicare explanation of benefits approving the service, if the Medicare claim was timely filed and the member was Medicare eligible at the time the Medicare claim was filed; or

(c) six months from the date on an adjustment notice from a third party payor, where the third party payor has previously processed the claim for the same service and the adjustment notice is dated after the periods described in (1)(a) and (b).

(2) For purposes of this rule:

(a) "Clean claim" means a claim that can be processed without additional information or documentation from or action by the provider of the service;

(b) For inpatient hospital services, date of service is the date of discharge;

(c) The date of submission to the Medicaid program is the date the claim is stamped "received" by the department or its designee; and

(d) The claim submission deadline specified in (1) through (1)(c) applies regardless of whether or not a third party has allowed or denied a provider's claim. If a third party has not allowed or denied a provider's claim, the provider may submit a claim to Medicaid according to the requirements of ARM 37.85.407(6)(c) and subject to the claim submission deadline specified in (1) through (1)(c).

(3) Claims must be submitted in accordance with this rule to be valid. In processing claims, the department or its agent may deny payment of or pend a claim upon determining that a basis exists for denial of payment or pending the claim. No further review or processing of a denied claim is required until resubmission of the claim by the provider. The department or its agent is not required to list or identify all possible grounds for denial or pending of the claim. The fact that a particular basis for denial or pending of a claim for a service or item was not identified on an earlier statement of remittance or other similar statement does not preclude denial or pending of the claim on that basis on a later submission of the claim.

(4) Except as provided in (7), all Medicaid claims submitted to the department are to be submitted on a state claim form which is:

(a) personally signed by that provider;

(b) personally signed by a person who has actual written authority to bind and represent the provider for this purpose. The department may require a provider to furnish this written authorization; or

(c) signed by the use of a facsimile signature stamp or a computer generated, typed or block letter signature. Providers submitting or causing to be submitted a claim using a facsimile, computer generated, typed or block letter signature shall bear full responsibility for submission of the claim as though the claim were personally signed by the provider or the provider's authorized agent.

(5) All Medicaid claims submitted to the department by a hospital for services provided by a physician who is required to relinquish fees to the hospital are to be submitted on a state claim form which is:

(a) personally signed by the physician provider;

(b) personally signed by a person who has actual written authority to bind and represent the physician provider for this purpose. The department may require a provider to furnish this written authorization; or

(c) signed by the use of a facsimile signature stamp or a computer generated, typed or block letter signature. Providers submitting or causing to be submitted a claim using a facsimile, computer-generated, typed or block letter signature shall bear full responsibility for submission of the claim as though the claim were personally signed by the provider or the provider's authorized agent.

(6) The department may require a hospital provider to obtain on the claim form the signature of a physician providing services for which fees are relinquished to the hospital.

(7) Electronic media claims may be submitted by a provider who enters into an agreement with the department for this purpose and who meets the department's requirements for documentation, record retention and signature requirements.

(8) Claims submitted for the professional component of electrodiagnostic procedures which do not involve direct personal care on the part of the physician and performed by physicians on contract to the hospital may be submitted on state approved claim forms signed by the person with authority to bind the hospital under (5)(b).

(a) Electrodiagnostic procedures include echocardiology studies, electroencephalography studies, electrocardiology studies, evoked potential studies, holter monitors, telephonic or teletrace checks and pulmonary function tests.

(b) If, after review, the department determines that claims for hospital-based physician services are not submitted by a hospital provider in accordance with this rule, the department may require the hospital provider to obtain the signature of the physician providing the service on the claim form.

(9) If the department pays a claim but subsequently discovers that the provider was not entitled to payment for any reason, the department is entitled to recover the resulting overpayment as provided in (10).

(10) The department is entitled to recover from the provider and the provider is obligated to repay to the department all Medicaid payments made to which the provider was not entitled under applicable state and federal laws, regulations and rules. At the option of the department, recoveries may be accomplished by a direct payment to the department or by automatic deductions from future payments due the provider. Notice of overpayment must be made in accordance with ARM 37.85.512.

(a) The department is entitled to recover under (10) any payment to which the provider was not entitled, regardless of whether the payment was the result of department or provider error, or other cause, and without proving that the provider submitted an improper or erroneous claim knowingly, intentionally, or with intent to defraud.

(b) The department is entitled to recover an overpayment from the provider in whose name the erroneous or improper claim was submitted, even if the provider was an employee of another individual or entity and was required as a condition of the provider's employment to turn over all fees received by the provider to the employer.

(11) Providers are required to accept, as payment in full, the amount paid by the Montana Medicaid program for a service or item provided to an eligible Medicaid member in accordance with the rules of the department. Providers must not seek any payment in addition to or in lieu of the amount paid by the Montana Medicaid program from a member or his representative, except as provided in these rules. A provider may bill a member for the copayments specified in ARM 37.83.826 and 37.85.204 and may bill certain members for amounts above the Medicare deductibles and coinsurance as allowed in ARM 37.83.825.

(a) A provider may bill a member for noncovered services if the provider has informed the member in advance of providing the services that Medicaid will not cover the services and that the member will be required to pay privately for the services, and if the member has agreed to pay privately for the services. For purposes of (11)(a), noncovered services are services that may not be reimbursed for the particular member by the Montana Medicaid program under any circumstances and covered services are services that may be reimbursed by the Montana Medicaid program for the particular member if all applicable requirements, including medical necessity, are met.

(b) Except as provided in this rule, a provider may not bill a member after Medicaid has denied payment for covered services because the services are not medically necessary for the member.

(i) A provider may bill a member for covered but medically unnecessary services, including services for which Medicaid has denied payment for lack of medical necessity, if the provider specifically informed the member in advance of providing the services that the services are not considered medically necessary under Medicaid criteria, that Medicaid will not pay for the services and that the member will be required to pay privately for the services, and the member has agreed to pay privately for the services. The agreement to pay privately must be based upon definite and specific information given by the provider to the member indicating that the service will not be paid by Medicaid. The provider may not bill the member under this exception when the provider has informed the member only that Medicaid may not pay or where the agreement is contained in a form that the provider routinely requires members to sign.

(ii) An ambulance service provider may bill a member after Medicaid has denied payment for lack of medical necessity.

(c) A provider may not bill a member for services as a private pay patient if, prior to provision of the services, the member informed the provider of Medicaid eligibility, unless, prior to provision of the services, the provider informed the member of its refusal to accept Medicaid and the member agreed to pay privately for the services.

(d) In service settings where the individual is accepted as a Medicaid member by an arranging provider including, but not limited to, a facility, institution, or other entity that arranges for provision of services by other providers, all other providers performing services for the individual in conjunction with the arranging provider will be deemed to have accepted the individual as a Medicaid member.

(i) The only exception to (d) is if the other provider, prior to providing services, informed the individual of their refusal to accept Medicaid and the individual agreed to pay privately for the services. The other provider may then bill the individual for services.

(e) The provider may not bill a member for services when Medicaid does not pay as a result of the provider's failure to comply with applicable enrollment, prior authorization, billing, or other requirements necessary to obtain payment.

(f) Acceptance of an individual as a Medicaid member applies to all services provided by the provider to the member, except as provided in (11)(a) or (b). A provider may not accept Medicaid payment for some covered services but refuse to accept Medicaid for other covered services. Subject to the requirements of ARM 37.85.402(4), a provider may terminate acceptance of Medicaid for a member in accordance with the provider's professional responsibility, by informing the member of the termination and the effect of the termination on provision of and payment for any further services.

(g) If an individual has agreed prior to receipt of services that payment will be made from a source other than Medicaid but later is determined retroactively eligible for Medicaid, the provider may choose to accept the individual as a Medicaid member with respect to the services or to seek payment in accordance with the original payment agreement.

(h) A provider that bills Medicaid for services rendered will be deemed to have accepted the individual as a Medicaid member.

(i) Nothing in this rule is intended to permit a provider to refuse to accept an individual as a Medicaid member where the provider is otherwise required by law to accept an individual as a Medicaid member.

(12) In the event that a provider of services is entitled to a retroactive increase of payment for services rendered, the provider must submit a claim within 180 days of the written notification of the retroactive increase or the provider forfeits any rights to the retroactive increase.

(13) The Montana Medicaid program will make payments directly to the individual provider of service unless the individual provider is required, as a condition of his employment, to turn his fees over to his employer.

(a) Exceptions to the above requirement may, at the discretion of the department, be made for transportation and/or per diem costs incurred to enable a member to obtain medically appropriate services.

(14) The method of determining payment rates for out-of-state providers will be the same as for in-state providers except as otherwise provided in the rules of the department.

(15) A government agency may bill the Medicaid program for covered medical services under the following circumstances:

(a) The government agency has complied with all federal and state law governing the Medicaid program, and assures that the provider has complied with all state and federal law governing the Medicaid program, including reimbursement levels.

(b) The government agency accepts assignment from an eligible Medicaid provider for services provided prior to eligibility determination.

(16) A person enrolled as an individual provider may not submit a claim for services that the provider did not personally provide, inclusive of services provided by another person under the provider's supervision, unless authorization to bill for and receive reimbursement for services the provider did not personally provide is stated in administrative rule or a Montana Medicaid program manual and is in compliance with any supervision requirements in state law or rule governing the provider's professional practice and the practice of assistants and aides. Other providers, including but not limited to hospitals, nursing facilities, and home health agencies, may bill for and receive reimbursement for services provided by supervised persons in accordance with the Medicaid rules and manual and any supervision requirements in state law or rule governing professional practice.

(17) Medicaid coverage and reimbursement is available only for services or items that are provided in accordance with all applicable Medicaid requirements and within the scope of practice permitted under state licensure laws and other mandatory standards applicable to the provider.

(18) Except as otherwise provided in the rules of the department which pertain to the method of determining payment rates for claims of recipients members who have Medicare and Medicaid coverage (cross-over claims), the Medicaid allowed amount for Medicare covered services is:

(a) for facility based providers who generally bill on the UB-04 billing form, for covered medical services the full Medicare coinsurance and deductible as defined by the Medicare carrier;

(i) there is an exception for inpatient ancillary services with Medicare Part B coverage only (no Medicare Part A) or FQHCs: Medicare payments for these services are treated as third party payments and are offset against the Medicaid payment;

(b) for medical providers who generally bill on the HCFA-1500 billing form, for covered medical services the lower of:

(i) the Medicare coinsurance and deductible (if not met); or

(ii) the Medicaid fee less the amount paid by Medicare for the same service, not to exceed the Medicaid fee for that service;

(i) the Medicaid allowed amount; or

(ii) the Medicare allowed amount, less the Medicare paid amount;

(d) for services to members eligible to receive both Medicare and Medicaid benefits, an amount not to exceed the Medicare allowed amount in instances where the Medicaid fee is higher than the Medicare allowable.

(19) For all purposes of this rule, the amount of the provider's usual and customary charge may not exceed the reasonable charge usually and customarily charged to all payers.

(20) Reimbursement from Medicaid may not exceed an amount which would cause total payment to the provider from both Medicaid and all other payers to exceed the Medicaid fee.

(21) Montana Medicaid does not reimburse for the facility component of a Provider Based entity service.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-131, 53-6-149, MCA
History: NEW, 1980 MAR p. 1491, Eff. 5/16/80; AMD, 1981 MAR p. 530, Eff. 5/29/81; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 771, Eff. 7/31/81; AMD, 1983 MAR p. 1197, Eff. 8/26/83; AMD, 1986 MAR p. 359, Eff. 3/14/86; AMD, 1987 MAR p. 894, Eff. 6/26/87; AMD, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1990 MAR p. 379, Eff. 2/23/90; AMD, 1990 MAR p. 1586, Eff. 8/17/90; AMD, 1992 MAR p. 234, Eff. 2/14/92; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; AMD, 1998 MAR p. 2168, Eff. 8/14/98; TRANS, from SRS, 2000 MAR p. 479; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; EMERG, AMD, 2002 MAR p. 797, Eff. 3/15/02; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2014 MAR p. 2171, Eff. 10/1/14; AMD, 2016 MAR p. 1712, Eff. 10/1/16; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.85.407 Third Party Liability

(1) No payment shall be made by the department for any medical service for which there is a known third party who has a legal liability to pay for that medical service except for those services specified in (6) below.

(2) For purposes of this section, the following definitions apply:

(a) A third party is defined as an individual, institution, corporation, or public or private agency that is or may be liable to pay all or part of the cost of medical treatment and medical-related services for personal injury, disease, illness, or disability of a recipient of medical assistance from the department or a county and includes but is not limited to insurers, health service organizations, and parties liable or who may be liable in tort. Indian health services is not a third party within the meaning of this definition.

(b) A known third party is a third party for which the provider has sufficient information to submit a claim and which if billed for a medical service is likely to pay the claim within a reasonable time.

(c) A potential third party is a third party for which the provider either has insufficient information to submit a claim or which if billed for a medical service, is likely to deny the claim as having no contractual or legal obligation to pay.

(3) For known recipients, the provider shall use its same usual and customary procedures for inquiring about possible third party resources as is done for non-recipients.

(4) If the provider delivers to a recipient or a recipient's legal representative a copy of a billing statement for services which have been or may be billed to the department, the statement must clearly indicate that third party benefits or payments have been assigned to the department by the patient or that the department may have a lien upon such benefits.

(a) The words "Medicaid has assignment of, or may have a lien upon third party benefits or payments" shall be sufficient to meet the notification requirement of this section.

(b) If a provider does not meet the notification requirements of this section, the department may withhold or recover from the provider an amount equal to any amounts paid by a third party towards the services described in the statement given to the recipient.

(5) If a provider learns of the existence of a known third party, that provider shall bill the third party prior to billing the department. If the department has knowledge of a known third party and the provider has not complied with (6) or (7) below, the department shall deny payment of the services.

(6) The department shall not deny payment of services solely because of the existence of a third party in the following circumstances:

(a) The primary diagnosis on the claim is for certain prenatal and preventive pediatric care as specified in the Medicaid provider manual, copies of which may be obtained from the Montana Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951. The provider may bill the third party or the department in this circumstance.

(b) The third party is an insurer under a health insurance policy provided by the absent parent of a recipient and that health insurance is obtained or maintained as a result of an enforcement action taken by the Child Support Services Division against that absent parent, if the following provisions are met:

(i) the provider submits evidence that the third party has been billed;

(ii) the claim is submitted to the department 30 or more days beyond the date of service and in compliance with the timely filing rules in ARM 37.85.406(1);

(iii) the provider certifies on the claim that notice of payment or denial of the claim has not been received from the third party; and

(iv) the claim is submitted directly to the third party liability unit (hereafter referred to as the TPL unit) within the department.

(c) The provider has billed the third party and has not received a reply from the third party either allowing or denying payment, if the following provisions are met:

(i) the provider submits evidence of the date the third party was billed;

(ii) the claim is submitted 90 or more days beyond the date established in (c)(i) and in compliance with the timely filing rules in ARM 37.85.406(1);

(iii) the provider certifies on the claim that notice of payment or denial has not been received; and

(iv) the provider submits the claim directly to the TPL unit.

(d) The claim is for services for which the department has been granted a waiver from use of the cost avoidance method and the department has chosen to use and continue to use that waiver, as identified in the Medicaid provider manual.

(e) The provider is unable to obtain a valid assignment of benefits, if the following provisions are met:

(i) the provider submits documentation that it attempted to obtain assignment;

(ii) the provider certifies on the claim that assignment could not be obtained; and

(iii) the provider submits the claim directly to the TPL unit.

(f) The third party is only a potential third party as defined in (2)(c).

(7) Except as stated in (8), the department shall pay its allowed amount for services, less any known third party payments for those services, for any claim where a known third party exists in the following circumstances:

(a) the claim is submitted under the provisions of (6);

(b) the submitted claim clearly indicates the amount paid by the third party and includes whatever documentation is received regarding the payment from the third party; or

(8) For inpatient hospital claims where Medicare Part A benefits have been paid, the department's sole obligation shall be to pay the Medicare Part A deductible. For nursing facility service claims where Medicare Part A benefits have been paid, the department's sole obligation shall be to pay in accordance with ARM 37.40.307.

(9) In the event the provider receives a payment from a third party after the department has made payment, the provider shall refund to the department, within 60 days of receipt of the third party payment, the lesser of the amount the department paid or the amount of the third party payment.

(a) The refund shall be made payable to Montana Medicaid and submitted to the department's fiscal office, and shall indicate the name of the third party payor.

(b) The provider is entitled to retain any third party payments which exceed the Medicaid allowed amount if all Medicaid payments toward those services have been refunded to the department as required in this subsection.

(10) The department shall make no payment for services in those cases where, if the patient were not a Medicaid recipient, the third party payment would constitute full payment with no further obligation owing from the recipient.

(11) For any service where an identified third party has only a potential liability as a tort-feasor, the provider may file a medical lien against that third party. The provider may bill the department prior to determination of liability of the third party if the provider notifies the TPL unit of the identity of the third party and its name and address if known. The provider may keep its lien in place and receive payment from the third party. If payment is received from the third party, the provider must refund to the department as described in (9).

(12) A provider may not refuse to furnish services to a recipient based upon a third party's potential liability for the service.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1491, Eff. 5/16/80; AMD, 1984 MAR p. 1637, Eff. 11/16/84; AMD, 1990 MAR p. 1719, Eff. 8/31/90; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 479; AMD, 2020 MAR p. 966, Eff. 5/30/20.

Mont. Admin. R. 37.85.410 Determination of Medical Necessity

(1) The department shall only make payment for those services which are medically necessary as determined by the department or by the designated review organization.

(2) In determining medical necessity the department or designated review organization may consider the type or nature of the service, the provider of the service, the setting in which the service is provided and any additional requirements applicable to the specific service or category of service.

(3) The department may review the medical necessity of services or items at any time either before or after payment. If the department determines that services or items were not medically necessary or otherwise in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements. The department is not precluded by an earlier screening, prior authorization, certification or similar process from reviewing and determining medical necessity of any service or item, or from denying payment or recovering any overpayment based upon any such review or determination. This rule does not require the department to notify a provider or recipient of a medical necessity determination until and unless the department completes its review and takes an adverse action against the provider based upon the determination.

(4) The provider must upon request provide to the department or its designated review organization without charge any records related to services or items provided to a recipient.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1491, Eff. 5/16/80; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.411 Provider Rights

(1) Except as otherwise provided in these rules, a provider who is aggrieved by an adverse department action which directly affects the rights or entitlements of the provider under the Montana Medicaid program, may request a hearing to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

(2) Except as otherwise provided in these rules, a provider who is aggrieved by an adverse department action affecting the applicant's or recipient's eligibility under the Montana Medicaid program, may request a hearing to the extent provided and according to the procedures specified in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

(3) This rule does not grant to providers any right to notice of actions affecting recipients, including but not limited to eligibility determinations.

History

Authorizing statute(s): 2-4-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1491, Eff. 5/16/80; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.85.412 Interpretation of Rules

(1) The department will interpret its rules by giving meaning to the plain language of the rules. If a provider requests an interpretation of a rule to provide clarification of a perceived ambiguity, clarification must be received in writing from the department before the service is billed to Medicaid, or the provider may not rely on it.

(2) Documentation of the clarification must contain:

(a) the date of the response;

(b) the identity of the person providing the clarification; and

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2005 MAR p. 459, Eff. 4/1/05.

Mont. Admin. R. 37.85.413 Limitations on Coding Advice

(1) Employees of the department, or of any contractor or agent of the department, may give a provider general information as to what codes are available for billing under Medicaid for a particular service or item being provided. However, the provider retains responsibility for selecting and submitting the proper code to describe the service or item provided. If an employee of the department or of a contractor or agent of the department suggests, recommends, or directs the provider to use a particular code from the choices available or gives other specific coding advice, the provider may not rely on such advice unless the advice is provided in writing before the provider submits a claim for the service or item.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2005 MAR p. 459, Eff. 4/1/05.

Mont. Admin. R. 37.85.414 Maintenance of Records and Auditing

(1) All providers of service must maintain records which fully demonstrate the extent, nature and medical necessity of services and items provided to Montana Medicaid recipients. The records must support the fee charged or payment sought for the services and items and demonstrate compliance with all applicable requirements.

(a) All records which support a claim for a service or item must be complete within 90 days after the date on which the claim was submitted to Medicaid for reimbursement. A record that is required to be signed and dated, including but not limited to an order, prescription, certificate of medical necessity, referral or progress note, is not complete until it has been signed and dated.

(b) When reimbursement is based on the length of time spent in providing the service, the records must specify the time spent or the time treatment began and ended for each procedure billed to the nearest minute. Total time billed using one or multiple procedure codes may not exceed the total actual time spent with the Medicaid client.

(c) These records must be retained for a period of at least six years and three months from the date on which the service was rendered or until any dispute or litigation concerning the services is resolved, whichever is later.

(d) In maintaining financial records, providers shall employ generally accepted accounting methods. Generally accepted accounting methods are those approved by the National Association of Certified Public Accountants.

(e) The department shall have access to all records so maintained and retained regardless of a provider's continued participation in the program.

(f) In the event of a change of ownership, the original owner must retain all required records unless an alternative method of providing for the retention of records has been established in writing and approved by the department.

(g) If a provider cannot provide medical records to prove that a service billed to Medicaid was provided and meets all requirements for reimbursement, the service will be deemed not to be provided and reimbursable due to the lack of documentation, and the department will recover all reimbursement paid to the provider. This recovery is permissible regardless of whether the documentation was destroyed or lost due to an event such as, but not limited to, misplaced records, a data processing failure, fire, earthquake, flood, or other natural disaster. The provider must have a backup system in place to allow recovery of documentation destroyed or lost due to such events or any other cause.

(h) These record keeping requirements are the minimum requirements for records to support all Medicaid claims. In addition to complying with these minimum requirements, providers must also comply with any specific record keeping requirements applicable to the type of service the provider furnishes, which may be more restrictive than the minimum requirements of this rule.

(2) In addition to the recipient's medical records, any Medicaid information regarding a recipient or applicant is confidential and shall be used solely for purposes related to the administration of the Montana Medicaid program. This information shall not be divulged by the provider or his employees, to any person, group, or organization other than those listed below or a department representative without the written consent of the recipient or applicant. In addition, the provider must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 USC 1320d et seq., and the Uniform Health Care Information Act, 50-16-501 et seq., MCA.

(3) The department, the designated review organization, the legislative auditor, the Department of Revenue, the Medicaid fraud control unit, and their legal representatives shall have the right to inspect or evaluate the quality, appropriateness, and timeliness of services performed by providers, and to inspect and audit all records required by this rule.

(a) Upon the department's request for records, the provider shall submit a true and accurate copy of each record of the service or item being reviewed as it existed within 90 days after the date on which the claim was submitted to Medicaid.

(b) Refusal to permit inspection, evaluation or audit of services shall result in the imposition of provider sanctions in accordance with the rules of the department.

(4) The provisions of this rule specifying the length of time for which records must be retained shall not be construed as a limitation on the period in which the department may recover overpayments or impose sanctions.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113 and 53-6-141, MCA
History: NEW, 1980 MAR p. 1491, Eff. 5/16/80; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 479; AMD, 2005 MAR p. 459, Eff. 4/1/05.

Mont. Admin. R. 37.85.415 Medical Assistance Medicaid Payment

(1) Medicaid will pay only for medical expenses:

(a) incurred by a person eligible for the Medicaid program;

(b) for services provided for and to the extent provided for under the Medicaid program;

(d) not used to meet the incurrment requirement at ARM 37.82.1101 and following rules for persons who are medically needy;

(e) which are not the cost sharing provided for in ARM 37.85.204; and

(f) to the extent allowed by Medicaid.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-131, MCA
History: NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 479; AMD, 2002 MAR p. 797, Eff. 3/15/02.

Mont. Admin. R. 37.85.416 Statistical Sampling Audits

(1) At the option of the department, the amount of money erroneously paid to a provider for any given period of time may be determined by the use of statistical sampling and extrapolation, rather than by an audit of 100% of the claims submitted by the provider during the period of time under review. Statistical sampling and extrapolation shall not be used to determine overpayments for inpatient hospital services, outpatient hospital services, or hospital inpatient psychiatric services, or in cases where the number of line items in the review period does not equal 500 or more.

(a) A line item consists of a single service, under one procedure rate with one or more units of service, procedure or item on a Medicaid claim form for which a provider has received payment.

(2) If the department chooses to use statistical sampling and extrapolation to determine an overpayment, it will use a statistical method to draw a random sample of claims for the review period and will audit these claims. The department will calculate the provider's error rate based on the net dollar amount overpaid to the provider after any underpayments occurring in the sample have been offset against the overpayments occurring in the sample. The department will then calculate the total overpayment for the review period using an appropriate statistical methodology.

(3) If the department chooses to use statistical sampling and extrapolation, it shall notify the provider of its intention to do so. When the sampling and extrapolation process is completed, the department shall provide the provider with information regarding the sample size, the sample selection method, and the formulas and calculations used in the extrapolation.

(4) It is presumed that the overpayment amount determined by the use of statistical sampling and extrapolation is correct. However, the provider may rebut this presumption by presenting evidence that the sampling and extrapolation process used by the department was invalid, by presenting evidence that claims in the sample determined by the department to be erroneous or overpaid were correctly paid, or by requesting an audit of 100% of the claims paid in the review period, as provided in (5).

(5) A provider who does not agree with the overpayment amount determined by statistical sampling may request that the department conduct a 100% audit of the claims paid in the review period. The request for a 100% audit must be made within 30 days of the date of the notice informing the provider of the results of the statistical sampling. The department must then conduct such a review.

(a) If the audit shows an overpayment amount which is different from the overpayment amount determined by sampling and extrapolation, the amount determined by the audit shall be used by the department in assessing an overpayment against the provider. A provider who is aggrieved by a department determination based upon the results of the audit may appeal by means of the fair hearing procedures set forth in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

(b) The provider must pay the department's costs for such an audit, unless the overpayment amount determined by the 100% audit is at least 10% less than the overpayment amount determined by the statistical sample.

(6) A provider who is aggrieved by an overpayment determined by statistical sampling and extrapolation may appeal by means of the fair hearing procedures set forth in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, MCA
History: NEW, 1993 MAR p. 441, Eff. 3/26/93; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Subchapter 37.85.5 Provider Sanctions

Mont. Admin. R. 37.85.501 Grounds for Sanctioning

(1) Sanctions may be imposed by the department against a provider of medical assistance, provided under ARM Title 37, chapters 40, 80, 82, 83, 85, 86, 88, for any one or more of the following reasons:

(a) Presenting or causing to be presented for payment any false or fraudulent claim for services or merchandise.

(b) Submitting or causing to be submitted false information for the purpose of obtaining greater compensation than that to which the provider is legally entitled under the rules of the department.

(d) Failure to maintain and retain records required by the rules of the department.

(e) Failure to disclose or make available required records to the department, its authorized agent or other legally authorized persons, organizations, or governmental entities.

(f) Failure to provide and maintain services to Medicaid recipients at a quality that is within accepted medical community standards as adjudged by a body of peers.

(g) Engaging in a course of conduct or performing an act which the department's rules or the decision of the applicable professional peer review committee, or licensing board, have determined to be improper or abusive of the Montana Medicaid program; or continuing such conduct following notification that the conduct should cease.

(h) Breach of the terms of the provider contract or failure to comply with the terms of the provider certification on medical assistance claim forms or the failure to comply with requirements imposed by the rules of the department.

(i) Over-utilizing the Montana Medicaid program by inducing, or otherwise causing a recipient to receive services or goods not medically necessary.

(j) Rebating or accepting a fee or portion of a fee or charge for a Medicaid patient referral.

(k) Violating any provision of the state Medicaid law, Title 53, chapter 6, MCA or any rule promulgated pursuant thereto, or violating any provision of Title XIX of the Social Security Act or any regulation promulgated pursuant thereto.

(l) Submission of a false or fraudulent application for provider status.

(m) Violations of any statutes, regulations or code of ethics governing the conduct of occupations or professions or regulated industries.

(n) Conviction of a criminal offense relating to medical assistance programs administered by the department or provided under contract with the state; or conviction for negligent practice resulting in death or injury to patients.

(o) Failure to meet requirements of state or federal law for participation (e.g. licensure).

(p) Exclusion from the Medicare program (Title XVIII of the Social Security Act) because of fraudulent or abusive practices.

(q) Charging Medicaid recipients for amounts over and above the amounts paid by the department for services rendered, except as specifically allowed under ARM 37.83.825 and 37.83.826.

(r) Refusal to execute a new provider agreement when requested to do so.

(s) Failure to correct deficiencies as defined by the ARM or federal regulation after receiving written notice of these deficiencies from the department, or the federal Department of Health and Human Services. The standards set forth at 42 CFR Part 442, Part 483 and Part 488, updated through February 2004, which identify deficiencies for providers of intermediate care facilities for the mentally retarded, skilled nursing and nursing facility services, are incorporated by reference. A copy of 42 CFR Part 442, Part 483 and Part 488, updated through February 2004, are available from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202653, Helena, MT 59620-2953.

(t) Formal reprimand or censure by an association of the provider's peers for unethical practices.

(u) Suspension or termination from participation in another government medical program including but not limited to workers' compensation, crippled children's services, rehabilitation services and Medicare.

(v) Filing of criminal indictment, information or complaint for fraudulent billing practices or negligent practice resulting in death or injury to the provider's patients.

(w) Civil judgement for fraudulent billing practices or negligent practice resulting in death or injury to the provider's patients.

(x) Failure to repay or make acceptable arrangements for the repayment of identified overpayments or otherwise erroneous payments.

(y) Threatening, intimidating or harassing patients or their relatives in an attempt to influence reimbursement rates or affect the outcome of disputes between the provider and the department.

(z) Submitting claims for reimbursement of costs or services which the provider knows or has reason to know are not reimbursable.

History

Authorizing statute(s): 53-2-201, 53-2-803, 53-4-111, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-2-306, 53-2-801, 53-2-803, 53-4-112, 53-6-111, 53-6-131, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; AMD, 1984 MAR p. 1639, Eff. 11/16/84; AMD, 1986 MAR p. 1321, Eff. 8/1/86; AMD, 1987 MAR p. 2164, Eff. 11/28/87; AMD, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 479; AMD, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.85.502 Sanctions

(1) The following sanctions may be invoked against providers based on the grounds specified in ARM 37.85.501:

(a) Termination from participation in the Medical Assistance program.

(b) Suspension of participation in the Medical Assistance program.

(d) Shortening of an existing provider agreement as permitted by the terms of such agreement.

(e) Required attendance at provider education sessions, the cost of which shall not be reimbursed by the department or any of its programs.

(f) Required prior authorization for provision of services.

(g) 100% review of the provider's claims prior to payment.

(h) Referral to the Department of Revenue for any action deemed necessary.

(i) In addition to the sanctions listed above, intermediate care facilities for the mentally retarded, skilled nursing and nursing facilities shall be subject to termination of participation when the deficiencies resulting from failure to meet conditions or standards of participation pose immediate jeopardy or the denial of payments for new admissions if the facility's deficiencies resulting from failure to meet conditions or standards of participation do not pose immediate jeopardy. Federal laws regarding termination from participation and intermediate sanctions provided in 42 CFR 442.2, 42 CFR 442.117 through 442.119, and 42 CFR Part 483 and 488, updated through February 2004 are incorporated by reference. A copy of 42 CFR 442.2, 42 CFR 442.117 through 442.119, and 42 CFR Part 483 and 488, updated through February 2004 may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, Helena, MT 59620-2953; or

(j) Notification to the public of sanctions taken against a provider.

History

Authorizing statute(s): 53-2-201, 53-2-803, 53-4-111, 53-6-108, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-2-306, 53-2-801, 53-4-112, 53-6-106, 53-6-107, 53-6-111, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; AMD, 1984 MAR p. 1639, Eff. 11/16/84; AMD, 1987 MAR p. 2164, Eff. 11/28/87; TRANS, from SRS, 2000 MAR p. 479; AMD, 2004 MAR p. 736, Eff. 4/9/04.

Mont. Admin. R. 37.85.505 Factors Governing Imposition of Sanction

(1) The decision to impose sanctions and which sanctions to impose shall be within the discretion of the department except as provided in (3).

(2) The following factors shall be considered in determining the sanction(s) to be imposed:

(a) seriousness of the offense(s);

(b) extent of violations;

(d) prior imposition of sanctions;

(e) prior provision of provider education;

(f) provider willingness to comply with program rules;

(g) whether a lesser sanction will be sufficient to remedy the problem;

(h) actions taken or recommended by peer review groups or licensing boards.

(3) Where a provider has been found by a court of competent jurisdiction in either a civil or criminal proceeding to have defrauded the Montana Medical Assistance program, or has been previously suspended due to program abuse, or has been terminated from the Medicare program for fraud or abuse, the department may terminate the provider from the Medical Assistance program.

History

Authorizing statute(s): 53-2-201, 53-2-803, 53-4-111, 53-6-108, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-2-306, 53-2-801, 53-4-112, 53-6-106, 53-6-107, 53-6-111, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; AMD, 1984 MAR p. 1639, Eff. 11/16/84; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.506 Scope of Sanction

(1) A sanction may be applied to all known affiliates of a provider, provided that each decision to include an affiliate is made on a case by case basis after giving due consideration to all relevant facts and circumstances. The violation, failure, or inadequacy of performance may be imputed to an affiliate where such conduct was accomplished within the course of the affiliate's official duty or was effectuated by the provider with the knowledge or approval of the affiliate.

(2) Suspension or termination from participation of any provider shall preclude such provider from submitting claims for payment, either personally or through claims submitted by any clinic, group, corporation or other association to the department or its fiscal agents for any services or supplies provided to persons eligible for the Montana Medical Assistance program except for those services or supplies provided prior to the suspension or termination. Providers of long term care facility services may submit claims for supplies and services provided for up to 30 days after the date of termination to allow for the transfer of recipients.

(3) No clinic, group, corporation, or other association which is a provider of services shall submit claims for payment to the department or its fiscal agents for any services or supplies provided by a person within such organization who has been suspended or terminated from participation in the Montana Medical Assistance program except for those services or supplies provided prior to the suspension or termination. Providers of long term care facility services may submit claims for supplies and services provided for up to 30 days after the date of termination to allow for the transfer of recipients.

(4) When the provisions of (3) of this rule are violated by a provider of services which is a clinic, group, corporation, the department may suspend or terminate such organization and/or any individual person within said organization who is responsible for such violation.

History

Authorizing statute(s): 53-2-201, 53-2-803, 53-4-111, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-2-306, 53-2-801, 53-4-112, 53-6-111, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; AMD, 1984 MAR p. 1639, Eff. 11/16/84; AMD, 1987 MAR p. 2164, Eff. 11/28/87; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.507 Notice of Sanction

(1) When a provider has been suspended or terminated, the department shall notify the appropriate professional society, board of registration or licensure, and federal or state agencies of the findings made and the sanctions imposed.

History

Authorizing statute(s): 53-6-111, MCA
Implementing statute(s): 53-6-111, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.511 Provider Education

(1) Except where termination has been imposed, the department may in its discretion direct each provider, who has been sanctioned, to participate in a provider education program as a condition of continued Medicaid participation.

(2) Provider education programs may include any of the following at the discretion of the department:

(a) instruction in claim form completion;

(b) instruction on the use and format of provider manuals;

(d) instruction on statutes and regulations governing the Montana Medicaid program;

(e) instruction on reimbursement rates;

(f) instructions on how to inquire about coding or billing problems;

(g) any other matter as determined by the department.

History

Authorizing statute(s): 53-6-111, MCA
Implementing statute(s): 53-6-111, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; TRANS, from SRS, 2000 MAR p. 479.

Mont. Admin. R. 37.85.512 Notice of Adverse Action

(1) As provided in this rule, the department must notify a provider of any adverse action it will take when the department has determined that the provider has engaged in fraud, improper billing, waste, abuse, has received payment to which the provider is not entitled, or where the department has verified a credible allegation of fraud, as that term is defined at ARM 37.5.304. The notice must address all of the following:

(a) a description of the fraud, allegation, improper billing, waste, abuse, or overpayments;

(b) the dollar value of any overpayment;

(d) explanation of any actions required of the provider; and

(e) the provider's right to submit written evidence for consideration by the department, an administrative review, and fair hearing.

(2) The department is not required to notify a provider pursuant to (1) until after the department has determined that fraud, a credible allegation of fraud, improper billing, waste, abuse, or an overpayment has occurred. The department is not required to notify the provider when the department merely suspects or has information which suggests that fraud, abuse or an overpayment has occurred or when the department has not determined to take a particular adverse action in response to the fraud, abuse, or overpayment.

(3) Subject to the provisions of (4) and (5), and excepting suspensions of payment under ARM 37.85.513(3), the department must notify the provider as required in this rule within 45 days after the department has determined that fraud, improper billing, waste, abuse, or an overpayment has occurred. The department's failure to notify a provider as required by this rule is not a defense to recovery of the overpayment or imposition of the sanction, but the department may be required to provide a new notice in compliance with this rule.

(4) This rule shall not be construed to require that the department investigate, complete an investigation, make a determination or take any other action regarding a potential fraud, abuse or overpayment within any particular time.

(5) While this rule does not require the department to act within any particular time, if any governmental agency or entity is conducting an investigation of a provider, the department shall not in any event be required to notify the provider of a violation or overpayment until the investigation is concluded and enforcement proceedings, if any, have been completed, if in the sole discretion of the department or the governmental agency or entity conducting the investigation, earlier notification would interfere with or jeopardize the investigation, recovery of an overpayment or imposition of a sanction.

History

Authorizing statute(s): 53-2-201, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 479; AMD, 2011 MAR p. 2823, Eff. 12/23/11.

Mont. Admin. R. 37.85.513 Suspension or Withholding of Payments

(1) Where the department has notified a provider of a violation, sanction, or an overpayment pursuant to ARM 37.85.512 the department may withhold payments on pending and subsequently received claims in an amount reasonably calculated to approximate the amounts in question or may suspend all payments pending the outcome of a departmental or law enforcement investigation.

(2) Where the department intends to withhold or suspend payments not regarding a credible allegation of fraud, as that term is defined at ARM 37.5.304, it shall notify the provider in writing at least ten days prior to commencement of withholding and shall include a statement of the provider's right to request an informal reconsideration of such decision as provided in ARM 37.5.305. This rule does not require that an informal reconsideration or any hearing be conducted prior to the withholding or suspension of payments.

(3) Where the department suspends payments based on a credible allegation of fraud in accordance with 42 CFR 455.23, the department may suspend payments without first notifying the provider.

(a) The department must send notice of its suspension of payments within the following timeframes:

(i) five days of taking such action unless requested in writing by a law enforcement agency to temporarily withhold such notice;

(ii) thirty days if requested by law enforcement in writing to delay sending such notice, which request for delay may be renewed in writing up to twice and in no event exceed 90 days.

(b) In addition to the noticing requirements of ARM 37.85.512(1), the notice must state that the suspension is in accordance with 42 CFR 455.23 and is for a temporary period and cite the circumstances under which the withholding will be terminated. Suspension of payment will not continue after either of the following:

(i) the agency or the prosecuting authorities determine that there is insufficient evidence of fraud or willful misrepresentation by the provider; or

(ii) legal proceedings related to the provider's alleged fraud are completed.

(4) Where the department has terminated or suspended a provider, the provider shall be eligible to bill for covered services for the period covered by the suspension or termination if an appeal is decided in the provider's favor.

History

Authorizing statute(s): 53-2-201, 52-2-211, 53-6-111, 53-6-113, MCA
Implementing statute(s): 52-2-112, 53-2-201, 53-6-111, MCA
History: NEW, 1980 MAR p. 1619, Eff. 6/13/80; AMD, 1984 MAR p. 1639, Eff. 11/16/84; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2011 MAR p. 2823, Eff. 12/23/11.

Subchapter 37.85.9 Physician-Administered Drugs

Mont. Admin. R. 37.85.903 Physician-Administered Drugs, Definitions

(1) "340B Drug Pricing Program (340B)" means a federal program administered by the Health Resources and Services Administration (HRSA) which allows qualified entities to purchase pharmaceuticals at a substantially reduced cost under PL 102-585, section 602, of the Veterans Health Care Act of 1992.

(2) "Carve out" means the process by which qualified entities may remove Medicaid clients from 340B program activities and, therefore, purchase pharmaceuticals at a non-340B cost.

(3) "Healthcare Common Procedures Coding System (HCPCS)" means the national uniform coding method maintained by the CMS that incorporates the American Medical Association (AMA) Physicians Current Procedural Terminology (CPT) and the three HCPCS unique coding levels, I, II, and III.

(a) For purposes of physician-administered drugs, HCPCS refers to billable codes with corresponding rebatable National Drug Codes (NDC).

(4) "National Drug Codes (NDC)" means an 11 digit numerical code maintained by the Federal Drug Administration (FDA) under the Drug Listing Act of 1972 that identifies the manufacturer, product, and package size.

(5) "Physician-administered drugs" means drugs other than vaccines covered under section 1927(k)(2) of the Social Security Act that are typically furnished incident to a physician's services.

(a) Physician-administered drugs are administered by a medical professional in a physician's office or other outpatient clinical setting.

(b) Physician-administered drugs are incident to a physician's services that are separately billed to Medicaid.

(c) Reimbursement for physician-administered drugs is allowed only if the drug qualifies for rebate in accordance with 42 USC 1396r-8.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2008 MAR p. 956, Eff. 5/9/08; AMD, 2008 MAR p. 2671, Eff. 12/25/08.

Mont. Admin. R. 37.85.905 Physician-Administered Drugs, Billing Requirements

(1) Billable claim lines submitted for reimbursement of physician-administered drugs must:

(a) include a valid 11 digit NDC;

(b) include the drug quantity billed for each code;

(i) international unit - F2;

(ii) gram - GR;

(iii) milliliter - ML;

(iv) units - UN; or

(v) milligram – ME;

(d) include corresponding CPT/HCPCS codes; and

(e) include a drug price.

(2) Reimbursement will be made only on those drugs manufactured by companies that have a signed rebate agreement with the CMS.

(3) A nonrebatable drug with a medically accepted indication may be prior authorized at the department's discretion. Prior authorized drugs will be reimbursed according to provider type.

(4) Drugs and devices purchased under the 340B Drug Pricing Program are exempt from this rule.

(5) Providers participating in the 340B Drug Pricing Program:

(a) must not submit an NDC for claim lines that are billed utilizing physician-administered drugs purchased under the 340B Drug Pricing Program;

(b) must submit CPT/HCPCS code(s) with all claims submitted to Montana Medicaid;

(d) must notify Montana Medicaid of newly acquired 340B status immediately upon approval from the Office of Pharmacy Affairs.

(6) Providers may elect to "carve out" Medicaid clients from their 340B program activities when billing non-340B priced physician-administered drugs and register their intent with the Office of Pharmacy Affairs.

(7) Providers who have registered with the Office of Pharmacy Affairs:

(a) must bill all claims as described in (1)(a) through (e); and

(b) will be reimbursed according to their provider type.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2008 MAR p. 956, Eff. 5/9/08; AMD, 2008 MAR p. 2671, Eff. 12/25/08; AMD, 2012 MAR p. 2625, Eff. 1/1/13.

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-111, MCA
History: NEW, 2011 MAR p. 1374, Eff. 7/29/11; REP, 2025 MAR, Notice No. 37-1102, Eff. 2/22/25.

Chapter 37.86 Medicaid Primary Care Services

Subchapter 37.86.1 Physician Services

Mont. Admin. R. 37.86.101 Physician Services, Definitions

(1) "Early elective delivery" means either a nonmedically necessary labor induction or cesarean section that is performed prior to 39 weeks and 0/7 days gestation.

(2) "Physician services" means those services provided by individuals licensed under the State Medical Practice Act to practice medicine or osteopathy which, as defined by state law, are within the scope of their practice.

(3) "Usual and customary" means those charges that the billing physician would charge for a particular service in a majority of cases, including Medicaid and non-Medicaid patients.

(4) The department hereby adopts and incorporates by reference the definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois. These materials set forth meanings of terms commonly used by the Montana Medicaid program in implementation of the program's physician fee schedule. A copy of the definitions herein incorporated may be obtained through the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(5) Payment-to-charge ratio means the percent determined by dividing the previous state fiscal year's total Medicaid reimbursement for RBRVS provider covered services as defined in ARM 37.85.212 by the previous state fiscal year's total Medicaid charges for RBRVS provider covered services. The effective date and payment-to-charge ratio are as provided in ARM 37.85.105(2).

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 1747, Eff. 6/27/80; AMD, 1988 MAR p. 1255, Eff. 7/1/88; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1994 MAR p. 313, Eff. 2/11/94; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2014 MAR p. 1407, Eff. 7/1/14; AMD, 2014 MAR p. 2171, Eff. 10/1/14; AMD, 2015 MAR p. 145, Eff. 2/13/15; AMD, 2015 MAR p. 2092, Eff. 11/26/15; AMD, 2017 MAR p. 1522, Eff. 9/9/17.

Mont. Admin. R. 37.86.104 Physician Services, Requirements

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) The department or its designated review organization may conduct utilization and peer review of physician services.

(3) Physician services for conditions or ailments that are generally considered cosmetic in nature are not a benefit of the Medicaid program except in such cases where it can be demonstrated that the physical and psycho-social well being of the recipient is severely affected in a detrimental manner by the condition or ailment. Such services must be prior authorized by the Medicaid services bureau, based on recommendations of the designated peer review organization.

(a) A request for prior authorization must include all relevant information to justify the need for the service. This information includes statements from a physician qualified in the area of concern and a potential provider.

(b) The information must clearly document the necessity for the service and include assurances that the plan will be followed to completion.

(4) Coverage of physician services for sterilization is limited as follows:

(a) The recipient to be sterilized must not be declared mentally incompetent by a federal, state, or local court of law.

(b) The recipient to be sterilized must be 21 years of age or older at the time informed consent to sterilization is obtained from the recipient.

(c) The recipient to be sterilized must not be institutionalized in a corrective, penal, mental, or rehabilitative facility.

(5) Physician services for sterilization must meet the following requirements in order to receive Medicaid reimbursement:

(a) The recipient to be sterilized must give informed consent, in accordance with the Medicaid approved informed consent to sterilization form, not less than 30 days nor more than 180 days prior to sterilization except in the case of premature delivery or emergency abdominal surgery. For these exceptions, at least 72 hours must pass between informed consent and the sterilization procedure. In cases of premature delivery, informed consent must be given at least 30 days before the expected delivery date.

(b) The recipient to be sterilized, the person who obtained the consent, and the interpreter (if required) must sign the informed consent form at least 30 days but not more than 180 days prior to the sterilization. The physician performing the sterilization must sign and date the informed consent form after the sterilization has been performed.

(c) A copy of the informed consent to sterilization form must be attached to the Medicaid claim when billing for sterilization procedures.

(6) Coverage of physician services for hysterectomies is limited as follows:

(a) The surgery must not be solely for the purpose of rendering the recipient incapable of reproducing; and

(b) The surgery must be medically necessary to treat injury or pathology.

(7) Physician services for hysterectomies must meet the following requirements in order to receive Medicaid reimbursement:

(a) The physician must inform the recipient that the hysterectomy will render her permanently incapable of reproducing;

(b) A completed copy of the approved acknowledgment of receipt of hysterectomy information form must be attached to the Medicaid claim when billing for hysterectomy services;

(c) In a case where the recipient is sterile before the hysterectomy or there is a life-threatening emergency that precludes the recipient from giving prior acknowledgment of receipt of hysterectomy information, the requirements in (7)(a) and (7)(b) do not apply. Instead, the physician who performed the hysterectomy either:

(i) must certify in writing that the recipient was sterile before the hysterectomy and state the cause of sterility; or

(ii) must certify in writing that the hysterectomy was performed during a life-threatening emergency situation that precluded the recipient from giving prior acknowledgment of receipt of hysterectomy information and gives a description of the nature of the emergency.

(8) Coverage of physician services for abortions is limited as follows:

(a) the life of the mother will be endangered if the fetus is carried to term;

(b) the pregnancy is the result of an act of rape or incest; or

(c) to the extent required by statute, when an abortion is a medically necessary service, even if the abortion does not meet the standard in (8)(a) and (9).

(9) Physician services for abortions, in a case of endangerment of the mother's life, must meet the following requirements in order to receive Medicaid reimbursement:

(a) The physician must find, and certify in writing, that in the physician's professional judgement, the life of the mother will be endangered if the fetus is carried to term. The certification must contain the name and address of the patient and must be on or attached to the Medicaid claim.

(10) Physician services for abortions in cases of pregnancy resulting from an act of rape or incest must meet the following requirements in order to receive Medicaid reimbursement:

(a) the recipient certifies in writing that the pregnancy resulted from an act of rape or incest; and

(b) the physician certifies in writing either that:

(i) the recipient has stated to the physician that she reported the rape or incest to a law enforcement or protective services agency having jurisdiction over the matter, or if the recipient is a child enrolled in a school, to a school counselor; or

(ii) in the physician's professional opinion, the recipient was and is unable for physical or psychological reasons to report the act of rape or incest.

(11) Abortion is a medically necessary service and eligible for coverage under the Montana Medicaid program when:

(a) a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed; or

(b) although it does not place the woman in danger of death unless an abortion is performed, a woman suffers from:

(i) a physical condition that would, as certified by a physician, be significantly aggravated by the pregnancy; or

(ii) a psychological condition that would, as certified by a physician, be significantly aggravated by the pregnancy.

(12) Physician services for abortions require prior authorization. If prior authorization is not obtained, due to an emergency situation or otherwise, a claim for payment for such physician services will undergo post-service, prepayment review. The request for prior authorization or the claim for payment must be accompanied by a completed and signed Physician Certification for Abortion Services Form (MA-037 form).

(13) Supporting documentation must be submitted for abortions covered under (8)(a) or (c). The following documentation must be submitted with the prior authorization request or with any claim for payment for which prior authorization was not received to support the determination of medical necessity:

(a) History and Physical, which should include (at a minimum) as it relates to the pregnancy:

(i) medical history, including age, current medications and allergies, number of times the patient has been pregnant and number of times she has had a live birth, last menstrual period, status and results of any pregnancy test, allergies, chronic illnesses, surgeries, behavioral health issues, smoking, substance abuse, and obstetric history;

(ii) brief review of systems to identify symptoms a patient may be experiencing;

(iii) the results of a physical examination, including vital signs, heart, lungs, abdomen, extremities, and estimate of gestational age (if imaging is not available);

(iv) results of laboratory tests (if available), including Rh factor, Hemoglobin, and Human Chorionic Gonadotropin;

(v) imaging (if available), to estimate gestational age;

(vi) documentation that the diagnosis of the physical or psychological condition leading to the medical necessity determination has been made by a medical professional qualified by education, training, and/or experience to make such diagnosis and that the woman is receiving care for such condition;

(vii) reason for the abortion procedure;

(viii) for medication/chemical abortions, documentation confirming review of contraindications, adequate patient education, and compliance with the requirements of the Physician-Related Services Manual;

(ix) treatment plan; and

(x) signed informed consent for the proposed abortion procedure.

(14) Physician services for abortions must be performed by a physician as defined in 37-3-102, MCA.

(15) Prior authorization is not required for treatments for incomplete abortions, miscarriages, or septic abortions.

(16) Physician services for routine podiatric care and orthotics must be in accord with the definitions of ARM 37.86.501 and meet the requirements of ARM 37.86.505.

(17) The department adopts and incorporates by reference the Physician-Related Services Manual governing the administration of the Physician program dated December 1, 2017. The Physician-Related Services Manual is available for public viewing at the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951 and at the department's web site at http://medicaidprovider.mt.gov .

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1747, Eff. 6/27/80; AMD, 1980 MAR p. 2664, Eff. 9/26/80; AMD, 1981 MAR p. 1061, Eff. 9/18/81; AMD, 1983 MAR p. 757, Eff. 7/1/83; AMD, 1988 MAR p. 1255, Eff. 7/1/88; AMD, 1991 MAR p. 824, Eff. 5/31/91; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1994 MAR p. 2975, Eff. 11/11/94; AMD, 1995 MAR p. 1580, Eff. 8/11/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2017 MAR p. 1522, Eff. 9/9/17; AMD, 2017 MAR p. 2445, Eff. 12/23/17; AMD, 2023 MAR p. 414, Eff. 5/1/23.

Mont. Admin. R. 37.86.105 Physician Services, Reimbursement/General Requirements and Modifiers

(1) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained, in the Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers, and HCPCS is available upon request from the Health Resources Division at the address stated in ARM 37.86.101(3).

(2) Reimbursement for physician services, except as otherwise provided in this rule, is the lower of:

(a) the provider's usual and customary charges (billed charges); or

(b) the department's fee schedule maintained in accordance with the methodologies described in ARM 37.85.212.

(3) Reimbursement for services of a psychiatrist, except as otherwise provided in this rule, is the lower of:

(a) the provider's usual and customary charges (billed charges); or

(b) to address problems of access to mental health services, subject to funding, mental health services performed by a psychiatrist are reimbursed using a provider rate of reimbursement which is a percentage of the reimbursement for physicians provided in accordance with the methodologies described in ARM 37.85.212. The effective date and percentage are as provided in ARM 37.85.105(2).

(4) Reimbursement to physicians for physician-administered drugs billed under HCPCS "A", "J", "Q", or "S" codes will be paid according to the department's fee schedule or the provider's usual and customary charge, whichever is lower. The department's fee schedule is updated at least annually based upon:

(a) the effective date and citation for the Medicare Average Sale Price (ASP) as provided in ARM 37.85.105(2);

(b) the RBRVS fee as defined in ARM 37.85.212 if there is an RBRVS fee;

(d) the Medicaid fee as determined in (9).

(5) Physician administered compound drugs must be billed with the associated HCPCS; an invoice is required to be attached. The invoice must list each ingredient in the compound with the associated NDCs, and the quantity of each ingredient. Physician administered compound drugs are paid by invoice.

(6) The maximum allowable cost limitation does not apply in those cases where the physician certifies in their own handwriting that in their medical judgment a specific brand name drug is medically necessary for a particular patient. Acceptable certification statements are "brand necessary" or "brand required." A check-off box on a form or a rubber stamp is not acceptable.

(7) Reimbursement rates for adult and children vaccines are extracted from the Private/Sector Cost/Dose fee schedule maintained by the Center for Disease Control (CDC). Private sector vaccine pricing are reported by vaccine manufacturers annually to the CDC.

(8) A Medicaid fee for services without fees is determined for physician services and anesthesia services as defined at ARM 37.85.212 and licensed direct-entry midwife services as defined at ARM 37.86.1201.

(a) The Medicaid fee is determined for procedure codes:

(i) that are new, less than one year in existence;

(ii) that have no or low utilization;

(iii) that have inconsistent charges by reviewing cost information for the service if available; or

(iv) by reviewing the reimbursement of similar services if cost information is not available.

(b) Otherwise, the Medicaid fee in this section is determined by multiplying the average charge for the service by the payment-to-charge ratio.

(9) Claims for child delivery must have one of the following line procedure code modifiers or the line will be denied:

(a) CG-cesarean section/induction prior to 39 weeks;

(b) GK-spontaneous vaginal delivery prior to 39 weeks (noninduced);

(d) SC - cesarean section at or after 39 weeks.

(10) The maternity policy adjustor is not applied to early elective delivery.

(11) Gestational age must be determined and documented in medical records. The department accepts the following American Congress of Obstetricians and Gynecologists guidelines for determining gestational age:

(a) fetal heart tones documented for 20 weeks by nonelectronic fetoscope or 30 weeks by Doppler;

(b) a positive serum or urine pregnancy test by a reliable laboratory at least 36 weeks prior to delivery;

(d) when pregnancy care is not initiated within 20 weeks of gestation, the gestational age may be documented from the first day of the last menstrual period (LMP).

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 1808, Eff. 6/27/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1976, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1987 MAR p. 1496, Eff. 8/28/87; AMD, 1988 MAR p. 1255, Eff. 7/1/88; AMD, 1989 MAR p. 881, Eff. 6/30/89; AMD, 1989 MAR p. 880, Eff. 7/1/89; AMD, 1990 MAR p. 1179, Eff. 6/15/90; AMD, 1990 MAR p. 1608, Eff. 8/17/90; AMD, 1990 MAR p. 2305, Eff. 12/28/90; AMD, 1991 MAR p. 824, Eff. 5/31/91; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2007 MAR p. 206, Eff. 1/1/07; AMD, 2009 MAR p. 1012, Eff. 7/1/09; AMD, 2010 MAR p. 433, Eff. 3/1/10; AMD, 2011 MAR p. 1700, Eff. 8/26/11; AMD, 2012 MAR p. 1266, Eff. 6/22/12; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1407, Eff. 7/1/14; AMD, 2014 MAR p. 2171, Eff. 10/1/14; AMD, 2015 MAR p. 145, Eff. 2/13/15; AMD, 2016 MAR p. 1065, Eff. 7/1/16; AMD, 2017 MAR p. 1522, Eff. 9/9/17; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.108 Mental Health Services Plan, Application Forms, Income Verification

(1) Application forms and information regarding eligibility for the plan are available at all local county human services departments.

(2) The applicant must submit with the application form a completed and signed income statement and the necessary documentation to verify the income reported.

(3) For purposes of (2), necessary income verification may include one or more of the following or other appropriate and persuasive documentation:

(a) pay stubs or other pay statements;

(b) employee's W-2 forms;

(d) union records;

(e) check copies;

(f) self-employment bookkeeping records;

(g) sales and expenditure records;

(h) employer's wage or payroll records;

(i) award notices or award letters;

(j) correspondence specifying a benefit;

(k) records of any government payer;

(l) court records or correspondence from attorneys;

(m) financial institution records;

(n) insurance company correspondence or records; or

(o) college or university financial aid correspondence or records.

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-6-113, 53-6-131, 53-6-701, 53-6-706, MCA
Implementing statute(s): 41-3-1103, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-113, 53-6-116, 53-6-117, 53-6-131, 53-6-701, 53-6-705, 53-6-706, 53-21-139, 53-21-202, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01.

Mont. Admin. R. 37.86.110 Mental Health Services Plan, Eligibility Redeterminations, Members Required to Notify Department of Changes, Repayment of Benefits

(1) Eligibility determinations under ARM 37.89.106 are effective until the earlier of:

(a) one year; or

(b) the effective date of any redetermination.

(2) The department may redetermine eligibility at any time.

(a) Eligibility must be redetermined within one year after the most recent determination or sooner based upon changes in income, family composition or the federal poverty level. Members may be required to submit completed forms and verification by a specified date for purposes of eligibility redetermination.

(b) Members must give notice of any change in total family income or family composition within 30 days of the change. Failure to give notice will be grounds for termination of eligibility until such time as complete and accurate income and family composition information is provided.

(c) Termination of eligibility, based upon a change in the federal poverty level, income or family composition, may not be effective earlier than ten days after mailing of written notice of termination to the member.

(d) An individual is liable to the department and the department may collect from the individual the amount of actual payments by the department or its agents to providers for any services furnished to the individual because of misrepresentation of income or a failure to give the required notice of changes in income or family composition.

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-6-113, 53-6-131, 53-6-701, 53-6-706, MCA
Implementing statute(s): 41-3-1103, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-113, 53-6-116, 53-6-117, 53-6-131, 53-6-701, 53-6-705, 53-6-706, 53-21-139, 53-21-202, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01.

Mont. Admin. R. 37.86.112 Mental Health Services Plan, Emergency Mental Health Services, Liability for Failure to Complete Application

(1) A nonmember receiving covered emergency mental health services, which do not include hospital emergency room or other hospital services, is eligible on an emergency basis for the plan and may receive covered medically necessary services for a covered diagnosis unless the provider determines that the individual has the means, financially or otherwise, by which to make payment. If the individual is subsequently determined ineligible for the plan or fails to complete an application for plan eligibility within 60 days following completion of emergency treatment, the individual is liable for and may be billed by the provider at its usual and customary (billed charges) private pay charges or by the department for the amount of payments actually made by the department or its agents to the provider for the services provided.

History

Authorizing statute(s): 41-3-1103, 53-2-201, 53-6-113, 53-6-131, 53-6-701, 53-6-706, MCA
Implementing statute(s): 41-3-1103, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-113, 53-6-116, 53-6-117, 53-6-131, 53-6-701, 53-6-705, 53-6-706, 53-21-139, 53-21-202, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01.

Subchapter 37.86.2 Mid-level Practitioner Services

Mont. Admin. R. 37.86.201 Mid-Level Practitioner Services, Requirements

(1) ARM 37.86.202 and 37.86.205 provide the requirements for Medicaid coverage of mid-level practitioner services. The requirements in these rules are in addition to those contained in ARM 37.85.401 through 37.85.414.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1994 MAR p. 313, Eff. 2/11/94; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.202 Mid-Level Practitioner Services, Definitions

For the purpose of these rules, the following definitions will apply:

(1) "Advanced practice registered nurse" means a registered professional nurse licensed as provided in Title 37, chapter 8, MCA and ARM Title 24, chapter 159, subchapter 14 and includes nurse practitioner, nurse anesthetist, and nurse midwife and clinical nurse specialist.

(2) "Clinical nurse specialist" means a person who is licensed in accord with 37-8-405 through 37-8-407, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1485.

(3) "Delivery services" means services necessary to protect the health and safety of the woman and fetus from the onset of labor through delivery.

(4) "Early elective delivery" means either a nonmedically necessary labor induction or cesarean section that is performed prior to 39 weeks and 0/7 days gestation.

(5) "Independent employment status" means that a separate federal tax identification number is obtained for the mid-level practitioner and the billed services are not provided in the course of the mid-level practitioner's employment by or contract with a physician, hospital, or ambulatory surgical center.

(6) "Mid-level practitioner" means the following professionals:

(a) advanced practice registered nurse; and

(b) physician assistant.

(7) "Mid-level practitioner services" means those services provided by mid-level practitioners in accord with the laws and rules defining and governing through licensing and certification the practices of advanced practice registered nurses and physician assistants.

(8) "Nurse anesthetist" means a person who is licensed in accord with 37-8-405 through 37-8-407, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1480.

(9) "Nurse midwife" means a person who is licensed in accord with 37-8-405 through 37-8-407, 37-8-409, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1475.

(10) "Nurse practitioner" means a person who is licensed in accord with 37-8-405 through 37-8-407, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1470.

(11) "Physician assistant" means a person who is licensed as provided in Title 37, chapter 20, MCA and ARM Title 24, chapter 159, subchapter 14.

(12) "Postpartum services" means services rendered to a woman during the 12-month postpartum period after pregnancy ends for any health conditions or complications that are pregnancy-related.

(13) "Pregnancy-related services" means services for the treatment of conditions or complications that exist or are exacerbated because of pregnancy.

(14) "Prenatal services" means services directed at protecting and insuring the health of the woman and the fetus during pregnancy.

(15) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted at ARM 37.86.101 set forth meanings of terms commonly used by the Montana Medicaid program in implementation of the program's mid-level practitioner fee schedule.

(16) The "Physician-Related Services Manual" means the physician-related services manual adopted at ARM 37.86.101. It governs the administration of the mid-level practitioner program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1991 MAR p. 1044, Eff. 6/28/91; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1995 MAR p. 1580, Eff. 8/11/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2014 MAR p. 2171, Eff. 10/1/14; AMD, 2015 MAR p. 145, Eff. 2/13/15; AMD, 2024 MAR p. 2021, Eff. 8/10/24.

Mont. Admin. R. 37.86.205 Mid-Level Practitioner Services, Requirements and Reimbursement

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) Medicaid coverage of mid-level practitioner services is available according to the requirements and procedures specified for physicians under ARM 37.86.101, 37.86.104, and 37.86.105.

(3) Mid-level practitioner services must be medically necessary as defined in ARM 37.82.102 and 37.85.410.

(4) Coverage of mid-level practitioner services is limited to the provision of services by the following providers:

(a) mid-level practitioners who are considered to have an independent employment status;

(b) hospitals employing or contracting with certified registered nurse anesthetists if:

(i) the Secretary of Health and Human Services has not granted the hospital authorization for continuation of cost pass-through under section 9320 of the Omnibus Budget Reconciliation Act of 1986, as amended by section 608(c) of the Family Support Act of 1988 (Public Law 100-485);

(ii) the hospital obtains from the department or its fiscal agent a provider number for certified registered nurse anesthetist services; and

(iii) the hospital bills for services on form CMS 1500 or CMS 837P electronic transaction.

(c) physicians, ambulatory surgical centers, diagnostic centers or public health departments, employing or contracting with mid-level practitioners if:

(i) the physician or the provider entity obtains from the department or its fiscal agent a provider number for the mid-level practitioner; and

(ii) the physician or the provider entity bills for services on form CMS 1500 or CMS 837P electronic transaction.

(5) Reimbursement for services, except as otherwise provided in this rule, is the lower of:

(a) usual and customary charges; or

(b) a provider rate of reimbursement which is a percentage of the reimbursement for physicians provided in accordance with the methodologies described in ARM 37.85.212 and 37.86.105. The effective date and percentage is as provided in ARM 37.85.105(2).

(6) Reimbursement for immunizations, drugs which are billed under associated HCPCS codes, family planning services, administration of injectables, radiology, laboratory and pathology, cardiography and echocardiography services, and for clients under 21 years of age is the lower of:

(a) usual and customary charges; or

(b) 100% of the reimbursement for physicians provided in accordance with the methodologies described in ARM 37.85.212 and 37.86.105.

(7) The following services are not covered by Medicaid as mid-level practitioner services:

(a) educational visits and educational materials (including group settings);

(b) mileage and travel expenses;

(d) preparation of special medical or insurance reports;

(e) consultations with other mid-level practitioners;

(f) delivery services not provided in a licensed health care facility unless provided in an emergency situation; and

(g) drug dispensing fees.

(8) Claims for child delivery must have one of the following line procedure code modifiers or the line will be denied:

(a) CG-cesarean section/induction prior to 39 weeks;

(b) GK–spontaneous vaginal delivery prior to 39 weeks (noninduced);

(d) SC–cesarean section at or after 39 weeks.

(9) The maternity policy adjustor is not applied to early elective delivery.

(10) Gestational age must be determined and documented in medical records. The department accepts the following American Congress of Obstetricians and Gynecologists guidelines for determining gestational age:

(a) fetal heart tones documented for 20 weeks by nonelectronic fetoscope or 30 weeks by Doppler;

(b) a positive serum or urine pregnancy test by a reliable laboratory at least 36 weeks prior to delivery;

(d) when pregnancy care was not initiated within 20 weeks gestation, the gestational age may be documented from the first day of the last menstrual period (LMP).

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1988 MAR p. 1255, Eff. 7/1/88; AMD, 1989 MAR p. 1848, Eff. 11/10/89; AMD, 1990 MAR p. 540, Eff. 3/16/90; AMD, 1990 MAR p. 2299, Eff. 12/28/90; AMD, 1990 MAR p. 2305, Eff. 12/28/90; AMD, 1991 MAR p. 1044, Eff. 6/28/91; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1995 MAR p. 1580, Eff. 8/11/95; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2002 MAR p. 1775, Eff. 6/28/02; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2009 MAR p. 1012, Eff. 7/1/09; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 2171, Eff. 10/1/14; AMD, 2017 MAR p. 1522, Eff. 9/9/17; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Subchapter 37.86.5 Podiatry Services

Mont. Admin. R. 37.86.501 Podiatry Services, Definitions

(1) "Orthotic" means a mechanical device to assist in restoring normal function of the foot, applied to the foot or used with the shoe either as an insert for the shoe or as an attachment to the exterior of the shoe.

(2) "Podiatry services" means those services provided by individuals licensed under state law to practice podiatry which are within the scope of their practice.

(3) "Routine podiatric care" means the cutting or removing of corns and calluses, the trimming of nails or the application of skin creams and other hygienic, preventive maintenance care and debridement of nails.

(4) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted at ARM 37.86.101 defines the terms commonly used by the Montana Medicaid program in implementation of the program's podiatry fee schedule.

(5) The "Physician-Related Services Manual" means the physician-related services manual adopted at ARM 37.86.101. It governs the administration of the Podiatry program.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 2664, Eff. 9/26/80; AMD, 1995 MAR p. 1580, Eff. 8/11/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 2625, Eff. 1/1/13.

Mont. Admin. R. 37.86.505 Podiatry Services, Requirements

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) The department or its designated review organization may conduct utilization and peer review of podiatry services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 2664, Eff. 9/26/80; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1995 MAR p. 1580, Eff. 8/11/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.506 Podiatry Services, Reimbursement

(1) Reimbursement for podiatry services is in accordance with the methodologies described in ARM 37.85.212 and 37.86.105.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-131, 53-6-141, MCA
History: NEW, 1980 MAR p. 2664, Eff. 9/26/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1995 MAR p. 1580, Eff. 8/11/95; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Subchapter 37.86.6 Therapy Services

Mont. Admin. R. 37.86.601 Therapy Services, Definitions

In ARM 37.86.601, 37.86.605, 37.86.606, and 37.86.610, the following definitions apply:

(1) "Assistant/aide" means an assistant, aide or other person authorized under and practicing in accordance with the applicable provisions of Title 37, MCA, who subject to supervision required by law, assists in the provision of a therapy service.

(2) "Condition" means an illness, injury, disorder, or disability.

(3) "Habilitative care" means services provided when a member requires help to maintain, learn, or improve skills and functioning for daily living, or to prevent deterioration. These services include: physical therapy, occupational therapy, speech-language pathology, and behavioral health professional treatment. Applied behavior analysis (ABA) for adults is excluded. Habilitative services are reimbursable if a licensed therapist is needed and the service must be provided by a licensed therapist. Services may be provided in a variety of inpatient and outpatient settings as prescribed by a physician or mid-level practitioner.

(4) "Licensed therapist" means a physical therapist, speech-language pathologist, or occupational therapist licensed under the applicable provisions of Title 37, MCA to practice the particular category of therapy services provided, but does not include an assistant, aide, or other person whose authority to perform services is restricted to working under the supervision of another.

(5) "Maintenance therapy" means repetitive therapy services that are required to maintain functions, that are performed without reasonable expectation of significant progress and that do not involve complex and sophisticated therapy services requiring the judgment or skill of a licensed therapist.

(6) "Mid-level practitioner" means an advanced practice registered nurse or a physician assistant as defined in ARM 37.86.202.

(7) "Occupational therapy services" means occupational therapy services as defined in 37-24-103, MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, 46.12.526, and 46.12.529, occupational therapy services do not include services provided by a hospital or home health agency.

(8) "Physical therapy services" means physical therapy services as defined in 37-11-101, MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, 46.12.526, and through 46.12.529, physical therapy services do not include services provided by a hospital or home health agency.

(9) "Rehabilitative care" means services provided when a member needs help to keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a member was sick, hurt, or disabled. Rehabilitative services include: physical therapy, occupational therapy, speech-language pathology, and behavioral health professional treatment. Applied behavioral analysis (ABA) for adults is excluded. Rehabilitative services are reimbursable if a licensed therapist is needed and the service must be provided by a licensed therapist. Services may be provided in a variety of inpatient and outpatient settings as prescribed by a physician or mid-level practitioner.

(10) "Restorative therapy" means therapy services that are performed with a reasonable expectation that the recipient's function will improve significantly in a reasonable and predictable period of time, based upon an assessment of the recipient's restoration potential made by a physician or mid-level practitioner in consultation, with the licensed therapist. Therapy services are not restorative therapy if the recipient's expected restoration potential would be insignificant in relation to the extent and duration of services required. Therapy services are no longer restorative therapy if at any time after commencement of treatment it is determined that the reasonable expectation of significant improvement in function will not materialize.

(11) "Speech therapy services" means the practice of speech-language pathology as defined in 37-15-102, MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, and 46.12.529, speech therapy services do not include services provided by a hospital or home health agency.

(12) "Therapy services" or "therapies" means speech therapy services, occupational therapy services and physical therapy services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1996 MAR p. 1687, Eff. 6/21/96; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2016 MAR p. 829, Eff. 5/7/16.

Mont. Admin. R. 37.86.605 Therapy Services, Provider Requirements

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) As a condition of participation in the Montana Medicaid program, a therapist must:

(a) maintain a current license issued by the applicable Montana licensing board for the category of therapy being provided, or, if the provider is serving recipients outside the state of Montana, maintain a current license in the equivalent category under the laws of the state in which the services are provided;

(b) enter into and maintain a current provider enrollment form under the provisions of ARM 37.85.402 with the department's fiscal agent to provide the category of therapy services being provided.

(3) An assistant/aide may not enroll as a provider.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 1996 MAR p. 1687, Eff. 6/21/96; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.606 Therapy Services, Service Requirements and Restrictions

(1) The requirements and restrictions in this rule apply for purposes of coverage and reimbursement of therapy services under the Montana Medicaid program.

(2) Except as otherwise provided by these rules, therapy services must be provided by a therapist or assistant/aide within the scope of practice permitted by state law. The provider's records maintained under ARM 37.85.414 must demonstrate compliance with applicable supervision and protocol requirements.

(a) Services provided by an assistant/aide may only be billed by a supervising therapist.

(3) Therapy services may be provided to a member only upon a current written or verbal order or referral by a physician or mid-level practitioner. All verbal orders or referrals must be followed up by a written order received by the provider within 30 days of the verbal order or referral.

(a) The provider is not entitled to Medicaid reimbursement if services are provided prior to actual receipt of the written or verbal order or referral. Referral and orders are valid for Medicaid purposes for no more than 180 days.

(b) The provider must maintain the referral or order of the physician or mid-level practitioner and appropriate records that demonstrate compliance with Medicaid requirements. The provider must provide copies of these documents at no charge to the department or its agents upon request.

(4) Services that do not require the performance or supervision of a licensed therapist are not reasonable and necessary even if the services are performed by or under the supervision of a licensed therapist.

(5) Medicaid reimbursement for therapy service procedures includes all related supplies and items used in the performance of the service, except that the design, fabrication, fitting, and instruction by a licensed therapist in the use of splints, braces, and slings are reimbursable as provided in ARM 37.86.1801 through 37.86.1807.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1996 MAR p. 1687, Eff. 6/21/96; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2016 MAR p. 829, Eff. 5/7/16.

Mont. Admin. R. 37.86.610 Therapies, Reimbursement

(1) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained, in the Health Care Financing Administration's Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers and HCPCS is available upon request from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) Subject to the requirements of this rule, the Montana Medicaid program pays the following for therapy services:

(a) For patients who are eligible for Medicaid, the lower of:

(i) the provider's usual and customary charge for the service;

(ii) the reimbursement provided in accordance with the methodologies described in ARM 37.85.212; or

(iii) for items or services where no RBRVS or Medicare fee is available, the fee schedule amount will be calculated using the following methodology:

(A) Establishing a fee for a service that has been billed at least 50 times by all providers in the aggregate during the previous 12-month period. The department will set each fee at the payment-to-charge ratio in accordance with ARM 37.85.105(2)(d).

(B) For services where utilization cannot meet the methodology outlined in (A), the fee will be set at the same rate as a service similar in scope.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1996 MAR p. 1687, Eff. 6/21/96; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2008 MAR p. 1980, Eff. 9/12/08; AMD, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2017 MAR p. 2287, Eff. 1/1/18.

Subchapter 37.86.7 Audiology Services

Mont. Admin. R. 37.86.701 Audiology Services, Provider Requirements

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Audiology service providers, as a condition of participation in the Montana Medicaid program, must:

(a) maintain a current audiology license issued by the Montana Board of Speech-Language Pathologists and Audiologists, or, if the provider is serving recipients outside the state of Montana, maintain a current license in the equivalent category under the laws of the state in which the services are provided;

(b) enter into and maintain a current provider enrollment form under the provisions of ARM 37.85.402 with the department's fiscal agent to provide audiology services.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1996 MAR p. 1687, Eff. 6/21/96; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.702 Audiology Services, Service Requirements, and Restrictions

(1) The following requirements and restrictions apply for purposes of coverage and reimbursement of audiology services under the Montana Medicaid program.

(2) Audiology services are hearing aid evaluations and basic audio assessments provided within the scope of practice permitted by state law to recipients with hearing disorders. Audiology services must be provided by a licensed practitioner within the scope of the practice permitted by state law. The provider's records maintained under ARM 37.85.414 must demonstrate the medical necessity for the service, and compliance with applicable supervision and protocol requirements.

(a) Medicaid coverage and reimbursement for dispensing of hearing aids is available to licensed hearing aid dispensers and audiologists, subject to the requirements of ARM 37.86.801 through 37.86.805 and the requirements generally applicable to Medicaid providers.

(3) Audiology services may be provided to a recipient only upon a current written or verbal order or referral by a physician or mid-level practitioner. All verbal orders or referrals must be followed up by a written order received by the provider within 30 days of the verbal order or referral.

(a) The provider is not entitled to Medicaid reimbursement if services are provided prior to actual receipt of the written or verbal order or referral. Referrals and orders are valid for Medicaid purposes for no more than 90 days.

(4) In addition to the requirements of ARM 37.85.414, a provider must maintain the written orders of the physician or mid-level practitioner and all diagnostic and evaluative reports. The provider must provide copies of these documents at no charge to the department or its agents upon request.

(5) The audiology services must be required as preliminary steps to obtaining a medically necessary hearing aid or device for the recipient.

(6) Basic audio assessments must include for each ear under earphones:

(a) Pure tone air conduction thresholds at the frequencies of .5, 1, 2, 3, and 4 KHZ;

(b) Speech reception threshold; and

(c) Speech discrimination (word recognition) test under phonetically-balanced (PB) max conditions, and either pure tone bone conduction thresholds at the frequencies specified in (6)(a), or tympanometry, including tympanogram, acoustic reflexes, and static compliance.

(7) Medicaid reimbursement for a basic audio assessment or a hearing aid evaluation includes all related supplies and items used in the performance of the assessment or evaluation.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1996 MAR p. 1687, Eff. 6/21/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2011 MAR p. 2293, Eff. 10/28/11.

Mont. Admin. R. 37.86.705 Audiology Services, Reimbursement

(1) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained in the Health Care Financing Administration's Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers, and HCPCS is available upon request from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951.

(2) Subject to the requirements of this rule, the Montana Medicaid program pays the following for audiology services:

(a) For patients who are eligible for Medicaid, the lowest of:

(i) the provider's usual and customary charge for the service;

(ii) the reimbursement provided in accordance with the methodologies described in ARM 37.85.212;

(iii) 100% of the Medicare Region D allowable fee; or

(iv) for items or services where no RBRVS fee is available, the fee schedule amount will be calculated using the following methodology:

(A) Establishing a fee for a service or item that has been billed at least 50 times by all providers in the aggregate during the previous 12-month period. The department will set each fee at the payment-to-charge ratio under ARM 37.85.105(2)(d).

(B) For services where utilization cannot meet the methodology outlined in (A), the fee shall be set at the same rate as a service similar in scope.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1996 MAR p. 1687, Eff. 6/21/96; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2008 MAR p. 1980, Eff. 9/12/08; AMD, 2009 MAR p. 2485, Eff. 1/1/10; AMD, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Subchapter 37.86.8 Hearing Aid Services

Mont. Admin. R. 37.86.801 Hearing Aid Services, Definitions

(1) "Audiologist" means a person holding a current audiology license issued by the Montana Board of Speech-Language Pathologists and Audiologists under Title 37, chapter 15, MCA, to engage in selling, dispensing, or fitting hearing aids.

(2) "Licensed hearing aid dispenser" has the meaning as defined in 37-16-102, MCA.

(3) The department adopts and incorporates into this rule the definition of "over-the-counter hearing aid" in 21 C.F.R. § 800.30 (April 1, 2024).

(4) The department adopts and incorporates into this rule the definition of "prescription hearing aid" in 21 C.F.R. § 801.422 (April 1, 2024).

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 973, Eff. 3/14/80; AMD, 1998 MAR p. 2168, Eff. 8/14/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2011 MAR p. 2293, Eff. 10/28/11; AMD, 2024 MAR p. 2024, Eff. 8/10/24.

Mont. Admin. R. 37.86.802 Hearing Aid Services, Requirements, and Limitations

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Over-the-counter hearing aids are not a covered benefit.

(3) A prescription hearing aid may be covered under the Medicaid program if all of the following conditions are satisfied:

(a) the member's physician or mid-level practitioner has referred the member to an audiologist for an audiological evaluation;

(b) the licensed audiologist has determined a prescription hearing aid would be effective in improving the member's hearing;

(d) prior authorization for the prescription hearing aid has been granted by the department or its designated review organization; and

(e) the prescription hearing aid is provided by a licensed hearing aid dispenser or an audiologist.

(4) The date of service is defined as the date the prescription hearing aid(s) is ordered by the dispenser.

(5) For members aged 21 or over, a replacement prescription hearing aid purchased by Medicaid requires prior authorization.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-141, MCA
History: NEW, 1980 MAR p. 973, Eff. 3/14/80; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 596, Eff. 3/25/88; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1990 MAR p. 1326, Eff. 7/13/90; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2009 MAR p. 2485, Eff. 1/1/10; AMD, 2011 MAR p. 2293, Eff. 10/28/11; AMD, 2024 MAR p. 2024, Eff. 8/10/24.

Mont. Admin. R. 37.86.805 Hearing Aid Services, Reimbursement

(1) The department will pay the lowest of the following for covered hearing aid services and items:

(a) the provider's reasonable usual and customary charge for the service or item;

(b) the amount specified for the particular service or item in the department's fee schedule. The department adopts and incorporates by reference the department's Hearing Aid Fee Schedule as provided in ARM 37.85.105(3)(c); or

(2) For items or services where no Medicare allowable fee is available, the fee schedule amount in (1)(b) will be calculated using the following methodology:

(a) Establishing a fee for a service that has been billed at least 50 times by all providers in the aggregate during the previous 12-month period. The department will set each fee at the payment-to-charge ratio under ARM 37.85.105(2)(e).

(b) For supplies or equipment, reimbursement will be set at 75% of the manufacturer's suggested retail price. For items without a manufacturer's suggested retail price, the charge will be considered reasonable if the provider's acquisition cost from the manufacturer is at least 50% of the charge amount. For items that are custom-fabricated at the place of service, the amount charged will be considered reasonable if it does not exceed the average charge of all Medicaid providers by more than 20%.

(c) For services where utilization cannot meet the methodology outlined in (a), the fee will be set at the same rate as a service similar in scope.

(3) The provider may bill Medicaid for a dispensing fee, as specified in the fee schedule adopted in (1)(b). The dispensing fee covers and includes the initial ordering, fitting, orientation, counseling, two return visits for the services listed, and the insurance for loss or damages covered under a one-year warranty.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 973, Eff. 3/14/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1988 MAR p. 596, Eff. 3/25/88; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1990 MAR p. 1326, Eff. 7/13/90; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2002 MAR p. 1779, Eff. 6/28/02; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2005 MAR p. 385, Eff. 3/18/05; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1156, Eff. 7/1/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2009 MAR p. 2485, Eff. 1/1/10; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2011 MAR p. 2825, Eff. 1/1/12; AMD, 2012 MAR p. 2494, Eff. 1/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18; AMD, 2024 MAR p. 2024, Eff. 8/10/24.

Subchapter 37.86.9 Collaborative Practice Drug Therapy Management

Mont. Admin. R. 37.86.901 Collaborative Practice Drug Therapy Management - Definitions

(1) "Clinical pharmacist practitioner" means a pharmacist who meets the requirements outlined in ARM 24.174.526 and is licensed in the State of Montana.

(2) "Collaborative practice drug therapy management" means face-to-face direct member care, provided by a clinical pharmacist practitioner as outlined in ARM 24.174.524. The care provided must be within the scope of practice for clinical pharmacist practitioners.

(3) "Medical practitioner" means a medical practitioner as defined in 37-2-101, MCA.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 908, Eff. 7/1/17.

Mont. Admin. R. 37.86.902 Collaborative Practice Drug Therapy Management - Requirements and Eligibility

(1) These requirements are in addition to those requirements contained in administrative rule and statutory provisions generally applicable to Medicaid providers.

(2) A clinical pharmacist practitioner who provides collaborative practice drug therapy management must:

(a) have a collaborative practice agreement with a medical practitioner, as provided in ARM 24.174.524;

(b) manage a member's drug therapy by providing face-to-face, direct care; and

(3) Members who have at least one chronic condition needing at least one maintenance medication are eligible for collaborative practice drug therapy management.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 908, Eff. 7/1/17.

Mont. Admin. R. 37.86.905 Collaborative Practice Drug Therapy Management - Reimbursement

(1) Reimbursement for collaborative practice drug therapy management is reimbursed only to the medical practitioner or facility, at the lower of the following:

(a) the provider's usual and customary charge to the general public for the service; or

(b) the department's current fee schedule in ARM 37.85.105 for the appropriate provider type.

(2) Collaborative practice drug therapy management services performed at a federally qualified health center or rural health clinic will be reimbursed in accordance with ARM 37.86.4401 through 37.86.4420.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 908, Eff. 7/1/17.

Subchapter 37.86.10 Dental Services

Mont. Admin. R. 37.86.1001 Dental Services, Definitions

For purposes of this subchapter, the following definitions apply:

(1) "By-report method" means the department reimburses a percent of the provider's usual and customary charges for a procedure code for which no fee has been assigned.

(2) "Conversion factor" means the multiplier used to convert the relative value unit or units of a procedure to a reimbursement rate a provider may receive in payment from Montana Medicaid. The dental conversion factor approximates the amount the Legislature has appropriated for one unit of value of dental services.

(3) "Dental service" means medically necessary treatment of the teeth and associated structures of the oral cavity. Dental service includes the provision of orthodontia and prostheses.

(4) "Dental hygiene" means services performed by a licensed preventive oral health practitioner known as a dental hygienist, that are therapeutic, prophylactic, or preventive procedures in nature.

(5) "Dental hygienist" means a licensed preventive oral health practitioner practicing in compliance with the provisions of Title 37, chapter 4, MCA.

(6) "Policy adjustor" means a factor by which the product of the relative value units of a procedure or the conversion factor is multiplied to increase or decrease the fees paid by Montana Medicaid for certain categories of services.

(7) "Procedure code" means the number identifying a particular procedure. Montana Medicaid has adopted national uniform procedure codes.

(8) "Public health supervision" means the provision of limited dental hygiene preventative services without the prior authorization or presence of a licensed dentist in a public health facility.

(9) "Relative Values for Dentists (RVD) Scale" means the scale published biennially by Relative Value Studies Inc., 1675 Larimer, Suite 410, Denver, CO 80202, listing the relative value of dental services provided by dentists and denturists.

(10) "Relative value unit (RVU)" means a numerical value assigned in the resource based relative value scale to each procedure code for which a relative value is available. The RVD is a comprehensive relative value system that lists dental procedures used by dentists, denturists, and hygienists as an expression of the relative effort and expense expended by a provider in providing one service as compared to another service.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1980 MAR p. 1747, Eff. 6/27/80; AMD, 1985 MAR p. 1410, Eff. 9/27/85; AMD, 1999 MAR p. 1522, Eff. 7/2/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1117, Eff. 6/22/01; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2009 MAR p. 1017, Eff. 7/1/09.

Mont. Admin. R. 37.86.1002 Dental Services, Requirements

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers and the provision of services under Medicaid coverage.

(2) Medicaid reimbursement for dental care is limited to those services specified in ARM 37.86.1006.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1747, Eff. 6/27/80; AMD, 1982 MAR p. 301, Eff. 2/12/82; AMD, 1985 MAR p. 1410, Eff. 9/27/85; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 286, Eff. 3/1/88; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1988 MAR p. 1995, Eff. 9/9/88; AMD, 1990 MAR p. 1331, Eff. 7/13/90; AMD, 1993 MAR p. 2433, Eff. 10/15/93; AMD, 1999 MAR p. 1522, Eff. 7/2/99; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.1004 Reimbursement Methodology for Resource Based Relative Value for Dentists (rvd)

(1) For procedures listed in the relative values for dentists scale, reimbursement rates shall be determined using the following methodology:

(a) The fee for a covered service shall be the amount determined by multiplying the relative value unit specified in the relative values for dentists scale by the conversion factor specified in (1)(c). The department adopts and incorporates by reference the Relative Values for Dentists (RVDs) as provided in ARM 37.85.105(3).

(b) The conversion factor and provider fees for dentists, dental hygienists, and denturists procedures are calculated as follows:

(i) The total units of each procedure code paid in a prior period is multiplied by the RVU as published in (1)(a) to equal the RVD for each procedure code. Typically, the prior period used is the prior state fiscal year.

(ii) The sum of all RVDs calculated in (1)(b)(i) equals the total units of dental service.

(iii) The Montana Legislature's appropriation for dental service during the appropriation period is divided by the total units of dental service calculated in (1)(b)(ii). The resulting dollar value is equal to one unit of dental value and is the dental conversion factor.

(iv) The RVU as published in (1)(a) for each dental procedure is multiplied by the dental conversion factor calculated in (1)(b)(iii) to calculate the Medicaid reimbursement for the procedure. When this calculation is made for all covered procedures the Montana Medicaid Dental, Dental Hygienist, and Denturist Fee Schedules are generated.

(v) A policy adjuster may be applied to some fees calculated in (1)(b)(iv) for certain categories of services or to the conversion factor to increase or decrease the fees paid by Medicaid.

(c) The conversion factor used to determine the Medicaid payment amount for services provided to eligible individuals is provided in ARM 37.85.105(3).

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2001 MAR p. 1117, Eff. 6/22/01; AMD, 2002 MAR p. 1780, Eff. 6/28/02; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2005 MAR p. 1073, Eff. 7/1/05; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1156, Eff. 7/1/08; AMD, 2009 MAR p. 1017, Eff. 7/1/09; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Mont. Admin. R. 37.86.1005 Dental Services, Reimbursement

(1) For dental services listed in the department's fee schedule, the department will pay the lowest of the following for dental services covered by the Medicaid program:

(a) the provider's usual and customary charge for the service;

(b) the amount determined using the methodology described in ARM 37.86.1004; or

(c) for items or services when there is no RVD, the department will set the fee at the same rate as a service similar in scope.

(2) No extra fee for pulp capping or bases is reimbursable.

(3) Payment for all dentures includes:

(a) payment for any tissue conditioners provided;

(b) the first three adjustments after the dentures are placed; and

(c) adjustments during the first year after delivery of the dentures is available only to a dentist or denturist who did not make the dentures.

(4) Medical procedures, within the scope of practice for licensed dentists, that are not listed in the dental services provider manual are reimbursed in accordance with the methodologies provided in ARM 37.85.212 and 37.86.105.

(5) A dentist examining more than one Medicaid recipient in a long term care facility on the same day is allowed payment for one nursing home call in addition to the examination fees. Examination is considered a recorded evaluation.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 1752, Eff. 6/27/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 301, Eff. 2/12/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1985 MAR p. 1410, Eff. 9/27/85; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 286, Eff. 3/1/88; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1988 MAR p. 1995, Eff. 9/9/88; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1990 MAR p. 1331, Eff. 7/13/90; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1993 MAR p. 2433, Eff. 10/15/93; AMD, 1995 MAR p. 1968, Eff. 10/1/95; AMD, 1999 MAR p. 1522, Eff. 7/2/99; AMD, 1999 MAR p. 2898, Eff. 12/17/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 1117, Eff. 6/22/01; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2009 MAR p. 1017, Eff. 7/1/09; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2014 MAR p. 2474, Eff. 7/1/14; AMD, 2017 MAR p. 134, Eff. 1/21/17.

Mont. Admin. R. 37.86.1006 Dental Services, Covered Procedures

(1) For purposes of specifying coverage of dental services through the Medicaid program, the department adopts and incorporates by reference the Dental and Denturist Program Provider Manual as provided in ARM 37.85.105(3). The Dental and Denturist Program Provider Manual informs the providers of the requirements applicable to the delivery of services. Copies of the manual are available on the Montana Medicaid provider web site at https://medicaidprovider.mt.gov and from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) Dentists who are Medicaid provider participants under ARM 37.85.401 may bill medical CPT procedure codes as provided in ARM 37.85.212 and 37.86.101 for any Medicaid covered medical procedure that they are allowed to provide under the Dental Practice Act that is not otherwise listed in the Dental and Denturist Program Provider Manual.

(3) All services which require prior authorization from the designated review organization are identified in the department's fee schedule. Reimbursement is not provided for such services unless prior authorization has been given by the designated review organization.

(4) A licensed dental hygienist practicing under public health supervision may provide dental hygiene preventative services as defined by the Board of Dentistry.

(5) Covered services for adults age 21 and over include:

(a) diagnostic;

(b) preventative;

(d) extractions; and

(e) porcelain fused to base metal crowns, and porcelain/ceramic crowns are limited to two per person per year, total.

(6) Medically necessary dental services outlined in (5)(c) through (e), excluding anesthesia services, have an annual limit. The limit is applied per benefit year, which runs from July 1 through June 30. Members determined categorically eligible for Aged, Blind, and Disabled (ABD) Medicaid, in accordance with ARM 37.82.204, are not subject to the annual limit. The annual limit is:

(a) $1,125 for dates of service June 30, 2024, and earlier;

(b) $1,170 for the benefit year starting July 1, 2024, and ending on June 30, 2025; and

(7) Full maxillary and full mandibular dentures are a Medicaid-covered service. Coverage is limited to one set of dentures every ten years. Only one lifetime exception to the ten-year time period is allowed per person if one of the following exceptions is authorized by the department:

(a) The dentures are no longer serviceable and cannot be relined or rebased; or

(b) The dentures are lost, stolen, or damaged beyond repair.

(8) Maxillary partial dentures and mandibular partial dentures are a Medicaid-covered service. Coverage is limited to one set of partial dentures every five years. Only one lifetime exception to the five-year limit is allowed per person if one of the following exceptions is authorized by the department:

(a) The partial dentures are no longer serviceable and can no longer be relined or rebased; or

(b) The partial dentures are lost, stolen, or damaged beyond repair.

(9) The limits on coverage of denture replacement may be exceeded when the department determines that the existing dentures are causing the person serious physical health problems. The dentist or denturist should indicate "replacement dentures" on the request for prior authorization of replacement dentures and document the medical necessity for the replacement.

(10) Coverage of all denture services is subject to the following requirements and limitations:

(a) A denturist may provide initial immediate full prosthesis and initial immediate partial prosthesis only when prescribed in writing by a dentist. The prescription must be signed and dated within 90 days of the order and must be maintained in the patient file.

(b) Requests for full prosthesis must show the approximate date of the most recent extractions, and/or the age and type of the present prosthesis.

(11) Orthodontia for persons age 21 and older who have maxillofacial anomalies that must be corrected surgically and for which the orthodontia is a necessary adjunct to the surgery is a covered service.

(12) Full band comprehensive orthodontic or interceptive orthodontic treatment for persons 20 and younger who have one of the following handicapping conditions, indicated with an 'X' on the HLD score sheet:

(a) cleft palate;

(b) deep impinging overbite;

(d) who score a 30 or higher without a handicapping condition (as listed above) on the Handicapping Labio-Lingual Form (HLD Index).

(13) Unless otherwise provided by these rules, interceptive orthodontia is limited to children 12 years of age or younger with one or more of the following conditions:

(a) posterior unilateral crossbite;

(b) bilateral crossbite; or

(14) All orthodontia treatment plans must receive prior authorization from the department's designated peer reviewer to determine individual eligibility for such orthodontia services.

(15) Orthodontic treatment not progressing to the extent of the treatment plan because of noncompliance by the person and which jeopardizes the health of the person may result in termination of orthodontic treatment. If termination of orthodontic treatment occurs because of noncompliance by the person, Medicaid will not authorize any future orthodontic requests for that person.

(16) Cosmetic dentistry is not a covered service of the Medicaid program.

(17) Dental implants are not a covered benefit of the Medicaid program.

(18) Nobel metal crowns, and bridges are not covered benefits of the Medicaid program for individuals age 21 and over.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1990 MAR p. 1331, Eff. 7/13/90; AMD, 1993 MAR p. 2433, Eff. 10/15/93; AMD, 1995 MAR p. 1968, Eff. 10/1/95; AMD, 1999 MAR p. 1522, Eff. 7/2/99; AMD, 1999 MAR p. 2898, Eff. 12/17/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2002 MAR p. 1780, Eff. 6/28/02; AMD, 2005 MAR p. 1073, Eff. 7/1/05; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2009 MAR p. 1017, Eff. 7/1/09; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2015 MAR p. 2315, Eff. 1/1/16; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2024 MAR p. 2269, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26.

Subchapter 37.86.11 Outpatient Drug Services

Mont. Admin. R. 37.86.1101 Outpatient Drugs, Definitions

(1) "Acquisition cost" means the actual price paid by a provider for a drug.

(2) "Active pharmaceutical ingredient (API)" means a nonrebatable bulk drug substance, defined in 21 CFR 207.3(a)(4) (2011) as any substance that is represented for use in a drug and that, when used in manufacturing, processing, or packaging of a drug, becomes an active ingredient of the drug product.

(3) "Allowed ingredient cost" means the "Average Acquisition Cost (AAC)" or "submitted ingredient cost," whichever is lower. If AAC is not available, drug reimbursement is determined at the lesser of "Wholesale Acquisition Cost (WAC)", "Federal Maximum Allowable Cost (FMAC)," or the "submitted ingredient cost."

(4) "Average acquisition cost (AAC)" means the calculated average drug ingredient cost per drug determined by direct pharmacy survey, wholesale survey, and other relevant cost information.

(5) "Average manufacturer price" means the price as defined at 42 CFR Part 447.504(a).

(6) "Best price" means with respect to a single source drug or innovator multiple source drug of a manufacturer the lowest price available from the manufacturer during the rebate period to any wholesaler, retailer, provider, health maintenance organization, nonprofit entity, or governmental entity within the United States. Best price includes the lowest price available to any entity for any such drug of a manufacturer that is sold under an approved new drug application.

(7) "Federal maximum allowable cost" (FMAC) means the per unit amount the department reimburses a provider for a prescription drug included in the federal upper-limit program. FMAC is the federal upper limit the department will pay for multi-source drugs as published by the Centers for Medicare and Medicaid Services (CMS) at: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/prescription-drugs/pharmacy-pricing.html .

(8) "Legend drugs" means drugs that federal law prohibits dispensing without a prescription.

(9) "Maintenance medications" means oral tablet or capsule drugs that:

(a) have a low probability for dosage or therapy changes due to side effects;

(b) are subject to serum drug concentration monitoring or therapeutic response of a course of prolonged therapy;

(d) therapeutically are not considered curative or promoting of recovery; and

(e) are administered continuously rather than intermittently.

(10) "Multi-source" means a drug product sold under its generic name for which the active ingredients are identical in chemical composition to one or more other drugs sold under trademark that can be purchased from different manufacturers or distributors.

(11) "Outpatient drugs" means drugs that are obtained outside of a hospital.

(12) "Preferred drug list (PDL)" means selected drugs that have a significant clinical benefit over other agents in the same therapeutic class and also represent good value to the department based on total cost.

(13) "Submitted ingredient cost" means a pharmacy's actual ingredient cost. For drugs purchased under the 340B Drug Pricing Program, "submitted ingredient cost" means the actual 340B purchase price. For drugs purchased under the Federal Supply Schedule (FSS), "submitted ingredient cost" means the actual FSS purchase price.

(14) "Usual and customary charge" means the price the provider charges a typical customer in the provider's typical course of business.

(15) "Wholesale acquisition cost (WAC)" is the cost as defined in 42 USC 1395w-3a(c)(6)(B).

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1998 MAR p. 495, Eff. 2/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 2313, Eff. 8/25/00; AMD, 2002 MAR p. 1788, Eff. 6/28/02; AMD, 2008 MAR p. 1157, Eff. 7/1/08; AMD, 2008 MAR p. 2669, Eff. 1/1/09; AMD, 2010 MAR p. 433, Eff. 3/1/10; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2011 MAR p. 2416, Eff. 11/11/11; AMD, 2016 MAR p. 1065, Eff. 7/1/16; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.1102 Outpatient Drugs, Requirements

(1) These requirements are in addition to those contained in ARM 37.85.401 through 37.85.415.

(2) For purposes of Medicaid reimbursement, outpatient drugs may not be filled or refilled without the authorization of the physician or other licensed practitioner who is authorized by law to prescribe drugs and is recognized by the Medicaid program.

(3) The department will only participate in the payment of legend and over-the-counter drugs listed on the department drug formulary, as determined by the Medicaid Drug Formulary Committee established by the department. The formulary committee is the Drug Use Review Board, established and operating in accordance with 42 USC 1396r-8 (2016), which governs Medicaid drug programs. The drug formulary includes a preferred drug list. Prescribers must prescribe from the preferred drug list if medically appropriate.

(a) The PDL includes drugs subject to a Centers for Medicare and Medicaid Services (CMS) approved supplemental rebate agreement between the manufacturer and the department. Drugs in the same therapeutic class as those identified on the preferred drug list but not identified as a preferred drug are subject to prior authorization as outlined in (6)(c).

(4) The inappropriate use of drugs, as determined by professional review, may result in the imposition of a limitation upon the quantities of medications which are payable by the medical assistance program. Retroactive limitation is not applied, unless the involved pharmacy has knowledge or can reasonably be expected to have had knowledge of the inappropriate use of drugs by the member.

(5) Each prescription must be dispensed in the quantity ordered except that:

(a) Prescriptions for which a specific quantity has not been ordered must be dispensed in sufficient quantities to cover the period of time for which the condition is being treated except for injectable antibiotics, which may be dispensed in sufficient quantities to cover a three-day period.

(b) Notwithstanding the above, maintenance medications may be dispensed in quantities sufficient for a 90-day supply or 100 units, whichever is greater. Other medications may not be dispensed in quantities greater than a 34-day supply. The department maintains a list of current drug classes which are considered maintenance medications and are posted on the department's web site at http://medicaidprovider.mt.gov .

(6) The department does not participate in the payment of a prescription drug:

(a) which the Secretary of Health and Human Services (HHS) has determined is less than effective for all conditions of use prescribed, recommended or suggested in the drug's labeling;

(b) that is not subject to a rebate agreement between the manufacturer and the secretary of HHS as required by 42 USC 1396r-8 (2016); and

(c) that does not meet prior authorization criteria as determined by the Medicaid Drug Formulary Committee, established and operating in accordance with 42 USC 1396r-8 (2016), without the existence of a prior authorization request approved by the department or its designated representative. A list of drugs subject to prior authorization, known as the prior authorization drug list, will be provided to interested Medicaid providers.

(7) The department may pay for nonrebatable API bulk powders and excipients compounded in accordance with ARM 37.86.1105(5).

(8) The drug formulary, PDL, and the prior authorization drug list is updated by the department on a monthly basis, on the last day of each month. A copy of the most current listings may be obtained from the department web site at www.dphhs.mt.gov , or by writing to the Department of Public Health and Human Services, Health Resources Division, Allied Health Services Bureau, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(9) The department has a drug rebate program administered in accordance with 42 USC 1396r-8 (2016) and CMS drug program state releases, CMS drug manufacturer releases, and the National Drug Rebate Agreement in effect in 2008. The department adopts and incorporates by reference the National Drug Rebate Agreement (2008). A copy of all documents incorporated by reference in this rule may be obtained from the department web site at www.dphhs.mt.gov , or by writing to the Department of Public Health and Human Services, Health Resources Division, Allied Health Services Bureau, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(a) Pharmaceutical manufacturers, hereafter referred to as the manufacturer, must make rebate payments to the department for each calendar quarter within 30 days after receiving from the department the Medicaid utilization information defined in their federal rebate agreement. The manufacturer is responsible for timely payment of the rebate within 30 days of receiving, at a minimum, information on the number of units paid, by NDC number.

(b) 42 USC 1396r-8 (2016) establishes the requirements that must be met by the department, drug manufacturers, and providers in order for providers to receive reimbursement for outpatient drugs that have been dispensed. This statute describes rebate agreements, covered drugs, prior authorization, reimbursement limits, and drug use review programs.

(10) A provider must maintain a signature log to act as proof that the dispensed medication has been received by the member or an individual acting on behalf of the member. The member, or an individual acting on behalf of the member, must sign the log each time that they receive a prescription drug from a pharmacy provider. For prescription drugs delivered to a nursing facility, the individual charged with ensuring the security of pharmaceutical supplies may sign the log after verifying delivery of all prescription drugs.

(11) The department uses the following procedures to develop the preferred drug list (PDL):

(a) The department performs a pharmacoeconomic analysis of the Medicaid Pharmacy Program and identifies therapeutic classes of drugs for possible PDL inclusion.

(b) The department and the Drug Use Review (DUR) Board/Formulary Committee members consider recommendations and determine which therapeutic drug classes will be reviewed at a meeting of the committee. Notice of the meeting and the therapeutic drug class to be considered is posted on the department's web site in advance of the meeting date.

(c) The department performs drug class reviews using peer-reviewed literature, established evidence-based practice methods, and local clinicians to interpret and apply practical experience to the structured evidence reviews. The department also conducts supplemental rebate negotiations.

(d) The committee combines its members' evaluations and the evaluations from the department to consider equivalent products within the drug class. Information used by the department and its contractors is available to the public prior to the meeting. During the meeting, the committee also hears comments from interested parties.

(e) The committee recommends to the department which preferred agents should be selected for the specific therapeutic class.

(f) The department makes a final decision and posts its decision on the department's web site.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 2978, Eff. 11/29/80; AMD, 1982 MAR p. 105, Eff. 1/29/82; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 753, Eff. 5/1/88; AMD, 1991 MAR p. 1039, Eff. 6/28/91; AMD, 1994 MAR p. 2443, Eff. 8/26/94; AMD, 1998 MAR p. 495, Eff. 2/13/98; TRANS, from SRS, 2000 MAR p. 481; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2004 MAR p. 1489, Eff. 7/2/04; AMD, 2008 MAR p. 1157, Eff. 7/1/08; AMD, 2008 MAR p. 2669, Eff. 1/1/09; AMD, 2011 MAR p. 2416, Eff. 11/11/11; AMD, 2016 MAR p. 1065, Eff. 7/1/16; AMD, 2018 MAR p. 1607, Eff. 8/11/18; AMD, 2019 MAR p. 1637, Eff. 9/21/19.

Mont. Admin. R. 37.86.1103 Outpatient Drugs, Fraud, Waste, and Abuse

(1) Medicaid, Healthy Montana Kids, and Mental Health Services Plan members may be subject to investigation for prescription fraud and abuse in accordance with 42 CFR 455.

(2) "Fraud" means the intentional deception or misrepresentation with knowledge that the deception could result in some unauthorized benefit to the individual or some other person. Examples include:

(a) doctor shopping;

(b) reported cash payment for drugs of abuse where it is suspected that the member has circumvented the Medicaid benefit system to avoid detection; and

(3) "Abuse" means the misuse of the prescription drug program resulting in undue expenditures or substance abuse. Examples include:

(a) high utilization;

(b) multiple provider usages that result in the receipt of unnecessary services;

(d) repeated use of emergency rooms or urgent care clinics; and

(e) unwarranted multiple pharmacy usage.

(4) "Drug not covered" means that a member is unable to receive a selected medication or class of medication unless a prior authorization is granted.

(5) "Opioid naïve member" means a member has not received a prescription for an opioid within the last 90 days.

(6) Pharmacy providers may notify the department when Medicaid members pay cash for controlled substances (CII-CV), ultram (tramadol), ultracet (tramadol and acetaminophen), carisoprodol, and gabapentin.

(7) Prescriptions for noncontrolled substances may be refilled after 75% of the estimated therapy days have elapsed. Prescriptions for controlled substances (CII-CV), ultram (tramadol), ultracet (tramadol and acetaminophen), carisoprodol, and gabapentin may be refilled after 90% of the estimated therapy days have elapsed. Members who have a "drug not covered" in place may be required to have 100% of the estimated therapy days elapse prior to a refill being authorized.

(8) As stated in ARM 37.86.1102, the department does not authorize payment for medications dispensed in quantities greater than a 34-day supply excluding maintenance medications and where manufacturer packaging precludes the 34-day supply limit. Authorization for early refills, lost or stolen medication, or vacation supplies will not be granted.

(9) Except as provided in (10), for an opioid-naïve member, the department does not authorize payment for opioid medications in quantities greater than a 7-day supply.

(10) The restriction imposed under (9) does not apply if the opioid is prescribed to treat:

(a) chronic pain, pain associated with cancer, or pain experienced while the patient is in palliative care; or

(b) opioid abuse or dependence, including but not limited to opioid agonists and opioid antagonists.

(11) The use of tamper-resistant pads for written prescriptions is required. The department follows ARM 24.174.831 established by the Montana Board of Pharmacy to define tamper-resistant prescriptions.

(12) As stated in ARM 37.86.1102, the department may impose prescription limitations and requirements due to inappropriate use of drugs, as determined by professional review. These limitations or requirements may include:

(a) random drug screening;

(b) random pill counts;

(d) restrictions through "Drug Not Covered";

(e) member requirement to have utilized 100 percent of the estimated therapy days prior to granting a prescription authorization; or

(f) member referral to the team care program, as outlined in ARM 37.86.5303.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2014 MAR p. 3094, Eff. 1/1/15; AMD, 2018 MAR p. 1607, Eff. 8/11/18, AMD, 2019 MAR p. 1637, Eff. 9/21/19.

Mont. Admin. R. 37.86.1105 Outpatient Drugs, Reimbursement

(1) Outpatient drugs are reimbursed at the lower of:

(a) the provider's "usual and customary charge"; or

(b) the "allowed ingredient cost" plus a dispensing fee.

(2) The FMAC limitation will not apply in a case where a physician certifies in their own handwriting the specific brand is medically necessary for a particular member. An example of an acceptable certification is the handwritten notation "Brand Necessary" or "Brand Required." A check-off box on a form or rubber stamp is not acceptable.

(3) The dispensing fee for filling prescriptions is determined for each pharmacy provider annually.

(a) The dispensing fee is based on the pharmacy's average cost of filling prescriptions and prescription volume. The average cost of filling a prescription is based on the direct and indirect costs that can be allocated to the cost of the prescription department and that of filling a prescription, as determined from the Montana Dispensing Fee Questionnaire. The prescription volume of a provider is determined using the information provided on the annual Montana Dispensing Fee Questionnaire. If a provider fails to submit a properly completed dispensing fee questionnaire, the provider will receive a dispensing fee in an amount equal to the lowest calculated cost to dispense assigned that year. A copy of the Montana Dispensing Fee Questionnaire is available upon request from the department.

(b) The dispensing fees assigned are as provided in ARM 37.85.105(3).

(c) If the individual provider's usual and customary average dispensing fee for filling prescription is less than the foregoing method of determining the dispensing fee, then the lesser dispensing fee is applied in the computation of the payment to the pharmacy provider.

(4) All pharmacy providers that are new to the Montana Medicaid program are assigned the maximum dispensing fee in ARM 37.85.105(3)(f)(i) until a dispensing fee questionnaire, as provided in (3), can be completed for six months of operation. At that time, a new dispensing fee is assigned which is the lower of the dispensing fee calculated in accordance with (3) for the pharmacy or the maximum allowed dispensing fee provided in (3)(b). If the provider fails to submit the

six-month dispensing fee questionnaire, the provider will receive a dispensing fee in an amount equal to the lowest calculated cost to dispense assigned that year.

(5) The department reimburses pharmacies for compounding drugs only if the member's drug therapy needs cannot be met by commercially available dosage strengths, forms of the therapy, or both.

(a) Prescription claims for compound drugs are billed and reimbursed using the National Drug Code (NDC) number and quantity for each compensable ingredient in the compound.

(b) No more than 25 ingredients may be reimbursed in any compound.

(d) Prior authorization requirements for individual components of a compound must be met for reimbursement purposes.

(e) The department reimburses pharmacies a compound-drug dispensing fee as provided in ARM 37.85.105(3) in lieu of the dispensing fee stated in (3). Prior authorization is required for reimbursement above the lowest compound dispensing fee.

(f) The department does not consider reconstitution to be compounding.

(g) The department publishes guidelines for billing the different level of effort fees.

(h) The department may reimburse for compounded nonrebatable API bulk powders and excipients on the department's drug formulary maintained in accordance with ARM 37.86.1102.

(6) The department reimburses pharmacies a vaccine administration fee as provided in ARM 37.85.105(3) in lieu of the dispensing fee stated in (3) for any covered vaccine as allowed by the Montana Pharmacy Practice Act, 37-7-101, MCA.

(7) Reimbursement for outpatient drugs provided to Medicaid persons in state institutions is as follows:

(a) for institutions participating in the state contract for pharmacy services, the rates agreed to in that contract. Such reimbursement must not exceed, in the aggregate, reimbursement under (1); or

(b) for institutions not participating in the state contract for pharmacy services, the actual cost of the drug and dispensing fee. Such reimbursement must not exceed, in the aggregate, reimbursement under (1).

(8) Full-benefit dual eligible persons qualify for pharmaceutical drug coverage under Medicare Part D prescription drug plans (PDPs) under 42 USC 1302, 1395w-101 through 1395w-152 (2011), the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). For purposes of the MMA and this rule, the term full-benefit dual eligible has the same meaning as stated in 42 CFR 423.772.

(9) The MMA allows PDPs to exclude from coverage the drug classes listed in 42 USC 1396r-8(d)(2) (2011). Montana Medicaid may also exclude these drugs and has chosen to do so except for the prescription and nonprescription drugs identified on the department's drug formulary. Montana Medicaid's reimbursement for outpatient drugs provided to full-benefit dual eligible persons, for whom third party payment is not available, is limited to the excluded drugs identified on the department's drug formulary.

(10) The department reimburses pharmacies a unit dose prescription fee as provided in ARM 37.85.105(3). The unit dose prescription fee offsets the additional cost of packaging supplies and materials which are directly related to filling unit dose prescriptions by the individual pharmacy. This fee is in addition to the regular dispensing fee allowed. The unit dose prescription fee is not paid for a unit dose prescription packaged by drug manufacturers. Unit dose prescriptions may not exceed the 34-day supply limit. Only one unit dose prescription fee is allowed each month for each prescribed medication.

(11) Providers must bill Montana Medicaid the following:

(a) their actual acquisition cost including providers who purchase drugs through the Federal Supply Schedule or providers who are participating in the 340B Drug Pricing Program; and

(b) their "usual and customary charge" as defined in ARM 37.86.1101.

(12) In accordance with the NCPDP 340B Information Exchange Reference Guide Version 1.0 (July 2011), a claim for Section 340B drugs must be identified through the use of a valid value 20 in the NCPDP Submission Clarification Code (420-DK) field. If a claim is identified as a 340B claim and the submitted ingredient cost is greater than the AAC, or the lower of WAC or FMAC, if no AAC is present, the claim will deny.

(13) Specialty pharmacies, hemophilia treatment centers, or centers of excellence that dispense clotting factors:

(a) not purchased through the 340B program will be reimbursed at the lesser of the usual and customary charge, submitted ingredient cost, or wholesale acquisition cost, plus the professional dispensing fee; or

(b) when purchased through the 340B program, will be reimbursed the lesser of the usual and customary charge or wholesale acquisition cost, plus the professional dispensing fee.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 2978, Eff. 11/29/80; AMD, 1983 MAR p. 607, Eff. 5/27/83; AMD, 1986 MAR p. 1967, Eff. 12/1/86; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 753, Eff. 5/1/88; AMD, 1989 MAR p. 879, Eff. 7/1/89; AMD, 1990 MAR p. 1481, Eff. 7/27/90; AMD, 1998 MAR p. 495, Eff. 2/13/98; AMD, 1998 MAR p. 2168, Eff. 8/14/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 3176, Eff. 11/10/00; AMD, 2002 MAR p. 1788, Eff. 6/28/02; AMD, 2006 MAR p. 227, Eff. 1/27/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 53, Eff. 1/18/08; AMD, 2008 MAR p. 1157, Eff. 7/1/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 433, Eff. 3/1/10; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2012 MAR p. 1367, Eff. 11/11/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2013 MAR p. 2151, Eff. 11/15/13; AMD, 2016 MAR p. 1065, Eff. 7/1/16; AMD, 2016 MAR p. 1462, Eff. 8/20/16; AMD, 2017 MAR p. 1050, Eff. 7/8/17; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 1607, Eff. 8/11/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.1106 Calculation of the Average Acquisition Cost

(1) The Average Acquisition Cost (AAC) is the cost per drug determined by direct pharmacy survey, wholesale survey, and other relevant cost information.

(a) The department reviews AAC rates on an ongoing basis and adjusts the rates as necessary to reflect prevailing market conditions and ensure reasonable access by providers to drugs at or below the applicable AAC rate.

(b) Pharmacies and providers that are enrolled in Montana Medicaid are required, as a condition of participation, to submit, upon request, to the department, or its designee, acquisition cost information, product availability information, and other information deemed relevant by the department for the efficient operation of the pharmacy benefit. Information is provided in the format requested by the department or its designee. Providers are not reimbursed for this information and must submit information to the department or its designee within 30 days following a request for such information unless the department or its designee grants an extension upon written request of the pharmacy or provider.

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 2010 MAR p. 433, Eff. 3/1/10; AMD, 2011 MAR p. 2416, Eff. 11/11/11; AMD, 2016 MAR p. 1065, Eff. 7/1/16.

Mont. Admin. R. 37.86.1111 Opportunity for Hearing

(1) In any quarter in which a discrepancy in Medicaid utilization information is discovered by the manufacturer, which the manufacturer and the department are unable to resolve, the manufacturer will provide written notice of the discrepancy, by NDC number, to the department prior to the due date specified in ARM 37.86.1102.

(2) If the manufacturer asserts the department's Medicaid utilization information is erroneous, the manufacturer shall pay the department that portion of the rebate amount that is not disputed by the required due date in ARM 37.86.1102. The balance due, if any, plus a reasonable rate of interest as set forth in 42 USC 1396b(d)(5)(2008), will be paid or credited by the manufacturer or the department by the due date of the next quarterly payment in ARM 37.86.1102(8) after resolution of the dispute.

(3) Adjustments to rebate payments shall be made if information indicates that either Medicaid utilization information, Average Manufacturer Price (AMP), or Best Price were greater or less than the amount previously specified.

(4) The department and the manufacturer will use their best efforts to resolve the discrepancy within 60 days of receipt of disputes noted by the manufacturer in ARM 37.86.1102. In the event that the department and the manufacturer are not able to resolve a discrepancy within 60 days, the department shall make available to the manufacturer the department's hearing mechanism as set forth in Title 37, chapter 5, subchapter 3.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2008 MAR p. 2669, Eff. 1/1/09.

Subchapter 37.86.12 Licensed Direct-Entry Midwife

Mont. Admin. R. 37.86.1201 Licensed Direct-Entry Midwife

(1) "Direct-entry midwife" means a person that is licensed as defined in Title 37, chapter 27, MCA and ARM Title 24, chapter 111, subchapter 6.

(2) Direct-entry midwives may provide prenatal labor and delivery or postpartum care in a member's home or in a birthing center as defined at ARM 37.86.3001. A home birth must comply with the standards and requirements in ARM 24.111.617 and ARM 24.159.1477.

(3) Reimbursement for direct-entry midwives will be determined in accordance with ARM 37.85.212 and 37.86.105.

(4) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted at ARM 37.86.101 describe the terms commonly used by the Montana Medicaid Program in implementation of the program's direct-entry midwife fee schedule.

(5) The "Physician-Related Services Manual" adopted at ARM 37.86.101 governs the administration of the Direct-Entry Midwife Program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2014 MAR p. 1407, Eff. 7/1/14; AMD, 2017 MAR p. 1522, Eff. 9/9/17; AMD, 2024 MAR p. 2278, Eff. 9/21/24.

Subchapter 37.86.14 Ambulatory Surgical Centers

Mont. Admin. R. 37.86.1401 Clinic Services, Definitions

(1) "Clinic services" means preventive diagnostic, therapeutic, rehabilitative, or palliative items or services provided under the direction of a physician by an outpatient facility that is not part of a hospital, but is organized and operated to provide medical care to outpatients independent of a hospital. Clinic services may be provided in surgical centers and public health departments. Clinic services do not include mental health center services as defined in ARM 37.88.901.

(2) "Ambulatory surgical center services" means clinic services which are provided in a licensed, freestanding ambulatory surgical center, but do not include physicians services, anesthesiologists services, ambulance services, or major prosthetic appliances such as intraocular lenses.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, Eff. 11/4/74; AMD, 1982 MAR p. 1695, Eff. 9/17/82; AMD, 1989 MAR p. 877, Eff. 6/30/89; AMD, 1989 MAR p. 1850, Eff. 11/10/89; AMD, 1992 MAR p. 1404, Eff. 7/1/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2014 MAR p. 1409, Eff. 7/1/14.

Mont. Admin. R. 37.86.1402 Clinic Services, Requirements

(1) These requirements are in addition to those requirements contained in ARM 37.85.401 through 37.85.414.

(2) Clinic services must be provided by a clinic which is licensed as an outpatient facility by the appropriate licensing entity of the state where the facility is located and meet the requirement for participation in Medicare.

(3) Clinic services must be provided by, or under the direction of a licensed physician or, where appropriate a licensed dentist.

(4) Conditions for coverage of listed ambulatory surgical center procedures:

(a) Subject to the exclusions in (b), covered surgical procedures are surgical procedures that would not be expected to pose a significant safety risk to a member when performed in an ambulatory surgical center and for which standard medical practice dictates that the member would not typically be expected to require active medical monitoring more than 24 hours following an admission. Active medical monitoring includes the monitoring or assessment of respiratory function, cardiovascular function, mental status, pain, temperature, or post-operative hydration at least every 30 minutes.

(b) Covered surgical procedures do not include those that:

(i) generally result in extensive blood loss;

(ii) requires a major or prolonged invasion of body cavities;

(iii) directly involves major blood vessels;

(iv) are generally emergency or life threatening in nature; or

(v) can safely be performed in a physician's or dentist's office.

(5) Telephone contacts are not a clinic service.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1982 MAR p. 1695, Eff. 9/17/82; AMD, 1989 MAR p. 877, Eff. 6/30/89; AMD, 1989 MAR p. 1850, Eff. 11/10/90; AMD, 1990 MAR p. 740, Eff. 3/16/90; AMD, 1991 MAR p. 1032, Eff. 7/1/91; AMD, 1992 MAR p. 1404, Eff. 7/1/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2014 MAR p. 1409, Eff. 7/1/14; AMD, 2019 MAR p. 341, Eff. 3/30/19.

Mont. Admin. R. 37.86.1405 Clinic Services, Covered Procedures

(1) Ambulatory surgical center (ASC) services:

(a) are services that will be covered by Medicaid if provided in an outpatient ASC setting incident to provision of physician or dental services to the patient where the services and supplies are furnished in the ASC on a physician's or dentist's order by ASC personnel under the supervision of ASC medical staff;

(b) are limited as provided by ARM 37.86.1402(1) through (4) with the term clinic taken to mean ASC.

(2) Clinic services, covered by the Medicaid program, include physician services covered in ARM 37.86.101, 37.86.104 and 37.86.105.

(3) Clinic services, covered by the Medicaid program, include mid-level practitioner services covered in ARM 37.86.201, 37.86.202 and 37.86.205.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1982 MAR p. 1695, Eff. 9/17/82; AMD, 1989 MAR p. 877, Eff. 6/30/89; AMD, 1992 MAR p. 1404, Eff. 7/1/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1516, Eff. 7/2/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2014 MAR p. 1409, Eff. 7/1/14.

Mont. Admin. R. 37.86.1406 Clinic Services, Reimbursement

(1) Ambulatory surgical center (ASC) services as defined in ARM 37.86.1401(2) provided by an ASC will be reimbursed on a fee basis as follows:

(a) 100% of the Medicare allowable amount. For purposes of determining the Medicare allowable amount for ASC services to Medicaid members under this rule, the department adopts and incorporates by reference the methodology at 42 CFR part 416, subpart F, and the schedule listing the allowable amounts for ASC services in the Medicare Claims Processing Manual. The cited authorities are federal regulations and manuals specifying the methods and rules used to determine reasonable cost for purposes of the Medicare program. The Medicare Claims Processing Manual can be found on the Centers for Medicare and Medicaid website at www.cms.gov . The Code of Federal Regulations can be found at www.gpo.gov .

(i) For purposes of applying the provisions of 42 CFR part 416, subpart F, and the Medicare Claims Processing Manual, any reference in such authorities to Medicare, Medicare beneficiary, beneficiary, intermediary or secretary shall be deemed to refer also to Medicaid, Medicaid member, member, or the department.

(b) For ASC services where no Medicare fee has been assigned, the fees will be set at the average Medicaid payment-to-charge ratio for all ASC services that have a Medicaid fee.

(c) Except as provided in (1)(d), the payment specified in (1)(a) or (1)(b) is an all inclusive bundled payment per procedure or service which shall be deemed to cover all outpatient services provided to the patient, including but not limited to nursing, pharmacy, laboratory, imaging services, other diagnostic services, supplies and equipment and other ASC services. For purposes of ASC surgery services, a visit shall be deemed to include all ASC services related or incident to the ambulatory surgery visit that are provided the day before or the day of the ambulatory surgery event.

(d) Physician services are separately billable according to the applicable Medicaid rules governing billing for physician services.

(e) When multiple procedures are performed at the same time on the same patient, the first procedure listed shall be paid as provided at (1)(a) or (1)(b) as appropriate. Subsequent procedures shall be paid at 50% of the amount provided at (1)(a) or (1)(b) as appropriate.

(2) Reimbursement for major prosthetic appliance shall be made in accordance with ARM 37.86.1806 and 37.86.1807.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1982 MAR p. 1695, Eff. 9/17/82; AMD, 1989 MAR p. 877, Eff. 6/30/89; AMD, 1989 MAR p. 1850, Eff. 11/10/89; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1992 MAR p. 1404, Eff. 7/1/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; AMD, 1999 MAR p. 1516, Eff. 7/2/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; EMERG, AMD, 2002 MAR p. 797, Eff. 3/15/02; EMERG, AMD, 2002 MAR 2665, Eff. 9/27/02; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2014 MAR p. 1409, Eff. 7/1/14; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Subchapter 37.86.15 Home Infusion Therapy Services

Mont. Admin. R. 37.86.1501 Home Infusion Therapy Services, Definitions

In ARM 37.86.1501, 37.86.1502, 37.86.1505, and 37.86.1506, the following definitions apply:

(1) "Agency staff services" means all services provided by the home infusion therapy agency's staff, as provided in ARM 37.106.2405, including all professional and nonprofessional employed and contracted individuals. Agency staff services include:

(a) preparation and revision of the plan of care;

(b) coordination of treatment with other health care providers;

(d) clinical monitoring of laboratory values and therapy progression;

(e) reporting clinical information to the recipient's physician and other health care providers;

(f) delivery, pick up, and disposal of equipment, supplies, or drugs;

(g) 24-hour on call status; and

(h) any other services provided by the agency staff related to the recipient's home infusion therapy services.

(2) "Home infusion therapy services" means a comprehensive treatment program for the preparation and administration of parenteral medications or parenteral nutritional services to a recipient who is not receiving infusion therapy as a hospital inpatient or outpatient. Home infusion therapy services include all pharmacist professional services, all agency staff services and all associated medical equipment and supplies for care required at home or an ambulatory infusion suite (AIS). Home infusion therapy services do not include professional physician services or drugs. Drugs are covered under the pharmacy outpatient program.

(3) "Home Nursing Services for Infusion/Specialty Drug Administration" means high-tech registered nurse (RN) services provided by an RN with special education, training and expertise in home administration of drugs via infusion, home/AIS administration of specialty drugs, or home nursing management of disease state and care management programs. Typical services include:

(a) evaluation and assessment;

(b) education and training for the patient or caregiver;

(d) catheter insertion/maintenance; and

(e) patient assessment.

(4) "Pharmacist professional services" include:

(a) preparation and revision of the plan of care;

(b) preparation and compounding of drugs;

(d) reporting clinical information to the recipient's physician and other health care providers;

(e) delivery, pick up, and disposal of equipment, supplies and/or, drugs; and

(f) 24-hour on call status.

(5) Other home infusion therapy services include services as provided in ARM 37.106.2411 and the procedure codes included in the department's Home Infusion Therapy Fee Schedule.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1996 MAR p. 2599, Eff. 10/4/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 1270, Eff. 7/1/12.

Mont. Admin. R. 37.86.1502 Home Infusion Therapy Services, Provider Requirements

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Home infusion therapy service providers, as a condition of participation in the Montana Medicaid program, must:

(a) maintain a current home infusion therapy agency license issued by the department's quality assurance division, and meet the standards set forth in ARM 37.106.2422, or if the provider is serving recipients outside the state of Montana, maintain a current license in the equivalent category under the laws of the state in which the services are provided; and

(b) enter into and maintain a current provider enrollment form under the provisions of ARM 37.85.402 with the department's fiscal agent to provide home infusion therapy services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1996 MAR p. 2599, Eff. 10/4/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 1270, Eff. 7/1/12.

Mont. Admin. R. 37.86.1505 Home Infusion Therapy Services, Requirements

(1) The requirements and restrictions in these rules apply for purposes of coverage and reimbursement of home infusion therapy services under the Montana Medicaid program.

(2) Medicaid coverage and reimbursement of home infusion therapy services is available, subject to applicable requirements, for services provided to recipients that are residing in their own home, a nursing facility or any setting other than a hospital. Medicaid coverage and reimbursement of home infusion therapy services is not available to recipients who are receiving infusion therapy as a hospital inpatient or outpatient service.

(3) Except as otherwise provided by these rules, home infusion therapy services must be provided within the scope of practice permitted by applicable state law.

(4) For those services subject to prior authorization, the Montana Medicaid program will not cover or reimburse home infusion therapy services unless the department or its designated agent has approved a prior authorization request. The department will determine the specific home infusion therapy services that require prior authorization in consultation with the department's Drug Use Review Board established pursuant to 42 USCA 1396r-8(g). A list of the specific services subject to prior authorization will be provided upon request made to the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(5) The Montana Medicaid program will not cover or reimburse home infusion therapy services for the following:

(a) medications which can be appropriately administered orally, through intramuscular or subcutaneous injection, or through inhalation; and

(b) drug products that are not FDA approved or whose use in the nonhospital setting presents an unreasonable health risk to the patient.

(6) The department will determine the specific therapies that are not allowable as home infusion therapy services under (5)(a) or (b) in consultation with the department's Drug Use Review Board established pursuant to 42 USCA 1396r-8(g). A list of the specific therapies determined not allowable under this rule will be provided upon request made to the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1996 MAR p. 2599, Eff. 10/4/96; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.1506 Home Infusion Therapy Services, Reimbursement

(1) Subject to the requirements of these rules, the Montana Medicaid program will pay for home infusion therapy services on a fee basis, as specified in the department's home infusion therapy services fee schedule. The department adopts and incorporates by reference the Home Infusion Therapy Services Fee Schedule as provided in ARM 37.85.105(3). A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.mt.gov . A copy of the Home Infusion Therapy Services Fee Schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951. The specified fees are on a per day or a per dose basis as specified in the fee schedule. The fees are bundled fees which cover all home infusion therapy services as defined in ARM 37.86.1501.

(2) For home infusion therapy services also reimbursed for the person by the Medicare program, Medicare payments will be considered to be third party payments and, if the Medicare payment is less than the Medicaid fee schedule amount, Medicaid will pay the difference between the Medicare payment and the Medicaid fee specified in the home infusion therapy fee schedule described in (1).

(3) Covered drugs prepared and administered as part of a person's home infusion therapy program are separately billable under the Montana Medicaid Outpatient Drug program as specified in ARM 37.86.1102 and 37.86.1105.

(4) Nursing services provided by licensed nurses employed by the home infusion therapy agency will be reimbursed to the agency as specified in the Home Infusion Therapy Fee Schedule. Home nursing services for infusion/specialty drug administration are not billable when the home infusion therapy program is provided in a nursing facility.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1996 MAR p. 2599, Eff. 10/4/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2004 MAR p. 750, Eff. 4/9/04; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1156, Eff. 7/1/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2012 MAR p. 1270, Eff. 7/1/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Subchapter 37.86.17 Family Planning Services

Mont. Admin. R. 37.86.1701 Family Planning Services

(1) Family planning services may be provided by a physician in accordance with ARM 37.86.101 through 37.86.105, mid-level practitioner in accordance with ARM 37.86.201 through 37.86.205, or a local family planning program defined at ARM 37.19.101. Family planning services include:

(a) comprehensive history;

(b) contraceptive supplies and procedures;

(d) laboratory services;

(e) medical counseling; and

(f) testing and treatment for sexually transmitted infections and testing for human immunodeficiency virus (HIV).

(2) A copy of the family planning procedures may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(3) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted at ARM 37.86.101 defines the terms commonly used by the Montana Medicaid program in implementation of the program's family planning clinic fee schedule.

(4) The "Physician-Related Services Manual" means the physician-related services manual. It governs the administration of the Family Planning Clinic program.

(5) Plan First waiver services, which are separate and distinct from family planning services covered by Medicaid, are set forth in ARM 37.86.1707.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, Eff. 11/4/74; AMD, 1986 MAR p. 970, Eff. 5/30/86; AMD, 1990 MAR p. 2302, Eff. 12/28/90; AMD, 1991 MAR p. 1037, Eff. 7/1/91; AMD, 1994 MAR p. 313, Eff. 2/11/94; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 757, Eff. 5/1/12; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2024 MAR p. 2284, Eff. 9/21/24.

Mont. Admin. R. 37.86.1705 Family Planning Services, Requirements

(1) These requirements are in addition to those contained in ARM 37.85.401, 37.85.406, 37.85.407, 37.85.410, and 37.85.414.

(a) Contraceptive clinic services are the services of a physician, a mid-level practitioner, or a local family planning program defined at ARM 37.19.101.

(b) Laboratory services must be ordered by a physician or a mid-level practitioner.

(d) Eligible clients requesting family planning services must be free from coercion or mental pressure and free to choose the method of family planning to be used.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1986 MAR p. 970, Eff. 5/30/86; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 757, Eff. 5/1/12.

Mont. Admin. R. 37.86.1706 Family Planning Services, Reimbursement

(1) Reimbursement for family planning services is as follows:

(a) for physicians reimbursement is provided in accordance with the methodologies described in ARM 37.85.212 and 37.86.105;

(b) for mid-level practitioners reimbursement is provided in accordance with the methodologies described in ARM 37.85.212 and 37.86.205;

(c) for local family planning programs as defined at ARM 37.19.101 reimbursement is provided in accordance with the methodologies described in ARM 37.85.212, 37.86.105, and 37.86.205.

(2) The procedure billing codes and department fee schedules are available at the department's web site located at

https://medicaidprovider.mt.gov/16#186992922-fee-schedules--family-planning .

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1986 MAR p. 970, Eff. 5/30/86; AMD, 1990 MAR p. 2302, Eff. 12/28/90; AMD, 1991 MAR p. 1037, Eff. 7/1/91; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2012 MAR p. 757, Eff. 5/1/12.

Mont. Admin. R. 37.86.1707 1115 Plan First Waiver

(1) "Plan First" refers to Montana's Social Security Act Section 1115 Waiver titled Plan First. This waiver is approved by the Centers for Medicare & Medicaid Services and managed by the Department of Public Health and Human Services (DPHHS) with eligibility determined by the Office of Public Assistance (OPA).

(2) A woman may receive coverage through Plan First if they are not eligible for other Medicaid benefits and:

(a) is a Montana resident;

(b) is aged 19 through 44 years;

(d) has a household income up to 211% of the federal poverty level (FPL).

(3) Except as otherwise provided in this rule, the limited Plan First benefits are available to all persons who are members of Plan First under this chapter.

(4) Services covered under Plan First are limited to family planning and family planning-related services.

(5) Plan First is a Medicaid program, and as a condition of participation in Montana Medicaid, all providers must comply with provider participation rules set forth in ARM 37.85.401 and the billing, reimbursement, claims processing, and payment provisions set forth in ARM 37.85.406.

(6) The procedure billing codes specific to Plan First are available at the Medicaid provider website located at https://medicaidprovider.mt.gov/planfirst.

(7) The Medicaid Program will not reimburse providers for services rendered to Plan First members for billing codes not listed on the website referred to in (6).

(8) Providers are responsible for confirming Medicaid eligibility and for identifying Plan First members to ensure the provider seeks Medicaid reimbursement for only those services that are covered by Plan First.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2024 MAR p. 2284, Eff. 9/21/24.

Subchapter 37.86.18 Prosthetic Devices, Durable Medical Equipment, and Medical Supplies

Mont. Admin. R. 37.86.1801 Prosthetic Devices, Durable Medical Equipment, and Medical Supplies, Definitions

(1) "Durable medical equipment and supplies" means the most economical equipment or supplies that are medically necessary to treat a health problem or a physical condition. The equipment or supplies must be appropriate for use in a patient's home, residence, school, or workplace. Equipment or supplies that are useful or convenient, but are not medically necessary to treat an illness or injury do not qualify for Medicaid coverage.

(2) "Prescription" means a prescription or order as provided in ARM 37.86.1802.

(3) "Prior authorization" means the Medicaid program's review and approval of an item's medical necessity and coverage by Medicaid prior to the delivery of the item.

(4) "Prosthetic devices" means replacement, corrective, or supportive devices or appliances which artificially replace a missing portion of the body to:

(a) prevent or correct physical deformity or malfunction; or

(b) support a weak or deformed portion of the body.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, Eff. 11/4/74; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1977, Eff. 1/1/82; AMD, 1986 MAR p. 1911, Eff. 1/1/87; AMD, 1992 MAR p. 1872, Eff. 8/28/92; TRANS, from SRS, 2000 MAR p. 481; AMD, 2007 MAR p. 2134, Eff. 1/1/08; AMD, 2008 MAR p. 2672, Eff. 1/1/09.

Mont. Admin. R. 37.86.1802 Prosthetic Devices, Durable Medical Equipment, and Medical Supplies, General Requirements

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers. Requirements for prosthetic devices, durable medical equipment, and medical supplies utilized by nursing facility residents are contained in the department's rules governing nursing facility reimbursement when the nursing facility bills for separately billable items as a skilled nursing durable medical equipment provider as outlined in ARM 37.40.330.

(2) Reimbursement for prosthetic devices, durable medical equipment, and medical supplies will be limited to items included on the department's fee schedule delivered in the most appropriate and cost effective manner. Montana Medicaid adopts Medicare coverage criteria for Medicare covered durable medical equipment as outlined in the Region D Supplier Manual, local coverage determinations (LCDs) and national coverage determinations (NCDs) and as provided in ARM 37.85.105(3). For prosthetic devices, durable medical equipment, and medical supplies not covered by Medicare coverage will be determined by the department and published on the department's fee schedule in accordance with ARM 37.86.1807. The items must be medically necessary and prescribed in accordance with (2)(a) by a physician or other licensed practitioner of the healing arts within the scope of his practice as defined by state law.

(a) A prescription or order must include the member's name or Medicaid identification number; order date; general description of the item or HCPCS code or HCPCS code narrative, or a brand name and model number; quantity to be dispensed, if applicable; treating practitioner's name or national provider identifier; and treating practitioner's signature. The original prescription must be retained in accordance with the requirements of ARM 37.85.414. Prescriptions may be transmitted by an authorized provider to the durable medical equipment provider by electronic means or pursuant to an oral prescription made by an individual practitioner and promptly reduced to hard copy by the durable medical equipment provider containing all information required. Prescriptions for durable medical equipment, prosthetics, and orthotics (DMEPOS) must follow the Medicare criteria outlined in chapters 3 and 4 of the Region D Medicare Supplier Manual as provided in ARM 37.85.105(3). A copy of the Region D Medicare Supplier Manual may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951. For items requiring prior authorization the provider must include a copy of the prescription when submitting the prior authorization request.

(i) Prescriptions for oxygen must include the liter flow per minute, the hours of use per day, and the person's PO2 or oxygen saturation blood test(s) results.

(ii) If applicable, an order for durable medical equipment must list separately all concurrently ordered options, accessories, or additional features that are separately billed or require an upgrade code.

(iii) If applicable, an order for medical supplies must include all concurrently ordered supplies that are separately billed, listing each separately.

(b) Subject to the provisions of (3), medical necessity for oxygen is determined in accordance with the Medicare criteria outlined in the Medicare Durable Medical Equipment Regional Carrier (DMERC) Region D Supplier Manual, Local Coverage Determination (LCD) and policy articles, and National Coverage Determination (NCD) as provided in ARM 37.85.105(3). The Medicare criteria specify the health conditions and levels of hypoxemia in terms of blood gas values for which oxygen will be considered medically necessary. The Medicare criteria also specify the medical documentation and laboratory evidence required to support medical necessity.

(c) Reimbursement for oxygen is made on a monthly basis. Only one unit may be billed per month regardless of the actual amount used by the patient.

(d) A statement of medical necessity for the rental of durable medical equipment, excluding oxygen equipment must indicate the length of time the equipment will be needed. All prescriptions must be signed and dated.

(e) No more than one month's medical supplies may be provided to a Medicaid person based on the physician's orders.

(f) A determination of the medical necessity of an item made by the Medicare program is applicable to the Medicaid program.

(g) Persons will be limited to a new wheelchair no more than once every five years, unless the department determines that a new chair is required sooner because the person's current chair is causing the person serious health problems or because of a significant change in the person's medical condition.

(3) Providers of oxygen to persons for whom oxygen was determined to be medically necessary prior to the adoption of the Medicare criteria, effective March 1, 1998, set forth in (2) may be reimbursed for oxygen services to those persons, even though the oxygen would not be medically necessary for them under the Medicare criteria, until the person's next recertification of medical necessity.

(4) Reimbursement for out-of-home use includes:

(a) medically necessary wheelchair tie downs and head rests for transportation to work or school and laterals and flat free inserts required for activities in the workplace or at school used by children age 20 and under; and

(b) medically necessary wheelchair tie downs and head rests for transportation outside the home to go to work or school and laterals and flat free inserts used by adults in the workplace or at school.

(5) Reimbursement for nursing home residents includes:

(a) medically necessary custom molded wheelchair positioning equipment used by nursing home residents not covered under nursing home per diem (see department nursing home rules). A copy of the Medicaid criteria may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951.

(6) The following items are not reimbursable by the program:

(a) items determined not to be medically necessary by the Medicare program, except as provided in (3);

(b) orthopedic shoes, corrections, and shoe repairs unless the criteria in (6)(b)(i) or (ii) are met and the physician's prescription indicates that:

(i) the shoes are attached to a brace or orthotic device which cannot be accommodated in a regular shoe; or

(ii) the shoes are covered under Medicare criteria for therapeutic shoes for diabetics under the same conditions the Medicare program will cover therapeutic shoes for diabetics. A copy of the Medicare criteria is available upon request from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951;

(d) payment for provider's travel;

(e) nutrient solutions except when they are for parenteral and enteral nutrition therapy, are the primary source of nutrition for patients, and are medically appropriate;

(f) purchase of air fluidized beds;

(g) any delivery, mailing or shipping fees, or other costs of transporting the item to the person's location;

(h) disposable incontinence wipes;

(i) adaptive equipment;

(j) building modifications;

(k) automobile modifications;

(l) environmental control devices;

(m) exercise equipment;

(n) personal care items;

(o) alarms;

(p) educational equipment;

(q) personal computers;

(r) sexual aids or devices;

(s) items included in the nursing home per diem rate;

(t) backup equipment;

(u) safety equipment unless explicitly covered by Medicare; and

(v) any item that does not appear on the DME fee schedule unless delivered in accordance with ARM 37.86.2201.

(7) The date of service for custom molded or fitted items is the date upon which the provider completes the mold or fitting and either orders the equipment from another party or makes an irrevocable commitment to the production of the item.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1981 MAR p. 1977, Eff. 1/1/82; AMD, 1986 MAR p. 1911, Eff. 1/1/87; AMD, 1989 MAR p. 282, Eff. 2/10/89; AMD, 1990 MAR p. 1951, Eff. 11/1/90; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1992 MAR p. 1872, Eff. 8/28/92; AMD, 1994 MAR p. 2546, Eff. 9/9/94; AMD, 1998 MAR p. 497, Eff. 2/13/98; AMD, 1998 MAR p. 2168, Eff. 8/14/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 986, Eff. 6/8/01; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2004 MAR p. 82, Eff. 1/1/04; AMD, 2007 MAR p. 2134, Eff. 1/1/08; AMD, 2008 MAR p. 2672, Eff. 1/1/09; AMD, 2009 MAR p. 2485, Eff. 1/1/10; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2011 MAR p. 2825, Eff. 1/1/12; AMD, 2012 MAR p. 2494, Eff. 1/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 3095, Eff. 1/1/15; AMD, 2020 MAR p. 1530, Eff. 8/8/20.

Mont. Admin. R. 37.86.1806 Prosthetic Devices, Durable Medical Equipment, and Medical Supplies, Reimbursement Requirements

(1) Requirements for the purchase or rental of prosthetic devices, durable medical equipment, medical supplies and related maintenance, repair, and services are as follows:

(a) Subject to the requirements of this rule, the department will pay the lowest of the following for prosthetic devices, durable medical equipment, medical supplies and related maintenance, repair, and services:

(i) the provider's usual and customary charge for the item; or

(ii) the department's fee schedule maintained in accordance with the methodology described in ARM 37.86.1807.

(b) For all purposes under this rule and ARM 37.86.1807, the amount of the provider's usual and customary charge may not exceed the reasonable charge usually and customarily charged by the provider to all payers. The charge will be considered reasonable if less than or equal to the manufacturer's suggested list price. For items without a manufacturer's suggested list price, the charge will be considered reasonable if the provider's acquisition cost from the manufacturer is at least 50% of the charge amount. For items that are custom fabricated at the place of service, the amount charged will be considered reasonable if it does not exceed the average charge of all Medicaid providers by more than 20%. For rental items, the reasonable monthly charge may not exceed a percentage of the reasonable purchase charge, as specified in (3).

(i) for any line item of prosthetic device, durable medical equipment, medical supplies and related maintenance, repair, and services on which the department's fee is equal to or greater than $1,000; and

(ii) all items identified as requiring prior authorization in the department's fee schedule referenced in ARM 37.86.1807(2).

(d) Prior authorization of a claim does not guarantee payment for the requested item or service.

(e) Reimbursement for prosthetic devices, durable medical equipment, medical supplies and related maintenance, repair and services utilized by nursing facility residents and billed by a nursing facility is subject to the limits in the department's rules governing nursing facility reimbursement.

(2) For items that require prior authorization, the authorization number must be included on the submitted claim.

(3) Medicaid reimbursement for items provided on a rental basis is limited as follows:

(a) Total Medicaid rental reimbursement for items listed in Medicare's capped rental program or classified by Medicare as routine and inexpensive rental will be limited to 105% of the purchase price for that item. Monthly rental fees will be limited to 10% of the purchase price for the first three months and 7.5% of the remaining months and payments will be limited up to 13 months or less as outlined in chapter 5 of the Region D Medicare Supplier Manual.

(i) For purposes of this limit, the purchase price is the purchase fee specified in the department's fee schedule established under ARM 37.86.1807.

(ii) Interruptions in the rental period of less than 60 days will not result in the start of a new 13-month period or new purchase price limit, but periods in which service is interrupted will not count toward the 13-month limit.

(iii) A change in supplier during the 13-month period will not result in the start of a new 13-month period or new purchase price limit. Providers are responsible to investigate whether another supplier has been providing the item to the recipient and Medicaid will not notify suppliers of this information. The provider may rely upon a separate written statement of the recipient that another supplier has not been providing the item, unless the provider has knowledge of other facts or information indicating that another supplier has been providing the item. The supplier providing the item in the thirteenth month of the rental period is responsible to transfer ownership to the recipient.

(iv) If rental equipment is changed to different but similar equipment, the change will not result in the start of a new 13-month period or new 120% of purchase price limit, unless:

(A) the change in equipment is medically necessary as a result of a substantial change in the recipient's medical condition;

(B) a new certification of medical necessity for the new equipment is completed and signed by a physician; and

(b) During the 13-month rental period, Medicaid rental reimbursement includes all supplies, maintenance, repair, components, adjustments, and services related to the item during the rental month. Separately billable supplies allowed by Medicare will be reimbursed by Medicaid as outlined in the most current Region D Medicare Supplier Manual. No additional amounts related to the item may be billed or reimbursed for the item during the 13-month rental period. The supplier providing the rental equipment during the rental period is responsible for all maintenance and servicing of the equipment.

(c) After 13 months rental, the recipient will be deemed to own the item and the provider must transfer ownership of the item to the recipient. After the 13-month rental period, the provider may bill separately for supplies, maintenance, repair, components, adjustments, and services related to the item, subject to the requirements of these rules, except that repair charges are not reimbursable during the manufacturer's warranty period.

(d) All rentals will be paid on a monthly basis, except phototherapy (bilirubin) lights which will be reimbursed at a daily rental rate.

(i) Medicaid will pay an entire monthly rental fee for the initial month of rental even if less than a full month. When a rental extends into a second or subsequent month, Medicaid will pay a rental fee for a partial month only if the partial month period is at least 15 days.

(e) Items classified by Medicare as needing frequent and substantial servicing will be reimbursed by Medicaid on a monthly rental basis only. The cap specified in (3)(a) does not apply and rental reimbursement may continue as long as the item is medically necessary.

(f) If the purchase of a rental item is cost effective, the department may negotiate with the provider to purchase the item.

(4) If no purchase fee has been set for a purchase item but a monthly rental fee has been set, Medicaid reimbursement for purchased items shall be limited to ten times the monthly rental fee established in accordance with ARM 37.86.1807.

(5) The department may contract with providers of prosthetic devices, durable medical equipment and medical supplies to be sole providers of a specific item in a geographic area.

(6) Medical coverage of diapers is limited to 180 diapers per recipient per month.

(7) Purchased breast pumps are paid by the department through a single-volume purchase contract.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1981 MAR p. 1977, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1986 MAR p. 1911, Eff. 1/1/87; AMD, 1989 MAR p. 282, Eff. 2/10/89; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1992 MAR p. 1872, Eff. 8/28/92; AMD, 1994 MAR p. 2546, Eff. 9/9/94; AMD, 1995 MAR p. 1970, Eff. 10/1/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 986, Eff. 6/8/01; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2004 MAR p. 82, Eff. 1/1/04; AMD, 2007 MAR p. 2134, Eff. 1/1/08; AMD, 2018 MAR p. 189, Eff. 1/27/18.

Mont. Admin. R. 37.86.1807 Prosthetic Devices, Durable Medical Equipment, and Medical Supplies, Fee Schedule

(1) Providers must bill for prosthetic devices, durable medical equipment, medical supplies and related maintenance, repair and services using the procedure codes and modifiers set forth and according to the definitions contained in the Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers and HCPCS is available upon request from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951.

(2) Prosthetic devices, durable medical equipment, and medical supplies will be reimbursed in accordance with the department's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule, as provided in ARM 37.85.105(3), which is adopted and incorporated by reference.

(3) The department's DMEPOS Fee Schedule for items other than those billed under generic or miscellaneous codes as described in (1) will include fees set and maintained according to the following methodology:

(a) 100% of the Medicare region D allowable fee;

(b) 100% of the Medicaid allowable fee established by the department if there is no Medicare region D allowable fee established; or

(c) Except as provided in (4), for all items for which no Medicare or Medicaid allowable fee is available, the department's fee schedule amount will be 75% of the provider's usual and customary charge.

(i) For purposes of (3)(c) and (4), the amount of the provider's usual and customary charge may not exceed the reasonable charge usually and customarily charged by the provider to all payers.

(A) The charge will be considered reasonable if less than or equal to the manufacturer's suggested list price.

(B) For items without a manufacturer's suggested list price, the charge will be considered reasonable if the provider's acquisition cost from the manufacturer is at least 50% of the charge amount.

(C) For items that are custom fabricated at the place of service, the amount charged will be considered reasonable if it does not exceed the average charge of all Medicaid providers by more than 20%.

(D) For rental items, the reasonable monthly charge may not exceed a percentage of the reasonable purchase charge, as specified in ARM 37.86.1806(3).

(ii) Items having no product retail list price, such as items customized by the provider, will be reimbursed at 75% of the provider's usual and customary charge as defined in (3)(b)(i).

(4) The department's DMEPOS Fee Schedule, referred to in ARM 37.86.1807(2), for items billed under generic or miscellaneous codes as described in (1) will be 75% of the provider's usual and customary charge as defined in (3)(b)(i).

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 1981 MAR p. 1977, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1986 MAR p. 1911, Eff. 1/1/87; AMD, 1990 MAR p. 1951, Eff. 11/1/90; AMD, 1991 MAR p. 1030, Eff. 7/1/91; AMD, 1993 MAR p. 1112, Eff. 7/1/93; AMD, 1994 MAR p. 2546, Eff. 9/9/94; AMD, 1995 MAR p. 1970, Eff. 10/1/95; AMD, 1998 MAR p. 497, Eff. 2/13/98; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 604, Eff. 4/27/01; AMD, 2001 MAR p. 986, Eff. 6/8/01; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2002 MAR p. 1779, Eff. 6/28/02; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2004 MAR p. 82, Eff. 1/1/04; AMD, 2005 MAR p. 385, Eff. 3/18/05; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2007 MAR p. 2134, Eff. 1/1/08; AMD, 2008 MAR p. 2672, Eff. 1/1/09; AMD, 2009 MAR p. 2485, Eff. 1/1/10; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2011 MAR p. 2825, Eff. 1/1/12; AMD, 2012 MAR p. 2494, Eff. 1/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Subchapter 37.86.20 Optometric Services

Mont. Admin. R. 37.86.2001 Optometric Services, Definitions

(1) "Optometric services" means services provided by a licensed optometrist that are within the scope of practice. Optometric services include visual training.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1758, Eff. 6/27/80; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1997 MAR p. 1269, Eff. 7/22/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.2002 Optometric Services, Requirements

(1) These requirements are in addition to the rule provisions generally applicable to Medicaid providers.

(2) The department hereby adopts and incorporates by reference the definitions found in the introduction of Physicians Current Procedural Terminology, fourth edition (CPT 4), published by the American Medical Association of Chicago, Illinois. These materials set forth meanings of terms commonly used by the Montana Medicaid program in implementation of the program's optometric schedule. A copy of the definitions herein incorporated may be obtained through the Department of Public Health and Human Services, Health Resources Division, P.O. Box 202951, 1400 Broadway, Helena, MT 59620-2951. Providers must bill for services using the procedure codes, and modifiers set forth, and according to the definitions contained in the Health Care Financing Administration's Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers and HCPCS is available upon request from the Health Resources Division at the address stated above.

(3) Members are limited to one eye examination for determination of refractive state per 365-day period unless one of the following circumstances exist:

(a) following cataract surgery more than one examination during the 365-day period is necessary; or

(b) the provider determines by screening that a loss of one line acuity has occurred with present glasses.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1758, Eff. 6/27/80; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1997 MAR p. 1269, Eff. 7/22/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2016 MAR p. 829, Eff. 5/7/16; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2024 MAR p. 2269, Eff. 9/21/24.

Mont. Admin. R. 37.86.2005 Optometric Services, Reimbursement

(1) Subject to the requirements of this rule, the department will pay the lowest of the following for optometric services:

(a) the provider's usual and customary charge for the service or item;

(b) the reimbursement provided in accordance with the methodologies described in ARM 37.85.212; or

(2) For items or services where no RBRVS or Medicare is available, the fee schedule amount in (1)(c) will be calculated using the following methodology:

(b) For supplies or equipment, reimbursement will be set at 75% of the manufacturer's suggested retail price. For items without a manufacturer's suggested retail price, the charge will be considered reasonable if the provider's acquisition charge from the manufacturer is at least 50% of the charge amount. For items that are custom-fabricated at the place of service, the amount charged will be considered reasonable if it does not exceed the average charge of all Medicaid providers by more than 20%.

(c) For services where utilization cannot meet the methodology outlined in (a), the fee shall be set at the same rate as a service similar in scope.

(3) To address problems of access to optometric services, a provider rate of reimbursement adjustment is provided in ARM 37.85.105(2)(h).

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 1612, Eff. 6/13/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2009 MAR p. 1012, Eff. 7/1/09; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Subchapter 37.86.21 Eyeglass Services

Mont. Admin. R. 37.86.2101 Eyeglasses, Definitions

(1) Eyeglasses mean corrective lens and/or frames prescribed by an ophthalmologist or by an optometrist, to aid and improve vision.

(a) Corrective lenses also include contact lenses.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1759, Eff. 6/27/80; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1997 MAR p. 1269, Eff. 7/22/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.2102 Eyeglasses, Services and Requirements

(1) These requirements are in addition to the rule provisions generally applicable to Medicaid providers.

(2) The dispensing service may be provided by an ophthalmologist, an optometrist, an optician, or their employees within the scope of their professional practice allowed by law.

(3) Ophthalmologists, optometrists, opticians, or their employees dispensing eyeglasses and ophthalmologists or optometrists, or their employees dispensing contact lenses must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained, in the Health Care Financing Administration's Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers and HCPCS is available upon request from the Department of Public Health and Human Services, Health Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(4) Members are limited to one pair of eyeglasses per 365-day period.

(5) A member may receive additional lenses in the following circumstances:

(a) cataract surgery;

(b) .50 diopter change in correction in sphere;

(d) .5 prism diopter change in vertical prism;

(e) .50 diopter change in the near reading power;

(f) a minimum of a 5 degree change in axis of any cylinder less than or equal to 3.00 diopters;

(g) a minimum of a 3 degree change in axis of any cylinder greater than 3.00 diopters; or

(h) any 1 prism diopter or more change in lateral prism.

(6) A member may obtain replacement lenses only 365 days after the existing eyeglasses were dispensed if the lenses are unusable.

(7) The following lens features are not covered:

(a) photochromatic or transition lenses;

(b) progressive lenses;

(d) scratch resistant coating;

(e) anti-reflective coating;

(f) polycarbonate lenses except for monocular members; and

(g) tinted lenses except for rose 1 or rose 2.

(8) A member is allowed two pairs of single vision eyeglasses in the place of bifocals when medically necessary, per 365-day period.

(9) Contact lenses may be provided only if medically necessary.

(a) The limits stated in (5) and (6) apply to contacts.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1759, Eff. 6/27/80; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2016 MAR p. 829, Eff. 5/7/16; AMD, 2016 MAR p. 2064, Eff. 12/1/16; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2024 MAR p. 2269, Eff. 9/21/24.

Mont. Admin. R. 37.86.2105 Eyeglasses, Reimbursement

(1) Eyeglasses are paid by the department through a single volume purchase contract.

(2) Reimbursement for contact lenses or dispensing fees is as follows:

(a) The department pays the lower of the following:

(i) the provider's usual and customary charge for the service; or

(ii) the amount specified for the particular service or item in the department's Eyeglasses Fee Schedule.

(3) The department adopts and incorporates by reference the department's Eyeglasses Fee Schedule effective May 1, 2024. A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at https://medicaidprovider.mt.gov. A copy of the department's fee schedule may also be obtained from Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1611, Eff. 6/13/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 676, Eff. 3/13/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 1117, Eff. 6/22/01; AMD, 2002 MAR p. 1779, Eff. 6/28/02; AMD, 2002 MAR p. 3329, Eff. 11/28/02; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2016 MAR p. 2064, Eff. 12/1/16; AMD, 2024 MAR p. 2269, Eff. 9/21/24.

Subchapter 37.86.22 Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT)

Mont. Admin. R. 37.86.2201 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Purpose, Eligibility, and Scope

(1) The early and periodic screening, diagnostic and treatment services (EPSDT) are preventive health screenings, diagnostic services, and medically necessary treatment services as specified in these rules.

(2) Services provided for EPSDT purposes are only available to Medicaid eligible persons up to and including 20 years of age.

(3) Limitations on the amount, scope or duration for particular services, funded with Medicaid monies, do not apply to such services when provided to EPSDT recipients unless otherwise provided in these rules.

(4) Criteria, requirements, and limitations applicable to eligibility for and the receipt of home and community services provided under a Medicaid waiver, govern the provision of waiver and EPSDT services to persons who are eligible for both EPSDT and waiver services.

(5) Criteria, requirements and limitations generally applicable to Medicaid services, recipients, or providers, including but not limited to medical necessity requirements, experimental or cosmetic service exclusions, prior authorization, prescreening, certification or utilization review requirements, provider participation, billing or reimbursement requirements, recipient eligibility or copayment requirements, or other similar requirements or restrictions apply to EPSDT recipients, EPSDT services, and providers of services to EPSDT recipients.

(6) An EPSDT service may only be provided by a provider that is appropriate and qualified to deliver the service in accordance with the relevant and applicable educational, professional and licensing standards and requirements.

(7) An EPSDT service must be delivered in accordance with those standards and requirements applicable to the provision of the service.

(8) School based health related services may only be provided in public school districts, full-service education cooperatives and joint boards described in ARM 37.86.2231.

(9) A service, item or provider category is not available as an EPSDT service unless made available in accordance with these rules.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1980 MAR p. 1790, Eff. 6/27/80; AMD, 1987 MAR p. 205, Eff. 2/27/87; AMD, 1990 MAR p. 2299, Eff. 12/28/90; AMD, 1992 MAR p. 2788, Eff. 1/1/93; AMD, 1995 MAR p. 2501, Eff. 11/23/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1998 MAR p. 3219, Eff. 12/4/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2003 MAR p. 1316, Eff. 6/27/03.

Mont. Admin. R. 37.86.2205 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Required Screening and Preventive Services

(1) EPSDT screening and preventive services are available in accordance with this rule.

(2) The number and timing of comprehensive health, vision, hearing and dental screenings should follow the American Academy of Pediatrics (AAP) Bright Futures schedule.

(a) Screening and preventive services must include assessments, exams, immunizations, tests, and appropriate health education.

(b) Caregiver depression screenings are covered for caregivers of children under one year of age. Appropriate evidence-based screening tools should be administered to caregivers as needed. Positive screenings must be appropriately referred for follow-up care.

(3) More frequent screening services than those specified in the AAP Bright Futures schedule are covered when considered medically necessary to determine the existence of suspected physical or mental illnesses or conditions.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1980 MAR p. 1790, Eff. 6/27/80; AMD, 1987 MAR p. 205, Eff. 2/27/87; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1990 MAR p. 2299, Eff. 12/28/90; AMD, 1992 MAR p. 1402, Eff. 7/1/92; AMD, 1992 MAR p. 2788, Eff. 1/1/93; AMD, 1995 MAR p. 2501, Eff. 11/23/95; AMD, 1998 MAR p. 3219, Eff. 12/4/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2017 MAR p. 1153, Eff. 7/22/17.

Mont. Admin. R. 37.86.2206 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Medical and Other Services

(1) EPSDT eligible persons may receive any services otherwise available to persons eligible for Medicaid funded services.

(2) In addition to the services generally available to Medicaid persons, the following services are available to EPSDT eligible persons:

(a) nutrition services as provided in ARM 37.86.2209;

(b) chiropractic services as provided in ARM 37.86.2211;

(d) private duty nursing as provided in ARM 37.86.2217;

(e) mental health services for youth as provided in ARM Title 37, chapter 87;

(f) school-based health related services as provided in ARM 37.86.2230; and

(g) orientation and mobility specialist services as provided in ARM 37.86.2235.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1980 MAR p. 1790, Eff. 6/27/80; AMD, 1987 MAR p. 205, Eff. 2/27/87; AMD, 1990 MAR p. 2299, Eff. 12/28/90; AMD, 1992 MAR p. 1402, Eff. 7/1/92; AMD, 1992 MAR p. 2788, Eff. 1/1/93; AMD, 1993 MAR p. 1540, Eff. 7/16/93; AMD, 1995 MAR p. 2501, Eff. 11/23/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1998 MAR p. 3219, Eff. 12/4/98; AMD, 1999 MAR p. 1806, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2003 MAR p. 1316, Eff. 6/27/03; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Mont. Admin. R. 37.86.2207 Early and Periodic Screening, Diagnostic and Treatment (epsdt) Services, Reimbursement

(1) Reimbursement for an EPSDT service, except as otherwise provided in this rule, is the lowest of the following:

(a) the provider's usual and customary charge for the service;

(b) the reimbursement determined in accordance with the methodologies provided in ARM 37.85.212 and 37.86.105;

(d) for public agencies, cost based reimbursement as determined in accordance with OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments as established and approved by the department. The department adopts and incorporates by reference the OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments, as further amended May 14, 2004. A copy of OMB Circular A-87 may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) Reimbursement for nutrition, private duty nursing services, and orientation and mobility specialist services are specified in the department's fee schedule. The department adopts and incorporates by reference the department's Private Duty Nursing Services EPSDT Fee Schedule, the Nutrition EPSDT Fee Schedule, and the Orientation and Mobility Specialist EPSDT Fee Schedule as provided in ARM 37.85.105(3). Reimbursement for outpatient chemical dependency treatment is outlined in ARM 37.27.912.

(3) A service for which a fee is not set in or determinable through the EPSDT provider manual, ARM 37.85.212 or 37.86.105 is reimbursed at a fee negotiated in advance of the provision of the service. A service provided before there is a negotiated fee is reimbursed at an amount determined by the department.

(4) Reimbursements for school-based health related services are specified in the School-Based Health Service Fee Schedule. Rates are adjusted to reimburse these services at the federal medical assistance percentage (FMAP) rate.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1992 MAR p. 2788, Eff. 1/1/93; AMD, 1993 MAR p. 1540, Eff. 7/16/93; AMD, 1995 MAR p. 2501, Eff. 11/23/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1998 MAR p. 3219, Eff. 12/4/98; AMD, 1999 MAR p. 1806, Eff. 7/1/99; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 27, Eff. 1/12/01; EMERG, AMD, 2001 MAR p. 989, Eff. 6/08/01; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2041, Eff. 10/12/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; AMD, 2002 MAR p. 1779, Eff. 6/28/02; EMERG, AMD, 2003 MAR p. 1316, Eff. 6/27/03; EMERG, AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2004 MAR p. 83, Eff. 1/1/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2006 MAR p. 1635, Eff. 6/23/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1488, Eff. 4/11/08; AMD, 2008 MAR p. 1980, Eff. 9/12/08; AMD, 2008 MAR p. 2673, Eff. 12/25/08; AMD, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2008 MAR p. 2674, Eff. 12/25/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2011 MAR p. 2824, Eff. 1/1/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Mont. Admin. R. 37.86.2209 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Nutrition Services

(1) Nutrition services may include:

(a) nutrition counseling for counseling directly with a child, or with a responsible care giver, to explain the nutrition assessment and to implement a plan of nutrition care;

(b) nutrition assessment for evaluation of a child's nutritional problems, and design of a plan to prevent, improve or resolve identified nutritional problems, based upon the health objectives, resources and capacity of the child;

(c) nutrition consultation for consultation with or for health professionals, researching or resolving special nutrition problems or referring a child to other services, pertaining to the nutritional needs of a child; or

(d) nutrition education for routine education for normal nutritional needs.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01.

Mont. Admin. R. 37.86.2211 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Chiropractic Services

(1) Chiropractic services are limited to evaluation and management office visits, manual manipulation of the spine, and x-rays to support the diagnosis of subluxation of the spine.

(2) There must be documented medical necessity for chiropractic services by the child's primary care provider and the treatment must be directly related to a neuromuscular diagnosis of the spine.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2017 MAR p. 1153, Eff. 7/22/17.

Mont. Admin. R. 37.86.2213 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Outpatient Chemical Dependency Treatment Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; REP, 2003 MAR p. 803, Eff. 4/25/03.

Mont. Admin. R. 37.86.2217 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt), Private Duty Nursing Services

(1) Private duty nursing services are limited to:

(a) skilled nursing services provided directly to a child; and

(b) patient-specific training provided to a registered nurse or licensed practical nurse when a child is new to the nursing agency, when a change in the condition of a child requires additional training for the current nurse, or when a change in nursing personnel requires a new nurse to be trained to care for a child.

(2) Private duty nursing services do not include:

(a) psychological or mental health counseling;

(b) nurse supervision services including chart review, case discussion, or scheduling by a registered nurse;

(d) services provided to allow the client's family or caregiver to work or to go to school; or

(e) services provided to allow respite for caregivers or the client's family.

(3) Private duty nursing services must be authorized prior to the initial provision of services and any time the condition of the client changes resulting in a change to the amount of skilled nursing services being provided. Authorization must be renewed with the department, or the department's designated review agent, every 90 days during the first six months of services, and every six months thereafter.

(a) Authorization for private duty nursing services provided through school districts may be authorized for the duration of the regular school year. Services provided during the summer months are additional services that require separate prior authorization.

(4) Authorization is based on approval of a plan of care by the department or department's designated review agent.

(5) A provider of private duty nursing services must be an incorporated entity meeting the legal criteria for independent contractor status that either employs or contracts with nurses for the provision of nursing services. The department does not contract with or reimburse individual nurses as providers of private duty nursing services.

(6) Private duty nursing services provided to an eligible client by a person who is the client's legally responsible person as that term is used in this rule must be prior authorized by the department or its designee.

(a) For purposes of this rule, "legally responsible person" means a person who has a legal obligation under the provisions of Montana law to care for another person. Legally responsible person includes the parents (natural, adoptive, or foster) of minor children, legally assigned caretaker relatives of minor children, and spouses.

(b) For private duty nursing services provided to a Medicaid client by a person who is legally responsible for the Medicaid client, the department will approve no more than 40 hours of services under the EPSDT program in a seven day period. The legally responsible person must meet the department's criteria for providing PDN services. The individual must be a licensed RN or LPN and be employed by an agency enrolled to provide private duty nursing services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2006 MAR p. 1894, Eff. 7/28/06.

Mont. Admin. R. 37.86.2219 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Therapeutic Youth Group Home Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; AMD, 2008 MAR p. 2360, Eff. 1/1/09; REP, 2011 MAR p. 49, Eff. 1/15/11.

Mont. Admin. R. 37.86.2221 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Therapeutic Family Care Treatment Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2008 MAR p. 2360, Eff. 1/1/09; REP, 2011 MAR p. 49, Eff. 1/15/11.

Mont. Admin. R. 37.86.2224 Early and Periodic Screening, Diagnostic, and Treatment Service (epsdt), Comprehensive School and Community Treatment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: EMERG, NEW, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2011 MAR p. 1708, Eff. 8/26/11; REP, 2013 MAR p. 415, Eff. 7/1/13.

Mont. Admin. R. 37.86.2225 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt), Csct Program Billing

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1786, Eff. 9/23/05; REP, 2013 MAR p. 415, Eff. 7/1/13.

Mont. Admin. R. 37.86.2230 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt), School-Based Health Related Services

(1) School-based services for the purposes of Medicaid are defined as medically necessary services provided through a public school district, joint board, or cooperative. The public school district or cooperative must receive funds from the state general fund for the purpose of providing special education.

(2) School-based health related services may include:

(a) physical therapy;

(b) speech-language pathology and audiology;

(d) private duty nursing;

(e) personal care paraprofessional services;

(f) licensed psychologist services;

(g) school psychologist services;

(h) licensed clinical social worker services;

(i) licensed professional counselor services;

(j) comprehensive school and community treatment;

(k) specialized transportation; and

(l) orientation and mobility specialist services.

(3) School-based health related services provided in the school to a child with disabilities, as that term is defined in Title 20, chapter 7, part 4, MCA, are eligible for Medicaid reimbursement when those services are required by the child's Individualized Education Program (IEP). The IEP is considered the order for health related services.

(4) School-based health related services include services that are not required by an IEP but are provided by schools to students for a fee and billed under the student's name. Schools cannot bill Medicaid for services not required by an IEP that are provided free to other children.

(5) All health related services billed to Medicaid must have PASSPORT approval with the exception of mental health related services and school-based health services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2003 MAR p. 1316, Eff. 6/27/03; AMD, 2004 MAR p. 83, Eff. 1/1/04; AMD, 2008 MAR p. 2673, Eff. 12/25/08; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Mont. Admin. R. 37.86.2231 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , Eligibility and Scope of School Based Health Related Services

(1) Only public school districts, full-service education cooperatives (established under 20-3-351 , MCA) and joint boards are eligible for enrollment and participation in the school based Montana Medicaid program.

(2) To qualify, the district, cooperative or joint board must receive special education funding from the state's general fund for the purpose of providing public education.

(3) School districts include only elementary, high school, and K-12 districts organized to provide public educational services under the jurisdiction of a board of trustees as provided in Title 20, MCA.

(4) Full-service education cooperatives and joint boards include only those cooperatives and joint boards eligible to receive direct state aid payments from the superintendent of public instruction for the purpose of providing special education services consistent with the provisions of Title 20, MCA.

(5) Cooperatives, joint boards and nonpublic schools that do not receive state general funds for special education do not meet the criteria for Medicaid enrollment and cannot participate in the Medicaid program as a school-based provider.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, MCA
History: NEW, 2003 MAR p. 1316, Eff. 6/27/03.

Mont. Admin. R. 37.86.2232 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , School Based Personal Care Paraprofessional Services

(1) Personal care paraprofessional services are medically necessary in-school services provided to Medicaid clients whose health conditions cause them to be functionally limited in performing activities of daily living.

(2) Personal care includes assistance with activities of daily living which include:

(a) grooming;

(b) transferring;

(d) eating;

(e) dressing;

(f) toileting; and

(g) bus escort for children with functional limitations.

(3) Personal care services do not include:

(a) any skilled services that require professional medical personnel; and

(b) instruction, tutoring or guidance in academics.

(4) Personal care service provided by an immediate family member will not be reimbursed. The term immediate family member includes:

(a) parent or stepparent;

(b) foster parent; or

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, MCA
History: NEW, 2003 MAR p. 1316, Eff. 6/27/03.

Mont. Admin. R. 37.86.2233 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , School Psychologist Services

(1) School psychologist services are those services provided by an individual with a class 6 specialist license with a school psychologist endorsement, as required by ARM 10.57.434.

(2) School psychologists may perform medically necessary evaluation and counseling services. Counseling services may be provided to individuals or groups.

(3) Group counseling and therapy services provided by a school psychologist must have no more than eight individuals participating in the group.

(4) When an eligible child receives school psychologist services and the psychologist consults with the parent as part of the child's treatment, time spent with the parent may be billed to Medicaid under the child's name. The provider shall indicate on the claim that the child is the patient and state the child's diagnosis.

(5) Services considered educational are not a covered benefit under Medicaid.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, MCA
History: NEW, 2003 MAR p. 1316, Eff. 6/27/03.

Mont. Admin. R. 37.86.2234 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt) , School-Based Specialized Transportation Services

(1) Coverage of specialized transportation is limited to school-based transportation of clients with disabilities for the purpose of obtaining nonemergency medical services covered by the Medicaid program.

(a) The client must be in need of specialized transportation due to the client either being wheelchair-bound or subject to transport by stretcher.

(2) Coverage of specialized transportation is not available if another mode of transportation is appropriate for the transport of the client and is less costly.

(3) Specialized transportation services must be listed in the Medicaid client's Individualized Education Plan (IEP) .

(4) Specialized transportation services may only be reimbursed by Medicaid if the Medicaid client receives a Medicaid covered service listed in his or her IEP on the day transportation is provided.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, MCA
History: NEW, 2004 MAR p. 83, Eff. 1/1/04.

Mont. Admin. R. 37.86.2235 Early and Periodic Screening, Diagnostic and Treatment Services (epsdt), Orientation and Mobility Specialist Services

(1) Orientation and Mobility Specialist Services are those services provided by an individual with:

(a) a certification from the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP); or

(b) a National Orientation and Mobility Certification (NOMC) offered by the National Blindness Professional Certification Board (NBPCB) to Medicaid clients with a diagnosis of a visual impairment.

(2) Orientation and Mobility Specialist Services are medically necessary services provided to Medicaid clients whose blindness and visual impairment cause them to need vision-assisted services.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2013 MAR p. 1111, Eff. 7/1/13.

Subchapter 37.86.24 Transportation Services

Mont. Admin. R. 37.86.2401 Transportation and Per Diem, Definitions

(1) "Per diem" means financial assistance with expenses for a Medicaid recipient's meals and lodging enroute to and from, and while receiving medically necessary medical care.

(2) "Prior authorization" means the department or its designee's review and approval of the medical necessity and coverage of a service prior to delivery of the service.

(3) "Transportation service" means travel furnished by common carrier or private vehicle.

(a) Transportation service does not include ambulance services or specialized nonemergency medical transportation services for persons with disabilities.

(b) A motor carrier operated by the Indian Health Service or by a federally recognized Indian Tribe which meets all applicable standards for a class B public service commission license need not obtain such a license to be enrolled as a Medicaid provider under (3).

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1981 MAR p. 1976, Eff. 1/1/82; AMD, 1987 MAR p. 907, Eff. 7/1/87; AMD, 1995 MAR p. 1218, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1183, Eff. 7/6/01; AMD, 2003 MAR p. 1200, Eff. 6/13/03; AMD, 2012 MAR p. 2278, Eff. 11/9/12.

Mont. Admin. R. 37.86.2402 Transportation and Per Diem, Requirements

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) Coverage of transportation and per diem is limited to transportation and per diem necessary to obtain necessary medical services covered by the Medicaid program.

(3) Coverage for transportation and per diem is only available for transportation and per diem to the site of medical services at the provider closest to the locality of the recipient.

(a) The closest provider is determined based on equivalent licensure or certification from the appropriate national or state licensing board without consideration of continuing education credits or units.

(b) The closest provider is determined using providers who are currently accepting Medicaid recipients regardless of any individual client's:

(i) noncompliance with medical treatment plans;

(ii) financial or legal actions pending or filed against the provider; or

(iii) behavior (including but not limited to aggressive, inappropriate communication, failure to keep appointments or to arrive for appointments on time) that may have caused an individual not to be accepted as a patient in a particular practice.

(c) Transportation and per diem to a site, other than the one nearest to the locality of the recipient, is available if the combined total cost to the Medicaid program of medical services and transportation and per diem at the more distant site is less than the total cost to the Medicaid program for the provision of the services in the closest location, or to a Center of Excellence, as defined in ARM 37.86.2901, if prior authorization requirements have been met.

(4) Private vehicle transportation is limited to mileage reimbursement. Reimbursement is not available for any other private vehicle costs or fees.

(5) Coverage of per diem is not available when a round trip can reasonably be made in one day.

(6) Coverage of nonemergent transportation and per diem must be prior authorized by the department or its designee.

(a) If a medical appointment has been rescheduled, any prior authorization of the original appointment does not apply to the rescheduled appointment. Prior authorization must be obtained for the rescheduled appointment.

(7) Coverage of emergent transportation and per diem must be authorized by the department or its designee.

(a) Notification of emergent transportation must be received by the department or its designee within 30 days of the initial emergency treatment.

(8) Reimbursement for transportation is made to the common carrier unless otherwise authorized by the department or its designee.

(9) Coverage of transportation is limited to the least expensive available mode of transportation suitable to the recipient's medical needs plus any applicable per diem.

(10) Coverage of transportation and per diem are not available for transportation and per diem costs incurred during a retroactive eligibility period.

(11) Coverage of transportation and per diem for an attendant is only available for an attendant that is determined to be medically necessary.

(a) Use of an attendant must be prior authorized by the department or its designee.

(b) Coverage of transportation and per diem for an attendant is limited to the same standards and fees as for a recipient.

(c) An attendant must return home after accompanying the recipient to the destination for provision of medical services unless the department or its designee determine that the cost of the attendant's stay for the recipient's course of treatment will be less than the cost of additional transportation costs resulting from the return to home.

(d) Coverage of per diem and transportation is available for a responsible adult to accompany a minor.

(12) If a recipient dies enroute to or during treatment outside of the recipient's community, the cost of the recipient's transportation to the medical service is reimbursable. The cost of returning the body of a deceased recipient is not reimbursable.

(13) Mileage reimbursement is rounded to the nearest whole mile.

(14) Prior authorization is not a guarantee of payment as the department may subsequently deny payment based on factors other than medical necessity, including but not limited to ineligibility of the individual to whom services were provided or failure to comply with billing requirements set forth in ARM 37.85.406 or with any other Medicaid rule or requirement.

(15) Commercial providers are required to maintain and retain original dispatch records for services provided to a Montana Medicaid recipient that include:

(a) name of recipient;

(b) originating address;

(d) date;

(e) time;

(f) authorized units;

(g) charges; and

(h) the authorization number.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1980 MAR p. 1787, Eff. 6/27/80; AMD, 1981 MAR p. 1976, Eff. 1/1/82; AMD, 1985 MAR p. 250, Eff. 3/15/85; AMD, 1987 MAR p. 907, Eff. 7/1/87; AMD, 1995 MAR p. 1218, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1183, Eff. 7/6/01; AMD, 2003 MAR p. 1200, Eff. 6/13/03; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 2182, Eff. 10/1/08; AMD, 2015 MAR p. 825, Eff. 7/1/15.

Mont. Admin. R. 37.86.2405 Transportation and Per Diem, Reimbursement

(1) The department pays the lower of the following reimbursement rates for transportation services:

(a) the provider's actual submitted charge; or

(b) the department's Personal and Commercial Transportation Fee Schedule adopted in this rule.

(2) The department adopts and incorporates by reference the department's Montana Medicaid Fee Schedule, Personal and Commercial Transportation as provided in ARM 37.85.105(3) that sets forth the reimbursement rates for transportation, per diem, and other Medicaid services.

(3) No payment is available for personal vehicle mileage or per diem costs that total less than $5 in a calendar month.

(4) Reimbursement for transportation and per diem may not exceed the reimbursement as calculated and specified by the department in the prior authorization.

(5) Mileage for transportation in a personally owned vehicle is reimbursed at the rate provided in the department's personal and commercial transportation fee schedule.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1980 MAR p. 1787, Eff. 6/27/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1976, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1987 MAR p. 161, Eff. 2/14/87; AMD, 1987 MAR p. 907, Eff. 7/1/87; AMD, 1995 MAR p. 1218, Eff. 7/1/95; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 1183, Eff. 7/6/01; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2003 MAR p. 999, Eff. 5/9/03; EMERG, AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1156, Eff. 7/1/08; AMD, 2009 MAR p. 145, Eff. 2/13/09; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Subchapter 37.86.25 Specialized Nonemergency Medical Transportation

Mont. Admin. R. 37.86.2501 Specialized Nonemergency Medical Transportation, Definitions

(1) Specialized nonemergency transportation means transportation service by a provider with a class B public service commission license allowing the provider to transport physically disabled individuals.

(a) A motor carrier operated by the Indian Health Service or by a federally recognized Indian Tribe which meets all applicable standards for a class B public service commission license need not obtain such a license to be enrolled as a Medicaid provider under (1).

(2) "Wheelchair bound" means individuals cannot mobilize without a wheelchair and are not able to get into or out of the wheelchair without assistance.

(3) "Prior authorization" means the department or its designee's review and approval of the medical necessity and coverage of a service prior to delivery of the service.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1989 MAR p. 2254, Eff. 12/22/89; TRANS, from SRS, 2000 MAR p. 481; AMD, 2003 MAR p. 1200, Eff. 6/13/03; AMD, 2012 MAR p. 2278, Eff. 11/9/12.

Mont. Admin. R. 37.86.2502 Specialized Nonemergency Medical Transportation, Requirements

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) Coverage of specialized nonemergency medical transportation is limited to transportation of persons with disabilities for the purpose of obtaining nonemergency medical services covered by the Medicaid program.

(a) The person must be in need of specialized transportation due to the person either being wheelchair-bound or subject to transport by stretcher.

(3) Coverage of specialized nonemergency medical transportation is not available if another mode of transportation is appropriate for the transport of the recipient and is less costly.

(4) Coverage of specialized nonemergency medical transportation is not available for costs for the service incurred during a retroactive eligibility period.

(5) Mileage reimbursement is rounded to the nearest whole mile.

(6) Coverage of specialized nonemergency medical transportation is limited to mileage fees and does not include any other fees. Reimbursement is not available for other fees.

(7) Specialized nonemergency medical transportation services must be prior authorized by the department or its designee.

(8) Commercial providers are required to maintain and retain original dispatch records for services provided to a Montana Medicaid recipient that include:

(a) name of recipient;

(b) originating address;

(d) date;

(e) time;

(f) authorized units;

(g) charges; and

(h) the authorization number.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-141, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1989 MAR p. 2254, Eff. 12/22/89; AMD, 1995 MAR p. 1218, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1183, Eff. 7/6/01; AMD, 2003 MAR p. 1200, Eff. 6/13/03.

Mont. Admin. R. 37.86.2505 Specialized Nonemergency Medical Transportation, Reimbursement

(1) The department pays the lower of the following for specialized nonemergency medical transportation services:

(a) the provider's usual and customary charge; or

(b) the department's fee schedule.

(2) The department adopts and incorporates by reference the department's fee schedule as provided in ARM 37.85.105(3) that sets forth the reimbursement rates for specialized nonemergency medical transportation services and other Medicaid services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1190, Eff. 4/11/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1989 MAR p. 2254, Eff. 12/22/89; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1995 MAR p. 1218, Eff. 7/1/95; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 1183, Eff. 7/6/01; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2003 MAR p. 1200, Eff. 6/13/03; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1156, Eff. 7/1/08; AMD, 2009 MAR p. 145, Eff. 2/13/09; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Subchapter 37.86.26 Ambulance Services

Mont. Admin. R. 37.86.2601 Ambulance Services, Definitions

(1) "Air ambulance services" means ambulance services provided by aircraft. There are two categories of air ambulance services, namely, fixed wing (airplane) and rotary wing (helicopter) aircraft.

(a) Fixed wing air ambulance services are furnished when the recipient's medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by fixed wing air ambulance may be necessary because the recipient's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, for example, heavy traffic, preclude such rapid delivery. Transport by fixed wing air ambulance may also be necessary because the recipient is inaccessible by land or water ambulance vehicle.

(b) Rotary wing air ambulance services are furnished when the recipient's medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by rotary wing air ambulance may be necessary because the recipient's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, for example, heavy traffic, preclude such rapid delivery. Transport by rotary wing air ambulance may also be necessary because the recipient is inaccessible by land or water ambulance vehicle.

(2) "Ambulance" means a vehicle that:

(a) is specifically designed for transporting the sick or injured;

(b) contains a stretcher, linens, first aid supplies, oxygen equipment, and other lifesaving equipment required by state or local laws; and

(3) "Ambulance services" means services provided by a licensed ambulance provider in the ground or air transportation of a sick or injured person in a specially designed and equipped vehicle as defined above, which includes a trained ambulance attendant who is licensed or certified as required by state law.

(4) "Appropriate facility" means an institution equipped to provide the required hospital or nursing care for the illness or injury involved. In the case of a hospital, it also means that a physician or a physician specialist is available to provide the necessary care required to treat the patient's condition. However, the fact that the patient's personal physician does not have staff privileges in a hospital is not a consideration in determining whether the hospital is an appropriate facility.

(5) "Emergency services" means services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of such severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

(6) "Ground ambulance services" means ambulance services provided by a vehicle designed to operate on the ground, including both water and land. Ground ambulance services include:

(a) Basic life support (BLS), which includes, when medically necessary, the provision of BLS services as defined in the national EMS education and practice blueprint for the EMT-basic, including other basic life support services, or the ambulance must be staffed by an individual who is qualified in accordance with state and local laws as an emergency medical technician-basic (EMT-basic);

(b) Basic life support emergency, which is furnished, when medically necessary, as specified above in (6)(a), in response to an emergency as defined in this rule;

(c) Advanced life support, level 1 (ALS1), which includes, when medically necessary, provision of an assessment by an ALS provider trained to the level of the emergency medical technician-intermediate or paramedic as defined in the national EMS education and practice blueprint or in accordance with state and local laws or the provision of one or more ALS interventions, that is, a procedure beyond the scope of an EMT-basic as defined in (6)(a). An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.

(d) Advanced life support, level 1 (ALS1) emergency, which includes, when medically necessary, the provision of ALS1 services specified in (6)(c) above, in response to an emergency as defined in this rule;

(e) Advanced life support, level 2 (ALS2), which includes, when medically necessary, supplies and services including the administration of at least three separate administrations of one or more different medications or the provision of at least one of the following ALS procedures:

(i) manual defibrillation/cardioversion;

(ii) endotracheal intubation;

(iii) central venous line;

(iv) cardiac pacing;

(v) chest decompression;

(vi) surgical airway;

(vii) intraosseous line;

(f) Specialty care transport (SCT), which includes, when medically necessary, for a critically-injured or ill recipient, a level of interfacility service provided beyond the scope of the paramedic. SCT is necessary when a recipient's condition requires ongoing care that must be provided by one of more health professionals in an appropriate specialty area such as nursing, medicine, respiratory care, cardiovascular care or paramedic with additional training.

(7) "Nonemergency" means all scheduled transportation, regardless of origin and destination, that does not meet the above criteria for emergency. By definition, hospital discharge trips, trips to and from end stage renal disease (ESRD) facilities for maintenance dialysis, trips to and from other outpatient facilities for chemotherapy or radiation therapy, and other diagnostic and therapeutic services are scheduled runs and, therefore, are considered to be "nonemergency" services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, 53-6-141, MCA
History: NEW, 1980 MAR p. 1764, Eff. 6/27/80; AMD, 1993 MAR p. 2819, Eff. 1/1/94; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1183, Eff. 7/6/01; AMD, 2003 MAR p. 1200, Eff. 6/13/03.

Mont. Admin. R. 37.86.2602 Ambulance Services, Requirements

(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) Ambulance services must be provided by a licensed ambulance provider.

(3) Coverage of ambulance services is limited to transportation necessary to obtain medically necessary services from the nearest appropriate facility.

(4) Coverage for ambulance services is not available where transportation by a mode other than the ambulance could be utilized without endangering the patient's health, whether or not such other transportation is actually available.

(5) Ground ambulance service is covered when the patient's medical condition requires transportation by ambulance. The following are examples of circumstances which may be considered in determining the medical need for ground ambulance service. However, the presence or absence of any one or more of the following does not necessarily establish the medical need for the service:

(a) the patient is transported in an emergency situation, e.g., as a result of an accident or injury;

(b) the patient is unconscious or in shock;

(c) the patient requires oxygen as an emergency rather than a maintenance measure or requires other emergency treatment on the way to the destination;

(d) the patient has to remain immobile because of a fracture that has not been set or the possibility of a fracture;

(e) the patient sustains an acute stroke or myocardial infarction; or

(f) the patient is hemorrhaging.

(6) Air ambulance services are covered if:

(a) All coverage requirements for ground ambulance services as specified in this rule are met; and

(b) One of the following conditions is met:

(i) the point of pickup is inaccessible by land vehicle; or

(ii) great distances or other obstacles are involved, and getting the patient to the nearest hospital with appropriate facilities and emergency admission is essential, for example, a situation where land transportation is available, but the time required to transport the recipient by land rather than air would endanger the recipient's life or health.

(c) Air ambulance services may be covered for the transfer of a patient from one hospital to another if the transferring hospital does not have adequate facilities to provide the specialized medical services needed by the recipient and if the requirements of (6)(a) through (b)(ii) are met.

(i) Air ambulance services are not covered to transport a recipient from a hospital capable of treating the recipient to another hospital simply because the recipient or his family prefers a specific hospital or physician.

(ii) Mileage is paid only to the nearest appropriate facility.

(7) Nonemergency scheduled ambulance services must be prior authorized by the department or its designee.

(8) Medicaid benefits cease at the time of death. When a recipient is pronounced dead after an ambulance is called but before pickup, the ambulance service provided to the point of pickup is covered at the base rate. If a recipient is pronounced dead by a legally authorized individual before the ambulance is called, no payment will be made.

(9) Emergency ambulance services must be reported to the department's designee within 180 days of the emergency transport or within 180 days of the retroactive eligibility determination date, by submitting an ambulance trip report and the associated professional claim form.

(10) Prior to processing payment, the department's designated review organization will evaluate ambulance claims for emergency services for medical necessity and appropriateness by reviewing the ambulance trip report and the associated professional claim form.

(11) Mileage submitted for travel reimbursement purposes must be rounded to the nearest whole mile.

(12) Ambulance services are reimbursable only to the extent that such services are medically necessary based on the recipient's condition. Where ambulance services are reimbursable, payment will be based on the level of services provided rather than being based on the type of vehicle used, regardless of any state or local ordinances or any policies which contain requirements for ambulance staffing or furnishing of ambulance services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 1764, Eff. 6/27/80; AMD, 1993 MAR p. 2819, Eff. 1/1/94; AMD, 1995 MAR p. 1218, Eff. 7/1/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2247, Eff. 7/6/01; AMD, 2003 MAR p. 1200, Eff. 6/13/03; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2015 MAR p. 825, Eff. 7/1/15.

Mont. Admin. R. 37.86.2604 Ambulance Services, Coverage and Billable Services

(1) Except as provided in (2), the base charge specified in the department's fee schedule referred to in ARM 37.86.2605 for both basic life support (BLS) and advanced life support (ALS) ambulance services includes charges for all personnel, reusable supplies and capital equipment. This includes:

(a) The driver and attendants, including extra attendants;

(b) Nurse, physician, or nonambulance personnel in ambulance;

(i) CPR and defibrillation;

(ii) monitoring of pulse oximeter;

(iii) monitoring of vital signs;

(iv) EKG monitoring;

(v) IV and drug therapy;

(vi) intubation; and

(vii) glucometer check.

(d) ALS director;

(e) Reusable supplies, including but not limited to:

(i) ambu bag (bag valve mask);

(ii) anti-shock trousers (mast pants/suits);

(iii) cervical collar (neck immobilization item), nondisposable;

(iv) CPR board;

(v) CPR pocket mask, nondisposable; and

(vi) splints, nondisposable.

(f) Capital equipment, including but not limited to:

(i) heart monitor;

(ii) defibrillator;

(iii) aspirator (see suction);

(iv) back board;

(v) pulse oximeter;

(vi) IV pumps;

(vii) special stretchers such as:

(A) scoop stretcher;

(B) plastic stretcher;

(D) flat cot;

(viii) suction and suction equipment;

(ix) glucometer;

(x) compressor; and

(xi) nebulizer.

(g) Billing charges;

(h) Decontamination of ambulance;

(i) Emergency charge;

(j) Night charge;

(k) Transporting of portable EKG to facility or location; and

(l) Waiting time.

(2) The following are not included in base rates for BLS and ALS and are separately billable:

(a) Mileage is allowed in addition to the base rate when the patient is transported to the nearest appropriate facility.

(i) charges for mileage must be based on loaded mileage only, i.e., from the pickup of a patient to their arrival destination; and

(ii) air ambulance mileage rate is calculated per actual loaded, patient onboard, miles flown and is expressed in statute miles, not nautical miles.

(b) EKG services (the technical component for obtaining tracing only, no interpretation and report) are reimbursable as a separate service for BLS, ALS and air ambulance. The reimbursement includes all EKG supplies.

(i) this service is allowed one time per transport;

(ii) reimbursement under this code includes the following:

(A) EKG paper;

(B) electrodes; and

(c) Defibrillation disposable supplies are for supplies used when a patient is actually defibrillated. Reimbursement includes the following:

(i) lubricant/conduction gel;

(ii) wet saline gauze;

(iii) disposable electrodes;

(iv) all disposable supplies used with defibrillation; and

(v) quick patch, fast patch, etc.

(d) Routine disposable, nonreusable supplies may be covered and reimbursed separately from the ambulance base rate. A service is allowed as a one time charge per transport and includes the following supplies:

(i) bandages/dressings;

(ii) gauze/4x4s, etc.;

(iii) CPR pocket mask;

(iv) restraints;

(v) gloves;

(vi) linens (disposable);

(vii) tape;

(viii) emesis basin;

(ix) urinal;

(x) needles and syringes;

(xi) alcohol wipes;

(xii) hot/cold packs;

(xiii) elastic bandages;

(xiv) splints (disposables);

(xv) sterile water or saline for irrigation;

(xvi) chemstrips;

(xvii) disposable cervical collar;

(xviii) disposable ambu bag; and

(xix) disposable suction supplies (NC tube, tubing, canister, etc.).

(e) IV drug therapy disposable supplies may be reimbursed separately only if they are medically necessary as documented in the trip report. No payment will be made for IV supplies when they are provided merely on the basis of ambulance protocol.

(i) This service is allowed one time per transport.

(ii) Reimbursement for this service includes the following:

(A) all needles/catheters (angiocath, etc.);

(B) all IV tubing (micro, macro and specialized);

(D) alcohol wipes;

(E) betadine or other antiseptic agents;

(F) filters;

(G) IV start kits;

(H) needles and syringes; and

(I) all dressings.

(f) Drugs may be reimbursed separately only if they are medically necessary as documented in the trip report.

(i) Injectable drugs and IV solutions administered in an emergency situation during the course of a covered ambulance trip are covered as nonreusable supplies. The medical necessity of such drugs and IV solutions and the need to administer them during transport must be clearly documented.

(g) Oxygen and oxygen supplies may be reimbursed separately only if they are medically necessary as documented in the trip report. No payment will be made for oxygen or oxygen supplies when they are provided merely on the basis of ambulance protocol.

(i) This service is allowed per 1/2 hour of oxygen usage per transport.

(ii) Reimbursement includes:

(A) oxygen;

(B) disposable oxygen supplies such as:

(I) cannulas;

(II) masks;

(III) tubing (extension, etc.);

(IV) humidifier;

(V) flow meter; and

(VI) nebulizers.

(iii) The administration of oxygen itself does not satisfy the requirement that a patient needs oxygen. If the patient travels for any other reason (e.g., church, grocery store, shopping, etc.) with portable oxygen, then they are not a candidate for ambulance transportation solely because of their oxygen requirement.

(h) Esophageal intubation may be reimbursed when establishing or maintaining an open airway but is not reimbursable for administering oxygen only.

(i) reimbursement for esophageal intubation includes the following:

(A) ET tube/NT tube;

(B) tape;

(D) bite mouthpiece;

(E) all airways (oral, esophageal, nasal, etc.);

(F) disposable ambu bag; and

(G) disposable airway suction equipment (suction catheters, tips, tubing, and canister).

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2001 MAR p. 1183, Eff. 7/6/01.

Mont. Admin. R. 37.86.2605 Ambulance Services, Reimbursement

(1) Except as provided in (4), the department pays the lowest of the following for ambulance services:

(a) the provider's usual and customary charge for the service; or

(b) the amount listed in the department's Ambulance Fee Schedule.

(2) The department adopts and incorporates by reference the Montana Medicaid Fee Schedule, Ambulance as provided in ARM 37.85.105(3) and ARM 37.85.105(2) for drugs.

(3) For items and services for which no fee has been set in the department's fee schedule referred to in (2), reimbursement will be set by the following method:

(a) if Medicare sets a fee, the Medicare fees are applicable as the Medicaid fee; or

(b) if Medicare does not set a fee, the Medicaid fees are set by evaluating the fees of services similar in scope to the new code.

(4) For supplies or equipment, where there is no Medicare or Medicaid set fee, the provider's usual and customary charge in (1)(a) will be considered reasonable if set at 75% of the manufacturer's suggested retail price. For items without a manufacturer's suggested retail price, the charge will be considered reasonable if the provider's acquisition cost from the manufacturer is at least 50% of the charge amount.

(5) The department may reimburse providers for ambulance services to transport patients to and from out-of-state facilities at negotiated fees where the department or its designee in its discretion determines that the in-state reimbursement rates are inadequate to assure that the person will receive medically necessary services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1980 MAR p. 1765, Eff. 6/27/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1991 MAR p. 1040, Eff. 7/1/91; AMD, 1993 MAR p. 2819, Eff. 11/1/93; AMD, 1995 MAR p. 1218, Eff. 7/1/95; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2001 MAR p. 1183, Eff. 7/6/01; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1156, Eff. 7/1/08; AMD, 2009 MAR p. 145, Eff. 2/13/09; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1405, 7/1/14; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.2606 Ambulance Services, Qualified Rate Adjustment, Payment Eligibility and Computation

(1) Eligible Montana ambulance providers may receive a qualified rate adjustment (QRA) from the department for ambulance services. Eligible providers are ambulance service providers that are either owned or operated by a local government unit.

(2) For an eligible provider to receive a QRA payment, the following conditions must be met:

(a) local government funds must be transferred in accordance with the contract required by (2)(d);

(b) the funds must be certified by the city or county treasurer, or an authorized local government official, as an intergovernmental transfer of public funds that qualifies as a payment of services eligible for federal financial participation (FFP, the federal government's share of a state's expenditures under the Medicaid program) in accordance with 42 CFR 433.51 (2004);

(d) the written contract covering the requirements for the QRA payment must be executed prior to the issuance of the QRA payment. A retroactive effective date on the written agreement will not be allowed.

(3) To be eligible for FFP, the local government funds cannot be federal funds unless the federal funds are authorized by federal law to be used to match other federal funds.

(4) The QRA payment will be computed separately for all eligible ambulance providers on or before December 31, annually, using the following formula:

QRA payment = C x D x FMAP

(a) For the purposes of calculating the QRA payment amount, the following definitions apply:

(i) "C" represents the number of the provider's complete set of Medicaid paid claims for dates of service for the most recent state fiscal year filed in accordance with ARM 37.85.406;

(ii) "D" represents the difference between the Medicare and Medicaid allowed amount per the Healthcare Common Procedure Coding System (HCPCS); and

(iii) "FMAP" represents the Federal Medical Assistance Percentage (FMAP) in effect at the time of department payment. This percentage is the amount of federal participating matching funds for payment of Montana Medicaid program services. The methodology for determining this percentage is set forth in 42 USC 1396b(a) (2004). The department adopts and incorporates by reference the methodology set out in 42 USC 1396b(a) (2004). A copy of that statute may be obtained from the Department of Public Health and Human Services, Health Resources Division, P.O. Box 202951, Helena, MT 59620-2951.

(5) The QRA is subject to the following conditions:

(a) the eligible ambulance provider's local government funds must be received by the department before it will disburse the QRA payment to the provider;

(b) information submitted from the eligible ambulance provider, the local Medicare fiscal intermediary, and the Montana Medicaid Paid Claims Database will be used for calculations, utilizing data from the most recent state fiscal year with completed Medicaid paid claims data filed in accordance with ARM 37.85.406;

(c) the limited situations where there is no Medicare HCPCS code or fee schedule for the ambulance service, the billed charges from the provider will be used in the computation; and

(d) the ambulance provider is not allowed to bill Medicaid more than it bills private payers and other insurers.

(6) The QRA payment is subject to the restrictions imposed by federal law and to the availability of sufficient local government, state and federal funding.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-113, MCA
History: NEW, 2005 MAR p. 385, Eff. 3/18/05; AMD, 2015 MAR p. 825, Eff. 7/1/15.

Subchapter 37.86.28 Reimbursement

Mont. Admin. R. 37.86.2801 All Hospital Reimbursement, General

(1) Reimbursement for inpatient hospital services is set forth in ARM 37.86.2806, 37.86.2905, 37.86.2907, 37.86.2912, 37.86.2916, 37.86.2918, 37.86.2920, 37.86.2924, 37.86.2925, 37.86.2928, 37.86.2943, and 37.86.2947. Reimbursement for outpatient hospital services is set forth in ARM 37.86.3005, 37.86.3006, 37.86.3007, 37.86.3009, 37.86.3014, 37.86.3016, 37.86.3018, 37.86.3020, 37.86.3022, 37.86.3025, 37.86.3037, and 37.86.3109. Cost of hospital services will be determined for inpatient and outpatient care separately. Administratively necessary days are not a benefit of the Montana Medicaid program.

(2) The department may require providers of inpatient or outpatient hospital services to obtain authorization from the department or its designated review organization either prior to provision of services, prior to admission, or prior to payment.

(3) Medicaid reimbursement shall not be made or shall be reduced unless the provider has obtained authorization from the department or its designated review organization prior to providing any of the following services:

(a) inpatient psychiatric services provided in an acute care psychiatric hospital, acute care general hospital or a distinct part psychiatric unit of an acute care general hospital, and outpatient partial hospitalization as required by ARM 37.88.101:

(i) if prior authorization is not obtained, the claim will be denied;

(ii) Medicare crossover claims do not need prior authorization; and

(iii) third party liability claims must be prior authorized.

(b) services related to transplantations covered under ARM 37.86.4701 and 37.86.4705:

(i) if prior authorization is not obtained, the claim will be denied;

(ii) Medicare crossover claims must be prior authorized; and

(iii) third party liability claims must be prior authorized.

(c) any other services for specific diagnosis or procedures that require all Medicaid providers to obtain prior authorization:

(i) if prior authorization is not obtained, the claim will be denied;

(ii) Medicare crossover claims must be prior authorized; and

(iii) third party liability claims must be prior authorized.

(d) inpatient services in facilities designated as a Center of Excellence and all out-of-state facilities:

(i) if prior authorization is not obtained, reimbursement of the inpatient claim will be 50% of the amount calculated in (1); except in claims subject to (3)(a), (b), and (c) will be denied;

(ii) Medicare inpatient crossover claims do not need prior authorization except claims subject to (3)(b) and (c); and

(iii) inpatient third party liability claims must be prior authorized:

(A) if prior authorization is not obtained, reimbursement of the inpatient third party liability claim will be 50% of the amount calculated in (1); except claims subject to (3)(a), (b), and (c) will be denied.

(4) Upon request, the department may grant retroactive authorization for the provision of the hospital's services when:

(a) the person to whom services were provided was determined by the department to be retroactively eligible for Montana Medicaid benefits including hospital benefits;

(b) the hospital can document that at the time of admission it did not know, or have any basis to assume, that the client was Montana Medicaid eligible;

(c) the hospital can document that the admission was medically necessary for purposes of emergency stabilization or stabilization for transfer;

(d) interim claims in a PPS hospital equal to or greater than 30 days of continuous inpatient services at the same facility; or

(e) the hospital is retroactively enrolled as a Montana Medicaid provider, and the enrollment includes the dates of service for which authorization is requested provided the hospital's retroactive enrollment is completed allowing time for the hospital to obtain prior authorization and to submit a clean claim within timely filing deadlines in accordance with ARM 37.85.406.

(5) For purposes of (4)(a), (b), and (c) the hospital must call for authorization within three working days (Monday through Friday) of the admission or the date it gained knowledge of the client's Medicaid eligibility and must meet the requirements for timely filing as specified in ARM 37.85.406:

(a) the basis for the request must be documented in the client's hospital record; and

(b) providers seeking retroactive authorization for adult mental health claims must submit their requests in writing.

(6) The department or its designated review organization may approve a request for prior authorization when the service is medically necessary under any of the following conditions:

(a) the client travels to another state because the department finds the required inpatient services are not available in Montana, or it is determined by the department that it is general practice for clients in a particular locality to use inpatient resources in a border hospital, or an in-state qualified provider who could normally render the inpatient service but does not think they can adequately treat the client;

(b) there is a medical emergency and the recipient's health would be endangered if the client were required to travel to Montana to obtain the medical services;

(c) the client, or the client's representative, can demonstrate to the satisfaction of the department that medical services represent the least costly service and all other viable alternatives have been exhausted per medical standards of care; or

(d) the client is a child residing in another state for whom Montana makes adoption assistance or foster care maintenance payments.

(7) Medicaid reimbursement for early elective delivery and nonmedically necessary cesarean sections will not be made unless the hospital submitting the claim meets the following requirements:

(a) Effective July 1, 2014, a hospital submitting claims for deliveries must have a hard stop policy regarding early elective deliveries and nonmedically necessary cesarean sections that complies with the requirements in ARM 37.86.2902(9).

(b) Effective October 1, 2014, hospital claims for inductions and cesarean sections must meet the following coding requirements:

(i) current ICD inpatient procedure codes must be used on all inpatient hospital claims; and

(ii) claims for inductions or cesarean sections must have one of the following condition codes:

(A) Condition Code 81–cesarean section or induction performed at less than 39 weeks for medical necessity;

(B) Condition Code 82–cesarean section or induction performed at less than 39 weeks gestation elective; or

(iii) The department will begin accepting these coding changes as of July 1, 2014.

(c) Beginning October 1, 2014, the department will reduce reimbursement to hospitals that perform early elective inductions or cesarean sections prior to 39 weeks and 0/7 days gestation, or nonmedically necessary cesarean sections at any gestation:

(i) a 33% reduction in PPS reimbursement; or

(ii) cost-based hospital interim reimbursement will be reduced 33% and the total claim payment will not be eligible for final reimbursement through cost settlement as provided in ARM 37.86.2806.

(8) All hospitals must use current ICD procedure codes for inpatient claims and current CPT codes for outpatient claims, including Medicare crossover claims.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1983 MAR p. 756, Eff. 7/1/83; EMERG, AMD, 1985 MAR p. 1160, Eff. 8/16/85; AMD, 1987 MAR p. 1658, Eff. 10/1/87; AMD, 1991 MAR p. 1027, Eff. 7/1/91; AMD, 1992 MAR p. 1496, Eff. 7/17/92; AMD, 1993 MAR p. 1520, Eff. 7/16/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1996 MAR p. 459, Eff. 2/9/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1388, Eff. 6/18/99; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2001 MAR p. 27, Eff. 1/12/01; EMERG, AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2011 MAR p. 1391, Eff. 7/29/11; AMD, 2014 MAR p. 1415, Eff. 7/1/14.

Mont. Admin. R. 37.86.2803 All Hospital Reimbursement, Cost Reporting

(1) Allowable costs will be determined in accordance with generally accepted accounting principles as defined by the American Institute of Certified Public Accountants.

(a) The department adopts and incorporates by reference CMS Publication 15, which is a manual published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), which provides guidelines and policies to implement Medicare regulations which set forth principles for determining the reasonable cost of provider services furnished under the Health Insurance for Aged Act of 1965, as amended. A copy of CMS Publication 15 may be obtained through the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(b) For cost report periods occurring on or after May 1, 2010, such definition of allowable costs is further defined in accordance with the Medicare Provider Reimbursement Manual, CMS Publication 15, Form 2552-10, subject to the exceptions and limitations provided in the department's administrative rules.

(c) For cost report periods occurring prior to May 1, 2010, such definition of allowable costs is further defined in accordance with the Medicare Provider Reimbursement Manual, CMS Publication 15, Form 2552-96, subject to the exceptions and limitations provided in the department's administrative rules.

(d) For cost report periods ending January 1, 2006 through December 31, 2017, for each hospital which is a critical access hospital, as defined in ARM 37.86.2901, reimbursement for reasonable costs of inpatient and outpatient hospital services shall be limited to 101% of allowable costs, as determined in accordance with (1).

(e) For cost report periods ending January 1, 2018 through June 30, 2018, for each hospital which is a critical access hospital, as defined in ARM 37.86.2901, reimbursement for reasonable costs of inpatient and outpatient hospital services will be limited to 97.98% of allowable costs, as determined in accordance with (1).

(f) For cost report periods ending on or after July 1, 2018, for each hospital which is a critical access hospital, as defined in ARM 37.86.2901, reimbursement for reasonable costs of inpatient and outpatient hospital services will be limited to 101% of allowable costs, as determined in accordance with (1).

(2) All hospitals reimbursed under ARM 37.86.2806, 37.86.2905, 37.86.2907, 37.86.2912, 37.86.2916, 37.86.2918, 37.86.2920, 37.86.2924, 37.86.2925, 37.86.2928, 37.86.2943, 37.86.2947, 37.86.3005, 37.86.3006, 37.86.3007, 37.86.3009, 37.86.3014, 37.86.3016, 37.86.3018, 37.86.3020, 37.86.3022, 37.86.3025, or 37.86.3109 must submit, as provided in (3), an annual Medicare cost report in which costs have been allocated to the Medicaid program as they relate to charges. The facility shall maintain appropriate accounting records which will enable the facility to fully complete the cost report.

(3) All hospitals reimbursed under ARM 37.86.2806, 37.86.2905, 37.86.2907, 37.86.2912, 37.86.2916, 37.86.2918, 37.86.2920, 37.86.2924, 37.86.2925, 37.86.2928, 37.86.2943, 37.86.2947, 37.86.3005, 37.86.3006, 37.86.3007, 37.86.3009, 37.86.3014, 37.86.3016, 37.86.3018, 37.86.3020, 37.86.3022, 37.86.3025, or 37.86.3109 must file the cost report with the Montana Medicare intermediary and the department on or before the last day of the fifth calendar month following the close of the period covered by the report. For fiscal periods ending on a day other than the last day of the month, cost reports are due 150 days after the last day of the cost reporting period.

(a) Extensions of the due date for filing a cost report may be granted by the intermediary only when a provider's operations are significantly adversely affected due to extraordinary circumstances over which the provider has no control.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2007 MAR p. 206, Eff. 1/1/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2012 MAR p. 624, Eff. 4/1/12; AMD, 2013 MAR p. 686, Eff. 4/26/13; AMD, 2015 MAR p. 2289, Eff. 12/25/15; AMD, 2016 MAR p. 1712, Eff. 10/1/16; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.2806 Cost-Based Hospital, General Reimbursement

(1) Cost-based reimbursement shall be applied as follows:

(a) Critical access hospital (CAH) interim reimbursement is based on a hospital specific Medicaid inpatient cost-to-charge ratio (CCR), not to exceed 100%. For dates of service January 1, 2018 through June 30, 2018, CAH interim reimbursement is based on a hospital-specific Medicaid inpatient cost-to-charge ratio (CCR), less 2.99%, not to exceed 100%.

(b) For cost report periods ending on or prior to December 31, 2017, CAH final reimbursement is for reasonable costs of hospital services limited to 101% of allowable costs, as determined in accordance with ARM 37.86.2803(1). For cost report periods ending January 1, 2018 through June 30, 2018, CAH final reimbursement is for reasonable costs of hospital services limited to 97.98% of allowable costs as determined in accordance with ARM 37.86.2803(1). For cost report periods ending on or after July 1, 2018, CAH final reimbursement is for reasonable costs of hospital services limited to 101% of allowable costs as determined in accordance with ARM 37.86.2803(1).

(2) Where applicable, the statewide CCR for cost-based hospitals is determined in accordance with ARM 37.86.2905(6).

(3) Cost-based hospital reimbursement for capital expenses is as determined in accordance with ARM 37.86.2912(3).

(4) Certified registered nurse anesthetist (CRNA) reimbursement for CAHs is as determined in accordance with ARM 37.86.2924.

(5) Cost-based hospitals may be eligible to receive a disproportionate share hospital (DSH) payment in accordance with ARM 37.86.2925.

(6) All diagnostic services are included in the cost-based payment. Diagnostic services that are performed at a second hospital because the services are not available at the first hospital (e.g., a CT scan) are included in the first hospital's payment. This includes transportation to the second hospital and back to the first hospital. Arrangement for payment to the transportation provider and the second hospital where the services were actually performed must be between the first and second hospital and the transportation provider.

(7) Cost-based hospital claims for clients with partial eligibility shall be billed from the first date of Medicaid eligibility.

(8) The following are cost-based hospital claims that are not eligible for final reimbursement through cost settlement:

(a) elective deliveries as set forth in ARM 37.86.2801; and

(b) services that are reimbursed at a set rate outside of the CCR.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2014 MAR p. 1415, Eff. 7/1/14; AMD, 2016 MAR p. 1712, Eff. 10/1/16; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.2810 Inpatient and Outpatient Hospital Services, Qualified Rate Adjustment Payment, Eligibility, and Computation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2002 MAR p. 1991, Eff. 7/26/02; REP, 2010 MAR p. 1534, Eff. 7/1/10.

Mont. Admin. R. 37.86.2820 Desk Reviews, Overpayments, and Underpayments

(1) Upon receipt of the cost report, the department will instruct the Medicare intermediary to consider Medicaid data when they perform a desk review or audit of the cost report and determine whether a Medicaid overpayment or underpayment has resulted.

(2) For cost reporting purposes where the department finds that an overpayment has occurred, the department will notify the provider of the overpayment.

(a) The provider will have 60 days from the date of the initial notification to repay the amount of the overpayment or to have an agreed upon repayment schedule. If the provider does not repay the whole overpayment within 60 days or defaults on a payment schedule, the department will withhold any future payments the state of Montana makes to the provider. Recovery will be undertaken even though the provider disputes in whole or part the department's determination of the overpayment and requests a fair hearing.

(b) The amount of the overpayment constitutes a debt due the department as of the date of the initial notification to the provider and may be recovered from any person, party, transferee, or fiduciary who has benefited from either the payment or from the transfer of assets.

(3) For cost reporting purposes in the event an underpayment has occurred, the department will reimburse the provider within 60 days from the date of the initial notification to the provider.

(4) When the upper payment limit has been exceeded based on filed cost reports the department will recover the overpayment amount. The department will collect overpayments using the following methodology:

(a) the costs of all facilities that are over the upper payment limit will be divided by the total amount to be collected; and

(b) the percentage in (a) will be multiplied by each facility's total costs to determine the recoverable amount.

(5) Providers aggrieved by adverse determinations by the department may request an administrative review and fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2007 MAR p. 1680, Eff. 10/26/07; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2014 MAR p. 1415, Eff. 7/1/14.

Subchapter 37.86.29 Inpatient Hospital Services

Mont. Admin. R. 37.86.2901 Inpatient Hospital Services, Definitions

(1) "Acute care psychiatric hospital" means a psychiatric facility accredited by the Joint Commission on Accreditation of Health Care Organizations that is devoted to the provision of inpatient psychiatric care for persons under the age of 21 and licensed as a hospital by:

(a) the department; or

(b) an equivalent agency in the state in which the facility is located.

(2) "Administratively necessary days" or "inappropriate level of care services" means those services for which alternative placement of a client is planned and/or effected and for which there is no medical necessity for acute level inpatient hospital care.

(3) "All patient refined diagnosis related groups (APR-DRGs)" means DRGs that classify each inpatient case based on claim information such as diagnosis, procedures performed, client age, client sex, and discharge status.

(4) "Bad debt" means inpatient and outpatient hospital services provided in which full payment is not received from the client or from a third party payor, for which the provider expected payment and the persons are unable or unwilling to pay their bill. Bad debts may be for services provided to clients who have no health insurance or clients who are underinsured and are net of payments (the amount that remains after payment) made toward these services. For the purpose of uncompensated care, bad debt is measured on the basis of revenue forgone, at full established rates, and bad debt does not include either provider discounts or Medicare bad debt.

(5) "Base price" means a dollar amount, including capital expenses, that is reviewed by the department each year to allow for appropriation neutrality.

(6) "Border hospital" means a hospital located outside Montana, but no more than 100 miles from the border.

(7) "Capital related cost" means a cost incurred in the purchase of land, buildings, construction, and equipment as provided in 42 CFR 413.130.

(8) "Center of Excellence" means a hospital specifically designated by the department as being able to provide a higher level multi-specialty of comprehensive care and meets the criteria in ARM 37.86.2947(3).

(9) "Charity care" means free or discounted inpatient and outpatient hospital services provided to persons who meet the hospital’s eligibility criteria for financial assistance and are unable to pay for all or a portion of the services. Charity care eligibility is determined pursuant to a hospital’s policies. For the purpose of uncompensated care, charity care is measured on the basis of revenue forgone, at full established rates. Charity care does not include contractual write-offs.

(10) "Clinical trials" means trials that are directly funded or supported by centers or cooperating groups funded by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS), the Department of Defense (DOD), or the Department of Veterans Affairs (VA).

(11) "Cost-based hospital" means a licensed acute care hospital that is reimbursed on the basis of allowable costs.

(12) "Cost outlier" means an additional payment for unusually high cost cases that exceeds the cost outlier thresholds as set forth in ARM 37.86.2916.

(13) "Critical access hospital" means a limited-service rural hospital licensed by the Montana Department of Public Health and Human Services.

(14) "Direct nursing care" means the care given directly to the client that requires the skills and expertise of a registered nurse (RN) or licensed practical nurse (LPN).

(15) "Discharging hospital" means a hospital, other than a transferring hospital as described in (45), that formally discharges an inpatient. Release of a client to another hospital, as described in (39), or a leave of absence from the hospital, is not recognized as a discharge. A client who dies in the hospital is considered a discharge.

(16) "Disproportionate share hospital" means a hospital serving a disproportionate share of low income clients as defined in section 1923 of the Social Security Act.

(17) "Disproportionate share hospital specific uncompensated care" means the costs of inpatient and outpatient hospital services provided to clients who have no health insurance or source of third party coverage.

(18) "Distinct part psychiatric unit" means a psychiatric unit of an acute care general hospital that meets the requirements of 42 C.F.R. § 412.27.

(19) "Distinct part rehabilitation unit" means a rehabilitation unit of an acute care general hospital that meets the requirements in 42 C.F.R. §§ 412.25 and 412.29.

(20) "Early elective delivery" means either a nonmedically necessary labor induction or cesarean section that is performed prior to 39 weeks and 0/7 days gestation.

(21) "Experimental/investigational service" means a noncovered item or procedure considered experimental and/or investigational by the U.S. Department of Health and Human Services or any other appropriate federal agency.

(22) "Graduate medical education (GME)” means a postgraduate primary care residency program approved by the Accreditation Council for Graduate Medical Education (ACGME) offered by an eligible in-state hospital for the purpose of providing formal hospital-based training and education under the supervision of a licensed medical physician.

(23) "Hospital Acquired Condition (HAC)" means a condition that occurs during an inpatient hospital stay and results in a high cost or high volume of care or both; results in a claim being assigned to a diagnosis related group (DRG) that has a higher payment when present as a secondary diagnosis; and could have reasonably been prevented through the application of evidence-based guidelines as defined in section 5001(c) of the Deficit Reduction Act of 2005.

(24) "Hospital reimbursement adjustor (HRA)" means a payment to a Montana hospital as specified in ARM 37.86.2928 and 37.86.2940.

(25) "Hospital resident" means a person who is unable to be cared for in a setting other than the acute care hospital as provided in ARM 37.86.2921.

(26) "Inpatient" means a person who has been admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services. A person generally is considered an inpatient if formally admitted as an inpatient with an expectation that the person will remain in the hospital for more than 24 hours. The physician or other practitioner is responsible for deciding whether the person should be admitted as an inpatient. Inpatient hospital admissions are subject to retrospective review by the department or the department’s designated review organization to determine whether the inpatient admission was medically necessary for Medicaid payment purposes.

(27) "Inpatient hospital services" means services that are ordinarily furnished in an acute care hospital for the care and treatment of an inpatient under the direction of a physician, dentist, or other practitioner as permitted by federal law, and that are furnished in an institution that:

(a) is licensed or formally approved as an acute care hospital by the officially designated authority in the state where the institution is located;

(b) except as otherwise permitted by federal law, meets the requirements for participation in Medicare as a hospital and has in effect a utilization review plan that meets the requirements of 42 C.F.R. § 482.30; or

(28) "Inpatient hospital utilization fee" means the utilization fee collected by the Department of Revenue as provided in 15-66-102, MCA.

(29) “Inpatient Rehabilitation Facility’s (IRF’s)” means free standing Rehabilitation Hospitals or Rehabilitation Units located in a hospital that meets the requirements in 42 CFR 412.29.

(30) "Interim claim" in a prospective payment system (PPS) hospital means a claim being billed for an inpatient hospital stay equal to or exceeding 30 days at the same facility as referenced in ARM 37.86.2905.

(31) "Long-acting reversible contraceptives (LARCs)" means intrauterine devices and contraceptive implants that provide long-acting reversible contraception.

(32) "Long term acute care hospital (LTAC)" means an acute care hospital as defined in 42 C.F.R. § 412.23.

(33) "Low income utilization rate" means a hospital's percentage rate as specified in ARM 37.86.2935.

(34) "Medicaid inpatient utilization rate" means a hospital's percentage rate as specified in ARM 37.86.2932.

(35) "Out-of-state hospital" means a hospital located more than 100 miles beyond the Montana state border.

(36) "Partial eligibility" means a client that is only eligible for Medicaid benefits during a portion of the inpatient hospital stay as specified in ARM 37.86.2918.

(37) "Present on admission (POA)" means conditions that are present at the time a medical order for an inpatient admission occurs.

(38) "Prior authorization (PA)" means the approval process required before certain services are paid by Medicaid. Prior authorization must be obtained before providing the service.

(39) "Prospective payment system (PPS) hospital" means a hospital reimbursed pursuant to the diagnosis related group (DRG) system. DRG hospitals are classified as such by CMS in accordance with 42 C.F.R. § 412.

(40) "Relative weight" means a weight assigned from a national database from 3M that reflects the typical resources consumed per APR-DRG.

(41) "Routine disproportionate share hospital" means a hospital in Montana which meets the criteria of ARM 37.86.2931.

(42) "Rural hospital" means for purposes of determining disproportionate share hospital payments, an acute care hospital that is located within a "rural area" as defined in 42 C.F.R. § 412.62.

(43) "Sole community hospital" means a DRG reimbursed hospital classified as such by CMS in accordance with 42 C.F.R. § 412.92.

(44) "Third party liability (TPL)" means any entity that is, or may be, liable to pay all or part of the medical cost of care for a Medicaid eligible client.

(45) "Transferring hospital" means a hospital that formally releases an inpatient client to another inpatient hospital or inpatient unit of a hospital.

(46) "Transplant" means to transfer either tissue or an organ from one body or body part to another as referenced in ARM 37.86.4701. A transplant may be either:

(a) "organ transplantation," the implantation of a living, viable, and functioning human organ for the purpose of maintaining all or a major part of that organ function in the client; or

(b) "tissue transplantation," the implantation of living, human tissue.

(47) "Uncompensated care" means hospital services provided in which no payment is received from the client or from a third party payor. Uncompensated care includes charity care and bad debts.

(48) "Upper payment limit" means a federal limit placed on fee-for-service reimbursement of Medicaid providers.

(49) "Urban hospital" means an acute care hospital that is located within a metropolitan statistical area, as defined in 42 C.F.R. § 412.62.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, Eff. 11/4/74; AMD, 1983 MAR p. 756, Eff. 7/1/83; AMD, 1987 MAR p. 1658, Eff. 10/1/87; AMD, 1988 MAR p. 1199, Eff. 7/1/88; AMD, 1988 MAR p. 2570, Eff. 12/9/88; AMD, 1991 MAR p. 198, Eff. 2/15/91; AMD, 1991 MAR p. 310, Eff. 3/15/91; AMD, 1991 MAR p. 1025, Eff. 7/1/91; AMD, 1993 MAR p. 1520, Eff. 7/16/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1996 MAR p. 3218, Eff. 12/20/96; AMD, 1997 MAR p. 1209, Eff. 7/8/97; AMD, 1999 MAR p. 1388, Eff. 6/18/99; AMD, 1999 MAR p. 2078, Eff. 9/24/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1666, Eff. 6/30/00; AMD, 2000 MAR p. 2034, Eff. 7/28/00; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 1640, Eff. 7/1/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2011 MAR p. 1391, Eff. 7/29/11; AMD, 2013 MAR p. 686, Eff. 4/26/13; AMD, 2014 MAR p. 1415, Eff. 7/1/14; AMD, 2014 MAR p. 3096, Eff. 1/1/15; AMD, 2018 MAR p. 1041, Eff. 5/26/18; AMD, 2019 MAR p. 2382, Eff. 1/1/20; AMD, 2025 MAR, Notice No. 2025-98, Eff. 10/11/25.

Mont. Admin. R. 37.86.2902 Inpatient Hospital Services, Requirements

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Except as otherwise permitted by federal law, inpatient hospital services must be ordered by a physician or dentist licensed under state law.

(3) Inpatient hospital services include:

(a) bed and board;

(b) nursing services and other related services;

(d) medical social services;

(e) drugs, biologicals, supplies, appliances, and equipment;

(f) other diagnostic or therapeutic items, or services provided in the hospital and not specifically excluded in ARM 37.85.207; and

(g) medical or surgical services provided by interns or residents-in-training in hospitals with teaching programs approved by the Council on Medical Education of the American Medical Association, the Bureau of Professional Education of the American Osteopathic Association, the Council on Dental Education of the American Dental Association or the Council on Podiatry Education of the American Podiatry Association.

(4) Clinical trials are limited to:

(a) Medicaid coverage of routine costs plus reasonable and necessary items and services used to diagnose and treat complications arising from participation in all qualifying clinical trials;

(b) trials that are directly funded or supported by centers or cooperating groups funded by the National Institutes of Health (NIH), Center for Disease Control (CDC), Agency for Healthcare Research and Quality (AHRQ), Department of Defense (DOD), or the Veterans Administration (VA); and

(5) Inpatient hospital services provided outside the borders of the United States will not be reimbursed by the Montana Medicaid program.

(6) Inpatient hospital providers must comply with the applicable conditions of participation for hospitals as authorized in 42 CFR 482.

(7) Acute care psychiatric hospitals must comply with 42 CFR 440.160, 42 CFR 441 subpart D, and the applicable conditions of participation for hospitals as authorized in 42 CFR 482.

(8) Effective July 1, 2014, all hospitals that perform deliveries must have a hard stop policy regarding early elective deliveries and nonmedically necessary cesarean sections. The policy must have the following parts:

(a) no nonmedically necessary inductions or cesarean sections prior to 39 weeks and 0/7 days gestation, and no nonmedically necessary cesarean sections at any gestation;

(b) confirmation of weeks gestation must be determined by the American Congress of Obstetricians and Gynecologists guidelines. At least one of the following guidelines must be met:

(i) fetal heart tones must have been documented for 20 weeks by nonelectronic fetoscope or 30 weeks by doppler;

(ii) 36 weeks since a positive serum or urine pregnancy test that was performed by a reliable laboratory; or

(iii) an ultrasound prior to 20 weeks gestation that confirms the gestational age of at least 39 weeks.

(c) if pregnancy care was not initiated prior to 20 weeks gestation, the gestational age may be documented from first day of the last menstrual period (LMP); and

(d) a multistep review process prior to all inductions and cesarean sections, including a requirement that the final decision be made by the perinatology chair/obstetrical chair, OB director, or medical director.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1983 MAR p. 756, Eff. 7/1/83; AMD, 1987 MAR p. 905, Eff. 7/1/87; AMD, 1987 MAR p. 2168, Eff. 11/28/87; AMD, 1989 MAR p. 281, Eff. 2/10/89; AMD, 1993 MAR p. 1520, Eff. 7/16/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1999 MAR p. 2078, Eff. 9/24/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2014 MAR p. 1415, Eff. 7/1/14; AMD, 2016 MAR p. 829, Eff. 5/7/16.

Mont. Admin. R. 37.86.2903 Inpatient Hospital Services, Exclusions

(1) Inpatient hospital services do not include:

(a) services excluded from coverage by the Medicaid program under ARM 37.85.207;

(b) experimental or investigational services such as, the use of off-label drugs where this usage is not a national standard of practice, or non-FDA approved use of drugs, biologicals, and devices;

(d) inpatient hospital services provided outside the borders of the United States will not be covered or reimbursed by the Montana Medicaid program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2006 MAR p. 1640, Eff. 7/1/06; AMD, 2010 MAR p. 1534, Eff. 7/1/10.

Mont. Admin. R. 37.86.2904 Inpatient Hospital Services, Billing Requirements

(1) Inpatient hospital service providers shall be subject to the billing requirements set forth in ARM 37.85.406. At the time a claim is submitted, the hospital must have on file a signed and dated acknowledgment from the attending physician that the physician has received the following notice: "Notice to physicians: Medicaid payment to hospitals is based on all of each patient's diagnoses and the procedures performed on the patient, as attested to by the patient's attending physician by virtue of his or her signature in the medical record. Anyone who misrepresents, falsifies or conceals essential information required for payment of federal funds, may be subject to fine, imprisonment or civil penalty under applicable federal laws."

(2) The acknowledgment must be completed by the physician at the time that the physician is granted admitting privileges at the hospital, or before or at the time the physician admits his or her first patient to the hospital.

(3) Existing acknowledgments signed by physicians already on staff remain in effect as long as the physician has admitting privileges at the hospital.

(4) The provider may, at its discretion, add to the language of this statement the word "Medicare" so that two separate forms will not be required by the provider to comply with both state and federal requirements.

(5) Except for hospital resident cases, a provider may not submit a claim until the recipient has been either:

(a) discharged from the hospital;

(b) a patient at least 30 days, in which case the hospital may bill on the 31st day and every 30 days thereafter;

(d) designated by the department as a hospital resident as set forth in ARM 37.86.2921.

(6) Cost based hospitals may split bill at their fiscal year end.

(7) Medical records must be received within 30 days of request by the department or the department's designated review organization.

(a) Claims may be denied if the receipt of the medical records exceeds the designated time period.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10.

Mont. Admin. R. 37.86.2905 Inpatient Hospital Services, General Reimbursement

(1) Prospective payment system (PPS) hospitals including in-state PPS facilities, distinct part units, border facilities, all out-of-state facilities, acute care psychiatric hospitals, and Center of Excellence facilities will be reimbursed under the All Patient Refined Diagnosis Related Groups (APR-DRG) prospective payment system described in ARM 37.86.2907, 37.86.2912, 37.86.2916, 37.86.2918, and 37.86.2920.

(2) Interim reimbursement for cost-based facilities is based on a hospital-specific Medicaid inpatient cost-to-charge ratio, not to exceed 100%. For dates of service January 1, 2018 through June 30, 2018, the interim reimbursement is based on a hospital-specific Medicaid inpatient cost-to-charge ratio, less 2.99%, not to exceed 100%. Cost-based facilities will be reimbursed their allowable costs as determined according to ARM 37.86.2803. For cost report periods ending on or prior to December 31, 2017 final cost settlements for CAH facilities will be reimbursed at 101% of allowable costs. For cost report periods ending January 1, 2018 through June 30, 2018, final cost settlements for CAH facilities will be reimbursed at 97.98% of allowable costs. For cost report periods ending on or after July 1, 2018 final cost settlements for CAH facilities will be reimbursed at 101% of allowable costs.

(3) Except as otherwise specified in these rules, facilities reimbursed under the APR-DRG prospective payment system may be reimbursed for the following:

(a) cost outliers as set forth in ARM 37.86.2916;

(b) readmissions, partial eligibility, and transfers, as set forth in ARM 37.86.2918;

(d) disproportionate share hospital payments as provided in ARM 37.86.2925; and

(e) hospital reimbursement adjustor payments as provided in ARM 37.86.2928.

(4) PPS facilities may interim bill for stays equal to or exceeding 30 days at the same hospital.

(a) The interim rate will be a flat per diem rate times the number of covered days for the claim.

(b) Upon discharge the interim claims will be voided or credited by the hospital and the hospital must bill a single admit through discharge claim which will be paid by APR-DRG.

(c) The hospital must obtain authorization to interim bill prior to submission of the first claim and must provide medical records upon request of the department or the department's designated review organization for continued stay reviews.

(5) All PPS inpatient and outpatient hospital services that occur during an inpatient stay are included in the APR-DRG grouper except:

(a) dialysis services; and

(b) long-acting reversible contraceptives (LARCs) inserted at the time of delivery.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1987 MAR p. 1658, Eff. 10/1/87; AMD, 1987 MAR p. 1804, Eff. 10/16/87; AMD, 1988 MAR p. 1199, Eff. 7/1/88; AMD, 1988 MAR p. 2570, Eff. 12/9/88; AMD, 1989 MAR p. 864, Eff. 6/30/89; AMD, 1989 MAR p. 1848, Eff. 11/10/89; AMD, 1990 MAR p. 1588, Eff. 8/17/90; AMD, 1991 MAR p. 310, Eff. 3/15/91; AMD, 1991 MAR p. 1025, Eff. 7/1/91; AMD, 1993 MAR p. 1520, Eff. 7/16/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1996 MAR p. 459, Eff. 2/9/96; AMD, 1996 MAR p. 1682, Eff. 6/21/96; AMD, 1997 MAR p. 1209, Eff. 7/8/97; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1388, Eff. 6/18/99; AMD, 1999 MAR p. 2078, Eff. 9/24/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1666, Eff. 6/30/00; AMD, 2000 MAR p. 2034, Eff. 7/28/00; EMERG, AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 797, Eff. 3/15/02; EMERG, AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2002 MAR p. 2665, Eff. 9/27/02; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2014 MAR p. 3096, Eff. 1/1/15; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.2907 Inpatient Hospital Prospective Reimbursement, Apr-Drg Payment Rate Determination

(1) The department’s all patient refined diagnosis related group (APR-DRG) prospective payment rate for inpatient hospital services is based on the classification of inpatient hospital discharges to APR-DRGs. The provider reimbursement rates for inpatient hospital services, except as otherwise provided in ARM 37.85.206, are stated in the department’s APR-DRG fee schedule adopted and effective at ARM 37.85.105. The procedure for determining the APR-DRG prospective payment rate is as follows:

(a) The department will assign an APR-DRG to each Medicaid client discharge in accordance with the current APR-grouper program version, as developed by 3M Health Information Systems. The assignment and reimbursement of each APR-DRG is based on:

(i) the ICD-10-CM principal diagnoses;

(ii) the ICD-10-CM secondary diagnoses;

(iii) all ICD-10-PCS medical procedures performed during the client's hospital stay;

(iv) the client's age;

(v) the client's gender;

(vi) the client's discharge status; and

(vii) diagnosis codes related to hospital-acquired conditions that are not present or undetermined to be present on admission.

(b) For each APR-DRG, the department determines a relative weight using a national database from 3M that reflects the cost of hospital resources used to treat cases. The relative weights have been re-centered so that the average Montana Medicaid stay has a base weight of 1.00. Adjustments are applied to specific APR-DRG weights to reflect department policy. The relative weight for each APR-DRG is available upon request from Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(c) The department computes a Montana average base price per case. This base price includes in-state and out-of-state distinct part rehabilitation units. The effective date and base rate amount is adopted and effective as provided at ARM 37.85.105. Disproportionate share payments are not included in this price.

(d) The department computes a base price for long term acute care (LTAC) hospitals. The effective date and base rate amount is adopted and effective as provided at ARM 37.85.105. Disproportionate share payments are not included in this price.

(e) The department computes a base price for inpatient rehabilitation facilities (IRFs). The effective date and base rate amount is adopted and effective as provided at ARM 37.85.105. Disproportionate share payments are not included in this price.

(f) The department computes a base price for Center of Excellence hospitals. The effective date and base rate amount is adopted and effective as provided at ARM 37.85.105. Disproportionate share payments are not included in this price.

(g) The relative weight for the assigned APR-DRG is multiplied by the average base price per case to compute the APR-DRG prospective payment rate for that Medicaid client discharge.

(h) For claims with dates of payment on or after August 1, 2011, when a hospital-acquired condition (HAC) occurs during hospitalization and the condition was not present or undetermined to be present on admission, claims will be paid as though the diagnosis is not present or undetermined to be present.

(i) Inpatient reimbursement will be calculated at the lesser of the assigned APR-DRG rate or the claim billed charges.

(2) The department adopts and incorporates by reference the APR-DRG Table of Weights and Thresholds adopted and effective at ARM 37.85.105. The Montana Medicaid APR-DRG relative weight values, average national length of stay (ALOS), outlier thresholds, and APR-DRG grouper are contained in the APR-DRG Fee Schedule which is adopted and effective as provided at ARM 37.85.105 and published by the department. Copies may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2006 MAR p. 1640, Eff. 7/1/06; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2007 MAR p. 1680, Eff. 10/26/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2011 MAR p. 1391, Eff. 7/29/11; AMD, 2011 MAR p. 2292, Eff. 10/28/11; AMD, 2012 MAR p. 624, Eff. 4/1/12; AMD, 2013 MAR p. 686, Eff. 4/26/13; AMD, 2014 MAR p. 507, Eff. 3/14/14; AMD, 2014 MAR p. 3074, Eff. 12/25/14; AMD, 2016 MAR p. 1712, Eff. 10/1/16; AMD, 2018 MAR p. 1116, Eff. 7/1/18; AMD, 2025 MAR, Notice No. 2025-98, Eff. 10/11/25.

Mont. Admin. R. 37.86.2910 Inpatient Hospital Reimbursement, Qualified Rate Adjustment Payment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2000 MAR p. 2034, Eff. 7/28/00; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2008 MAR p. 1983, Eff. 10/1/08; REP, 2010 MAR p. 1534, Eff. 7/1/10.

Mont. Admin. R. 37.86.2912 Inpatient Hospital Prospective Reimbursement, Capital-Related Costs

(1) Capital expenses are included within the APR-DRG base payment and will not be paid separately to PPS facilities and will not be cost settled.

(2) The interim payment made to CAHs is based on the hospital-specific cost-to-charge ratio and includes capital costs. For dates of service January 1, 2018 through June 30, 2018, the interim payment made is based on the hospital-specific cost-to-charge ratio, less 2.99%, and includes capital costs. For dates of service on or after July 1, 2018, the interim payment made is based on the hospital-specific cost-to-charge ratio, and includes capital costs.

(3) The department adopts and incorporates by reference 42 CFR 412.113(a) and (b), and will calculate as provided in (1) and (2) capital-related costs that are allowable under Medicare cost reimbursement principles as established in 42 CFR 412.113(a) and (b) (March 29, 1985). Copies of the cited regulation may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.2914 Inpatient Hospital Prospective Reimbursement, Medical Education Costs

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 2849, Eff. 11/10/06; REP, 2008 MAR p. 1983, Eff. 10/1/08.

Mont. Admin. R. 37.86.2916 Inpatient Hospital Prospective Reimbursement, Cost Outliers

(1) In addition to the APR-DRG payment, providers reimbursed under the APR-DRG prospective payment system may receive payment as provided in this rule for cost outliers for APR-DRGs.

(2) To receive payment for a cost outlier, the combined costs of the medically necessary days and services of the inpatient hospital stay, as determined by the department, must exceed the cost outlier threshold established by the department for the APR-DRG.

(3) The department determines the outlier reimbursement for cost outliers for all hospitals and distinct part units, entitled to receive cost outlier reimbursement, as follows:

(a) computing an estimated cost for the inpatient hospital stay by multiplying the allowed charges for the stay by:

(i) the facility-specific cost-to-charge ratio as set forth in ARM 37.86.2905; or

(ii) for non-Center of Excellence out-of-state facilities, their statewide average cost-to-charge ratio;

(b) subtracting the cost outlier threshold amount from the estimated costs to compute the cost outlier amount; and

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2016 MAR p. 1712, Eff. 10/1/16.

Mont. Admin. R. 37.86.2918 Inpatient Hospital, Readmissions, Partial Eligibility, Outpatient Bundling, and Transfers for Prospective Payment System (pps) Facilities

(1) All readmissions occurring within 30 days will be subject to review to determine whether additional payment as a new APR-DRG or as an outlier is warranted. As a result of the readmission review, the following payment changes will be made:

(a) If it is determined that complications have arisen because of premature discharge and/or other treatment errors, then the APR-DRG payment for the first admission must be altered by combining the two admissions into one for payment purposes.

(b) If it is determined that the readmission is for the treatment of conditions that could or should have been treated during the previous admission, the department will combine the two admissions into one for payment purposes.

(c) A client readmission occurring in an inpatient rehabilitation hospital or a rehabilitation distinct part unit three days after the initial date of discharge must be combined into one admission for payment purposes, with the exception of discharge to an acute care hospital for surgical APR-DRGs.

(d) Inpatient readmissions within 24 hours of discharge must be combined if the same condition is diagnosed.

(e) Services that are performed at a second hospital because the services are not available at the first hospital (e.g., a CT scan) are included in the first hospital's payment. This includes transportation to the second hospital and back to the first hospital. Arrangement for payment to the transportation provider and the second hospital where the services were actually performed must be between the first and second hospital and the transportation provider.

(2) A transfer, for the purpose of this rule, is limited to those instances in which a client is transferred for continuation of medical treatment between two hospitals or distinct part units, one of which is paid under the Montana Medicaid prospective payment system.

(a) A transferring hospital or distinct part unit reimbursed under the APR-DRG prospective payment system is paid for the services and items provided to the transferred recipient, the lesser of:

(i) a per diem rate of two times the average per diem amount for the first inpatient day plus one per diem payment for each subsequent day of inpatient care. The per diem payment is determined by dividing the sum of the APR-DRG payment for the case as computed in ARM 37.86.2907 by the national average length of stay for the DRG. Outlier and add-on payments are then added if applicable after the transfer payment is computed; or

(ii) the sum of the APR-DRG payment for the case as computed in ARM 37.86.2907 and the appropriate outlier, and add-ons, if applicable, as computed in ARM 37.86.2916, and 37.86.2925.

(b) A discharging hospital or distinct part unit (i.e., the hospital to which the recipient is transferred) reimbursed under ARM 37.86.2907 is paid the full APR-DRG payment plus any appropriate outliers and add-ons, if applicable.

(3) Outpatient hospital services, including emergency room services and diagnostics services (including clinical diagnostic laboratory tests) that are provided by an entity owned or operated by the hospital and occur the day of or the day before the inpatient hospital admission are deemed to be inpatient services and must be bundled into the inpatient claim.

(4) A hospital or distinct part unit reimbursed under the APR-DRG prospective payment system is paid for the services and items provided to a recipient who is eligible for only part of the inpatient stay, the lesser of:

(a) a rate of one per diem payment for each eligible day of inpatient care. The per diem payment is determined by dividing the sum of the APR-DRG payment for the case as computed in ARM 37.86.2907 plus outlier if applicable, by the national average length of stay for the DRG. Add-on payments are then added if applicable; or

(b) the sum of the APR-DRG payment for the case as computed in ARM 37.86.2907 and the appropriate outlier and add-ons, if applicable, as computed in ARM 37.86.2916 and 37.86.2925.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2012 MAR p. 624, Eff. 4/1/12; AMD, 2014 MAR p. 3096, Eff. 1/1/15; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.2920 Inpatient Hospital Prospective Reimbursement, Hospital Residents

(1) Payment for hospital residents will be made as follows:

(a) the hospital must request residency status from the department prior to submission of the first claim;

(b) prior to obtaining hospital residency status, claims for that recipient may be billed on an interim basis as provided in ARM 37.86.2905(4);

(c) final payment for the first hospital stay will be paid the APR-DRG payment for the case as computed in ARM 37.86.2907 plus any appropriate outlier and add-on payments:

(i) the hospital stay is from admit through the request for residency, if approved by the department; and

(ii) the length of stay must be greater than or equal to 180 days of inpatient care at the same facility.

(d) final payment for all client care subsequent to the request date, which must be greater than 180 days will be reimbursed at 80% of the hospital specific estimated cost-to-charge ratio as computed by the department without cost settlement; and

(e) the hospital must provide medical records upon request of the department or the department's designated review organization for continued stay reviews.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10.

Mont. Admin. R. 37.86.2921 Hospital Residency Requirements

(1) To obtain hospital residency status, the client must meet the following requirements:

(a) a client who is unable to be cared for in a setting other than the acute care hospital is eligible for hospital residency status;

(b) the client must utilize a ventilator for a continuous period of not less than eight hours in a 24-hour period or require at least ten hours of direct nursing care in a 24-hour period; and

(c) the client must have been an inpatient in the same hospital as the requesting hospital for a minimum of six continuous months.

(2) The provider will have the responsibility of determining whether services could be provided in a skilled nursing care facility or by the Home and Community-Based Waiver Program to a Medicaid client within the state of Montana.

(3) The provider shall maintain written records of inquiries and responses about the present and future availability of openings in nursing homes and the Home and Community-Based Waiver Program.

(4) A redetermination of nursing home or waiver availability must be made at least every six months.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2010 MAR p. 1534, Eff. 7/1/10.

Mont. Admin. R. 37.86.2924 Inpatient Hospital Cost Based Reimbursement, Certified Registered Nurse Anesthetists

(1) If the Secretary of Health and Human Services has granted the facility authorization for continuation of cost pass-through under section 9320 of the Omnibus Budget Reconciliation Act of 1986, as amended by section 608(c) of the Family Support Act of 1988 (Public Law 100-485), the department shall reimburse cost based inpatient hospital service providers for certified registered nurse anesthetist costs on a reasonable cost basis as provided in ARM 37.86.2803.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2008 MAR p. 1983, Eff. 10/1/08.

Mont. Admin. R. 37.86.2925 Inpatient Hospital Reimbursement, Disproportionate Share Hospital (dsh) Payments

(1) Routine disproportionate share hospitals (RDSH) will receive an additional payment amount equal to the product of the hospital's prospective base rate times the adjustment percentage of:

(a) 4% for rural hospitals; or

(b) 10% for urban hospitals.

(2) DSH payments will be limited to the cap established by CMS for the state of Montana. The adjustment percentages specified in (1) will be ratably reduced as determined necessary by the department to avoid exceeding the cap.

(a) The department will submit an independent certified audit to CMS for each completed Medicaid state plan rate year, consistent with 42 CFR Part 455, Subpart D.

(b) To the extent that audit findings demonstrate that DSH payments exceed the documented hospital-specific limits, the department will collect overpayments and redistribute DSH payments.

(c) Beginning with state fiscal year (SFY) 2011, based on audit findings, should the department determine that there is an overpayment to a provider, the department will:

(i) recover the overpayment from the provider;

(ii) redistribute the amount in overpayment to providers that had not exceeded the hospital-specific limit during the period in which the DSH payments were determined utilizing the methodology used in the payment of the original allocation; and

(iii) ensure all payments will be subject to hospital-specific limits.

(d) Should the DSH overpayment exceed the aggregate hospital-specific limit, the federal amount of overpayment will be returned to CMS.

(e) Beginning with SFY 2011, facilities choosing not to participate in the annual DSH audit will forfeit 100% of their DSH payment allocated for that year. This allocation will be deemed an overpayment and will be recovered from the provider.

(f) Disproportionate share payments must not exceed the DSH state allotment, except as otherwise required by the Social Security Act. In no event is the department obligated to use state Medicaid funds to pay more than the state Medicaid allotment of DSH payments due a provider.

(3) Eligibility for RDSH payments will be determined based on a provider's year-end reimbursement status.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2012 MAR p. 624, Eff. 4/1/12; AMD, 2013 MAR p. 2310, Eff. 1/1/14; AMD, 2018 MAR p. 1041, Eff. 5/26/18.

Mont. Admin. R. 37.86.2928 Inpatient Hospital Reimbursement, Hospital Reimbursement Adjustor

(1) The inpatient hospital reimbursement adjustor (HRA) payment is payable to a PPS hospital or critical access hospital, as those terms are defined in 50-5-101, MCA, that provides inpatient hospital services. Eligibility for an HRA payment will be determined based on a hospital's year-end reimbursement status.

(2) Revenue generated from the inpatient hospital utilization fee plus applicable federal financial participation (FFP) is utilized to calculate the following supplemental payments:

(a) the continuity of care payment described in ARM 37.87.1224;

(b) Part 1 of the HRA; and

(3) Part 1 of the HRA payment is payable to all hospitals, including critical access hospitals, as those terms are defined in 50-5-101, MCA. The payment will be based upon Medicaid inpatient utilization, and will be computed as follows: HRA1 = (M ÷ D) x P.

(a) For the purposes of calculating Part 1 of the HRA, the following apply:

(i) "HRA1" represents the calculated Part 1 HRA payment.

(ii) "M" equals the number of Medicaid inpatient days provided by the hospital for which the payment amount is being calculated.

(iii) "D" equals the total number of Medicaid inpatient days provided by all hospitals eligible to receive an HRA payment.

(iv) "P" equals the total amount to be paid via Part 1 of the HRA. "P" consists of a state-paid amount plus the applicable federal financial participation (FFP). The portion of "P" that is paid by the state will equal the amount of revenue generated by Montana's inpatient hospital utilization fee, less all the following:

(A) 4% of the total revenue generated by the inpatient hospital utilization fee, which will be expended as match for continuity of care adjustor payments, as provided in ARM 37.87.1224; and

(B) 8% of the total revenue generated by the inpatient hospital utilization fee, which will be expended as match for Part 2 of the HRA, as provided in (4).

(4) Part 2 of the HRA payment is limited to critical access hospitals to maintain access and quality in the most rural areas in Montana. Part 2 will be based upon total hospital Medicaid charges, and will be computed as follows: HRA2 = (I ÷ D) x P.

(a) For the purposes of calculating Part 2 of the HRA, the following apply:

(i) "HRA2" represents the calculated Part 2 HRA payment.

(ii) "I" equals the total hospital charges from Medicaid paid claims for which Montana Medicaid was the primary payer for the hospital for which the payment is being calculated.

(iii) "D" equals the total hospital charges from Medicaid paid claims for which Montana Medicaid was the primary payer for all hospitals eligible to receive Part 2 of the HRA payment.

(iv) "P" equals the total amount to be paid via Part 2 of the HRA. "P" will be 8% of the total revenue generated by Montana's inpatient hospital utilization fee plus applicable FFP.

(5) The numbers used in (3) through (4) must be from the department's paid claims data for the most recent calendar year.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, 2004 MAR p. 650, Eff. 2/27/04; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2013 MAR p. 686, Eff. 4/26/13; AMD, 2013 MAR p. 2310, Eff. 1/1/14; AMD, 2016 MAR p. 2429, Eff. 1/1/17; AMD, 2018 MAR p. 1041, Eff. 5/26/18; AMD, 2019 MAR p. 2382, Eff. 1/1/20.

Mont. Admin. R. 37.86.2931 Routine Disproportionate Share Hospital

(1) A hospital is deemed a routine disproportionate share hospital if:

(a) it has a Medicaid inpatient utilization rate of at least one standard deviation above the mean Medicaid inpatient utilization rate for all hospitals receiving Medicaid payments in Montana or a low income utilization rate exceeding 20%; and

(b) it has a Medicaid inpatient utilization rate of at least 1%.

(2) Urban hospitals must have at least two obstetricians with staff privileges who have agreed to provide obstetric services to Medicaid patients. Rural hospitals must have at least two physicians with staff privileges to perform nonemergent obstetric procedures who have agreed to provide obstetric services to Medicaid recipients.

(3) This rule does not apply to hospitals which:

(a) serve inpatients who are predominantly individuals under 18 years of age; or

(b) do not offer nonemergent obstetric services as of December 21, 1987.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2018 MAR p. 1041, Eff. 5/26/18.

Mont. Admin. R. 37.86.2932 Medicaid Utilization Rate

(1) A hospital's Medicaid inpatient utilization rate is the hospital's percentage rate computed by dividing the total number of Medicaid inpatient days in the hospital's fiscal year by the total number of the hospital's inpatient days in that same period.

(2) The period used to determine whether a hospital is deemed a routine disproportionate share hospital will be the most recent calendar year for which final cost reports are available for all hospital providers.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2007 MAR p. 1680, Eff. 10/26/07; AMD, 2018 MAR p. 1041, Eff. 5/26/18.

Mont. Admin. R. 37.86.2935 Calculating Low Income Utilization Rate, for Routine Disproportionate Share Hospitals

(1) The low income utilization rate is used to determine whether a hospital is deemed a routine disproportionate share hospital. The percentage rate is computed as follows:

(a) LIUR=((A + B)/C) + (D/E) where:

(i) "LIUR" is the low income utilization rate;

(ii) "A" is the total revenue paid to the hospital to determine patient services under the Medicaid state plan regardless of whether the services were furnished on a fee-for-service basis or through a managed care program in the hospital's fiscal year;

(iii) "B" is the cash subsidies received directly from state and local governments for patient services in the hospital's fiscal year;

(iv) "C" is the total revenues of the hospital for patient services, including the amount of such cash subsidies in the hospital's fiscal year;

(v) "D" is the total hospital charges for inpatient hospital services attributable to charity care in the hospital's fiscal year, less any amount received for payment of these charges attributable to inpatient services. This amount shall not include contractual allowances and discounts (other than for indigent patients not eligible for public assistance); and

(vi) "E" is the hospital's total charges for inpatient hospital services in the hospital's fiscal year.

(b) The above amounts used in the formula must be from the hospital's most recent fiscal year for which initial cost reports are available for all hospital providers.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04.

Mont. Admin. R. 37.86.2940 Hospital Reimbursement Adjustor (hra), Data Sources

(1) An inpatient hospital reimbursement adjustor (HRA) payment will be made to a Montana PPS hospital or critical access hospital, as those terms are defined in 50-5-101, MCA, that provides inpatient hospital services.

(2) Data sources for the department to determine which hospitals meet the criteria to receive HRA payments, and the amount of the payments, may include, but are not limited to:

(a) the Montana Hospital Association (MHA) database;

(b) the Medicaid paid claims database;

(d) reports from the Licensure Bureau of the Quality Assurance Division.

(3) Eligibility evaluations, payment amount calculations, and payments will be made annually.

(4) The Montana State Hospital or a hospital or a facility operated by the state, a political subdivision of the state, the United States, or an Indian Tribe or any facility authorized under the Indian Health Care Improvement Act are not eligible for HRA.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2019 MAR p. 2382, Eff. 1/1/20.

Mont. Admin. R. 37.86.2943 Border Hospital Reimbursement

(1) Inpatient hospital services provided in border hospitals will be reimbursed under the APR-DRG prospective payment system described in ARM 37.86.2905, 37.86.2907, 37.86.2912, 37.86.2916, 37.86.2918, and 37.86.2920.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1983, Eff. 10/1/08.

Mont. Admin. R. 37.86.2947 Out-of-State Hospital and Centers of Excellence Reimbursement

(2) Medicaid reimbursement for inpatient services shall not be made to hospitals located more than 100 miles outside the borders of Montana or Centers of Excellence unless the provider has obtained authorization from the department or its designated review organization prior to providing services or prior to admission. All inpatient services provided in an emergent situation must be authorized as described in ARM 37.86.2801(4)(d).

(a) Should prior authorization not be obtained, reimbursement will be 50% of the amount as calculated in ARM 37.86.2905, 37.86.2907, 37.86.2912, 37.86.2916, 37.86.2918, and 37.86.2920 for services determined to be medically necessary.

(3) A Center of Excellence is an out-of-state or border acute care medical hospital as defined in ARM 37.86.2901 that:

(a) provides through its main hospital or on-site affiliate all specialty and subspecialty medical care; and

(i) has a medical school affiliation; or

(b) provides a specialized medical service not available elsewhere; and

(i) has a medical school affiliation; and

(ii) conducts bench to bedside research.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10.

Mont. Admin. R. 37.86.2950 Graduate Medical Education Payment Program

(1) Subject to the availability of funding, restrictions imposed by federal law, and the approval of the state plan by the Centers for Medicare and Medicaid Services (CMS), the department will pay, in addition to the Medicaid payments provided for in ARM 37.86.2806, 37.86.2905, 37.86.2907, 37.86.2912, 37.86.2916, 37.86.2918, 37.86.2920, 37.86.2924, 37.86.2925, 37.86.2928, 37.86.2943, and 37.86.2947, a Graduate Medical Education (GME) payment for the purpose of partially funding primary care and psychiatry residency programs for eligible hospitals located in Montana.

(2) Revenue for the GME payment will be generated through a transfer of funds from the Montana University System to the department through an Intergovernmental Transfer contract agreement. The transfer of funds from the University System will occur prior to July 31 of each year.

(3) The department will make an annual payment to each eligible hospital on or before August 31 of each year.

(a) The payment will be calculated based upon the eligible hospital's inpatient Medicaid utilization per year, as calculated in (4).

(b) If an eligible hospital reports no primary care or psychiatry resident full time equivalents (FTE) participating in the GME program for any given program year or portion thereof, the eligible hospital will not receive payment for those time periods of nonparticipation. FTE totals include residents conducting rural rotations. For purposes of this rule, a rural rotation is a period of one month where a primary care or psychiatry resident is working in a rural location, outside of their primary facility and urbanized area, with the express purpose of the resident being available to provide care to the rural area's patient population.

(4) To calculate an eligible hospital's GME payment, the department will:

(a) divide the total amount of GME funding, including federal match, by the total number of primary care and psychiatry resident full-time equivalents (FTE) participating in the program to establish the per-resident amount (PRA);

(b) divide the number of FTE residents at each eligible hospital by the total number of primary care and psychiatry resident FTEs at all eligible hospitals participating in the program to establish each hospital's resident FTE percentage;

(c) divide the eligible hospital's Medicaid inpatient days by its total inpatient days to determine each eligible hospital's Medicaid utilization percentage;

(d) multiply each eligible hospital's Medicaid utilization percentage by its resident FTE percentage and then add the results from all of the eligible hospitals to establish the weighted average Medicaid utilization percentage for all hospitals;

(e) divide an eligible hospital's Medicaid utilization percentage from (c) by the weighted Medicaid utilization percentage for all eligible hospitals to establish each eligible hospital's Medicaid utilization index;

(f) multiply the eligible hospital's Medicaid utilization index by the PRA in (a) to establish each eligible hospital's adjusted PRA; and

(g) multiply the eligible hospital's adjusted PRA by the number of resident FTEs at the hospital to determine the GME payment amount.

(5) The GME payment must comply with the following criteria:

(a) if the eligible hospital's cost of inpatient hospital services do not exceed the total Montana Medicaid allowed payments for inpatient care, the eligible hospital will receive a GME payment as calculated in (4);

(b) as-filed cost reports from eligible hospitals and information from the Medicaid paid claims database will be used for calculations;

(c) the GME payment must be for services derived from Medicaid paid claims. The dates of these services must occur within the eligible hospital's fiscal year end, and the hospital's fiscal year must be the year immediately prior to the payment date; and

(d) at the end of the contract period, the department will reconcile the total Medicaid payments including the Medicaid GME payments to ensure that the total of these payments do not exceed the Medicaid Upper Payment Limit (UPL) for the fiscal year.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2011 MAR p. 1391, Eff. 7/29/11; AMD, 2017 MAR p. 2083, Eff. 11/10/17; AMD, 2020 MAR p. 1742, Eff. 9/26/20.

Subchapter 37.86.30 Outpatient Hospital Services

Mont. Admin. R. 37.86.3001 Outpatient Hospital Services, Definitions

(1) "Ambulatory payment classification (APC)" means Medicare's ambulatory payment classification assignment groups of CPT or HCPCS codes.

(2) "Bad debt" means inpatient and outpatient hospital services provided in which full payment is not received from the patient or from a third party payor, for which the provider expected payment and the persons are unable or unwilling to pay their bill. Bad debts may be for services provided to patients who have no health insurance or patients who are underinsured and are net of payments made toward these services. For the purpose of uncompensated care, bad debt is measured on the basis of revenue forgone, at full established rates, and bad debt does not include either provider discounts or Medicare bad debt.

(3) "Birthing center" means a facility that provides comprehensive obstetrical care for women in which births are planned to occur away from the mother's usual residence following normal, uncomplicated, low risk pregnancy and is either:

(a) a licensed outpatient center for primary care with medical resources as defined at 50-5-101, MCA; or

(b) a private office of a physician or certified nurse midwife that is accredited by a national organization as an alternative to a homebirth or a hospital birth.

(4) "Charity care" means inpatient and outpatient hospital services in which hospital policies determine the patient is unable to pay and did not expect to receive full reimbursement. Charity care results from a provider's policy to provide health care services free of charge (or where only partial payment is expected) to individuals who meet certain financial criteria. For the purpose of uncompensated care, charity care is measured on the basis of revenue forgone, at full established rates. Charity care does not include contractual write-offs.

(5) "Conversion factor" means a base rate initially calculated by CMS and used to translate APC relative weights into dollar payment rates.

(6) "Diagnostic service" means an examination or procedure performed on an outpatient or on materials derived from an outpatient to obtain information to aid in the assessment or identification of a medical condition.

(7) "Disproportionate share hospital-specific uncompensated care" means the costs of inpatient and outpatient hospital services provided to clients who have no health insurance or source of third-party coverage.

(8) "Full-day partial hospitalization program" means a partial hospitalization program providing services at least six hours per day, five days per week.

(9) "Early elective delivery" means either a nonmedically necessary labor induction or cesarean section that is performed prior to 39 weeks and 0/7 days gestation.

(10) "Half-day partial hospitalization program" means a partial hospitalization program providing services for at least four but less than six hours per day, at least four days per week.

(11) "Healthcare common procedures coding system (HCPCS)" means the national uniform coding method maintained by the Centers for Medicare and Medicaid Services (CMS) that incorporates the American Medical Association (AMA) Physicians Current Procedural Terminology (CPT) and the three HCPCS unique coding levels, I, II, and III.

(12) "ICD-9-CM" means the International Classification of Diseases, Ninth Revision based on the official version of the United Nations World Health Organization's Ninth Revision, effective for dates of service or discharge date prior to and including September 30, 2015.

(13) "ICD-10-CM" means the International Classification of Diseases, Tenth Revision based on the official version of the World Health Organization's Tenth Revision for diagnosis coding, effective for dates of service or discharge date October 1, 2015 and thereafter.

(14) "Imaging service" means diagnostic and therapeutic radiology, nuclear medicine, CT scan procedures, magnetic resonance imaging services, ultra-sound, and other imaging procedures.

(15) "Lactation services" means support through breastfeeding education and consultations with certified lactation providers to increase the health of both mother and baby.

(16) "Outpatient" means a person who:

(a) has not been admitted by a hospital or birthing center as an inpatient;

(b) is expected by the hospital or birthing center to receive services in the hospital for less than 24 hours;

(d) receives outpatient services from the hospital or birthing center, other than supplies or drugs alone, for nonemergency medical conditions.

(17) "Outpatient hospital reimbursement adjustor (HRA)" means a payment to a Montana PPS hospital or critical access hospital as specified in ARM 37.86.3015.

(18) "Outpatient hospital services" means preventive, diagnostic, therapeutic, rehabilitative, or palliative services provided to an outpatient by or under the direction of a physician, dentist, or other practitioner as permitted by federal law, by an institution that:

(a) is licensed or formally approved as a hospital by the officially designated authority in the state where the institution is located; and

(b) except as otherwise permitted by federal law, meets the requirements for participation in Medicare as a hospital.

(19) "Outpatient hospital utilization fee" means the utilization fee collected by the Department of Revenue as provided in 15-66-102, MCA.

(20) "Outpatient prospective payment system (OPPS)" means Medicare's outpatient prospective payment system mandated by the Balanced Budget Refinement Act of 1999 (BBRA) and the Medicare, Medicaid, SCHIP Benefits Improvement and Protection Act (BIPA) of 2000.

(21) "Outpatient revenue" means the gross revenue from a hospital's charges for services provided on an outpatient basis. Charges for professional services provided as part of an outpatient treatment are not included.

(22) "Partial hospitalization services" means an active treatment program that offers therapeutically intensive, coordinated, structured clinical services provided only to individuals who are determined to have a serious emotional disturbance or severe disabling mental illness. Partial hospitalization services are time-limited and provided within either an acute level program or a subacute level program. Partial hospitalization services include day, evening, night, and weekend treatment programs that employ an integrated, comprehensive, and complementary schedule of recognized treatment or therapeutic activities.

(23) "Prospective payment system (PPS) hospital" means a hospital reimbursed pursuant to the diagnosis related group (DRG) system. DRG hospitals are classified as such by the Centers for Medicare and Medicaid Services (CMS) in accordance with 42 CFR part 412.

(24) "Provider-based entity" means a provider that is either created by, or acquired by, a main provider for purposes of furnishing health care services under the name, ownership, and administrative and financial control of the main provider as in 42 CFR 413.65.

(25) "Uncompensated care" means hospital services provided in which no payment is received from the patient or from a third party payer. Uncompensated care includes charity care and bad debts.

(26) "Upper payment limit" means the federal limit placed on fee-for-service reimbursement of Medicaid providers.

(27) "340B drug pricing program" means a drug pricing program established under section 340B of the Veterans Health Care Act which offers outpatient pharmaceuticals at substantially reduced prices to qualified entities.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, Eff. 11/4/74; AMD, 1983 MAR p. 756, Eff. 7/1/83; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1996 MAR p. 1539, Eff. 7/1/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 27, Eff. 3/1/01; EMERG, AMD, 2001 MAR p. 989, Eff. 6/8/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 768, Eff. 3/24/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2007 MAR p. 1680, Eff. 10/26/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2014 MAR p. 507, Eff. 3/14/14; AMD, 2014 MAR p. 1415, Eff. 7/1/14; AMD, 2015 MAR p. 2289, Eff. 12/25/15; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2019 MAR p. 2382, Eff. 1/1/20.

Mont. Admin. R. 37.86.3002 Outpatient Hospital Services, Scope and Requirements

(1) The requirements of ARM 37.86.2801, 37.86.2803, 37.86.3001, 37.86.3005 and this rule are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Outpatient hospital services are services that would also be covered by Medicaid if provided in a nonhospital setting and are limited to the following diagnostic and therapeutic services furnished by hospitals to outpatients:

(a) diagnostic services, including:

(i) the services of nurses, psychologists and technicians;

(ii) drugs and biologicals;

(iii) laboratory and imaging services;

(iv) psychological tests;

(v) supplies and equipment; and

(vi) other tests to determine the nature and severity of a medical condition;

(b) therapeutic services and supplies, including:

(i) emergency room services;

(ii) clinic services; and

(iii) the use of hospital facilities incident to provision of physician services to the patient where the services and supplies are furnished in the hospital on a physician's order by hospital personnel under the supervision of hospital medical staff;

(d) services provided outside the hospital, as follows:

(i) diagnostic services provided by hospital personnel outside the hospital premises with or without direct personal supervision of a physician;

(ii) therapeutic services that are incidental to physician services and provided under the direct personal supervision of a physician. Outpatient physical therapy, occupational therapy, and speech therapy are not subject to the direct physician supervision requirement. Therapy services are limited as in ARM 37.86.606;

(e) diabetes education services provided by a hospital whose diabetes education programs are in compliance with ARM 37.86.5401 through 37.86.5404; and

(f) lactation services performed by nonphysician providers, i.e., certified lactation providers. These services will only be allowed to be billed by the facility effective January 1, 2016.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1983 MAR p. 756, Eff. 7/1/83; AMD, 1993 MAR p. 2819, Eff. 11/1/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1996 MAR p. 1682, Eff. 6/21/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1209, Eff. 7/8/97; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2015 MAR p. 2289, Eff. 12/25/15.

Mont. Admin. R. 37.86.3003 Outpatient Hospital Services, Exclusions

(1) Outpatient hospital services do not include:

(a) services excluded from coverage by the Medicaid program under ARM 37.85.207;

(b) exercise programs and programs primarily educational in nature unless covered as preventative outpatient services, including, but not limited to independent exercise programs, such as pool therapy, swim programs, or health club memberships;

(c) outpatient physical therapy, occupational therapy, and speech therapy services that are primarily maintenance therapy as defined in ARM 37.86.601;

(d) experimental or investigational services such as the use of off-label drugs where this usage is not a national standard of practice, or non-FDA-approved use of drugs, biologicals, and devices;

(e) services that do not comply with national standards of medical care; and

(f) outpatient hospital services provided outside the borders of the United States will not be covered or reimbursed by the Montana Medicaid program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2006 MAR p. 1640, Eff. 7/1/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2015 MAR p. 2289, Eff. 12/25/15.

Mont. Admin. R. 37.86.3005 Outpatient Hospital Services, Reimbursement

(1) The department will reimburse for outpatient hospital services and birthing center services compensable under the Montana Medicaid program as provided in this rule.

(2) Outpatient hospital services that are not provided by critical access hospitals as defined in ARM 37.86.2901 will be reimbursed under ARM 37.86.3007, 37.86.3009, 37.86.3016, 37.86.3018, 37.86.3020, 37.86.3025, 37.86.3109, and 37.86.3037 for medically necessary services.

(3) Birthing center services as defined in ARM 37.86.3001 will be reimbursed under ARM 37.86.3007, 37.86.3016, 37.86.3018, and 37.86.3020, for medically necessary services.

(4) For critical access hospitals, interim reimbursement for outpatient hospital services is based on hospital-specific Medicaid outpatient cost-to-charge ratio, not to exceed 100%. Critical access hospitals will be reimbursed their actual allowable costs determined according to ARM 37.86.2803.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
History: NEW, 1987 MAR p. 1658, Eff. 10/1/87; AMD, 1991 MAR p. 1027, Eff. 7/1/91; AMD, 1993 MAR p. 1520, Eff. 7/16/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1995 MAR p. 1961, Eff. 10/1/95; AMD, 1996 MAR p. 1539, Eff. 7/1/96; AMD, 1996 MAR p. 3218, Eff. 12/20/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1209, Eff. 7/8/97; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1806, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 564, Eff. 1/12/01; EMERG, AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 797, Eff. 3/15/02; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12.

Mont. Admin. R. 37.86.3006 Mental Health Outpatient Partial Hospital Services, Requirements

(1) Medicaid reimbursement is not available for outpatient partial hospitalization services unless:

(a) the person is experiencing psychiatric symptoms of sufficient severity to create severe impairments in educational, social, vocational, or interpersonal functioning;

(b) the person cannot be safely and appropriately treated in a less restrictive level of care;

(c) proper treatment of the person's psychiatric condition requires acute treatment services on an outpatient basis under the direction of a physician; and

(d) the services can reasonably be expected to improve the person's condition or prevent further regression.

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

(3) Acute level partial hospitalization is provided by programs which:

(a) are operated by a hospital as defined in 50-5-101, MCA, and are collocated with that hospital such that in an emergency a patient of the acute partial hospitalization program can be transported to the hospital′s inpatient psychiatric unit within 15 minutes;

(b) serve primarily persons being discharged from inpatient psychiatric treatment or inpatient psychiatric residential treatment; and

(c) provide psychotherapy services consisting of at least individual, family, and group sessions at a frequency designed to stabilize the person sufficiently to allow discharge to a less intensive level of care at the earliest appropriate opportunity.

(4) Acute level partial hospitalization is reimbursed according to ARM 37.86.3022.

(5) Subacute partial hospitalization is provided for in ARM 37.87.903(8).

(6) Prior authorization is not a guarantee of payment.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2014 MAR p. 2147, Eff. 9/19/14.

Mont. Admin. R. 37.86.3007 Outpatient Hospital Services, Prospective Payment Methodology, Clinical Diagnostic Laboratory Services

(1) Clinical diagnostic laboratory services, including automated multichannel test panels (commonly referred to as "ATPs") and lab panels, will be reimbursed on a fee basis as follows with the exception of hospitals reimbursed under ARM 37.86.3005 and specific lab codes which are paid under ARM 37.86.3020:

(a) The fee for a clinical diagnostic laboratory service is the applicable percentage of the Medicare fee schedule as follows:

(i) 60% of the prevailing Medicare fee schedule for a birthing center or where a hospital laboratory acts as an independent laboratory, i.e., performs tests for persons who are nonhospital patients;

(ii) 62% of the prevailing Medicare fee schedule for a hospital designated as a sole community hospital as defined in ARM 37.86.2901; or

(iii) 60% of the prevailing Medicare fee schedule for a hospital that is not designated as a sole community hospital as defined in ARM 37.86.2901.

(b) For clinical diagnostic laboratory services where no Medicare fee has been assigned, but a Medicaid fee has been assigned, the fee is the amount set in ARM 37.85.212; or

(c) if there is no Medicare or Medicaid fee, the service will be reimbursed at hospital specific outpatient cost to charge ratio as in ARM 37.86.2803. Birthing centers will be reimbursed the statewide outpatient cost to charge ratio.

(2) For purposes of this rule, clinical diagnostic laboratory services include the laboratory tests listed in codes defined in the HCPCS and listed in the Clinical Diagnostic Fee Schedule (CLAB) published January 1, 2018.

(3) Specimen collection will be reimbursed separately for drawing a blood sample through venipuncture or for collecting a urine sample by catheterization. Specimen collection will be reimbursed as specified in the department's outpatient fee schedule as adopted in ARM 37.86.3025, whether or not the specimens are referred to physicians or other laboratories for testing. No more than one collection fee may be allowed for each patient visit, regardless of the number of specimens drawn.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Mont. Admin. R. 37.86.3009 Outpatient Hospital Services, Payment Methodology, Emergency Visit Services

(1) For emergency visits that are not provided by exempt hospitals or critical access hospitals as defined in ARM 37.86.2901, reimbursement will be based on the ambulatory payment classifications APC methodology in ARM 37.86.3020, except emergency room visits with CPT codes 99281 and 99282 will be reimbursed based on the clinical APC weight.

(a) Passport to Health provider authorization is not required for emergency room visits.

(2) Physician services are separately billable according to the applicable rules governing billing for physician services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1119, Eff. 6/22/01; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2014 MAR p. 1415, Eff. 7/1/14.

Mont. Admin. R. 37.86.3011 Outpatient Hospital Services, Prospective Payment Methodology, Nonemergent Emergency Room Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1119, Eff. 6/22/01; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; REP, 2003 MAR p. 1652, Eff. 8/1/03.

Mont. Admin. R. 37.86.3014 Outpatient Hospital Services, Prospective Payment Methodology, Dialysis Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2003 MAR p. 1652, Eff. 8/1/03; REP, 2012 MAR p. 1382, Eff. 7/13/12.

Mont. Admin. R. 37.86.3015 Outpatient Hospital Reimbursement, Outpatient Hospital Reimbursement Adjustor

(1) The outpatient hospital reimbursement adjustor (HRA) payment is payable to a PPS hospital or critical access hospital, as those terms are defined in 50-5-101, MCA, that provides outpatient hospital services. Eligibility to receive the outpatient HRA is based on a hospital's year-end reimbursement status.

(2) An individual hospital's outpatient HRA payment will be based upon total hospital Medicaid outpatient charges and will be computed as follows: HRA = (J ÷ D) x P.

(a) "HRA" represents the calculated hospital specific outpatient HRA payment.

(b) "J" equals the total outpatient hospital charges billed to Medicaid by the hospital for which the payment is calculated.

(c) "D" equals the total outpatient hospital charges billed to Medicaid by all hospitals eligible to receive an outpatient HRA payment.

(d) "P" equals the distributable revenue generated by the outpatient hospital utilization fee plus applicable federal financial participation.

(3) Data sources for the department to determine which hospitals meet the criteria to receive an outpatient HRA payment and the amount of the payment may include, but are not limited to:

(a) the Montana Hospital Association (MHA) database;

(b) the Medicaid paid claims database for the most recent calendar year;

(d) reports from the Licensure Bureau of the Quality Assurance Division.

(4) Eligibility evaluations, payment calculations, and payments will be made annually.

(5) The Montana State Hospital or a hospital or facility operated by the state, a political subdivision of the state, the United States, or an Indian Tribe or any facility authorized under the Indian Health Care Improvement Act are not eligible for the HRA payment.

History

Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-113, 53-6-149, MCA
History: NEW, 2019 MAR p. 2382, Eff. 1/1/20.

Mont. Admin. R. 37.86.3016 Outpatient Hospital Services, Prospective Payment Methodology, Imaging Services

(1) Imaging services will be reimbursed with the exception of hospitals reimbursed under ARM 37.86.3005(3) as follows:

(a) For each imaging service or procedure, the fee will be the APC rate as in ARM 37.86.3020 or Medicare fee if no APC rate exists. The imaging services reimbursed under this subsection are the individual imaging service codes defined in the CPT/HCPCS.

(b) For imaging services where no APC rate or Medicare fee has been assigned, a Medicaid fee will be set in accordance with the resource based relative value scale (RBRVS) methodology found at ARM 37.85.212.

(c) For imaging services where no APC rate, Medicare fee, or Medicaid fee has been assigned, outpatient hospital-specific percent of charges will be paid. Birthing centers and out-of-state hospitals will be reimbursed the statewide outpatient cost-to-charge ratio.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12.

Mont. Admin. R. 37.86.3018 Outpatient Hospital Services, Prospective Payment Methodology, Other Diagnostic Services

(1) Other diagnostic services will be reimbursed as follows with the exception of hospitals reimbursed under ARM 37.86.3005(4):

(a) the fee will be the APC rate as in ARM 37.86.3020 or the Medicare fee for the same service if no APC rate exists. The individual diagnostic services reimbursed under this subsection are those defined in the CPT/HCPCS;

(b) for other diagnostic services without an APC rate or Medicare fee, a Medicaid fee will be assigned in accordance with the RBRVS methodology in ARM 37.85.212; or

(c) for other diagnostic services where no APC rate, Medicare fee, or Medicaid fee has been assigned, outpatient hospital-specific percent of charges will be paid. Birthing centers and out-of-state hospitals will be reimbursed the statewide outpatient cost-to-charge ratio.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12.

Mont. Admin. R. 37.86.3020 Outpatient Hospital Services, Outpatient Prospective Payment System (opps) Methodology, Ambulatory Payment Classification

(1) Outpatient hospital or birthing center services that are not provided by critical access hospitals will be reimbursed on a rate-per-service basis using the Outpatient Prospective Payment System (OPPS) schedules. The provider reimbursement rates for outpatient hospital services is stated in the department's Outpatient Prospective Payment System (OPPS) Fee Schedule as provided in ARM 37.85.105(3). Under this system, Medicaid payment for outpatient services included in the OPPS is made at a predetermined, specific rate. These outpatient services are classified according to a list of APCs published annually in the Code of Federal Regulations (CFR). The rates for OPPS are determined as follows:

(a) The department uses a conversion factor for each APC group as defined in ARM 37.86.3001(5). The conversion factor is as provided in ARM 37.85.105(3). The APC-based fee equals the Medicare specific relative weight for the APC times the conversion factor that is the same for all APCs with the exceptions of services in ARM 37.86.3025. APCs are based on classification assignment of CPT/HCPCS codes.

(b) At the claim level, payment will be the lower of the provider's charge or the payment as calculated using OPPS. There will be no charge cap at the line level.

(c) APCs are an all-inclusive bundled payment per visit which covers all outpatient services provided to the patient, including but not limited to nursing, pharmacy, laboratory, imaging services, other diagnostic services, supplies and equipment, and other outpatient services. For purposes of OPPS, a visit includes all outpatient hospital or birthing center services related or incident to the outpatient visit that are provided the day before or the day of the outpatient visit.

(d) If two or more surgical procedures are performed at the same hospital on the same patient on the same day, payment for the most expensive procedure will be made at 100% of the APC for that service and payment for all other procedures will be made at 50% of the APC for those services.

(e) If the OPPS does not assign a Medicare fee or APC for a particular procedure code, a Medicaid fee will be assigned in accordance with the resource based relative value scale (RBRVS) methodology found at ARM 37.85.212. If there is not a Medicaid fee, the service will be reimbursed at hospital-specific outpatient cost-to-charge ratio as in ARM 37.86.2803. Birthing centers and out-of-state hospitals will be reimbursed the statewide outpatient cost-to-charge ratio:

(i) The Medicaid statewide average outpatient cost-to-charge ratio is as provided at ARM 37.85.105(3).

(f) The department will make separate payment for observation care procedure codes for Medicare qualifying conditions or obstetric complications. If an observation service does not meet these criteria for these services, payment for observation care will be considered bundled into the APC for other services.

(i) The diagnosis used to define a potential obstetric qualification will be taken from diagnosis-related groups 565 (false labor) and 566 (other antepartum diagnosis with medical complications).

(ii) The department will make separate payment for observation care procedure codes when billed as a direct admit or have a high level clinic visit, high level critical care, or high level emergency room visit.

(iii) The department will make separate payment for observation care procedure codes if billed using a qualifying diagnosis as per the CMS Claims Processing Manual.

(g) The department follows Medicare guidelines for procedures defined as "inpatient only". When these procedures are performed in the outpatient hospital or birthing center setting, the claim will be denied.

(h) Procedures started on patients but discontinued before completion will be reimbursed at 50% of the APC for those services.

(2) The department adopts and incorporates by reference the OPPS Schedules published by the Centers for Medicare and Medicaid Services (CMS) as provided in ARM 37.85.105(3).

(3) All outpatient hospitals including birthing centers are subject to the requirements in ARM 37.86.2801(9).

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1119, Eff. 6/22/01; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2007 MAR p. 1680, Eff. 10/26/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1415, Eff. 7/1/14.

Mont. Admin. R. 37.86.3022 Outpatient Hospital Services, Partial Hospitalization Services

(1) Partial hospitalization services will be reimbursed on a prospective per diem rate which shall be the lesser of the amount specified in the department's Medicaid Mental Health Fee Schedule or the provider's usual and customary charges (billed charges). The per diem rates specified in the department's Medicaid Mental Health Fee Schedule are bundled prospective per diem rates for full-day programs and half-day programs, as defined in ARM 37.86.3001. The bundled prospective per diem rate includes all outpatient psychiatric and psychological treatments and services, laboratory and imaging services, drugs, biologicals, supplies, equipment, therapies, nurses, social workers, psychologists, licensed professional counselors, and other outpatient services, that are part of or incident to the partial hospitalization program, except as provided in the department's Medicaid Mental Health Fee Schedule.

(2) The professional component of physician services, including psychiatrist services, is separately billable according to the applicable department rules governing billing for physician services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 768, Eff. 3/24/06.

Mont. Admin. R. 37.86.3025 Outpatient Hospital Services, Reimbursement for Services Not Paid Under the Ambulatory Payment Classification System

(1) Therapy services will be paid the facility fee in accordance with the RBRVS methodologies in ARM 37.85.212 using the allied services conversion factor. Therapy services include physical therapy, occupational therapy, and speech-language pathology and are subject to requirements and restrictions as in ARM 37.86.606.

(2) Dental services not grouping to an ambulatory payment classification (APC) will be reimbursed as specified in the department's outpatient fee schedule.

(3) Immunizations not grouping to an APC will be paid the same reimbursement provided in accordance with the RBRVS methodologies in ARM 37.85.212.

(a) If the recipient is under 19 years old and vaccine is available to providers for free under the Vaccines For Children program, then the payment to the hospital is zero.

(b) Immunization administration is considered an incidental service and will be bundled with other APCs on the claim and paid at zero.

(4) Professional services must bill separately on a professional billing form according to applicable rules governing billing for professional services.

(5) Interim payment for certified registered nurse anesthetists (CRNAs) will be reimbursed at hospital specific outpatient cost to charge ratio and settled as a pass through in the cost settlement, as provided in ARM 37.86.2924.

(6) The department adopts and incorporates by reference the Outpatient Hospital Fee Schedule which is updated each quarter and is posted on the Medicaid web site. A written copy may be obtained through the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.3031 Provider Based Entity Services, General

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12; REP, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.3033 Provider-Based Entity Services, Recipient Access and Notification

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12; REP, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.3035 Provider Based Entity Services, Compliance, and Penalties

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2006 MAR p. 3078, Eff. 1/1/07; REP, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.3037 Provider-Based Entity Services, Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12; REP, 2018 MAR p. 458, Eff. 3/1/18.

Subchapter 37.86.31 Outpatient Hospital Rehabilitation and Therapy Services

Mont. Admin. R. 37.86.3101 Outpatient Hospital Services, Cardiac and Pulmonary Rehabilitation Services

(1) Coverage for medically necessary outpatient cardiac and pulmonary rehabilitation services is effective January 1, 2006.

(2) All cardiac and pulmonary rehabilitative services must be medically necessary and prior authorized by the department's designated review organization.

(3) The following conditions are contraindications to cardiac or pulmonary rehabilitation, and except as provided in ARM 37.86.3107, patients with one or more contraindications are not eligible for cardiac or pulmonary rehabilitation:

(a) severe psychiatric disturbance including, but not limited to, dementia and organic brain syndrome; or

(b) significant or unstable medical conditions including, but not limited to, substance abuse, liver dysfunction, kidney dysfunction, and metastatic cancer.

History

Authorizing statute(s): 53-2-201, 53-6-111, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2014 MAR p. 1415, Eff. 7/1/14.

Mont. Admin. R. 37.86.3103 Outpatient Hospital Services, Cardiac Rehabilitation Services

(1) Cardiac rehabilitation services are limited to the following cardiac events and diagnoses:

(a) myocardial infarction within the preceding 12 months;

(b) coronary artery bypass surgery;

(d) current stable angina pectoris;

(e) percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting;

(f) heart valve repair or replacement; and

(g) chronic stable heart failure.

History

Authorizing statute(s): 53-2-201, 53-6-111, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2014 MAR p. 1415, Eff. 7/1/14; AMD, 2016 MAR p. 829, Eff. 5/7/16.

Mont. Admin. R. 37.86.3105 Outpatient Hospital Services, Pulmonary Rehabilitation Services

(1) Pulmonary rehabilitation services are limited to members with moderate to severe COPD, defined as GOLD classification II, III, and IV.

(2) If applicable, the patient must have ceased smoking or be in a smoking cessation class.

(3) The following pulmonary rehabilitation services are not covered:

(a) education, treatment, and therapies that are not individualized to a specific patient need or are not an integral part of the treatment session;

(b) routine psychological screening and treatment where intervention is not indicated;

(d) duplicate services;

(e) maintenance care when there is no expectation of further improvement;

(f) treatment that is not medically necessary because the patient requires a general strengthening and endurance program only; and

(g) treatment that is not medically necessary because the patient is at an early stage of pulmonary disease as demonstrated by a lack of significant findings in diagnostic testing.

History

Authorizing statute(s): 53-2-201, 53-6-111, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2014 MAR p. 1415, Eff. 7/1/14; AMD, 2016 MAR p. 829, Eff. 5/7/16.

Mont. Admin. R. 37.86.3107 Outpatient Hospital Services, Cardiac and Pulmonary Rehabilitation, Waiver of Service Limitations

(1) The service limitations provided in ARM 37.86.3103 and 37.86.3105 may be waived for extenuating circumstances on a case-by-case basis by the department.

History

Authorizing statute(s): 53-2-201, 53-6-111, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2006 MAR p. 1640, Eff. 6/23/06.

Mont. Admin. R. 37.86.3109 Outpatient Cardiac and Pulmonary Rehabilitation Reimbursement

(1) Critical access hospital (CAH) interim reimbursement is based on a hospital-specific Medicaid outpatient cost-to-charge ratio, not to exceed 100%. For dates of service January 1, 2018 through June 30, 2018, the interim reimbursement is based on the hospital specific Medicaid outpatient cost-to-charge ratio (CCR), less 2.99% not to exceed 100%. For dates of service on or after July 1, 2018, the interim reimbursement is based on the hospital-specific Medicaid outpatient cost-to-charge ratio. CAHs will be reimbursed their actual allowable costs determined according to ARM 37.86.2803.

(2) Prospective payment hospitals will be reimbursed on a rate-per-service basis using the outpatient prospective payment system (OPPS) schedules as provided in ARM 37.86.3020.

(3) Out-of-state hospitals will not be reimbursed for these services.

History

Authorizing statute(s): 53-2-201, 53-6-111, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Subchapter 37.86.32 Nonhospital Laboratory and Radiology (X-Ray) Services

Mont. Admin. R. 37.86.3201 Nonhospital Laboratory and Radiology (x-Ray) Services, Requirements

(1) "Nonhospital laboratory and radiology (x-ray) services" are professional and technical laboratory and radiology services which are ordered and provided by a physician, dentist, or other practitioner licensed within the scope of his practice as defined by state law.

(2) Nonhospital laboratory and radiology (x-ray) services may be provided in an office or similar facility other than a hospital outpatient department or clinic.

(3) Providers must meet the following requirements:

(a) Providers of laboratory services must be:

(i) Medicare certified; and

(ii) meet licensing requirements of the state in which they are located.

(b) Providers of radiology services must:

(i) be supervised by a physician who is licensed to practice medicine within the state in which the services are provided; and

(ii) meet state facility licensing requirements, if applicable.

(5) The "Physician-Related Services Manual" adopted at ARM 37.86.101 governs the administration of the Nonhospital Laboratory and Radiology (X-ray) program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, 53-6-141, MCA
History: NEW, 1988 MAR p. 2228, Eff. 10/14/88; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2012 MAR p. 2625, Eff. 1/1/13.

Mont. Admin. R. 37.86.3205 Nonhospital Laboratory and Radiology (x-Ray) Services, Reimbursement

(1) These reimbursement requirements are in addition to those contained in ARM 37.85.212 and 37.86.105.

(2) Independent laboratory providers must meet the following requirements to receive Medicaid reimbursement:

(a) the independent laboratory provider must be certified by Medicare;

(b) the independent laboratory provider must meet any state licensing requirements for laboratory facilities; and

(c) the independent laboratory service must have been ordered by a physician, dentist, or other practitioner licensed to practice in Montana.

(i) Medicaid does not reimburse services ordered by chiropractors.

(3) Independent radiology (x-ray) services must meet the following requirements to receive Medicaid reimbursement:

(a) the independent radiology provider must meet any state licensing requirements for radiology facilities;

(b) the independent radiology service must be ordered by a physician, dentist, or other practitioner licensed within the scope of his practice as defined by state law;

(c) technical components of diagnostic and therapeutic radiology services must be performed by an appropriately licensed provider within the scope of his practice as defined by state law and under the supervision of a physician; and

(d) the physician with supervisory responsibilities for the radiology services must meet state licensing requirements; and

(e) technical components of the radiology (x-ray) service must be billed by and reimbursed to the supervising physician.

(4) For clinical laboratory services, the department pays the lower of:

(a) the provider's usual and customary charges for the service;

(b) 60% of the Medicare fee schedule for physician offices and independent labs and hospitals functioning as independent labs; or

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-113, MCA
History: NEW, 1988 MAR p. 2228, Eff. 10/14/88; AMD, 1997 MAR p. 1269, Eff. 7/22/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2014 MAR p. 1407, Eff. 7/1/14; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.

Subchapter 37.86.33 Case Management Services - General

Mont. Admin. R. 37.86.3301 Case Management Services, General Definitions

(1) "Case management" means the process of planning and coordinating care and services to meet individual needs of a client and to assist the client in obtaining necessary medical, social, nutritional, educational, and other services. Case management includes assessment, case plan development, monitoring, and service coordination. Case management provides coordination among agencies and providers in the planning and delivery of services.

(2) "Caregiver" means a parent, family member, foster parent, or guardian with legal responsibility for the well-being of the client.

(3) "Case management provider" or "provider" means an entity that as provided for in this subchapter may provide case management services to clients.

(4) "Case manager" means a person or a team of persons assigned by a case management provider to do case management for the client.

(5) "Client" means a person who is eligible for and is receiving case management services.

(6) "Presumptive eligibility" means the process of determining eligibility for pregnant women to receive ambulatory prenatal care services under the Medicaid presumptive eligibility program as provided at ARM 37.82.701.

(7) "Department" or "DPHHS" means the Department of Public Health and Human Services.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.3305 Case Management Services, General Provisions

(1) Case management services assure healthy outcomes by assisting recipients to access needed services and by coordinating between all agencies and providers responsible for service delivery. A case management plan sets goals for meeting a client's needs and where appropriate the needs of the client's caregivers and identifies the means for implementing those goals with emphasis on the self-sufficiency of the client and caregivers in obtaining services.

(2) Case management services are available to persons who are determined by the department or its designees in accordance with this subchapter to be within the covered groups set forth in ARM 37.86.3306.

(3) Receipt of case management services does not restrict a client's right to receive other Montana Medicaid services from any certified Medicaid provider.

(4) Case management services cannot duplicate any other Medicaid service or other services available to the client.

(5) Case management services must be delivered by a case manager whose primary responsibility is the delivery of case management services to one or more of the populations identified in ARM 37.86.3306. Exceptions to this requirement may be approved by the department or its designee.

(6) Except as otherwise provided for in this subchapter, a client may select a case management service provider and other service providers whose services are received with the assistance of case management.

(7) A client in accordance with the following criteria may temporarily receive case management services from more than one case management service provider if:

(a) there is need for more than one case manager to manage the provision of services to the client;

(b) there is a single coordinated individualized plan for case management of the provision of services;

(d) there is an agreement as to which case management services provider will bill Medicaid; and

(e) the plan of care contains the following:

(i) designation of the lead case management service provider;

(ii) justification for the use of more than one case management service provider;

(iii) specification of roles and responsibilities each case management service provider is to undertake;

(iv) documentation of all the case management services provided on behalf of the client, including those not reimbursed by Medicaid;

(v) assurances of nonduplication of case management services; and

(vi) strategies for reducing case management to a single service provider.

(8) Medicaid reimbursement for case management services except as provided in ARM 37.86.3902, is only available for the case management services provided by the lead case management provider.

(9) Decisions as to which case management provider is to be the lead case management provider for a client, except as provided in ARM 37.86.3902, are made locally. If there is disagreement that cannot be resolved locally, the department contacts for each program involved are to make the necessary decision.

(10) A case management plan must be developed jointly by the case manager and the client and where appropriate the client's caregivers.

(a) The plan should be signed by the client and where appropriate the client's caregivers. If the plan is not signed, the reason for the lack of signature must be documented.

(b) Refusal to sign the plan will not result in a denial of case management services.

(c) A case management plan for a minor or for an adult who is subject to full guardianship must be signed by the parents or guardian.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1994 MAR p. 3201, Eff. 12/23/94; AMD, 1997 MAR p. 898, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.3306 Case Management Services, General Eligibility

(1) Persons who are Medicaid recipients and are from the following groups are eligible for case management services:

(a) high risk pregnant women;

(b) adults with severe disabling mental illness;

(d) youth with serious emotional disturbance;

(e) children at risk for abuse and neglect;

(f) children with special health care needs;

(g) post-adjudicated youth offenders who are exiting state-operated secure facilities and who are:

(i) under age 21; or

(ii) former foster care children under age 26; and

(h) adult offenders with a serious mental illness or substance use disorder who are exiting state-operated secure facilities.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1992 MAR p. 1248, Eff. 6/12/92; AMD, 1994 MAR p. 3201, Eff. 12/23/94; AMD, 1997 MAR p. 496, Eff. 3/11/97; AMD, 1997 MAR p. 898, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.

Subchapter 37.86.34 Targeted Case Management Services for High Risk Pregnant Women

Mont. Admin. R. 37.86.3401 Targeted Case Management Services for High Risk Pregnant Women, Definitions

The definitions of targeted case management services for high risk pregnant women are as follows:

(1) "Care plan" means a specific written plan that is based on the information collected through the comprehensive assessment and periodic reassessment that:

(a) specifies the goals and actions to address the medical, social, educational, and other services needed by the member;

(b) includes activities such as ensuring the active participation of the member, and working with the member and others to develop those goals; and

(2) "Comprehensive Assessment and Periodic Reassessment" means an evaluation to identify a member's need for any medical, educational, social, or other services. These assessment activities include:

(a) taking a member's history;

(b) identifying the member's needs and completing the related documentation; and

(3) "Monitoring and follow-up activity" means activities and contacts that are necessary to ensure the care plan is implemented and adequately addresses the member's needs. The activities may be with the member, family members, service providers, or other entities or individuals and may be conducted as frequently as necessary. Monitoring may be furnished through face-to-face visits, telephone calls, and telemedicine services.

(4) "Paraprofessional" means a person to whom a particular aspect of a professional task is delegated but who is not licensed to practice as a fully qualified professional.

(5) "Referral" means activities that help link the member with medical, social, or educational providers, and other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

(6) "Targeted case management" means services that assist a member to access needed medical, social, or other resources and services by establishing and maintaining a referral process for needed and appropriate services and avoiding duplication of services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.

Mont. Admin. R. 37.86.3402 Targeted Case Management Services for High Risk Pregnant Women, Eligibility

(1) A member is eligible for targeted case management as a high risk pregnant woman if:

(a) the person is receiving Medicaid or is presumptively eligible for Medicaid; and

(b) the member's pregnancy outcome is considered high risk.

(2) A pregnancy is of high risk if the member:

(a) is age 17 or younger;

(b) has medical factors which indicate the potential for a poor pregnancy outcome;

(d) has someone in the member's immediate environment who abuses alcohol, tobacco, or drugs;

(e) is currently in an abusive relationship;

(f) is homeless;

(g) has had greater than three residences during pregnancy; or

(h) demonstrates an inability to obtain necessary resources and services and the person meets three of the following criteria:

(i) has a history of physical or sexual abuse;

(ii) has no support system or involvement of a spouse or other supporting person;

(iii) has not had a dental cleaning in the last year;

(iv) is not educated beyond the 12th grade level or does not have a GED;

(v) has a physical disability or mental impairment;

(vi) has had no prenatal care before or during the first 20 weeks of gestation;

(vii) is a refugee or a migrant worker;

(viii) is age 18 or 19;

(ix) is over the age of 35; or

(x) has limited English proficiency.

(3) The member is not eligible for targeted case management services if enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program (HIP).

(4) Targeted case management services may be delivered to the member, if Medicaid eligibility continues, until the last day of the month in which the 12-month postpartum period following delivery ends.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17; AMD, 2024 MAR p. 2021, Eff. 8/10/24.

Mont. Admin. R. 37.86.3405 Targeted Case Management Services for High Risk Pregnant Women, Coverage

(1) Reimbursable targeted case management services for high risk pregnant women are:

(a) comprehensive assessment and periodic reassessment;

(b) care plan development;

(d) monitoring and follow up.

(2) Face-to-face comprehensive assessments must occur at least monthly during the pregnancy.

(3) Two postpartum reassessments must occur after the end of pregnancy and prior to the last day of the month in which the 12-month postpartum period occurs.

(4) Monitoring must include at least one annual monitoring to determine if the following conditions are met:

(a) services are being furnished in accordance with the member's care plan;

(b) services in the care plan are adequate; and

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17; AMD, 2024 MAR p. 2021, Eff. 8/10/24.

Mont. Admin. R. 37.86.3410 Targeted Case Management Services for High Risk Pregnant Women, Provider Requirements

(1) These requirements are in addition to those requirements contained in rule and statutory provisions generally applicable to Medicaid providers.

(2) To be qualified as a provider of targeted case management services for high risk pregnant women, an enrolled Montana Medicaid provider must:

(a) be approved by the department;

(b) meet the requirements in (3) through (8);

(d) demonstrate an understanding of the concept of prenatal care coordination services; and

(e) have developed collaborative working relationships with health care and other agencies in the area to be served.

(3) A targeted case management provider must use an interdisciplinary team that includes members from the professions of nursing, social work, and nutrition.

(a) The professional requirements are the following:

(i) nursing must be provided by a registered nurse who has a current Montana license and is either:

(A) a registered nurse whose education includes course work in public health; or

(B) a certified nurse practitioner;

(ii) social work must be provided by one of the following:

(A) a clinical social worker with a master's in social work (MSW), who has a current Montana license;

(B) a master's level counselor (LCPC), who has a current Montana license; or

(iii) nutrition services must be provided by a registered dietitian who is licensed as a nutritionist in Montana and has one year experience in public health and/or maternal-child health.

(b) The department must be notified within 30 days regarding any staff changes or updates.

(c) To accommodate special agency and geographic needs and circumstances, exceptions to the staffing requirements, including the use of paraprofessionals, may be allowed if approved by the department. If the targeted case management team includes a paraprofessional, that individual must have a minimum of an associate's degree in behavioral sciences or a related field with two years of closely related work experience, and complete a state-sponsored training for paraprofessional targeted case managers. Qualifying experience may be substituted, year for year, for education.

(4) The targeted case management provider must be able to provide the services of at least one of the professional disciplines listed in (3) directly. The other disciplines may be provided through subcontracts. Where services are provided through a subcontractor, the subcontract must be submitted to the department or designee for review and approval.

(5) A targeted case management provider must:

(a) conduct activities to inform the target population and health care and social service providers in the geographic area to be served of its prenatal care coordination services;

(b) deliver prenatal care coordination services appropriate to the individual member's level of need;

(d) perform assessments and develop care plans for the appropriate level of care and document services provided;

(e) schedule services to accommodate the member's situation;

(f) inform members regarding whom and when to call for pregnancy emergencies;

(g) establish working relationships with medical providers, community agencies, and other appropriate organizations;

(h) assure that ongoing communication and coordination of member care occurs within the targeted case management team and with the member's medical prenatal care provider at least quarterly or at the time of any medical referrals;

(i) provide services in a home, office, or clinic setting, with telephone contacts as appropriate;

(j) have a system for handling member grievances; and

(k) maintain an adequate and confidential records system. All services provided directly or through a subcontractor must be documented in this system.

(6) A case manager providing services for a targeted case management provider must have knowledge of:

(a) federal, state, and local programs for children and pregnant women such as WIC, immunizations, perinatal health care, family planning, genetic services, hepatitis B screening, and other healthcare related programs in Montana;

(b) individual health care plan development and evaluation;

(d) nationally recognized perinatal and child health care standards.

(7) A case manager providing services for a targeted case management provider must have the ability to:

(a) develop an individual care plan based on an assessment of a member's health, nutritional and psychosocial status, and personal and community resources;

(b) inform a member regarding health conditions and implications of risk factors;

(d) establish linkages with service providers.

(e) coordinate access to multiple agency services to the benefit of the member; and

(f) evaluate a member's progress in obtaining appropriate medical care and other needed services.

(8) Providers must maintain case records that meet the maintenance of records and auditing guidelines set forth in ARM 37.85.414 and that document for all members receiving targeted case management the following:

(a) the name of the member;

(b) the dates of the targeted case management services;

(d) the nature, content, and units of the targeted case management services received and whether goals specified in the care plan have been achieved;

(e) whether the member has declined services in the care plan;

(f) the need for, occurrences of, and coordination with other targeted case managers;

(g) a timeline for obtaining needed services; and

(h) a timeline for reevaluation of the plan.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.

Mont. Admin. R. 37.86.3411 Case Management Services for High Risk Pregnant Women, Financial Records, and Reporting

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 2-4-201, 53-2-201, 53-2-606, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1992 MAR p. 1496, Eff. 7/17/92; AMD, 1996 MAR p. 1566, Eff. 6/7/96; AMD, 1997 MAR p. 474, Eff. 3/11/97; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2004 MAR p. 482, Eff. 2/27/04; REP, 2017 MAR p. 1906, Eff. 10/14/17.

Mont. Admin. R. 37.86.3415 Targeted Case Management Services for High Risk Pregnant Women, Reimbursement

(1) Targeted case management services for high risk pregnant women are reimbursed at the lower of the following:

(a) the provider's customary charge to the general public for the service; or

(b) the department's current fee schedule under ARM 37.85.105.

(2) The following activities may not be billed as targeted case management and are not reimbursable as a unit of targeted case management:

(a) outreach to the member or member's representative;

(b) application activities related to Medicaid services or eligibility;

(d) duplicate payments that are made to providers under Medicaid or other program authorities;

(e) writing, recording, or entering case notes for the member's files;

(f) travel to and from member activities;

(g) coordination of the investigation of any suspected abuse, neglect, or exploitation cases; and

(h) any service less than eight minutes duration if it is the only service provided that day.

(3) Targeted case management services are not separately billable for members enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program.

(4) All targeted case management services must meet the guidelines of medical necessity set forth in ARM 37.85.410.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1996 MAR p. 1997, Eff. 6/7/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2010 MAR p. 424, Eff. 2/12/10; AMD, 2011 MAR p. 449, Eff. 3/25/11; AMD, 2011 MAR p. 1394, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2018 MAR p. 725, Eff. 5/1/18.

Subchapter 37.86.36 Case Management Services for Persons Age 16 and Over with Developmental Disabilities

Mont. Admin. R. 37.86.3601 Case Management Services for Persons Age 16 and Over with Developmental Disabilities, Definitions

The definitions of case management services for persons with developmental disabilities age 16 years of age and over are as follows:

(1) "Developmental disability" means a disability attributable to mental retardation, cerebral palsy, epilepsy, autism, or any other neurological handicapping condition closely related to mental retardation and requiring treatment similar to that required by mentally retarded persons if the disability originated before the person attained age 18, has continued or can be expected to continue indefinitely, and constitutes a substantial handicap of the person.

(2) "Developmental disabilities program" means the program of services administered by the department for persons with developmental disabilities.

(3) "Intermediate care facility for the mentally retarded (ICF/MR)" means a residential facility as defined at 42 USC 1396d(d) and licensed by the Montana Department of Public Health and Human Services to provide active treatment services to persons with developmental disabilities.

(4) "Nursing facility" means a residential facility as defined at 42 USC 1396r(a) and licensed by the Montana Department of Public Health and Human Services to provide nursing services.

(5) "Monitor" means periodic review of the implementation of services identified in the individual plan.

(6) "Individual plan (IP)" means a written plan developed with the client's participation for the provision and management of services in the least restrictive manner to recipients. The plan must contain:

(a) reference to all provided services including identification of providers;

(b) documentation of who was involved in developing the plan;

(d) short term services and objectives;

(e) schedules for service initiation and frequency; and

(f) schedules for updating the plan.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1994 MAR p. 3201, Eff. 12/23/94; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.3602 Case Management Services for Persons Age 16 and Over with Developmental Disabilities, Eligibility

(1) A person is eligible for case management as a person with developmental disabilities if the person:

(a) is receiving Medicaid;

(b) is 16 years of age or over; and

(2) Case management services are not available to:

(a) a person residing in an intermediate care facility for the mentally retarded (ICF/MR) or in a Medicaid certified nursing facility except as provided for in (3); or

(b) a person receiving case management services under a home and community-based waiver program authorized under section 1915 (c) of the Social Security Act.

(3) A person residing in a Medicaid certified nursing facility or intermediate care facility for the mentally retarded (ICF/MR) may receive case management services during the 30 day period immediately preceding the scheduled discharge from a nursing facility in order to coordinate postdischarge services in a noninstitutional setting.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1994 MAR p. 3201, Eff. 12/23/94; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.3605 Case Management Services for Persons Age 16 and Over with Developmental Disabilities, Coverage

(1) Reimbursable case management services for persons age 16 and over with developmental disabilities are:

(a) service coordination which includes the following:

(i) assessment and evaluation of the appropriateness and need for case management and other community services for which the client might be eligible;

(ii) assistance in accessing and obtaining needed services as requested by the client;

(iii) assisting the client's entry into services; and

(iv) monitoring and follow up services received by the client.

(b) planning which includes the following:

(i) development, facilitation, coordination, and monitoring of an individual plan (IP) for the client.

(i) crisis intervention for personal, financial, social, legal, or medical crisis; and

(ii) preventative problem solving with the client and where appropriate the client's family to prevent a crisis.

(d) quality of life which includes the following:

(i) building of personal relationship, communication, trust, and a basic understanding of the client as a unique human being by establishing a rapport with the client and the client's family and friends;

(ii) getting an understanding for how the client is doing or for how client wants to be doing; and

(iii) conducting a quality of life assessment for the client.

(2) Case management services for persons age 16 and over with developmental disabilities are available without geographic limitation.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1994 MAR p. 3201, Eff. 12/23/94; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.3606 Case Management Services for Persons with Developmental Disabilities, Provider Requirements

(1) These requirements are in addition to those contained in rule and statutory provisions generally applicable to Medicaid providers.

(2) The case management provider for persons age 16 and over with developmental disabilities is the Developmental Disabilities program of the department. The program may contract for the delivery of case management services.

(3) Contractors with the program for the provision of case management services must be either accredited by one of the national accreditation agencies for developmental disabilities services specified in ARM 37.34.1801 or licensed under 50-5-201 , MCA as a health care facility by the department.

(4) A case manager must be employed by the Developmental Disabilities program of the department or by a case management provider contracting with the program.

(5) A case manager must meet the following criteria:

(a) A case manager, except as otherwise provided for in (5)(b), must:

(i) have a bachelor's degree in social work or a related field from an accredited college; and

(ii) one year experience in developmental disabilities or other human services:

(A) if the experience is in a human service other than developmental disabilities, the case manager must have completed at least 40 hours of training in the delivery of services to persons with developmental disabilities under a training curriculum reviewed by the developmental disabilities program of the department within no more than three months of hire or designation as a case manager.

(6) All services provided to the client will be monitored by the case manager and the case manager's supervisor. The IP will be reviewed and revised according to the client's needs at least annually, or when major changes are needed.

(7) A provider of direct care services to persons with developmental disabilities may not act as the case management provider for clients for whom the provider delivers services.

(8) A case manager must participate in a minimum of 20 hours of advanced training in services to persons with developmental disabilities each year under a training curriculum reviewed by the Developmental Disabilities program of the department. On-going documentation of the qualifications of case managers and completions of mandated training must be maintained by the employer of the case manager.

(9) A case management provider must:

(a) have a system for handling client grievances; and

(b) protect the confidentiality of client records.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1994 MAR p. 3201, Eff. 12/23/94; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.3607 Case Management Services for Persons with Developmental Disabilities, Reimbursement

(1) Reimbursement for the delivery by provider entities of Medicaid funded targeted case management services to persons with developmental disabilities is provided as specified in the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915(c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, dated July 1, 2025.

(2) The department adopts and incorporates by this reference the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915(c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, dated July 1, 2025. The manual is posted at https://dphhs.mt.gov/BHDD/DisabilityServices/developmentaldisabilities/ddpratesinf.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1994 MAR p. 3201, Eff. 12/23/94; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2007 MAR p. 1681, Eff. 10/26/07; AMD, 2011 MAR p. 1389, Eff. 7/29/11; AMD, 2012 MAR p. 1638, Eff. 8/10/12; AMD, 2013 MAR p. 1210, Eff. 7/12/13; AMD, 2014 MAR p. 1408, Eff. 7/1/14; AMD, 2015 MAR p. 827, Eff. 7/1/15; AMD, 2016 MAR p. 1709, Eff. 9/24/16; AMD, 2017 MAR p. 2312, Eff. 1/1/18; AMD, 2020 MAR p. 593, Eff. 3/28/20; AMD, 2021 MAR p. 1679, Eff. 11/20/21; AMD, 2022 MAR p. 1078, Eff. 7/1/22; AMD, 2023 MAR p. 1025, Eff. 9/9/23; AMD, 2024 MAR p. 2269, Eff. 9/21/24; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26.

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; REP, 2009 MAR p. 266, Eff. 2/27/09.

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2004 MAR p. 1404, Eff. 6/18/04; REP, 2017 MAR p. 1906, Eff. 10/14/17.

Subchapter 37.86.39 Targeted Case Management Services for Children with Special Health Care Needs

Mont. Admin. R. 37.86.3901 Targeted Case Management Services for Children with Special Health Care Needs, Definitions

The definitions of targeted case management services for children and youth with special health care needs are as follows:

(1) "Care plan" means a specific written plan that is based on the information collected through the comprehensive assessment and periodic reassessment process that:

(a) specifies the goals and actions to address the medical, social, educational, and other services needed by the child;

(b) includes activities such as ensuring the active participation of the child and child's caregiver and working with the child and others to develop those goals; and

(2) "Comprehensive assessment and periodic reassessment" means an evaluation to identify a child's need for any medical, educational, social, or other services. These assessment activities include:

(a) taking a child's history;

(b) identifying the child's needs and completing the related documentation; and

(3) "Monitoring and follow-up activity" means activities and contacts that are necessary to ensure the care plan is implemented and adequately addresses the child's needs. The activities may be with the child, family members, service providers, or other entities or individuals and may be conducted as frequently as necessary. Monitoring may be furnished through face-to-face visits, telephone calls, and telemedicine services.

(4) "Paraprofessional" means a person to whom a particular aspect of a professional task is delegated but who is not licensed to practice as a fully qualified professional.

(5) "Referral" means activities that help link the child or child's caregiver with medical, social, or educational providers, and other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

(6) "Targeted case management" means services that assist a child and a child's caregivers to access needed medical, social, or other resources and services by establishing and maintaining a referral process for needed and appropriate services and avoiding duplication of services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.

Mont. Admin. R. 37.86.3902 Targeted Case Management Services for Children with Special Health Care Needs, Eligibility

(1) A child who is receiving Medicaid or is presumptively eligible for Medicaid is eligible for targeted case management services for children and youth with special health care needs if the child meets one of the requirements in (a) or (b) and meets one of the requirements in (c).

(a) The child is under the age of one and meets one of the following:

(i) was born to a mother who abused drugs or alcohol during her pregnancy;

(ii) was born prior to 37 weeks gestation;

(iii) was born at a birth weight of less than 2500 grams; or

(iv) the department has care and placement authority, a voluntary services agreement, an in-home service agreement or a voluntary placement agreement with the parent/guardians.

(b) The child is birth through 18 years of age and meets one of the following:

(i) is infected with the human immunodeficiency virus (HIV), as determined by a positive HIV antibody or antigen test, or who has a diagnosis of HIV disease or AIDS;

(ii) has been diagnosed with a congenital heart condition;

(iii) has been diagnosed with a neurological disorder or brain injury;

(iv) has been diagnosed with a condition that requires use of a ventilator;

(v) has been diagnosed with a condition that causes paraplegia or quadriplegia;

(vi) has been diagnosed with another chronic physical health condition that is expected to last at least 12 months and causes difficulty performing activities of daily living; or

(vii) has been diagnosed with failure to thrive in the past year.

(i) failure to take advantage of necessary health care services;

(ii) noncompliance with their prescribed medication regime; or

(iii) an inability to coordinate multiple medical, social, and other services.

(2) Initial assessment of children covered by these special health care needs targeted case management services may occur in the hospital following the infant's birth. This assessment must be followed by a referral to appropriate service providers in the community. Assessments by all professionals will be accepted, shared, and integrated into planning for all children covered by these services.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.3905 Targeted Case Management Services for Children with Special Health Care Needs, Coverage

(1) The following services are reimbursable targeted case management services for children and youth with special health care needs:

(a) comprehensive assessment and periodic reassessment;

(b) care plan development;

(d) monitoring and follow up.

(2) Monitoring must be at least once annually to determine if the following conditions are being met:

(a) services are being furnished in accordance with the child's care plan;

(b) services in the care plan are adequate; and

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.

Mont. Admin. R. 37.86.3906 Targeted Case Management Services for Children with Special Health Care Needs, Provider Requirements

(1) These requirements are in addition to those contained in rule and statutory provisions generally applicable to medicaid providers.

(2) To be qualified as a provider of targeted case management services for children and youth with special health care needs, an enrolled Montana Medicaid provider must:

(a) be approved by the department;

(b) meet the requirements in (3) through (8);

(c) have knowledge and experience in the delivery of home and community services to children and youth with special health care needs;

(d) demonstrate an understanding of service coordination for children up to 18 years of age; and

(e) have developed collaborative working relationships with health care and other providers in the area to be served.

(3) A targeted case management provider must use an interdisciplinary team that includes members from the professions of nursing and social work.

(a) The professional requirements are the following:

(i) nursing must be provided by a registered nurse, who has a current Montana license and is either:

(A) a registered nurse whose education includes course work in public health; or

(B) a certified nurse practitioner; and

(ii) social work must be provided by one of the following:

(A) clinical social worker with a master's in social work (MSW), who has a current Montana license;

(B) master's level counselor (LCPC), who has a current Montana license; or

(b) The department must be notified within 30 days regarding any staff changes or updates.

(4) The targeted case management provider must be able to directly provide services of at least one of the professional disciplines listed in (3) of this rule. The other disciplines may be provided through subcontracts. Where services are provided through a subcontractor, the subcontract must be submitted to the department or designee for review and approval.

(5) A targeted case management provider must:

(a) conduct activities to inform the target population and health care and social service providers in the geographic area to be served of its services for youth and children with special health care needs;

(b) deliver targeted case management services appropriate to the child and caregiver's level of need;

(d) perform assessments and develop care plans for the appropriate level of care and document the services provided;

(e) schedule services to accommodate the child's situation;

(f) inform a child and the child's caregivers regarding whom and when to call for health care emergencies;

(g) establish working relationships with medical providers, community agencies, and other appropriate organizations;

(h) assure ongoing communication and coordination of the child's care occur within the targeted case management team and the child's primary care provider at least quarterly or at the time of any medical referral;

(i) provide services in a home, office, or clinic setting with telephone contacts as appropriate;

(j) have a system for handling grievances; and

(k) maintain an adequate and confidential record system. All services provided must be documented in this system.

(6) A case targeted manager must have knowledge of:

(a) federal, state and local programs for children and youth such as WIC, immunizations, children's special health services, genetic services, hepatitis B screening, EPSDT, Montana Milestones (Part C Early Interventions), and other health care related programs in Montana;

(b) individual health care systems, plan development, and evaluation;

(d) nationally recognized early childhood health care and well child health standards.

(7) A targeted case manager must have the ability to:

(a) develop or participate in the development of an individual care plan based on assessment of a child's health, nutritional and psychosocial status, and personal and community resources;

(b) inform a child and the child's caregivers regarding health conditions and implications of risk factors;

(d) assist the child and the child's caregivers to establish linkages among service providers;

(e) coordinate access to multiple provider services to benefit the child and the child's caregivers; and

(f) evaluate a child's and the child's caregiver's progress in obtaining appropriate medical care and other needed services.

(8) Providers must maintain case records that meet the maintenance of records and auditing guidelines set forth in ARM 37.85.414 and that document, for all members receiving targeted case management, the following:

(a) the name of the member;

(b) the dates of the targeted case management services;

(d) the nature, content, and units of the targeted case management services received, and whether goals specified in the care plan have been achieved;

(e) whether the member has declined services in the care plan;

(f) the need for, and occurrences of, coordination with other targeted case managers;

(g) a timeline for obtaining needed services; and

(h) a timeline for reevaluation of the plan.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Mont. Admin. R. 37.86.3910 Targeted Case Management Services for Children with Special Health Care Needs, Reimbursement

(1) Targeted case management services for children and youth with special health care needs are reimbursed at the lower of the following:

(a) the provider's customary charge to the general public for the service; or

(b) the department's current fee schedule under ARM 37.85.105.

(2) The following activities may not be billed as targeted case management and are not reimbursable as a unit of targeted case management:

(a) outreach to the child or child's caregiver(s);

(b) application activities related to Medicaid services or eligibility;

(d) duplicate payments that are made to providers under Medicaid or other program authorities;

(e) writing, recording, or entering case notes for the member's files;

(f) travel to and from member activities;

(g) coordination of the investigation of any suspected abuse, neglect, or exploitation cases; and

(h) any service less than eight minutes duration if it is the only service provided that day.

(4) All targeted case management services must meet the guidelines of medical necessity set forth in ARM 37.85.410.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.

Subchapter 37.86.40 Targeted Case Management Services for Substance Use Disorders

Mont. Admin. R. 37.86.4001 Targeted Case Management Services for Substance Use Disorders, Definitions

(1) "Adult" means a person 21 years of age or older.

(2) "Assessment" and "periodic reassessment" means determining the need for any medical, educational, social, or other services. These assessment activities include the following:

(a) taking client history;

(b) identifying the needs of the individual and completing related documentation;

(c) gathering information from other sources, such as family members, medical providers, social workers, and educators (if necessary) to form a complete assessment of the eligible individual.

(3) "Case Planning" means the development and periodic revision of a specific care plan based on the information collected through the assessment, that includes the following:

(a) specifies the goals and actions to address the medical, social, education, and other services needed by the eligible individual.

(b) includes activities such as ensuring the active participation of the eligible individual and working with the individual, the individual's authorized health care decision maker, if appropriate, or others to develop those goals.

(4) "Coordination, referral, and related activities" means activities that help the eligible individual obtain needed services. The activities include ones that help link the individual with medical, social, and educational providers or other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

(5) "Monitoring and follow-up activities" means activities and contacts necessary to ensure the care plan is effectively implemented and adequately addresses the needs of the eligible individual. These activities may be with the person, family members, service providers, or other entities or individuals and conducted as frequently as necessary to help determine whether the following conditions have occurred:

(a) services are being furnished in accordance with the person's care plan;

(b) services in the care plan are adequate to meet the needs of the person; or

(6) "SSA" means Social Security Act.

(7) "Substance Abuse" means a person meets requirements in DSM-IV-TR for diagnosis of: 305.00; 305.20; 305.30; 305.40; 305.50; 305.60; 305.70; or 305.90.

(8) "Substance Dependency" means a person meets requirements in DSM-IV-TR for diagnosis of: 303.90; 304.20; 304.30; 304.40; 304.60; 304.70; 304.80; 305.50; or 307.90.

(9) "Substance Use Disorders" means a person who has either a diagnosis of substance abuse and/or substance dependency.

(10) "TCM" means Targeted Case Management.

(11) "Youth" means a person from birth up to and including 20 years of age.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2013 MAR p. 269, Eff. 3/1/13.

Mont. Admin. R. 37.86.4002 Targeted Case Management Services for Substance Use Disorders, Eligibility

(1) TCM services are available under ARM 37.86.4001, 37.86.4002, 37.86.4005, 37.86.4006, 37.86.4007, and 37.86.4010 only to persons who meet the following criteria:

(a) Youth who are 20 years of age or younger with a diagnosis of substance dependency or substance abuse.

(b) Adults who are 21 years of age or older with a diagnosis of substance dependency.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA NEW, 2013 MAR p. 269, Eff. 3/1/13.

Mont. Admin. R. 37.86.4005 Targeted Case Management Services for Substance Use Disorders, Service Coverage

(1) TCM services must meet all requirements found in ARM 37.86.3301 through 37.86.3306.

(2) TCM services for substance use disorders include those indicated in ARM 37.86.4001(2) through (5).

(3) TCM services for substance use disorders are provided by state-approved chemical dependency treatment programs in accordance with these rules and the provisions of ARM 37.27.901 through ARM 37.27.912, and 53-24-208, MCA.

(4) TCM services may include contacts with noneligible individuals for purposes related to identification of the person's needs, accessing needed services, identifying needs and supports to assist in obtaining identified services, providing case managers with useful feedback, and alerting case managers to changes in the person's needs.

(5) TCM does not include:

(a) direct delivery of medical, educational, social, or other services to which a person has been referred;

(b) when activities are an integral and inseparable component of another covered Medicaid service;

(d) writing, recording, or entering case notes for the person's file;

(e) coordination of the investigation of suspected abuse, neglect, and/or exploitation cases;

(f) travel to and from activities, with or without the person;

(g) any service that does not incorporate the allowable TCM components, even if written into the individualized TCM case plan;

(h) Medicaid determination and redetermination (arranging for appointments, monitoring completion of needed steps for determination are eligible TCM services); and

(i) activities for which a person may be eligible that are integral to the administration of another nonmedical program such as guardianship, child welfare/child protective services, parole, probation, foster care services, or specialized education programs except for case management that is included in an individualized education program or individualized family service plan consistent with SSA section 1903c for services furnished to a child with a disability or to an infant or toddler with a disability.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2013 MAR p. 269, Eff. 3/1/13.

Mont. Admin. R. 37.86.4006 Targeted Case Management Services for Substance Use Disorders, Service Requirements

(1) Persons receiving TCM services are allowed the freedom of choice of any qualified Medicaid provider for targeted case management services.

(2) TCM service providers cannot restrict a person's access to other Medicaid services.

(3) TCM services will not duplicate payments made to public agencies or private entities under the Medicaid program and other program authorities.

(4) A person cannot be compelled to receive TCM services as a condition of receipt of other Medicaid services or condition of receipt of other Medicaid services on receipt of TCM services.

(5) TCM services must be supported by narrative documentation of all services provided.

(6) TCM services must be provided according to a TCM plan which must:

(a) be developed jointly by the case manager and the person;

(b) identify measurable objectives;

(d) identify agencies and contacts which will assist in meeting the objectives;

(e) be incorporated into the treatment plan;

(f) identify natural and community supports to be utilized and developed; and

(g) include an objective to serve the person in the least restrictive and most culturally appropriate therapeutic environment possible for the person. The TCM plan should also be directed toward facilitating preservation of the person in the family unit, preventing out-of-community placement, or facilitating the person's return from inpatient or residential care.

(7) Objectives in a TCM plan must have an identified date of review no more than 90 days after the plan date. Plans will be revised to reflect changes in personal goals and needs, and services provided to the person.

(8) TCM services must be delivered in accordance with the person's needs.

(9) Comprehensive TCM services must be provided on a one-to-one basis, to one person, and through one case manager.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2013 MAR p. 269, Eff. 3/1/13.

Mont. Admin. R. 37.86.4007 Targeted Case Management Services for Substance Use Disorders, Provider Requirements

(1) The requirement in (2) is in addition to those requirements contained in rules generally applicable to Medicaid providers.

(2) TCM services for substance use disorders must be provided by a state-approved substance use disorder treatment program that is enrolled in the Montana Medicaid program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2013 MAR p. 269, Eff. 3/1/13.

Mont. Admin. R. 37.86.4010 Targeted Case Management Services for Substance Use Disorders, Reimbursement

(1) TCM services for substance use disorders will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is a period of 15 minutes.

(2) The department may, in its discretion, designate a single provider to provide targeted case management services in a designated geographical region. Any provider designated as the sole case management provider for a designated geographical region must, as a condition of such designation, agree to serve the entire designated geographical region.

(3) The provider reimbursement rate for case management services for substance use disorders is stated in the department's fee schedule provided in ARM 37.85.105(5).

(4) The department will pay the lower of the following for TCM services:

(a) the provider's actual submitted charge for services; or

(b) the amount specified in the State Approved Chemical Dependency Program Manual.

(5) Providers may bill TCM services for persons transitioning from an institution to a community setting as follows:

(a) With a covered inpatient stay, the person receiving services may be eligible for TCM services during the last 14 days prior to discharge to the community.

(b) TCM activities must be coordinated with and not duplicate inpatient discharge planning.

(c) Amount, duration, and scope of the case management activities will be documented in a person's plan of care including activities prior to and post-discharge, to facilitate a successful transition to community living.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2013 MAR p. 269, Eff. 3/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13.

Subchapter 37.86.42 Dialysis Clinics for End Stage Renal Disease

Mont. Admin. R. 37.86.4201 Dialysis Clinics for End Stage Renal Disease, Definitions

(1) "Dialysis clinics (DC)" are facilities licensed by the officially designated authority in the state where the institution is located and certified by the Centers for Medicare and Medicaid Services (CMS) to:

(a) furnish outpatient maintenance dialysis directly to end stage renal disease (ESRD) patients; and

(b) provide training for self-dialysis and home dialysis.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1990 MAR p. 1607, Eff. 8/17/90; TRANS, from SRS, 2000 MAR p. 481; AMD, 2011 MAR p. 2294, Eff. 10/28/11.

Mont. Admin. R. 37.86.4202 Dialysis Clinics for End Stage Renal Disease, Requirements

(1) These requirements are in addition to those contained in ARM 37.85.401, 37.85.402, 37.85.406, 37.85.407, 37.85.410, 37.85.414, and 37.85.415.

(2) The provision of outpatient maintenance dialysis and related services by the Medicaid program will be coordinated with the Medicare renal disease program as provided in CFR Title 42 section 413.171 and 413.172.

(3) Outpatient maintenance dialysis and related services in a DC will be provided only to a person who has been diagnosed as suffering from chronic ESRD by a physician.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1990 MAR p. 1607, Eff. 8/17/90; TRANS, from SRS, 2000 MAR p. 481; AMD, 2011 MAR p. 2294, Eff. 10/28/11; AMD, 2014 MAR p. 1410, Eff. 7/1/14.

Mont. Admin. R. 37.86.4205 Dialysis Clinics for End Stage Renal Disease, Reimbursement

(1) Reimbursement for outpatient maintenance dialysis and other related services provided in a dialysis clinic to include the bundled Medicare composite rate is provided in ARM 37.85.105(3). The department will not allow add-on adjustments to the composite rate.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1990 MAR p. 1607, Eff. 8/17/90; TRANS, from SRS, 2000 MAR p. 481; AMD, 2011 MAR p. 2294, Eff. 10/28/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1410, Eff. 7/1/14.

Subchapter 37.86.44 Rural Health Clinics and Federally Qualified Health Centers

Mont. Admin. R. 37.86.4401 Rural Health Clinics and Federally Qualified Health Centers, Definitions

(1) "Allowable costs" are the costs incurred by an RHC or FQHC, which are reasonable in amount and necessary and proper to the efficient delivery of services. Allowable costs are defined in accordance with reasonable cost principles in 42 CFR Parts 405 and 413.

(2) "Baseline PPS rate" is defined as an RHC's or FQHC's current prospective payment system (PPS) rate established in accordance with ARM 37.86.4413, 37.86.4420(2), 37.86.4409, or 37.86.4410, as adjusted annually by the Medicare economic index (MEI).

(3) "Category of service" means a type of Medicaid covered service that is furnished in an RHC or FQHC.

(4) "Change in the scope of service" means a change that affects the type, intensity, duration, or amount of services provided by an RHC or FQHC. The change in the scope of service must reasonably be expected to last at least one year.

(5) "Crossover claim" means a claim for services provided to Medicare/Medicaid dual eligibles or qualified Medicare beneficiaries.

(6) "Federally qualified health center (FQHC)" means an entity as defined in 42 USC 1396d(l)(2). A copy of the cited statute is available upon request from the Department of Public Health and Human Services, Health Resources Division, Hospital and Physicians Services Bureau, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(7) "FQHC services" are as defined in 42 USC 1396d(l)(2).

(8) "Health professional" means services furnished by a:

(a) physician;

(b) nurse practitioner (NP);

(d) certified nurse-midwife (CNM);

(e) licensed clinical psychologist (LCP);

(f) licensed clinical social worker (LCSW);

(g) licensed professional counselor (LCPC);

(h) licensed marriage and family therapist (LMFT);

(i) licensed addiction counselor (LAC);

(j) clinical pharmacist practitioner; and

(k) in-training mental health professional, as defined in ARM 37.85.213.

(9) "Incremental change" means a positive or negative adjustment to a baseline PPS rate.

(10) "Independent entity" means an RHC or an FQHC that is not a provider-based entity.

(11) "Interim PPS rate" is the rate established when an RHC or FQHC initially opens and is set in accordance with ARM 37.86.4413(1) and (2).

(12) "Provider" means the entity enrolled in the Montana Medicaid program as an RHC or FQHC.

(13) "Provider-based entity" means an FQHC or RHC that is an integral and subordinate part of a hospital, skilled nursing facility, or home health agency that is participating in the Medicare program and that is operated with other departments of the provider under common licensure, governance and professional supervision.

(14) "Reporting period" means a period of 12 consecutive months specified by an RHC or FQHC as the period for which the entity must report its costs and utilization. The reporting period must correspond to the provider's fiscal year. The first and last reporting periods may be less than 12 months.

(15) "Rural health clinic (RHC)" means an entity as defined in 42 USC 1396d(l)(1).

(16) "Rural health clinic (RHC) services" are as defined in 42 USC 1396(l)(1).

(17) "Temporary PPS rate" is the rate established in accordance with ARM 37.86.4410.

(18) "Visit" has the meaning set forth in ARM 37.86.4402.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2043, Eff. 10/12/01; AMD, 2005 MAR p. 975, Eff. 6/17/05; AMD, 2015 MAR p. 761, Eff. 7/1/15; AMD, 2016 MAR p. 1712, Eff. 10/1/16; AMD, 2017 MAR p. 908, Eff. 7/1/17; AMD, 2019 MAR p. 1866, Eff. 10/19/19; AMD, 2021 MAR p. 1232, Eff. 9/25/21; AMD, 2024 MAR p. 2014, Eff. 8/10/24.

Mont. Admin. R. 37.86.4402 Rural Health Clinics and Federally Qualified Health Centers, Visits and Encounters

(1) A visit is a face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC health professional for the purpose of providing RHC or FQHC services. Reimbursement is available for one encounter per day per eligible member unless it is necessary for the member:

(a) to be seen by different health professionals with different specialties; or

(b) to be seen multiple times per day due to unrelated diagnoses.

(2) Encounters with the same primary diagnosis are not considered separately billable visits, regardless of the health professional providing the service.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 975, Eff. 6/17/05; AMD, 2019 MAR p. 1866, Eff. 10/19/19.

Mont. Admin. R. 37.86.4405 Rural Health Clinics and Federally Qualified Health Centers, Provider Participation Requirements

(1) The requirements of this subchapter are in addition to those contained in rule provisions generally applicable to medicaid providers.

(2) As a condition of participation in the Montana medicaid program, a RHC or FQHC must maintain a current Montana medicaid provider enrollment according to the requirements of ARM 37.85.402.

(3) As a condition of participation in the Montana medicaid program, a rural health clinic must be and remain certified by the medicare program under the conditions of certification specified in 42 CFR Part 491, subpart A.

(4) As a condition of participation in the Montana medicaid program, an FQHC must be a federally qualified health center as defined in 42 USC 1396d(l) (2) (B) .

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2043, Eff. 10/12/01.

Mont. Admin. R. 37.86.4406 Rural Health Clinics and Federally Qualified Health Centers, Service Requirements

(1) The Montana Medicaid program will cover and reimburse under the RHC or FQHC programs only those services that are RHC services or FQHC services as defined in ARM 37.86.4401 and subject to the provisions of this subchapter.

(2) The Montana Medicaid program will not reimburse an RHC or FQHC for RHC or FQHC services that are services covered by a health maintenance organization for an enrolled member, as provided in ARM Title 37, chapter 86, subchapter 50, except as provided in ARM 37.86.4414.

(3) RHC or FQHC services are covered by Montana Medicaid when provided in accordance with these rules to a member in an outpatient setting, including the RHC or FQHC, other medical facility (including a dental office), or a member's place of residence. A member's place of residence may be a nursing facility or other institution.

(4) Services provided to a member in a hospital setting are not reimbursed in accordance with these rules.

(5) The Montana Medicaid program will cover and reimburse RHC or FQHC services only if the services are provided in accordance with the same requirements that would apply if the service were provided by an individual or entity other than an RHC or an FQHC, except as specifically provided otherwise in this subchapter. These requirements include but are not limited to the following:

(a) The health professional providing the RHC or FQHC service must meet the same requirements that would apply if the health professional were to enroll directly in the Montana Medicaid program in the category of service to be provided. Such requirements include but are not limited to applicable licensure, certification and registration requirements, and applicable restrictions upon the form of entity or category of individual provider that may provide particular services. The health professional is not required to enroll separately as a Medicaid provider.

(b) The RHC or FQHC services are subject to any applicable limitations on the amount, scope, or duration of services covered by the Medicaid program, e.g., scope of practice restrictions under state licensure law, coverage exclusions, e.g., noncoverage of physical therapy maintenance services, limits on the number of hours, visits, or other units of service covered in a particular period or on the frequency of services covered, limits on the type of items or services covered within a particular category, medical necessity requirements, including specific medical necessity criteria applicable to a particular item or service, and early and periodic screening, diagnostic and treatment services (EPSDT) program requirements and restrictions.

(c) In addition to general record requirements under ARM 37.85.414, RHCs and FQHCs must comply with any additional particular record or documentation requirements applicable to the particular category or type of service, e.g., requirements for documentation of compliance with supervision and protocol requirements, requirements for written documentation of prescription or referral, requirements for written care plans and prerequisites for receipt of a particular item or service by a particular recipient.

(d) Providers must bill for RHC or FQHC services using the revenue codes specified in the department's RHC/FQHC services provider manual. The department must provide 30 days prior written notice to providers of any changes in revenue codes.

(e) RHCs and FQHCs must comply with requirements for Medicaid program authorization prior to provision of services or prior to payment, as applicable to the particular category of services being provided.

(f) Reimbursement will be made to RHCs and FQHCs for RHC and FQHC services as provided in ARM 37.86.4412 through 37.86.4414, 37.86.4420, 37.86.4408, 37.86.4409, and 37.86.4410, rather than as provided in the rules applicable to the particular category of services. This rule does not permit reimbursement of services provided by health professionals under ARM 37.86.4412 through 37.86.4414, 37.86.4420, 37.86.4408, 37.86.4409, and 37.86.4410 when the services are not provided as an RHC or FQHC service and when the health professional is separately enrolled in and providing services under a particular Medicaid service category, subject to the rules applicable to the particular service category.

(6) A provider must notify the department, in writing, of a change in the scope of service offered by the RHC or FQHC to Medicaid members, in accordance with 37.86.4408, 37.86.4409, and 37.86.4410.

(7) The opening of new or additional service locations absent of a change in scope of service will be assigned the same baseline PPS rate as the primary RHC or FQHC.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2043, Eff. 10/12/01; AMD, 2005 MAR p. 975, Eff. 6/17/05; AMD, 2007 MAR p. 1680, Eff. 10/26/07; AMD, 2015 MAR p. 761, Eff. 7/1/15; AMD, 2019 MAR p. 1866, Eff. 10/19/19.

Mont. Admin. R. 37.86.4407 Rural Health Clinics and Federally Qualified Health Centers, Record Keeping and Reports

(1) A provider must meet the record keeping and other requirements of ARM 37.85.414 in addition to the requirements of this rule.

(2) A provider must make and maintain adequate financial and statistical records in accordance with generally accepted accounting principles, as defined by the American institute of certified public accountants. The provider's records must be sufficient to allow the department and its agents to determine payment for the RHC or FQHC services provided to medicaid recipients and to provide a record that may be audited using generally accepted auditing standards. Such records must be maintained for a period of six years, three months after a cost report is filed with respect to the period covered by such records or until such cost report is finally settled, whichever is later.

(3) The records described in (2) must be available at the provider facility at all reasonable times and shall be subject to inspection, review and audit by the department or its agents, the United States department of health and human services, the general accounting office, the Montana legislative auditor, and other governmental agencies as authorized by law.

(4) Upon failure or refusal of the provider to make available and allow access to such records, or to report an increase or decrease in scope of services, the department may recover in full all payments made to the provider during the reporting period to which such records relate and may suspend any further payments to the provider until such time as the provider fully complies with this rule.

(5) No later than 30 days prior to the beginning of its initial reporting period as a new provider or following a change in ownership, a provider must submit to the department or its agent an estimate of budgeted costs and visits for RHC or FQHC services for the reporting period in the form and detail required by the department and such other information as the department may require to establish a rate as provided at ARM 37.86.4413.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2043, Eff. 10/12/01; AMD, 2005 MAR p. 975, Eff. 6/17/05.

Mont. Admin. R. 37.86.4408 Rural Health Clinics and Federally Qualified Health Centers, Requirements for Change in Scope of Service Request

(1) An RHC or FQHC experiences a change in scope of service if it has experienced a change in the type, intensity, duration, or amount of an RHC or FQHC service. A change in scope of service may result in an incremental change to the baseline PPS rate.

(2) An RHC or FQHC must apply to the department if it experiences a change in scope of service, even if the change in scope of service will not result in an incremental change to the baseline PPS rate. An RHC or FQHC must follow the procedures in ARM 37.86.4409 and ARM 37.86.4410 to apply for a change in scope of service.

(3) A change in scope of service is limited to the following circumstances, and an RHC or FQHC applying for a change in scope of service must demonstrate at least one of the following:

(a) the addition of a new service not incorporated in the baseline PPS rate or deletion of a service incorporated in the baseline PPS rate;

(b) the addition or deletion of a covered Medicaid RHC or FQHC service under the State Plan;

(d) a change in service due to a change in applicable technology or medical practices utilized by the RHC or FQHC not otherwise paid for through state or federal funds;

(e) a change in the types of patients served, including but not limited to, populations with HIV/AIDS, populations with other chronic diseases, or homeless, elderly, migrant, or other special populations that require more intensive and frequent care, corresponding to a change in the services provided by the RHC or FQHC;

(f) a change in operating costs attributable to capital expenditures corresponding to a change in the services provided by the RHC or FQHC; or

(g) a change in the provider mix, including, but not limited to:

(i) a transition from mid-level providers to physicians with a corresponding change in the services provided by the RHC or FQHC; or

(ii) the addition or removal of specialty providers with a corresponding change in the services provided by the RHC or FQHC.

(4) An RHC or FQHC must demonstrate how one or more of the circumstances in (3) impacts services provided by the RHC or FQHC and must demonstrate an overall change to the RHC or FQHC. For example, the RHC or FQHC may increase services to a high need population; however, this increase may be offset by growth in the number of lower intensity visits, thereby not warranting an incremental change to the baseline PPS rate.

(5) The following circumstances alone do not constitute a change in scope of service rate adjustment:

(a) a change in ownership, including acquisition by another healthcare entity or RHC or FQHC;

(b) a change in the number of staff furnishing an existing service;

(d) a change in the number of encounters;

(e) a change in the cost of supplies for existing services;

(f) a change in salaries and benefits not directly related to a change in scope of service;

(g) a change in patient type and/or volume without a corresponding change in the services provided;

(h) capital expenditures for losses covered by insurance;

(i) a change in office location or office space;

(j) a change in office hours not directly related to a change in the scope of service as described in (3);

(k) expansion or remodel not directly related to a change in the scope of service as described in (3); or

(l) the addition of a new site or removal of an existing site, which offers the same RHC or FQHC services.

(6) The circumstances in (5) may be factors in demonstrating a change in scope of service as long as the RHC or FQHC also demonstrates one or more of the circumstances in (3).

(7) RHCs or FQHCs that choose to participate in contracted programs to provide services outside of the PPS rate must meet the requirements and adhere to the rules outlined in the applicable contract.

(a) Contracts for services outside of RHC or FQHC services will be reimbursed outside the PPS rate and such services will not be included in calculation of the baseline PPS rate or in a request for change in scope of service. Providers who chose to enter contracted programs and meet all related requirements will receive a separate payment as established in the Montana Medicaid State Plan or Centers for Medicare and Medicaid Services approved waiver.

(b) If an RHC's or FQHC's existing baseline PPS rate includes costs associated with contracted programs, the RHC or FQHC must submit a change in scope of service to remove the contracted services from the baseline PPS rate.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2019 MAR p. 1866, Eff. 10/19/19.

Mont. Admin. R. 37.86.4409 Prospective Change in Scope of Service

(1) A prospective change in scope of service is a change the RHC or FQHC plans to implement in the future. An RHC or FQHC may file an application for a prospective change in scope of service and, if approved, may receive a temporary PPS rate, pending final approval of the incremental change to the baseline PPS rate.

(2) An application is deemed timely if the department receives the completed application for a prospective change in scope of service no later than 120 days in advance of the prospective change in scope of service, or otherwise the application is deemed untimely.

(3) An application is completed if it includes the information in (4), and, if applicable, (5).

(4) To apply for a prospective change in scope of service rate adjustment, an RHC or FQHC must submit the following application materials:

(a) a narrative description of each change in scope of service;

(b) the date on which the change in scope of service is scheduled to occur;

(d) the cost report for the fiscal year prior to the year in which the prospective change in scope of service is scheduled to be implemented; and

(e) a projected cost report for the fiscal year in which the change in scope of service is implemented, which considers the change in scope of service. If a projected cost report cannot be completed, the RHC or FQHC must provide sufficient cost and encounter information to establish a temporary rate.

(5) The department may request additional information from the RHC or FQHC. The requested information must be received by the department no later than 30 calendar days from the date of the request to be deemed timely. If the requested information is not received within that timeframe, the application for a prospective change in scope of service is deemed untimely.

(6) No later than 90 days after receiving a completed application, the department shall:

(a) establish the temporary PPS rate by calculating the RHC's or FQHC's allowable cost of services both with and without the added or removed services; and

(b) notify the RHC or FQHC of the temporary PPS rate.

(7) After the change in scope of service occurs, the RHC or FQHC shall notify the department in writing of the implementation date, even if the change is implemented on the scheduled date.

(8) For timely applications, the effective date of the temporary PPS rate is the date the change in scope of service is implemented.

(9) For untimely applications, the effective date of the temporary PPS rate is the later of:

(a) the date the department receives the RHC's or FQHC's completed application materials in (4) and, if applicable, (5); or

(b) the date the change in scope of service is implemented.

(10) No later than six months after the close of the RHC's or FQHC's fiscal year in which the change in scope of service occurred, the RHC or FQHC must supplement its application by filing with the department the following materials:

(a) a narrative description of each change in scope of service, including how the services were provided both before and after the change;

(b) the date on which the prospective change in scope of service was implemented;

(c) the RHC's or FQHC's as-filed Medicare cost reports for the fiscal year prior to the year in which the change in scope of service occurred and for the fiscal year in which the change in scope of service occurred;

(d) for the FQHCs the Uniform Data System reports for the calendar year prior to the change in scope of service, and the calendar year in which the change in scope of service occurred;

(e) a description of each cost center on the cost report affected by the change in scope of service;

(f) an attestation statement that certifies the accuracy, truth, and completeness of the information in the application signed by an officer or administrator of the RHC or FQHC; and

(g) any approved changes in scope of project as defined by the federal Health Resources and Service Administration (HRSA).

(11) The department may request additional information to process the application and must receive the additional information no later than 30 calendar days from the date of the request, or otherwise the application is deemed untimely. The request for additional information will include a notice that failure to submit the materials within the requested 30 calendar days will result in suspension of payments for Medicaid services billed to the department until such time as the supplemental materials are received by the department.

(12) The department must receive the supplemental materials no later than six months after the close of the RHC's or FQHC's fiscal year in which the change in scope of service occurred, or otherwise the application is deemed untimely. Thirty days prior to the expiration of the six-month deadline, if the department has not yet received the supplemental materials, the department shall send a notice to the RHC or FQHC and inform it that failure to submit the materials in a timely manner will result in suspension of payments for Medicaid services billed to the department until such time as the supplemental materials are received by the department.

(13) No later than 90 days after receiving the supplemental materials, the department shall:

(a) establish the incremental change in the baseline PPS rate by calculating the RHC's or FQHC's allowable costs of services both with and without the added or removed services; and

(b) notify the RHC or FQHC of the incremental change in the baseline PPS rate.

(14) For timely filed supplemental materials, the effective date of the incremental change to the baseline PPS rate is the date the change in scope of service was implemented. If the final PPS rate differs from the temporary PPS rate, the department shall calculate the amount of underpayment or overpayment to the RHC or FQHC and reimburse or recoup the amount from future payments to the RHC or FQHC.

(15) If an RHC or FQHC fails to timely submit supplemental materials, the department shall suspend all payments to the RHC or FQHC for Medicaid services billed to the department until such time as the supplemental materials are received. Once all required supplemental materials are received the effective date of the incremental change to the baseline PPS rate is the date the change in scope of service was implemented.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2019 MAR p. 1866, Eff. 10/19/19.

Mont. Admin. R. 37.86.4410 Retrospective Change in Scope of Service

(1) A retrospective change in scope of service occurs when a change took place in the past and the RHC or FQHC is seeking to adjust its rate based on that change. An approved retrospective change in scope of service request may result in an incremental change to the baseline PPS rate.

(2) An RHC or FQHC may apply for an incremental change to the baseline PPS rate for a retrospective change in scope of service once per calendar year. In order to be deemed timely, the completed application must be received by the department no later than six months after the close of the RHC's or FQHC's fiscal year in which the change in scope of service occurred, or otherwise the application is untimely. A completed application must include the information in (3) and, if applicable, (4).

(3) To apply for an incremental change to the baseline PPS rate for a retrospective change in scope of service, an RHC or FQHC must submit the following application materials:

(a) a narrative description of each change in scope of service, including how services were provided both before and after the change;

(b) the RHC's or FQHC's as-filed Medicare cost reports for the fiscal year prior to the change in scope of service, and the fiscal year in which the change in scope of service occurred;

(c) for FQHCs the Uniform Data System reports for the calendar year prior to the change in scope of service, and the calendar year in which the change in scope of service occurred;

(d) a description of each cost center on the cost report affected by the change in scope of service;

(e) an attestation statement that certifies the accuracy, truth, and completeness of the information in the application signed by an officer or administrator of the RHC or FQHC; and

(f) any approved changes in scope of project as defined by the Health Resources and Services Administration (HRSA).

(4) The department may request additional information from the RHC or FQHC. The requested information must be received by the department no later than 30 calendar days from the date of the request, or otherwise the application is deemed untimely.

(5) After receiving a completed application, the department shall calculate the RHC's or FQHC's allowable cost of services both with and without the added or removed services to establish the incremental change to the baseline PPS rate. The department shall notify in writing the RHC or FQHC of the incremental change to the baseline PPS rate within 90 calendar days of receiving the information requested in (3) and (4).

(6) For timely applications, the effective date of the incremental change to the baseline PPS rate is the beginning of the facility's fiscal year following the retrospective change in scope of service. For untimely applications, the effective date of the incremental change to the baseline PPS rate is the date all required information is received by the department.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2019 MAR p. 1866, Eff. 10/19/19.

Mont. Admin. R. 37.86.4412 Rural Health Clinics and Federally Qualified Health Centers, Reimbursement

(1) This subchapter specifies requirements applicable to provision of and reimbursement for RHC and FQHC services. These rules are in addition to requirements generally applicable to Medicaid providers as otherwise provided in state and federal statute, rules, regulations, and policies.

(2) Unless otherwise provided in these rules, this subchapter applies to rate years beginning on or after January 1, 2001. Reimbursement and other substantive RHC and FQHC requirements for earlier periods are subject to the laws, regulations, rules, and policies then in effect. Procedural and other nonsubstantive provisions of these rules are effective upon adoption.

(3) All RHCs and FQHCs will be reimbursed on a prospective payment system (PPS) beginning January 1, 2001 and each succeeding calendar year. The PPS will apply equally to provider based and independent RHCs and FQHCs.

(4) On January 1 of each succeeding calendar year, the rate for the preceding year must be adjusted by the percentage increase in the medicare economic index (MEI) applicable to primary care services for that calendar year.

(5) The department will reimburse the RHC or FQHC for the rate change in (4) retroactive to the effective date of January 1 of the calendar year, beginning with January 1, 2002.

(6) For RHCs or FQHCs that had their initial Medicaid prospective payment system base visit rate calculated in 2001 or starting with the third fiscal year (for "new" RHCs or FQHCs as defined at ARM 37.86.4413), the prospective payment system per-visit rate may be adjusted to take into account any increase or decrease in the scope of service. The department uses the following calculations to determine the amount of an incremental change, if any, and the resulting new PPS rate:

A/B = C

D/E = F

F-C = IC

Current PPS rate + IC = New PPS rate

(a) "A" represents allowable costs before the change in scope of service;

(b) "B" represents total visits before the change in scope of service;

(d) "D" represents allowable costs after the change in scope of service;

(e) "E" represents total visits after the change in scope of service;

(f) "F" represents cost per visit after the change in scope of service; and

(g) "IC" represents the incremental change due to the change in scope of services.

(7) Effective July 1, 2017, approved RHCs and FQHCs participating in Promising Pregnancy Care (PPC) will be reimbursed an enhanced PPS rate. Therefore, RHCs and FQHCs will be reimbursed their existing PPS rate plus an additional amount, in accordance with the fee schedule adopted and effective as provided in ARM 37.85.105, whenever a member attends the educational aspect of the PPC session.

(8) Effective July 1, 2017, RHCs and FQHCs will be reimbursed separately for long-acting reversible contraceptives (LARCs) in addition to their PPS rate. LARCs include intrauterine devices (IUDs) and birth control implants.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2043, Eff. 10/12/01; AMD, 2005 MAR p. 975, Eff. 6/17/05; AMD, 2016 MAR p. 1712, Eff. 10/1/16; AMD, 2017 MAR p. 2303, Eff. 12/9/17; AMD, 2019 MAR p. 1866, Eff. 10/19/19.

Mont. Admin. R. 37.86.4413 Rural Health Clinics and Federally Qualified Health Centers, Establishment of Interim Payment for New Rhc or Fqhc

(1) The interim Medicaid prospective payment system (PPS) base per-visit rate for a newly qualified RHC or FQHC or an FQHC shifting from non-state government operated to privately operated shall be equal to 100% of the average PPS rate for other RHCs or FQHCs located in the same or adjacent area with a similar caseload. In the event that there is no such RHC or FQHC, payment shall be made in accordance with the methodology provided in (2).

(2) If there is no RHC or FQHC located in the same or adjacent area with a similar caseload, the interim PPS rate shall be equal to the RHC's or FQHC's total projected allowable costs divided by the RHC's or FQHC's total projected allowable visits. The provider must submit to the department or its agent an estimate of budgeted costs and visits for the RHC or FQHC for the reporting period in the form and detail required by the department and such other information as the department may require to establish a rate. The projected allowable cost and allowable visit information is subject to a reasonableness review by the department.

(3) At the end of the RHC's or FQHC's first two complete fiscal years, the department will establish the facility specific baseline PPS rate.

(4) The department must receive the RHC's or FQHC's as-filed Medicare cost reports for the first two complete fiscal years no later than six months after the end of the RHC's or FQHC's first two complete fiscal years, or otherwise the request is deemed untimely.

(a) The department may request additional information from the RHC or FQHC, and the facility is required to submit the requested information within 30 days of the department's request. If the requested information is not received within that timeframe, the request is deemed untimely. The request for additional information will include a notice that failure to submit the materials within the requested 30 calendar days will result in suspension of payments for Medicaid services billed to the department until such time as the supplemental materials are received by the department.

(b) If the department has not received the materials in (4)(a) thirty days prior to the expiration of the six month deadline, the department shall send a notice to the RHC or FQHC and inform it that failure to submit the materials in a timely manner will result in suspension of payments for Medicaid services billed to the department until such time as the materials are received by the department.

(5) Upon receiving the RHC's or FQHC's as-filed Medicare cost reports and any additional information requested pursuant to (4)(a), the department will establish the RHC's and FQHC's baseline PPS rate by calculating the total allowable cost of RHC or FQHC services for the first two complete fiscal years divided by the total allowable visits for the first two complete fiscal years. The baseline PPS rate may be adjusted to take into account any increase or decrease in the scope of service as provided in ARM 37.86.4412.

(6) The department will provide written notification of the calculated baseline PPS rate to the RHC or FQHC within 90 days of receiving all information related to the request.

(7) The department shall reimburse the RHC or FQHC the baseline PPS rate for requests submitted within the timeframe specified in (4)(a) and (b) effective the date of the RHC or FQHC enrollment.

(8) If an RHC or FQHC fails to timely submit the materials in (4)(a), or if applicable (2)(b), the department shall suspend all payments to the RHC or FQHC for Medicaid services billed to the department until such time as the supplemental materials are received. Once all required materials are received the effective date of the baseline PPS rate is the effective date of the RHC or FQHC enrollment.

(9) Reimbursement after the baseline PPS rate is only modified through the processes outlined in ARM 37.86.4406, 37.86.4408, 37.86.4409, 37.86.4410, and 37.86.4412.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2043, Eff. 10/12/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2005 MAR p. 1402, Eff. 6/17/05; AMD, 2019 MAR p. 1866, Eff. 10/19/19.

Mont. Admin. R. 37.86.4414 Rural Health Clinics and Federally Qualified Health Centers, Supplemental Payments in Case of Managed Care

(1) In the case of services furnished by an RHC or FQHC pursuant to a contract between the RHC or FQHC and a managed care entity (as defined in section 1932(a) (1) (B) and 1932(a) (1) (C) of the Social Security Act) , payment to the RHC or FQHC shall be a supplemental payment equal to the amount (if any) by which the amount determined under medicaid prospective payment system exceeds the amount of the payments provided under the contract.

(2) The supplemental payment required shall be made quarterly.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2043, Eff. 10/12/01.

Mont. Admin. R. 37.86.4420 Rural Health Clinics and Federally Qualified Health Centers, Alternative Payment Methodologies

(1) In the case of a catastrophic event or extraordinary circumstance that would directly impact the cost of medical services provided by an RHC or FQHC, or upon mutual agreement of the department and the RHC or FQHC the department may provide for payment in any year to an RHC or FQHC for services described in section 1905(a)(2)(B) and (C) of the Social Security Act in an amount determined under an alternative payment methodology that:

(a) is agreed to by the department and the RHC or FQHC; and

(b) results in payment to the RHC or FQHC of an amount which is at least equal to the amount otherwise required to be paid to the RHC or FQHC under the Medicaid prospective payment system.

(2) Beginning July 1, 2019, RHC or FQHC providers may elect to be reimbursed under an Alternative Payment Methodology (APM) equal to the per-visit cost as calculated utilizing the two most recently completed as-filed Medicare cost reports and/or other requested information. Examples include the Uniform Data Systems report, audited financial statements, and Electronic Health Record visit reconciliation.

(a) The APM per-visit rate will not be less than the RHC's or FQHC's existing baseline PPS rate.

(b) RHC or FQHC providers who choose to be reimbursed under the APM, must make the request to the department in writing no later than July 1, 2020.

(c) The department will provide a written notification of the calculated APM per-visit rate to the RHC or FQHC within 90 days of receiving all information related to the request.

(3) The effective date of the APM per-visit rate will be the later of the start of the facility's fiscal year following the most recent submitted Medicare as-filed cost report or July 1, 2019.

(4) If the required information as outlined in (2) is not received prior to July 1, 2020, the option to be reimbursed on the APM is not available.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1998 MAR p. 2045, Eff. 7/31/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 2043, Eff. 10/12/01; AMD, 2019 MAR p. 1866, Eff. 10/19/19.

Subchapter 37.86.45 Promising Pregnancy Care

Mont. Admin. R. 37.86.4501 Promising Pregnancy Care - Definitions

(1) "Group prenatal care" means a combination of individual prenatal care with facilitated group education and support. The groups consist of four to twelve pregnant women with similar due dates.

(2) "Promising Pregnancy Care (PPC)" means the Montana Healthcare Programs reimbursable group prenatal care program. The Montana Healthcare Programs include:

(a) Montana Medicaid;

(b) Healthy Montana Kids (HMK);

(d) the Health and Economic Livelihood Plan (HELP).

(3) "Self-care activities" means activities that members complete on their own and includes activities such as measuring weight and blood pressure.

(4) "State approved program" means a program that meets the education requirement of the department or is Centering Certified through the Centering Healthcare Institute and has been approved for reimbursement by the department.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 2303, Eff. 12/9/17.

Mont. Admin. R. 37.86.4502 Promising Pregnancy Care - General Provisions

(1) These requirements are in addition to those requirements contained in rule and statutory provisions generally applicable to Medicaid providers.

(2) For purposes of Medicaid reimbursement, providers must be a state-approved program.

(3) Pregnant members of Montana Healthcare Programs are eligible for Promising Pregnancy Care.

(4) The department must approve educational materials.

(5) A pregnancy notebook that includes personal health tracking and education materials must be provided to class participants.

(6) Data on all pregnant Medicaid members under the provider's care must be collected and reported to the department. The required data elements are available at the department's website at http://medicaidprovider.mt.gov .

(7) Classes must be provided in a group setting.

(8) Individual assessment will occur in a private area of the group space.

(9) Each class must include time for the participants to interact with other participants.

(10) The classes must be facilitated and have a planned learning objective.

(11) Participants must engage in self-care activities.

(12) The program must include the following information:

(a) nutrition information;

(b) healthy lifestyle choices;

(d) body changes in pregnancy;

(e) stress management;

(f) family planning;

(g) labor education, including types of delivery;

(h) newborn care;

(i) preventing shaken baby syndrome;

(j) preventing sudden infant death syndrome (SIDS); and

(k) postpartum care and adjustments.

(13) The program must include a participant satisfaction survey. The results of this survey must be reported to the department semi-annually. A sample survey is posted at the department's web site at http://medicaidprovider.mt.gov .

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 2303, Eff. 12/9/17.

Mont. Admin. R. 37.86.4503 Promising Pregnancy Care - Reimbursement

(1) Promising Pregnancy Care is reimbursed at the lower of the following:

(a) the provider's usual and customary charge to the general public for the service; or

(b) the department's current fee schedule under ARM 37.85.105 for the appropriate provider type.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2017 MAR p. 2303, Eff. 12/9/17.

Subchapter 37.86.47 Organ Transplant Services

Mont. Admin. R. 37.86.4701 Organ Transplantation, Definitions

(1) "Organ transplantation" means the implantation of a functional human organ for the purpose of maintaining all or a major part of that organ function in the recipient.

(2) "Tissue transplantation" means the implantation of functional, human tissue. For purpose of the transplantation rules, tissue transplants include only corneal, bone marrow, and peripheral stem cell transplants.

(3) Organ and tissue transplantation includes the transplant surgery and those activities directly related to the transplantation. These activities may include:

(a) evaluation of the patient as a potential transplant candidate;

(b) pre-transplant preparation including histo-compatibility testing procedures;

(d) outpatient care, including Federal Drug Administration (FDA) approved medications deemed necessary for maintenance or because of resulting complications.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-141, MCA
History: NEW, 1987 MAR p. 907, Eff. 7/1/87; AMD, 1991 MAR p. 2049, Eff. 11/1/91; AMD, 1993 MAR p. 1367, Eff. 6/25/93; TRANS, from SRS, 2000 MAR p. 481; AMD, 2009 MAR p. 1806, Eff. 10/16/09.

Mont. Admin. R. 37.86.4705 Organ Transplantation, Requirements

(1) This rule provides the requirements for Medicaid coverage of organ and tissue transplantations. The requirements in this rule are in addition to those contained in ARM 37.85.401, 37.85.402, 37.85.406, 37.85.407, 37.85.410, 37.85.412, 37.85.413, 37.85.414, and 37.85.415.

(2) General requirements for Medicaid coverage of transplantations are as follows:

(a) Medicaid will only cover medically necessary organ or tissue transplants.

(i) Services must comply with Medicare coverage guidelines for organ or tissue transplant service.

(ii) If Medicare coverage guidelines are not available, the department or the department's designated review organization will review the requested transplant surgery to determine whether the surgery is medically necessary and is not experimental or investigational.

(b) All cases presented for organ or tissue transplantation require prior authorization from the department's designated review organization, with the exception of corneal transplantation.

(c) Organ transplants must be performed in a Medicare certified center. If Medicare has not designated a certified center, the transplant must be performed by a program that is located in a hospital or parts of a hospital certified by the Organ Procurement and Transplantation Network (OPTN) for the specific organ being transplanted.

(3) Services considered experimental and/or investigational are not a benefit of the Montana Medicaid Program.

(a) Experimental and/or investigational services include:

(i) Procedures and items including prescription drugs, considered experimental and/or investigational by the U.S. Department of Health and Human Services or any other appropriate federal agency.

(ii) Procedures and items, including prescribed drugs, provided as part of a control study, approved by the Department of Health and Human Services or any other appropriate federal agency to demonstrate whether the item, prescribed drug, or procedure is safe and effective in caring, preventing, correcting, or alleviating the effects of certain medical conditions.

(iii) Procedures and items, including prescribed drugs, which may be subject to question, but are not covered in (3)(a)(i) and (ii), will be evaluated by the department or the department's designated medical review organization to determine whether they are experimental and/or investigational.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-131, 53-6-141, MCA
History: NEW, 1987 MAR p. 907, Eff. 7/1/87; AMD, 1991 MAR p. 2049, Eff. 11/1/91; AMD, 1993 MAR p. 1367, Eff. 6/25/93; TRANS, from SRS, 2000 MAR p. 481; AMD, 2009 MAR p. 1806, Eff. 10/16/09.

Mont. Admin. R. 37.86.4706 Organ Transplantation, Reimbursement

(1) Reimbursement for physician services in organ transplantation is provided in accordance with the methodologies described in ARM 37.85.212 and 37.86.105.

(2) All hospital services for organ and tissue transplantation are reimbursed as provided for in ARM 37.85.212, 37.86.2801, 37.86.2806, 37.86.2907, 37.86.2916, 37.87.3005, 37.87.3009, 37.87.3020, 37.87.3025, and 37.87.3037.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-131, 53-6-141, MCA
History: NEW, 1987 MAR p. 907, Eff. 7/1/87; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2009 MAR p. 1806, Eff. 10/16/09.

Subchapter 37.86.50 Health Maintenance Organizations (HMO)

Mont. Admin. R. 37.86.5001 Health Maintenance Organizations: Definitions

(1) "Administrative contractor for managed care" means the entity the department contracts with to perform certain administrative functions of the managed health care programs.

(2) "Basic medicaid" means the program of medicaid services for adults receiving medical assistance through the FAIM program who are 21 years and older and not pregnant. Basic medicaid excludes coverage for dental services, most durable medical equipment and supplies, eye examinations, eyeglasses, hearing aids, audiology services, and personal care services.

(3) "Capitation rate" means the fee the department pays monthly to an HMO for the provision of covered medical and health services to each enrolled recipient. The fee is reimbursed whether or not the enrolled recipient received services during the month for which the fee is intended. The fee may vary by age, eligibility category and region.

(4) "Community-based organizations" means local governmental and nonprofit organizations providing programs of preventive and other health related services. Community-based organizations include but are not limited to: local family planning services; local women, infants and children (WIC) projects; local projects of Montana initiative for the abatement of mortality of infants (MIAMI) ; HIV testing, partner notification and early intervention; childhood lead poisoning prevention services; cherish our Indian children; follow me programs for special needs children.

(5) "Complaint" means an informal, verbal communication which an enrollee or their authorized representative presents regarding what the enrollee or their authorized representative perceives to be an inappropriate or lack of appropriate action by the HMO or any of its providers.

(6) "Contract" means a contract between the department and an HMO for the provision of medical and health services to medicaid recipients.

(7) "County office" means the location people go to apply for medicaid benefits that is either the department's local office of human services or the human services or welfare office of a county.

(8) "Covered services" means all or a part of the medical and health services set forth in ARM 37.86.5007 that an HMO is responsible for delivering to enrolled recipients under a contract with the department.

(9) "Day" means calendar days, except where the term working days or business days is expressly used.

(10) "Department" means the Montana department of public health and human services.

(11) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

(a) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

(b) serious impairment to bodily functions; or

(12) "Emergency room screens" means a medical screening examination within the capacity of the hospital's emergency department, including stabilization when necessary, to determine whether an emergency medical condition exists.

(13) "Emergency services" means, as defined at ARM 37.82.102, inpatient and outpatient hospital services that are necessary to treat an emergency medical condition.

(14) "Enrollee" means a medicaid recipient who has been certified by the department as eligible to enroll with an HMO, and whose name appears on the HMO's enrollment information that the administrative contractor for managed care transmits to the HMO every month as specified in the contract.

(15) "Enrollment area" means the county or counties that an HMO's certificate of authority from the state of Montana permits it to serve and in which the HMO has service capability as required by the department and set forth in the contract. If a proposed enrollment area is other than an entire county or counties, the proposed enrollment area should correspond to the normal service delivery area.

(16) "Exempt" means medicaid recipients who are not ineligible for managed care and who can prove it would be a hardship to participate in a managed care program. The department has the discretion to determine hardship and to place time limits on all exemptions on a case by case basis.

(17) "Families achieving independence in Montana (FAIM) " is a comprehensive welfare reform package. Participation in FAIM affects medicaid coverage for able-bodied adults 21 years and older. FAIM participants who are 21 years and older and not pregnant:

(a) are only eligible for basic medicaid;

(b) are required to enroll in an HMO if one is available in their area. If there is no HMO available, they must enroll in the passport to health program. If there is neither a passport to health program nor an HMO available, recipients stay on regular fee-for-service medicaid.

(18) "Federally qualified HMO" means an HMO qualified under section 1315(a) of the Public Health Service Act as determined by the U.S. public health service.

(19) "Full medicaid" means the full scope of medicaid benefits as defined in ARM 37.85.206.

(20) "Grievance" means a formal, written communication which an enrollee or their authorized representative presents regarding what the enrollee or their authorized representative perceives to be an inappropriate action or lack of appropriate action by the HMO or its providers.

(21) "Health maintenance organization (HMO) " means a health maintenance organization or its parent corporation with a certificate of authority issued in accordance with 33-31-201 , et seq., MCA.

(22) "Ineligible" means medicaid recipients who are not allowed by the department to be under managed care and who must stay on regular medicaid. The following categories of recipients are ineligible:

(a) recipients with a spend down (medically needy) ;

(b) recipients living in a nursing home or institutional setting;

(d) recipients on the medicaid restricted card program;

(e) recipients who have medicare;

(f) recipients who live in an area without medicaid managed care;

(g) recipients in the medicaid eligibility subgroup of subsidized adoption;

(h) recipients whose eligibility period is only retroactive;

(i) recipients who cannot find a primary care provider who is willing to provide case management;

(j) recipients who are receiving medicaid home and community services for persons who are aged or disabled; and

(k) recipients who reside in a county in which there are not enough primary care providers to serve the medicaid population required to participate in the program.

(23) "Managed health care provider" means any one of the alternative systems for delivery of regular fee-for-service medicaid services. Managed health care provider includes health maintenance organizations (HMOs) and primary care case management programs.

(24) "Participating provider" means any person or entity that has entered into a contract with an HMO to provide medical care.

(25) "Primary care provider" means a physician, clinic, or mid-level practitioner other than a certified registered nurse anesthetist that is responsible by contract to serve an HMO's enrollees that has been designated by an enrollee as the provider through whom the enrollee obtains health care benefits provided by the HMO. A primary care provider attends to an enrollee's routine medical care, supervises and coordinates all of the enrollee's health care, determines the need for and initiates all referrals, determines the provider of medical services and determines the medical necessity of the medical services to be performed. Obstetrician or gynecologist means a physician who is board eligible or board certified by the American board of obstetrics and gynecology.

(26) "Recipient" means a person who is eligible for medicaid in accordance with the legal authorities governing eligibility.

(27) "Regular medicaid" means the program of medicaid services for medicaid recipients that would have been available to an enrollee if the enrollee were not enrolled in an HMO.

(28) "Routine care" means medical care for a condition that is not likely to substantially worsen in the absence of immediate medical intervention and is not an urgent condition or an emergency. Routine care can be provided through regularly scheduled appointments without risk of permanent damage to the person's health status.

(29) "School based provider" means a provider that provides services in a school setting.

(30) "Upper payment limit" means the cost to the department of providing the same services to an actuarially equivalent non-enrolled population.

(31) "Urgent care" means medical care necessary for a condition that is not life threatening but which requires treatment that cannot wait for a regularly scheduled clinical appointment because of the prospect of the condition worsening without timely medical intervention.

(32) "Usual manner" means obtaining medicaid benefits in the manner that medicaid recipients obtain them through the regular medicaid program.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5002 Health Maintenance Organizations: Recipient Eligibility

(1) A recipient in any one of the following categories is eligible to enroll with an HMO contracting with the department:

(a) a FAIM or family-related recipient required by ARM 37.86.5103 to participate in a primary care case management program; or

(b) an SSI recipient or SSI-related recipient required by ARM 37.86.5103 to participate in a primary care case management program.

(2) A recipient who is ineligible to participate in a primary care case management program is not eligible to enroll with an HMO contracting with the department.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113, 53-6-116 and 53-6-117, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1997 MAR p. 503, Eff. 3/11/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5005 Health Maintenance Organizations: Enrollment

(1) Recipient enrollment with an HMO contracting with the department is voluntary, except as noted below.

(a) Individuals 21 years of age or older receiving medicaid or medically needy assistance as participants of the FAIM project, and who are not pregnant, are required to enroll in an HMO if one is available in the enrollment area and has not reached its maximum enrollment. If the HMOs in the enrollment area are at maximum enrollment, the individual must participate in the passport to health program as required in ARM 37.86.5101, et seq.

(2) An eligible recipient may request enrollment with a particular HMO.

(3) An eligible recipient may only enroll with an HMO contracting with the department to provide HMO services in the locality of the recipient's residence.

(4) An eligible recipient who is hospitalized, other than a newborn recipient, may enroll initially with an HMO contracting with the department only after the recipient's discharge from the hospital.

(5) Enrollment is requested either by completing a form designated by the administrative contractor for managed care or by a written or verbal request to the administrative contractor for managed care.

(a) The form must be available through the county office, the HMO office, the administrative contractor for managed care, or other locations designated by the department.

(b) An HMO or any entity responsible for making the form available, receiving a form or a request, must forward the form or request in writing to the administrative contractor for managed care within 3 working days.

(6) An HMO must accept without restriction eligible recipients in the order in which they are received for enrollment by the administrative contractor for managed care until the HMO's maximum enrollment under the contract is reached.

(7) The effective date of enrollment for an eligible recipient must be no later than the first day of the second month subsequent to the date on which the administrative contractor for managed care receives the designated managed health care choice form or written or verbal request. The effective date must be earlier than the second subsequent month if enrollment can be processed before the last 4 working days of the month.

(8) An HMO may issue an appropriate identification card to an enrollee. A medicaid card is issued to enrollees by the department.

(9) Enrollment with an HMO is indicated by the appearance of the HMO's name and 24-hour telephone number on the medicaid card.

(10) An enrollee must obtain covered services as defined in ARM 37.86.5007 through the HMO.

(11) An enrollee may obtain noncovered services as defined in ARM 37.86.5007 in the usual manner.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113, 53-6-116 and 53-6-117, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1997 MAR p. 503, Eff. 3/11/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5006 Health Maintenance Organizations: Disenrollment

(1) An enrollee may request, without good cause, disenrollment from an HMO at any time, except that an individual required to enroll in an HMO per ARM 37.86.5005(1) (a) may disenroll only for good cause as defined in (11) of this rule.

(2) A disenrollment request must be accompanied by a choice for another managed health care provider.

(3) Disenrollment is requested by either completing a form designated by the administrative contractor for managed care or by a written or oral request to the administrative contractor for managed care.

(a) The form must be available through the same locations as specified in ARM 37.86.5005 for the enrollment form.

(b) An HMO or any other entity responsible for making the form available upon receiving a form or a request, must forward the form or request to the administrative contractor for managed care within 3 working days.

(4) An HMO, based on good cause, may request that the department disenroll a recipient. The request with the basis for the request must be in writing.

(a) Good cause does not include an adverse change in health status.

(b) An enrollee may be terminated from medical assistance for good cause if the enrollee:

(i) has committed acts of physical or verbal abuse that pose a threat to providers or other enrollees of the HMO;

(ii) has allowed a non-enrollee to use the HMO certification card to obtain services or has knowingly provided fraudulent information in applying for coverage;

(iii) has violated rules of the HMO stated in the evidence of coverage;

(iv) has violated rules adopted by the commissioner of insurance for enrollment in an HMO; or

(v) is unable to establish or maintain a satisfactory physician-patient relationship with the physician responsible for the enrollee's care. Disenrollment of an enrollee for this reason must be permitted only if the HMO can demonstrate that it provided the enrollee with the opportunity to select an alternate primary care physician, made a reasonable effort to assist the enrollee in establishing a satisfactory physician-patient relationship, and informed the enrollee that the enrollee may file a grievance on this matter.

(5) Disenrollment takes effect, at the earliest, the first day of the month after the month in which the administrative contractor for managed care receives the request for disenrollment, but no later than the first day of the second calendar month after the month in which the administrative contractor for managed care receives a request for disenrollment. The enrollee remains enrolled with the HMO and the HMO is responsible for services covered under the contract until the effective date of disenrollment which is always the first day of a month.

(6) The department will disenroll an enrollee from a particular HMO if:

(a) the contract between the department and the HMO is terminated; or

(b) the enrollee permanently moves outside the HMO's enrollment area.

(7) The department will disenroll an enrollee from an HMO if:

(a) the enrollee enters a medicaid eligibility group excluded from HMO enrollment; or

(b) the enrollee becomes ineligible for medicaid; or

(8) If an enrollee becomes ineligible for medicaid and is reinstated into medicaid within 1 month, the enrollee may be reenrolled with the same HMO.

(9) A recipient disenrolling or disenrolled from an HMO who remains medicaid eligible is eligible for regular medicaid.

(10) A person participating in the FAIM project who is required to enroll in an HMO under ARM 37.86.5005 is considered to have good cause to disenroll if the person:

(a) has a terminal illness;

(b) meets one of the conditions for exemption from or is ineligible for the passport to health program as defined in ARM 37.86.5103; or

(c) is under treatment by a physician or mid-level practitioner who is not affiliated with a medicaid HMO and the patient, provider, and department believe that a disruption of the patient/provider relationship may adversely affect treatment or cause unnecessary hardship to the patient.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113, 53-6-116 and 53-6-117, MCA
History: NEW, 1995 MAR p. 2155, Eff. 9/29/95; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1997 MAR p. 503, Eff. 3/11/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5007 Health Maintenance Organizations: Covered Services

(1) An HMO must provide the following services:

(a) inpatient hospital services as defined at ARM 37.86.2901 and 37.86.2902;

(b) outpatient hospital services as defined at ARM 37.86.3001 and 37.86.3002;

(d) family planning services as defined at ARM 37.86.1701 and 37.86.1705;

(e) home health services as defined at ARM 37.40.701 and 37.40.702;

(f) early periodic screening, diagnosis and treatment services for individuals under the age of 21 (EPSDT) as defined at ARM 37.86.1401, 37.86.1402, 37.86.2201, 37.86.2205 and 37.86.2206;

(g) non-hospital laboratory and x-ray services as defined at ARM 37.86.911;

(h) rural health clinic services as defined at ARM 37.86.4001;

(i) ambulance services as defined at ARM 37.86.2601 and 37.86.2602;

(j) ambulatory surgical center services as defined at ARM 37.86.1401, 37.86.1402 and 37.86.1405;

(k) chiropractor services as defined at ARM 37.86.2206(2) (b) ;

(l) diagnostic clinic services as defined at ARM 37.86.1401 and 37.86.1402;

(m) nutrition services as defined at ARM 37.86.2206(2) (a) ;

(n) federally qualified health center services as defined at ARM 37.86.4401;

(o) hospice services as defined at ARM 37.40.801 and 37.40.806;

(p) mid-level practitioner services as defined at ARM 37.86.201 and 37.86.202;

(q) immunizations recommended by the advisory committee on immunization practices;

(r) occupational therapy services as defined at ARM 37.86.601;

(s) physical therapy services as defined at ARM 37.86.601;

(t) podiatry services as defined at ARM 37.86.501 and 37.86.505;

(u) private duty nursing services as defined at ARM 37.86.2206(2) (f) ;

(v) county public health clinic services as defined at ARM 37.86.1401 and 37.86.1402;

(w) respiratory therapy services as defined at ARM 37.86.2206(2) (d) ;

(x) immunizations and well child screens provided by school based providers;

(y) speech therapy services as defined at ARM 37.86.601;

(z) targeted case management services for high risk pregnant women as defined at ARM 37.86.3301, 37.86.3305, 37.86.3006, 37.86.3401, 37.86.3402 and 37.86.3405; and

(aa) transplant services as defined at ARM 37.86.4701 and 37.86.4705.

(bb) prescription drugs supplied by a participating provider or a provider with a family planning and/or public health clinic;

(cc) durable medical equipment limited to diabetic supplies, oxygen, prosthetics, ostomy or incontinence supplies and only if supplied by a participating provider or a provider with a family planning and/or public health clinic;

(dd) optometric/ophthalmic services for medical conditions of the eye.

(2) An enrolled recipient may obtain the following covered services through self-referral to a participating or nonparticipating provider and the HMO must reimburse the provider of a service to which the enrollee may self-refer:

(a) family planning services:

(i) for enrollees with reproductive capacity, reproductive health exams comprised of taking history and conducting a physical assessment when such an exam is necessary to obtain birth control supplies or to determine the most appropriate birth control method or supply;

(ii) patient counseling and education for the following: contraception, sexuality, infertility, pregnancy, preconceptual care, pregnancy options, disease, HIV/AIDS, sterilizations, nutrition to maximize reproductive health, the need for rubella and hepatitis B immunizations, and other topics related to the patient's reproductive and general health;

(iii) lab tests to detect the presence of conditions affecting reproductive health, such as those involving the thyroid, cholesterol/triglycerides, prolactin, pregnancy tests, and diagnosis of infertility;

(iv) sterilizations as defined at ARM 37.86.104;

(v) screening, testing, and treatment of and pre- and post-test counseling for sexually transmitted diseases and HIV;

(vi) family planning supplies provided by Title X clinics; and

(vii) rubella and hepatitis B immunizations.

(b) immunizations provided by a public health clinic;

(d) emergency service.

(3) If a nonparticipating provider detects a problem outside the scope of family planning services as defined above, such provider shall refer the enrollee back to the HMO.

(4) An enrollee is eligible for all non-covered services and may obtain non-covered services in the usual manner.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 2155, Eff. 9/29/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1998 MAR p. 2045, Eff. 7/31/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5010 Health Maintenance Organizations: Contracts for Services

(1) The department may enter into a contract with an HMO with a certificate of authority under the provisions of 33-31-201 , et seq., MCA, to provide any of the services specified in ARM 37.86.5007.

(2) An HMO, entering into a contract with the department, must meet the requirements in 53-6-705 , MCA.

(3) A contract for the provision of services through an HMO must meet the requirements of 42 CFR part 434. The department hereby adopts and incorporates by reference 42 CFR part 434, dated October 1998. A copy of the incorporated provisions may be obtained through the Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(4) An HMO entering into a contract with the department for the delivery of services assumes the risk that the costs of performance may exceed the consideration available through the capitation rate and otherwise.

(5) An HMO must provide the department with documented assurances to show that the HMO is not likely to become insolvent. This requirement may be satisfied by documenting compliance with 33-31-216 , MCA.

(6) An HMO may not in any manner hold an enrollee responsible for the debts of the HMO.

(7) A contract with an HMO must:

(a) list the covered services to be provided by the HMO;

(b) specify the method and rate of reimbursement; and

(d) owners, directors, officers, or partners of the HMO must certify that they meet federal nondebarment requirements.

(8) A contract may be terminated for cause, if the contractor fails to:

(a) perform the services within the time limits specified in the contract;

(b) perform any requirement of the contract;

(c) perform its contractual duties or responsibilities specified in the standards of contractor performance defined in the contract;

(d) comply with any law, regulation or licensure and certification requirement; or

(e) comply with the restrictions and limitations placed on contractor activities under the contract and its attachments.

(9) Prior to termination of a contract or withholding of payments for cause, except as provided in (9) (a) , a notice to cure will be sent to the HMO, stating the failures in performance and specifying the HMO has 30 days to correct the failures. The department may proceed with the proposed termination or withholding of payments, if the HMO fails to correct the failures in performance in the specified time period for correction.

(a) A contract with an HMO may be terminated immediately in whole or in part by the department when:

(i) the HMO becomes insolvent;

(ii) the HMO loses a certificate of authority;

(iii) the department determines that termination is necessary to protect the health of enrollees;

(iv) the HMO applies for or consents to the appointment of a receiver, trustee, or liquidation for itself or any of its property;

(v) the HMO admits in writing that it is unable to pay its debts as they mature;

(vi) the HMO assigns for the benefit of creditors;

(vii) the HMO commences a proceeding in bankruptcy, reorganization, insolvency, or readjustment under a provision of a federal or state law or files an answer admitting the material allegations of a petition filed against the contract in any such proceeding; or

(viii) there is a commencement of an involuntary proceeding against the HMO under any bankruptcy, reorganization, insolvency, or readjustment in a provision of federal or state law that is not dismissed within 60 days.

(10) An HMO may not appeal a contractual matter through the fair hearing process provided at ARM 37.5.304, et seq.

(11) An HMO may specify in a contract a limit to the number of enrollees who can be enrolled with the HMO. If a limit is specified, the HMO must accept the number of voluntarily and assigned enrollees up to the limit specified in the contract.

(12) The department may contract with one or more HMO or other managed health care providers to provide managed health care in an enrollment area.

(13) The contract may contain proprietary information. An HMO entering into a contract with the department to provide HMO covered services does not constitute an agreement to release information, including information concerning the provider's information system, which is proprietary in nature.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 2155, Eff. 9/29/95; AMD, 1997 MAR p. 503, Eff. 3/11/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5011 Health Maintenance Organizations: Provision of Services

(1) An HMO may impose the following requirements in the provision of services:

(a) the use of certain types of providers;

(b) the preauthorization for services and use of network providers other than emergency services, family planning, immunizations and blood lead testing at a public health clinic;

(d) directing an enrollee to the appropriate level of care for receipt of covered services; and

(e) denial of payment to a provider for services provided to an enrollee if the participation requirements in this rule are not met by the enrollee; or

(f) if a recipient is mandated into an HMO and chooses to go to an FQHC that is not on the provider panel, approval for services is not required, but the recipient must inform the HMO before receiving services.

(2) An enrollee must use the participating providers in the enrollee's HMO.

(3) An enrolled recipient may use a nonparticipating provider in the following circumstances:

(a) the HMO authorizes a nonparticipating provider to provide a service;

(b) the enrollee receives a family planning service provided by a family planning provider as specified in ARM 37.86.5007(3) ;

(d) the enrollee receives services provided for an urgent condition or emergency or emergency room screen.

(4) An HMO must provide covered services as listed in ARM 37.86.5007 to enrollees in the same manner as those services are provided to non-medicaid enrollees.

(5) An HMO must make a reasonable effort to inform enrollees of alternate providers for noncovered services.

(6) An HMO, at a minimum, must provide enrollees the same amount, scope and duration for covered services as would be available under regular medicaid for those covered services.

(7) An HMO may at its discretion offer services to enrollees beyond the scope of medicaid as defined in ARM 37.85.206.

(8) An HMO must ensure that services for urgent conditions and emergencies are available on an immediate basis 24 hours a day, 7 days a week.

(a) An HMO may require that follow-up treatment to an urgent condition or emergency be provided by HMO participating providers.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5012 Health Maintenance Organizations: Participating Providers

(1) An HMO, except as otherwise provided in this rule, may select the providers of medical services the HMO determines necessary to meet its contractual obligations with the department.

(2) The HMO must offer to:

(a) medicaid-enrolled targeted case managers for high risk pregnant women who serve recipients in the enrollment area, terms and conditions that are at least as favorable as those offered to other participating providers providing this service and that substantially meet the same access and credentialing criteria as like participating providers; and

(b) federally qualified health centers or rural health clinics which serve recipients in the enrollment area, terms and conditions, excluding reimbursement, that are at least as favorable as those offered to other primary care providers, providing the FQHC or RHC substantially meets the same access and credentialing criteria as the HMO's other primary care providers.

(3) An HMO must make a reasonable effort to cooperate, where appropriate and feasible, with community-based organizations in the referral for and delivery of services available through those organizations.

(4) An HMO may not contract for a service from a provider located over 125 miles distant from the Montana border if services of comparable cost and quality are available from a provider located within Montana.

(5) Upon written notice by the department, the HMO must exclude from providing covered services to medicaid enrollees a provider who has been terminated by the medicaid program in accordance with ARM 37.85.501(1) (a) .

(6) An HMO may set notification and claim filing time limitations relating to the provision of care by nonparticipating providers. Failure to give notice or file claims within those time limitations, however, does not invalidate any claim if it can be shown not to have been reasonably possible to give such notice and that notice was in fact given as soon as was reasonably possible.

(7) A participating provider has no right to an administrative hearing as provided in ARM 37.5.101 and 37.5.117 or other department rule for a denial of payment by the HMO to the provider for a service provided to an enrollee.

(8) A participating provider, in providing services under contract with an HMO, is not subject to any requirements or rights provided in ARM 37.85.402(1) , pertaining to medicaid provider enrollment, ARM 37.85.406 pertaining to medicaid billing and, ARM 37.85.411, pertaining to provider rights.

(9) An HMO must permit obstetricians/gynecologists to become primary care providers. An obstetrician or gynecologist seeking designation as a primary care provider must meet the same criteria with regard to credentials and other selection criteria for a participating primary care physician and other providers who are participating as primary care providers.

(10) An HMO may not prohibit a participating provider from discussing a treatment option with an enrollee or from advocating on behalf of an enrollee within the utilization review or grievance processes established by the HMO.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.86.5013 Health Maintenance Organizations: Reimbursement of Providers

(1) An HMO must reimburse a federally qualified health center or a rural health clinic which is a participating provider either the same payment per enrollee or service made to other primary care providers or the facility specific medicaid interim rate for each enrollee visit.

(2) An HMO need not reimburse, except as otherwise provided in this rule, claims for medically necessary services provided by non-participating providers if the same service is covered by the HMO under its contract with the department.

(3) An HMO must reimburse medically necessary family planning services as defined in ARM 37.86.5007(3) provided by a nonparticipating family planning provider to an enrollee who sought the services without referral.

(4) An HMO must reimburse immunizations and blood lead testing provided by a public health clinic to an enrollee.

(5) An HMO must reimburse nonparticipating providers for services for urgent conditions, emergencies or emergency room screenings provided to an enrollee.

(6) An HMO, owned, controlled or sponsored by or affiliated with a religious organization, must reimburse a covered service received by an enrollee that the HMO does not make available due to the service constituting a violation of the religious tenets of the organization, to which the HMO is related.

(7) An HMO is not responsible for reimbursement of the disproportionate share payments for inpatient hospital services provided to an enrollee.

(8) An HMO must reimburse services for an urgent condition, emergency or emergency room screens in an amount that is not less than the department's medicaid rates for those services.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 2155, Eff. 9/29/95; AMD, 1997 MAR p. 503, Eff. 3/11/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.5014 Health Maintenance Organizations: Reimbursement of Hmos

(1) In consideration for all services rendered by an HMO under a contract with the department, the HMO will receive a payment each month for each enrollee. This payment is the capitation rate. Except as otherwise provided in this rule, the capitation rate represents the total obligation of the department with respect to the costs of medical care and services provided to each enrollee under the contract.

(a) The capitation rate must be actuarially determined.

(b) The capitation rate must be:

(i) based on medicaid fee-for-service expenses incurred in the provision of the HMO-covered services to a non-HMO population of similar characteristics during the base fiscal year; and

(ii) based on services that are reasonably available to the enrollees of the HMO.

(c) The capitation rate may not exceed the cost to the department of providing the same services to an actuarially equivalent nonenrolled population group.

(d) The capitation rate may be updated annually.

(e) The capitation rate does not include:

(i) any amounts for the recoupment of losses suffered by an HMO for risks assumed under the contract or any previous risk contract;

(ii) any disproportionate share payments;

(iii) any payments made by the department reflecting the difference between the amounts paid to participating federally qualified health centers and rural health clinics by the HMO and the reasonable cost of providing services to enrollees; and

(iv) any payments made as a result of reinsurance purchased by an HMO from the department.

(f) At a minimum, the capitation rate must be 5% less than the upper payment limit. The department may reduce the capitation rates under the conditions set forth in the contract if there is a funding shortfall.

(2) The HMO may retain any savings realized by the HMO from the expenditures for necessary health services by the enrolled population totaling less than the capitation rate paid by the department.

(3) The department reimburses to federally qualified health centers and rural health clinics that are participating providers the difference between the amounts paid to them by the HMO and the reasonable cost of providing services to enrolled recipients.

(a) The department recoups from federally qualified health centers and rural health clinics that are participating providers any excess between the amounts paid to them by the HMO and the reasonable cost of providing services to enrollees, unless the provider notifies both the HMO and the department in writing that it forfeits cost-based reimbursement for enrollees in favor of the reimbursement paid by the HMO.

(b) If an HMO becomes a subcontractor to a federally qualified health center or rural health clinic, the department is under no obligation to pay reasonable costs to the HMO. Only the federally qualified health center or rural health clinic itself remains eligible for reasonable cost settlement for federally qualified health center and rural health clinic services.

(4) The department reimburses disproportionate share payments for inpatient hospital services provided to enrollees.

(5) The department will recoup the TANF-based capitation payments made for a newborn enrollee retroactively determined SSI eligible within 4 months of life and instead pay the SSI-based capitation rate for each month of enrollment.

(6) The department reimburses an HMO for 80% of regular medicaid reimbursement for cost above the reinsurance threshold chosen by the HMO if an HMO chooses to purchase reinsurance from the department.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1997 MAR p. 503, Eff. 3/11/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5020 Health Maintenance Organizations: Access to Services

(1) An enrollee must have the opportunity to choose a primary care provider to the extent possible and medically appropriate from any of the participating primary care providers in the enrollee's HMO. The HMO may assign an enrollee to a primary care provider when an enrollee fails to chose one after being notified to do so. The assignment must be appropriate to the enrollee's age, sex and residence. The HMO may limit an enrollee's ability to change primary care providers without cause.

(2) An HMO must have in effect the following arrangements which provide for adequate after hours call-in coverage by participating providers:

(a) An after hours call-in must include 24-hour-a-day phone coverage;

(b) If a medical provider is unavailable to answer the initial telephone call, there must be a written protocol specifying when the answering party must consult a medical provider;

(d) A response to each call which requires a medical decision must be provided by the medical provider within 60 minutes.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5025 Health Maintenance Organizations: Grievance Procedures

(1) An enrollee has the right of appeal as provided at ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

(2) An HMO must have a written procedure, approved in writing by the department prior to implementation, for resolution of grievances brought by enrollees either individually or as a class. Except as noted below, the HMO's grievance procedure must provide for resolution of a grievance within 45 days of receipt of the grievance. Resolution may be extended beyond 45 days only with the written approval of the department. In a situation requiring urgent care or emergency care, the department may require the HMO to expedite resolution.

(3) An enrollee must exhaust the HMO's grievance procedure before appeal of the matter may be made to the department under the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

(4) For purposes of ARM 37.5.307(1) (c) , the 90 day appeal period starts on the day the enrollee files a grievance with the HMO.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.86.5026 Health Maintenance Organizations: Records and Confidentiality

(1) An HMO must comply with the provisions of ARM 37.86.414 regarding maintenance and retention of medical and fiscal records.

(2) An HMO must submit reports and maintain records as required in the contract with the department.

(3) An HMO must have in effect arrangements to provide for an adequate medical record-keeping system which includes a complete medical record for each enrollee in accordance with provisions set forth in the contract. The complete medical record may be maintained by an HMO's participating provider.

(4) HMOS, participating providers, and the department are subject to the disclosure requirements of Title 50, chapter 16, MCA, and 33-19-306 , MCA.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5027 Health Maintenance Organizations: Recipient Education

(1) An HMO must have written instructions for enrollees in the use of all services provided. The policy must include, but is not limited to, written information on service restrictions and limitations regarding appropriate use of the referral system, grievance procedure, after hours call-in system, provisions for emergency treatment, how the enrollee may obtain services that are the responsibility of the HMO under ARM 37.86.5007 and the contract between the HMO and the department but which are not available through the HMO due to religious objections and how to request a list of the HMO's participating providers.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481.

Mont. Admin. R. 37.86.5035 Health Maintenance Organizations: Quality Assurance

(1) An HMO must have in effect an internal quality assurance system as specified in the contract.

(2) An internal quality assurance system must meet the requirements of 42 CFR 434.34. The department hereby adopts and incorporates by reference 42 CFR 434.34, dated October 1998.

(a) Copies of 42 CFR 434.34 may be obtained through the Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 1974, Eff. 9/29/95; AMD, 1997 MAR p. 503, Eff. 3/11/97; AMD, 1997 MAR p. 1210, Eff. 7/8/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00.

Mont. Admin. R. 37.86.5036 Health Maintenance Organizations: Third Party

(1) The HMO is responsible for investigating third party resources and seeking payment from these sources.

(2) The HMO may retain all funds collected from third party resources.

(3) A complete record of all payments received from third party sources must be maintained and reported as required in the contract.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-116, MCA
History: NEW, 1995 MAR p. 2155, Eff. 9/29/95; TRANS, from SRS, 2000 MAR p. 481.

Subchapter 37.86.51 Passport to Health Program

Mont. Admin. R. 37.86.5101 Passport to Health Program: Authority

(1) The department has been granted by the United States Department of Health and Human Services (HHS), as provided in 42 U.S.C. 1396n(b), the authority to establish a primary care case management program for Medicaid members.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-116, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; TRANS, from SRS, 2000 MAR p. 481; AMD, 2013 MAR p. 1447, Eff. 8/9/13.

Mont. Admin. R. 37.86.5102 Passport to Health Program: Definitions

(1) "Case management" means directing and overseeing the delivery of certain services to an enrollee.

(2) "Clinic" means a federally qualified health center, a rural health clinic, an Indian health service clinic on a reservation, or any other clinic as defined in ARM 37.86.1401 which can meet the requirements of ARM 37.86.5111.

(3) "Emergency service" means, as defined at ARM 37.82.102(11), inpatient and outpatient services that are necessary to treat an emergency medical condition.

(4) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

(a) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

(b) serious impairment to bodily functions; or

(5) "Enroll" means to choose a primary care provider.

(6) "Enrollee" means a Medicaid member participating in the program and who is enrolled with a primary care provider under the program.

(7) "Exempt" means a Medicaid member who is:

(a) eligible for managed care but able to establish that participating would be a hardship;

(b) enrolled in a health maintenance organization that provides case management services;

(d) residing in a county in which there are not enough primary care providers to serve the Medicaid population required to participate in the program; or

(e) a Medicaid member who has entered into a Direct Patient Care agreement as defined by 50-4-107, MCA, for primary care services as defined in ARM 37.86.5102(12), who is receiving primary care services under such agreement in accordance with 53-6-116(7), MCA. The department has the discretion to determine hardship and to place time limits on all exemptions described in (a) through (e) on a case-by-case basis.

(8) "Ineligible" means a Medicaid member who is not eligible to participate in a managed care program, such as the Passport to Health Program, but is eligible for regular Medicaid. The following categories of members are ineligible for the Passport to Health Program:

(a) eligible for Medicaid with a spend down (medically needy);

(b) living in a nursing home or institutional setting;

(d) eligible for Medicare;

(e) eligible for Medicaid adoption assistance or guardianship;

(f) eligible for pregnancy Medicaid;

(g) retroactive Medicaid eligibility;

(h) receiving Medicaid home and community-based services for persons who are aged or disabled;

(i) eligible for Plan First;

(j) receiving Medicaid under a presumptive eligibility program; and

(k) eligible for the Breast and Cervical Cancer program.

(9) "Medical care" means care provided to meet the medical and medically related needs of a person.

(10) "Participate" means compliance with the requirements of the program.

(11) "Passport to Health Program" or "the program" means the Primary Care Case Management (PCCM) Program for Medicaid members.

(12) "Primary care" means medical care provided at a person's first point of contact with the health care system, except for emergencies. It includes treatment of illness and injury, health promotion and education, identification of persons at special risk, early detection of serious disease, promotion of preventive health care, and referral to specialists when appropriate.

(13) "Primary care case management" or "managed care" means promoting the access to, coordination of, quality of, and appropriate use of medical care, and containing the costs of medical care by having an enrollee obtain certain medical care from and through a primary care provider.

(14) "Primary care provider" means a physician, clinic, or midlevel practitioner other than a certified registered nurse anesthetist that is responsible by agreement with the department for providing primary care case management to enrollees in the Passport to Health Program.

(15) "Referral" means the approval by the Passport enrollee's primary care provider for the delivery by another provider of a service(s) that requires Passport referral. Referral is the provision of the primary care provider's program referral number to the other provider. The primary care provider shall establish the parameters of the referral.

(16) "Team Care" means a program for members identified as excessive or inappropriate utilizers of the Medicaid program as set forth in ARM 37.86.5303.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-113, 53-6-116, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1994 MAR p. 2983, Eff. 11/11/94; AMD, 1996 MAR p. 2193, Eff. 8/9/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00; AMD, 2004 MAR p. 1624, Eff. 7/23/04; AMD, 2013 MAR p. 1447, Eff. 8/9/13; AMD, 2018 MAR p. 650, Eff. 4/1/18; AMD, 2026 MAR, Notice No. 2026-285, Eff. 5/9/26.

Mont. Admin. R. 37.86.5103 Passport to Health Program: Eligibility

(1) The department may require a Medicaid member to enroll and participate in the Passport to Health Program, unless exempted from or ineligible for participation as defined by ARM 37.86.5102(7) or (8).

(2) At the department's discretion, Medicaid members who are exempted from participation, as defined in ARM 37.86.5102(7), may elect to enroll in the Passport to Health Program by choosing a primary care provider unless the member is ineligible.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-113, 53-6-116, 53-6-117, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1994 MAR p. 2983, Eff. 11/11/94; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1996 MAR p. 2193, Eff. 8/9/96; AMD, 1997 MAR p. 2085, Eff. 11/18/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00; AMD, 2004 MAR p. 1624, Eff. 7/23/04; AMD, 2013 MAR p. 1447, Eff. 8/9/13.

Mont. Admin. R. 37.86.5104 Passport to Health Program: Enrollment in the Program

(1) The department will notify a Medicaid member required by ARM 37.86.5103 to enroll in the program that the member must enroll in the program.

(2) The member required to enroll in the program must select a primary care provider within 45 days of being notified of the enrollment requirement. For Team Care Program members, enrollment with a provider will be as required at ARM 37.86.5303.

(3) If the member does not choose a provider within 45 days of the notification, the department will designate a primary care provider for the member. For Team Care Program members, enrollment with a provider will be as required in ARM 37.86.5303.

(4) An enrollee may choose a new primary care provider up to once per month. For Team Care Program members, a change of provider may be made in accordance with ARM 37.86.5303. The frequency of a member's request to change providers will be monitored by the department.

(5) Each enrollee in a household may choose a different primary care provider.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-113, 53-6-116, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1996 MAR p. 2193, Eff. 8/9/96; AMD, 1997 MAR p. 2085, Eff. 11/18/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00; AMD, 2003 MAR p. 1203, Eff. 6/13/03; AMD, 2004 MAR p. 1624, Eff. 7/23/04; AMD, 2013 MAR p. 1447, Eff. 8/9/13.

Mont. Admin. R. 37.86.5110 Passport to Health Program: Services

(1) A member must obtain services directly from, or through, a Passport referral by the member's primary care provider except for:

(a) obstetrical services, both inpatient and outpatient;

(b) family planning services as defined in Social Security Act 1905(a)(4)(c) and ARM 37.86.1701;

(d) pathology services;

(e) ophthalmology services for medical conditions of the eye;

(f) immunization;

(g) testing and treatment for sexually transmitted diseases as defined in ARM 37.114.101;

(h) testing for lead blood levels;

(i) dental, vision, hearing, and EPSDT screening and preventive services;

(j) school-based health services as defined in ARM 37.86.2230;

(k) swing-bed hospital services as defined in ARM 37.40.401;

(l) audiology services as defined in ARM 37.86.702;

(m) hearing aid services as defined in ARM 37.86.801;

(n) personal care services as defined in ARM 37.40.1101;

(o) home dialysis services for end-stage renal disease as defined in ARM 37.40.901;

(p) home infusion therapy services as defined in ARM 37.86.1501;

(q) mental health center services as provided in ARM 37.88.901 and 37.88.905 through 37.88.907;

(r) licensed psychologists services provided in ARM 37.88.601, 37.88.605, and 37.88.606;

(s) substance use disorder services as provided in ARM 37.27.102;

(t) licensed clinical social work services provided in ARM 37.88.201, 37.88.205, and 37.88.206;

(u) dental services as defined in ARM 37.86.1001;

(v) licensed professional counselor services provided in ARM 37.88.301, 37.88.305, and 37.88.306;

(w) outpatient drugs as defined in ARM 37.86.1101;

(x) prosthetic devices, durable medical equipment, and medical supplies as defined in ARM 37.86.1801;

(y) optometric services as defined in ARM 37.86.2001;

(z) eyeglasses as defined in ARM 37.86.2101;

(aa) transportation and per diem as defined in ARM 37.86.2401;

(bb) specialized nonemergency medical transportation as defined in ARM 37.86.2501;

(cc) ambulance services as defined in ARM 37.86.2601;

(dd) emergency services as defined in ARM 37.82.102;

(ee) skilled care facility services as defined in ARM 37.40.105;

(ff) intermediate care facility services as defined in ARM 37.40.106;

(gg) institution for mental disease services as provided in ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411, and 37.88.1420;

(hh) home and community-based services as defined in ARM 37.40.1406;

(ii) freestanding dialysis clinic for end-stage renal disease services as defined in ARM 37.86.4201;

(jj) case management services as defined in ARM 37.86.3301;

(kk) hospital inpatient laboratory and radiology (x-ray);

(ll) admission for inpatient psychiatric services as provided in ARM 37.86.2901, 37.86.2902, 37.87.1201, and 37.87.1203;

(mm) therapeutic youth group home or home support and therapeutic foster care services under the EPSDT program;

(nn) hospice as defined in ARM 37.40.801 and 37.40.806; and

(oo) professional inpatient services.

(2) The requirement that specific services not listed in (1) be referred by the primary care provider does not replace or eliminate other regulatory or statutory requirements for or limits on obtaining and being reimbursed for Medicaid services.

(3) Nothing in this rule reduces or otherwise affects the requirements that must be met under ARM 37.88.101, to obtain or access adult mental health services as provided in this chapter.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-116, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1994 MAR p. 2983, Eff. 11/11/94; AMD, 1996 MAR p. 2193, Eff. 8/9/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1997 MAR p. 2085, Eff. 11/18/97; AMD, 1998 MAR p. 2045, Eff. 7/31/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1338, Eff. 3/31/00; AMD, 2003 MAR p. 1203, Eff. 6/13/03; AMD, 2008 MAR p. 2673, Eff. 12/25/08; AMD, 2013 MAR p. 1447, Eff. 8/9/13; AMD, 2015 MAR p. 1912, Eff. 10/30/15.

Mont. Admin. R. 37.86.5111 Passport to Health Program: Primary Care Providers Requirements

(1) A primary care provider must meet the following requirements:

(a) enroll as a Medicaid provider;

(b) provide primary care;

(d) keep a paper or electronic log, spreadsheet, or other record of all Passport referrals given and received.

(2) A primary care provider may be subject to utilization review to determine that the care and services provided through the program are fulfilling the provisions of the primary care case management agreements with the program and are only those which are medically necessary or otherwise permissible.

(3) Passport providers who reach their specified caseloads of Passport patients, per their provider agreements with the department, will not be assigned additional members. Providers who have reached their capacity will be provided the opportunity to increase their caseloads. Providers that are not provider-based as described at ARM 37.86.3031 may request an exemption from this rule.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-116, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00; AMD, 2013 MAR p. 1447, Eff. 8/9/13; AMD, 2014 MAR p. 125, Eff. 1/17/14.

Mont. Admin. R. 37.86.5112 Passport to Health Program: Reimbursement

(1) Reimbursement for primary care case management services is as follows:

(a) $3.00 per enrollee per month for individuals categorically eligible for Aged, Blind, Disabled and Medically Frail Medicaid; or

(b) $1.00 per enrollee per month for all others who are members of Passport eligible populations.

(2) A primary care provider may be reimbursed for primary care case management for an enrollee for a month during which case management or medical care was not provided to the enrollee if the primary care provider is otherwise in compliance with the agreement with the program.

(3) Medicaid services authorized or provided by a primary care provider are reimbursed as provided in ARM Title 37, chapters 40, 82, 83, 85, 86, and 88.

(4) Services requiring Passport referral are not reimbursable unless referral is provided by a Passport enrollee's primary care provider.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-116, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1996 MAR p. 2193, Eff. 8/9/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2013 MAR p. 1447, Eff. 8/9/13; AMD, 2018 MAR p. 650, Eff. 4/1/18.

Mont. Admin. R. 37.86.5120 Passport to Health Program: Fair Hearing

(1) An enrollee or a provider has the right to appeal an adverse action in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-116, MCA
History: NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1996 MAR p. 2193, Eff. 8/9/96; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00.

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, 53-6-113, MCA
History: NEW, 2003 MAR p. 2892, Eff. 12/25/03; AMD, 2010 MAR p. 1544, Eff. 6/25/10; REP, 2018 MAR p. 650, Eff. 4/1/18.

Subchapter 37.86.53 Passport to Health Team Care Program

Mont. Admin. R. 37.86.5303 Passport to Health's Team Care Program

(1) A recipient may be subject to restrictions on, or prior approval for, physician related services, pharmacy services or any other services covered by the Medicaid Program if the department determines that the recipient's utilization of service is excessive, inappropriate, or fraudulent with respect to medical need.

(2) The restrictions described in (1) may be imposed if any of the following events occur:

(a) the recipient seeks medical services that are not medically necessary;

(b) there is multiple provider usage that results in the receipt of unnecessary services;

(d) there is unwarranted multiple pharmacy usage, indicated by the use of more than three pharmacies, that results in the receipt of unnecessary prescriptions;

(e) there is admission of or conviction for forgery of Medicaid drug prescriptions by the recipient; or

(f) the recipient utilizes a Medicaid card in any unlawful or fraudulent manner.

(3) The department will use payment records, reports from medical consultants, provider referrals or other pertinent recipient or service information, to determine if recipient overutilization, or other abuses, have occurred.

(4) A recipient's restriction does not apply to other members of the household.

(5) Restriction of Medicaid services may include limiting a recipient to a designated provider or providers or requiring the recipient to obtain department approval to receive non-emergent services. A recipient with restricted services is participating in the Team Care Program. Medicaid payment for medical services provided to a Team Care Program participant will only be made to the recipient's designated provider(s) except:

(a) when emergency services, as defined at ARM 37.82.102(11), are required;

(b) when the designated provider refers the recipient to another provider; or

(6) A recipient restricted to the Team Care Program is required to participate in the Passport to Health Program set forth in this subchapter unless the recipient is ineligible, or exempt, as those terms are defined in ARM 37.86.5102.

(7) A recipient whose medical service usage meets the criteria for restriction listed in (2), but who is ineligible for the Passport to Health Program for the reasons listed in ARM 37.86.5102, may be required to participate in the Team Care Program. A recipient living in a nursing home or institutional setting or a recipient whose eligibility period is only retroactive cannot be required to participate in either the Passport to Health or the Team Care Programs.

(8) The department will notify a recipient in writing at least 10 days prior to the date of the intended action restricting medical services paid by the Medicaid Program.

(9) The department will determine the provider type to which the recipient is restricted (pharmacy, physical health provider or both). The recipient will have an opportunity to choose the recipient's primary care provider and pharmacy unless:

(a) the department determines that the selected provider has been sanctioned by the department in accordance with ARM 37.85.501;

(b) the designated review organization has determined that the selected provider has not properly managed the medical care of a recipient who has been restricted; or

(10) The recipient will have 10 days from the date of notification of restriction by the department to choose a primary care provider and a pharmacy provider. If the recipient does not choose a primary care provider and a pharmacy provider within 10 days, a primary care provider and a pharmacy will be selected for the recipient. If the department is unable to obtain a primary provider for the restricted recipient, all non-emergency services must be prior authorized by the department.

(11) A restricted recipient may request a change of provider. The request must be in writing and submitted to the department for approval. Provider changes will not be approved unless the department determines that there is good cause for the requested provider change. The department will have 30 days to take action on the request.

(12) The department will review all restricted recipients annually unless the recipient's medical service usage indicates an earlier review should occur. Restriction may be continued if:

(a) the department determines the recipient's use of services has remained excessive or unnecessary. Examples of excessive or unnecessary usage include, but are not limited to, those listed in (2);

(b) the designated provider recommends, with supporting rationale, that the recipient should remain restricted; or

(c) the recipient has received or attempted to receive Medicaid services not authorized under the restricted card program.

(13) A recipient aggrieved by an adverse departmental action under this rule may request a fair hearing in accordance with ARM Title 37, chapter 5, subchapter 3.

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-104, 53-6-113, MCA
History: NEW, 2004 MAR p. 1624, Eff. 7/23/04; AMD, 2026 MAR, Notice No. 2026-285, Eff. 5/9/26.

Mont. Admin. R. 37.86.5306 Team Care Program: Reimbursement

(1) Reimbursement for team care case management services is $6.00 a month for each enrollee.

(2) A provider may be reimbursed for team care case management for an enrollee for a month during which case management or medical care was not provided to the enrollee if the primary care provider is otherwise in compliance with the agreement with the program.

(3) Medicaid services authorized or provided by a primary care provider are reimbursed as provided in ARM Title 37, chapters 40, 82, 83, 85, 86 and 88.

(4) Services listed in ARM 37.86.5110(1) provided to enrollees are not reimbursable unless provided or authorized by an enrollee's primary care provider in accordance with these rules.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-6-104 and 53-6-113, MCA
History: NEW, 2004 MAR p. 1624, Eff. 7/23/04.

Subchapter 37.86.54 Preventive Services

Mont. Admin. R. 37.86.5401 Purpose

(1) The rules in this chapter implement Montana Medicaid diabetes and cardiovascular disease prevention services. Diabetes and cardiovascular disease prevention services are evidence-based to assist in preventing Medicaid eligible individuals from developing diabetes and cardiovascular disease.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-131, MCA
History: NEW, 2012 MAR p. 1671, Eff. 8/24/12.

Mont. Admin. R. 37.86.5402 Definitions

For purposes of Montana Medicaid diabetes and cardiovascular disease prevention services, the following definitions apply:

(1) "After core program" means six consecutive monthly sessions.

(2) "Core program" means 16 consecutive weekly sessions.

(3) "Eligible client" means Medicaid eligible individuals at high risk for developing diabetes or cardiovascular disease.

(4) "Eligible provider" means Medicaid providers with licensed and trained health care professionals on staff delivering standardized curriculum and reporting data to the Public Health and Safety Division of the Department of Public Health and Human Services.

(5) "Evidence-based intervention" means the group-based National Institutes of Health's Diabetes Prevention Program as adapted by the Public Health and Safety Division of the Department of Public Health and Human Services.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-131, MCA
History: NEW, 2012 MAR p. 1671, Eff. 8/24/12.

Mont. Admin. R. 37.86.5403 Diabetes and Cardiovascular Disease Prevention Services General

(1) Diabetes and cardiovascular disease prevention services include the following evidence-based intervention services:

(a) Group nutrition counseling to prevent diabetes and cardiovascular disease; and

(b) Physical activity coaching to prevent diabetes and cardiovascular disease.

(2) Services are provided to eligible clients in 16 core program weekly sessions and six after core program monthly sessions.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-131, MCA
History: NEW, 2012 MAR p. 1671, Eff. 8/24/12.

Mont. Admin. R. 37.86.5404 Diabetes and Cardiovascular Disease Prevention Services Reimbursement

(1) Reimbursement for diabetes and cardiovascular disease prevention services to eligible providers is in accordance with fee-for-service fee schedules for appropriate provider types posted on the department's web site at www.mtmedicaid.org .

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-131, MCA
History: NEW, 2012 MAR p. 1671, Eff. 8/24/12.

Chapter 37.87 Children's Mental Health Services

Subchapter 37.87.1 Definitions

Mont. Admin. R. 37.87.102 Mental Health Services (mhs) for Youth with Serious Emotional Disturbance (sed), Definitions

As used in this chapter, the following terms apply:

(1) "In-training mental health professional services" means services provided by a licensure candidate in accordance with ARM 37.85.213.

(2) "Licensed mental health center" means a mental health center licensed in accordance with ARM 37.106.1906 through 37.106.1965.

(3) "Medically necessary service" has the same meaning as provided in ARM 37.82.102.

(4) "Mental health professional" means one of the following practitioners:

(a) physician;

(b) licensed professional counselor;

(d) licensed clinical social worker;

(e) licensed marriage and family therapist; or

(f) advanced practice registered nurse, with a clinical specialty in psychiatric mental health nursing.

(5) "Provider" means a person or entity that has enrolled and entered into a provider agreement with the department in accordance with the requirements of ARM 37.85.401 through 37.85.513 to provide mental health services to youth with SED on Medicaid.

(6) "Provider agreement" means the written enrollment agreement entered into between the department and a person or entity to provide mental health services to youth with SED.

(7) "Serious emotional disturbance (SED)" criteria are defined in the Children's Mental Health Bureau, Medicaid Services Provider Manual as adopted and incorporated by reference in ARM 37.87.903.

(8) "System of care account" has the same meaning as provided in 52-2-309, MCA, and allows the department to fund via the state special revenue fund the administering and delivering of services to high-risk youth with multiagency service needs and to provide for the youth's care, protection, and mental, social, and physical development.

(9) "Youth" means, for Medicaid services, a person who is up to 20 years of age. A youth may receive Psychiatric Residential Treatment Facility services through the age of 17.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; AMD, 2013 MAR p. 270, Eff. 3/1/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15; AMD, 2021 MAR p. 331, Eff. 3/27/21; AMD, 2024 MAR p. 2014, Eff. 8/10/24; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Subchapter 37.87.3 Serious Emotional Disturbance Criteria

Mont. Admin. R. 37.87.303 Youth Mental Health Services, Serious Emotional Disturbance Criteria

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; REP, 2014 MAR p. 2147, Eff. 9/19/14.

Subchapter 37.87.7 Mental Health Center Services for Youth With Serious Emotional Disturbance (SED)

Mont. Admin. R. 37.87.701 Community-Based Psychiatric Rehabilitation Support Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; REP, 2014 MAR p. 2858, Eff. 11/21/14.

Mont. Admin. R. 37.87.702 Mental Health Center Services for Youth with Serious Emotional Disturbance (sed), Definitions

For purposes of this subchapter, the following definitions apply:

(1) "Community-based psychiatric rehabilitation and support (CBPRS)" means rehabilitation services provided in home, school, and community settings for youth with serious emotional disturbance (SED) who are at risk of out of home or residential placement, or risk removal from current setting for youth under six years of age. CBPRS services are provided for a short period of time, generally 90 days or less, to improve or restore the youth's functioning in one or more of the impaired areas identified in the SED definition in ARM 37.87.102. Services are provided by trained mental health personnel under the supervision of a licensed mental health professional and according to rehabilitation goals.

(2) "Comprehensive school and community treatment" is defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(3) "In-training mental health professional services" refers to services provided by a candidate for licensure who:

(a) has completed all academic requirements for licensure as a psychological resident (as defined in ARM 24.189.301(8)), licensed clinical social worker, licensed professional counselor, or licensed marriage and family therapist;

(b) is under the supervision of a licensed mental health professional approved by the candidate's licensing board;

(c) is in the process of completing the supervised experience requirement for licensure, in accordance with ARM Title 24, chapter 189 or 219; and

(d) is in the process of completing the supervised experience requirement for licensure, in accordance with ARM Title 24, chapter 189 or 219; and

(4) "Licensed mental health center" is defined in ARM 37.87.102. For purposes of this subchapter the following provisions also apply:

(a) For a mental health center to be licensed, there are specific services that must be provided to its clients in accordance with ARM 37.106.1906.

(b) A mental health center may provide other appropriate services with an endorsement by the department in accordance with ARM 37.106.1906.

(5) "Mental health center services for youth with serious emotional disturbance" reimbursed by Medicaid means community-based psychiatric rehabilitation and support services, comprehensive school and community treatment programs, day treatment services, therapeutic foster care services, home support services, in-training mental health professional services, outpatient therapy services, mental health professional services, and targeted case management services.

(6) "Mental health professional" is defined in ARM 37.87.102.

(7) "Outpatient therapy service" is defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(8) "Serious emotional disturbance (SED)" criteria are defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(9) "Treatment day" means a calendar day, including night, daytime, or evening, during which a youth receives services according to applicable requirements.

(10) "Youth" is defined in ARM 37.87.102.

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

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2021 MAR p. 331, Eff. 3/27/21; AMD, 2024 MAR p. 2014, Eff. 8/10/24.

Mont. Admin. R. 37.87.703 Mental Health Center Services for Youth with Serious Emotional Disturbance (sed), Covered Services

(1) Mental health center services for youth with SED include:

(a) Community-Based Psychiatric Rehabilitation and Support (CBPRS) services as defined in ARM 37.87.702.

(b) Comprehensive school and community treatment in accordance with ARM Title 37, chapter 87, subchapter 18.

(d) In-training mental health professional services as defined in ARM 37.87.702. Services are subject to the same requirements that apply to licensed mental health professionals.

(e) Outpatient therapy services provided according to an individualized treatment plan and such services must include:

(i) psychotherapy services provided in accordance with the current edition of the American Medical Association's Current Procedural Terminology, Professional Edition, and codes approved by the department. The department adopts and incorporates by reference this manual;

(ii) family therapy, provided with or without the youth present, directed at the eligible youth's mental health needs and their impact on the family dynamics; and

(iii) individual and family therapy are targeted at reducing or eliminating symptoms or behaviors related to a youth's mental health diagnosis as specified in the treatment plan.

(f) Targeted case management (TCM) services as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(g) Mental health professional services, which include the professional component of physician or psychiatrist services covered in ARM 37.86.101, 37.86.104, and 37.86.105. Mental health professional services are subject to the following limitations:

(i) To the extent otherwise permitted by applicable Medicaid rules, such mental health professional services may be billed either by the mental health center as mental health center services or by the mental health professional under the applicable Medicaid category of service, but may not be billed as both mental health center services and mental health professional services.

(ii) Mental health professional services may be covered and reimbursed by Medicaid only if the mental health professional is enrolled as a provider and the services are provided according to the Medicaid rules and requirements applicable to the mental health professional's category of service.

(h) Home support services (HSS) and therapeutic foster care (TFC) as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(i) Mental health intensive outpatient therapy (IOP) as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2024 MAR p. 611, Eff. 3/23/24.

Mont. Admin. R. 37.87.705 Mental Health Center Services for Youth with Serious Emotional Disturbance, Noncovered Services

(1) Mental health professional services, provided in a hospital on an inpatient basis, that are covered by Medicaid as part of the diagnosis related group (DRG) payment under ARM 37.86.2907 are not reimbursable as mental health center services. These noncovered services include:

(a) mental health professional services provided by mental health professionals who are staff members of a mental health center which has a contract with a hospital involving consideration;

(b) services provided for purposes of discharge planning as required by 42 CFR part 482.43; and

(c) services including but not limited to group therapy that are required as a part of hospital licensure or certification.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09.

Mont. Admin. R. 37.87.723 Mental Health Center Services for Youth with Serious Emotional Disturbance (sed), Provider Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; REP, 2015 MAR p. 1500, Eff. 10/1/15.

Mont. Admin. R. 37.87.733 Mental Health Center Services for Youth with Serious Emotional Disturbance (sed), Reimbursement

(1) Medicaid reimbursement for mental health center services shall be the lesser of:

(a) the provider's actual (submitted) charge for the service; or

(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.105.

(2) For day treatment services, the department will not reimburse a mental health center provider for more than one fee per treatment day per youth. This does not apply to mental health professional services to the extent such services are separately billed in accordance with these rules or targeted case management services for youth with SED.

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2012 MAR p. 1273, Eff. 7/1/12; AMD, 2013 MAR p. 2153, Eff. 11/15/13

Subchapter 37.87.8 Targeted Case Management Services for Youth With Serious Emotional Disturbance

Mont. Admin. R. 37.87.802 Targeted Case Management Services for Youth with Serious Emotional Disturbance, Definitions

As used in this chapter, the following terms apply:

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

(2) "Natural supports" means relationships and supports that occur within the community in everyday life including but not limited to relationships with family members, friends, neighbors, and community acquaintances.

(3) "Targeted case management services (TCM)" means case management as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(4) The definitions in ARM 37.86.3301 also apply when not inconsistent with this subchapter.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.805 Targeted Case Management Services for Youth with Serious Emotional Disturbance, Eligibility

(1) If otherwise eligible for Medicaid services, youth with SED may receive medically necessary targeted case management services in the community setting or when transitioning to a community setting as provided in this subchapter.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.807 Targeted Case Management Services for Youth with Serious Emotional Disturbance, Covered Services

(1) Targeted case management services include:

(a) comprehensive assessment and periodic reassessment of an eligible youth and the youth's family or caregivers to determine the need for any medical, educational, social, or other services. The assessment activities include the following:

(i) taking youth and the youth's family or caregivers history;

(ii) identifying the needs of the youth and the youth's family or caregivers, and completing related documentation; and

(iii) gathering necessary information from other sources, such as family members, medical providers, social workers, and educators to make a complete assessment of the eligible youth.

(b) development and periodic revision of a specific care plan based on the information collected through the assessment that includes the following:

(i) specific goals and actions to address the service needs of the youth and the youth's family or caregivers, including but not limited to medical, social, and educational needs;

(ii) the active participation of the eligible youth and the youth's family or caregivers in developing the goals and actions of the care plan; and

(iii) a course of action designed to respond to the assessed needs of the eligible youth and the youth's family or caregivers.

(c) referral and related activities, such as making referrals and scheduling appointments for the youth, helping the eligible youth and the youth's family or caregivers obtain needed services, helping to link the youth and the youth's family or caregivers with medical, social, and educational providers or other programs and services that provide needed services to address identified needs and achieve goals specified in the care plan; and

(d) monitoring and follow-up activities, including activities and contacts necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible youth and the youth's family or caregivers. The monitoring and follow-up activities may be with the youth, family members or caregivers, service providers, or other entities or individuals and may be conducted as frequently as necessary, including at least one annual monitoring review to help determine whether the following conditions are met:

(i) services are being furnished in accordance with the youth's care plan;

(ii) services in the care plan are adequate to meet the needs of the youth and youth's family or caregivers; and

(iii) changes in the needs or status of the eligible youth have been accommodated. Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers.

(2) Targeted case management may include contacts with noneligible individuals who are directly related to the identification of the eligible youth's needs and care for the purpose of helping the youth access services, identifying needs and supports to assist the eligible youth in obtaining services, providing case managers with useful feedback, and alerting case managers to changes in the eligible youth's needs.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2014 MAR p. 2858, Eff. 11/21/14; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.808 Targeted Case Management Services for Youth with Serious Emotional Disturbance, Authorization Requirements

(1) Targeted case management services for youth with SED do not require prior authorization to be reimbursed.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2011 MAR p. 1708, Eff. 8/26/11.

Mont. Admin. R. 37.87.809 Targeted Case Management Services for Youth with Serious Emotional Disturbance, Reimbursement

(1) Targeted case management (TCM) services for youth with SED will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is based on a 15-minute unit increment:

(a) one unit of service is equal to 8 minutes but less than 23 minutes;

(b) two units of service are greater than or equal to 23 minutes but less than 38 minutes;

(d) four units of service are greater than or equal to 53 minutes but less than 68 minutes;

(e) five units of service are greater than or equal to 68 minutes but less than 83 minutes;

(f) six units of service are greater than or equal to 83 minutes but less than 98 minutes;

(g) seven units of service are greater than or equal to 98 minutes but less than 113 minutes; and

(h) eight units of service are greater than or equal to 113 minutes but less than 128 minutes.

(2) Targeted case management services rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.106.

(3) The department will pay providers of targeted case management services for youth with SED the lesser of:

(a) the provider's actual submitted charge for services; or

(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.106.

(4) Case managers may not bill for time spent writing progress notes. This activity is included in the rate for TCM services.

(5) TCM services may be billed whether provided face-to-face or by telephone.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2012 MAR p. 1273, Eff. 7/1/12; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2016 MAR p. 2063, Eff. 11/11/16; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.823 Targeted Case Management Services for Youth with Serious Emotional Disturbance, Provider Requirements

(1) The requirements in this subchapter are in addition to those contained in provisions generally applicable to Medicaid providers.

(2) Targeted case management services for youth with SED must be provided by a licensed mental health center as defined in ARM 37.87.102. A mental health center must:

(a) have a current license endorsement permitting the mental health center to provide targeted case management services; and

(b) be enrolled in the Montana Medicaid program as a targeted case management services provider.

(3) Targeted case management services for youth with SED must be supported by narrative documentation in accordance with ARM 37.85.414 record keeping requirements.

(4) Targeted case management services for youth with SED must be provided under a case management plan in accordance with ARM 37.86.3305.

(5) Case management plans for youth with SED must be completed within the first 21 days of admission to targeted case management services and updated at least every 90 days or whenever there is a significant change to the youth's condition. The case management plan must:

(a) use the standardized assessment tool approved by the department to determine the appropriate level of service intensity needed by the youth and the youth's family or caregivers;

(b) incorporate standardized assessment tool findings into the plan;

(d) reflect the least restrictive and appropriate level of care;

(e) identify the strengths of the youth and the youth's family or caregivers;

(f) include a crisis response plan;

(g) include a plan for each youth age 16 1/2 and older to transition to adult mental health services; and

(h) include a discharge and transition plan from targeted case management services.

(6) Upon admission to TCM services and prior to all treatment team meetings of TCM services, the targeted case manager shall meet face-to-face with the youth's family or caregivers to complete a family treatment team meeting preparation checklist and questionnaire. If the meeting cannot be accomplished face-to-face, the targeted case manager shall document in the youth's file the reason for conducting the meeting through phone contact or telehealth. The checklist and questionnaire must contain and document the following components:

(a) explanation of the purpose of the treatment meeting and documentation of the youth's family or caregivers understanding;

(b) identification of natural supports in the youth's life;

(c) a notice to the family that the youth's treatment plan shall be delivered at times and in locations that are flexible, accessible, and convenient to the youth and the youth's family or caregivers, including evenings and weekends;

(d) evaluation with the youth and the youth's family or caregivers to identify and address risks and safety concerns at home and in the school and in the community; and

(e) evaluation with the youth and the youth's family or caregivers to identify strengths that can be used as the basis of the treatment plan in the areas of school, vocational, family, social, and community functioning as well as towards meeting developmental skills and abilities.

(7) Individual treatment plans and those participating in treatment team meetings must:

(a) use language that is understandable to the youth and the youth's family or caregivers and, where necessary, translate clinical terminology including but not limited to diagnoses and acronyms into language that is understandable; and

(b) actively seek to understand and demonstrate respect for the unique and diverse backgrounds of the youth and the youth's family or caregivers including but not limited to roles, values, beliefs, races, ethnicities, sexual orientations, gender expressions, gender identities, languages, traditions, communities, and cultures.

(8) In addition to the requirements outlined in (7), individual treatment plans must include:

(a) identification of natural supports or treatment goals intended to develop natural supports; and

(b) a crisis plan that identifies safety concerns, potential crises, triggers, de-escalation and coping strategies, actionable stabilization steps, prevention measures, and identified supports of the youth and the youth's family or caregivers.

(9) Targeted case management providers shall share with the youth and the youth's family or caregivers baseline and updated outcome measurements including measurements of the youth's emotional and behavioral functioning, living situation, school outcomes, risk of harm to self or others, substance use, and progress toward individualized goals. Targeted case management providers shall meet with the youth and the youth's family or caregivers at least every 90 days for the purpose of sharing this information.

(10) In addition to the discharge requirements outlined in ARM 37.106.1917, a youth must be discharged from targeted case management services when treatment plan goals have been met, when the youth no longer desires targeted case management, or when the youth no longer meets the criteria for entry into targeted case management services.

(11) Mental health centers with a youth targeted case management endorsement must have policies and procedures in place to provide timely access to services for youth by:

(a) ensuring mental health centers have adequate resources to provide timely access to the standard assessment tool for intake of youth; and

(b) detailing a communication plan to the youth's family or caregivers if the youth is placed on a waitlist, including a process for referral to other services providers.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Subchapter 37.87.9 Medicaid Mental Health Services for Youth

Mont. Admin. R. 37.87.901 Medicaid Mental Health Services for Youth, Reimbursement

(1) Medicaid reimbursement for mental health services will be the lowest of:

(a) the provider's actual (submitted) charge for the service; or

(b) the rate established in the department's fee schedule. Reimbursement fees are as provided in ARM 37.85.105(6).

(2) For services for which Medicare does not specify Relative Value Unit (RVU) as provided in ARM 37.85.212, the department determines the Medicaid fee for children's mental health services as follows:

(a) if there is use resulting in Medicaid reimbursements totaling at least $10,000 in a state fiscal year (SFY), and a minimum of four separate providers have billed the code, then the Medicaid fee is determined by multiplying the average charges by the payment-to-charge ratio; or

(b) if there is use resulting in Medicaid reimbursements totaling less than $10,000 in an SFY and fewer than four separate providers have billed the code in an SFY, the Medicaid fee will be determined by:

(i) reviewing similar procedure codes within the same service scope and adjusting the rate to be equal to a comparable procedure code or the average of similar procedure codes if there is more than one; or

(ii) reviewing similar procedure codes within the same service scope and adjusting the rate to be equal to a comparable procedure code or the average of similar codes plus 10% when severity is higher or increased resources are needed for the service. If the code is determined to have a lower severity component or fewer resources are required than when compared to the similar procedure code or average of similar procedure codes, the rate will equal the comparable procedure code or average of similar procedure codes less 10%.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 1273, Eff. 7/1/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1407, Eff. 7/1/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15.

Mont. Admin. R. 37.87.903 Medicaid Mental Health Services for Youth, Authorization Requirements

(1) The department will not reimburse providers for two services that duplicate one another on the same day.

(2) The department will reimburse providers of Medicaid mental health youth services if they meet the prior authorization or continued stay review requirements specified in the Children's Mental Health Medicaid Services Provider Manual, referenced in (7).

(3) Youth are not required to have a serious emotional disturbance to receive the following outpatient therapy services:

(a) the first 24 sessions of individual, family, or both outpatient therapies per state fiscal year. Group outpatient therapy is not included in the 24-session limit; and

(b) group outpatient therapy.

(4) The department may waive a requirement for prior authorization or continued authorization when the provider submits documentation that:

(a) there was a clinical reason why the request for prior authorization or continued authorization could not be made at the required time, and the provider submitted a subsequent authorization request within ten business days; or

(b) a timely request for prior authorization or continued authorization was not possible because of an equipment failure or malfunction of the department or its designee that prevented the transmittal of the request at the required time and the provider submitted a subsequent authorization request within ten business days.

(5) In computing any time period specified in this subchapter, every day is counted, including Saturdays, Sundays, and legal holidays. If the last day falls on a weekend or holiday, the deadline is the next business day.

(6) If the department finds exceptional circumstances that reasonably justify a provider's failure to timely request prior authorization or continued authorization, it may extend the deadline for meeting the requirement.

(7) In addition to the requirements contained in rule, the department has developed and published a provider manual entitled Children's Mental Health Medicaid Services Provider Manual (manual), dated May 9, 2026, for the purpose of implementing requirements for utilization management. The department adopts and incorporates by reference the Children's Mental Health Medicaid Services Provider Manual, dated May 9, 2026. A copy of the manual may be obtained at https://dphhs.mt.gov/bhdd/cmb/Manuals.

(8) The department may review the medical necessity of services or items at any time either before or after payment in accordance with the provisions of ARM 37.85.410. If the department determines that services or items were not medically necessary or were otherwise not in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.

(9) The department or its designee may require providers to report outcome data or measures regarding mental health services, as determined in consultation with providers and interested persons.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15; AMD, 2016 MAR p. 1393, Eff. 8/6/16; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 1116, Eff. 7/1/18; AMD, 2020 MAR p. 691, Eff. 4/18/20; AMD, 2020 MAR p. 2435, Eff. 1/1/21; AMD, 2022 MAR p. 159, Eff. 1/29/22; AMD, 2024 MAR p. 611, Eff. 3/23/24; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Subchapter 37.87.10 Therapeutic Group Home

Mont. Admin. R. 37.87.1011 Therapeutic Group Home (tgh), Provider Requirements

(1) The requirements in this subchapter are in addition to those requirements contained in rules generally applicable to Medicaid providers.

(2) Therapeutic group home (TGH) services may be provided by an in-state facility which is licensed as a TGH by the department in accordance with the provisions of Title 52, chapter 2, part 6, MCA, and found in ARM 37.87.1011, 37.87.1017, and the manual adopted and incorporated by reference in ARM 37.87.903, or by an out-of-state facility similarly licensed in the state in which it operates.

(3) TGH services must be provided to a youth in accordance with an individualized treatment plan developed and maintained as specified by licensure requirements and this subchapter.

(4) In addition to the clinical records required by TGH licensure rules, the provider must maintain the records required by ARM 37.85.414.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2024 MAR p. 611, Eff. 3/23/24.

Mont. Admin. R. 37.87.1013 Therapeutic Group Home (tgh), Reimbursement

(1) For the purpose of this subchapter, the following definitions apply:

(a) "Patient day" means a whole 24-hour period that a youth is present and receiving TGH services. Even though a youth may not be present for a whole 24-hour period, the day of admission is a patient day. The day of discharge is not a patient day.

(b) "Therapeutic intervention" is defined in ARM 37.97.102(23).

(2) The reimbursement rate for the therapeutic and rehabilitative portion of TGH or TGH with extraordinary needs aide (ENA) services is the lesser of (1)(a) or (b):

(a) the amount specified in the department's Medicaid Mental Health Fee Schedule as adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(3) The purpose of the therapeutic services in (1) is:

(a) to reduce the impairment of the mental disability of the youth and to improve the functional level of the youth;

(b) to alleviate the emotional disturbances;

(d) to encourage personal growth and development.

(4) TGHs are reimbursed a daily or patient day rate.

(5) TGH providers must use the procedure codes designated by the department, per the fee schedule in (1)(a) to be reimbursed for TGH, TGH with ENA, or TGH therapeutic home visit (THV) services.

(6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of TGH services.

(7) Reimbursement will be made to a provider for reserving a TGH bed while the youth is temporarily absent for a THV for a maximum of 14 patient days per state fiscal year.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14.

Mont. Admin. R. 37.87.1015 Therapeutic Group Home (tgh), Authorization Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 49, Eff. 1/15/11; REP, 2013 MAR p. 2153, Eff. 11/15/13

Mont. Admin. R. 37.87.1017 Therapeutic Group Home (tgh), Extraordinary Needs Aide (ena) Services, and Authorization Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 49, Eff. 1/15/11; REP, 2013 MAR p. 2153, 11/15/13

Mont. Admin. R. 37.87.1021 Therapeutic Family Care (tfc) and Therapeutic Foster Care (tfoc) Services Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 49, Eff. 1/15/11; REP, 2013 MAR p. 166, Eff. 2/1/13.

Mont. Admin. R. 37.87.1023 Therapeutic Family Care (tfc) and Therapeutic Foster Care (tfoc) Services, Authorization Requirements and Covered Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 49, Eff. 1/15/11; REP, 2013 MAR p. 166, Eff. 2/1/13.

Mont. Admin. R. 37.87.1025 Therapeutic Family Care (tfc) and Therapeutic Foster Care (tfoc) Services, Definition of Permanency Tfoc Treatament

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 49, Eff. 1/15/11; REP, 2013 MAR p. 166, Eff. 2/1/13.

Subchapter 37.87.12 Psychiatric Residential Treatment Facility Services

Mont. Admin. R. 37.87.1201 Psychiatric Residential Treatment Facility Services, Purpose

(1) The purpose of ARM Title 37, chapter 87, subchapter 12 is to specify provider participation and program requirements and to define the basis and procedure the department will use to pay for psychiatric residential treatment facility (PRTF) services.

(2) Facilities in which these services are available are referred to as providers.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1202 Psychiatric Residential Treatment Facility Services, Definitions

As used in this subchapter, the following definitions apply:

(1) "Continuity of care payment" means an annual payment made to qualifying hospital-based psychiatric residential treatment facilities (PRTF) according to the eligibility criteria and payment calculation methodology in ARM 37.87.1224.

(2) "Devoted to the provision of inpatient psychiatric care for persons under the age of 21" means an inpatient psychiatric hospital facility or residential treatment facility whose goals, purpose, and care are designed for and devoted exclusively to persons under the age of 21.

(3) "Hospital-based psychiatric residential treatment facility" means a residential treatment facility that meets the requirements of ARM 37.87.1207.

(4) "Inpatient psychiatric services" means psychiatric residential treatment facility services, or hospital-based psychiatric residential treatment facility services.

(5) "Patient day" means a whole 24-hour period in which a person is present and receiving inpatient psychiatric services. Even though a person may not be present for a whole 24-hour period, the day of admission and, subject to the limitations and requirements of ARM 37.87.1223, therapeutic home leave days are patient days. The day of discharge is not a patient day for purposes of reimbursement.

(6) "Psychiatric residential treatment facility (PRTF)" is defined in the Children's Mental Health Bureau Medicaid Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

(7) "Therapeutic Home Visit (THV)" is defined in the Children's Mental Health Bureau Medicaid Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2010 MAR p. 1511, Eff. 6/25/10; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2013 MAR p. 2433, Eff. 12/27/13; AMD, 2015 MAR p. 2147, Eff. 12/11/15; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1203 Psychiatric Residential Treatment Facility Services

(1) Inpatient psychiatric services are services that comply with the requirements of this subchapter and the applicable federal regulations and are provided in a psychiatric residential treatment facility (PRTF) that is devoted to the provision of inpatient psychiatric care for persons under the age of 21.

(2) 42 CFR 440.160 and Title 42 CFR, part 441, subpart D provide federal definitions and federal PRTF program requirements. The department adopts and incorporates by reference 42 CFR 440.160 (2010) and Title 42 CFR, part 441, subpart D (2010). A copy of the regulations may be obtained through the Department of Public Health and Human Services, Developmental Services Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59620-4210.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1206 Psychiatric Residential Treatment Facility Services, Participation Requirements

(1) These requirements are in addition to those contained in rule generally applicable to Medicaid providers.

(2) Psychiatric residential treatment facility (PRTF) providers, as a condition of participation in the Montana Medicaid program, must comply with the following requirements:

(a) maintain a current license as a residential treatment facility under the rules of the department's Quality Assurance Division to provide PRTF services, or, if the provider's facility is not located within the state of Montana, maintain a current license in an equivalent category under the laws of the state in which the facility is located;

(b) maintain a current PRTF certification for Medicaid participation by the state in which the facility is located as required by the Centers for Medicare and Medicaid;

(c) for all providers, enter into and maintain a current provider enrollment form with the department's fiscal agent to provide psychiatric PRTF services;

(d) license and/or register facility personnel in accordance with applicable state and federal laws;

(e) for providers maintaining patient trust accounts, ensure that any funds maintained in those accounts are used only for those purposes for which the youth or legal representative has given written authorization. A provider may not borrow funds from these accounts for any purpose;

(f) maintain accreditation as a PRTF by an organization designated by the Secretary of the United States Department of Health and Human Services as authorized to accredit PRTF for Medicaid participation;

(g) submit to the department within 30 days of receipt, all documentation issued by the accrediting organization to the provider;

(h) agree to indemnify the department in the full amount of the state and federal shares of all Medicaid inpatient psychiatric services reimbursement paid to the facility during any period when federal financial participation is unavailable due to facility failure to meet the conditions of participation specified in these rules or due to other facility deficiencies or errors.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2010 MAR p. 1511, Eff. 6/25/10; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1207 Hospital-Based Psychiatric Residential Treatment Facility Services, Requirements

(1) A hospital-based psychiatric residential treatment facility (PRTF) must meet the following requirements:

(a) the PRTF must be in a hospital facility that includes inpatient psychiatric hospital beds and provides inpatient hospital psychiatric care to individuals under age 21. The PRTF beds and the hospital beds must be owned and operated by a single entity, and they must be located in an integrated facility;

(b) the PRTF must be located in Montana;

(c) the inpatient psychiatric hospital beds and the PRTF beds must be served by a common administrative and support staff;

(d) the PRTF must be served by no less than one full-time equivalent psychiatrist for every 25 youth;

(e) both the hospital and the PRTF must have an organized medical staff that is on call and available within 20 minutes, 24 hours a day, seven days a week; and

(f) both the hospital and the PRTF must have 24-hour nursing care by licensed registered nurses.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1210 Out-of-State Psychiatric Residential Treatment Facility (prtf) Service Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2013 MAR p. 2433, Eff. 12/31/13; REP, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1214 Psychiatric Residential Treatment Facility Services, Substance Use Disorder Assessment and Treatment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2013 MAR p. 2433, Eff. 12/27/13; REP, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1215 Psychiatric Residential Treatment Facility Services, Assessment Services

(1) Psychiatric residential treatment facility (PRTF) assessment services are provided by in-state PRTF facilities and must comply with the requirements of this subchapter and the applicable federal regulations for PRTF services.

(2) PRTF assessment services:

(a) require prior authorization by the department or its designee;

(b) are short-term lengths of stay, 14 days or less;

(3) Assessment services include the following, as clinically indicated:

(a) diagnostic and functional assessment;

(b) medication evaluation;

(d) substance use disorder assessment; and

(e) supported group or independent living needs assessment.

(4) Assessment services include a written report within 14 days after the discharge that includes clear recommendations for treatment of the youth.

(5) If the PRTF admission continues beyond the assessment period and becomes a regular admission, the department will not reimburse at the higher rate for assessment services.

(a) If the youth is re-admitted to the facility within 30 days of the assessment, the admission for assessment may be subject to department review and full recovery.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1216 Psychiatric Residential Treatment Facility Services, Benefit Limits, Certification of Need, Utilization Review and Inspections of Care Requirements

(1) Prior to admission and as frequently as the department deems necessary, the department or its agents may evaluate the medical necessity and quality of services for each Medicaid member.

(a) In addition to the other requirements of these rules, the provider must provide to the department or its agent upon request any records related to services or items provided to a Medicaid member.

(b) The department may contract with and designate public or private agencies or entities, or a combination of public and private agencies and entities, to perform utilization review, inspections of care, and other functions under this rule as an agent of the department.

(2) The department or its agents may conduct periodic inspections of care in PRTFs participating in the Medicaid program.

(3) A provider must submit a certificate of need as described in the Children's Mental Health Bureau Medicaid Services Manual, adopted and incorporated by reference in ARM 37.87.903.

(4) An authorization by the department or its utilization review agent under this rule is not a final or conclusive determination of medical necessity and does not prevent the department or its agents from evaluating or determining the medical necessity of services or items at any time.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2013 MAR p. 270, Eff. 3/1/13; AMD, 2015 MAR p. 2147, Eff. 12/11/15.

Mont. Admin. R. 37.87.1217 Psychiatric Residential Treatment Facility (prtf) Services, Treatment Requirements

(1) PRTF services must include active treatment designed to achieve the discharge of the youth to a less restrictive level of care at the earliest possible time.

(2) PRTF services must be provided under the direction of a licensed physician.

(3) The PRTF treatment plan must be comprehensive and address all psychiatric, medical, educational, psychological, social, behavioral, and developmental treatment needs.

(4) The treatment plan and discharge plan for the youth must be reviewed at least every 30 days at the multidisciplinary treatment team meeting, and more frequently if there is a significant change in the condition of the youth. The multidisciplinary treatment team must be consistent with 42 CFR 441.156. The parent or legal representative of the youth must be invited to participate in these meetings, and given adequate notice to participate. Adequate notice means generally a week unless the condition of the youth dictates otherwise.

(5) PRTF services include only treatment or services provided in accordance with all applicable licensure, certification, and accreditation requirements, and these rules.

(6) The content of the treatment plan and discharge plan must meet all minimum state and federal requirements.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2009 MAR p. 2486, Eff. 1/1/10; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2013 MAR p. 270, Eff. 3/1/13; AMD, 2013 MAR p. 2433, Eff. 12/27/13; AMD, 2015 MAR p. 2147, Eff. 12/11/15; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1222 Psychiatric Residential Treatment Facility (prtf) Services, Interim Rate and Cost Settlement Process

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2674, Eff. 1/1/09; AMD, 2009 MAR p. 2486, Eff. 1/1/10; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2013 MAR p. 270, Eff. 3/1/13; REP, 2013 MAR p. 2433, Eff. 12/31/13.

Mont. Admin. R. 37.87.1223 In-State Psychiatric Residential Treatment Facility (prtf) Services, Reimbursement

(1) The Montana Medicaid Program will reimburse providers of inpatient psychiatric services provided to a youth in a psychiatric residential treatment facility (PRTF) for each patient day, which is consistent with the definition of a PRTF and all other applicable requirements are met.

(2) The Montana Medicaid Program will pay a provider for each Medicaid patient day, the following bundled per diem rate less any third party or other payments. The bundled per diem rate for in-state PRTF services is the lesser of:

(a) the amount specified in the department's Medicaid Youth Mental Health fee schedule, as adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(3) The bundled per diem rate for in-state PRTFs coverage includes the following services:

(a) services, therapies, and items related to treating the psychiatric condition of the youth;

(b) services provided by licensed psychologists, licensed clinical social workers, and licensed professional counselors;

(d) lab and pharmacy services related to treating the psychiatric condition of the youth; and

(e) supportive services necessary for daily living and safety.

(4) A direct-care wage add-on is reimbursed in addition to the in-state per diem through a contract with the department or in the bundled per diem rate, as applicable.

(5) The Montana Medicaid Program will reimburse enrolled providers directly for the following services which are not included in the in-state per diem rate:

(a) services provided by a licensed physician, psychiatrist, or midlevel practitioner;

(b) non-psychotropic medication and related lab services;

(c) adult mental health center evaluations for transition age youth 17 to 18, to determine whether or not they qualify for adult mental health services and have a severe and disabling mental illness; and

(d) up to 60 consecutive days of targeted case management services for the purpose of planning the youth's transition to the community. A youth should retain the case manager the youth had prior to entry into PRTF services, if applicable. If the youth is assigned a case manager who is different from the one previous to PRTF services, the case manager must document the rationale for the change.

(6) The Montana Medicaid Program will reimburse state plan ancillary services in addition to the in-state PRTF bundled per diem rate when these ancillary services are provided by a PRTF or by a different provider under arrangement with the PRTF. The ancillary services provided must be:

(a) directed by a PRTF physician;

(b) stated in the treatment plan of the youth; and

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2009 MAR p. 418, Eff. 4/17/09; AMD, 2009 MAR p. 2486, Eff. 1/1/10; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2013 MAR p. 270, Eff. 3/1/13; AMD, 2013 MAR p. 2433, Eff. 12/31/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 2147, Eff. 12/11/15; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1224 Psychiatric Residential Treatment Facility (prtf) Services, Continuity of Care Payment

(1) Hospital-based psychiatric residential treatment facilities as defined in ARM 37.87.1207 qualify for a continuity of care payment.

(a) The amount of the continuity of care adjustor payment will be calculated and paid annually.

(b) The amount will be determined by the department according to the following formula: CCA=[M/D]*P:

(i) "CCA" represents the calculated continuity of care payment;

(ii) "M" is the number of Medicaid inpatient residential days provided by the facility for which the continuity of care payment is being calculated;

(iii) "D" is the total number of Medicaid inpatient residential days provided by all eligible facilities; and

(iv) "P" is the total amount available for distribution via the continuity of care payments. P equals 4% of the revenue generated by the Montana inpatient hospital utilization fee, plus federal financial participation.

(2) The number of Medicaid days must be from the department's paid claims data for the most recent calendar year.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2019 MAR p. 2382, Eff. 1/1/20.

Mont. Admin. R. 37.87.1225 Psychiatric Residential Treatment Facility Services, Administrative Review and Fair Hearing Procedures

(1) The right to administrative review and fair hearing shall be in accordance with the provisions of ARM 37.5.310.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2008 MAR p. 2360, Eff. 1/1/09.

Mont. Admin. R. 37.87.1226 Out-of-State Psychiatric Residential Treatment Facility Services, Reimbursement

(1) The Montana Medicaid Program will reimburse a provider of inpatient psychiatric services provided to a youth in a psychiatric residential treatment facility (PRTF) for each patient day, in accordance with the requirements of this subchapter and the Children's Mental Health Bureau Medicaid Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

(2) The Montana Medicaid Program will reimburse a provider for each Medicaid patient day the following bundled per diem rate less any third party or other payments. The bundled per diem rate for out-of-state PRTF services is the lesser of:

(a) the amount specified in the department's Medicaid Youth Mental Health fee schedule, as adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(3) The bundled per diem rate for out-of-state PRTFs services coverage includes the following services:

(a) all services, therapies, and items related to treating the psychiatric condition of the youth;

(b) all services provided by licensed physicians, psychiatrists, midlevel practitioners, psychologists, clinical social workers, and professional counselors;

(d) lab and pharmacy services related to treating the psychiatric condition of the youth; and

(e) supportive services necessary for daily living and safety.

(4) The Montana Medicaid Program will reimburse enrolled providers directly for the following services which are not included in the out-of-state per diem rate:

(a) up to 60 consecutive days of targeted case management services for the purpose of planning the youth's transition to the community. A youth should retain the case manager the youth had prior to entry into PRTF services, if applicable. If the youth is assigned a case manager who is different from the one previous to PRTF services, the case manager must document the rationale for the change; and

(b) a clinical intake assessment by a licensed mental health center, with an endorsement to provide adult services for transition age youth 17 to 18, to determine whether they have a severe and disabling mental illness and if they qualify for adult mental health services.

(5) The Montana Medicaid Program will reimburse state plan ancillary services in addition to the out-of-state bundled per diem rate when these ancillary services are provided by a different provider under arrangement with the PRTF. The ancillary services provided must be:

(a) directed by the PRTF physician;

(b) stated in the treatment plan of the youth; and

History

Authorizing statute(s): 53-6-101, MCA
Implementing statute(s): 53-6-113, MCA
History: NEW, 2015 MAR p. 2147, Eff. 12/11/15; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2023 MAR p. 1025, Eff. 9/9/23; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Subchapter 37.87.13 Home and Community-Based Services for Youth With Serious Emotional Disturbance

Mont. Admin. R. 37.87.1303 HOME AND COMMUNITY-BASED 1915(c) SERVICES BRIDGE WAIVER FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: FEDERAL AUTHORIZATION AND AUTHORITY OF STATE TO ADMINISTER PROGRAM

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; AMD, 2011 MAR p. 1382, Eff. 7/29/11; AMD, 2012 MAR p. 622, Eff. 3/23/12; AMD, 2012 MAR p. 2186, Eff. 10/26/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2015 MAR p. 1500, Eff. 10/1/15; REP, 2016 MAR p. 1856, Eff. 10/15/16.

Mont. Admin. R. 37.87.1305 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Eligibility for Program

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; AMD, 2011 MAR p. 1382, Eff. 7/29/11; REP, 2012 MAR p. 2186, Eff. 10/26/12.

Mont. Admin. R. 37.87.1306 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Selection for Placement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2012 MAR p. 2186, Eff. 10/26/12.

Mont. Admin. R. 37.87.1307 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Loss of a Service and Disenrollment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; AMD, 2011 MAR p. 1382, Eff. 7/29/11; AMD, 2012 MAR p. 622, Eff. 3/23/12; REP, 2012 MAR p. 2186, Eff. 10/26/12.

Mont. Admin. R. 37.87.1313 1915(i) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN PROGRAM FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: FEDERAL AUTHORIZATION AND AUTHORITY OF STATE TO ADMINISTER PROGRAM

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2013 MAR p. 128, Eff. 2/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2013 MAR p. 2311, Eff. 12/13/13; AMD, 2015 MAR p. 1500, Eff. 10/1/15; REP, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1314 1915(i) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN PROGRAM FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: REIMBURSEMENT

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2013 MAR p. 128, Eff. 2/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13; REP, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1315 1915(i) HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN PROGRAM FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: NOTICE AND FAIR HEARING

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2013 MAR p. 128, Eff. 2/1/13; REP, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1321 Home and Community-Based Services for Youth with Serious Emotional Disturbance: the Provision of Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; AMD, 2011 MAR p. 1382, Eff. 7/29/11; AMD, 2012 MAR p. 622, Eff. 3/23/12; REP, 2012 MAR p. 2186, Eff. 10/26/12.

Mont. Admin. R. 37.87.1323 Home and Community-Based Services for Youth with Serious Emotional Disturbance and Plans of Care: Plan Management

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1325 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Cost of Plan of Care

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2012 MAR p. 2186, Eff. 10/26/12.

Mont. Admin. R. 37.87.1331 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Provider Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; AMD, 2010 MAR p. 2983, Eff. 12/24/10; REP, 2012 MAR p. 2186, Eff. 10/26/12.

Mont. Admin. R. 37.87.1333 HOME AND COMMUNITY-BASED 1915(c) SERVICES BRIDGE WAIVER FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: REIMBURSEMENT

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; AMD, 2011 MAR p. 1382, Eff. 7/29/11; AMD, 2012 MAR p. 622, Eff. 3/23/12; AMD, 2012 MAR p. 2186, Eff. 10/26/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13; REP, 2016 MAR p. 1856, Eff. 10/15/16.

Mont. Admin. R. 37.87.1335 HOME AND COMMUNITY-BASED 1915(c) SERVICES BRIDGE WAIVER FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: NOTICE AND FAIR HEARING

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; AMD, 2012 MAR p. 2186, Eff. 10/26/12; REP, 2016 MAR p. 1856, Eff. 10/15/16.

Mont. Admin. R. 37.87.1338 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Consultative Clinical and Therapeutic Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1339 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Customized Goods and Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1340 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Education and Support Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1341 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Home-Based Therapy Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1342 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Nonmedical Transportation Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1343 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Respite Care Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1344 Home and Community-Based Services for Youth with Serious Emotional Disturbance : Family Support Specialist Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1345 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Caregiver Peer-to-Peer Support Specialist Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1346 Home and Community-Based Services for Youth with Serious Emotional Disturbance: Wraparound Facilitation Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2009 MAR p. 2376, Eff. 12/11/09; REP, 2011 MAR p. 1382, Eff. 7/29/11.

Mont. Admin. R. 37.87.1350 Integrated Co-Occurring Treatment (ict), Definitions

(1) "Community psychiatric supportive treatment (CPST)" means a treatment method that assists a youth and family members or other collaterals to identify strategies or treatment options associated with the youth's mental illness, with the goal of minimizing the negative effects of mental illness symptoms or emotional disturbances or associated environmental stressors which interfere with the youth's daily living, financial management, housing, academic or employment progress, personal recovery or resilience, family or interpersonal relationships, and community integration.

(2) "Fidelity" means adherence to the integrated co-occurring treatment (ICT) model, defined in (3). A program which adheres to the ICT model is more likely to replicate the positive outcomes of the model's initial implementation or testing.

(3) "Integrated co-occurring treatment (ICT) model" means the ICT model developed by the Center for Innovative Practices at Case Western Reserve University. Services are provided to the fidelity of the model in the home or community where the youth lives, with the goal of safely maintaining the youth in the least restrictive, most normative environment. The frequency and intensity of services may fluctuate based on the needs and unique circumstances of the youth and family. ICT provides a family driven, comprehensive mix of integrated services designed to meet the mental health and substance abuse needs of the youth through implementation of the following services:

(a) ICT therapeutic interventions as described in (6); and

(b) CPST as described in (1).

(4) "ICT clinical supervisor" means a person who is an employee of a provider agency who is dually licensed as a mental health professional, as defined in ARM 37.87.102(3) and is a licensed addiction counselor (LAC), under 37-35-202, MCA.

(5) "ICT clinician" means a person who is an employee of a provider agency who:

(a) is licensed as a mental health professional, as defined in ARM 37.87.102(3), or is an in-training mental health professional, as defined in ARM 37.87.702(3); and

(b) is a LAC, or is a candidate for licensure, under 37-35-202, MCA, or will meet the requirements for candidacy under 37-35-202, MCA, within one year of hire and has completed ICT approved core training.

(6) "ICT therapeutic interventions" means crisis response and management; individual and family counseling matched to assessed readiness to change and assessed ability of youth and family, not to include group therapy; and behavioral management and skill training matched to assessed ability of youth and family.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2016 MAR p. 1856, Eff. 10/15/16.

Mont. Admin. R. 37.87.1351 Integrated Co-Occurring Treatment (ict), Eligibility

(1) ICT services are available to Medicaid eligible youth as defined in ARM 37.87.102.

(2) The youth must have a co-occurring substance use disorder (SUD) as defined by the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and a serious emotional disturbance (SED) as defined in the manual, adopted and incorporated by reference in ARM 37.87.903.

(3) The youth must undergo an integrated bio-psycho-social assessment which supports referral to the ICT program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2016 MAR p. 1856, Eff. 10/15/16; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1352 Integrated Co-Occurring Treatment (ict), Requirements

(1) Providers of ICT must be trained in, and use, ICT as defined by the model.

(2) Providers who wish to provide ICT must undergo and pass the following provided by an entity approved by the department:

(a) a readiness assessment; and

(b) an annual fidelity review.

(3) An ICT team must have a minimum of one .125 full-time equivalent (FTE) ICT clinical supervisor and one FTE ICT clinician.

(4) One FTE ICT clinical supervisor may supervise up to eight FTE ICT clinicians.

(5) The ICT clinical supervisor must provide supervision as defined by the model, including:

(a) providing weekly one-on-one supervision; and

(b) providing weekly team case consultation to the ICT clinician who holds primary case responsibility.

(6) A clinical supervisor who is dually licensed as a licensed mental health professional and a licensed addiction counselor (LAC) must be available 24 hours a day, 7 days a week to the ICT clinicians.

(7) One FTE ICT clinician may provide services for up to six families at a time.

(8) The following requirements must be met, as described by the ICT model by the ICT clinical supervisor, the ICT clinicians, or both:

(a) conduct an average of three hours of ICT services per week with each family through the course of treatment at the frequency, location, and duration that are sufficient to meet the identified needs of the family, unless there is a documented reason that an average of three hours of service per week cannot be met; and

(b) provide 24 hours a day, 7 days a week, face-to-face or telephonic crisis response.

(9) Treatment begins when the family consents in writing to begin services.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2016 MAR p. 1856, Eff. 10/15/16.

Mont. Admin. R. 37.87.1353 Integrated Co-Occurring Treatment (ict), Reimbursement and Authorization

(1) A prior authorization (PA) request must be submitted to the Children's Mental Health Bureau no earlier than ten business days prior to the first date of the service for the youth. Requests received earlier than ten days prior to the admission of the youth, will be technically denied. If a request is received after the youth has been admitted, the request will be considered from the date the request was received by the department.

(2) The clinical reviewer will complete the PA review process within two business days of receipt of complete information and take one of the following actions:

(a) request additional information as needed to complete the review and the provider must submit the requested information within five business days of the request for additional information;

(b) authorize the PA for up to 180 days as medically necessary and generate notification to all appropriate parties if the request meets the medical necessity criteria; or

(c) defer the case to a board-certified psychiatrist for review and determination if the PA request does not appear to meet the medical necessity criteria.

(3) The board-certified psychiatrist will complete the review and determination within four business days of receipt of the information from the clinical reviewer.

(4) After a denial, a new PA request may be submitted only if there is new clinical information.

(5) The following services will not be reimbursed concurrently with ICT:

(a) outpatient therapy;

(b) home-support services;

(d) therapeutic group home;

(e) psychiatric residential treatment facility;

(f) day treatment;

(g) comprehensive school and community treatment;

(h) acute inpatient hospital services; and

(i) targeted case management.

(6) CPST services may be provided by the ICT team to a youth that is enrolled in partial hospitalization for up to 14 days.

(7) The ICT provider must provide to the family a document that explains which services cannot be reimbursed concurrently as well as the potential for repayment if such services are provided concurrently.

(8) ICT therapeutic interventions will be reimbursed as follows: procedure code H0040 at $18.73 per 15-minute unit.

(9) CPST will be reimbursed as follows: procedure code H0039 UA at $14.30 per 15-minute unit.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 2016 MAR p. 1856, Eff. 10/15/16.

Subchapter 37.87.14 Home Support Services, Therapeutic Foster Care, Therapeutic Foster Care - Permanency

Mont. Admin. R. 37.87.1401 Home Support Services and Therapeutic Foster Care, Services Reimbursement

(1) Reimbursement for the therapeutic portion of home support services (HSS) and therapeutic foster care (TFC) services is the lesser of:

(a) the amount specified in the department's fee schedule adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(2) HSS and TFC providers must use the procedure codes designated by the department, in the fee schedule referred to in (1)(a) to be reimbursed for HSS and TFC.

(3) The TFC provider is reimbursed a daily rate. For TFC services, the department will reimburse the provider the daily rate for every day of a four-week period if the provider meets the minimum number of contacts as described in ARM 37.87.1410(6) during the four-week period.

(4) The HSS provider is reimbursed on a fee per unit of service basis. The two-hour weekly service requirement for HSS services must be met to be eligible for reimbursement. For purposes of this rule, a unit of service is based on a 15-minute unit increment. A unit of service is a period of 15 minutes as follows:

(a) one unit of service is equal to 8 minutes but fewer than 23 minutes;

(b) two units of service are greater than or equal to 23 minutes but fewer than 38 minutes;

(d) four units of service are greater than or equal to 53 minutes but fewer than 68 minutes;

(e) five units of service are greater than or equal to 68 minutes but fewer than 83 minutes;

(f) six units of service are greater than or equal to 83 minutes but fewer than 98 minutes;

(g) seven units of service are greater than or equal to 98 minutes but fewer than 113 minutes; and

(h) eight units of service are greater than or equal to 113 minutes but fewer than 128 minutes.

(5) HSS rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.105.

(6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of HSS or TFC treatment, including when this service is delivered in a foster home.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2020 MAR p. 2435, Eff. 1/1/21.

Mont. Admin. R. 37.87.1402 Home Support Services (hss) and Therapeutic Foster Care (tfc), Definitions

(1) "Behavioral Aide" means for therapeutic foster care permanency, an unlicensed employee of the mental health center who works under the supervision of the licensed mental health professional. All behavioral aides must have, at a minimum, a high school diploma and at least two years of experience working with emotionally disturbed youth or providing direct services in a human services field. Aides may only provide services for which they have demonstrated competency and which are not limited to the scope and practice of the licensed mental health professional.

(2) "Caregiver" means a person responsible for the well-being of the youth on a day-to-day basis with written permission from the legal representative of the youth, when applicable.

(3) "Clinical lead" means a person who is an employee of the provider agency who is responsible for the supervision and overall provision of treatment services to youth in HSS and TFC. The clinical lead must be a licensed mental health professional as defined in ARM 37.87.102 or an individual providing in-training mental health services as defined in ARM 37.87.702.

(4) "Concurrent" means any time during the 90-day period of the individualized treatment plan for HSS and TFC, unless the youth is discharged from service.

(5) "Family support specialist" (FSS) means a person who is an employee of the provider agency who provides therapeutic interventions to youth who are receiving HSS and TFC. The FSS must have a bachelor's degree in a human services field or a combination of experience and education equivalent to a bachelor's degree. For an FSS, six years of human services experience equates to a bachelor's degree, and each year of post-secondary education in human services equates to one year of experience.

(6) "Home support services (HSS)" is defined in the Manual adopted and incorporated by reference in ARM 37.87.903.

(7) "Natural supports" means relationships and supports that occur within the community in everyday life including but not limited to relationships with family members, friends, neighbors, and community acquaintances.

(8) "Therapeutic foster care (TFC)" means medically necessary, intensive in-home services delivered by a provider with specialized training and experience working with caregivers and youth in their homes, with temporary services available when a youth is homeless for fewer than 90 days.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2020 MAR p. 2435, Eff. 1/1/21.

Mont. Admin. R. 37.87.1404 Home Support Services (hss) and Therapeutic Foster Care (tfc), Individualized Treatment Plan

(1) The individualized treatment plan (ITP) must be developed in accordance with ARM 37.106.1916.

(2) The caregiver may select the members of the ITP team.

(3) Providers must inform the youth and their caregiver that Medicaid requires coordination of HSS and TFC with comprehensive school and community treatment (CSCT) planning, when applicable, and coordination of HSS with therapeutic group home (TGH) and outpatient therapy treatment planning, when applicable.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Mont. Admin. R. 37.87.1405 Home Support Services (hss) and Therapeutic Foster Care (tfc), Assessments

(1) A clinical assessment consistent with ARM 37.106.1915 must be completed for each youth documenting the youth has a serious emotional disturbance as defined in ARM 37.87.102.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.87.1407 Therapeutic Foster Care (tfc), Provisions of Service

(1) The main focus of the service is to address the mental health needs and strengthen the structure and support for youth and the caregivers. TFC serves the youth and the caregivers in their home and community environment through understanding the needs of the youth and the dynamics of the caregivers. TFC requires a structured, consistent, strength based therapeutic relationship between the provider and the youth and the caregiver for the purpose of treating the behavioral health needs of the youth, including improving the caregiver's ability to provide effective support for the youth and to promote healthy functioning.

(2) The following must be available and provided as clinically indicated by a mental health professional:

(a) conduct a treatment team meeting with the caregiver to develop an individualized treatment plan in accordance with ARM 37.106.1916(5);

(b) write treatment summaries at a minimum of every month describing progress and changes in the strengths and needs of the youth and the caregiver to inform service provisions; and

(c) develop a crisis plan with the caregiver that identifies a range of potential crisis situations with a range of corresponding responses including direct (face-to-face) and telephonic responses 24/7.

(3) The following services, identified in the individualized treatment plan, must be available and provided as clinically indicated:

(a) individualized therapeutic support to the youth and the caregiver based on strengths and needs;

(b) identification, coordination, and strengthening of formal and informal supports; and

(4) The following services must be available and provided as clinically indicated. The services must be identified in the ITP and include two of the following:

(a) skill building;

(b) assistance for the youth and the caregiver to identify resources to meet their needs;

(d) psycho-educational programs.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2020 MAR p. 2435, Eff. 1/1/21.

Mont. Admin. R. 37.87.1408 Therapeutic Foster Care (tfc), Discharge Planning and Documentation

(1) The youth may be discharged from this level of care based upon at least one the following criteria:

(a) the caregiver no longer needs this level of support or is actively using other formal and informal support networks;

(b) the treatment plan for the youth indicates the goals and objectives for the services have been substantially met;

(c) the caregiver is not engaged in the services. The lack of engagement is of such a degree that this type of support becomes ineffective or unsafe, despite documented attempts to address the engagement issues;

(d) the caregiver withdraws consent for the treatment;

(e) the youth is placed in a residential treatment setting with no plan for return to the home setting; or

(f) the youth has moved to an independent living situation and is no longer in or returning to the family setting.

(2) A discharge summary must be documented and indicate the reason for the discharge.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2020 MAR p. 2435, Eff. 1/1/21.

Mont. Admin. R. 37.87.1410 Therapeutic Foster Care (tfc), Provider Requirements

(1) The TFC provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19.

(2) The provider must also be a child-placing agency.

(3) A full-time clinical lead is responsible for not more than five full-time family support specialists (FSS).

(4) The clinical lead must:

(a) provide direction and consultation to the FSS to address the clinical needs of the youth and the needs of the caregiver as identified in the youth's individualized treatment plan (ITP);

(b) respond to the youth's and the caregiver's needs when the FSS is not available;

(d) provide one-on-one supervision at least monthly to the FSS.

(5) A full-time FSS is responsible for not more than ten youths at a time.

(6) The following requirements must be met by either the clinical lead, the FSS, or both:

(a) provide contacts at the frequency, location, and duration that are sufficient to meet the identified needs of the youth and the caregiver, with the duration of the contacts not limited;

(b) conduct a minimum of four scheduled contacts or sessions with the caregiver in each four-week period, two of which must be face-to-face within the home and community environment, excluding the provider's office or facility, based on the needs of the caregiver that are documented in the ITP;

(c) conduct a minimum of two scheduled treatment sessions with the youth, one of which must be face to face, within the home and community environment, excluding the provider's office or facility, in each four-week period, based on the needs of the youth that are documented in the ITP;

(i) For both requirements in (b) and (c), face-to-face delivery of the treatment services is preferred. Telehealth may be substituted if clinically indicated or if the youth does not have access to face-to-face services. Case notes must include the reason(s) for telehealth delivery of service, including documentation of attempts to identify local supports, if the need for telehealth delivery of services is related to access issues; and

(d) services provided above the minimum face-to-face contact requirements in (b) and (c) may be provided in the provider's office or facility to further meet the identified needs of the youth and the caregiver documented in the ITP. The duration of the contacts are not limited.

(7) 24/7 face-to-face and telephonic crisis response is expected.

(8) The provider of TFC must use a research-based practice curriculum to provide family-based services. Staff training in the research-based practice must be documented in the provider's personnel records.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2017 MAR p. 607, Eff. 5/13/17; AMD, 2020 MAR p. 2435, Eff. 1/1/21; AMD, 2024 MAR p. 611, Eff. 3/23/24.

Mont. Admin. R. 37.87.1411 Therapeutic Foster Care Permanency Services, Authorization Requirements and Covered Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13; REP, 2013 MAR p. 2153, Eff. 11/15/13

Mont. Admin. R. 37.87.1413 Therapeutic Foster Care Permanency Services, Provider Participation

(1) Therapeutic foster care permanency (TFOC-P) services must be provided in accordance with ARM 37.87.1401 through 37.87.1408 (HSS/TFC).

(2) TFOC-P must be provided by a child placement agency in accordance with ARM Title 37, chapter 93.

(3) TFOC-P is an intensive level of treatment for youth in a therapeutic foster family placement which is permanent and includes:

(a) individual, family, and group therapies;

(b) clinical supervision provided by a licensed psychologist on a 1:20 ratio;

(d) behavioral aide services averaging at least ten hours per week;

(e) respite care at least one weekend per month; and

(f) additional specialized training for families.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2013 MAR p. 166, Eff. 2/1/13.

Mont. Admin. R. 37.87.1414 Home Support Services (hss), Provisions of Service

(1) Home support services (HSS) providers must support the strengths of youth and caregivers by:

(a) identifying behavioral health abilities and needs across key areas such as school, family, social, community, and vocational environments;

(b) identifying strengths that can form the basis of the treatment plan in the areas of school, family, social, community, and vocational functioning; and

(c) prioritizing the most critical behavioral health needs and concerns as the focus of the treatment planning and delivery.

(2) HSS providers must engage in treatment planning that:

(a) clearly states the treatment goals identified in the clinical eligibility recommendation;

(b) is based on the functional assessment conducted pursuant to the manual adopted and incorporated by reference in ARM 37.87.903;

(c) is a collaborative process that involves youth and caregivers in developing a treatment plan with a manageable number of prioritized needs along with goals and strategies for addressing each need and goal;

(d) includes goals with measurable and observable outcomes;

(e) includes updates every 90 days, which include outcome measurements of treatment goals; and

(f) unifies treatment plans with a targeted case management (TCM) provider, if applicable, and identifies all services and supports to caregivers.

(3) The provider must conduct a treatment team meeting with the caregiver to develop an individualized treatment plan in accordance with ARM 37.106.1916.

(4) The provider must measure progress on individualized treatment goals, using both the department-approved standardized assessment and treatment goal indicators to measure progress from baseline. Progress towards individualized treatment goals must be considered as part of discharge planning.

(5) The provider must collaborate and coordinate with the TCM provider, if youth and caregivers are engaged in TCM services.

(a) HSS team members may not provide TCM and HSS services to the same youth.

(6) The provider must collaborate with youth and caregivers to identify and address suicidality, risk, and safety concerns at home, in school, and in the community to develop an individualized safety plan for each youth. Individual safety plans must be completed within 21 days of admission to HSS and must be reviewed monthly and after crisis with updates as necessary. Individual safety plans must contain the following components:

(a) delineate required safety planning and processes, youth and caregiver involvement, and plan dissemination;

(b) identification of what is considered a crisis for youth and caregivers;

(d) current resources and skills accessible to the youth and caregivers;

(e) crisis escalation patterns and triggers;

(f) de-escalation strategies that are easily understood and can be implemented by the youth and caregivers;

(g) if indicated by suicidality screening, a specific plan to address suicidal thoughts or ideations;

(h) when to call the HSS team; and

(i) when to call 911.

(7) The provider must maintain requirements for crisis response as defined in ARM 37.106.1945. Individual treatment and safety plans must be immediately available to mental health center employees engaged in crisis response.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2020 MAR p. 2435, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Mont. Admin. R. 37.87.1415 Home Support Services (hss), Provider Requirements

(1) The HSS provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19.

(2) HSS teams should consist of a family support specialist (FSS) and a clinical lead.

(3) HSS providers must ensure caseload sizes are sufficiently small to permit home support teams to respond flexibly to differing service needs of youth and families, including frequency of contact. FSS caseloads may vary between 1 to 14 families.

(4) HSS providers must provide coaching to an FSS on in-home behavioral health skills. The clinical lead shall provide feedback based on observation of practice, review of plans of care and other documentation, and progress for each youth and caregiver. The FSS must meet with their clinical lead regularly. Frequency must be at least once a week, or more frequently based on documented skills and competencies.

(5) Coaching and mentoring must be skills-based and include coaching to promote competencies in key skill sets such as safety planning, behavior management, cognitive behavioral interventions, caregivers and systemic interventions, and psychoeducation.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, MCA
History: NEW, 2020 MAR p. 2435, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Subchapter 37.87.15 Mental Health Services Plan Member Eligibility

Mont. Admin. R. 37.87.1503 Mental Health Services (mhs) Plan for Youth with Serious Emotional Disturbance, Eligibility

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; REP, 2013 MAR p. 685, Eff. 5/1/13.

Mont. Admin. R. 37.87.1513 Mental Health Services (mhs) Plan for Youth with Serious Emotional Disturbance, Limitations

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; REP, 2013 MAR p. 685, Eff. 5/1/13.

Subchapter 37.87.16 Alternatives to Out-of-State Placement

Mont. Admin. R. 37.87.1601 Alternatives to Out-of-State Placement, Purpose

(1) The purpose of ARM 37.87.601 through 37.86.1606 is to specify provider participation and program requirements to define the basis and procedure available for placement of high-risk children to in-state services as an alternative to out-of-state placement.

History

Authorizing statute(s): 52-2-308, MCA
Implementing statute(s): 52-2-310, 52-2-311, MCA
History: NEW, 2012 MAR p. 2192, Eff. 10/26/12.

Mont. Admin. R. 37.87.1602 Alternatives to Out-of-State Placement, Definitions

(1) ″At risk″ means high-needs youth who have proven challenging for typical in-state placements, and are at risk for out-of-state placement or returning from out-of-state placement.

(2) ″Qualified provider pool″ means all in-state Medicaid providers who meet the requirements established in ARM 37.87.1604 and who are granted access to the department-approved data management system.

History

Authorizing statute(s): 52-2-308, MCA
Implementing statute(s): 52-2-310, 52-2-311, MCA
History: NEW, 2012 MAR p. 2192, Eff. 10/26/12.

Mont. Admin. R. 37.87.1604 Alternatives to Out-of-State Placement, Provider Requirements

(1) Services funded through the program may only be provided by or through a provider that:

(a) is enrolled with the department as a Montana Medicaid provider;

(b) meets all the requirements necessary for the receipt of Medicaid monies;

(c) has been determined by the department to be qualified to provide services to youth with serious emotional disturbance in accordance with the criteria set forth in these rules and must be:

(i) a licensed mental health center;

(ii) a therapeutic group home;

(iii) a psychiatric residential treatment facility; or

(iv) a 1915(i) home and community-based state plan provider.

(d) is a legal entity; and

(e) meets all facility and other licensing requirements applicable to the services covered, the service settings provided, and the professionals employed.

History

Authorizing statute(s): 52-2-308, MCA
Implementing statute(s): 52-2-310, MCA
History: NEW, 2012 MAR p. 2192, Eff. 10/26/12.

Mont. Admin. R. 37.87.1606 Alternatives to Out-Ot-State Placement, Provider Participation and Procedures

(1) Qualified providers and acute care hospitals may request access to the system for an alternative to out-of-state placement by supplying an OM300 form which can be obtained by contacting the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(2) Department-approved acute care hospitals and the department may place treatment plans on the department-approved data management system for review by qualified providers.

(3) Upon approval for access and according to the requirements of this subchapter a qualified provider may review the treatment plans on the department-approved data management system. The qualified provider must follow all applicable department rules, policies, and procedures when proposing a plan of care for providing services in-state for at-risk youth.

(4) All services that require prior authorization must be prior authorized in accordance with ARM 37.87.903.

History

Authorizing statute(s): 52-2-308, MCA
Implementing statute(s): 52-2-310, 52-2-311, MCA
History: NEW, 2012 MAR p. 2192, Eff. 10/26/12.

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; REP, 2013 MAR p. 685, Eff. 5/1/13.

Subchapter 37.87.18 Comprehensive School and Community Treatment Program (CSCT)

Mont. Admin. R. 37.87.1801 Comprehensive School and Community Treatment Program: Referrals

(1) Comprehensive school and community treatment (CSCT) services must be provided as set forth in ARM 37.106.1916, 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965 in order to receive payment under this program.

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

(a) without treatment the youth may become at risk of self-harm or harm to others;

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

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

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

(f) the youth is not attending school due to the mental health condition of the youth.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2022 MAR p. 159, Eff. 1/29/22.

Mont. Admin. R. 37.87.1802 Comprehensive School and Community Treatment Program: Contract Requirements

(1) The licensed mental health center providing a comprehensive school and community treatment (CSCT) program must have a written contract with the school district.

(2) The licensed mental health center must provide a description of the mental health services provided by the licensed mental health center during and outside of normal classroom hours.

(3) The school must identify:

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

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

(c) program supports, including telephone, computer access, locking file cabinet(s), and copying, that the school will make available to CSCT staff while providing services within the school;

(d) office space dedicated to CSCT which must be adequate and appropriate for confidentiality and privacy for the services provided; and

(e) treatment space available to CSCT large enough to host a group during both school and non-school days.

(4) The school and licensed mental health center must specify a referral process to the CSCT program.

(5) The school and licensed mental health center must specify an enrollment process that:

(a) includes the CSCT licensed or in-training mental health professional and a school administrator or designee;

(b) ensures youth have access to services prioritized according to acuity and need as specified in ARM 37.87.1801; and

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

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

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

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

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

(a) CSCT program and services;

(b) CSCT referral process and criteria;

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

(8) The contract must identify program data and information which will be shared between the school district and the licensed mental health center to evaluate program effectiveness to include ARM 37.106.1956(10).

(9) The contract must identify the responsible party for each requirement specified in this rule.

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

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2022 MAR p. 159, Eff. 1/29/22.

Mont. Admin. R. 37.87.1803 Comprehensive School and Community Treatment Program: Reimbursement

(1) Comprehensive school and community treatment (CSCT) services delivered by a licensed mental health center with an endorsement under ARM 37.106.1955 must be billed under the school district's provider number.

(2) CSCT services may be provided to:

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

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

(3) A team with one employee will not be reimbursed for more than 450 units per month, and a team with two employees will not be reimbursed for more than 900 units per month. A team of three employees will not be reimbursed for more than 1350 units per month. Billing units are calculated based on the sum total of minutes of CSCT service for the youth per day.

(a) Core services, meeting the definition of CSCT as a community mental health outpatient treatment under ARM 37.106.1902, include intake and annual assessment, individual therapy, family therapy, group psychotherapy or psychoeducation, behavioral interventions, crisis response during typical working hours, and care coordination.

(b) Care coordination may only be considered a core service and be billable if two other core services are provided within that week. Care coordination includes phone calls, treatment team meetings, IEP meetings, referrals, and school advocacy for youth. Care coordination does not include documentation time. For the purposes of this subsection, a week begins on Monday and ends on Sunday.

(4) If the sum total of daily units per youth is over 20 units, the claim will suspend for clinical review. The provider must submit documentation to the department demonstrating medical necessity of service.

(5) Up to 20 CSCT units per youth, per state fiscal year, may be billed for an intervention, assessment, and if necessary, referral to other services. There is no limit on the number of youth that may be served. These units must be billed as part of the monthly team total.

(6) For a youth to qualify for more than 20 units of CSCT, a full clinical assessment is required, and the youth must meet the SED criteria identified in the Children's Mental Health Bureau Medicaid Services Provider Manual as referenced in ARM 37.87.903(7).

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

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

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

(8) The school district or the contracted provider must bill for youth not eligible for Medicaid. The school district may use a sliding-fee schedule.

(9) The school district must meet the match requirements through the intergovernmental transfer (IGT) process.

(10) CSCT services rendered to youth attending school in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.106.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2014 MAR p. 1401, Eff. 6/27/14; AMD, 2016 MAR p. 1706, Eff. 9/24/16; AMD, 2022 MAR p. 159, Eff. 1/29/22; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Subchapter 37.87.19 Authorization/Certificate of Need Requirements Mental Health Services Plan

Mont. Admin. R. 37.87.1903 Mental Health Services (mhs) Plan for Youth with Serious Emotional Disturbance, Authorization Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; REP, 2013 MAR p. 685, Eff. 5/1/13.

Mont. Admin. R. 37.87.1915 Mental Health Services (mhs) Plan for Youth with Serious Emotional Disturbance, Premium Payments and Copayments

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; REP, 2013 MAR p. 685, Eff. 5/1/13.

Subchapter 37.87.21 Grievance, Rights, Member Notice Mental Health Services Plan

Mont. Admin. R. 37.87.2103 Mental Health Services (mhs) Plan for Youth with Serious Emotional Disturbance, Notice, Grievance and Reconsideration, and Rights

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; REP, 2013 MAR p. 685, Eff. 5/1/13.

Subchapter 37.87.22 Youth System of Care Account

Mont. Admin. R. 37.87.2202 Mental Health Services for Youth with Serious Emotional Disturbance (sed) Respite Care Services, Definition

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2012 MAR p. 2274, Eff. 11/9/12; REP, 2015 MAR p. 1274, Eff. 10/1/15.

Mont. Admin. R. 37.87.2203 Non-Medicaid Services Program

(1) The Children's Mental Health Bureau (CMHB) administers the Non-Medicaid Services Program for youth with serious emotional disturbance to provide the following short-term funding:

(a) Supplemental Services Program;

(b) Room and Board Account;

(d) Non-Medicaid Respite Care Service.

(2) This subchapter is not intended to and does not establish an entitlement for any youth to be determined eligible for or to receive any services under the CMHB Non-Medicaid Services Program. The department may, in its discretion, limit services, rates, eligibility, and the number of youth determined eligible under the plan based upon such factors as availability of funding, the degree of financial need, the degree of medical need, and other factors.

(3) The department adopts and incorporates by reference the CMHB's Non-Medicaid Services Program Provider Manual, dated March 1, 2024 (Manual), which sets forth the requirements and limitations of the CMHB's Non-Medicaid Services Program.

(4) The CMHB Non-Medicaid Services Program for youth with serious emotional disturbance must be delivered in accordance with the requirements and limitations of the Manual. A copy of the Manual may be obtained from the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604 or at http://dphhs.mt.gov/dsd/CMB/Manuals.aspx.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-701, 53-21-702, MCA
History: NEW, 2008 MAR p. 1988, Eff. 9/12/08; AMD, 2013 MAR p. 2160, Eff. 11/15/13; AMD, 2015 MAR p. 1274, Eff. 10/1/15; AMD, 2017 MAR p. 1908, Eff. 10/14/17; AMD, 2024 MAR p. 2280, Eff. 9/21/24.

Mont. Admin. R. 37.87.2205 Mental Health Services for Youth with Serious Emotional Disturbance (sed) Non-Medicaid Respite Care Services, Limitations

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2012 MAR p. 2274, Eff. 11/9/12; AMD, 2013 MAR p. 175, Eff. 2/1/13; REP, 2015 MAR p. 1274, Eff. 10/1/15.

Mont. Admin. R. 37.87.2225 Mental Health Services for Youth with Serious Emotional Disturbance (sed) Non-Medicaid Respite Care Services, Provider Participation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2012 MAR p. 2274, Eff. 11/9/12; REP, 2015 MAR p. 1274, Eff. 10/1/15.

Mont. Admin. R. 37.87.2233 Mental Health Services for Youth with Serious Emotional Disturbance (sed) Respite Care Services, Provider Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2012 MAR p. 1273, Eff. 7/1/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; REP, 2015 MAR p. 1274, Eff. 10/1/15.

Chapter 37.88 Medicaid Mental Health Services

Subchapter 37.88.1 General Requirements

Mont. Admin. R. 37.88.101 Medicaid Mental Health Services for Adults, Authorization Requirements

(1) Mental health services for a Medicaid adult under the Montana Medicaid program will be reimbursed only if the client is 18 or more years of age and has been determined to have a severe disabling mental illness.

(3) Medicaid reimbursement for mental health services will be the lowest of:

(a) the provider′s actual (submitted) charge for the service; or

(b) the rate established in the department′s fee schedule. Reimbursement fees are as provided in ARM 37.85.105 and 37.85.106.

(4) The department may review the medical necessity of services or items at any time either before or after payment in accordance with the provisions of ARM 37.85.410. If the department determines that services or items were not medically necessary or otherwise not in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.

(5) The department or its designee may require providers to report outcome data or measures regarding mental health services, as determined in consultation with providers and consumers.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2020 MAR p. 1161, Eff. 7/1/20; AMD, 2020 MAR p. 1740, Eff. 10/1/20; AMD, 2021 MAR p. 331, Eff. 3/27/21; AMD, 2022 MAR p. 1889, Eff. 9/24/22; AMD, 2023 MAR p. 1890, Eff. 12/23/23; AMD, 2024 MAR p. 729, Eff. 4/13/24; AMD, 2024 MAR p. 2014, Eff. 8/10/24; AMD, 2025 MAR, Notice No. 37-1104, Eff. 3/8/25; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26; AMD, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.

Mont. Admin. R. 37.88.110 Temporary Rate Adjustment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-6-113, 53-21-201, MCA
Implementing statute(s): 53-6-101, 53-6-113, 53-21-201, MCA
History: EMERG, NEW, 2002 MAR p. 1328, Eff. 4/26/02; REP, 2018 MAR p. 725, Eff. 5/1/18.

Subchapter 37.88.2 Licensed Clinical Social Work Services

Mont. Admin. R. 37.88.201 Licensed Clinical Social Work Services, Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.205 Licensed Clinical Social Work Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2014 MAR p. 2857, Eff. 11/21/14; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.206 Licensed Clinical Social Work Services, Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(1) Providers must bill for covered services using the procedure codes and modifiers set forth and according to the definitions contained in the CMS's Healthcare Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers, and HCPCS is available upon request from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) Subject to the requirements of this rule, the Montana Medicaid program pays the following for licensed clinical social worker services:

(a) For patients who are eligible for Medicaid, the lower of:

(i) the provider's usual and customary charge for the service; or

(ii) the amount specified in the department's Medicaid Mental Health Fee Schedule.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703 MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-6-101, 53-6-113, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1988, Eff. 9/12/08; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Subchapter 37.88.3 Licensed Professional Counselor Services

Mont. Admin. R. 37.88.301 Licensed Professional Counselor Services, Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.305 Licensed Professional Counselor Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 865; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2014 MAR p. 2857, Eff. 11/21/14; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.306 Licensed Professional Counselor Services, Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(1) Providers must bill for covered services using the procedure codes and modifiers set forth, and according to the definitions contained, in the CMS's Healthcare Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers and HCPCS is available upon request from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) Subject to the requirements of this rule, the Montana Medicaid program pays the following for licensed professional counselor services:

(a) For patients who are eligible for Medicaid, the lower of:

(i) the provider's usual and customary charge for the service; or

(ii) the amount specified in the department's Medicaid Mental Health Fee Schedule.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-6-101, 53-6-113, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 865; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1988, Eff. 9/12/08; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Subchapter 37.88.6 Licensed Psychologist Services

Mont. Admin. R. 37.88.601 Licensed Psychologist Services, Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.605 Licensed Psychologist Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2014 MAR p. 2857, Eff. 11/21/14; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.606 Licensed Psychologist Services, Reimbursement

Publisher status: INEFFECTIVE (not currently effective).

(2) Subject to the requirements of this rule, the Montana Medicaid program pays the following for licensed psychologist services:

(a) For patients who are eligible for Medicaid, the lower of:

(i) the provider's usual and customary charge for the service; or

(ii) the amount specified in the department's Medicaid Mental Health Fee Schedule.

History

Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-6-101, 53-6-113, 53-21-202, 53-21-701, 53-21-702, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1988, Eff. 9/12/08; AMD, 2018 MAR p. 458, Eff. 3/1/18.

Subchapter 37.88.9 Mental Health Center Services

Mont. Admin. R. 37.88.901 Mental Health Center Services for Adults, Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2002 MAR p. 2225, Eff. 8/16/02; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2012 MAR p. 617, Eff. 4/1/12; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.903 Mental Health Center Services for Adults, Defined

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 1489, Eff. 8/28/09; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.905 Mental Health Center Services for Adults, Requirements

(1) These requirements are in addition to those requirements contained in rules generally applicable to Medicaid providers.

(2) Mental health center services may be provided only by a facility that is licensed as a mental health center by the department in accordance with the provisions of Title 50, chapter 5, part 2, MCA, and implementing administrative rules.

(3) Mental health center services must be provided by, or under the direction of a licensed physician.

(4) Mental health center services must be available to individuals continuously throughout the year.

(5) Mental health center services must be provided to an individual in accordance with an individualized strength-based treatment plan developed and maintained in accordance with license requirements.

(6) In addition to the clinical records required by mental health center license rules, the provider must maintain for day treatment services the records required by ARM 37.85.414, which shall include, but are not limited to, documentation of the individual's attendance and activities for the required period of time for the service billed and entry of progress notes in the individual's record at least every 30 days and upon any significant change in the individual's condition.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2002 MAR p. 2225, Eff. 8/16/02; AMD, 2009 MAR p. 1489, Eff. 8/28/09.

Mont. Admin. R. 37.88.906 Mental Health Center Services for Adults, Covered Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2002 MAR p. 2225, Eff. 8/16/02; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2009 MAR p. 1489, Eff. 8/28/09; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.907 Mental Health Center Services for Adults, Reimbursement

(1) The department adopts and incorporates by reference the Medicaid Adult Mental Health fee schedule as provided in ARM 37.85.105(5). A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at www.dphhs.mt.gov/amdd/services/index.shtml . A copy may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, PO Box 202905, Helena, MT 59620-2905. Medicaid reimbursement for mental health center services will be the lowest of:

(a) the provider's actual (submitted) charge for the service; or

(b) the department's fee for the service as specified in the department's fee schedules.

(2) The provider reimbursement rate for a covered service for mental health centers is stated in the department's fee schedule adopted and effective at ARM 37.85.105(5). These fees are calculated based on:

(a) the biennial legislative appropriation; and

(b) the estimated demand for covered services during the biennium.

(3) For services for which Medicare does not specify Relative Value Unit as provided in ARM 37.85.105, the department determines the Medicaid fee for adult mental health services as follows:

(a) if there is use resulting in Medicaid reimbursements totaling at least $10,000 in a state fiscal year (SFY), and a minimum of four separate providers have billed the procedure code, then the Medicaid fee is determined by multiplying the average charges by the payment-to-charge ratio;

(b) if there is use resulting in Medicaid reimbursements totaling less than $10,000 in an SFY and fewer than four separate providers have billed the procedure code in an SFY, then the Medicaid fee will be determined by:

(ii) reviewing similar procedure codes within the same service scope and adjusting the rate to be equal to a comparable procedure code or the average of similar codes plus 10% when severity is higher or increased resources are needed for the service. If the code is determined to have a lesser severity component or fewer resources are required than when compared to the similar procedure code or average of similar procedure codes, the reimbursement rate will equal the comparable procedure code or average of similar procedure codes less 10%.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2002 MAR p. 1328, Eff. 4/26/02; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2006 MAR p. 1635, Eff. 6/23/06; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2011 MAR p. 1394, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2014 MAR p. 1407, Eff. 7/1/14; AMD, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.908 Mental Health Center Services for Adults, Program of Assertive Community Treatment (pact)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2012 MAR p. 617, Eff. 4/1/12; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.909 Mental Health Center Services for Adults, Intensive Community-Based Rehabilitation Facility

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA
History: NEW, 2009 MAR p. 1489, Eff. 8/28/09; REP, 2018 MAR p. 725, Eff. 5/1/18.

Mont. Admin. R. 37.88.910 Residential Psychiatric Care Outside Montana

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2004 MAR p. 482, Eff. 2/27/04; REP, 2011 MAR p. 1154, Eff. 6/24/11.

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 2360, Eff. 1/1/09.

Subchapter 37.88.14 Institutions for Mental Diseases

Mont. Admin. R. 37.88.1401 Institutions for Mental Diseases, Purpose

(1) ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 specify requirements for the provision of and reimbursement for medicaid nursing facility and hospital services to medicaid recipients who are residents of an institution for mental diseases. These rules are in addition to requirements generally applicable to medicaid providers as otherwise provided in state and federal statutes, rules, regulations and policies.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2000 MAR p. 2036, Eff. 7/28/00.

Mont. Admin. R. 37.88.1402 Institutions for Mental Diseases, Definitions

In ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 the following definitions apply:

(1) "Department" means the Montana department of public health and human services or its agents, including but not limited to parties under contract to perform audit services, claim processing and utilization review.

(2) "Devoted to the provision of inpatient psychiatric hospital care to adults" means an institution for mental disease which is licensed and certified as a hospital and whose goals, purpose and care are designed for and devoted exclusively to providing diagnosis, treatment or care to persons with mental diseases age 18 and older.

(3) "Hospital" means a facility licensed, accredited or approved under the laws of Montana or a facility operated as a hospital by the state that provides, by or under the supervision of licensed physicians, services for the diagnosis, treatment, rehabilitation and care of persons with mental diseases.

(4) "Institution for mental diseases" means a hospital, nursing facility, or other institution with more than 16 beds which the department has determined is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. An institution for the mentally retarded, including an intermediate care facility for the mentally retarded, is not an institution for mental diseases.

(a) An institution for mental diseases is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such.

(i) In making a determination of whether an institution is an institution for mental diseases, the department shall consider the guidelines set forth in subsection C of section 4390 of the state medicaid manual, but no single guideline or combination of guidelines shall necessarily be determinative. The state medicaid manual is promulgated by the federal health care financing administration to provide guidance to states on administration of the medicaid program. The department hereby adopts and incorporates herein by reference subsection C of section 4390 of the state medicaid manual (1994) . A copy of subsection C of section 4390 of the state medicaid manual may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(5) "Medicaid recipient" means a person who is eligible and receiving assistance under Title XIX of the Social Security Act for nursing facility services.

(6) "Mental disease" means a disease listed as a mental disorder in the current edition of the Diagnostic and Statistical Manual of Mental Diseases but does not include mental retardation, senility and organic brain syndrome.

(7) "Nursing facility services" means services defined in ARM 37.40.302, but not including intermediate care facility services for the mentally retarded.

(8) "Patient contribution" means the total of all of a resident's income from any source available to pay the cost of care, less the resident's personal needs allowance. The patient contribution includes a resident's incurment determined in accordance with applicable eligibility rules.

(9) "Patient day" means a whole 24-hour period that a person is present and receiving nursing facility services, regardless of the payment source. Even though a person may not be present for a whole 24-hour period on the day of admission or day of death, such day will be considered a patient day.

(10) "Provider" means a nursing facility or hospital that meets the provider participation requirements specified in ARM 37.88.1405.

(11) "Resident" means a person admitted to the provider's facility who has been present in the facility for at least one 24-hour period.

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2000 MAR p. 2036, Eff. 7/28/00.

Mont. Admin. R. 37.88.1405 Institutions for Mental Diseases, Provider Participation Requirements

(1) An institution for mental diseases, as a condition of participation in the Montana medicaid program, under ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 must be a provider that meets the following requirements:

(a) complies with the requirements set forth at ARM 37.40.306 for medicaid nursing facility service providers;

(b) has been determined by the department, in accordance with ARM 37.88.1402, to be an institution for mental diseases;

(d) enters into and maintains a written agreement with the department that specifies the respective responsibilities of the department and the provider including arrangements for:

(i) joint planning between the parties to the agreement;

(ii) development of alternative methods of care;

(iii) permission for immediate readmission to the institution when the recipient's need for readmission has been determined to be medically necessary;

(iv) access by the department to the recipient, the recipient's records and the facility;

(v) recording, reporting and exchanging medical and social information about recipients; and

(vi) other procedures necessary to carry out the agreement; or

(e) is a hospital which is devoted to the provision of inpatient psychiatric hospital care to adults. A publicly owned hospital devoted to the provision of inpatient psychiatric care to adults shall not be required to enter into and maintain a written agreement as provided in (1) (d) .

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2000 MAR p. 2036, Eff. 7/28/00.

Mont. Admin. R. 37.88.1406 Institutions for Mental Diseases, Individual Treatment Plans

(1) Institutions for mental diseases providing services under ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 must provide for and maintain recorded individual plans of treatment and care to ensure that institutional care maintains the recipient at, or restores the recipient to, the greatest possible degree of health and independent functioning. The plans must include:

(a) an initial review of the recipient's medical, psychiatric and social needs within 30 days after the date of admission;

(b) periodic review of the recipient's medical, psychiatric and social needs;

(c) a determination at least every 90 days of the recipient's need for continued institutional care and for alternative care arrangements;

(d) appropriate medical treatment in the institution; and

(e) appropriate social services.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195.

Mont. Admin. R. 37.88.1410 Institutions for Mental Diseases, Reimbursement

(1) The Montana medicaid program does not cover and will not reimburse for services provided in institutions for mental diseases, except:

(a) services provided to medicaid recipients ages 18 through 21 and 65 or over in hospitals devoted to the provision of inpatient psychiatric hospital care for adults; or

(b) as provided in ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 for medicaid recipients age 65 or over receiving nursing facility services in a nursing facility that the department has determined to be an institution for mental diseases under ARM 37.88.1402.

(2) For nursing facility services provided to medicaid recipients age 65 years or over in an institution for mental diseases, the Montana medicaid program will pay a provider:

(a) for each patient day, an interim per diem rate, as specified in (3) , minus the amount of the medicaid recipient's patient contribution; and

(b) additional reimbursement for separately billable items as provided in (4) .

(3) The final per diem payment rate for:

(a) the Montana state hospital is $335; and

(b) the Montana mental health nursing care center at Lewistown is $150 for high acuity patients and $100 for low acuity patients.

(4) Separately billable items are those items specified in ARM 37.40.330 and are reimbursable by medicaid according to the provisions of ARM 37.40.330.

(5) For hospital services provided to medicaid recipients age 18 through 21 and 65 or over, the Montana medicaid program will pay hospitals devoted to the provision of inpatient psychiatric hospital care to adults an all-inclusive per diem rate which includes the cost of physician and dental services as well as the cost of the services listed in ARM 37.86.2902(2) .

History

Authorizing statute(s): Sec. 53-2-201 and 53-6-113, MCA
Implementing statute(s): Sec. 53-6-101 and 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2000 MAR p. 2036, Eff. 7/28/00.

Mont. Admin. R. 37.88.1411 Institutions for Mental Diseases, Billing and Payment

(1) Providers must bill for all services and supplies in accordance with the provisions of ARM 37.85.406. The department will pay a provider on a monthly basis the amount determined in accordance with these rules upon receipt of an appropriate billing which reports the number of patient days provided to authorized medicaid recipients during the billing period.

History

Authorizing statute(s): Sec. 53-6-113, MCA
Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195.

Mont. Admin. R. 37.88.1420 Institutions for Mental Diseases, Administrative Review and Fair Hearing Procedures

(1) Providers may appeal adverse determinations by the department through the administrative review and fair hearing procedures specified in ARM 46.12.1268.

History

Authorizing statute(s): Sec. 2-4-201 and 53-6-113, MCA
Implementing statute(s): Sec. 2-4-201, 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA
History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195.

Chapter 37.89 Mental Health Services

Authorizing statute(s): 53-2-201, MCA
Implementing statute(s): 53-1-601, 53-1-612, 53-2-201, 53-21-202, MCA
History: NEW, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2001 MAR p. 27; REP, 2008 MAR p. 1988, Eff. 9/12/08.

Subchapter 37.89.2 Non-Medicaid Mental Health Services

Mont. Admin. R. 37.89.201 Non-Medicaid Mental Health Services for Adults: Requirements

(1) In addition to requirements contained in rule, the department has developed and published the Behavioral Health and Developmental Disabilities Division Non-Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health, dated January 1, 2024, which provides information and policies pertaining to state-funded behavioral health services and substance use disorder services and implements requirements for utilization management and services. The department adopts and incorporates by reference the manual as part of this rule. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at https://dphhs.mt.gov/bhdd/BHDDMedicaidServicesProviderManual .

History

Authorizing statute(s): 53-2-201, 53-21-1405, MCA
Implementing statute(s): 53-21-1401, 53-21-1402, 53-21-1403, 53-21-1404, 53-21-1405, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22; AMD, 2023 MAR p. 1890, Eff. 12/23/23; AMD, 2024 MAR p. 729, Eff. 4/13/24; AMD, 2024 MAR p. 2014, Eff. 8/10/24.

Authorizing statute(s): 53-6-101, 53-6-113, MCA
Implementing statute(s): 53-6-101, MCA
History: NEW , 2008 MAR p. 1489, Eff. 4/11/08; REP, 2022 MAR p. 1882, Eff. 9/24/22.

Subchapter 37.89.10 Crisis Diversion Grants

Mont. Admin. R. 37.89.1001 Crisis Diversion Grants, Purpose

(1) Crisis Diversion Grants, as provided under Title 53, chapter 21, part 12, MCA, provide funding to eligible county and federally recognized tribal governments to support the implementation of community-based jail diversion, crisis intervention services, and short-term inpatient treatment services for individuals with mental illness. The grants are in the form of matching state funds awarded based on criteria set forth in 53-21-1203, MCA.

History

Authorizing statute(s): 53-21-1202, 53-21-1203, MCA
Implementing statute(s): 53-21-1203, MCA
History: NEW, 2010 MAR p. 1306, Eff. 5/28/10; AMD, 2022 MAR p. 1856, Eff. 9/24/22.

Mont. Admin. R. 37.89.1003 Crisis Diversion Grants, Application and Participants

(1) At the beginning of the program's funding cycle, the department will issue a request for proposal (RFP) describing the program requirements, evaluation criteria, and eligibility criteria for award of Crisis Diversion Grant funding.

(2) The following entities may submit an application for Crisis Diversion Grants awarded under this subchapter:

(a) a county government as defined in ARM 37.2.902;

(b) a federally recognized tribal government; or

(3) A county or group of counties that includes tribal lands must demonstrate coordination efforts with tribal representatives to be eligible for Crisis Diversion Grants.

(4) The department will evaluate applications as set forth in the RFP and determine eligibility for a Crisis Diversion Grant. Counties and federally recognized tribal governments who the department determines are eligible for grants must enter into a contract with the department to receive the funding award.

History

Authorizing statute(s): 53-21-1203, MCA
Implementing statute(s): 53-21-1203, MCA
History: NEW, 2010 MAR p. 1306, Eff. 5/28/10; AMD, 2022 MAR p. 1856, Eff. 9/24/22.

Mont. Admin. R. 37.89.1005 Crisis Diversion Grants, Determining Grant Amounts

(1) The department will base Crisis Diversion Grants awarded under this subchapter on the criteria specified in 53-21-1203, MCA.

(2) The total amount of Crisis Diversion Grants will not exceed available funding.

(3) For each county and federally recognized tribal government, the department will include in the request for proposal (RFP) the rate at which local funds will be matched. The match rate is based on the most recent Montana State Hospital admission data and census data, as provided in 53-21-1203, MCA.

(4) The department will bi-annually recalculate the match rate.

(5) Eligible participants may use cash or in-kind contributions as matching funds.

(6) If appropriation remains after grants have been allocated, the department will allocate remaining funds to a county or federally recognized tribal government that requests continued funding of a project funded in the previous biennium. In allocating these funds, the department will use the match rate published in the RFP.

History

Authorizing statute(s): 53-21-1203, MCA
Implementing statute(s): 53-21-1203, MCA
History: NEW, 2010 MAR p. 1306, Eff. 5/28/10; AMD, 2022 MAR p. 1856, Eff. 9/24/22.

Mont. Admin. R. 37.89.1007 Crisis Diversion Grants, Distribution

(1) If the amount requested for Crisis Diversion Grants exceeds the funding available, the department shall allocate available funding based on a percentage of the total points awarded to an applicant.

(2) Points will be awarded by an evaluation committee, as described by the criteria listed within the request for proposal.

(3) If the amount requested for Crisis Diversion Grants exceeds the funding available, the department may use discretion to fund only specific activities within a proposal.

History

Authorizing statute(s): 53-21-1203, MCA
Implementing statute(s): 53-21-1203, MCA
History: NEW, 2010 MAR p. 1306, Eff. 5/28/10; AMD, 2022 MAR p. 1856, Eff. 9/24/22.

Mont. Admin. R. 37.89.1009 Crisis Diversion Grants, Strategic Plan Requirements

(1) Successful grant applicants will be those submitting a grant application with at least the following elements:

(a) a jail diversion and crisis intervention strategic plan, which must include a plan for community-based or regional emergency crisis response, court-ordered detention and examination services, and short term inpatient treatment;

(b) a detailed proposal for how the grant applicant and other local entities will collaborate and commit local funds for mental health services for crisis intervention, jail diversion, involuntary precommitment, and short-term inpatient treatment costs including a plan for the collection and reporting of data and information;

(c) a detailed budget that identifies cash and in-kind local contribution amounts designated for match, anticipated expenses for each fiscal year being applied for including start up or one time only costs. Multi-jurisdiction grant applications must identify the county or federally recognized tribal government that will act as the fiduciary agent for distribution of the grant funds;

(d) a statement from the grant applicant agreeing to report key data elements according to the department's specifications; and

(e) counties that include tribal lands must demonstrate coordination efforts with tribal representatives both on and off reservations.

(2) Each successful grant applicant will submit an annual report to the department within 30 days of the end of each funding year describing implementation of the strategic plan provided for in this rule, including key data elements as defined by the department, for the funded grant period.

History

Authorizing statute(s): 53-21-1203, MCA
Implementing statute(s): 53-21-1203, MCA
History: NEW, 2010 MAR p. 1306, Eff. 5/28/10; AMD, 2022 MAR p. 1856, Eff. 9/24/22.

Mont. Admin. R. 37.89.1021 Jail Diversion and Crisis Intervention, Contracts for Psychiatric Treatment Beds

(1) The department may contract with a mental health facility for psychiatric treatment beds as provided for in 53-21-1204, MCA, to the extent of available funding.

(2) Contracts will be developed in each service area as defined in 53-21-1001, MCA.

(3) Eligible providers include:

(a) licensed mental health centers who operate a secured crisis stabilization facility (SCSF) as defined in ARM 37.106.2027; and

(b) hospitals, including critical access hospitals.

(4) Reimbursement to an eligible mental health facility under this rule is for vacant contracted psychiatric treatment beds. A contractor must prioritize placement in contracted beds for persons admitted for the purposes specified in 53-21-1204, MCA.

History

Authorizing statute(s): 53-21-1204, MCA
Implementing statute(s): 53-21-1204, MCA
History: NEW, 2010 MAR p. 1306, Eff. 5/28/10.

Mont. Admin. R. 37.89.1025 Contracts for Payment of Short-Term Inpatient Treatment

(1) The department may contract with eligible providers for payment for short-term inpatient treatment to eligible patients as provided in 53-21-1205 and 53-21-1206, MCA, to the extent of available funding.

(2) Eligible providers include:

(a) licensed mental health centers that operate inpatient crisis stabilization programs as defined in ARM 37.106.2027; and

(b) hospitals with an inpatient behavioral health unit.

(3) Documentation of services and outcomes must be provided to the department as required by contract.

(4) Eligible patients are the subjects of civil commitment petitions under Title 53, chapter 21, part 1, MCA, for whom the following conditions are met:

(a) diversion to short-term inpatient treatment has been recommended by the evaluating professional person as provided in 53-21-123(2)(a), MCA;

(b) the facility has agreed to accept the patient for up to 14 days inpatient treatment as provided in 53-21-1205, MCA, and 53-21-1206, MCA;

(c) the patient has agreed to voluntary short- term inpatient treatment as provided in 53-21-1205, MCA, and 53-21-1206, MCA;

(d) the commitment court has ordered a suspension of the civil commitment proceeding for the purpose of short-term inpatient treatment, as provided in 53-21-123(3)(b), MCA; and

(e) no known third party has a legal liability to pay for the services provided. Third party liability is defined in ARM 37.85.407, with the exception that the Montana Medicaid program is a third party for the purposes of this rule.

(5) Each contract with an eligible provider must provide that reimbursement will be made for up to 14 contiguous days of inpatient care for each eligible patient. The 14 day limit must be extended if voluntary treatment is continued pending a hearing scheduled pursuant to 53-21-1205(5), MCA. Reimbursement must be made in the order in which claims from all eligible providers are received by the department until the available funding has been exhausted. The department must notify each eligible provider who has entered into a contract under this rule in writing when 75 percent of the available funding has been exhausted.

(6) The following rates will apply:

(a) inpatient hospital behavioral health unit: an all-inclusive rate of $875 per day, which includes hospitalization, professional fees, laboratory services, medications, minor medical procedures that do not require transfer to another unit of the hospital, evaluating and assessment services, discharge planning, and therapies.

(b) inpatient crisis stabilization program: an all-inclusive rate of $575 per day, which includes crisis facility stay, professional fees, laboratory services related to psychiatric treatment, medications related to psychiatric treatment, evaluating and assessment services, case management, and therapies.

(7) This rule is effective July 1, 2015.

History

Authorizing statute(s): 53-21-1202, MCA
Implementing statute(s): 53-21-1202, 53-21-1205, MCA
History: NEW, 2015 MAR p. 1761, Eff. 10/16/15.

Chapter 37.90 Mental Health Medicaid Funded 1115 and 1915 Waivers

Subchapter 37.90.4 Home and Community-Based Services Waiver for Adults With Severe and Disabling Mental Illness

Mont. Admin. R. 37.90.401 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Federal Authorization and State Administration

(1) The department has established the Severe and Disabling Mental Illness, Home and Community Based Services waiver program for members who have severe and disabling mental illness, as defined in ARM 37.90.409, and who would otherwise have to reside in and receive Medicaid reimbursed care in a nursing facility.

(2) The department, in accordance with state and federal statutes, administrative rules, federal-state agreements governing the provision of the Medicaid funded home and community-based services delivered under this program, and within the available funding appropriated for the program, may determine within in its discretion:

(a) the types of services available through the program;

(b) the amount, scope, and duration of the services available through the program;

(d) the total number of members who may receive services through the program;

(e) delivery approach; and

(f) eligibility of members for the program.

(3) Enrollment in the program and the provision of services through the program are at the discretion of the department. There is no legal entitlement to enroll in the program or to receive any or all the services available through the program.

(4) The Severe and Disabling Mental Illness, Home and Community Based Services waiver program is referred to throughout this subchapter as "the SDMI HCBS waiver program" or "the waiver program."

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2010 MAR p. 1538, Eff. 6/25/10; AMD, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.402 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Services

(1) The services available through the waiver program are:

(a) adult day health, as described in ARM 37.90.430;

(b) behavioral intervention assistant, as described in ARM 37.90.433;

(d) community transition services, as described in ARM 37.90.415;

(e) consultative clinical and therapeutic services, as described in ARM 37.90.418;

(f) environmental accessibility adaptations, as described in ARM 37.90.414;

(g) health and wellness, as described in ARM 37.90.417;

(h) homemaker chore, as described in ARM 37.90.419;

(i) life coach, as described in ARM 37.90.434;

(j) meals, as described in ARM 37.90.426;

(k) non-medical transportation, as described in ARM 37.90.450;

(l) pain and symptom management, as described in ARM 37.90.416;

(m) personal assistance service, as described in ARM 37.90.431;

(n) personal emergency response system, as described in ARM 37.90.448;

(o) private duty nursing, as described in ARM 37.90.447;

(p) residential habilitation, as described in ARM 37.90.451, 37.90.452, 37.90.453, 37.90.454, and 37.90.455;

(q) respite care, as described in ARM 37.90.438;

(r) specialized medical equipment and supplies, as described in ARM 37.90.449; and

(s) supported employment, as described in ARM 37.90.435.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.403 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Definitions

(1) "Activities of daily living" (ADL) means basic personal everyday activities.

(2) "Applicant" means an individual requesting services but not enrolled in the SDMI program.

(3) "Community First Choice" and "Personal Assistance Service" Programs (CFC/PAS) are Medicaid state plan programs designed to provide long term supportive care in a home setting. These programs are distinct from the PAS waiver service described in ARM 37.90.431.

(4) "Critical incident" is an incident that is serious in nature and poses a risk to the health, safety, or welfare of an enrolled member or others. It is a serious occurrence that includes abuse, neglect, and exploitation, each of which are defined under 52-3-803, MCA.

(5) "Enrolled member" means an individual enrolled in the SDMI program and authorized to receive services under the SDMI program.

(6) "Institutionalization" means placement in a nursing facility, a mental health nursing facility, or a state mental health hospital.

(7) "Instrumental activities of daily living" (IADL) means household tasks which are limited to cleaning the area used by the member.

(8) "Level of care assessment" (LOC) means a functional assessment used to determine if an individual requires the level of care normally provided in a nursing facility.

(9) "Level of impairment assessment" (LOI) means an assessment used to identify areas in which a member requires long term services and supports.

(10) "Mental health professional" has the meaning provided in 53-21-102, MCA.

(11) "Non-critical incidents" are minor in nature and do not pose a risk to the health, safety, or welfare of an enrolled member or others.

(12) "Person-centered recovery plan" (PCRP) is a written plan that identifies the supports and services that are necessary for the enrolled member to remain out of institutional level of care, allow the enrolled member to function at the enrolled member's maximum capacity, and enable the enrolled member to achieve personal goals toward recovery.

(13) "Quality improvement organization" (QIO) means the entity under contract with the department to complete agreed upon utilization review activities for Montana Medicaid services.

(14) "SDMI" is used in this subchapter to refer to severe and disabling mental illness, which is described in ARM 37.90.409.

(15) "SDMI HCBS waiver program" is used in this subchapter to refer to severe and disabling mental illness home and community-based services waiver services.

History

Authorizing statute(s): 52-3-803, 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.406 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Provider Requirements

(1) The waiver program services may only be provided by a provider that:

(a) is enrolled as a Montana Medicaid provider except as provided in (2);

(b) meets all facility, licensing, and insurance requirements applicable to the services offered, the service settings provided, and the professionals employed; and

(2) A provider of services must ensure that the services adhere to the requirements of 42 CFR 441.301(c)(4), which permits reimbursement with Medicaid monies only for services within settings that meet certain qualities set forth under the regulation. These qualities include that the setting:

(a) is integrated in and facilitates full access of the individual to the greater community;

(b) ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid Home and Community-Based Services;

(c) is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting;

(d) ensures the individual's rights of privacy, dignity, and respect, and freedom from coercion and restraint;

(e) supports health and safety based upon the individual's needs, decisions, or desires;

(g) provides an opportunity to seek employment and work in competitive integrated settings; and

(h) facilitates individual choice of services and supports, and who provides them.

(3) The department may authorize a contracted case management entity to issue pass-through payment for reimbursement of services rendered by a non-Medicaid provider for the following services:

(a) community transition;

(b) environmental accessibility adaptations;

(d) homemaker chore;

(e) meals; and

(f) specialized medical equipment and supplies.

(4) A provider must document the completion of required training in the personnel file of the staff or in the provider's staff training files which includes:

(a) title of the training;

(b) the date of the training;

(d) type or topic of the training;

(e) the agenda of the training;

(f) the hours of the training; and

(g) the signature and date of the staff who received the training.

(5) Providers must ensure that direct care staff are trained and capable of providing waiver program services.

(6) The department adopts and incorporates by reference 42 CFR 441.301(c)(4), as amended January 16, 2014. A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 612, Eff. 3/23/24; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.408 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Reimbursement

(1) The department adopts and incorporates by reference the Medicaid Home and Community-Based Services for Adults with Severe and Disabling Mental Illness fee schedule. Unless otherwise provided for in rule, the provider reimbursement rate for waiver program services is stated in the department's fee schedule as provided in ARM 37.85.105(5)(b). These fees are calculated based on:

(a) the biennial legislative appropriation; and

(b) the estimated demand of covered services during the biennium.

(2) Medicaid reimbursement for the SDMI HCBS waiver program will be the lesser of:

(a) the provider's usual and customary charge for the service; or

(b) the rate established in the department's Medicaid fee schedule adopted and incorporated into ARM 37.85.105(5)(b).

(3) The SDMI HCBS waiver program is the payor of last resort and will not reimburse a service that otherwise is or should be paid by another source.

(4) The SDMI HCBS waiver program will not reimburse for services provided to individuals of an enrolled member's household or family.

(5) All SDMI HCBS services, except for case management, must be prior authorized before delivery of services. Services that are delivered before prior authorization is received will not be approved and, if reimbursed, may be subject to repayment.

(6) A provider must ensure that services adhere to the requirements of ARM 37.85.405.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2011 MAR p. 1394, Eff. 7/29/11; AMD, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2018 MAR p. 1116, Eff. 7/1/18; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24; AMD, 2025 MAR, Notice No. 2025-523, Eff. 11/22/25.

Mont. Admin. R. 37.90.409 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Severe and Disabling Mental Illness Criteria

(1) To be found to have a qualifying SDMI diagnosis, an individual must:

(a) be 18 years of age or older;

(b) have a minimum of three areas of high-level impairment indicated by a score of three or higher on the Behavioral Health and Developmental Disabilities (BHDD) Severe and Disabling Mental Illness, Home and Community-Based (HCBS) Waiver, Evaluation and Level of Impairment (LOI) form; and

(i) involuntarily committed because of a mental disorder to the Montana State Hospital or the Montana Mental Health Nursing Care Center for at least 30 consecutive days; or

(ii) diagnosed with one of the following diagnoses, excluding mild or not otherwise specified:

(A) Schizophrenia, paranoid type;

(B) Schizophrenia, disorganized type;

(D) Schizophrenia, undifferentiated type;

(E) Schizophrenia, residual type;

(F) Delusional disorder;

(G) Schizoaffective disorder;

(H) Schizoaffective disorder, depressive type;

(I) Bipolar I disorder, manic, moderate;

(J) Bipolar I disorder, manic, severe without psychotic features;

(K) Bipolar I disorder, manic, severe with psychotic features;

(L) Bipolar I disorder, depressed, moderate;

(M) Bipolar I disorder, depressed, severe without psychotic features;

(N) Bipolar I disorder, depressed, severe with psychotic features;

(O) Bipolar I disorder, mixed, moderate;

(P) Bipolar I disorder, mixed, severe without psychotic features;

(Q) Bipolar I disorder, severe with psychotic features;

(R) Bipolar II disorder;

(S) Major depressive disorder, single, moderate;

(T) Major depressive disorder, single, severe without psychotic features;

(U) Major depressive disorder, single, severe with psychotic features;

(V) Major depressive disorder, recurrent, moderate;

(W) Major depressive disorder, recurrent, severe without psychotic features;

(X) Major depressive disorder, recurrent, severe with psychotic features;

(Y) Post traumatic stress disorder, acute;

(Z) Post traumatic stress disorder, chronic;

(AA) Generalized anxiety disorder; and

(BB) Borderline personality disorder.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2021 MAR p. 1555, Eff. 11/6/21; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.410 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Consideration for Program Eligibility and Enrollment Selection

(1) An applicant may be considered for enrollment in the program if the applicant meets the following criteria:

(a) is at least 18 years of age;

(b) is Medicaid eligible;

(d) meets the criteria in ARM 37.90.409; and

(e) meets the following additional criteria:

(i) the case management team determines that the applicant needs at least two SDMI HCBS waiver program services that can only be met through the SDMI HCBS waiver program. One of those services must be case management, and the SDMI HCBS waiver program service of meals cannot be counted as one of the two services; and

(ii) the case management team determines that the service providers necessary to deliver the services requested by the applicant are available at the time of enrollment.

(2) When an applicant is found eligible to receive waiver program services, the case management team will:

(a) offer the applicant an available opening for program services if an opening is available; or

(b) place the applicant on the wait list if an opening for program services is not available.

(3) If an applicant is placed on the wait list in accordance with (2)(b), the applicant will be placed on the SDMI HCBS waiver program wait list in the service areas the applicant selects.

(4) The case management team must use the applicant's combined LOC and LOI scores to determine the applicant's score for relative placement on the SDMI HCBS waiver program wait list.

(5) If more than one applicant has the same combined wait list score, then each applicant is placed on the SDMI HCBS waiver program wait list based upon the applicant's wait list score as determined in (4), and thereafter in the order in which the applicant is placed on the SDMI HCBS waiver program wait list.

(6) Placement on the SDMI HCBS waiver program wait list is not a guarantee an applicant will receive enrollment into the SDMI HCBS waiver program. Individuals qualified but not enrolled in another waiver program may be placed on the SDMI HCBS waiver program wait list.

(7) The case management teams must review the SDMI HCBS waiver program wait list and update the SDMI HCBS waiver program wait list quarterly to ensure that individuals on the list continue to meet criteria for SDMI HCBS waiver program services. The review consists of verifying each wait list individual's ongoing need for at least two SDMI HCBS waiver program services, and continued LOC and LOI criteria. In addition, the case management teams will confirm, through the approved documentation process with the Office of Public Assistance (OPA), each individual meets the financial/non-financial Medicaid eligibility criteria prior to enrolling the individual into the SDMI program.

(8) An applicant must be removed from the wait list for the following reasons:

(a) the applicant's whereabouts are unknown, and the case management team has attempted to contact the applicant a minimum of once per quarter for two consecutive quarters and no response has been received from the applicant;

(b) the case management team determines that the service providers necessary to deliver at least two SDMI HCBS waiver program services requested by the applicant are unavailable. Unavailable means when there is no provider who has said the provider has the staff and resources to serve the applicant in the applicant's current or requested area and who would accept the applicant if the applicant was enrolled in the SDMI program. Unavailable is established on the date of the quarterly review. The SDMI HCBS waiver program meals service does not count towards the two services;

(d) the applicant has reported he or she will not or cannot pay any Medicaid spend down;

(e) the applicant has moved out of state;

(f) the applicant requests to be removed from the wait list;

(g) the Office of Public Assistance has determined the applicant does not meet established financial and resource criteria; or

(h) the applicant's death is confirmed.

(9) An applicant must not remain on the wait list for more than six consecutive months. Exceptions may be made with prior approval from SDMI program staff.

(10) The case management team must provide an enrolled member with written notice ten working days before termination of services due to a determination of program ineligibility. An enrolled member may be removed from the SDMI HCBS waiver program for the following reasons:

(a) a determination by a mental health professional that the enrolled member no longer meets the SDMI diagnosis criteria set forth in ARM 37.90.409;

(b) the enrolled member fails to select or does not actively participate in at least two services in the waiver program within 30 calendar days from the date the enrolled member agrees to and signs the PCRP. The service of meals cannot be counted as one of the two services;

(c) the department determines that the enrolled member has failed to utilize or to attempt to utilize at least two waiver services, in 30 days, with repeated attempts documented by the case management team to engage the enrolled member;

(d) the enrolled member no longer requires the level of care of a nursing facility as determined by the QIO under contract with the department;

(e) the case management team or program staff received written notification from the Office of Public Assistance confirming Medicaid ineligibility;

(f) insufficient SDMI HCBS waiver program funds;

(g) the enrolled member moved out of state;

(h) the enrolled member refuses to sign or participate in the completion of the PCRP or quarterly review;

(i) the enrolled member's behavior creates serious risk to the member, caregivers, or others, or substantially impedes the delivery of services as established in the PCRP;

(j) the enrolled member's death;

(k) the enrolled member's failure to use services as established in the PCRP;

(l) the enrolled member's needs cannot be met through the SDMI HCBS waiver program;

(m) the enrolled member's written request to withdraw from the program;

(n) the health of the enrolled member deteriorates or in some manner places the enrolled member at serious risk of harm;

(o) the enrolled member is admitted to a nursing facility or hospital for a stay exceeding 30 days;

(p) the service providers necessary for the delivery of services are unavailable; or

(q) the services are no longer appropriate or effective in relation to the enrolled member's needs as determined by the case management team.

(11) Eligibility for consideration for the waiver program does not entitle an individual to selection and entry into the program.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2010 MAR p. 1538, Eff. 6/25/10; AMD, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.412 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Person-Centered Recovery Plan

(1) The PCRP is developed by the enrolled member and the case management team to meet the enrolled member's identified needs as well as cost of identified services.

(2) All services must be specifically authorized in writing in the enrolled member's PCRP.

(3) Each PCRP must be developed, reviewed, and revised by the CIO case management team. The case management team must:

(a) develop an initial PCRP upon the enrolled member's enrollment into the SDMI HCBS waiver program which is the date the enrolled member begins receiving services under the SDMI HCBS waiver program;

(b) ensure the initial PCRP includes all aspects of (5)(a) through (m) based on the LOC, LOI, and the information obtained by the case management team;

(c) initiate the strength assessment upon the enrolled member's enrollment into the SDMI HCBS waiver program to determine the enrolled member's strengths, needs, preferences, goals, and desired outcomes, along with his/her health status and risk factors;

(d) complete the strength assessment within three months of the enrolled member's enrollment into the program. Upon completion of the strength assessment, the PCRP is finalized;

(e) have monthly telephone contact with the enrolled member consisting of monthly monitoring calls;

(f) conduct in-person reviews of the PCRP with the enrolled member every three months. Any issues with the PCRP and the delivery and implementation of services are to be discussed at this time. The review is conducted at the enrolled member's place of residence, place of service, or other appropriate setting, as determined by the enrolled member's needs. This is an opportunity for case management teams to monitor the health and welfare of the enrolled member and evaluate the delivery of services to the enrolled member. This review includes evaluating and assessing strategies for meeting the needs, preferences, and goals of the enrolled member. It also includes evaluating and obtaining information concerning the enrolled member's satisfaction with the services, the effectiveness of services being provided, changes in the enrolled member's function, and cost effectiveness of the services.

(g) update the PCRP to reflect any changes to the information listed in (5)(a) through (j); and

(h) complete an annual review of the PCRP with the enrolled member and update the PCRP if there are any changes to the information listed in (5)(a) through (j).

(4) The case management team must develop the PCRP in consultation with:

(a) the enrolled member or the enrolled member's legal representative;

(b) the enrolled member's treating professional and other appropriate health care professionals; and

(5) The PCRP must include:

(a) the primary SDMI diagnosis and any other diagnosis of the enrolled member that are relevant to the services provided;

(b) the enrolled member's symptoms, complaints, and complications indicating the need for services;

(d) the SDMI HCBS waiver program services that will be provided;

(e) all other services the enrolled member requires including Montana Medicaid state plan services and community-based services and supports. However, including non-program services in the PCRP does not obligate the department to pay for the non-program services or ensure their delivery or quality;

(f) a description of how each service addresses each of the enrolled member's functional needs outlined in the Severe and Disabling Mental Illness, Home and Community Based Services, Evaluation and Level of Impairment form;

(g) a crisis plan;

(h) physicians' orders;

(i) a discharge plan;

(j) the projected annual cost of SDMI Home and Community-Based Services (HCBS) waiver program services provided;

(k) the signature of the enrolled member or the enrolled member's legal representative which signifies the participation in and agreement of the PCRP;

(l) the names and signatures of all individuals who participated in the development of the PCRP which signifies the participation in and agreement of the PCRP; and

(m) the enrolled member's bill of rights that informs enrolled members they have the right to choose from the full range of services available in the waiver if appropriate and that services will be delivered by a qualified provider of the enrolled member's choice.

(6) The case management team must provide a copy of the plan to the recipient.

(7) The case management team must retain all of the enrolled member's records in accordance with ARM 37.85.414.

(8) The PCRP must be approved by the department initially and then annually. The annual review must ensure compliance with this rule and federal guidance. If the initial PCRP is found to meet program criteria, the department must approve the PCRP within 30 days of enrollment into the care management system.

(9) The department reviews all initial and annual PCRP and at any time there is a change.

(10) The PCRP is subject to review by the department at any time.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.413 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Cost of Person-Centered Recovery Plan

(1) In order to maintain the program cost within the appropriated federal and state funds, the cost of a member's Person-Centered Recovery Plan (PCRP) may be limited by the department.

(2) The total annual cost of services for each member, except as approved by the department, may not exceed a maximum amount set by the department.

(3) The department may limit the services members receive under the waiver program based upon the appropriation of funding by the legislature.

(4) The cost of services in the PCRP must be determined prior to implementation of the PCRP and may be revised as necessary by the department or the department's designee.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.414 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Environmental Accessibility Adaptations

(1) Environmental accessibility adaptations are modifications to a member's home that are necessary to increase accessibility, independence, and prevent the need for a higher level of care.

(2) The member's need for the adaptation must be documented by an individual with the appropriate licensure, certification, or experience with home modification to document the member's need for the adaptation to increase accessibility, independence, and prevent the need for a higher level of care.

(3) The provision of environmental accessibility adaptations may include the provision of consultation regarding the appropriateness of the equipment or supplies.

(4) The waiver program does not cover:

(a) additions to the square footage of the home;

(b) services that are for comfort or convenience;

(d) services that are for maintenance, repair, or building code compliance that is the responsibility of the homeowner.

(5) Environmental accessibility adaptations must:

(a) ensure the health, welfare, and safety of the member in their home; and

(b) allow the member to function with greater independence in their home.

(6) Environmental accessibility adaptations must be provided in accordance with applicable state and local building codes by individuals licensed through the Montana Department of Labor and Industry to do home modifications.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.415 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Community Transition Services

(1) Community transition services are nonrecurring set-up expenses for members who are transitioning from an institutional setting into a community living setting or a private residence and are necessary to coordinate and purchase to establish a basic household.

(2) The department may approve community transition services on a case-by-case basis from other settings in circumstances that address a member's health or safety.

(3) The case management team must complete a needs assessment prior to implementation of the service.

(4) The needs assessment must demonstrate community transition services are required to:

(a) address a health or safety concern; and

(b) discharge from or avert institutionalization.

(5) Allowable expenses are those necessary to enable a person to establish a basic household and may include:

(a) customary security deposits that are required to obtain a lease on an apartment or home;

(b) essential household items;

(c) moving expenses incurred directly from the moving, transport, provision, or assembly of household furnishings for the residence;

(d) customary setup fees or deposits for utility or service access, including telephone landline or cell phone, electricity, heating, and water;

(e) services necessary for a member's health and safety; and

(f) fees associated with obtaining legal or identification documents necessary for housing applications.

(6) Community transition services do not include monthly rental or mortgage expenses, food, and diversion/recreational expenses.

(7) Refunded security deposits must be paid to the department.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.416 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Pain and Symptom Management

(1) Pain and symptom management is defined as a service that provides traditional and nontraditional methods of pain reduction or management.

(2) Allowable non-traditional or mind-body therapies include:

(a) acupuncture;

(b) reflexology;

(d) craniosacral therapy;

(e) hypnosis;

(f) biofeedback; and

(g) pain mitigation counseling/coaching.

(3) Allowable traditional therapies include:

(a) chiropractic therapy; and

(b) nursing services by a nurse specializing in pain and symptom management.

(4) The service must be prescribed by a licensed health care professional.

(5) The service must be documented in the member's Person-Centered Recovery Plan and:

(a) address the member's chronic or acute symptoms, complaints, or complications indicating the need for services;

(b) include the number of authorized sessions; and

(6) Services must be provided by a person licensed or certified to provide the service.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.417 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Health and Wellness

(1) Health and wellness services are services that assist a member in acquiring, retaining, and improving self-help, socialization, and adaptive skills to reside successfully in the community.

(2) The services include:

(a) classes on weight loss, smoking cessation, and healthy lifestyles;

(b) health club memberships and exercise classes;

(d) costs associated for participating in adaptive sports and recreational activities;

(e) classes on managing disabilities; and

(f) hippotherapy.

(3) The service must be prescribed by a licensed health care professional.

(4) The service must be documented in the member's Person-Centered Recovery Plan and:

(a) address the member's symptoms, complaints, or complications indicating the need for services;

(b) include the number of authorized sessions; and

(5) Services may be provided in a setting appropriate to the provision of the service.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.418 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Consultative Clinical and Therapeutic Services

(1) Consultative clinical and therapeutic services provide comprehensive expertise, training, and technical assistance to improve the ability of providers and caregivers to carry out therapeutic interventions and reduce challenges that may be interfering with a member's daily functioning, independence, and quality of life.

(2) Consultative clinical and therapeutic services include:

(a) a clinical/functional evaluation;

(b) implementation of positive behavioral supports as part of the member's Person-Centered Recovery Plan (PCRP);

(c) training and technical assistance for the member's paid and non-paid caregivers to implement the positive behavioral supports; and

(d) monitoring the member's response to the positive behavioral supports and updating the PCRP if necessary.

(3) Consultative clinical and therapeutic services must meet a documented behavioral need that cannot be addressed through other waiver or state plan services.

(4) Consultative clinical and therapeutic services may be provided by a:

(a) psychiatrist;

(b) psychologist;

(d) licensed clinical professional counselor; or

(e) licensed clinical social worker.

(5) Training must be aimed at assisting the provider and caregiver in meeting the needs of the member and must include instruction to implement the positive behavioral supports outlined in the member's PCRP.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.419 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Homemaker Chore

(1) Homemaker chore services are extensive cleaning beyond the scope of general household cleaning under Community First Choice/Personal Assistance Service (CFC/PAS) state plan and is needed to return a residence to a sanitary and safe environment.

(2) Homemaker chore may be provided by:

(a) entities that provide deep cleaning, yard, trash removal, and moving services;

(b) home health providers; and

(3) Homemaker chore is provided when neither the member nor other community resources are available to provide the service.

(4) Moving expenses must be prior authorized by the department.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.420 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Notice and Fair Hearing

(1) The department provides written notice to a member when a determination is made by the department concerning:

(a) Medicaid eligibility;

(b) eligibility for the SDMI HCSB waiver program; and

(2) The department provides a member with notice ten working days before termination of services due to a determination of ineligibility.

(3) Requirements for administrative review and fair hearings are provided for in ARM Title 37, chapter 5, subchapter 3.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.425 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Case Management

(1) Case management means case management as defined in the Code of Federal Regulations (CFR) at 42 CFR 440.169(d)(e).

(2) Case management services offered under the Severe and Disabling Mental Illness, Home and Community Based waiver program are provided through a selective contract for conflict free case management under the authority of a 1915(b)(4) waiver authorized under Section 1915(b) of the Social Security Act.

(3) A case management team must consist of:

(a) a case manager with a bachelor's level education in the field of human services; and

(b) a registered nurse, licensed practical nurse, licensed clinical social worker, or licensed clinical professional counselor to provide clinical supervision for every two case managers.

(4) Case management teams submit annual report cards to the SDMI HCBS waiver program staff as well as monthly utilization reports to ensure that quality assurance measures are met in accordance with performance measures.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.426 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Meals

(1) Meal service is the provision of hot or cold meals to a member up to twice daily.

(2) Meals may be provided by:

(a) a non-profit entity or public agency that provides congregate or home-delivered meals on a regular basis to individuals who are unable to gain access to meals due to age or disability;

(b) entities that provide home-delivered meals that are transported from a preparation site to the member's residence; or

(3) Members must need special assistance to ensure adequate nutrition due to:

(a) special nutritional needs; or

(b) the member's inability to gain access to proper nutrition due to a disability.

(4) The provider must follow the rules that govern the provision of meal services at ARM 37.41.306 through 37.41.315.

(5) If meals are provided during the provision of another service, the total combined meals provided to the member may not exceed two meals per day.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.428 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Adult Residential Care, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2012 MAR p. 1265, Eff. 7/1/12; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.429 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Supported Living, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.430 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Adult Day Health

(1) Adult day health is a supervised daytime program that offers health and social services for adults with severe and disabling mental illness to ensure optimal functioning of the member and enrichment activities through engaging social community but who do not require the intervention or services of a registered nurse or licensed rehabilitative therapist onsite.

(2) An entity providing adult day health services must be licensed as an adult day care center as provided at ARM 37.106.301, et seq.

(3) Adult day health services are furnished in an outpatient setting that does not include overnight residential services.

(4) Adult day health includes the following service components:

(a) meals as described in ARM 37.106.2616;

(b) health, nutritional, recreational, and social habilitation; and

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.431 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Personal Assistance Service

(1) Personal assistance service (PAS) is the provision of long term service and supports in a member's home and in the community tailored to each member's needs and living situation.

(2) PAS may be provided by:

(a) a home health agency provider;

(b) a community first choice/personal assistance service (CFC/PAS) provider; or

(3) PAS may be provided only when the services available in CFC/PAS are insufficient to meet the following needs of the member:

(a) the member has a documented physical need that requires hours in addition to the 42 bi-weekly hours available under CFC/PAS; or

(b) the member requires services outside of their residence that cannot be provided by CFC/PAS.

(4) PAS may not be provided in a residential habilitation.

(5) PAS includes the following service components:

(a) activities of daily living;

(b) instrumental activities of daily living; and

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.432 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Habilitation, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.433 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Behavioral Intervention Assistant

(1) Behavioral Intervention Assistant service is provided when the PAS available in the waiver and CFC/PAS provided in the state plan are insufficient in meeting the needs of the enrolled member due to challenging behaviors and assistance is required to improve or restore function in ADLs, IADLs, or social and adaptive skills.

(2) Behavioral intervention assistant service is provided by entities that are licensed and insured to deliver personal care services. If an enrolled member chooses to self-direct their services as a co-employer, the enrolled member must use an agency providing personal assistance, behavioral intervention assistance, or life coach type services, with the goal of ensuring the enrolled member is successful with the self-direction experience.

(3) Behavioral intervention assistants must:

(a) have at least eight hours of mental health training within six months of hire and annually thereafter, in order to develop and maintain specialized skills to address the challenging behaviors of enrolled members;

(b) be at least 18 years of age;

(i) abuse reporting;

(ii) incident reporting;

(iii) client confidentiality; and

(iv) any specialty training required or needed to sufficiently address the entire needs of the enrolled member, to provide whole person care;

(d) possess the ability to complete the documentation requirements of the program; and

(e) possess a valid driver's license and proof of auto liability insurance if transporting the enrolled member.

(4) Behavioral intervention assistants provide instructive assistance, cueing to prompt, and supervision, to assist the enrolled member in completion of ADLs, IADLs, and community integration activities.

(5) Behavioral intervention assistant services may not be provided concurrently with personal assistance services or supported employment services.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.434 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Life Coach

(1) Life coach focuses on social determinants of health (SDoH) that impact a enrolled member's overall health and well-being, and addresses the obstacles that impede an enrolled member's progress towards self-sufficiency, improved health, and well-being.

(2) Life coach services may be provided by:

(a) independent living centers;

(b) personal care entities;

(d) a member self-directing the service, as described in ARM 37.90.439.

(3) Life coaches must have at least eight hours of specialized behavioral health training annually approved by the department.

(4) All life coach providers must complete and submit the designated application to the department.

(5) An enrolled member must have a SDoH assessment with identified needs and established goals in their PCRP.

(6) Life coach services must include at least one of the following social determinants of health:

(a) economic stability;

(b) neighborhood and physical environment;

(d) regular and consistent access to healthy foods, education on nutrition, and overall health impacts;

(e) access to needed healthcare; and

(f) community and social context.

(7) Life coach services may not duplicate services provided under behavioral intervention assistant.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.435 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Supported Employment

(1) Supported employment services assist members to prepare for, find, and keep competitive jobs that exist in the open labor market, pay at least minimum wage, and are in a variety of integrated work settings.

(2) Supported employment services are provided by public or private employment agencies, Independent Living Centers, organizations that provide support for individuals with disabilities, Mental Health Centers, or a self-employed individual with at least:

(a) an associate degree in vocational rehabilitation, career development, or disability services;

(b) an Individual Placement Services (IPS) certification; or

(c) two years of experience in vocational rehabilitation, career development, or disability services and receive an IPS certification within six months of hire.

(3) A supported employment provider must have at least eight hours of specialized behavioral health training annually approved by the department.

(4) Supported employment services are for members who have previously been unable to succeed in competitive employment due to significant disabilities or challenging behaviors and need intensive, ongoing job supports to maintain long-term employment.

(5) The need for supported employment must be documented in the member's Person-Centered Recovery Plan and individualized to meet the identified need.

(6) Supported employment may:

(a) continue for as long as the member wants and needs support; and

(b) be provided in conjunction with other employment services.

(7) Supported employment may be provided only in a competitive employment setting.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.436 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Specially Trained Attendant Care, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.437 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Homemaking Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.438 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Respite Care

(1) Respite care is planned or emergency care provided to a member with need for support and supervision in order to provide temporary relief to the unpaid caregiver of the member.

(2) Respite care services may be provided in:

(a) a member's place of residence;

(b) an alternative private residence; or

(3) Respite care is provided for members who:

(a) in the absence of respite care, would require institutional level of care;

(b) are unable to care for themselves; and

(4) A person providing respite care services must be:

(a) physically and mentally qualified to provide this service to the member;

(b) aware of emergency assistance systems and CPR-certified; and

(5) A person who provides respite care services to a member may be required by the case management team to have the following when the member's needs so warrant:

(a) knowledge of the physical and mental conditions of the member;

(b) knowledge of common medications and related conditions of the member; and

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.439 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Self-Directed Services

(1) Enrolled members in the waiver program must be offered an opportunity to utilize self-directed services as a co-employer. Once an enrolled member's comprehensive assessment and PCRP process have been completed and needed waiver services are identified, the enrolled member may select the specific services they wish to self-direct from the list of services indicated in (10). The enrolled member may also receive some of the services in their PCRP through traditional supports and services from a provider agency, as long as no services are duplicated. The entities responsible for supporting self-direction include case managers, the QIO, and the provider agencies.

(2) Services may be directed by:

(a) an enrolled member who has the capacity to self-direct, as determined by the department or the department's designee;

(b) a legal representative of the enrolled member, including a parent, spouse, or legal guardian; or

(3) The person directing the services must:

(a) be 18 years of age or older;

(b) successfully complete required training for self-direction; and

(c) if acting in the capacity of a representative, demonstrate understanding of the enrolled member's needs and preferences.

(4) If an enrolled member indicates an interest in the self-directed option, the case management team is responsible for referring the enrolled member to the QIO. The QIO must assign a health care professional to:

(a) conduct a capacity interview over the telephone; and

(b) certify that the enrolled member, legal representative, or nonlegal personal representative is capable of managing the tasks and understands the risks involved. An approved capacity determination is required to self-direct services.

(5) The case management teams must:

(a) assist the enrolled member to develop an emergency backup plan, identifying and mitigating risks or potential risks, and monitor the health and safety of the enrolled member. Agency-based PAS managed by provider agencies under agreement with Medicaid are not available to enrolled members who are participating in the self-directed program. The use of PAS managed by provider agencies is permissible only if the enrolled member's backup plan fails;

(b) educate enrolled members regarding self-directed opportunities;

(c) meet with enrolled members to detail the self-directed service options during the intake process, annual visit, as well as throughout their service plan year as indicated through assessed need;

(d) provide assistance for informed decision-making by enrolled members and their families/representatives about the election of self-direction with information and training on the roles, risks, and responsibilities assumed by those who choose self-direction;

(e) inform enrolled members they are able to assist with the development of formal/informal supports, plan development, as well as available resources for self-direction; and

(f) oversee the service delivery in the self-direct option.

(6) The enrolled member, the enrolled member's legal representative, or the nonlegal personal representative must:

(a) be capable of making choices about activities of daily living, understand the impact of their choices, and assume responsibility for those choices;

(b) be capable of managing all tasks related to service delivery including recruiting, hiring, scheduling, training, directing, and dismissal of attendants; and

(7) Enrolled members will be able to choose from several agencies providing personal assistance type services, ensuring members are successful with the self-direction experience. The provider agency must:

(a) advise, train, and support the enrolled member, as identified in the member's PCRP;

(b) assist with recruiting, interviewing, hiring, training, managing, paying, and dismissing workers; and

(8) Self-directed services can be terminated when:

(a) the enrolled member chooses not to self-direct; or

(b) the case management team or the department identifies an instance where the self-directed option is not in the best interest of the enrolled member, and a corrective action does not improve the situation.

(9) The enrolled member must be informed in writing of the plan to transfer to an agency-based service delivery.

(10) The following services may be self-directed as a co-employer:

(a) personal assistance services;

(b) behavioral intervention assistance; and

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234.

Mont. Admin. R. 37.90.440 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Outpatient Occupational Therapy, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.441 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Psycho-Social Consultation, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.442 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Substance-Related Disorders Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2012 MAR p. 1265, Eff. 7/1/12; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.445 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Dietetic Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.446 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Nutrition, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.447 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Private Duty Nursing

(1) Private duty nursing are medically necessary nursing services delivered to a member in their place of residence.

(2) Private duty nursing may be provided by:

(a) a licensed registered nurse (RN); or

(b) a licensed practical nurse (LPN) under the supervision of a RN, physician, dentist, osteopath, or podiatrist authorized by the state of Montana to prescribe medication.

(3) Private duty nurses may be employed by a home health care provider or self-employed.

(4) Private duty nursing may be provided when Home Health Agency services under state plan, defined in ARM 37.40.701, are not appropriate or available.

(5) Private duty nursing must be prescribed by an appropriately licensed medical professional.

(6) Private duty nurses must comply with the Montana Nurse Practice Act.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.448 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Personal Emergency Response Systems

(1) A personal emergency response system (PERS) is an electronic device used to secure assistance in an emergency situation to allow a member to gain greater independence.

(2) A PERS must be connected to an emergency response unit with the capacity to activate emergency personnel.

(3) The provision of a personal emergency response system as a service does not include the purchase, installation, or routine monthly charges of a telephone.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.449 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Specialized Medical Equipment and Supplies

(1) Specialized medical equipment and supplies service is the provision of items of medical equipment and supplies to an enrolled member for the purpose of maintaining and improving the enrolled member's ability to reside at home and to function in the community.

(2) Specialized medical equipment and supplies must:

(a) be functionally necessary and relate specifically to the enrolled member's disability;

(b) substantively meet the enrolled member's needs for accessibility, independence, health, or safety;

(c) be likely to improve the enrolled member's functional ability or the ability of a caregiver or service provider to maintain the enrolled member in the enrolled member's home; and

(d) be the most cost-effective item that can meet the needs of the enrolled member.

(3) Specialized medical equipment and supplies service does not include:

(a) items used for leisure and recreational purposes only;

(b) items of clothing;

(d) educational items including computers, software, and books unless such items are purchased in conjunction with an environmental control unit; or

(e) coverage for dentistry or dental-related procedures, services, equipment or supplies. This includes any 'D' procedure code definitions identified in the current American Medical Association's Common Procedural Terminology (CPT) manual or identified as dental pursuant to Medicare, the American Dental Association, and/or Montana Medicaid.

(4) Specialized medical equipment and supplies service includes service animals as defined in ARM 37.90.463.

(5) Certain items of medical equipment or supplies for short term use, as specified by the department, may be leased or rented instead of purchased.

(6) The department may require a consultation prior to the purchase of certain equipment and supplies.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.450 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Nonmedical Transportation

(1) Nonmedical transportation is the provision to a member of transportation through common carrier or private vehicle for access to social or other nonmedical activities.

(2) Nonmedical transportation services are provided only after volunteer transportation services, or transportation services funded by other programs, have been exhausted.

(3) Nonmedical transportation may be provided by accessible transportation providers, cabs, personal care provider agencies, and Life Coaches. Nonmedical transportation providers must show proof of:

(a) a valid Montana driver's license; and

(b) adequate automobile insurance.

(4) Nonmedical transportation services must be:

(a) provided by the most cost-effective mode; and

(b) provided only after all volunteer, state plan, or other publicly funded transportation programs have been exhausted or determined inappropriate.

(5) Nonmedical transportation services are available only for the transport of members to and from activities identified in the member's Person-Centered Recovery Plan.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.451 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Residential Habilitation, Assisted Living

(1) Residential habilitation, assisted living, provides 24-hour services and supports designed to ensure the health, safety, and welfare of a member and assist the member acquiring and improving behaviors necessary to live and participate in the community.

(2) Assisted living facilities must be licensed in accordance with ARM Title 37, chapter 106, subchapter 28.

(3) Assisted living includes the following service components:

(a) personal care;

(b) social and recreational activities;

(d) medical escort;

(e) non-medical transportation;

(f) meals; and

(g) 24-hour onsite awake staff.

(4) A provider of adult residential care must report serious occurrences, as defined in ARM 37.90.403, to the department.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.452 Home and Community Based Services for Adults with Severe and Disabling Mental Illness: Residential Habilitation, Intensive Mental Health Group Home

(1) Residential habilitation, intensive mental health group home, provides 24-hour care designed to ensure the health, safety, and welfare of a member and provide supervision for the member to live and participate in the community.

(2) Intensive mental health group homes must be licensed in accordance with ARM Title 37, chapter 106, subchapter 19.

(3) Only the Montana State Hospital, the Montana Mental Health Nursing Care Center, or the Addictive and Mental Disorders Division may refer a member for intensive mental health group home services under the waiver program.

(4) An intensive mental health group home must:

(a) be a licensed mental health center with a group home endorsement;

(b) be approved by the Addictive and Mental Disorders Division; and

(c) be knowledgeable about commitment and recommitment processes, as well as the process for use of involuntary medications.

(5) Intensive mental health group homes consist of the following staff:

(a) a program supervisor, .5 FTE, who provides clinical supervision as described in the member's Person-Centered Recovery Plan;

(b) a residential manager, 1.0 FTE; and

(c) 24 hour onsite awake staff with at least a 1:3 staffing ratio for at least 16 hours per day during awake hours and at least one staff for eight hours during sleeping hours, as determined by the provider.

(6) The member must:

(a) have a history of repeated unsuccessful placements in less intensive community-based programs;

(b) have at least one full year combined of institutionalization within the past three years; and

(c) exhibit an inability to perform activities of daily living in an appropriate manner due to the member's Severe and Disabling Mental Illness (SDMI) diagnosis.

(7) Intensive mental health group homes must offer the following service components:

(a) assistance with activities of daily living and instrumental activities of daily living, as needed;

(b) medication management, administration, and oversite;

(d) crisis stabilization services as needed by the member;

(e) close supervision and support of daily living activities;

(f) access to community involvement;

(g) care coordination;

(h) discharge planning; and

(i) transportation and supervision, if appropriate, to suitable community resources.

(8) A provider of adult residential care must report serious occurrences, as defined in ARM 37.90.403, to the department.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.453 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Residential Habilitation, Mental Health Group Home

(1) Residential habilitation, mental health group home, provides 24 hours of available services and supports designed to ensure health, safety, and welfare of a member and assist the member in the acquisition and improvement of behaviors necessary to live and participate in the community.

(2) A mental health group home must be a licensed mental health center with a group home endorsement.

(3) Mental health group homes consist of the following staff:

(a) a program supervisor, .5 FTE, who provides clinical supervision as determined in the member's Person-Centered Recovery Plan;

(b) a residential manager, 1.0 FTE; and

(c) 24-hour onsite awake staff with a minimum 1:4 staffing ratio for at least 16 hours per day during awake hours and at least one staff for eight hours during sleeping hours, as determined by the provider.

(4) The member must have:

(a) a history of repeated unsuccessful placements in less intensive rehabilitative community-based programs;

(b) impaired interpersonal or social functioning;

(d) impaired judgment;

(e) poor impulse control; or

(f) a lack of family or other community or social supports.

(5) The member must exhibit:

(a) an inability to perform activities of daily living in an appropriate manner due to the member's SDMI diagnosis; and

(b) symptoms related to the SDMI severe enough that a less intensive level of service would be insufficient to support the member in an independent living environment and requires a structured treatment environment to be successfully treated in a less restrictive setting.

(6) Mental health group homes must offer the following service components:

(a) assistance with activities of daily living and instrumental activities of daily living as needed;

(b) medication management, administration, and oversite as needed;

(d) crisis stabilization services as needed by the member;

(e) supervision and support of daily living activities;

(f) assistance with medications, including administration of medications as necessary;

(g) skills building in areas of community reintegration and independent living;

(h) care coordination;

(i) discharge planning for transition to a less restrictive setting; and

(j) transportation and supervision, if appropriate, to suitable community resources.

(7) A provider of adult residential care must report serious occurrences, as defined in ARM 37.90.403, to the department.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.454 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Residential Habilitation, Adult Group Home

(1) Residential habilitation, adult group home, provides 24-hour available services and supports designed to ensure health, safety, and welfare of a member and assist the member in the acquisition and improvement of behaviors necessary to live and participate in the community.

(2) An adult group home must be provided in the setting as defined in ARM Title 37, chapter 88, subchapter 9.

(3) Placement in an adult group home must be supported by the member's level of impairment and strengths assessment found in the Person-Centered Recovery Plan.

(4) Adult group home is a bundled service that includes:

(a) personal care;

(b) homemaker services;

(d) recreational activities;

(e) medication management and oversite;

(f) medical escort;

(g) nonmedical transportation; and

(h) 24-hour onsite awake staff to meet the needs of the members and provide supervision for safety and security.

(5) Members in an adult group home may not receive the following services under the Home and Community Based Services, Adults with Severe and Disabling Mental Illness Waiver Program:

(a) personal assistance;

(b) homemaker chore;

(d) environmental accessibility adaptations; or

(e) meals.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.455 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Residential Habilitation, Foster Care

(1) Residential habilitation, foster care, provides 24-hour services and supports designed to ensure the health, safety, and welfare of a member and assist the member in acquiring and improving behaviors necessary to live and participate in the community.

(2) Residential habilitation, foster care, must be licensed in accordance with ARM Title 37, chapter 106, subchapter 20.

(3) Residential habilitation, foster care, includes the following components:

(a) personal care;

(b) social activities;

(d) medication management and oversite;

(e) medical escort;

(f) nonmedical transportation;

(g) meals; and

(h) 24-hour on-site supervision to meet the needs of the member for safety and security.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.460 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Illness Management and Recovery Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2012 MAR p. 1265, Eff. 7/1/12; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.461 Home and Community-Based Services for Adults with Severe Disabling Mental Illness: Wellness Recovery Action Plan (wrap) Services, Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-2-401, 53-6-402, MCA
History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; REP, 2020 MAR p. 1173, Eff. 7/1/20.

Mont. Admin. R. 37.90.462 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Provision of Services by Legally Responsible Individuals

(1) A legally responsible individual (LRI) is an enrolled member's spouse or a court-appointed guardian for the enrolled member.

(2) The following services may be provided by a LRI:

(a) private duty nursing;

(b) personal assistance;

(d) respite; and

(e) behavioral intervention assistant.

(3) In order for a LRI to receive payment for services, it has to be demonstrated that services provided meet the following criteria:

(a) be a service/support identified in the approved SDMI HCBS waiver program application;

(b) be necessary to avoid institutionalization;

(d) be provided by a LRI who meets the provider qualifications and training standards specified in the waiver for that service;

(e) be paid at a rate that does not exceed what is allowed by the department for the payment of similar services; and

(f) be extraordinary care, as provided in (4).

(4) The CMT must assess the enrolled member's need for extraordinary care using the following criteria:

(a) the activity is one that exceeds the range of activities that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to assure the health and welfare of the enrolled member and meet either (i) or (ii) as listed below:

(i) the enrolled member scores as severely or gravely impaired on the Behavioral Health and Developmental Disabilities (BHDD) Severe and Disabling Mental Illness (SDMI) Home and Community Based Services (HCBS) Waiver Evaluation and Level of Impairment (LOI) Form in Areas One, Two, or Seven; or

(ii) the enrolled member scores a 4 (total dependence) in the Activities of Daily Living/Instrumental Activities of Daily Living section on the Level of Care form.

(5) An enrolled member must be offered a choice of providers. If the enrolled member or the enrolled member's authorized representative chooses a relative or legal guardian as a care provider, the choice must be documented on the PCRP. In addition to case management, monitoring, and reporting activities required for all waiver services, the following requirements are applied when a relative or legal guardian is paid as a care provider:

(a) quarterly face-to-face reviews with the enrolled member of expenditures, and the enrolled member's health, safety, and welfare status;

(b) monthly reviews by the provider agency of hours billed for relative provided care;

(c) a relative or legal guardian who is an enrolled member's authorized representative may not also be paid to provide services; and

(d) an enrolled member's spouse employed by a personal care agency may not be reimbursed directly to provide personal care to the enrolled member.

(6) A relative or legal guardian may not provide more than 40 hours of paid time in a seven-day period.

(7) The CMT checks in with the LRI to see if there are concerns regarding the risk factors. A back-up plan is part of the PCRP plan that would provide relief to the caregiver in the event they are at risk.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2024 MAR p. 2234, Eff. 9/21/24.

Mont. Admin. R. 37.90.463 Home and Community-Based Services for Adults with Severe and Disabling Mental Illness: Specialized Medical Equipment and Supplies –service Animals

(1) A service animal is an animal trained to undertake a particular task or tasks on behalf of an enrolled member that the enrolled member cannot perform and that are necessary to meet the enrolled member's needs for accessibility, independence, health, or safety. A service animal is limited to a dog trained to perform a task or tasks directly related to the enrolled member's disability.

(2) The following requirements must be met prior to the department approving and paying for a service animal:

(a) the enrolled member must be evaluated by a physician to determine if the member would benefit from a service animal in maintaining and improving the enrolled member's ability to reside at home and to function in the community;

(b) the evaluating physician must provide a recommendation for a service animal for the enrolled member and must identify the work or task the service animal will perform for the enrolled member and whether and how the work or task relates to the enrolled member's SDMI;

(c) the work or task performed by the service animal must relate to the enrolled member's SDMI as defined in ARM 37.90.403; and

(d) the enrolled member's case management team must determine that a service animal is a practical means of meeting the enrolled member's need and that there exists no alternative method of meeting the enrolled member's need that is significantly less expensive than a service animal.

(3) A service animal does not include any of the following:

(a) pets, companion animals, emotional support animals, and therapy animals;

(b) guard dogs, rescue dogs, sled dogs, tracking dogs, or any other animal not specifically designated as a service animal; or

(4) The following expenses will be covered by the program:

(a) supplies necessary for the service animal to perform work or tasks for the enrolled member;

(b) veterinary care, transportation to veterinary care, licensing or registering of service animal, and grooming if the enrolled member or the enrolled member's primary care giver is unable to groom the service animal;

(c) training of service animal to undertake the particular tasks on behalf of an enrolled member as long as a qualified trainer has assessed the service animal and determined the animal to have the behavioral characteristics to successfully complete training.

(5) The program does not pay for food for the service animal.

(6) The department may require a consultation prior to the purchase of certain equipment and supplies.

History

Authorizing statute(s): 53-2-201, 53-6-402, MCA
Implementing statute(s): 53-6-402, MCA
History: NEW, 2024 MAR p. 2234, Eff. 9/21/24.

Subchapter 37.90.5 Targeted Case Management for Adults With Serious Mental Illness or Substance Use Disorder

Mont. Admin. R. 37.90.501 Healing and Ending Addiction Through Recovery and Treatment (heart), Targeted Case Management for Adults with Serious Mental Illness or Substance Use Disorder: Reimbursement

(1) TCM for Adults with Serious Mental Illness or SUD, who receive HEART Waiver services exiting the state-operated secure facility, will be reimbursed on a fee per unit of service basis as follows. For purposes of this rule, a unit of service is a period of 15 minutes.

(2) The department adopts and incorporates by reference the department's fee schedule which sets forth the reimbursement rates for TCM. The provider reimbursement rate for Targeted case management services for Adults with Serious Mental Illness or SUD, who receive HEART Waiver services exiting the state operated secure facility is stated in the department's fee schedule as provided in ARM 37.85.106.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.

Subchapter 37.90.6 Consolidated Appropriations Act, Section 5121 Targeted Case Management

Mont. Admin. R. 37.90.601 Targeted Case Management for the Consolidated Appropriations Act, Section 5121: Reimbursement

(1) TCM under the provisions of CAA, Section 5121 will be reimbursed on a fee per unit of service basis as follows. For purposes of this rule, a unit of service is a period of 15 minutes.

(2) The department adopts and incorporates by reference the department's fee schedule which sets forth the reimbursement rates for TCM. The provider reimbursement rate for TCM under the provisions of CAA, Section 5121 is stated in the department's fee schedule as provided in ARM 37.85.106.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA
History: NEW, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.

Chapter 37.91 Certification of Mental Health Professional Persons

Subchapter 37.91.1 General Requirements

Mont. Admin. R. 37.91.101 Professional Person Certification

(1) The purpose of this chapter is to:

(a) adopt a procedure whereby persons may be certified as mental health professional persons as authorized in 53-21-106 , MCA;

(b) set forth specific conditions and qualifications which must be met before certification can be obtained; and

(c) set limits of authority and responsibility for persons who have obtained full certification and for persons who have obtained facility certification.

History

Authorizing statute(s): Sec. 53-21-106, MCA
Implementing statute(s): Sec. 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039.

Mont. Admin. R. 37.91.102 Exemptions

(1) Medical doctors who are licensed to practice in Montana by the board of medical examiners are designated mental health professional persons by 53-21-102, MCA and are therefore exempt from the provisions of ARM 37.91.106.

(2) Advanced practice registered nurses with a clinical specialty in psychiatric mental health nursing are designated mental health professional persons under 53-21-102, MCA, and are therefore exempt from the provisions of ARM 37.91.106.

(3) Licensed psychologists are designated mental health professional persons under 53-21-102, MCA, and are therefore exempt from the provisions of ARM 37.91.106.

History

Authorizing statute(s): 53-21-102, 53-21-106, MCA
Implementing statute(s): 53-21-102, 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; TRANS and AMD, from DOC, 1998 MAR p. 2039, Eff. 7/31/98; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Mont. Admin. R. 37.91.106 Definitions

(1) "Accredited college or university" means a college or university which is accredited by a regional accreditation organization recognized by the Montana Board of Regents.

(2) "Approved facility training program" means a course of instruction and supervised clinical experience planned and conducted by the employing facility and approved by the department and by the certification committee. An approved facility training program must include:

(a) a minimum of six months of full-time clinical experience in the facility; and

(b) instruction on Montana law; these rules; and facility policies, practices, and procedures as they relate to the privileges described in ARM 37.91.407.

(i) An approved facility training program must be directed by a professional person with full mental health certification who is responsible for its overall implementation and maintenance and for periodic review of each trainee's progress.

(ii) The clinical experience component of the approved training program must include instruction in, observation of, and supervised participation in all facility procedures involving or requiring the privileges specified in ARM 37.91.407. The trainee's clinical experience must be directly supervised by a professional person with either full or facility mental health certification who will report to the training director on a regular schedule.

(3) "Certification committee" means the committee established to rule on applications for certification. The committee consists of three members, the committee chairperson and two members appointed by the chairperson and approved by the director of the department. The chairperson is appointed by the director of the department. At least one member of the committee must have full mental health professional person certification.

(4) "Clinical competency evaluation" means a clinic-based procedure and written instrument for the assessment of an applicant's conceptual understanding of and competency in using the materials and skills presented in the approved facility training program. A clinical competency evaluation will be designed and conducted by the facility and must be approved as to form and content by the department and by the certification committee. The clinical competency evaluation must be supervised by a professional person with full mental health certification who will endorse the individual's application for facility mental health certification upon successful performance in the evaluation.

(5) "Clinical mental health experience" means work experience evaluating persons for mental illness and providing direct mental health treatment to a caseload which includes persons 18 years and older who are seriously impaired due to mental illness. Such experience must take place in an agency, organization, or unit within an organization in which the primary purpose is the treatment of mental disorders.

(6) "Department" means the Department of Public Health and Human Services provided for in 2-15-2201, MCA.

(7) "Facility" means a mental health facility as defined in 53-21-102, MCA.

(8) "Facility mental health certification" means a level of certification which qualifies the person so certified to act as a mental health professional person only in the facility for which the person is certified and only with those privileges described in ARM 37.91.407.

(9) "Full mental health certification" means a level of certification which qualifies the person so certified to act as a mental health professional person in all areas described in Title 53, chapter 21, MCA.

(10) "Mental Health Professional Person" means a type of professional person who is certified by the department under 53-21-106, MCA, to perform the privileges granted under ARM 37.91.402.

(11) "Professional person" means a mental health professional person as defined in 53-21-102(16), MCA.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Subchapter 37.91.2 Certification Procedures

Mont. Admin. R. 37.91.201 Application Process

(1) Application for professional person certification will be made on forms provided by the department.

(2) An applicant for full mental health certification must submit documentation of academic training, documentation of current Montana licensure as a clinical mental health professional, letters of reference testifying to clinical competence, and an endorsement by a professional person with full mental health certification indicating that the applicant fully understands the responsibilities of a professional person. In addition, an applicant for full mental health certification must successfully complete a written examination covering knowledge of Title 53, chapter 21, MCA and the mental health services in the state to include the role of, and treatment services provided at, the Montana state hospital.

(3) An applicant for facility mental health certification must submit documentation of academic training, documentation of successful completion of the employing facility's approved training program, and an endorsement from the professional person with full mental health certification who directly supervised the applicant's clinical competency evaluation.

(4) The certification committee will meet as necessary, but no fewer than 4 times per year, to review applications. Applicants will be notified in writing of the decision of the committee. The certification committee may grant certification, deny certification, grant certification conditioned upon a passing score on the written examination for full mental health certification, or request additional information from the applicant.

(5) Any denial of certification may be appealed pursuant to ARM 37.91.601.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53- 21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Mont. Admin. R. 37.91.205 Expiration and Renewal of Certification

(1) Professional person certification will expire three years from the date of certification.

(2) The professional person will be notified at least 30 days prior to the expiration date and will be provided a renewal form to record the information required by the certification committee.

(3) The certification committee will renew full mental health certification upon submission of proof that the individual continues to perform satisfactorily within Montana in direct treatment of mental illness or direct supervision of mental health treatment programs and evidence that continuing education, training, or instruction relevant to the exercise of professional person privileges and duties was received during the current certification period.

(4) The certification committee will renew facility mental health certification upon submission of proof that the individual continues to perform satisfactorily in direct treatment of mental illness in the facility for which the person is certified and evidence from the employing facility that continuing education, training, or instruction relevant to the privileges and duties of a professional person with facility certification was received during the current certification period.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Mont. Admin. R. 37.91.210 Revocation of Certification

(1) The certification committee may revoke an individual's certification for any of the following reasons:

(a) misrepresentation of professional person authority;

(b) exercising professional person authority regarding the treatment of a patient without personal knowledge of the patient, situation, or both;

(d) providing an endorsement for an applicant for facility mental health certification without personal knowledge of the applicant's successful performance on the clinical competency evaluation; and

(e) failing to meet ongoing educational requirements or suspension or revocation of their mental health professional license.

(2) The certification committee will investigate any allegations against a professional person which falls into one of the above categories and give the professional person an opportunity to rebut the allegations prior to making a decision regarding revocation of certification.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Mont. Admin. R. 37.91.220 Continuation of Certification

(1) Persons who are certified as a full mental health professional person as of the date of final adoption of these rules will be granted full mental health certification on that date for a period of two years or the length of time required to obtain licensure, whichever is shortest.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Subchapter 37.91.4 Certification Requirements and Privileges

Mont. Admin. R. 37.91.401 Requirements for Full Mental Health Certification

(1) Applicants for full mental health certification must demonstrate successful performance as licensed mental health clinicians, a thorough understanding of the statutory responsibilities of a mental health professional person, and knowledge of the full range of mental health services in Montana. Licensed clinicians who relocate to Montana and have never performed professional person duties in any other state must have at least three months' experience as a Montana mental health professional person in training before applying for certification.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Mont. Admin. R. 37.91.402 Privileges of Full Mental Health Certification

(1) A professional person with full mental health certification is qualified to:

(a) approve applications for voluntary admissions to mental health facilities;

(b) participate as a mental health professional person in involuntary commitments and recommitments to mental health facilities;

(d) order the discharge of a patient during, or at the end of, the initial commitment period;

(e) request a court-ordered release to alternative treatment;

(f) request a conditional release from a mental health facility;

(g) request the readmission of a conditionally released patient;

(h) review and initial, within 24 hours, summaries of extraordinary incidents involving patients;

(i) supervise approved training programs and clinical competency evaluations; and

(j) perform all the privileges specified in ARM 37.91.407.

(2) Mental health facilities may impose stricter standards than those in ARM 37.91.401 when defining staff privileges.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Mont. Admin. R. 37.91.406 Requirements for Facility Mental Health Certification

(1) Applicants for facility mental health certification must be employed by the facility in a position requiring the exercise of the privileges specified in ARM 37.91.407. They must also demonstrate clinical competency and a thorough understanding of the statutory responsibilities of a professional person with facility mental health certification. This can be accomplished only by successful completion of the facility's approved training program and satisfactory performance on the clinical competency evaluation. In addition, a professional person with facility mental health certification must have earned one of the following:

(a) licensure as a registered nurse; or

(b) a bachelor's degree or graduate degree from an accredited college or university in a field which is directly related to some aspect of treatment of mental illness.

(2) For a period of 6 months following the effective date of these rules the certification committee may grant facility mental health certification to any individual who:

(a) has been employed by the facility in a position requiring the exercise of the privileges specified in ARM 37.91.407 for at least 6 months;

(b) has received training and supervision substantially equivalent to the facility's approved training program as evidenced by a letter from the professional person directing the approved training program;

(d) meets the specified educational requirements for facility mental health certification.

History

Authorizing statute(s): Sec. 53-21-106, MCA
Implementing statute(s): Sec. 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039.

Mont. Admin. R. 37.91.407 Privileges of Facility Mental Health Certification

(1) A professional person with facility mental health certification is qualified to:

(a) approve and monitor the implementation of treatment plans of inpatients in accordance with the facility's written policies;

(b) supervise nonprofessional staff in accordance with the facility's written policies; and

(2) Mental health facilities may impose stricter standards than those in ARM 37.91.406 when defining staff privileges.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Subchapter 37.91.6 Appeals Process

Mont. Admin. R. 37.91.601 Appeal Process

(1) Any action of the certification committee concerning certification denial or revocation may be appealed to the director of the department. All findings and actions of the director will be binding on the certification committee.

(2) The notice of appeal must be directed to the director of the department who may appoint a hearings officer.

(3) The appeal must be in writing setting forth the nature of the grievance and arguments supporting the grievance and actions desired. The appealing party may also present oral argument before the director or hearings officer.

(4) All parties to the appeal will be notified in writing ten days prior to the hearing. The written notice must contain as a minimum, the date, day, time, and location of the hearing.

(5) The guidelines for conducting the hearing will be established by the director.

(6) Any party to the appeal who is dissatisfied with the written decision of the director may appeal to the appropriate district court.

History

Authorizing statute(s): 53-21-106, MCA
Implementing statute(s): 53-21-106, MCA
History: NEW, 1986 MAR p. 260, Eff. 2/28/86; AMD, 1992 MAR p. 1485, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 2039; AMD, 2014 MAR p. 503, Eff. 3/14/14.

Chapter 37.93 Licensure of Child Placing Agencies

Subchapter 37.93.1 General Requirements

Mont. Admin. R. 37.93.101 Child-Placing Agency: Definitions

(1) "Agency youth foster home" means a youth foster home licensed by the department after being studied by a child placing agency other than the department.

(2) "Biological parent" or "birth parent" means the mother and father who conceived and gave birth to the child.

(3) "Child" or "youth" means any person under the age of 18 years without regard to sex or emancipation.

(4) "Child-placing agency" (agency) means any corporation, partnership, association, firm, agency, institution, or person, other than an attorney or health care provider acting under 52-8-103(2), MCA, who places or who arranges for the placement of any child with any family, person, or facility not related by blood or marriage, either for foster care or for adoption.

(a) "To arrange for placement" means to act as an intermediary by assisting a parent, guardian or legal custodian to place or plan to place a child with persons other than persons related to the child.

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

History

Authorizing statute(s): 53-4-111, 53-4-403, MCA
Implementing statute(s): 53-4-113, 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661; AMD, 2022 MAR p. 537, Eff. 4/16/22.

Mont. Admin. R. 37.93.105 Child Placing Agency: Governing Body

(1) The governing body shall be the corporation, partnership, association, firm, agency, institution or person in whom the ultimate authority and legal responsibility is vested for the conduct of the child placing agency.

(2) The governing body shall be identified by its legal name. If the governing body has a board of directors, the names of the officers of the board shall be given to the department prior to licensure.

(3) The governing body of the child placing agency shall:

(a) be responsible for the protection of the legal rights of children served by the agency;

(b) be responsible for approval of the budget, obtaining and disbursing the agency's funds;

(c) appoint an executive director who meets the requirements and certify that staff members responsible for placement of children and/or conducting a licensing study meet the requirements set forth in these rules.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.110 Child Placing Agency: Personnel

(1) Personnel policy. Each child placing agency must have a written personnel policy covering at least the following items: job qualifications, job descriptions, supervisory structure, salary schedules, fringe benefits, insurance, hours of work, and performance evaluations.

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

(3) General personnel qualifications. All child placing agency personnel responsible for providing services to children and/or conducting a licensing study must meet the following general qualifications:

(a) be at least 18 years of age;

(b) be of good character;

(d) like and understand children;

(e) be in good mental and physical health;

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

(g) have experience in working with children; and

(h) meet any additional qualifications for the position established by these rules.

(4) Executive director. The agency must have an executive director who shall be responsible for the administration and management of the agency, including the supervision of the placement services provided to children.

(a) The executive director shall have demonstrated knowledge of and experience in the provision of child welfare services, including administrative and supervisory experience.

(b) Any executive director appointed after the adoption of these rules shall have the following qualifications:

(i) a bachelors degree from an accredited college or university, with a minimum of 30 semester credits, or equivalent quarter credits, in social science courses;

(ii) at least 2 years' experience in an administrative or supervisory capacity;

(iii) three letters of recommendation from individuals unrelated to the applicant, one of whom should be a former employer or supervisor of the applicant, which describe the executive director's character, reliability, knowledge of child welfare services, and general ability to perform the tasks of the executive director as set forth in the job description for that position;

(iv) if the executive director is also to act as a placement supervisor, she/he must also meet the qualifications of a placement supervisor.

(5) Placement supervisor. The agency must have a placement supervisor who is responsible for supervising the selection, matching, placement of and provision of services to children.

(a) Any placement supervisor appointed after the adoption of these rules shall have the following qualifications:

(i) a masters degree in a behavioral or social science, with an emphasis in child development or family relations;

(ii) at least 2 years' experience of full time or equivalent part time employment in social work, with demonstrated experience in child placement; and

(iii) two letters of recommendation which describe the person's character, knowledge of child welfare services and child placement, and ability to perform the tasks of a placement supervisor as set forth in the person's job description.

(6) Social workers. The agency shall employ an adequate number of social workers to provide selection, matching, placement and supportive services to the children and families and to the youth care facilities utilized by the agency.

(a) The social worker(s) must meet the following qualifications:

(i) bachelor's degree from an accredited college or university in social work, social science or related field;

(ii) Persons employed as social workers who do not meet the qualifications for placement supervisor must be supervised by a person qualified to be a placement supervisor.

(7) Paraprofessionals and trainees. The agency may employ persons not qualified to act as social workers to assist the social worker, but such persons may not assume primary responsibility for providing placement-related services. Qualifications for such persons shall be contained in the job descriptions prepared by the agency for such persons.

(8) The child placing agency is responsible for assuring that no persons hired by the agency shall pose any potential threat to health, welfare and safety of the children placed.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Subchapter 37.93.2 License Requirements

Mont. Admin. R. 37.93.201 Child Placing Agency: License Required

(1) No person shall maintain or operate a child placing agency without first securing a license in writing from the department.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.203 Child Placing Agency: Licenses

(1) One-year licenses. The department shall issue a 1-year license to any license applicant that meets all requirements established by these rules in this subchapter, as determined by the department after a licensing study.

(a) The department shall renew the license annually on the expiration date of the previous year's license if:

(i) the child placing agency makes written application for renewal at least 60 days prior to the expiration date of its current license; and

(ii) the child placing agency continues to meet all requirements established by these rules, as determined by the department after a relicensing study.

(2) A child placing agency may be licensed to conduct a licensing study for the licensing of agency youth foster homes, to place children in youth foster homes and/or in adoptive homes. The license shall specify those services which the child placing agency is licensed to provide.

(3) Licensing procedures. Application for a child placing agency license must be made on an application form provided by the department.

(a) Upon receipt of the application for license or renewal of license, the department shall, within 60 days, conduct a licensing study to determine if the applicant meets all applicable requirements for licensure established in these rules.

(b) If the department determines that an application or accompanying information is incomplete or erroneous, it will notify the applicant of the specific deficiencies or errors, and the applicant shall submit the required or corrected information within 60 days. The department shall not issue or renew a license until it receives all required or corrected information.

(c) At the initial application the agency shall submit a written purpose and policy statement for the general operation and management of the agency. The statements shall include:

(i) statement of the purpose of the agency, the geographic area the agency expects to serve, the ages of children to be placed and any other specific factors regarding the children to be placed or the homes in which the children shall be placed;

(ii) a written placement policy, including parental agreement forms, and a description of the legal procedures which will be used to obtain the authority to place the child;

(iii) a written statement of the fees which will be charged for each type of service;

(iv) for child placing agencies conducting licensing studies, a description of how studies will be conducted and sample of the application and study report forms.

(4) At annual relicensing the agency shall submit a copy of its yearly budget and annual audit of expenditures.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.204 Child Placing Agency: License Revocation and Denial

(1) The department, after written notice to the applicant or licensee, may deny, suspend, restrict, revoke or reduce to a provisional status a license upon finding that:

(a) the agency is not in substantial compliance with licensing requirements established by these rules;

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

(c) the agency or a member of its staff have been named as a perpetrator in a substantiated report of child abuse or neglect.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.210 Child Placing Agency, Applicable Hearing Procedures

(1) Any person aggrieved by an adverse department action denying, revoking, suspending or restricting a license may request a hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337 .

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403(3), MCA
Implementing statute(s): Sec. 53-4-113(4) and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS & AMD, from DFS, 2000 MAR p. 1653, Eff. 6/30/00.

Subchapter 37.93.5 Records

Mont. Admin. R. 37.93.501 Child Placing Agency: Confidentiality of Records

(1) All records maintained by an agency pertaining to an individual child are confidential and may not be disclosed to any person, agency or organization except as specified in 40-8-126 , MCA, and 50-15-206 , MCA.

(2) All records pertaining to individual children placed by the agency shall be made available at any time to the department's designated representatives.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.505 Child Placing Agency: Adoptive Child's Record

(1) The agency shall maintain individual records for each child placed in any adoptive home. The records shall be current to the date of adoption and shall contain the following if applicable:

(a) demographic information including the name, address, sex, race, birth date, and birth place of the child;

(b) the name, address, telephone number, and marital status of the parent(s) and guardian(s) of the child;

(c) the name, address, and telephone number of siblings if placed elsewhere and other significant relatives if available;

(d) copies of legal documents of importance to the child, such as birth record and any court dispositions;

(e) the medical history, cumulative health record, and available psychological and psychiatric reports;

(f) the social assessment and background of the family and parent(s) ;

(g) a summary which reflects the dates of contact, initial assessment, case plan, and content of the worker's visits;

(h) the circumstances leading to the decision to place a child, the agency's involvement with the parent(s) , including services offered, delivered, or rejected;

(i) educational records and reports;

(j) summary of any administrative or outside service reviews on the progress of each child toward goal determination;

(k) summary of the child's contacts with family members; and

(l) a record of the child's placements with names of caregivers, addresses, and date of care.

(2) The agency shall insure that upon discharge, a child's record contains the following:

(a) a discharge summary showing services provided during care, the growth and accomplishments, assessed needs which remain to be met, and recommendations of the services needed to meet these goals;

(b) dates of discharge, reason for discharge, and the name, address, telephone number, and relationship of the person(s) or agency to whom the child was discharged; and

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.510 Child Placing Agency: Birth Family Records

(1) The agency shall maintain a record of the birth family of every child whom the agency places into care. Such records shall contain:

(a) demographic information including address, birth dates, race, religion, family composition, and interested others;

(b) the social history, including any psychological or psychiatric reports and medical histories;

(d) worker's assessment and initial case plan;

(e) signed agreements between the agency and family;

(f) summary of dates of contact and progress toward goals;

(g) case review reports;

(h) legal documents which grant the agency the legal authority to place the child for adoption; and

(i) discharge summary.

(2) The agency shall keep all records current and shall record the following events within 1 month of occurrence: intake study, case plan, case plan reviews, and major events in the lives of the child and family members.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.511 Child Placing Agency: Adoptive Study Records

(1) The agency shall keep separate records for each adoptive family which contain:

(a) the application;

(b) the adoptive assessment study;

(d) references from at least three sources;

(e) a copy of the information given to the parent(s) concerning child(ren) to be placed for adoption with them;

(f) all legal documents pertaining to the adoption; and

(g) summary containing the placement decision, preplacement and post-placement contacts with the family and the adoptive child.

(2) In the event a family was not accepted or did not have a child placed with them, the agency shall keep on file a narrative clearly indicating the reason and the manner in which the decision was presented to the family.

(3) If an agency ceases operation all agency records of children, birth families and adoptive families shall be forwarded to the department upon cessation.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.515 Child Placing Agency: Youth Foster Home Records

(1) The agency shall keep separate records for each agency youth foster home which shall contain:

(a) the application;

(b) the foster home licensing study;

(d) annual assessment of strengths and weaknesses of the foster family relative to the care of individual children placed with them;

(e) annual licensing compliance study and reports connected with it;

(f) history of the care given by the family, children placed, dates admitted and discharged from care; and

(g) a termination summary for homes which are closed containing the reasons for the closing.

(2) Copies of all of the above shall be provided to the department.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Subchapter 37.93.7 Placement Services

Mont. Admin. R. 37.93.701 Child Placing Agency: Services to Foster Parent(s)

(1) Orientation. The agency shall provide orientation to applicant(s) for an agency youth foster home license to acquaint them with the agency's policies and practices and the department's licensing rules.

(2) Agreement. The agency shall have a signed agreement with all foster parent(s) which includes the following:

(a) expectations and responsibilities of the agency, the staff, and the foster parent(s) ;

(b) the services to be provided;

(d) the authority the foster parent(s) can exercise for the children placed in their home;

(e) the actions which require agency staff authorization; and

(f) the legal responsibility for damage or risk resulting from children in their homes.

(3) Payments. The agency shall have a written statement as to the reimbursement rates paid to foster parent(s) for cost of care expenditures and/or fees for service.

(a) Reimbursement payments must be an amount sufficient to assure adequate care for the child in the youth foster home.

(b) Payment at the rate adopted by the department for youth foster care will be presumed to be an amount sufficient to assure adequate care.

(c) When homes are used which are not reimbursed, the agency shall include a written statement of the reasons why reimbursement is not necessary and a written statement assuring that the child can be adequately cared for without reimbursement as part of the written agreement between the agency and the foster home.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.705 Child Placing Agency: the Placement Process

In addition to an agency's responsibility to study and supervise the ongoing operation of its licensed agency youth foster homes, the agency shall comply with the following requirements applicable to the placement process:

(1) Intake procedures and practices.

(a) The intake study shall be written and shall include:

(i) the identification of the specific needs of the child and family which warrant consideration of removal and placement of the child;

(ii) the family's strengths;

(iii) the involvement of the child's parent(s) and significant others in his/her care;

(iv) the available resources;

(v) the stated goals for the family;

(vi) available social and medical history of the child and all family members; and

(vii) the child's legal status, including parental agreement/court order.

(b) The agency shall keep a record of all requests for services, placements and the reasons for acceptance and denial of services.

(2) Case plan.

(a) The agency shall develop a written case plan upon completion of the intake study and prior to placement. In cases of emergency placements, the assessment and case plan shall be initiated within 1 week and completed within 6 weeks of placement. The plan shall include, but not be limited to, the following:

(i) documentation of whether available social services to preserve and strengthen the family unit have been provided to the family and child and that all alternatives to placement and their consequences have been explored with them;

(ii) the reasons for the selection of the type of care and how it meets the child's and family's needs;

(iii) projected duration of care;

(iv) preplacement activities with child and family;

(v) specific initial case goals for the child and family;

(vi) specific steps to accomplish goals;

(vii) specific time schedule for goals;

(viii) designation of responsibility for carrying out steps with the child, parent(s) , foster parent(s) , adoptive parent(s) , and the court (when involved) , including frequency of contacts;

(ix) visiting plans between the child, parent(s) , and siblings, if appropriate;

(x) date of first review of progress; and

(xi) description of the conditions under which the child shall be returned home or when termination of parental rights should be initiated.

(b) The agency shall include the parent(s) , other significant persons, and the child (when appropriate to age and understanding) in the development of placement and case plans.

(c) The agency, prior to accepting a child for placement, shall secure from parent(s) , guardian(s) , or court, written authority to place the child and to obtain medical care.

(d) The agency shall help the parent(s) to understand the legal rights and obligations that they retain and those delegated to the agency by the court.

(3) Supervision and review of the case plan.

(a) The agency shall complete a review of the case plan at least every 6 months indicating progress toward goal achievement and changes made in the service plan.

(b) The agency shall include in the review an assessment of the child in care, the progress of the growth and development of the child, the relationships between the child and care givers, and the problems which may have occurred.

(c) The case review shall utilize either administrative staff or outside agency personnel to ascertain whether children are being served in a prompt, effective manner and the progress on permanent plans for each child.

(4) In the case of a temporary placement of a child prior to placement with the potential adoptive parents which will not exceed 7 consecutive days in duration, the requirements of (1) and (2) of this rule shall be waived. A study incorporating the applicable requirements of (1) and (2) shall be written within 7 days of termination of the temporary interim placement.

(5) Placement services to families and children.

(a) Services to biological parent(s) :

(i) The agency shall make services accessible and available to parent(s) requesting them.

(ii) The agency shall help the family gain access to the services necessary to preserve and strengthen the family and to accomplish the case plan goals. While the child is in care, the agency shall assist parent(s) with the problems and needs that brought about the need for placement.

(iii) The agency shall make counseling available to expectant parent(s) considering placement before the child is born and immediately thereafter.

(iv) The agency shall encourage contacts between parent(s) and children after placement, in accordance with the case plan.

(v) The agency shall have a signed agreement with the parent(s) of the child in care which includes, but is not limited to, the expectations and responsibilities of the agency and the parent(s) for carrying out the steps to meet the case plan goals, the financial arrangements for the child in care, and visiting plans.

(b) Selection of care:

(i) The agency shall select the most appropriate form of care for the child consistent with the child's and family's needs for foster care or adoption.

(ii) In choosing such care, the agency shall provide for any specialized services the child may need and shall make every effort when placing to select the least restrictive and most appropriate setting closest to the child's home.

(iii) The agency shall involve the child's parent(s) in the selection of care to the maximum extent possible.

(iv) The agency shall only place the child(ren) in a licensed youth care facility.

(i) The agency social worker for the child shall become acquainted with the child and biological family prior to placement, except when a child is placed on an emergency basis.

(ii) The agency social worker shall help the child understand the reasons for placement and prepare him/her for the new environment. The caseworker shall plan and participate in at least one preplacement visit (except when placing under emergency conditions) and shall be available for supportive services to the child, the birth parent(s) , and the foster parent(s) .

(iii) The agency shall obtain and record a developmental history for each child.

(d) Services during care:

(i) The agency shall supervise care of the child and shall coordinate the planning and services for the child and family as stated in the case plan.

(ii) The agency worker shall see a child as often as necessary to carry out the case plan. For children in foster homes, there shall be no less than two visits per month during the first 3 months of care and monthly visits thereafter. For children in youth group homes or child care agencies, there shall be no less than two visits during the first month of care and quarterly thereafter.

(iii) The agency worker or, by written agreement, the residential group care worker shall meet with the parent(s) and child together on a regular basis to assess and work on the following:

(A) progress in resolving problems which precipitated placement;

(B) parent and child relationship difficulties;

(D) achievement of case plan goals.

(iv) The agency shall refer the parent(s) to other agencies in the community providing appropriate services when they require services which the agency does not offer. The agency shall maintain communication with the agency providing service when a cooperative effort has been arranged.

(v) The agency shall make provisions for specialized services and health care services as stated in the case plan.

(vi) The agency shall be available to give foster parent(s) assistance, consultation, and emotional support with situations and problems encountered in fostering children.

(e) Aftercare services:

(i) The agency shall make continuing supportive services available for children and families for at least 6 months following an adoption or a child's return to his/her family in order to strengthen and support new or renewed family functioning.

(ii) The agency shall offer supportive help and referral services to parent(s) who decide not to place their child after receiving agency services.

(f) Interstate placements. The agency shall send written notice to the administrator of the interstate compact on placement of children whenever an agency plans to place a child in another state or receives for placement a child from another state and shall comply with the requirements of 41-4-101 , et seq., MCA, in making or receiving an interstate placement.

(6) If the parents' rights have been legally terminated or the whereabouts of the child's parents is unknown or the child has no parents or guardians in the United States, the requirements set forth in this rule regarding the involvement of parents in the placement process do not apply.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.708 Child Placing Agency: Adoptive Services

In addition to the child placing agency licensing requirements, those agencies that place children for adoption must meet the following requirements:

(1) Adoptive home recruitment:

(a) Agencies serving Indian children shall actively recruit Indian homes and shall comply with the placement requirements contained in the Indian Child Welfare Act (42 USC 1901 et seq.) .

(b) The agency shall provide information to prospective adoptive parent(s) about the adoption process:

(i) the agency's policies and practices, legal procedures and the approximate time the process will take, adoptive requirements, types of children placed, the fees, and the availability of subsidy.

(2) Adoptive home application:

(a) The agency shall have an application process that allows for notice to prospective adoptive parents of the status of their application.

(b) The agency may bill applicants for applications commensurate with professional application services rendered.

(3) Adoptive home study:

(a) The study process shall be a joint effort of the child placing agency and the applicant(s) .

(b) The process shall be conducted by the social worker in a minimum of three meetings with the applicants, at least one meeting of which shall be in the applicant's home.

(d) The agency shall study the following areas and shall record the information in the adoptive applicant(s) record:

(i) motivation for adoption;

(ii) strengths and weaknesses of each member of the household with regard to adoption of a child;

(iii) the attitudes and feelings of the family, extended family, and significant others involved with the family toward accepting adoptive children, and parenting children who are not born to them;

(iv) attitudes of the applicant(s) toward the birth parent(s) and the reason(s) the child is in need of adoption;

(v) the applicant's plan for discussing adoption with the child;

(vi) emotional stability and maturity of applicant(s) ;

(vii) ability to cope with problems, stress, frustrations, crises, and loss;

(viii) capacity to give and receive affection;

(ix) child caring skills and willingness to acquire additional skills needed for the child's development;

(x) ability to provide for the child's physical and emotional needs;

(xi) adjustment of birth children or previously adopted children;

(xii) a report of a physical examination for members of the adoptive family living in the household which verifies that each person is free from communicable disease, specific illness, or disabilities which would interfere with the family's ability to parent a child;

(xiii) ability to provide financially for the child or children to be adopted with or without agency financial assistance through adoption subsidy;

(xiv) personal and community character references;

(xv) location and physical environment of the home;

(xvi) plan for child care if parent(s) work; and

(xvii) recommendations for adoption in regard to number, age, sex, characteristics, and special needs of children best served by the family.

(4) Notification regarding denial:

(a) When applicant(s) are not accepted, the agency shall notify the applicant(s) in writing within 10 days of the decision and share with them the reasons why a child cannot be placed in their home. The agency shall offer services to the applicant(s) to assist them to adjust to such a decision.

(5) Services to adoptive parent(s) :

(a) The agency shall discuss the potential children with the adopting family.

(b) The agency shall prepare the adoptive family for the placement of a particular child. Preparation shall include:

(i) information about the needs, characteristics, and expectations of the child, of the child's family, and of the adopting family; and

(ii) review of medical histories of the child and of the child's family; and

(iii) visiting by the adoptive parents with the child prior to placement.

(c) The agency worker shall visit the adoptive family home within 6 months after the placement of a child, prior to the final decree. If the child is an infant (0-1 years old) , the agency worker shall conduct at least one home visit. If the child is 1 year old or older, the agency worker shall conduct at least two home visits. Observations made during the visits shall be used in making recommendations for the finalization of the adoption.

(d) The agency shall make post-adoption services available to the adoptive parent(s) , the birth parent(s) , and the adoptee after the finalization of the adoption.

(6) Agencies must secure a court order terminating the parental rights of the birth parents and legal authority to place the child for adoption prior to adoptive placements.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.715 Child Placing Agency: Reports

(1) The agency shall agree to submit to the department, upon its request, any reports required by federal or state law or regulation.

(2) The agency shall report any of the following changes to the department prior to the effective date of the change:

(a) a change of administrator;

(b) a change in location;

(3) At the application for relicensure the agency shall report to the department any significant changes in the organization, administration, purposes, programs, policies or services.

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

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

(b) The agency shall inform each new employee, within the first 24 hours of employment, of the child abuse and neglect reporting statute and responsibilities of staff relative to this law.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Mont. Admin. R. 37.93.716 Child Placing Agency: Conducting Licensing Studies of Agency Foster Home

(1) Licensed child placing agencies are authorized by these rules to conduct licensing studies of youth foster homes and to make recommendations to the department for approval or denial of the license consistent with the licensing requirements adopted by the department.

(a) The licensing requirements which are established by the department for youth foster homes must be met by any foster home being recommended by the child placing agency for licensure.

(b) Copies of the licensing rules for youth foster homes shall be supplied by the department to each child placing agency which shall provide copies to each youth foster home applicant.

(2) The agency shall provide information to prospective foster parent(s) about foster care, the agency's policies and practices, the licensing process including licensing requirements for foster homes, the children needing foster care, and the reimbursement rates.

(3) An agency youth foster home applicant shall complete an application form provided by the department.

(a) The department, in response to an application for a license, may request the agency to conduct a licensing study to determine compliance with the state licensing rules for youth foster homes.

(b) Only persons who meet the qualifications of social workers, placement supervisors or executive directors may conduct licensing studies.

(4) The agency shall conduct a youth foster home licensing study to determine the applicant(s) compliance with the state licensing rules for youth foster homes.

(a) The agency's foster home study shall also assess the following areas:

(i) the applicant's motivation for foster care;

(ii) strengths and weaknesses of each member of the household in providing foster care;

(iii) applicant's ability to provide for the child's physical and emotional needs;

(iv) adjustment of own children;

(v) recommendations for number, age, sex, characteristics, and special needs children best served by the family, and recommendations regarding children which would not be appropriate for the family;

(vi) any other factors which may affect the ability of the applicant to provide protection and supervision of a child placed in the home.

(b) The agency shall submit the written licensing study and recommendations to the department.

(c) The agency shall contact three personal and community references of the applicant(s) and shall investigate any incomplete, negative or questionable references.

(5) Agency recommendation for licensure.

(a) The agency shall submit a recommendation for licensing action to the department.

(b) The agency shall submit the licensing study to the department.

(d) If the applicant(s) do not meet the requirements for licensure the department shall notify the applicant(s) in writing within 30 days of completing the licensing study.

(6) Agency youth foster home monitoring and annual licensing study.

(a) The agency shall monitor all licensed agency youth foster homes which were licensed after being studied by the agency for compliance with the department's youth foster home rules.

(b) The agency shall conduct annual relicensing studies of all licensed agency youth foster homes to determine continued compliance with the youth foster home rules and to make licensing renewal recommendations to the department. The annual relicensing studies shall include at least one home visit by the agency.

(7) Agency youth foster home complaints in licensed foster homes. When receiving a complaint which may indicate possible violations of the youth foster home rules, the agency shall:

(a) conduct an investigation to assess compliance with applicable rules;

(b) submit a written report of the investigation to the department with a statement on rule compliance and a recommendation regarding any licensing action which should be taken; and

(c) send a written report to the home stating findings, conclusions, and any anticipated action affecting the license. (d) When a complaint is received regarding abuse or neglect of a child in care, the agency shall immediately notify the county's child protective services office which will conduct an investigation.

(8) Agency youth foster home recommendations to revoke, deny or suspend a license. The agency shall send the department a written assessment of rule compliance and any documents supporting the findings with any recommendation for revocation, denial or suspension of a youth foster home license. The department shall be solely responsible for revoking, denying or suspending agency youth foster home licenses.

(9) The department shall conduct periodic visits to agency youth foster homes for the purpose of inspecting the home and assuring continued compliance with the department's licensing standards.

History

Authorizing statute(s): Sec. 53-4-111 and 53-4-403, MCA
Implementing statute(s): Sec. 53-4-113 and 53-4-403, MCA
History: NEW, 1985 MAR p. 278, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 661.

Chapter 37.95 Licensure of Day Care Facilities (repealed)

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2006 MAR p. 1424, Eff. 6/2/06; AMD, 2012 MAR p. 1368, Eff. 7/13/12; AMD, 2018 MAR p. 308, Eff. 2/10/18; AMD, 2018 MAR p. 191, Eff. 6/1/18; REP, 2025 MAR, 37-1044, Eff. 5/1/25.

Authorizing statute(s): 53-4-503, MCA
Implementing statute(s): 53-4-504, MCA
History: NEW, 1982 MAR p. 722, Eff. 4/16/82; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1992 MAR p. 45, Eff. 1/17/92; TRANS, from DFS, 1998 MAR p. 2881; REP, 2000 MAR p. 2415, Eff. 9/8/00.

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-731, 52-2-733, MCA
History: NEW, 2000 MAR p. 2415, Eff. 9/8/00; AMD, 2002 MAR p. 2231, Eff. 8/16/02; REP, 2025 MAR, 37-1044, Eff. 5/1/25.

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-731, 52-2-733, MCA
History: NEW, 2000 MAR p. 2415, Eff. 9/8/00; AMD, 2018 MAR p. 308, Eff. 2/10/18; REP, 2025 MAR, 37-1044, Eff. 5/1/25.

Authorizing statute(s): 53-4-503, MCA
Implementing statute(s): 53-4-504, MCA
History: NEW, 1982 MAR p. 717, Eff. 4/16/82; AMD, 1985 MAR p. 2041, Eff. 12/27/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1992 MAR p. 798, Eff. 4/17/92; TRANS, from DFS, 1998 MAR p. 2881; REP, 2000 MAR p. 2415, Eff. 9/8/00.

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-731, MCA
History: NEW, 1982 MAR p. 722, Eff. 4/16/82; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 2881; AMD, 2000 MAR p. 2415, Eff. 9/8/00; AMD, 2012 MAR p. 1368, Eff. 7/13/12; REP, 2025 MAR, 37-1044, Eff. 5/1/25.

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-731, MCA
History: NEW, 2010 MAR p. 2390, Eff. 10/15/10; REP, 2025 MAR, 37-1044, Eff. 5/1/25.

Chapter 37.96 Licensure of Day Care Facilities

Subchapter 37.96.1 General

Mont. Admin. R. 37.96.101 General Definitions

(1) "Applicant" means an individual or legal entity who has made a formal request for a child care license or registration.

(2) "Capacity" means the maximum number of children a facility is authorized by the department to have in care at any given time.

(3) "Child" is defined in 52-2-703, MCA, and means:

(a) a person under 13 years old; or

(b) a person with special needs, as defined by the department, who is under 18 years old or is 18 years old and a full-time student expected to complete an educational program by 19 years old.

(4) "Child care" has the same meaning as "day care," as defined in 52-2-703, MCA, and means care for children provided by an adult, other than a parent of the children or other person living with the children as a parent, on a regular basis for daily periods of less than 24 hours, whether that care is for daytime or nighttime hours. The term does not include:

(a) school-age care, unless the provider opts to be licensed or registered;

(b) informal short term, drop-in care for children provided on an unscheduled or on-demand basis while parents attend discrete activities such as meetings, appointments, or leisure activities, unless the provider opts to be licensed or registered;

(c) recreational, creative, educational, or religious programs and camps operating at specific and limited times of the year;

(d) programs established chiefly for educational purposes that limit their services to children who are three years old or older, unless the provider opts to be licensed or registered;

(e) relative care, unless they opt to be registered; or

(f) Family, Friend, and Neighbor care, unless they opt to be registered.

(5) "Child care center" has the same meaning as "day-care center" as defined in 52-2-703, MCA, and means an out-of-home place in which child care is provided to 16 or more children on a regular basis. The term does not include a place where child care is provided if a parent of a child for whom child care is provided remains on the premises, unless the parent is a director/owner, staff member, support staff, or volunteer of the child care center, or unless the child care center is on the premises or campus of an employer who employs the parent.

(6) "Child care facility" has the same meaning as "day-care facility" as defined in 52-2-703, MCA.

(7) "Child Care Licensing (CCL)" is the program at the Montana Department of Public Health and Human Services that regulates and supports child care providers.

(8) "Continuous" means without interruptions, gaps, or stopping.

(9) "Department" means the Montana Department of Public Health and Human Services.

(10) "Discrimination" means unjust or prejudicial treatment in child admissions or employment of staff on the basis of race, sex, religion, creed, color, national origin, marital status, age, or physical or mental disability.

(11) "Drop-in child care" means a child care facility which only provides care to children on an unscheduled or on-demand basis while parents/guardians attend discrete activities.

(12) "Family child care facility" or "family day care home" is defined in 52-2-703, MCA, and means a private residence or other structure in which child care is provided to three to eight children on a regular basis. A person who provides child care in a private residence for six or fewer children may opt to be registered as a family child care facility if that person desires to receive child care subsidy payments as described in 52-2-713, MCA.

(13) "Family, Friend, and Neighbor (FFN)" means a child care provider who can provide care for no more than six children from separate families or all children from a "sibling group" and who opts to be registered.

(14) "Group child care facility" or "group day-care home" is defined in 52-2-703, MCA, and means a private residence or other structure in which child care is provided to nine to 15 children on a regular basis.

(15) "Group size" means the number of children in a defined space or intentionally grouped around an activity.

(16) "Harm to children" means harm to a child's health, safety, or welfare that falls within the definitions of child abuse or neglect in 41-3-102, MCA.

(17) "Infant" means a child through 11 months old.

(18) "Irregular" means periods of time less than six hours a day or for no more than three consecutive weeks at a time.

(19) "Lapsed registration/license" means:

(a) an application for registration/licensing renewal which is received by the department after the registration/licensing expiration date;

(b) an application which is incomplete and results in a break-in-license span; or

(c) any break in the registration/license span resulting from a lapse of required insurance or resulting from a failure to comply with another licensure requirement.

(20) "License" is defined in 52-2-703, MCA, and is required for child care centers and is optional for school-age care and drop-in child care facilities. License statuses include:

(a) "Probationary license" means a child care license with a status that has been reduced for a specified period of time based on a licensing violation and which will be reinstated to regular status upon successful completion of, and compliance with, remedial measures identified by the department to address specific deficiencies.

(b) "Provisional license" means a license status that is given to a child care provider if the provider does not meet all the requirements, but is attempting to comply. This status can be granted for a period of up to three months, and may be renewed. This license status is used for current licensees who are renewing and for new providers after their pre-licensing inspection.

(c) "Regular license" means a license status that is given upon determination that the child care provider is meeting all requirements set forth for that specific type of licensed child care.

(d) "Revocation" or "revoked license" means an enforcement action by the department to close a child care facility and permanently remove the license.

(e) "Suspended license" means an enforcement action by the department to put a license on hold to protect the health, safety, or welfare of enrolled children or the public.

(21) "Licensee," "owner," or "registered provider" means the legally responsible person or organization who holds a license or registration from the department.

(22) "Negative action" means denial, suspension, revocation, or modification of a license or registration.

(23) "Night care" or "non-traditional hours" means care provided for a child between the hours of 6 p.m. and 6 a.m.

(24) "Overlap care" means care provided at a registered family or group child care facility for children three years and older, and approved by the department for a designated time period not to exceed three hours when the number of children in care may exceed the number of children on the registration.

(25) "Parent" or "guardian" means birth parent, custodial parent, adoptive parent, foster parent, legal guardian, or an individual authorized to act with respect to a child by the parent or entity legally responsible for the welfare of the child.

(26) "Pre-inspection" means a child care licensing or registration inspection before a child care provider begins providing care. The pre-inspection ensures the applicant has the required components in place to be a licensed or registered child care facility, excluding FFNs and Relative Care Exempt providers.

(27) "Premises" means the private residence, facility, or other structure in which licensed or registered child care will be provided and the associated approved outdoor space.

(28) "Provider" means the applicant, the license holder, or registration holder.

(29) "Registration" is defined in 52-2-703, MCA, and is required for group child care facilities and family child care facilities. "Registration" also means department approval of a Relative Care Exempt provider or FFN provider who opts to be registered. Registration statuses include:

(a) "Probationary registration" means a child care registration that has been reduced for a specified period of time based on a registration violation and which will be reinstated to regular status upon successful completion of, and compliance with, remedial measures identified by the department to address specific deficiencies.

(b) "Provisional registration" means a registration status that is given to a family or group child care provider if the provider does not meet all the requirements, but is attempting to comply. This status can be granted for a period of up to three months, and may be renewed. This registration status is used for current registration holders who are renewing and for new providers after their pre-registration inspection. This status does not apply with respect to FFN or RCE (Relative Care Exempt) providers.

(c) "Regular registration" means a registration status that is given upon determination that a registered provider is meeting all requirements set forth for that specific type of registered child care.

(d) "Revocation" or "revoked registration" means an enforcement action by the department to close a child care facility and permanently remove the registration.

(e) "Suspended registration" means an enforcement action by the department to put a registration on hold to protect the health, safety, or welfare of enrolled children or the public.

(30) "Regular basis" is defined in 52-2-703, MCA, and means providing child care to children of separate families for any daily periods of less than 24 hours and for three or more consecutive weeks at a time.

(31) "Relative care" means the child is the brother, sister, nephew, niece, grandchild, or great grandchild of the persons providing child care and includes a child in a step, foster, or adoptive relationship.

(32) "Relative care exempt (RCE) provider" means a person providing relative care who opts to be registered by the department to receive payments to provide child care.

(33) "Renewal" is a process for providers to demonstrate ongoing compliance with licensing or registration requirements and for the department to reissue a license or registration to continue operating a child care facility.

(34) "School-age care" means regularly scheduled care exclusively for school-age children during out-of-school-time hours, licensed by the department.

(35) "School-age child" means a child who is five years old or older.

(36) "Sibling group" means all children are from the same household.

(37) "Staff" refers to all persons who work or substitute in a child care facility, including directors, and count in child-to-staff ratio.

(38) "Supervision" means the provider and/or such staff as are necessary to maintain required child-to-staff ratios must be able to see or hear the children at all times.

(39) "Support staff" means a staff member of a child care provider who does not participate in a caregiving role and is not counted in child-to-staff ratios. Examples of support staff are cooks, administrative staff, or cleaning staff.

(40) "Technical assistance" means education, training, coaching, and other support provided by the department, its partners, or its contractors to child care providers and staff to assist in meeting licensing and registration requirements and enhancing quality of care.

(41) "Toddler" means a child who is 12 months old through 36 months old.

(42) "Waiver" means the department has approved an exception to a rule within this chapter.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.102 Types of Licenses and Registration

(1) Montana has different types of child care licenses and registrations, which vary by the number of children in care, the care settings or facility type, and sometimes the ages of children in care. Providers have a choice in selecting their license or registration category based on the benefits and requirements associated with each type of care.

(a) Child care can be provided in child care centers, group child care facilities, family child care facilities, school-age care facilities, drop-in child care facilities, FFN providers, and RCE providers.

(b) Each rule in this child care licensing chapter describes the types of child care to which it applies.

(i) When the rule refers to "all licensed child care facilities," that includes child care centers, school-age care facilities if they choose to be licensed, and drop-in child care facilities if they choose to be licensed.

(ii) When the rule refers to "all licensed and registered child care facilities," that means licensed child care centers, licensed school-age care facilities, licensed drop-in care facilities, registered group child care providers, registered family child care providers, and registered FFN providers.

(iii) RCEs are only included when specifically referenced in the rule.

(2) Child care types are determined based on the following criteria:

(a) RCE providers provide care in a private residence either for a sibling group of any size or for no more than two children from separate households.

(b) FFN providers provide care in a private residence either for a sibling group of any size or for no more than six children from separate households.

(c) Family child care facilities provide care in a private residence or other structure for three to eight children on a regular basis.

(d) Group child care facilities provide care in a private residence or other structure for nine to 15 children on a regular basis.

(e) Child care centers provide care in an out-of-home setting for 16 or more children on a regular basis.

(f) School-age care facilities provide care on a regular basis only to school-age children and during out-of-school-time hours.

(g) Drop-in child care facilities provide care for children in an out-of-home setting on an unscheduled or on-demand basis while parents attend discrete activities, like meetings, appointments, or leisure activities.

(3) Any provider serving seven or more children on a regular basis must be licensed or registered.

(a) Child care centers must be licensed.

(i) Drop-in child care facilities and school-age care facilities have the option of being licensed.

(b) Group child care facilities serving nine to 15 children and family child care facilities serving seven or eight children must be registered.

(i) Providers serving three to six children have the option of registering as a family child care provider or as an FFN provider. Registration is required for providers who receive or wish to receive subsidy payments.

(ii) RCE and FFN providers have the option of being registered.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-724, 52-2-731, 52-2-732, 52-2-733, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.103 Determining Facility Type and Counting Children on License or Registration

(1) The facility type is determined by:

(a) the provider's application;

(b) the license or registration capacity for the facility;

(d) the number of staff members available to meet the child-to-staff ratio requirements; and

(e) whether any other safety, health, or program requirements are affected or violated.

(2) Children of staff or owners who are present in the child care space during child care hours are included when counting children for license or registration type and capacity.

(a) Children of owners who attend school full time will not be included when counting children.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.106 Child-to-Staff Ratios, Staff Numbers, and Supervision

(1) A licensed or registered child care facility may not provide care for more than the number of children permitted by its license or registration at any one time.

(2) Child care centers and licensed drop-in child care facilities must meet the following requirements:

(a) The child-to-staff ratio and maximum group size are:

(i) 4:1 for children newborn through 11 months old with a maximum group size of 12;

(ii) 6:1 for children 12 months through 23 months with a maximum group size of 12;

(iii) 8:1 for children two years old with a maximum group size of 16;

(iv) 10:1 for children three years through five years old with a maximum group size of 20; and

(v) 20:1 for children six years old and over with a maximum group size of 40.

(b) When children of different ages are mixed, the child-to-staff ratio and group size for the youngest child in the group must be maintained.

(c) Only the director, site directors, lead teachers, teachers, substitutes, and trainees may be counted as staff when determining the child-to-staff ratio.

(d) Group sizes must be maintained except for mealtimes, outdoor play, rest periods, or during large group activities, such as educational assemblies.

(3) At nap time in licensed child care centers, the child-to-staff ratio may be doubled for children two years and over when the following conditions are met:

(a) at least half the children are sleeping;

(b) another staff member is onsite in the center and is immediately available;

(d) the staff member responsible for direct supervision of the napping children is not a trainee.

(4) Licensed school-age care providers must have a maximum child-to-staff ratio of 20:1 for children five years old and over with a maximum group size of 40.

(a) Group sizes must be maintained except for mealtimes, outdoor play, rest periods, or during large group activities, such as educational assemblies.

(b) School-age care providers may exceed the group size limitation during transportation.

(5) Family and group child care facilities must meet the following staffing requirements:

(a) Family and group child care facilities serving mixed age groups may use an 8:1 child-to-staff ratio, with no more than three children under two years old.

(i) Any time there are more than three children under two years old in a program serving mixed age groups, there must be at least two staff members present with the group of children.

(b) Family and group child care facilities serving solely children under two years old must use a 4:1 child-to-staff ratio.

(6) Overlap care may be approved by the department for family child care and group child care facilities in situations, such as before and after school, when the number of children in care over three years old exceeds the licensed capacity for a short period of time. Overlap care must meet the following requirements:

(a) Overlap care for children under three years old is not permitted.

(b) Overlap care must not exceed three hours total in any day.

(d) Family child care facilities may care for up to two additional children during the approved overlap time.

(e) Child care facilities providing two shifts of 12-hour care may be granted three hours of overlap care for each 12 hours of continuous care.

(f) During approved overlap care times, family and group child care facilities may use a 10:1 child-to-staff ratio.

(g) Facilities wanting to provide overlap care must submit a written plan to CCL which includes the specific hours in which the overlap will occur, proof of insurance to care for the total number of children, and documentation of square footage sufficient to care for the total number of children.

(h) A facility must not provide overlap care until it has received written approval of this plan from CCL.

(7) Children must be supervised at all times.

(8) Staff providing direct care must be responsible for protection, supervision, and guidance of children through active involvement or direct observation.

History

Authorizing statute(s): 52-2-704, 52-2-731, 52-2-735, MCA
Implementing statute(s): 52-2-703, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.107 License or Registration Application

(1) Any individual, agency, or group may apply for a license or registration to operate a child care facility. Applications may be obtained from the Department of Public Health and Human Services, Early Childhood and Family Support Division, Child Care Licensing Program, P.O. Box 4210, Helena, MT 59620-4210 or at https://dphhs.mt.gov/ecfsd/childcare/childcarelicensing.

(2) Applications for a license or registration by American Indians residing on American Indian reservations must follow the requirements of 52-2-722, MCA.

(3) The department will determine whether or not a license or registration will be issued within 30 days of receipt of the application.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.108 Rce and Ffn Application Requirements

(1) RCE and FFN providers must meet the following requirements to be registered under this chapter:

(a) be 18 years old or older;

(b) limit the care they provide to a period of less than 24 consecutive hours;

(c) have satisfactory results of background checks for the applicant as set forth in ARM 37.96.1002. If care is provided in the applicant's home, all adults who reside there must also have satisfactory results of background checks;

(d) complete orientation approved by the department that includes health and safety training; and

(e) complete a department-approved health and safety review course at least every three years.

(2) In addition to the requirements in (1), FFN providers must hold current certification for infant, child, and adult CPR, infant choking response, and pediatric first aid. CPR certification must be completed in a hands-on setting.

(3) For payment purposes, subsidized care provided in a child's home can only be paid to FFN and RCE providers, pursuant to ARM 37.80.208.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-703, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.111 Issuing a License or Registration

(1) The department must conduct a pre-inspection with all child care center, school-age care, drop-in child care, group child care, and family child care license or registration applicants before the applicant can care for children.

(a) FFN and RCE providers are not subject to pre-inspection requirements.

(2) The department will issue a 90-day provisional license or registration following successful pre-inspection. The facility can begin caring for children under the provisional license or registration.

(3) The department will observe the facility during the provisional license or registration period while children are in care to assess compliance with requirements before removing the provisional status.

(4) The department will issue a regular license or registration after the observation and completion of any required compliance measures. The department issues regular licenses and registrations for a period of one year.

(5) The department will recognize the status of, and will not require a state license or registration for, a facility that is licensed as a child care facility by a branch of the United States armed forces, including the United States Coast Guard.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-721, 52-2-723, 52-2-731, 52-2-732, 52-2-733, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.112 Renewing a License or Registration

(1) A child care provider must submit an application for renewal at least 60 days prior to expiration of the license or registration.

(2) Provided a complete renewal application is filed timely, the expiring license or registration will remain in effect until the department makes a determination on the renewal application.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.113 License or Registration Application Denial

(1) A child care license or registration application must be denied if:

(a) the application process has exceeded 90 days from the date the application is received because the applicant has not submitted all required materials to the department;

(b) the applicant discriminates in the provision of child care services on the basis of the race, sex, religion, creed, color, age, marital status, mental or physical disability, or national origin of the parent/guardian or the child; or

(c) background check results include offenses on the part of the applicant, any adult residing in the child care facility, or other adult who regularly or frequently stays in the facility.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.114 Technical Assistance

(1) The department provides the following licensing and registration support:

(a) assistance to current and prospective providers to understand and meet licensing and registration requirements;

(b) consultation with child care providers on enrichment experiences for children, proper environment, and nutrition; and

(c) referral services and technical assistance to child care providers for staff training and development. Technical assistance may be concurrent with other department actions.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-731, 52-2-733, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.117 License or Registration Assignment

(1) A license or registration is valid only for the licensee or registered provider and premises for which it was issued. A license or registration may not be sold, assigned, or transferred.

(2) Separate licenses or registrations are required for child care facilities maintained on separate premises, even when operated by the same provider.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-721, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.118 Facilities Inspections

(1) The department may inspect the conditions and qualifications of licensed or registered child care facilities or applicants during child care business hours.

(a) The department may conduct unannounced inspections of licensed or registered child care facilities.

(b) The department must schedule inspections for FFN providers.

(2) The department is responsible for inspecting child care facilities in addition to those inspections required by the local health authority and/or local or state fire marshal inspections.

(3) The department must visit and inspect all licensed and registered child care facilities annually, except RCE providers.

(4) RCE providers and RCE applicants are not subject to any annual inspection or pre-inspection requirements.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 52-2-732, 52-2-733, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.121 Requirements for Facilities Operating with Joint Programs

(1) A child care facility operating in connection with another activity unrelated to child care must meet the following requirements:

(a) have separate staff and separate space for each program. However, staff and space may be shared for janitorial, maintenance, cooking, or other support services;

(b) children attending the child care facility must not come in contact with other persons unrelated to child care in the facility unless the provider can prove to the department's satisfaction that those persons will not pose any threat to the health, safety, and well-being of the children in child care; and

(c) if multiple programs, including multiple child care facilities in the same commercial building, increase the number of people regularly in the building to 16 or more children, the child care facility must comply with all fire, safety, and sanitation requirements for licensed child care facilities.

(2) Persons or organizations may be licensed or registered for more than one child care facility.

(a) If the child care facility is located in a private single-family living structure, the department will issue only one registration or license for child care in the structure and premises.

(b) If more than one child care facility exists in one retail or commercial structure, the department will grant individual licenses to each facility.

(c) Multi-family structures, such as an apartment building or duplex, may house multiple child care facilities so long as each is individually licensed or registered and meets the requirements of (1)(a) and (b).

(3) A provider may be licensed or registered to provide care in a facility that is also licensed to offer foster or respite care services, or another licensed or certified human services program.

(a) If the facility is licensed or registered as a child care facility and serves as a foster care home, the department's Child and Family Services Division (CFSD) and Early Childhood and Family Support Division (ECFSD) must both approve the dual license or registration.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.122 Waivers and Pilot Projects

(1) New and renewal license or registration applications may include written requests to waive any provision of a rule within the child care licensing chapter. The department and its partner agencies (e.g., local public health departments) may grant waivers if the department determines that the health and safety of the children in care are not diminished. The written request must:

(a) include the basis for request, such as significant hardship to provider or facility;

(b) propose an alternative that is consistent with best practices in early childhood or school-age care; and

(2) Proposals for innovative pilot projects will be considered by the department upon written request. The department may grant an extended provisional license or registration for approved projects that meet all criteria for provisional license or registration status. Projects must not be implemented without prior written approval from the department. The department reserves the right to revoke such extended provisional licenses or registrations.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.2 Program Activities

Mont. Admin. R. 37.96.201 Programming Definitions

(1) "Guidance approach" means the use of direction to resolve mistaken behavior without punishment.

(2) "Positive child guidance" means age-appropriate, non-punitive methods used to redirect a child to achieve a desired behavior.

(3) "Programming" means the activities, schedules, and curriculum of a child care facility.

(4) "Punishment" means any form of discipline that causes pain, discomfort, humiliation, shame, or fear, including name-calling, spanking, slapping, pinching, pulling, and hitting with an object.

(5) "Screen time" means time during which content on a mobile phone, tablet, computer, television, or other device can be viewed.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.202 General Programming Requirements

(1) Child care centers, group child care facilities, family child care facilities, and licensed drop-in child care facilities must have a written plan of daily activities and routines. Programming must:

(a) be flexible to accommodate the ages and needs of individual children and the group. Both active and passive learning experiences, and outdoor play each day except when precluded by weather, must be provided under direct supervision;

(b) ensure facilities provide durable, safe, clean, and child-sized furniture or furniture adapted for children's use; and

(2) Child care centers, group child care providers, family child care providers, and licensed drop-in child care providers offering night care must meet the following criteria in addition to compliance with other requirements:

(a) develop plans for staff, equipment, and space which will provide for the personal safety and emotional and physical care of children away from their families at night.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-722, 52-2-723, 52-2-724, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.205 Infant and Toddler Activities

(1) Child care centers, group child care facilities, family child care facilities, and licensed drop-in child care facilities that provide care for children under 36 months old must have a written plan of daily activities and routines that ensures:

(a) a child who is awake must not spend more than 30 minutes of consecutive time confined in a crib, playpen, jump chair, highchair, or other apparatus; and

(b) each infant can maintain the infant's own pattern of sleeping and waking periods according to instructions from the parents/guardians.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.206 Positive Child Guidance

(1) All staff of licensed and registered child care facilities must use guidance approaches appropriate to the child's age and developmental level to help children resolve conflicts, manage transitions, engage in challenging situations, or express feelings, needs, and wants.

(a) Positive child guidance should include forming positive adult-child relationships, clear direction, showing positive alternatives, redirection, and setting expectations and clear limits that foster the child's ability to self-regulate.

(b) All staff must model appropriate behaviors for children.

(2) All child care staff are prohibited from using abusive or physical punishment, including:

(a) spanking or other forms of physical punishment;

(b) shaking an infant or child of any age;

(c) any punishment or discipline that is humiliating, shaming, frightening, or otherwise damaging to the child or their family; or

(d) punishment for any toilet training issue.

(3) Parental or guardian permission does not allow for the use of any physical punishments or other approaches to discipline listed in (2).

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-2-211, 53-2-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.3 Administrative

Mont. Admin. R. 37.96.301 Administrative Definitions

(1) "Abusive head trauma" means a preventable and severe form of physical child abuse that results in an injury to the brain of a child caused by violent shaking and/or blunt impact.

(2) "Expulsion" or "expel" means terminating the enrollment of a child.

(3) "Shaken baby syndrome" is a preventable, severe form of physical child abuse resulting from violently shaking an infant by the shoulders, arms, or legs, and which may result from both shaking alone or from shaking with impact.

(4) "Suspension" means reducing the amount of time a child may be in attendance, either by requiring the child to stop attending for a particular period of time or reducing the number of days or hours a child may attend. Requiring a child to attend the facility in a special place away from the other children in the regular group setting is included in this definition.

(5) "Volunteer" means any person who is not compensated with employment pay or benefits.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.302 Emergency Communication

(1) Each licensed or registered child care facility must have:

(a) a working telephone;

(b) telephone numbers of emergency services and the Emergency Montana Poison Control Center (800) 222-1222 posted where they are visible to staff; and

(c) emergency contact information for each child easily accessible to staff in a location that maintains privacy for families.

History

Authorizing statute(s): 52-2-704, 52-2-731, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 52-2-732, 52-2-734, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.303 Policy Requirements

(1) All licensed child care providers and registered group or family child care providers must adopt and follow written policies for first aid consistent with recommendations from Caring for Our Children: National Health and Safety Performance Standards, Guidelines for Early Care and Education Programs. These must include:

(a) procedures for handling medical emergencies;

(b) a plan for preventing and responding to emergencies due to food and allergic reactions;

(d) directions to complete an incident or injury report:

(i) if the incident requires only onsite first aid, a copy of the report must be provided to the parents/guardians of the children involved, and a copy retained on file at the child care facility.

(ii) if the incident requires emergency services, hospitalization, or medical treatment, a copy of the report must be provided to the parents/guardians of the children involved, and a copy retained on file at the child care facility. The provider must inform also CCL within 24 hours of the incident;

(e) directions for calling parents/guardians or someone else designated as responsible for the child when a child is sick or injured; and

(f) a medication administration policy which must include:

(i) types of medication which may be administered;

(ii) medication administration procedures for each child, including the route of medication administration, the amount of medication given, and the times when medication is to be administered; and

(iii) a parent/guardian authorization.

(2) All licensed child care facilities and registered group or family child care facilities must have a written emergency disaster plan for each structure in which child care is provided. Emergency disaster plans must include:

(a) plans for evacuation, including identification of at least one off-site gathering point;

(b) plans to address children's individual needs, including mobility and special health care needs;

(d) plans for communicating with parents/guardians and reunifying children with their parents/guardians;

(e) plans to shelter in place and for lock down; and

(f) plans for continuity of operations.

(3) All licensed child care providers and registered group or family child care providers serving children under two years old must develop a written policy that describes the practices used to promote a safe sleep environment. All child care staff must sign an acknowledgment indicating that they read and understand the facility's safe sleeping policy.

(4) All licensed child care programs and registered group or family child care programs must have a written policy on identifying and preventing shaken baby syndrome and abusive head trauma. The policy must include:

(a) how the child care provider will ensure all staff are knowledgeable about and able to recognize the signs and symptoms of shaken baby syndrome and abusive head trauma;

(b) procedures for coping with a crying, fussing, or distraught infant or child; and

(5) All licensed child care programs and registered group or family child care programs must have a written expulsion and suspension policy.

(6) If providing any transportation, the licensed child care provider or registered group or family child care provider must develop a written transportation policy that outlines safe transport practices.

(7) If providing any opportunity for children to use swimming pools or be near other bodies of water, the licensed child care provider or registered group or family child care provider must develop a written water safety policy that outlines safe supervision practices for children in and around water.

(8) FFN providers have limited policy documentation requirements. FFNs must provide written health and safety standards to parents/guardians and the department relating to:

(a) managing infectious disease;

(b) safe sleep practices, if caring for children under two years old;

(d) food and allergy emergencies;

(e) shaken baby syndrome and abusive head trauma;

(f) emergency preparedness;

(g) transportation safety, if applicable;

(h) expulsion and suspension; and

(i) mandatory reporting of suspected child abuse and neglect.

(9) If a child care provider obtains a waiver from the department of any rule in this chapter, the program must develop a written alternative plan that includes policies and procedures to maintain compliance.

(10) All policies must be reviewed and updated annually by the program.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 52-2-732, 52-2-734, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.306 Record Retention

(1) Licensed and registered child care providers may maintain records in paper or electronic format, with the exception of the state-issued emergency contact and consent form, which needs to be in paper form. The department must be able to easily access such records. Records may be stored on-site or in the facility's administrative office, except the state-issued emergency contact and consent form which must be stored on-site.

(a) The provider must make records available during normal working hours to representatives of the department.

(2) Upon request, parents/guardians must be allowed to inspect the records pertaining to their child.

(3) All records that the department requires the provider to maintain must be kept for three years, unless otherwise provided by law.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-732, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.307 Program Records

(1) Licensed and registered child care providers must maintain the following records as applicable to the program type:

(a) All licensed and registered child care providers must maintain:

(i) a copy of the current license or registration, inspection reports by department staff, and correction plans for deficiencies;

(ii) documentation that any vehicle used for transportation of children while in care is registered and insured in accordance with state law;

(iii) results of well-water tests and lead paint tests, as applicable;

(iv) documentation that the facility complies with sewer requirements of this chapter;

(v) a log of fire extinguisher and smoke detector checks;

(vi) a medication administration log if medications are administered at the facility; and

(vii) a real-time attendance record of the children in care.

(b) All licensed child care providers and registered group and family child care providers must maintain:

(i) proof of current fire and liability insurance coverage for the provision of child care in the facility;

(ii) a record of each emergency drill conducted;

(iii) a master list of the names, addresses, and phone numbers of all children in care and their parents/guardians;

(iv) for any injury or incident that occurs in the facility, reports which include the date, time of day, nature of the injury or incident, treatment or remediation, and whether the parents/guardians were notified; and

(v) written menu records.

(i) an annual inspection report from the state fire marshal or the fire marshal's official designee indicating the fire safety rules have been met; and

(ii) an annual inspection report from public health authorities certifying the satisfactory completion of training or a certificate of approval following inspection by local health authorities.

(2) If a child care provider obtains a waiver from any rule in this chapter, a copy of the alternate plan and its approval by the department must be on file.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-722, 52-2-723, 52-2-731, 52-2-732, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.308 Children's Records

(1) All child care staff and volunteers must maintain personal information about a child and the child's family as confidential.

(2) All licensed and registered child care providers must have the following information prior to a child being enrolled in a child care facility. Forms must be signed by the parent or guardian:

(a) Written health information explaining any special medical needs of the child, including allergies, and a health care and medication plan if medication for chronic health conditions is required.

(i) Child care providers administering medications must have necessary medical documentation, including medication authorizations, the name of a health care provider to be contacted in event of an emergency, and the prescription, if required.

(b) Authorization of persons allowed to pick up the child.

(c) An emergency contact and consent form. Once children are enrolled, this form must accompany staff when children are away from the child care site for activities.

(3) All licensed and registered child care providers must maintain the following records related to enrolled children:

(a) the names, addresses, and phone numbers of children and their parents/guardians;

(b) a medication administration log if medications are administered to children at the facility;

(c) for any injury or incident that occurs in the facility, documentation which includes the date, time of day, nature of the injury or incident, treatment or remediation, and whether the parents/guardians were notified;

(d) written parent/guardian permission to swaddle children under three months old, if desired by the parents/guardians;

(e) for children 12 to 18 months old who are placed on a cot or mat, a signed statement indicating that the parents/guardians have given permission for their child to be placed on a cot or mat;

(f) special dietary instructions written by parents/guardians;

(g) written consent from the parents/guardians for any transportation provided; and

(h) adequate documentation of immunization status as outlined in ARM 37.96.806(2) through (5).

(4) Children's records must be reviewed and updated as necessary, but not less frequently than once per year.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-731, 52-2-732, 52-2-735, 52-2-736, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.311 Staff Records

(1) If a licensed or registered child care provider employs staff, the provider must maintain the following records for each staff member:

(a) contact information; and

(b) acknowledgment of, and agreement to follow, program policies for:

(i) identifying and preventing shaken baby syndrome and abusive head trauma;

(ii) mandatory reporting; and

(iii) safe sleep, if the program provides care for children under two years old.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-722, 52-2-723, 52-2-731, 52-2-732, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.312 Family Access to Information

(1) Before a child is enrolled at any licensed child care facility or registered group or family child care facility, the following information must be made available to all parents/guardians:

(a) a typical daily schedule of activities;

(b) admission requirements, enrollment procedures, and hours of operations;

(d) fees and payment plan;

(e) regulations concerning sick children;

(f) transportation and trip arrangements, if applicable;

(g) positive child guidance policy; and

(h) expulsion and suspension policy.

(2) All child care facilities must post a copy of the facility license or registration and the phone number of state and local Early Childhood and Family Support Division offices in a place where parents/guardians can see them. Parents/guardians should be encouraged to contact the division if they have questions regarding the license or registration or child care regulations.

(3) All child care facilities must allow custodial parents, non-custodial parents, and legal guardians access to the facility at any time during which child care is provided, unless there is a current court order preventing parent-child contact.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-723, 52-2-731, 52-2-732, 52-2-735, 52-2-736, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.313 Notifications to the Department

(1) Within ten days of the change, providers must notify the department of any changes that would affect the terms of the license or registration, including changes in staff, temporary or permanent closures, change in ownership of the program, changes in the category of license or registration based on the number and ages of children in child care, change to the business or mailing address, or changes to the child care property.

(2) All staff and owners of licensed and registered child care facilities are mandatory reporters of suspected child abuse and neglect pursuant to 41-3-201, MCA. Any child care staff member or owner who has reason to suspect that any child is or has been abused or neglected is required to personally report the matter to the department's child abuse hotline at (866) 820-5437. The staff member or owner must make the report within 24 hours of receiving information concerning suspected child abuse or neglect.

(3) All licensed and registered child care providers must report to CCL the following events involving the child care facility, regardless of whether it occurs on or away from the premises within 24 hours:

(a) a lost or missing child or an incident involving a child being left alone;

(b) suspected maltreatment of a child;

(d) injuries to children requiring medical or dental care;

(e) illness or injuries requiring hospitalization or emergency treatment;

(f) mental health emergencies;

(g) health and safety emergencies involving parents, guardians, and visitors to the program;

(h) death of a child or staff member, if the death was the result of a serious illness or injury that occurred on the premises of the child care facility, even if the death occurred outside of the child care facility;

(i) the presence of a threatening individual who attempts or succeeds in gaining entrance to the child care facility;

(j) fire involving the fire department; and

(k) any environmental danger or other hazard at the facility that the provider is aware of that could affect the health, welfare, or safety of children in care.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.4 Safety and Facilities

Mont. Admin. R. 37.96.401 Safety and Facilities Definitions

(1) "Bodies of water" means rivers, streams, ponds, ditches, fountains, and other water sources into which a child can step.

(2) "Crib" means a bed that is designed to provide a sleeping environment for children under two years old that meets U.S. Consumer Product Safety Commission requirements.

(3) "Exit" means the point (door or window) that allows people inside the facility to leave and move to the outside of the facility.

(4) "Firm sleep surface" means a crib mattress or a cradleboard.

(5) "Means of egress" means a continuous and unobstructed path from any point inside a facility to a safe place outside of the facility.

(6) "Portable wading pool" means a structure which contains water, is used for aquatic activities, and is less than 24 inches high.

(7) "Remote means of egress" means two exits whose distance apart is equal to or greater than one-half the diagonal distance of the space occupied to minimize the possibility that both exits will be blocked off by a fire or other emergency condition.

(8) "Safe sleep environment" means an environment where a child under 12 months old is placed on a firm sleep surface with no incline and no items in the sleeping environment other than a pacifier, and a child 12 months old or older is placed on a firm sleep surface or on a cot or mat. A safe sleep environment does not include waterbeds, water mattresses, gel pads, or sheepskin covers.

(9) "Sauna" means a small room or structure used for hot-air or steam baths.

(10) "Spa" means a hot tub or similar large tub of hot water.

(11) "Transportation" means any time a child is transported in a motor vehicle.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.402 Hazards

(1) All licensed and registered child care providers are responsible for keeping hazardous materials and objects inaccessible to children in care, including personal property of staff and licensee.

(2) Cleaning materials, flammable liquids, aerosol cans, and other toxic materials must be kept in their original containers and in a place inaccessible to children. They must not contaminate play surfaces, food, food preparation areas, or constitute a hazard to the children when used.

(3) Bio-contaminants including blood, bodily fluids, and other infectious materials must be properly disposed of.

(4) The building and grounds used by children must be maintained to ensure the following:

(a) the building is in good repair;

(b) the floors, walls, ceilings, furnishings, and other equipment are easily cleanable and reasonably clean;

(d) the building and grounds are reasonably neat and free from the accumulation of dirt, rubbish, or other health and safety hazards;

(e) all rooms must be dry, well ventilated, and well lit; and

(f) the children attending the facility must not be exposed to paint containing lead in excess of .0009%.

(5) During business hours, any guns stored on the premises of a child care facility must be kept in locked storage. Ammunition must be kept in locked storage separate from the gun.

(6) Electrical outlets must be tamper-resistant or covered in areas occupied by children under five years old, and exposed light sockets must be suitably protected to prevent electrocution.

(7) Toys, play equipment, and any other equipment used by the children must be sturdy and free from rough edges, sharp corners, splinters, and must be kept in good repair.

(8) Choking hazards must not be accessible to children who are still placing objects in their mouths, including:

(a) toys and objects with a diameter of less than one inch (2.5 centimeters) and objects with removable parts that have a diameter of less than one inch (2.5 centimeters);

(b) plastic bags;

(d) balloons.

(9) Full-size trampolines, ball pits, and other inflatable play structures are prohibited for use by children in care and, if they exist on the premises, must be inaccessible to children in care.

(a) Mini trampolines are permitted when used according to manufacturer's specifications, by one child at a time, and with supervision.

(10) Bathtubs, buckets, water tables for play, and other water receptacles must be emptied immediately after use.

(11) Guardrails, gates, or protective barriers must be installed along open-sided walking surfaces including stairs, ramps, and landings, where there is more than a 36-inch vertical distance to fall.

History

Authorizing statute(s): 52-2-704, 52-2-731, 52-2-735, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-724, 52-2-731, 52-2-734, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.403 Animals

(1) Any pet or domesticated animal present at any licensed or registered child care facility, indoors or outdoors, must be in good health, show no evidence of carrying disease, and either pose no safety threat to children or adults, or be kept separate from children, families, and staff.

(2) Staff must closely supervise all interactions between children and animals and instruct children on safe behavior when near animals.

(3) The program is responsible for:

(a) maintaining the animal's vaccinations and vaccination records; and

(b) making vaccination records available to the department upon request.

(4) The child care provider must make reasonable efforts to keep stray animals off the premises.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-724, 52-2-731, 52-2-734, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.404 Building Requirements Related to Exits

(1) In an emergency, all occupants must be able to escape from a child care facility in a safe and timely manner.

(a) Doorways, aisle ways, corridors, and stairs must be clear of any obstruction.

(i) Gates or guards at the top and bottom of stairways are allowed if they have latching devices that are easily opened by adults in case of emergency.

(ii) Sleeping equipment must be arranged to permit easy access to every child and unobstructed means of egress.

(2) All facilities must have two exits that create remote means of egress on each level that is used for child care.

(a) All nap rooms must have at least two means of egress.

(b) Exits/means of egress must meet the following requirements:

(i) one exit must be a door that is at least 32 inches wide and 80-inches tall; and

(ii) the second exit may be a window that provides a clear opening of at least 20 inches in width or 24 inches in height and 5.7 square feet in area. The bottom of the exit must not be more than 44 inches above the floor.

(3) Exit doors, windows, and their opening hardware must be maintained in good repair.

(4) If a child care provider chooses to lock exterior facility doors to prevent unauthorized access to the facility or to prevent a child from escaping, the lock:

(a) may not prevent free escape from the interior;

(b) must be easily opened with one motion from the inside of the facility; and

(c) may not prohibit access by parents/guardians. A facility may not use locking devices to prevent unannounced access by authorized individuals, including parents/guardians. If a lock is used, the provider must make adequate provision to allow authorized persons unannounced access to the facility and must provide authorized persons with information about how to gain access.

(5) Children must be able to open every closet door from the inside without a key, a tool, or special knowledge or effort.

(6) Every bathroom door must be designed to permit opening of the locked door from the outside in an emergency. The opening device must be readily accessible.

(7) This rule applies to all licensed and registered child care facilities except RCE facilities.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-724, 52-2-731, 52-2-734, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.407 Indoor Space Requirements

(1) All licensed and registered child care providers, except RCE providers, must ensure there is at least 35 square feet of usable floor space per child who will be in a room at any one time. A provider may request a waiver from this rule with an alternate plan, such as when limited indoor space is offset by sheltered outdoor space.

(2) Calculation of the required minimum 35 square feet of space per child must exclude food preparation areas of the kitchen, bathrooms, toilets, offices, staff rooms, corridors, hallways, closets, lockers, laundry areas, furnace rooms, cabinets, shelving, and other storage spaces.

(3) When play and sleep areas for children are in the same room, a minimum of 35 square feet of usable space per child must be provided except for:

(a) when large group activities, such as educational assemblies, occur; and

(b) periods when children are using their rest equipment.

(4) During sleep periods, the area must be sufficient to provide spacing between the children using sleep equipment.

(5) The equipment and furniture arrangement must permit unobstructed floor area sufficient to allow play appropriate for each group of children in care.

(6) In licensed child care facilities that include infants and toddlers, play areas for infants must be separate from play areas used by children over two years old, or not be used for any children over two years old while being used for children under two years old. Sleeping areas must be separate from play areas.

(7) A licensed child care facility must have space, furniture, and equipment to provide for support functions, such as storage, food preparation, custodial services, laundry, and administrative office functions.

(8) Facilities that use shared spaces should care for children in the licensed/registered, dedicated space most of the time.

(9) Family and group child care providers must not use third stories in private homes for child care purposes; such stories must be barricaded or locked to prevent entry by children. The use of second or higher stories in commercial or apartment buildings is subject to fire and building code requirements.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-731, 52-2-734, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.408 Outdoor Space Requirements

(1) Outdoor play space must contain a minimum of 75 square feet of usable space per child accessing the play space at any given time. A provider may request a waiver from this rule if a facility does not have enough outdoor play space to accommodate all enrolled children at one time with an alternate plan such as:

(a) offsetting limited outdoor space with indoor space not included in indoor space calculations, such as a gym, permitting an equivalent activity program; or

(b) offsetting limited outdoor or unfenced space with the availability or use of a nearby school playground, parks, or other safe outdoor play areas.

(2) Outdoor play areas at all child care facilities must be surrounded by a fence or natural barrier that is at least four feet high and in good repair without any holes or spaces greater than four inches in diameter.

(a) If a provider submits an alternative plan for outdoor space that includes space not completely surrounded by a fence, the provider must include, in the plan, details about supervision to maintain safety.

(3) Any outdoor play area must be maintained free from health and safety hazards.

(4) Provisions must be made for both sunny and shady activity areas.

(5) Outdoor areas must be designed or monitored so that all parts are always visible, allowing for direct supervision by child care staff.

(6) All licensed and registered child care providers except RCE providers must anchor outdoor equipment, such as a climbing apparatus, slides, and swings, firmly, and place in a safe location according to manufacturer's specifications.

(7) All licensed child care providers must maintain ground cover under outdoor equipment, which must be a shock-absorbing surface as defined by the U.S. Consumer Product Safety Commission, or with a minimum of six inches of sand, fine gravel, or woodchips.

(a) School-age care facilities operating on school premises or utilizing other inspected outdoor space must follow the outdoor equipment requirements of the premises and are not subject to additional licensing requirements.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 52-2-734, 52-2-735, 52-2-736, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.409 Fire Safety Requirements

(1) Licensed child care facilities must meet International Fire Code requirements to open and operate as a child care facility. New child care center, school-age care, or drop-in care providers should consult with their local jurisdiction or state fire marshal before selecting a facility.

(2) Licensed child care providers must provide CCL an annual inspection report from the state or local jurisdiction fire marshal indicating the fire safety rules have been met.

(a) Providers using a commercial or public space that receive an annual fire safety inspection, such as a school, do not need a separate inspection. The child care provider is responsible for providing a copy of the inspection reports to CCL.

(3) Group child care, family child care, and FFN providers must meet fire safety requirements by:

(a) having a fire extinguisher that:

(i) is easily accessible on each floor level that is used by the child care;

(ii) has a minimum level of extinguisher classification of 2A10BC with a hose; and

(iii) is installed and maintained in accordance with the manufacturer's specifications;

(b) having operational UL smoke alarms on each floor of the facility that is used for child care that are:

(i) installed in accordance with the manufacturer's specifications;

(ii) installed in front of the doors to stairways, in corridors of all floors, and in all rooms where children sleep; and

(iii) tested at least once a month to ensure that they are operating correctly and replaced every ten years or in accordance with the manufacturer's instructions;

(c) ensuring all wood burning stoves meet building codes and have a protective enclosure if used during the hours of care;

(d) not using portable electric or unvented fuel-fired heating devices, and ensuring all radiators, if too hot to touch, have a protective enclosure; and

(e) using extension cords according to the manufacturer's specifications and not using extension cords to supply electricity to equipment or appliances that are fixed in place.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-724, 52-2-731, 52-2-734, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.410 Emergency and Disaster Preparation

(1) All licensed and registered child care providers must have a written emergency disaster plan. The plan for each structure used for child care must be developed in such a way that the plan can be followed in the event of a natural or human-caused disaster or emergency.

(2) All licensed child care providers and registered group and family child care providers must conduct eight emergency drills per year, including six fire drills, and two other disaster drills. Providers should identify problems that occurred during the drill and take corrective actions.

(3) FFN providers must conduct at least two disaster drills per year, including one fire drill and one other disaster drill.

(4) All emergency drills must be documented and include the following minimum information:

(a) who conducted the drill;

(b) date and time of the drill;

(d) the length of time to evacuate.

(5) All licensed and registered child care facilities must have an emergency disaster kit including an emergency supply of blankets, water, food, and supplies.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 52-2-734, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.413 Safety Around Bodies of Water

(1) All licensed and registered child care providers except RCE providers must ensure all in-ground and above-ground swimming pools located in the outdoor play space area or accessible to children are surrounded by a fence that is least five feet high with a locked gate to prevent access to children. The fence must come within 3 1/2 inches of the ground and be constructed to discourage climbing. Exit and entrance points must have self-closing, positive latching gates with locking devices a minimum of 55 inches from the ground. The child care building wall must not constitute one side of the fence unless there are no openings in the wall.

(2) Children must not be permitted in hot tubs, spas, or saunas.

(a) Hot tubs must have bolted and securely locked covers.

(b) Spas and saunas must be inaccessible to children.

(3) Ponds and other bodies of water on child care premises must be surrounded by a fence that is at least five feet high to prevent access by children.

(4) Portable wading pools are permitted. If the portable wading pool is filled with water and will sit unused for any period of time prior to use by children, the program must equip the wading pool with a fence, wall, gate, or screen that locks to prevent unsupervised access by children.

(5) When children are swimming or in any body of water, children must be continuously supervised consistent with the following requirements:

(a) Children under 36 months old must have 1:1 supervision and always be either in direct contact or within arm's reach of the supervising adult who must be in the water.

(b) Children ages three to five years old must be supervised using 4:1 child-to-staff ratio. Children must be within arm's reach of the supervising adult who must be in the water.

(6) When children of any age are swimming in a pool or in a body of water without a lifeguard, a staff member with an advanced lifesaving or an equivalent certificate by a recognized organization must continuously supervise children. This staff member must not be counted in the child-to-staff ratio. One person with an advanced lifesaving or an equivalent certificate is required for each group of 25 or fewer children.

(a) A staff member must continuously supervise children using a portable wading pool.

(7) Each swimming pool more than six feet in width, length, or diameter must be equipped with an easily accessible ring buoy and rope and either a throw line or a shepherd's hook of sufficient length to reach the center of the pool from the edge of the pool.

(8) Swimming pool safety rules must be posted near the swimming pool.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-731, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.414 Transportation Safety

(1) If providing any transportation, all licensed child care providers and registered group and family child care providers must:

(a) obtain written consent from the parents/guardians for any transportation provided; and

(b) develop a written transportation policy that outlines safe transport practices. The plan must describe how children are transported to and from the program, in an emergency, and on field trips. The plan must also address the safety and supervision of children who walk or who arrive by public transportation once they arrive on the child care premises. The plan must include any special arrangements for children with disabilities.

(2) All licensed and registered child care providers providing transportation for children of any age must ensure:

(a) that the operator of the vehicle transporting children be at least 18 years old and possess a valid Montana driver's license;

(b) that the passenger doors on the vehicle transporting children be locked whenever the vehicle is in motion;

(c) with the exception of public transportation that is not required by law to be equipped with safety restraints, that no vehicle begin moving until all children are seated and secured in age and weight-appropriate safety restraints, which must remain fastened at all times the vehicle is in motion;

(d) that all car seats and booster seats be used according to National Highway Traffic Safety Administration standards; and

(e) that children never be left unsupervised in a vehicle.

(3) All licensed and registered child care providers providing transportation for children under six years old must ensure that an adult accompanies each child to and from the vehicle to the child's home or the home authorized by the parents/guardians to receive the child.

(4) Providers using school buses must comply with the school bus regulations defined in ARM 10.7.110(3) through (5) and ARM 10.64.301.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, 52-2-733, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.415 Sleeping

(1) In all licensed and registered child care facilities, except those used by school-age care programs, there must be adequate opportunities for sleep periods during the day in a safe sleep environment suited to individual needs.

(2) In all licensed and registered child care facilities, except school-age care programs, each child must have age-appropriate rest equipment and supervision that create a safe sleep environment, meaning:

(a) for infants:

(i) each infant must be provided with a firm sleep surface;

(ii) if an infant sleeps in a crib, a firm mattress must be covered by a tight-fitting sheet. Mattresses must fit snugly to prevent the infant from being caught between the mattress and crib siderail;

(iii) unless the parents/guardians have provided medical documentation from a health care provider ordering otherwise, infants must be placed on their back and on a firm surface with no incline while sleeping;

(iv) no items are allowed in the crib when an infant is laid down for sleep except for a pacifier that does not include a string;

(v) sleep sacks and similar safe sleep clothing may be used if the item does not restrict the infant's arms;

(vi) infants under three months old may only be swaddled with written parent/guardian permission on file with the program;

(vii) infants over three months old or able to roll over must not be swaddled; and

(viii) when cribs are used, infants must be continuously supervised through sight or hearing, including proper use of audio or video monitors.

(A) In a licensed child care center, a staff member who is not a trainee must remain with children while they are sleeping;

(b) for toddlers 12 through 36 months old:

(i) children 12 to 18 months old who are placed on a cot or mat must have a signed permission statement in the file indicating that parents/guardians have given permission for their child to be placed on a cot or mat;

(ii) toddlers may be provided a clean washable blanket or other suitable covering for their use while sleeping; and

(iii) when cots and mats are used, toddlers must be continuously supervised through sight or hearing, including proper use of audio or video monitors.

(A) In a licensed child care center, a staff member who is not a trainee must remain with children while they are sleeping.

(3) All cries of children during sleep times must be investigated.

(4) Any facility providing night care must have a supervision plan which involves practices where no child is left unattended. Staff must be in the immediate vicinity and on the same floor level of sleeping children to adequately hear and respond to the children if they wake up and to respond to any emergency.

(5) Children of any age must not be allowed to sleep in a car seat, infant swing, bouncy seat, or other infant apparatus.

(6) Sleeping equipment must be thoroughly cleansed before assignment to another child.

(7) Crib mattresses must be waterproof and easily sanitized.

(8) Cot or mat surfaces may be of plastic or canvas or other material which can be cleaned with detergent solution and allowed to air dry.

(9) Each child's bedding must be stored separately.

(10) Cribs must be made of durable, cleanable, nontoxic material, and have secure latching devices.

(11) All cribs must meet the requirements as specified by the U.S. Consumer Product Safety Commission.

(12) Cribs, cots, or mats must be spaced to allow for easy access to each infant and toddler, adequate ventilation, and easy exit.

(13) The use of stackable cribs for infants is permitted until the infants reach one year old or weigh 26 pounds, whichever comes first.

(14) Licensed child care providers and registered group and family child care providers must develop a policy that describes the practices to be used to promote a safe sleeping environment when children are sleeping.

History

Authorizing statute(s): 52-2-704, 52-2-731, 52-2-735, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-724, 52-2-731, 52-2-734, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.5 Medical Health

Mont. Admin. R. 37.96.501 Medical Health Definitions

(1) "CPR" means cardiopulmonary resuscitation.

(2) "Health care provider" means a person who is licensed, certified, or otherwise authorized by any U.S. state or by Canada to provide health care and who meets the additional qualifying criteria specified in 20-5-405, MCA.

(3) "Local health authority" or "local health jurisdiction" means a local health officer, local department of health, or local board of health.

(4) "Medication" includes "prescription medication" and "over-the-counter medication" as defined in this rule.

(5) "Over-the-counter medication" means any medication, ointment, or cream that is topical or oral and is not specifically prescribed by a health care provider, but is recommended by a health care provider or a parent or guardian for a specific child.

(6) "Physician" means a person licensed to practice medicine in any jurisdiction in the United States or Canada and who holds a degree as a doctor of medicine or of osteopathy.

(7) "Prescription medication" means medication prescribed by a licensed health care provider for a specific person which may only be obtained through a pharmacy.

(8) "Supplement" means vitamins, herbals, and other topical or oral substances that are not regulated by the U.S. Food and Drug Administration.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.502 Medication Administration

(1) No child care staff of any type of licensed or registered child care provider may administer any medication or supplement to a child without the written authorization of a parent or guardian. The authorization must include the child's name, duration of the authorization, dosage instructions (amount and time), and the signature of the child's parent or guardian.

(2) Any medication or supplement brought into the facility for use by a specific child must be labeled with the following information:

(a) the date range and duration of use;

(b) the child's first and last name;

(c) the expiration date and specific, legible instructions for administration and storage (i.e., the manufacturer's instructions); and

(d) the name of the health care provider, parent, or guardian who made the recommendation.

(3) Any prescription medication brought into the facility by the parent or guardian of a child must be kept in the original container labeled by a pharmacist with the date the prescription was filled.

(4) All medications and supplements for children and staff must be kept in a location inaccessible to children.

(5) All medications for children and staff, refrigerated or unrefrigerated, must:

(a) have child-protective caps;

(b) be kept in an orderly fashion; and

(6) Medication and supplements must not be used beyond the date of expiration. Expired medication and supplements must be properly disposed of or removed from the child care facility.

(7) If an emergency arises and the parent or guardian of the child is unavailable, child care staff may administer medication to a child if either:

(a) a health care provider provides a written authorization containing the child's name, dates for which the authorization is applicable, dosage instructions, and the health care provider's signature; or

(b) a health care provider, emergency service provider, or 911 responder verbally directs the child care staff to immediately administer a medicine to the child, in which case the child must then be transported to a health care facility or a health care provider for follow up care within a reasonable time by the child's parent or guardian or by child care staff.

(8) Child care staff may not give medication to a child in a manner that is inconsistent with the container instructions on dosage or frequency unless directed to do so by a health care provider as provided in 52-2-736, MCA.

(9) If the child care provider elects to administer medication or supplements to children, the provider must maintain a medication administration log with the time, date, and dosage each time the medication is administered to an individual child.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-724, 52-2-731, 52-2-732, 52-2-733, 52-2-736, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.505 Management of Illness

(1) All licensed and registered child care providers must designate a staff member to check daily the health status of each child immediately upon that child's entry into the child care facility.

(2) All licensed and registered child care providers must exclude any child or staff member with an illness until symptoms have resolved, adequate treatment has been received, or a health care provider states that the person is noninfectious. The following symptoms or illnesses require exclusion:

(a) a fever of 100.4°F that is accompanied by behavior change or other symptoms;

(b) diarrhea;

(d) mouth sores with drooling, if unable to contain drool, unless a health care provider states that it is a noninfectious condition;

(e) a rash with fever or behavioral change or a rash that is quickly spreading, unless a health care provider states that it is a noninfectious condition;

(f) active tuberculosis, until a health care provider states that the person is noninfectious and can return;

(g) group A strep pharyngitis (strep throat) until the person appears well and at least 12 hours after beginning appropriate antimicrobial therapy;

(h) impetigo, until treatment is initiated and if lesions on exposed skin are covered with a waterproof dressing;

(i) head lice, scabies, or ringworm, until treatment is started. Children and staff can remain in the child care setting until the end of the day;

(j) chickenpox (varicella), until sores have dried or crusted. Child care providers must not purposefully expose susceptible children to chickenpox, even with the permission of the susceptible child's parents/guardians;

(k) rubella, until seven days after the rash appears;

(l) pertussis, until five days after antibiotic treatment was initiated;

(m) mumps, until five days after onset of parotid gland swelling;

(n) measles, until four days after onset of rash;

(o) hepatitis A, until one week after onset of illness or as directed by the local health authority;

(p) shigellosis, salmonella, or E. coli, until a local health authority clears the person for readmission; or

(q) if the child is unable to participate in activities or needs care from staff that compromises the health or safety of other children.

(3) Children and staff must be excluded from all child care facilities, and a health care provider must evaluate the conditions to ensure the person's return will not harm that person or the other people, when a child or staff:

(a) has symptoms of severe illness, such as fever with behavior change, lethargy, uncontrolled coughing, breathing difficulty or wheezing, stiff neck, irritability, persistent crying, poor food or fluid intake, progressive rash with any other symptoms, or a seizure; or

(b) has persistent abdominal pain for two or more hours, or intermittent abdominal pain associated with fever, dehydration, or other signs or symptoms of illness.

(4) A child or staff member does not need to be excluded, but a child's parents/guardians should be notified of new onset, for minor illnesses or symptoms including:

(a) a runny nose or cough not accompanied by a fever;

(b) pinkeye or other eye discharge not accompanied by fever;

(c) fever without behavior change for people aged four months and older, including children with immunization-related fevers; or

(d) rash without behavior change or fever and that is not quickly spreading.

(5) If a child develops symptoms of any illness other than those included in (2) or (3) while at the child care facility and after the parents/guardians have left, the child care provider must:

(a) isolate the child immediately from other children in a room or area segregated for that purpose; and

(b) contact and inform the parents/guardians as soon as possible about the illness and request they pick up the child.

(6) Disease charts that identify reportable diseases are available from the department. A child care provider must notify the local health authority, on the same day or as soon as possible if no contact can be made the same day, if:

(a) a child becomes ill or is suspected of having a communicable disease reportable to the health department while in care;

(b) a child is absent and a reportable communicable disease is suspected; or

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-724, 52-2-731, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.506 First Aid

(1) All child care facilities must maintain a complete, well-stocked, portable first aid kit. The first aid kit must accompany staff and children on trips away from the facility and must contain:

(a) sterile, absorbent bandages;

(b) antiseptic wipes or product to clean wounds and hands;

(d) tape and a variety of adhesive bandages;

(e) tweezers and scissors; and

(f) disposable single use gloves.

(2) Child care staff must take appropriate precautions to minimize the risk of any child suffering sunburn, heat stroke, or receiving insect bites. Children under six months old should be kept out of direct sunlight.

(a) Sunscreen must be applied to children over six months old when outdoor conditions dictate.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-724, 52-2-731, 52-2-736, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.6 Environmental Health

Mont. Admin. R. 37.96.601 Environmental Health Definitions

(1) "Public sewage system" means a system of collection, transportation, treatment, or disposal of sewage that is designed to serve or serves 15 or more families or 25 or more persons for a period of at least 60 days out of the calendar year.

(2) "Public water supply system" means a system for the provision of water for human consumption from any community well, water hauler for cisterns, water bottling plant, water dispenser, or other water supply that is designed to serve or serves 15 or more families or 25 or more persons daily or has at least 15 service connections at least 60 days out of the calendar year.

(3) "Smoke-free environment" means no smoking, vaping, or use of e-cigarettes.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.602 Health Rules Included in Inspection by Public Health Authorities

(1) Licensed child care providers must provide to CCL an annual training or inspection certificate from their local health authority, except:

(a) Providers using a commercial or public space that receive an annual public health inspection, such as a school, do not need a separate inspection. The child care provider is responsible for providing a copy to CCL.

(2) Child care facilities requiring a public health inspection may request a waiver of any of the environmental health rules in this subchapter. Child care providers will submit a written plan to CCL describing an alternative approach with respect to the rule from which they are seeking a waiver, and how this approach supports child and staff health and safety.

History

Authorizing statute(s): 52-2-735, MCA
Implementing statute(s): 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.603 Smoke-Free Environment

(1) All licensed and registered child care providers except RCE providers must provide and ensure a smoke-free and tobacco-free environment for children, ensuring there will be no smoking or use of vapor, tobacco, or alternative nicotine products other than cessation products indoors during child care hours, or outdoors while children are outdoors.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-704, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.604 Outdoor Air Quality

(1) All licensed and registered child care providers except RCE providers must reference the guidelines in ARM 37.111.827 to determine local air quality conditions and whether to cancel outdoor activities.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-704, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.607 Indoor Air Quality

(1) Centralized ventilation systems and air filters in child care facilities, excluding RCEs, must be properly maintained.

(2) Licensed child care facilities must ensure that the temperature is maintained at a minimum of 65°F in the areas used for child care.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-704, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.608 Hand Hygiene

(1) Staff, volunteers, and children in all licensed and registered child care facilities, excluding RCEs, must learn and follow good handwashing practices at the following times:

(a) before and after:

(i) preparing or handling food or beverages, eating, or feeding a child;

(ii) giving medication or applying a medical ointment or cream; and

(iii) diapering;

(b) after:

(i) using the toilet or helping a child use a toilet;

(ii) handling bodily fluid (mucous, blood, vomit) from sneezing, wiping and blowing noses, or from mouths or from sores;

(iii) handling animals or cleaning up animal waste;

(iv) cleaning or handling the garbage; and

(v) applying sunscreen and/or insect repellent.

(2) All licensed child care providers and registered group and family child care providers must provide soap and disposable or single-use towels or other hand-drying devices at all hand washing sinks. Common-use cloth towels are prohibited.

(3) All licensed child care providers must post hand washing signs in all food preparation, hand washing, diapering, and toileting areas.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.609 Bathroom Hygiene

(1) Licensed child care facilities must provide lavatories (sinks), water closets (toilets), and urinals in the ratio of the number of each to the number of individuals using them, including children, staff, and volunteers, as follows:

(a) lavatories (sinks): 1:15;

(b) water closets (toilets): 1:15; and

(2) All licensed and registered child care facilities must provide toilet tissue next to all toilets.

(3) Hand sinks in all licensed and registered child care facilities must have water at a temperature of at least 100°F and not more than 120°F.

(4) In licensed and registered child care facilities where tooth brushing is an activity, toothbrushes must be managed in a way that avoids contamination.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.612 Solid Waste Management

(1) All licensed and registered child care providers must ensure that solid waste is safely stored and disposed of.

(a) Store all solid waste between removals in containers which have lids and are corrosion resistant, fly-tight, watertight, and rodent-proof.

(b) Clean all solid waste containers frequently.

(c) Store solid waste containers in a way that prevents the containers from being tipped, protects them from deterioration, and allows easy cleaning below and around them.

(d) Remove solid waste at least weekly.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-704, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.613 Laundry and Clothing

(1) All licensed and registered child care providers must ensure that children's wet or soiled clothing is changed promptly. Facilities must have a supply of spare clothing to allow at least one change per day. Soiled clothing must be placed in a sealed bag and returned to the parent or guardian.

(2) Licensed and registered child care providers must ensure that soiled laundry does not endanger the health of children by:

(a) refraining from storing soiled laundry in a dining, food preparation, or food storage room;

(b) ensuring soiled laundry is not accessible to children;

(c) providing sufficient space for sorting and storing clean and soiled laundry so clean and soiled laundry do not contact the same surface or each other; and

(d) laundering bedding whenever it is soiled.

(3) Staff working with infants in licensed child care facilities must ensure clothing worn to and from work is covered by or replaced with a clean, comfortable, nonirritating, and washable smock or similar clothing.

History

Authorizing statute(s): 52-2-704, 52-2-731, MCA
Implementing statute(s): 52-2-704, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.614 Sanitation

(1) All licensed and registered child care providers must:

(a) provide sanitary drinking facilities for each child;

(b) clean and sanitize their toys routinely. Toys must be cleaned and sanitized in a solution containing one tablespoon of unscented household bleach to one gallon of water, and then either washed through the sanitizing cycle of the dish washer or rinsed with clean hot water, and then air dried;

(d) keep cleaning devices for toilets and urinals, sinks, and tubs separate from each other, and do not use such cleaning devices for any other purpose; and

(e) store cleaning compounds, pesticides, and cleaning devices for toilet bowls, toilet seats, or urinals separately and out of the reach of children. Cleaning compounds must be disposed of in accordance with the manufacturer's instructions.

History

Authorizing statute(s): 52-2-735, MCA
Implementing statute(s): 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.615 Diapering

(1) All licensed child care providers and registered group and family child care providers that care for children requiring diapers must:

(a) provide an adequate and cleanable area for diaper changing separate from food preparation and play areas;

(b) ensure diapering and toileting areas contain a wash basin that is separate from that used for food preparation;

(c) have available a sufficient supply of clean, dry diapers, and change diapers as frequently as needed. Disposable diapers, a commercial diaper service, or reusable cloth diapers supplied by the child's family may be used;

(d) use soft, absorbent, disposable towels, or clean reusable towels which have been laundered between each use for cleaning the child;

(e) keep safety pins out of reach of children;

(f) not leave children being diapered unattended on a surface from which they might fall;

(g) specifically label all toilet articles for each child. Each item must be separated and kept in a sanitary condition;

(h) clean surfaces after each diapering and change the pad or disposable sheeting (if used). Sanitize surfaces using a solution of one tablespoon of unscented household bleach to one gallon of water, rinse with clean water, and air dry;

(i) store soiled disposable diapers in easily cleanable or lined receptacles with tight-fitting lids in an area inaccessible to children; and empty, clean, and wash the receptacles once per day or more often as needed. Soiled disposable diapers must be disposed of immediately into an outside trash disposal or discarded indoors in a way that is inaccessible to children until outside disposal is possible;

(j) place soiled reusable cloth diapers in a labeled container with a tight-fitting lid provided by a commercial diaper service, or in a sealed waterproof bag or container for removal from the facility by an individual child's family. Soiled cloth diapers should be sent home with the child at the end of each day. The containers or sealed diaper bags of soiled cloth diapers should not be accessible to any child; and

(k) ensure the hands of the diapered child are washed after changing.

(2) Toilet training must only be initiated when the child is ready and in consultation with the child's parents or guardian. There must not be a routine attempt to toilet train children under 18 months old.

History

Authorizing statute(s): 52-2-735, MCA
Implementing statute(s): 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.618 Bathing

(1) If bathing is necessary, licensed child care providers and registered group or family child care providers must:

(a) directly supervise children when being bathed;

(b) sanitize bathing materials after bathing each child;

(d) make sure children cannot turn on hot water while being bathed. Water supply to bathing area must not exceed 120°F.

(2) Bathing facilities must be separate from food service, food preparation, and play or sleeping areas.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.619 Water Supply System

(1) All child care facilities must provide an adequate and potable supply of water that is connected to a public water supply system in accordance with 75-6-102, MCA.

(2) If the child care facility uses a nonpublic water system source, the program must:

(a) have the water source tested prior to operation and at least once each January and once each June for the total coliform bacteria and fecal coliform or E. coli bacteria;

(b) provide laboratory test results to the department as part of the licensing and registration or license/registration renewal process; and

(3) Prior to operation, the water source of all licensed child care facilities must be tested to determine that the maximum contamination levels for nitrate (10 milligrams per liter) and nitrite (1 milligram per liter) are not exceeded, and documentation of testing must be retained on the premises for 24 months from the date of the test.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.620 Sewage System

(1) All child care facilities must have an adequate and safe sewage system.

(2) The child care facility must:

(a) be connected to a public sewage system in accordance with 75-6-102, MCA; or

(b) if a nonpublic system is used, retain documentation that it has complied with sewage disposal requirements adopted by the local board of health in the jurisdiction in which the child care facility is located as well as documentation of any necessary sewage system repairs or replacement.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.623 Swimming Pool Sanitation

(1) All licensed child care providers and registered group and family child care providers must allow children to only use swimming pools that are maintained in accordance with ARM 37.115.102, 37.115.103, and 37.115.106.

(2) Licensed child care providers and registered group and family child care providers using a portable wading pool must add one tablespoon household bleach to 100 gallons of water to the pool on the day of use, drain, clean, and refill it with fresh water daily and as otherwise needed. Bleach must be added any time the pool is refilled.

History

Authorizing statute(s): 52-2-735, MCA
Implementing statute(s): 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.624 Food Preparation and Handling

(1) At a minimum, all licensed child care providers and registered group and family child care providers must:

(a) cook food to the proper temperatures:

(i) chicken, poultry, stuffed foods, and leftovers to 165°F;

(ii) ground meats (including fish, e.g., fish sticks) to 155°F;

(iii) eggs, whole cuts of pork and fish to 145°F; and

(iv) vegetables and fruits for hot holding to 135°F;

(b) hold hot food prior to serving and after cooking at 135°F or hotter;

(d) use milk and other dairy products that are pasteurized;

(e) require that hands be properly washed, and single use gloves, tongs, single use napkins, utensils, or deli tissues be used to handle food; and

(f) ensure no people with open wounds or communicable diseases handle food or food utensils.

(2) Licensed child care providers must at a minimum:

(a) obtain food from sources that comply with the Montana Food, Drug and Cosmetic Act, Title 50, chapter 31, MCA, and not use home canned foods;

(b) dispose of food that has been in family-style service containers, on the table, or in the service area after the meal; and

(i) cool food and place in the refrigerator within two hours of the meal; and

(ii) reheat food to 165°F within one hour prior to meal service and do not mix with new batches of food.

(3) All licensed child care providers and registered group and family child care providers must ensure that a probe type thermometer is available in the facility to check food temperatures and that the thermometer is calibrated and used following the manufacturer's specifications.

(4) If using a domestic style dishwasher, all licensed child care providers and registered group and family child care providers must use the heat option to dry the dishes.

(a) Licensed child care facilities must provide at least a two-compartment sink as a backup in the event the dishwasher becomes inoperable.

(5) If any licensed child care facility uses a two-compartment sink to hand-wash dishes, the provider must use the wash, rinse, and sanitize three-step process.

(a) All dishware, utensils, and food service equipment are thoroughly cleaned in the first sink compartment with a hot detergent solution, at a concentration indicated on the manufacturer's label, then rinsed with clear water separately, and then dipped/soaked in sanitizer solution in a separate compartment or container that will provide the equivalent bactericidal effect of a solution containing at least 50 ppm of available chlorine at a temperature of at least 75°F for one minute. Dishes must be air dried before being stored.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.7 Nutrition and Food Service

Mont. Admin. R. 37.96.701 Nutrition and Food Service Definitions

(1) "CACFP" means the Child and Adult Care Food Program as designated in section 17 of the National School Lunch Act as amended (codified at 42 USC 1766 and effective as of December 13, 2010).

(2) "Nutritious meals and snacks" means quality and quantity of food that meets the USDA CACFP guidelines in 7 CFR 226.20 as of February 7, 2022.

(3) "USDA" means the United States Department of Agriculture.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.704 Nutrition Requirements

(1) All licensed child care providers and registered group and family child care providers must:

(a) provide nutritious meals and snacks to children in such quality and quantity to meet the USDA CACFP recommended dietary allowances for children of each age or have a policy stating that parents/guardians are required to send food for meals and/or snacks;

(b) serve meals and snacks at standard times, to ensure that:

(i) children in care for five to ten daytime hours are offered at least one meal and two snacks or two meals and one snack. Children must be offered a mid morning snack if they are not offered breakfast at the child care facility less than 2 1/2 hours before lunch;

(ii) children in care for a continuous period of ten hours or more must be provided at least one meal every six hours and one snack between meals. The six-hours requirement does not apply during the hours that the child is sleeping when night care is provided;

(iii) children receiving night care are offered dinner and/or breakfast, and a bedtime snack; and

(iv) children in care for fewer than five hours are offered one snack every 2 1/2 hours;

(c) for each child with nutritional therapeutic needs, request and carefully follow written special dietary instructions from either the child's parents/guardians or health care provider. Food brought from home for special dietary purposes must be carefully labeled with the child's name;

(d) plan menus in advance, post menus for parents/guardians, and serve meals and snacks in accordance with the planned menus;

(e) supervise children if they prepare food and while they eat;

(f) ensure that drinking water is freely available and offered at regular intervals to all children; and

(g) retain written menu records and any special dietary instructions.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-731, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.705 Infant Feeding

(1) All licensed and registered child care providers must provide an individualized diet and feeding schedule for infants according to a written plan submitted by the parents/guardians. A change of diet and schedule must be noted on each infant's daily diet and feeding schedule.

(a) Licensed child care providers must post each infant's diet and schedule in an area clearly visible to the center's infant care staff.

(2) A day's supply of breast milk in nursing bottles or formula must:

(a) require no more preparation than dilution with water and must be provided by the parents/guardians, unless an alternative agreement is reached between the parents/guardians and child care provider that ensures the infant's nutritional needs are sufficiently met; and

(b) be clearly labeled with each infant's name and date and be immediately refrigerated.

(3) Special dietary foods that infants require must be prepared by the parents/guardians.

(4) Bottles must be prepared in a sanitary food preparation sink or other sink separated by at least six feet from diapering and bathroom areas.

(5) Bottles must not be propped. Children too young to sit in high chairs must be held in a semi-sitting position for all bottle feedings.

(a) Infants must not be allowed to lie on their backs when drinking from a bottle or spill-proof cup (sippy cup).

(b) Infants who show a preference for holding their own bottles may do so if the infant is still held for the bottle feeding and the infant remains in a semi-sitting or upright position.

(6) If the parents/guardians are unable to bring sufficient or usable formula or breast milk, the program may use commercially prepared and packaged formula.

(7) Older infants must be provided suitable foods which encourage freedom in self-feeding.

(8) Bottles must be refrigerated immediately if not used, and contents discarded if not used within 24 hours.

(9) Bottles and nipples must be cleaned and sanitized using generally accepted means of sanitation.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.708 Food Service Equipment

(1) All licensed and registered child care providers must provide one piece of age-appropriate feeding equipment for every four infants or toddlers. This includes safe high chairs, baby feeding tables, booster seats, and child-size tables and chairs. These types of equipment must be used in accordance with the manufacturer's specifications.

(2) Portable high chairs that hook onto tables are not allowed in any licensed or registered child care facility.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-724, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.8 Immunization

Mont. Admin. R. 37.96.801 Immunization Definitions

(1) "ACIP" means the Advisory Committee on Immunization Practices, which provides advice to the U.S. Centers for Disease Control and Prevention on routine administration of vaccines to pediatric and adult populations.

(2) "Adequate documentation" means documentation which meets the specifications set forth in ARM 37.96.806.

(3) "CLIA" means the federal clinical laboratory improvement amendments of 1988.

(4) "Conditional attendance" means that children are allowed to attend child care on a conditional basis until they meet the requirements of an established vaccination schedule.

(5) "Conditional Attendance Form (HES 103)" means the form used by parents or guardians and health care providers to allow children to attend child care on a conditional basis until they meet vaccination requirements on a set schedule.

(6) "DT vaccine" means a vaccine containing a combination of diphtheria and tetanus toxoids.

(7) "DTP vaccine" and "DTAP vaccine" mean vaccines containing diphtheria and tetanus toxoids and pertussis (whooping cough) vaccine combined, including a vaccine referred to as DTaP, diphtheria, tetanus toxoid, and acellular pertussis vaccine combined.

(8) "Hep B vaccine" means a vaccine containing Hepatitis B vaccine.

(9) "Hib vaccine" means a vaccine immunizing against infection by Haemophilus influenza type B disease.

(10) "Immunization information system" means a confidential, computerized, population-based system managed and maintained by the department that collects and consolidates vaccination data from vaccine providers.

(11) "Medical exemption" means a vaccination exemption from a health care provider indicating that the physical condition of the child is such that one or more vaccinations would endanger their life or health or is medically contraindicated.

(12) "Medical Exemption Statement Form (HES 101A)" means the form provided by the department to document a medical exemption(s) from one or more vaccinations.

(13) "MMR vaccine" means a vaccine containing a combination of measles, mumps, and rubella vaccines.

(14) "Montana Certificate of Immunization Form (HES 101)" means the form provided by the department to consolidate immunization history.

(15) "MR vaccine" means a vaccine containing a combination of measles and rubella vaccines.

(16) "Official vaccination record" means a standard electronic or paper record that is maintained by the department, by another state's principal health agency, or by a healthcare provider to record the vaccination status of a child, and includes the following:

(a) child's legal name;

(b) birth date;

(d) vaccination date (month, day, and year) by vaccine type, or, in the case of a post secondary record, the month and year of vaccine administration.

(17) "PCV vaccine" means a vaccine containing pneumococcal conjugate vaccine.

(18) "Polio vaccine" means a trivalent polio vaccine.

(19) "Religious exemption" means a vaccination exemption based on an affidavit of exemption on religious grounds attesting that receipt of a vaccine or vaccines is contrary to an individual's religious belief, observance, or practice.

(20) "Religious exemption form" means an affidavit of exemption on religious grounds from vaccine administration.

(21) "Td vaccine" means a vaccine containing tetanus and diphtheria toxoids.

(22) "Tdap vaccine" means a vaccine containing tetanus and diphtheria toxoids, and acellular pertussis.

(23) "Vaccine" means:

(a) if administered in the United States, an immunizing agent recommended by ACIP and licensed by the U.S. Food and Drug Administration; or

(b) if administered outside of the United States, an immunizing agent administered by a person licensed to practice medicine in the country where it is administered or by an agent of the principal public health agency of that country and properly documented as required by ARM 37.114.708.

(24) "Varicella vaccine" means an attenuated, live virus vaccine to prevent chicken pox disease.

History

Authorizing statute(s): 52-2-704, 52-2-735, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.802 Minimum Child Immunization Requirements

(1) Children attending all licensed and registered Montana child care facilities are required to be immunized against certain diseases. Minimum child immunization requirements apply to children in all child care facilities with exceptions described in ARM 37.96.805. Before a child may attend any licensed or registered Montana child care program, a program must be provided with documentation that the child has been vaccinated, as required for the child's age group, against measles, rubella, mumps, poliomyelitis, diphtheria, pertussis (whooping cough), tetanus, varicella, hepatitis B, pneumococcal disease (pneumonia), and Haemophilus influenza type B, unless the child qualifies for conditional attendance in accordance with (5) or has a medical or religious exemption:

(*) varies depending on vaccine type used or the ACIP catch-up schedule.

(2) Hib and PCV vaccines are not required or recommended for children five years old and older.

(3) Doses of MMR and varicella vaccines, to be acceptable under this rule, must be given no earlier than 12 months old, and a child who received a dose prior to 12 months old must be revaccinated; however, vaccine doses given up to four days before the minimum interval or age are counted as valid. Live vaccines not administered at the same visit must be separated by at least four weeks.

(4) Vaccines immunizing against diphtheria, pertussis, and tetanus must be administered as follows:

(a) a child less than seven years old must be administered four or more doses of DTP or DTaP vaccine, at least one dose of which must be given after the fourth birthday;

(b) DT vaccine administered to a child less than seven years old is acceptable for purposes of this rule only if accompanied by a medical or religious exemption exempting the child from pertussis vaccination; and

(c) a child seven years old or older who has not completed the requirement in (1) must receive additional doses of Tdap vaccine or Td vaccine to become current in accordance with the ACIP schedule.

(5) A child may initially conditionally attend a child care facility if:

(a) the child has received at least one dose of each of the vaccines required for the child's age;

(b) documentation of the child's conditional immunization status is on file at the child care facility; and

(c) the child is not past due for the next required dose (as noted on the conditional enrollment form) of the vaccine in question.

(6) Children attending licensed school-age care facilities serving only school-age children must meet the minimum student immunization requirements defined in ARM 37.114.702 and 20-5-403, MCA.

(7) Children in a sibling group receiving care from a registered FFN in the children's home are not subject to the immunization requirements, provided there are no unrelated children also receiving care.

(8) Children receiving care through registered RCE providers are not subject to vaccination requirements.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.805 Exemptions from Vaccination

(1) A child is exempt from receiving the required vaccinations when the requirements of any of the following are met:

(a) Medical exemption: A child is not required to have any vaccinations which are medically contraindicated. A written and signed statement from a health care provider that a vaccination otherwise required by ARM 37.96.802 is medically contraindicated will exempt a child from those vaccination requirements as deemed necessary by the health care provider. It is preferred, but not mandatory, that a health care provider's medical exemption be recorded on HES-101A. Medical exemption documentation must include:

(i) which specific vaccination is contraindicated;

(ii) the period of time during which the vaccination is contraindicated;

(iii) the reasons for the medical contraindication; and

(iv) when deemed necessary by a health care provider, the results of immunity testing. The tests must indicate serological evidence of immunity and must be performed by a CLIA approved lab.

(b) Religious exemption: A child seeking to attend a child care program is not required to be vaccinated if the child's parent or guardian attests that vaccination is contrary to their religious belief, observance, or practice. An exemption on religious grounds must be maintained on an Affidavit of Exemption on Religious Grounds Form (HES-113) prescribed by the department.

(i) A certificate of religious exemption is required only for the required vaccines listed in ARM 37.96.802.

(c) A child experiencing homelessness or a child in foster care is exempt from required vaccinations outlined in ARM 37.96.802(1) for a 30-day grace period beginning the first day the child attends a child care program as verified on the sign-in/sign-out records.

(i) The child experiencing homelessness must meet the definition in 42 U.S.C. 11434a (2).

(ii) A child is in foster care when the foster care environment meets ARM 37.50.101(4).

(iii) A child must meet the vaccination requirement for conditional enrollment outlined in ARM 37.96.802(5) before the end of the 30-day period.

(iv) A child may not be granted consecutive grace periods.

(2) Family child care providers, group child care providers, and registered FFN providers may choose whether to enroll children who have a medical or religious exemption to the minimum immunization schedule included in ARM 37.96.802(1). These providers must have written policies and procedures to notify the parents/guardians of prospective and enrolled children of this choice.

(a) These policies will be made available upon request to families prior to enrolling their children with a child care provider.

(b) Policies must be submitted to CCL.

(3) School-age care facilities serving only school-age children must accept school vaccination exemptions, including medical exemption statements from ARM 37.114.715 and religious exemptions defined in ARM 37.114.716.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.806 Requirements for Adequate Documentation of Immunization Status

(1) All licensed and registered child care providers must have received completed immunization documentation, in accordance with this rule, before any child can be enrolled into a child care facility. The child care provider must maintain a record of immunization status for each enrolled child, and any child of a staff member who resides at the child care facility, with respect only to the vaccines, number of doses, and timing set forth in ARM 37.96.802. The provider must make those records available during normal working hours to representatives of the department or the local health authority.

(2) The following are considered adequate documentation of vaccination for the purposes of this chapter:

(a) a record from any local health department in the United States, signed by a local health officer or nurse;

(b) a certificate signed by a local health officer or nurse;

(d) immunization recorded on a form approved by the U.S. government;

(e) any state's official parent-maintained immunization record;

(f) an international certificate of vaccination on a form approved by the World Health Organization; or

(g) in the case of a vaccine administrated outside of the United States, a record of the vaccination signed by an official of the principal public health agency of the country where the vaccination occurred.

(3) Vaccine administration data may not be filled out by a parent, guardian, or other person unless they are a health care provider, health department official, or person otherwise authorized to do so by this subchapter.

(4) The following are considered adequate documentation in lieu of receiving required vaccines:

(a) the conditional enrollment form prescribed by the department;

(b) a medical exemption;

(d) documentation of immunity from varicella, measles, mumps, or rubella by laboratory evidence or diagnosis/verification of disease by physician, nurse practitioner, or physician's assistant. The tests must indicate serological evidence of immunity and must be performed by a CLIA-certified lab. A copy of the test results must be attached to the child's official immunization record.

(5) Parents or legal guardians of students attending school must provide a written parental statement that the required immunization is on file with the child's school. Parents/guardians of these students do not have to provide other immunization documentation to school-age care facilities.

History

Authorizing statute(s): 20-5-407, 52-2-704, 52-2-735, MCA
Implementing statute(s): 20-5-402, 52-2-704, 52-2-723, 52-2-731, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.809 Examination and Audit of Official Child Immunization Records

(1) The department and local health authority representatives have the right to audit and verify child vaccination records maintained by licensed and registered child care providers to determine compliance with vaccination requirements.

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-732, 52-2-733, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.810 Immunization Status as Condition of Attendance

(1) In order to continue to attend a licensed or registered child care facility, a child must continue to be vaccinated on the schedule described in ARM 37.96.802(1) and must be immediately excluded from attendance if the child:

(a) is not vaccinated on that schedule with all of the required vaccines;

(b) does not have on file at the child care program a record of medical exemption, religious exemption, a conditional enrollment form which indicates that no vaccine dose is past due; or

History

Authorizing statute(s): 52-2-704, 52-2-735, MCA
Implementing statute(s): 52-2-704, 52-2-735, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.9 Qualifications and Training

Mont. Admin. R. 37.96.901 Qualifications and Training Definitions

(1) "Director" means the person designated as the person responsible for the daily operation of a child care facility. A director is also responsible for implementing appropriate child development principles and knowledge of family relationships in providing daily care to the children cared for in the facility.

(2) "Lead teacher" means the lead staff person in charge of a child or group of children who implements facility activities.

(3) "On-the-job training" is training provided by the director or designee, during business hours, to educate new staff members on facility and provider-specific policies, procedures, and department requirements pertaining to their role.

(4) "Orientation training" means initial required training to educate new staff.

(5) "Practitioner Registry" is a statewide registry that is used to help develop and track a knowledgeable and skilled child care workforce based on an individual's verified professional achievements.

(6) "Site director" means the person who plans and implements child care services at one site of a multi-site program under the oversight of the director.

(7) "Staff" refers to all persons who work or substitute in a child care facility and count in the child-to-staff ratio during hours when children are or may be present, excluding licensees or registration holders.

(8) "Substitute" means any person not regularly employed by a child care provider who temporarily takes the place of an approved staff person, other than the director.

(9) "Teacher" means a program staff member who carries out assigned caregiving and teaching tasks under the guidance and oversight of a lead teacher or program director.

(10) "Trainee" means a staff member who has been approved to work in a child care facility based on initial criteria but has not yet completed required training.

History

Authorizing statute(s): 52-2-704, 53-4-212, MCA
Implementing statute(s): 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-211, 53-4-212, 53-4-611, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.902 Director Responsibilities and Qualifications

(1) All facilities except RCEs must have a director.

(a) For the purposes of this rule, FFN providers are considered a director.

(2) A director and their program staff are responsible for the health, safety, supervision, protection, and guidance of the children in care. The director is responsible for operating the child care program at all times.

(3) A director must demonstrate knowledge and ability to carry out day-to-day operations and is responsible for being on-site at the facility, unless there is a site director, designated staff member, or substitute filling the on-site role.

(4) Directors must meet the following qualifications:

(a) be at least 18 years old;

(b) have satisfactory results of background checks as set forth in ARM 37.96.1002;

(d) have current CPR and pediatric first aid certification;

(e) successfully complete orientation training; and

(f) have a combination of education, training, other licensing, or experience in working with children to demonstrate an ability to fulfill the director responsibilities for the licensed or registered facility type, subject to approval through the Practitioner Registry or to department approval.

(5) If the director will be absent from the facility for more than 30 continuous days, the director must notify the department in writing of the individual who has been appointed as the designee. The appointed designee must meet all the requirements of this rule.

(6) The director must ensure compliance with all applicable administrative rules within this chapter.

(7) The director or designee must review every incident or accident causing injury to a child resulting in medical or dental care and document the appropriate corrective action taken to avoid a reoccurrence.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.903 Site Director Responsibilities and Qualifications

(1) Site director is an optional role. Providers may employ site directors when they have multiple facilities in geographically dispersed locations. An individual may only serve as a site director at one location or site. Site directors plan and implement facility services under the oversight of the director/owner.

(2) Site directors must meet the following qualifications:

(a) be at least 18 years old;

(b) have satisfactory results of background checks as set forth in ARM 37.96.1002;

(d) have current CPR and pediatric first aid certification;

(e) successfully complete orientation training;

(f) complete on-the-job training; and

(g) have a combination of education, training, other licensing, or experience in working with children to demonstrate an ability to fulfill the site director responsibilities for the licensed or registered facility type, subject to approval through the Practitioner Registry or to department approval.

(3) The site director is responsible for being on-site during the facility's operating hours and providing regular supervision and mentoring of lead teachers, teachers, substitutes, support staff, and volunteers.

(4) One person may be the director and site director.

(5) A site director may also serve as a lead teacher.

(6) The director absence requirements in ARM 37.96.902 apply to site directors.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.904 Lead Teacher Responsibilities and Qualifications

(1) Lead teacher is an optional role.

(2) Lead teachers are responsible for facility activity planning and delivery.

(3) A lead teacher must:

(a) be at least 18 years old;

(b) have satisfactory results of background checks as set forth in ARM 37.96.1002;

(d) be current on the Practitioner Registry;

(e) have current CPR and pediatric first aid certification;

(f) successfully complete required orientation training; and

(g) have a combination of education, training, other licensing, or experience in working with children to demonstrate an ability to fulfill the lead teacher responsibilities for the licensed or registered facility type, subject to approval through the Practitioner Registry or to department approval.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-702, 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.907 Teacher Responsibilities and Qualifications

(1) Teacher is an optional role.

(2) Teachers help a lead teacher or director provide instructional support to children and implement developmentally appropriate programming.

(3) Teachers must:

(a) receive oversight and guidance from a lead teacher, site director, or director;

(b) be at least 16 years old;

(d) complete on-the-job training;

(e) be current on the Practitioner Registry;

(f) have current CPR and pediatric first aid certification; and

(g) successfully complete required orientation training.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.908 Substitute Responsibilities and Qualifications

(1) Substitutes must:

(a) have satisfactory results of background checks as set forth in ARM 37.96.1002;

(b) meet the age requirement for the role for which they are substituting;

(d) be current on the Practitioner Registry;

(e) have current CPR and pediatric first aid certification; and

(f) successfully complete required orientation training.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.909 Trainee Responsibilities and Qualifications

(1) Trainees must:

(a) have satisfactory results of background checks as set forth in ARM 37.96.1002;

(b) be at least 16 years old;

(d) receive oversight and guidance from an onsite lead teacher, site director, or director; and

(e) not remain in this role for longer than 90 days.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.910 Support Staff Qualifications

(1) Support staff who do not provide direct care for children must:

(a) have satisfactory results of background checks as set forth in ARM 37.96.1002; and

(b) complete on-the-job training.

(2) Support staff do not count toward compliance with required child-to-staff ratios.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.913 Volunteer Qualifications

(1) Volunteers may include a parent or guardian helping on a field trip, special guest presenters, or a parent or guardian, family member, or community member helping with a cultural celebration, or other activity. Volunteers:

(a) must be at least 15 years old; and

(b) must have satisfactory results of background checks as set forth in ARM 37.96.1002 if they will have unsupervised access to children.

(2) Volunteers do not count toward compliance with required child-to-staff ratios.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.914 Orientation Training

(1) All staff and owners included in child-to-staff ratios must complete department-approved orientation training. Orientation training includes 30-day and 90-day training requirements.

(2) Within 30 days of hire and before providing unsupervised care to children, the following training is required:

(a) infant, child, and adult CPR, infant choking response, and pediatric first aid. CPR certification must be completed in a hands-on setting. Alternatively, staff can provide verification of current infant, child, and adult CPR, infant choking response, and pediatric first aid certification from the American Heart Association, American Red Cross, or other CCL-approved entity;

(b) if the child care license or registration permits care for infants, prevention of sudden infant death syndrome and use of safe sleep practices;

(c) if the child care license or registration permits care for infants or toddlers, prevention of shaken baby syndrome and abusive head trauma.

(3) The staff and owners of licensed and registered child care facilities providing care exclusively to school-age children are not required to take infant CPR, infant choking response, sudden infant death syndrome, safe sleep, and shaken baby syndrome training.

(4) Within 90 days of hire, the following orientation training is required:

(a) prevention and control of infectious diseases, including immunization;

(b) child development;

(d) prevention and response to emergencies due to food and allergic reactions;

(e) building and physical premises safety;

(f) emergency preparedness and response;

(g) proper handling, storage, and disposal of hazardous materials;

(h) appropriate disposal of toxic (bio-contaminants) materials including blood, bodily fluids, and other infectious materials;

(i) transportation; and

(j) recognizing and mandatory reporting of child abuse and neglect to proper state authorities.

(5) Orientation training will be counted toward annual training requirements.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.915 Annual Training

(1) All staff and owners working more than 500 hours annually at any licensed or registered child care facility must successfully complete required annual training as defined in the Practitioner Registry.

(a) Staff and owners of licensed child care centers, and registered group and family child care facility must complete 16 hours of annual training.

(b) Staff and owners of licensed school-age care or registered FFN providers must complete eight hours of annual training.

(2) The training must be approved through the Practitioner Registry.

(3) Education and training must relate to the Montana Early Care and Education Knowledge Base.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.918 Health and Safety Refresher Course

(1) All staff required to complete orientation training, including RCE and FFN providers, must complete a department-approved health and safety refresher course at least every three years. The health and safety review course will count toward the annual training required in ARM 37.96.915.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.10 Background Check

Mont. Admin. R. 37.96.1001 Background Check Definitions

(1) "May deny crime" means a crime that gives the department the ability to determine that a background check result is unsatisfactory, and an individual is not eligible to work or be present in a child care facility.

(2) "Must deny crime" means a crime that requires the department to determine that a background check result is unsatisfactory, and an individual is not eligible to work or be present in a child care facility.

(3) "Satisfactory results of background checks" means that the results do not include any conviction, pending charge, or child abuse or neglect determination from a state's child protective agency that the department has determined makes an individual ineligible to work in a child care program.

(4) "Unsatisfactory results of background checks" means that the results include a conviction, pending charge, or child abuse or neglect determination from a state's child protective agency that is a must deny or may deny crime or offense.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1002 Fingerprint and Background Checks

(1) The following individuals must provide satisfactory results of background checks prior to approval of any license or registration, or staff approval:

(a) child care directors, owners, site directors, lead teachers, teachers, substitutes, trainees, support staff, and volunteers who have unsupervised contact with children; and

(b) any adult residing in the child care facility, or other adult who regularly or frequently stays in the facility, unless care is being provided in the home of a child or children who belong to the same sibling group.

(i) In the case of a FFN provider caring for children from more than one sibling group in a child's home, all adults residing in the home must have satisfactory results of a background check.

(2) The following background checks are required prior to working in a child care facility and annually thereafter, with the exception of national background checks, which are required every five years:

(a) a fingerprint background check by the Montana Department of Justice (DOJ) and Federal Bureau of Investigation; and

(b) the national Sexual Offender Registry from the National Criminal Information Center (NCIC);

(i) fingerprints must be processed by a trained individual within a certified fingerprinting agency. Results will be transmitted electronically to the department by DOJ;

(d) a child protective services check for Montana and any state where the individual has resided in the preceding five years; and

(e) a name-based criminal records check for Montana and any state where the individual has resided in the preceding five years.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-703, 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1003 Background Check Results That Must Result in the Denial of an Applicant

(1) After written notice to the applicant, licensee, or registration holder, the department must deny, suspend, restrict, revoke, or reduce to a provisional or probationary status a license or registration upon finding that any person who is required to have a background check has been convicted of a crime that must make an individual ineligible to work in a child care facility. These crimes are felonies and misdemeanors that are direct crimes against a person's physical or emotional well-being. Convictions for the following crimes make an individual ineligible to work or be present in a child care facility:

(a) a serious crime, such as homicide, sexual intercourse without consent, sexual assault, aggravated assault, assault on a minor, assault on an officer, assault with a weapon, kidnapping, aggravated kidnapping, robbery, or arson; or

(b) a crime pertaining to children or families, including child abuse or neglect, incest, child sexual abuse, ritual abuse of a minor, felony partner or family member assault, child pornography, child prostitution, internet crimes involving children, felony endangering the welfare of a child, felony unlawful transactions with children, or aggravated interference with parent-child contact.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1004 Background Check Results That May Result in the Denial of an Applicant

(1) After written notice to the applicant, licensee, or registered provider, the department may deny, suspend, restrict, revoke, or reduce to a provisional or probationary status a license or registration upon finding that any person who is required to have a background check has been convicted of a crime that may make an individual ineligible to work in a child care facility. These are direct crimes against a person's physical or emotional well-being. Conviction or determination of the following may make an individual ineligible to work or be present in a child care facility:

(a) a conviction for misdemeanor partner/family member assault, misdemeanor endangering the welfare of a child, misdemeanor unlawful transaction with children, prostitution, burglary, or a crime involving an abuse of the public trust;

(b) being named as a perpetrator in a substantiated report of abuse or neglect;

(c) being named as a perpetrator in a founded report of abuse or neglect, although this cannot be the sole basis for denial;

(d) abuse, neglect, or exploitation of an elderly person or a person with a developmental disability; or

(e) a felony conviction for a drug-related offense within the previous five years, including distribution or possession of controlled substances, criminal possession of precursors to dangerous drugs, criminal manufacture of dangerous drugs, criminal possession of imitation dangerous drugs with the purpose to distribute, criminal possession, manufacture or delivery of drug paraphernalia, or driving under the influence of alcohol or other drugs.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1005 Offenses and Investigations That Are Pending Resolution

(1) Any staff member, support staff, trainee, volunteer, or other adult residing in the child care facility, or other person who regularly or frequently stays in the facility, who is charged with a crime that will potentially make them ineligible to work in a child care facility must not provide care or be present in the facility when children in care are on the premises, pending the resolution of the charges.

(a) Child care providers must notify the CCL program within 48 hours if any charges are filed against any staff member, support staff, trainee, volunteer, or other adult residing in the child care facility, or other person who regularly or frequently stays in the facility, that will potentially make them ineligible to work in a child care facility.

(2) Any staff member, support staff, trainee, volunteer, or other adult residing in the child care facility, or other person who regularly or frequently stays in the facility, who is subject to an investigation by CFSD may be ineligible to be present in the child care facility when children in care are on the premises.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1008 Process to Request Administrative Reconsideration of Background Check Results and Department Determination

(1) If an unsatisfactory background check occurs based upon a conviction or determination identified in ARM 37.96.1003, 37.96.1004, or 37.96.1005 the staff applicant in conjunction with the license or registration holder, if different, may submit additional information to correct any inaccuracies or errors in the background check results.

(2) The staff applicant, in conjunction with the license or registration holder, if different, may request an administrative reconsideration of a denial based on a may-deny background check finding. The requester and license or registration holder must establish that the person has been sufficiently rehabilitated to warrant the public trust and not pose a risk to children.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Subchapter 37.96.11 Enforcement

Mont. Admin. R. 37.96.1101 Complaints and Investigations

(1) Any individual, group, or other agency may submit a written complaint against a child care facility or provider. The complainant's personal information is not public information.

(2) Any individual, group, or other agency may request that the department determine whether a child care facility should be licensed or registered according to law. Referral may be either in writing or by telephone.

(3) An authorized representative of the department may conduct an on-site visit of a facility and property without prior notice to the owner or staff of the program whenever the department considers it necessary and when children are in care.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, 52-2-732, 52-2-733, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1102 Licensing or Registration Corrective Action

(1) At the department's discretion, when a program is not in compliance with this chapter or Title 52, chapter 2, part 7, MCA, a corrective action plan may be required.

(2) The department will apply progressive corrective actions in plans based on:

(a) the scope and severity of non-compliance;

(b) the potential threat or actual harm to the health, safety, and well-being of the children in care;

(c) the number of times the licensee or registration holder has not complied with rules in this chapter or under Title 52, chapter 2, part 7, MCA; and

(d) mitigating and aggravating factors.

(3) The department's corrective action plan includes:

(a) a description of non-compliance and the rule or law that was violated;

(b) the date by which the finding of non-compliance must be corrected; and

(c) information about other licensing or registration actions that may be imposed if compliance does not occur by the required date.

(4) The provider must submit a response within ten business days of receiving the corrective action plan, including a statement from the provider regarding the proposed plan to comply with the rule or law.

(5) The provider may submit additional information as to why the provider believes non-compliance did not occur.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1103 Time Period for Correcting Non-Compliance

(1) The length of time a licensee or registered provider has to make corrections will be determined by the department, which must consider:

(a) the scope and severity of non-compliance;

(b) the potential threat or actual harm to the health, safety, and well-being of the children in care;

(c) the number of times the licensee or registration holder has not complied with rules in this chapter or under Title 52, chapter 2, part 7, MCA; and

(d) mitigating and aggravating factors.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1104 Denial, Suspension, Revocation, or Modification of a License or Registration

(1) The department, after written notice to the applicant or provider may deny, suspend, revoke, or modify a license or registration.

(2) The department may modify a license or registration by restricting or reducing it to a provisional or probationary status.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1107 Violations That May Result in Negative Licensing or Registration Action

(1) The department may deny, suspend, or revoke a license or registration, or take another action such as requiring an individual be excluded from a facility, when:

(a) the provider, any staff member, support staff, trainee, volunteer, or any person residing or staying in the child care facility on a frequent or regular basis has been named as the perpetrator in a substantiated report of abuse or neglect;

(b) the licensee/registered provider, staff member, support staff, trainee, volunteer, or any person residing or staying in the child care facility on a frequent or regular basis is disqualified under the child care licensing background check rules;

(d) the child care program has not met or is no longer meeting the requirements for licensure or registration set forth in these rules;

(e) the program has made any material misrepresentations to the department, either negligent or intentional, including an omission of information the provider is obligated to disclose to the department, regarding any aspect of the child care facility or its operations;

(f) through a CCL investigation, it is determined that the owner/director, staff member, trainee, support staff, volunteer, or adult residing in the facility or staying in the facility on a regular or frequent basis has violated a CCL regulation that has resulted in child abuse or neglect pursuant to 41-3-102, MCA, whether or not a criminal prosecution is initiated or that person was prosecuted or convicted of child abuse or neglect;

(g) upon referral of suspected child abuse or neglect regarding an operating child care facility, the initial investigation by the department or law enforcement determines that there is probable cause to believe that a child in the facility may be in danger of harm;

(h) the provider or any staff member has failed to report an incident of suspected abuse or neglect of any child to the department as required by 41-3-201, MCA, within 24 hours of receiving information pertaining to the incident;

(i) the provider or any staff member, trainee, support staff, volunteer, or adult residing in the facility or staying in the facility may pose any risk or threat to the safety or welfare of a child in the child care program;

(j) the child care provider has failed to protect the health, welfare, or safety of a child, or the child care facility presents a reasonably foreseeable serious hazard to the health, safety, or welfare of a child; or

(k) the licensee's or registered provider's child is removed from the licensee or registered provider by the Child and Family Services Division.

(2) Suspension or revocation may be immediate upon a determination by the department that public health, safety, or welfare imperatively requires emergency action.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1108 Notice of License or Registration Denial, Suspension, or Revocation

(1) The department must provide written notification to a licensee, registered provider, or applicant of a denial, suspension, or revocation.

(2) The licensee, registered provider, or applicant has the right to request an administrative hearing regarding the denial, suspension, revocation, or modification of a license or registration. The department notice will include information on hearing rights and how to request a hearing.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1111 Issuing a Probationary License or Registration

(1) When the department issues a probationary license or registration, the licensee, registered provider, or owner must:

(a) provide the parents and guardians of enrolled children notice of the probationary license or registration in a department-approved format within five working days of the licensee, registered provider, or owner receiving the probationary license or registration;

(b) provide documentation to the department that parents or guardians of enrolled children have been notified within seven working days of the licensee, registered provider, or owner receiving the probationary license or registration;

(d) post documentation of the probationary license or registration.

History

Authorizing statute(s): 52-2-704, 52-2-741, MCA
Implementing statute(s): 52-2-741, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1112 Providing Unlicensed or Unregistered Care

(1) If the department determines a person is providing unlicensed or unregistered care when a license or registration is required, the department will send a notice including:

(a) the department's basis for determining unlicensed or unregistered child care is being provided when a license or registration is required;

(b) how to respond to the department;

(d) that unlicensed or unregistered child care must stop being provided;

(e) the consequences of providing unlicensed or unregistered care and the penalties that may be imposed; and

(f) how to apply for a license or registration and the benefits of licensure or registration.

(2) If the department finds that a facility is providing unlicensed or unregistered care when a license or registration is required, it will take steps pursuant to 52-2-741, MCA.

History

Authorizing statute(s): 52-2-704, 52-2-741, MCA
Implementing statute(s): 52-2-741, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1113 Reapplication After Denial, Suspension, or Revocation

(1) Applicants who have been denied due to an incomplete application may reapply for a license or registration immediately.

(2) Individuals or legal entities that have had a child care license or registration suspended may not reapply for licensure or registration within one year of the suspension.

(3) If the suspension is contested and upheld after an administrative hearing, the reapplication may not be made until one year after the date of the final agency decision.

(4) Individuals or legal entities that have had a child care license or registration revoked are permanently ineligible for licensure, registration, or a staff position at a child care facility.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Mont. Admin. R. 37.96.1116 Fair Hearing

(1) An applicant, licensee, or registered provider who is subject to a negative licensing action is entitled to a fair hearing in accordance with ARM 37.5.103.

History

Authorizing statute(s): 52-2-704, MCA
Implementing statute(s): 52-2-704, 52-2-723, 52-2-726, 52-2-731, MCA
History: NEW, 2025 MAR, 37-1044, Eff. 5/1/25.

Chapter 37.97 Licensure of Youth Care Facilities

Subchapter 37.97.1 General Requirements

Mont. Admin. R. 37.97.101 Youth Care Facility (ycf): Purpose

(1) These rules establish licensing procedures and licensing requirements for youth care facilities.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-602, 52-2-622, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1991 MAR p. 2605, Eff. 12/27/91; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.102 Youth Care Facility (ycf): Definitions

The following definitions apply to all YCF licensing rules:

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

(2) "Child" or "youth" means any person under the age of 18 years, without regard to emancipation, except for youth covered by Montana Medicaid programs which allow for participation of youth up to the age of 20 years as defined in ARM 37.87.102, and parenting or pregnant youth, up to the age of 21 years, who are placed in a child care agency-maternity home.

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

(4) "Clinical assessment" means an assessment with a DSM diagnosis and a social history completed by the mental health professional. Clinical assessments include the following information:

(a) diagnosis supported by a rationale, with specific behaviors and risk factors identified;

(b) trauma history;

(d) presenting problem;

(e) history of problem;

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

(g) developmental history;

(h) medical history;

(i) social and educational history; and

(j) identified strengths and needs.

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

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

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

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

(9) "Family" means the youth, the youth's biological, adoptive, or foster family, including siblings, grandparents, and fictive kin, which refers to someone who, though unrelated by birth or marriage, has such a close emotional relationship with the youth that they may be considered part of the family.

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

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

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

(13) "Mental health professional" means a licensed clinical psychologist, licensed clinical social worker (LCSW), licensed marriage and family therapist (LMFT), licensed clinical professional counselor (LCPC), or any of following licensure candidates under Title 37, chapter 22, 23, or 37, MCA:

(a) social worker licensure candidate;

(b) professional counselor licensure candidate; or

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

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

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

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

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

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

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

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

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

(23) "Therapeutic intervention" means interventions that are implemented as described in the TGH trauma informed treatment model addressing goals and objectives identified in the youth's treatment plan.

(24) "Therapeutic milieu" means the entire treatment environment in which comprehensive treatment is delivered as described in the TGH's policy and procedures.

(25) "Therapeutic services" means the provision of therapy and therapeutic interventions to reduce the impairment of the youth's mental disability and to improve the youth's functional level; to alleviate the emotional disturbances; to reverse or change maladaptive patterns of behavior, and to encourage personal growth and development. Therapeutic services must be provided under a treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma and in accordance with recognized principles of a trauma-informed approach and trauma specific interventions to address trauma's consequences and facilitate healing.

(26) "Therapy" means the provision of appropriate therapeutic services and rehabilitative services provided by the mental health professional acting within the scope of the professional's license and in compliance with the trauma-informed treatment model.

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1942, Eff. 7/1/87; AMD, 1988 MAR p. 172, Eff. 1/29/88; AMD, 1991 MAR p. 2605, Eff. 12/27/91; AMD, 1992 MAR p. 2728, Eff. 12/25/92; AMD, 1993 MAR p. 403, Eff. 3/26/93; AMD, 1993 MAR p. 1209, Eff. 6/11/93; AMD, 1993 MAR p. 1506, Eff. 7/16/93; AMD, 1995 MAR p. 471, Eff. 3/31/95; AMD, 1198 MAR p. 489, Eff. 2/13/98; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2015 MAR p. 756, Eff. 6/12/15; AMD, 2019 MAR p. 1526, Eff. 10/1/19; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.105 Youth Care Facility (ycf): License Required

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

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

History

Authorizing statute(s): 52-2-111, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-621, 52-2-623, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.106 Youth Care Facility (ycf): Licenses

(1) The department shall issue a one year YCF license to any license applicant that meets all licensing requirements established by these rules, as determined by the department after a licensing survey, or that is licensed or otherwise approved by another state agency.

(a) The department shall renew the license annually on the expiration date of the previous year's license if:

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

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

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

(2) A therapeutic group home must be accredited by the following independent organizations:

(a) The Commission on Accreditation of Rehabilitation Facilities (CARF);

(b) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO);

(d) another independent, not-for-profit accrediting organization that has been approved by the Secretary of the U.S. Department of Health and Human Services.

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

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

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

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

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

(5) The YCF shall not accept more children than the number specified on the license.

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 41-3-1142, 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1983 MAR p. 1746, Eff. 11/26/83; AMD, 1984 MAR p. 1635, Eff. 11/16/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 2217, Eff. 10/14/88; AMD, 1990 MAR p. 590, Eff. 3/30/90; AMD, 1991 MAR p. 2605, Eff. 12/27/91; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.110 Youth Care Facility (ycf): Licensing Procedures

(1) Application for a YCF license must be made on an application form provided by the department.

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

(3) Upon receipt of a complete application for license or renewal of license, the department shall conduct a licensing survey to determine if the applicant meets all applicable licensing requirements.

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1979 MAR p. 443, Eff. 5/11/79; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1991 MAR p. 2605, Eff. 12/27/91; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.115 Youth Care Facility (ycf): License Denial, Suspension, Restriction, and Revocation

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

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

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

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

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

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

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

(g) the YCF or any member of its staff do not meet the requirements in ARM 37.97.140;

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1983 MAR p. 1746, Eff. 11/26/83; AMD, 1984 MAR p. 1635, Eff. 11/16/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1990 MAR p. 590, Eff. 3/30/90; AMD, 1991 MAR p. 2605, Eff. 12/27/91; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.118 Youth Care Facility, Hearing Procedures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-503, 41-3-1103, 41-3-1142, 52-2-111, 52-2-602, 52-2-622, 52-2-704, 53-4-111, MCA
Implementing statute(s): 41-3-503, 41-3-1103, 41-3-1142, 52-2-111, 52-2-113, 53-2-201, 52-2-602, 52-2-622, 53-4-113, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS & AMD, from DFS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2001 MAR p. 1107, Eff. 6/22/01; AMD, 2002 MAR p. 1553, Eff. 5/31/02; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.125 Youth Care Facility: Persons Affected by Department Records

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 41-3-1103, 41-3-1142 and 52-2-111, MCA
Implementing statute(s): Sec. 2-4-201, 41-3-1103, 41-3-1142 and 52-2-111, MCA
History: NEW, 1994 MAR p. 3011, Eff. 11/24/94; TRANS, from DFS, 1998 MAR p. 663; REP, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.97.126 Youth Care Facility (ycf): Discharge

(1) The YCF must develop and implement written discharge policies and procedures that include discharge planning to begin at the time of admission.

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

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

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

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

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

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

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

(h) youth's continuing needs and recommendations for follow-up services for the youth;

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

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

(3) Therapeutic group homes must document that the youth, parent/legal guardian, and placing agency participated in the development of the discharge plan and summary.

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.127 Youth Care Facility (ycf): Case Records

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

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

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

(i) therapeutic group homes must maintain contact information on all known family and document outreach efforts;

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

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

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

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

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

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

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

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

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

(m) treatment or clinical records and reports;

(n) records of special or critical incidents;

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

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

(q) an immediate needs assessment and assigned responsibilities.

(2) In addition to the requirements in (1), therapeutic group homes must maintain:

(a) an updated copy of the youth's clinical assessment;

(b) a list and contact information of all known family, as provided by the entity placing the youth, and family known to the TGH through their work with the youth; and

(c) documentation of all outreach efforts to identified family, to build a positive network to support the wellbeing of the youth. Documentation must include:

(i) a minimum of two attempts to contact all identified family;

(ii) results of each contact; and

(iii) how the TGH will support and facilitate regular contact with identified family as outlined in the youth's treatment plan.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.128 Youth Care Facility (ycf): Confidentiality of Records and Information

(1) All records maintained by a YCF and all personal information made available to a YCF pertaining to an individual youth must be kept confidential and are not available to any person, agency, or organization except as specified in (2) through (4) of this rule.

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-622, 53-2-105, 53-2-106, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1984 MAR p. 1635, Eff. 11/16/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.130 Youth Care Facility (ycf): Reports

(1) The provider shall agree to submit to the department, upon its request, any reports required by federal or state law or regulation.

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

(a) a change of administrator;

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

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

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

(4) Disasters or emergencies which require closure of a residence unit shall be reported to the licensing worker within the next working day.

History

Authorizing statute(s): 41-3-1103, 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-622, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1983 MAR p. 1746, Eff. 11/26/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.132 Youth Care Facility (ycf): General Requirements for All Administrators, Staff, Interns, and Volunteers

(1) A YCF must have written personnel and program policies and procedures covering the following items:

(a) screening procedure for all applicants;

(b) job qualifications;

(d) supervisory structure; and

(e) performance evaluations.

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

(a) application for employment;

(b) written results of at least two references;

(d) periodic performance evaluations;

(e) copy of current licenses and certifications;

(f) documentation of approved fingerprint-based background check as specified in ARM 37.97.140;

(g) documentation of child protective services background checks, and if applicable, tribal criminal background checks as specified in ARM 37.97.140;

(h) documentation of state sexual or violent offender registry check as specified in ARM 37.97.140;

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

(j) a copy of an independent contractor status and contractual agreement for contacted personnel; and

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

(3) In addition to the specific requirements set out in subchapters 1 and 2 of this chapter, all staff working in a YCF must:

(a) be at least 19 years of age;

(b) have a high school diploma or GED;

(d) be in good general health.

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

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

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

(7) YCF volunteers and interns must:

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

(b) be under the supervision of YCF staff;

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

(d) complete all required background checks; and

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

(8) All direct-care staff who transport youth must have a valid driver's license and, while transporting youth, follow all laws applicable to driving in Montana.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
History: NEW, 1991 MAR p. 2262, Eff. 11/28/91; AMD, 1997 MAR p. 1664, Eff. 9/23/97; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2015 MAR p. 756, Eff. 6/12/15; AMD, 2019 MAR p. 1526, Eff. 10/1/19; AMD, 2021 MAR p. 1217, Eff. 10/1/21; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.97.135 Youth Care Facility (ycf): Quality Assessment

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.136 Youth Care Facility (ycf): Child Abuse or Neglect and Serious Incidents

(1) Each YCF shall require each staff member, employee, intern, and volunteer to read and sign a statement that clearly defines child abuse and neglect and outlines the individual's responsibility to report all known or suspected incidents of child abuse or neglect of any youth to the department within 24 hours.

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

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

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

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

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

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

(i) termination of employment;

(ii) retraining of the staff member; or

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

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

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

(i) the date and time of the incident;

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

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

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

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

History

Authorizing statute(s): 52-2-603, 52-2-622, MCA
Implementing statute(s): 41-3-201, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.140 Youth Care Facility (ycf): Staff Background Checks

(1) All administrators, staff, volunteers, interns, and any adult working in the YCF hired after October 1, 2019 must complete a National Crime Information Center (NCIC) fingerprint-based background check by the Federal Bureau of Investigation. Results of the fingerprint-based background check must be documented prior to working in the YCF.

(2) All administrators, staff, volunteers, interns, and any adult working in the YCF must complete a Montana Department of Public Health and Human Services child protective services background check, and if applicable, a tribal child protective services background check and a tribal criminal background check prior to working in the YCF.

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

(3) All administrators, staff, volunteers, interns, and any adult working in the YCF must complete a Montana Sexual and Violent Offender Registry check. Results of the registry check must be documented prior to working in the YCF.

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

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

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

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

(d) the administrator, staff member, volunteer, intern, or any adult working in the YCF has been convicted of abuse, sexual abuse, neglect, or exploitation of an elderly person or a person with a developmental disability; or

(e) the administrator, staff member, volunteer, intern, or any adult working in the YCF is a registered offender on the Montana Sexual and Violent Offender Registry ( https://www.nsopw.gov ) or the National Sexual and Violent Offender Registry ( https://app.doj.mt.gov/apps/svow/search.aspx ).

(5) The department may deny or revoke a license upon finding that the administrator, staff member, volunteer, intern, or any adult working in the YCF has a conviction for a misdemeanor partner and family member assault, misdemeanor endangering the welfare of a child, misdemeanor unlawful transaction with a child, or a crime involving an abuse of the public trust.

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

(7) No administrator, staff member, volunteer, intern, or any adult working in the YCF shall have been named as a perpetrator in a substantiated report of child abuse or neglect.

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2019 MAR p. 1526, Eff. 10/1/19.

Mont. Admin. R. 37.97.141 Youth Care Facility (ycf): Youth to Awake Staff Ratios

(1) The following ratio must be followed:

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

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

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

(3) Therapeutic group homes shall meet staffing requirements as set forth in ARM 37.97.903.

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.142 Youth Care Facility (ycf): Staff Training

(1) A YCF shall have written policies, procedures, and initial and ongoing training curriculum that meet the minimum requirements in this rule.

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

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

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

(b) mandatory child abuse reporting laws;

(d) fire safety, including emergency evacuation routes;

(e) confidentiality;

(f) suicide prevention;

(g) emergency medical procedures;

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

(i) youth rights as outlined in ARM 37.97.159; and

(j) hours required for on the job training.

(4) Therapeutic group homes must include training on trauma informed care in initial orientation training.

(5) Orientation training shall be completed and documented before the staff person may count in the youth to awake staff ratio as specified in ARM 37.97.141 and 37.97.903.

(6) All direct care staff shall complete the following certification training within six months of hire:

(a) the use of de-escalation training and methods of managing youth as described in the provider's policies and ARM 37.97.172;

(b) first aid and CPR certification; and

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.145 Youth Care Facility (ycf): Admissions

(1) Each YCF shall admit only those youth for whom it has an operational program and who meet its admissions policies.

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

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

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

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

(4) An initial assessment of the youth's emotional, medical, developmental, social, and behavioral status must be conducted within 24 hours of the youth's admission.

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25.11.

Mont. Admin. R. 37.97.146 Youth Care Facility (ycf): Placement Agreements

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

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

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

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

(5) An exception to the placement agreement requirement may be granted until custody for youth placed under runaway grant funding has been determined.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.147 Youth Care Facility (ycf): Youth Orientation

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

(a) a procedure for ensuring that each youth receives a personal orientation to the YCF as soon as appropriate, but not later than 24 hours after admission;

(b) inventory of each youth's belongings;

(d) information on privilege systems;

(e) discipline policy;

(f) health and safety procedures;

(g) YCF rules;

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

(i) emergency evacuation procedures, including escape routes.

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.148 Youth Care Facility (ycf): Case Plan

(1) Except for therapeutic group homes, each YCF must develop a case plan for each youth in care. A case plan is a specific plan for providing care, treatment, and services of any kind to a specific youth.

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

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

(b) behavior management issues;

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

(e) education plans;

(f) measurable goals and objectives;

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

(h) identification of all treatment members.

(3) The initial case plan must be developed with the youth (over the age of 5), parent/legal guardian, and placing agency and within seven business days after admission.

(4) The case plan must be reviewed and updated at least every three months from the day of development, be conducted face-to-face with the youth, and document the input of the youth (over the age of 5), parent/legal guardian, and placing agency.

(a) If the parent/legal guardian or placing agency are unable to attend face-to-face, telecommunication must be provided at a time that is convenient for the parent/legal guardian and placing agency.

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

(6) Therapeutic group homes must meet the treatment plan requirements in ARM 37.97.907.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.152 Youth Care Facility (ycf): Physical Care

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.153 Youth Care Facility (ycf): Medication Storage and Administration

(1) A YCF shall have and follow written policies and procedures regarding the storage, administration, and disposal of prescription, nonprescription, and over-the-counter medication.

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

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

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

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

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

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

(a) youth's name;

(b) name and dosage of the medication;

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.154 Youth Care Facility (ycf): Care and Guidance

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

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

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

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

(a) participation in case conferences; and

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.155 Youth Care Facility (ycf): Nutrition

(1) A YCF shall provide for orserve three regular, well-balanced meals per day, and snacks. The meals and snacks must be appropriate to the nutritional needs of the youth and must include the four basic food group requirements.

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

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

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

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

(6) Hands must be washed with warm water and soap before the handling of food.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW; 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.156 Youth Care Facility (ycf): Personal Needs

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.159 Youth Care Facility (ycf): Youth Rights

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

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

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

(d) receive care according to individual need;

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.160 Youth Care Facility (ycf): Religion and Culture

(1) The YCF shall have written policies and procedures on how the youth's individual religious and cultural beliefs will be addressed.

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.161 Youth Care Facility (ycf): Privacy and Individualism

(1) A YCF shall allow youth to have privacy.

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.162 Youth Care Facility (ycf): Money

(1) Money earned by a youth or received as a gift or allowance must be part of the youth's personal property and accounted for separately from the YCF funds.

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.163 Youth Care Facility (ycf): Youth Training and Employment

(1) For youth age 16 and older a YCF may assist in:

(a) preparing youth for economic independence;

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

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

(i) completing applications;

(ii) personal appearances for employment situations;

(iii) attitudes toward employment; and

(iv) interviewing for jobs.

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.164 Youth Care Facility (ycf): Education

(1) A YCF shall provide access to an educational program appropriate to the needs of each youth and comply with state school attendance laws.

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.165 Youth Care Facility (ycf): Recreation

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.170 Youth Care Facilities (ycf): Time-Out

(1) A YCF must develop a written time-out policy and procedures which clearly provide:

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

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

(d) purpose of time-out; and

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.171 Youth Care Facility (ycf): Behavior Management Policies

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

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

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

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

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

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

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

(g) locked confinement or seclusion;

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

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

(j) isolation as punishment; and

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.172 Youth Care Facility (ycf): Use of Crisis Intervention and Physical Restraint Strategies

(1) The YCF shall have written policies and procedures governing the appropriate use of crisis intervention and physical restraint strategies, including but not limited to the use of de-escalation techniques and physical restraint methods if used by provider.

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

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

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

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

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

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

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

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

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

(i) the behavior which required the physical restraint;

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

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

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

(v) the type of physical restraint used;

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

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

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

(3) All TGHs must provide physical restraint training and comply with this rule.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.175 Youth Care Facility (ycf): Searches

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

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

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

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

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

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

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

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

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

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

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

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

(a) strip searches;

(b) body cavity searches; or

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

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

(i) has been ordered by a court;

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

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

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

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

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

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

(i) has been ordered by a court;

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.176 Youth Care Facility (ycf): Contraband

(1) A YCF shall define prohibited contraband in a written policy.

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.177 Youth Care Facility (ycf): Safety

(1) A YCF shall have and follow appropriate written policies and procedures on safety and equipment.

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

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

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

(d) be inventoried on a quarterly basis.

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

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

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

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

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.178 Youth Care Facility (ycf): Emergency and Evacuation Plans

(1) A YCF shall have and follow a written emergency plan developed in conjunction with emergency services in the community, and it must include specific procedures for evacuations, disasters, medical emergencies, hostage situations, casualties, missing youth, and other serious incidents identified by the YCF.

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

(a) designation of authority and staff assignment;

(b) a specific evacuation plan;

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.179 Youth Care Facility (ycf): Potential Weapons

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.182 Youth Care Facility (ycf): Food Preparation and Handling

(1) Safe food handling and preparation practices must be followed in all YCFs.

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

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

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

(i) before touching anything used to prepare food;

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

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

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

(v) after using the toilet facilities;

(vi) after eating or drinking;

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

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

(ix) after touching any soiled object.

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

(3) General food safety requirements include the following:

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

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

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

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

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

(g) Frozen food must be kept frozen.

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

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

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

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

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

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

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

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

(5) Minimum food storage requirements include the following:

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

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

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

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

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.184 Youth Care Facility (ycf): Infection Control

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.185 Youth Care Facility (ycf): Animals and Pets

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.186 Youth Care Facility (ycf): Physical Environment

(1) A YCF must provide a minimum of ten foot-candles of light in all rooms and hallways, with the following exceptions:

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

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

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

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

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

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

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

(6) The YCF must provide:

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

(b) one bathing facility for every six residents.

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

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

(9) Facilities licensed prior to September 23, 2010, that did not meet the requirements of (8) are allowed to maintain the existing bathroom access through resident room, kitchen, or dining areas. However, if future remodeling or additions are to be made to these structures, the remodeling or additions must comply with current standards.

(10) Hot and cold water must be available in the YCF. Water temperatures for hot water must be limited to 120°F or below.

(11) For adequate housekeeping the YCF must ensure that:

(a) the building and grounds are free, to the extent possible, of harborage for insects, rodents, and other vermin;

(b) the floors, walls, ceilings, furnishings, and other equipment is clean and in good repair, free of hazards, and offensive odors;

(c) cleaning equipment and supplies are provided in sufficient quantity to meet the housekeeping needs of the facility; and

(d) a maintenance policy and schedule, which describes the regular maintenance of the facility, is adhered to.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2015 MAR p. 756, Eff. 6/12/15.

Mont. Admin. R. 37.97.187 Youth Care Facility (ycf): Water Supply

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

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

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.188 Youth Care Facility (ycf): Sewage System and Solid Waste

(1) An adequate and safe wastewater system must be provided for conveying, treating, and disposing of all sewage. Immediate measures must be taken to alleviate health and sanitation hazards caused by wastewater at the YCF when they occur.

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.190 Youth Care Facility (ycf): Finances

(1) Each YCF shall:

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.191 Youth Care Facility (ycf): Fire Safety

(1) The department adopts and incorporates by reference the occupancy designation/classification group R-3 of the International Fire Code (IFC), 2012, which sets forth the fire safety regulations that apply to youth care facilities. A copy of the IFC definitions and requirements for R-3 occupancies may be obtained from the Fire Prevention and Investigation Section of the Department of Justice, 2225 11th Avenue, Helena, Montana, 59620.

(2) The state fire marshal must annually certify a YCF for fire and life safety.

(3) Smoke detectors approved by a recognized testing laboratory must be located on each level of the facility, at the top of stairways, in any bedroom, in any hallway leading to bedrooms, and in areas requiring separation as set forth in IFC Section 907.2.11.

(4) Carbon monoxide detectors installed in facilities with fuel-burning appliances or with attached garages must be installed per manufacture recommendations according to Section 1103.9, IFC.

(5) A workable portable fire extinguisher, with a minimum rating of 2A10BC, must be located on each floor of the facility. Fire extinguishers must be:

(a) mounted on the wall not to exceed five feet from handle to floor and no closer than four inches from the floor;

(b) no more than 75 feet from each other;

(c) inspected, recharged, and tagged at least once a year by a person certified by the state to perform such services; and

(d) not obstructed or obscured from view.

(6) Facility staff must check smoke detector batteries at least once each month and the batteries must be replaced at least once each year. Documentation, including the date and the signature of the person checking or replacing the batteries, must be maintained at the facility.

(7) The staff must be trained in the proper use of facility fire extinguishers and documentation of the training must be maintained at the facility.

(8) Staff, at the time of hire, and residents, at the time of admission, must be instructed in the facility's fire evacuation procedure. The fire evacuation procedure must be posted in a conspicuous place in the YCF.

(9) All exits must be clear and unobstructed at all times.

(10) Paint, flammable liquids, and other combustible material must be kept in locked storage away from heat sources or in outbuildings not used by the youth.

(11) The YCF must conduct at least four fire drills annually, no closer than two months apart, with at least one drill occurring on each shift. Drill observations must be documented and maintained in the facility files for at least two years. The documentation must include:

(a) location of the drill;

(b) identification of participating staff;

(d) steps taken to correct such problems.

History

Authorizing statute(s): 52-2-111, 52-2-113, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
History: NEW, 2015 MAR p. 756, Eff. 6/12/15.

Subchapter 37.97.2 Child Care Agencies

Mont. Admin. R. 37.97.201 Child Care Agency: Admissions and Discharges

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-503, 41-3-1103, 41-3-1142, 53-4-111, 53-4-113, MCA
Implementing statute(s): 41-3-503, 41-3-1103, 41-3-1142, 53-2-201, 53-4-113, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1984 MAR p. 327, Eff. 2/17/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.202 Child Care Agency: Case Plans

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-503, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-3-503, 41-3-1142, 53-2-201, 53-4-113, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.206 Child Care Agency: Personnel

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

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

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

(a) a bachelor's degree;

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

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

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

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

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-113, 52-2-603, 52-2-622, MCA
Implementing statute(s): 41-3-503, 52-2-113, 52-2-603, 52-2-622, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1978 MAR p. 908, Eff. 6/24/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1984 MAR p. 327, Eff. 2/17/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1991 MAR p. 2262, Eff. 11/28/91; AMD, 1993 MAR p. 403, Eff 3/26/93; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.207 Child Care Agency: Child/Staff Ratio

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-111, 52-2-622, MCA
Implementing statute(s): 52-2-111, 52-2-622, 53-2-201, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1993 MAR p. 403, Eff. 3/26/93; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.213 Child Care Agency: Finances

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-503, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-3-503, 41-3-1142, 53-2-201, 53-4-113, MCA
History: NEW, 1978 MAR p. 88, Eff. 1/26/78; AMD, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.216 Child Care Agency: Records

(1) Each child care agency shall maintain accurate and current records on each youth in care, including:

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

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

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

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

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

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

(b) a report stating the reasons for placement and the current case plan;

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

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

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

(g) a case plan with written quarterly reviews of the plan.

(3) In addition, a copy of the youth's most recent physical examination must be kept by the child care agency.

History

Authorizing statute(s): 41-3-1103, 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 41-3-1103, 52-2-113, 52-2-603, 52-2-622, 53-2-201, 53-4-113, MCA
History: NEW, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.220 Child Care Agency: Supervision of Medication

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-4-111, 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1993 MAR p. 403, Eff. 3/26/93; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.225 Child Care Agency: Time-Out

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 53-4-111, MCA
Implementing statute(s): 53-2-201, 53-4-111, 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.226 Child Care Agency: Passive Physical Restraint

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-2-201, 53-4-111. 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.230 Child Care Agency: Treatment Program

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

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

(b) identification of staff responsible for planning and implementing the various treatment procedures and techniques;

(d) description of staff training requirements;

(e) description of the various treatment procedures and techniques used;

(f) the anticipated levels of disturbance for which such procedures and techniques are to be used;

(g) provisions for follow-up and after care;

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

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

(j) provisions for ongoing monitoring and recording; and

(k) procedures for regular review of the overall treatment program and the individualized treatment strategies.

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

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

(b) the least restrictive method to accomplish treatment goals; and

History

Authorizing statute(s): 52-2-113, 52-2-603, MCA
Implementing statute(s): 52-2-603, MCA
History: NEW, 1984 MAR p. 327, Eff. 2/17/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; AMD, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.233 Child Care Agency: Management

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 53-4-113, MCA
Implementing statute(s): 41-3-1103, MCA
History: NEW, 1984 MAR p. 327, Eff. 2/17/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.238 Child Care Agency: Education

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 53-4-113, MCA
Implementing statute(s): 41-3-1103, MCA
History: NEW, 1984 MAR p. 327, Eff. 2/17/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.239 Child Care Agency: Recreation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 53-4-113, MCA
Implementing statute(s): 41-3-1103, MCA
History: NEW, 1984 MAR p. 327, Eff. 2/17/84; AMD, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.250 Child Care Agency: Residential Treatment Center, Staffing

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 53-2-201, 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.253 Child Care Agency: Residential Treatment Center, Education

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1142, 53-4-111, MCA
Implementing statute(s): 53-2-201, 53-4-111, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.254 Child Care Agency: Residential Treatment Center, Recreation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1142, 53-4-111, MCA
Implementing statute(s): 53-4-111, 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.257 Child Care Agency: Residential Treatment Center, Seclusion

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 41-3-1142, 53-2-201, 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.258 Child Care Agency: Residential Treatment Center, Mechanical Restraint

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-4-1103, 41-3-1141, 41-3-1142, 53-4-111, 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.259 Child Care Agency: Residential Treatment Center, Chemical Restraint

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-1103, 41-3-1142, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 41-3-1141, 41-3-1142, 53-4-111, 53-4-113, MCA
History: NEW, 1986 MAR p. 2080, Eff. 12/27/86; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Mont. Admin. R. 37.97.270 Child Care Agency: Additional Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 41-3-503, 41-3-1103, 53-4-111, 53-4-113, MCA
Implementing statute(s): 41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA
History: NEW, 1983 MAR p. 742, Eff. 7/1/83; AMD, 1984 MAR p. 327, Eff. 2/17/84; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Authorizing statute(s): 41-3-503, 41-3-1103, 53-4-111, MCA
Implementing statute(s): 41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA
History: NEW, 1983 MAR p. 742, Eff. 7/1/83; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1992 MAR p. 2728, Eff. 12/25/92; AMD, 1993 MAR p. 1506, Eff. 7/16/93; AMD, 1994 MAR p. 2739, Eff. 10/14/94; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Authorizing statute(s): 41-3-1103, 41-3-1142, 52-2-111, MCA
Implementing statute(s): 41-3-1142, 52-2-113, MCA
History: NEW, 1998 MAR p. 489, Eff. 2/13/98; TRANS, from DFS, 1998 MAR p. 663; REP, 2011 MAR p. 387, Eff. 3/25/11.

Subchapter 37.97.9 Therapeutic Group Homes

Mont. Admin. R. 37.97.903 Therapeutic Group Homes (tgh): Staffing

(1) In addition to the requirements specified in ARM 37.97.141, TGH providers must meet staffing requirements specified in this rule to provide a therapeutic environment and treatment interventions identified in the youth's individual treatment plan.

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

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

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

(a) During regular school hours when youth are not normally present, at least one on-call staff must be available only if there are no other staff in the facility. Staff must report to work at the TGH within 30 minutes of notification that they are needed.

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

(c) The program manager may be counted in the direct care ratio during the morning hours between 6:00 a.m. and 8:00 a.m., or beginning at some other reasonable two-hour time frame prior to the youth leaving for school.

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

(6) A TGH must employ a program manager who is responsible for no more than 16 youth. The program manager may not be counted in the direct care staffing to youth ratio except as provided in (4)(b) and (c).

(7) A TGH must employ or contract with a mental health professional as defined in ARM 37.97.102(13). Services must be provided on-site or as specified in the treatment model. The mental health professional must not be counted in the direct care staffing to youth ratio.

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

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

(10) The TGH must have nursing services available 24 hours a day seven days a week as described in the TGH's treatment model.

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

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2019 MAR p. 1526, Eff. 10/1/19; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.905 Therapeutic Group Homes (tgh): Clinical Assessment

(1) A TGH must develop written policies and procedures to implement a trauma informed treatment model designed to address the identified emotional, behavioral, and clinical needs of the youth.

(2) The mental health professional must complete a clinical assessment on a youth admitted to a TGH within ten business days (Monday through Friday) of admission, unless a clinical assessment has been completed within the last three months prior to admission and is submitted with the youth's referral packet.

(3) All assessments must be documented in the youth's case record.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.906 Therapeutic Group Homes (tgh): Therapeutic Service Requirements

(1) The TGH must provide therapeutic services to all youth. Therapeutic services include therapy and therapeutic interventions. The purpose of therapeutic services is to:

(a) reduce the impairment of the youth's mental disability and to improve the youth's functional level;

(b) alleviate the emotional disturbances;

(d) encourage personal growth and development.

(2) Each youth must receive 75 minutes of therapy and 75 minutes of therapeutic intervention services per week (Sunday through Saturday).

(3) Therapy requirements must be provided by the mental health professional and include the following:

(a) Individual therapy must be provided at least 50 minutes out of the required 75 minutes per week as outlined in the youth's treatment plan.

(b) Family therapy must be provided to the youth and family members as defined in ARM 37.97.102(9) and provided as outlined in the youth's treatment plan.

(c) If no identified family members as defined in ARM 37.97.102(9) are able to participate in family therapy, specific reasons why family therapy cannot be provided must be documented in the youth's treatment plan.

(d) If the youth is on a home visit or the family is unable to participate in therapy on-site, the mental health professional may provide therapy electronically via video conferencing or telehealth.

(4) In the event the mental health professional is unavailable due to vacation, illness, or other similar circumstance for more than 150 minutes in a 24-week period per youth, arrangements for therapy must be made based on the program's policy and procedures.

(a) The TGH must document in the youth's case record why the mental health professional could not provide therapy and what arrangements for therapy were made.

(b) The 24-week time period will be based on the youth's admission date.

(5) Therapeutic interventions may be provided by the mental health professional, program manager, or direct care staff as outlined in the youth's treatment plan.

(6) Therapy sessions and therapeutic interventions must address the youth's treatment goals and objectives in the treatment plan, and each session must be documented in the case record by the individual providing the service. Documentation must include the signature of the person who provided the service and the date, start and end times of each session.

(7) Internal staff meetings to address the needs of each youth must be conducted weekly and must include the program manager, lead clinical staff, and direct care staff. Staff meeting time spent addressing the needs of youth may not be included as therapy or therapeutic intervention time.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Mont. Admin. R. 37.97.907 Therapeutic Group Homes (tgh): Treatment Plan

(1) A TGH must develop and implement a treatment plan for each youth in care based on the results of the clinical assessment.

(2) The initial treatment plan must be developed within 10 business days of admission and include:

(a) names of treatment team members including the youth's family, relatives, and fictive kin of the youth, appropriate school personnel, placing agency representative, and other professionals as appropriate;

(b) contact information for all treatment team members;

(d) behavior management issues;

(e) short-term and long-term mental and behavioral goals with corresponding time frames;

(f) specific interventions with corresponding time frames in accordance with the TGH treatment model;

(g) identifying how the TGH will facilitate participation of family in the treatment of the youth, including siblings;

(h) identifying how the TGH will facilitate family visitation or contact outside of family therapy;

(i) criteria for the youth's completion of the program;

(j) education plans; and

(k) a discharge plan, including planning for aftercare services, and estimated discharge date.

(3) Treatment plans must be reviewed and updated at least every 30 days from the date of development and:

(a) be conducted face-to-face with the youth and document the input of the youth (over the age of 5), parent/legal guardian, and placing agency;

(b) include all treatment team members;

(d) if treatment team members are unable to attend face-to-face, telecommunication must be provided at a time that is convenient for the parent/legal guardian and placing agency;

(4) The TGH must document in the youth's case record notification to all treatment team members of the time and place of the treatment plan review.

(5) All direct care staff and treatment team members, including the mental health professional involved in the care of the youth, must read and sign off on the treatment plan within seven days of its development and update.

(6) A copy of the treatment plan must be provided to the youth's placing agency and parent/legal guardian within ten days of the plan's development or update.

History

Authorizing statute(s): 52-2-111, 52-2-603, 52-2-622, MCA
Implementing statute(s): 52-2-113, 52-2-603, 52-2-622, MCA
History: NEW, 2011 MAR p. 387, Eff. 3/25/11; AMD, 2021 MAR p. 1217, Eff. 10/1/21.

Authorizing statute(s): 41-3-1103, 53-4-111, MCA
Implementing statute(s): 41-3-1103, 53-4-113, MCA
History: NEW, 1983 MAR p. 1746, Eff. 11/26/83; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 663; REP, 2006 MAR p. 1395, Eff. 6/2/06.

Chapter 37.98 Outdoor Behavioral Program

Subchapter 37.98.1 General Provisions

Mont. Admin. R. 37.98.102 Definitions

The following definitions apply to this subchapter:

(1) "Administrative office" means the office where business operations, public relations and management procedures take place.

(2) "Administrator" means the person designated on the facility application or by written notice to the department as the person responsible for the daily operation of the facility and for the daily resident care provided in the facility.

(3) "Case plan" means an individualized plan of services to be provided to each youth, based on his or her identified treatment needs, designed to help him or her reach treatment goals.

(4) "Child abuse or neglect" is that as defined at 41-3-102 , MCA.

(5) "CPR" means cardiopulmonary resuscitation.

(6) "Contraband" means any item possessed by a youth or found on the program's premises that is illegal by law or expressly prohibited by the program. Such items include, but are not limited to, weapons, illegal or unauthorized drugs, drug paraphernalia, intoxicants and flammable items.

(7) "Debrief" means to interview youth and staff members following the use of physical restraint, or following any other incident or occurrence in which it is necessary or helpful for the program to obtain information from youth and staff members.

(8) "Department" means the Montana department of public health and human services.

(9) "Direct care staff" means program personnel who directly participate in the care, supervision and guidance of youth in an outdoor behavioral program, including the field director, senior field staff and field staff.

(10) "Expedition" means an excursion undertaken for specific treatment purposes that takes the youth away from the field office.

(11) "Expedition camp" means a nonpermanent campsite. Youth and staff may move from one expedition camp to another when on expedition.

(12) "Field office" means the office where all coordination of expedition operations takes place.

(13) "Global positioning system (GPS) receiver" means a receiver which receives signals from a network of satellites known as the global positioning system, or GPS, which identifies the receiver's location by:

(a) latitude;

(b) longitude; and

(14) "High adventure activity" means an outdoor activity provided to youth for the purposes of behavior management or treatment and which requires specially trained staff and special safety precautions to reduce the possibility of an accident or injury.

(15) "Illegal contraband" means items or substances the possession of which by a youth constitute a violation of state or federal law.

(16) "Lead clinical staff member (LCS) " is a licensed clinical psychologist, a licensed clinical social worker or a licensed professional counselor. The LCS is responsible for the supervision and overall provision of treatment services to youth in the program.

(17) "Leave no trace principles" means wilderness and land use ethics designed to minimize the impact of visitors to back country areas.

(18) "Licensed health care professional" is defined at 50-5-101 , MCA.

(19) "Mechanical restraint" is any object or apparatus, device or contraption applied or affixed to the youth to limit movement, and includes, but is not limited to:

(a) handcuffs;

(b) leg irons;

(d) restraint chairs; or

(e) straight jackets.

(20) "Near miss" means an unplanned, unforeseen or potentially dangerous situation where safety was compromised but that did not result in injury.

(21) "Nonviolent crisis intervention strategies" mean preventive measures that are used to manage the behavior of the youth and include the use of de-escalation techniques, physical assists and physical restraints.

(22) "Physical assist" is a behavioral control technique by which a staff member physically aids or supports youth who are not physically resisting.

(23) "Physical restraint" means any physical method of restricting a person's freedom of movement that prevents the person from independent and purposeful functioning. This activity includes seclusion, controlling physical activity, or restricting normal access to the body.

(24) "Placing agency" means any corporation, partnership, association, firm, agency, institution or person who places or arranges for placement of any youth with a program.

(25) "Practitioner" is defined at 50-5-101 , MCA.

(26) "Program" means outdoor behavioral program as defined at 50-5-101 (40) , MCA.

(27) "Residential outdoor services" means services provided by a program to youth at designated stationary sites including permanent buildings where the youth reside.

(28) "Seclusion" is a behavioral control technique involving locked isolation. The term does not include time outs.

(29) "Serious incident" means:

(a) a suicide attempt;

(b) the excessive use of physical force by staff;

(d) injury to a youth which requires medical attention;

(e) the death of a youth; or

(f) known or suspected abuse or neglect of a youth by staff or youth.

(30) "Solo experience" means separation of a youth from the group as part of the outdoor therapeutic process, not including a time out.

(31) "Time out" means imposed separation of a youth from any group activity or contact as a means of behavior management.

(32) "Wilderness first responder" means a licensed first responder with the medical training course for outdoor professionals as offered by the national association of search and rescue.

(33) "Youth" means a youth 13 through 18 years of age, who may be admitted to or is a participant in an outdoor behavioral program.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.3 Administrative Provisions

Mont. Admin. R. 37.98.301 License Application Process

(1) Application for a license accompanied by the required fee must be made to the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

(2) The application for a license must be made on forms provided by the department and shall include full and complete information as to the identity of:

(a) each officer and director of the corporation, if organized as a corporation;

(b) each general partner if organized as a partnership or limited liability partnership;

(d) name, address and phone number of the management company if applicable;

(e) physical location address, mailing address and phone number of the program; and

(f) maximum number of beds in the program.

(3) The application for a license must also include the program management policies such as:

(a) the program statement and description of services;

(b) policies for decision making, supervision of staff and consultation;

(d) case review policy;

(e) admission and discharge policies and procedures;

(f) policies and procedures for support services;

(g) youth's grievance procedure;

(h) transportation policies and procedures;

(i) policies for personnel and financial records; and

(j) any other policies required by these rules.

(4) The application for a license must also include the placement agreement intended to be used by the program.

(5) Every program shall have a distinct identification or name and shall notify the department in writing within 30 days prior to changing such identification or name.

(6) Each program shall promptly report to the department any plans to relocate the program at least 30 days prior to such a move.

(7) The current program license must be publicly displayed at the administrative office.

(8) In the event of a change of ownership, the new owners shall provide the department the following:

(a) a completed application with fee;

(b) a copy of the fire inspection conducted within the past year;

(c) policies and procedures as prescribed in (3) , or if applicable, a written statement indicating that the same policies and procedures will be used;

(d) a copy of the placement agreement as outlined in (4) ; and

(e) documentation of compliance with ARM 37.98.401.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.303 License Restrictions

(1) A license is not subject to sale, assignment or other transfer, voluntary or involuntary.

(2) A license is valid only for the premises for which the original license was issued.

(3) The license remains the property of the department and shall be returned to the department upon closing or transfer of ownership. The address for returning the license is Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.304 License Denial, Suspension, Restriction, Revocation, or Reduction to Provisional Status and Hearing Procedures

(1) The department, after written notice to the applicant, may deny an application for licensure upon finding that the applicant has not met the minimum requirements for licensure established by this subchapter, or upon finding that the applicant has made any misrepresentation to the department, either negligently or intentionally, regarding any aspect of its operations or facility.

(2) The department, after written notice to a licensed program, may suspend, restrict, revoke or reduce to a provisional status a license upon finding that the program is not in substantial compliance with the minimum requirements for licensure established by this subchapter. Suspension or revocation may be immediate if:

(a) the department is denied access to the program, to any youth placed in the program by the department, or to any program records;

(b) the program has made any misrepresentation to the department, either negligently or intentionally, regarding any aspect of its operations or facility;

(d) the initial investigation of a report of child abuse or neglect results in reasonable cause to suspect that a youth in the program may be in danger of harm;

(e) the program or any member of its staff has been named as the perpetrator in a substantiated report of abuse or neglect;

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

(g) it is determined on the basis of a department or law enforcement investigation that the program or any member of its staff may pose a risk or threat to the health or welfare of a youth placed in the program.

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

History

Authorizing statute(s): Sec. 50-2-220, MCA
Implementing statute(s): Sec. 50-2-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.308 Administrative Policies and Procedures

(1) The program shall have established policies and organizational plans clearly defining legal responsibility, administrative authority and responsibility for services to program participants and the community.

(2) The program shall have written policies for personnel and financial records. The policies shall be furnished to the department with the initial license application.

(3) The program shall have written position descriptions for all employees which include a description of duties, responsibilities, limitations of authority, and principal measures of accountability and performances.

(4) The program shall develop policies and procedures for screening, hiring and assessing staff which include practices that assist the employer in identifying employees that may pose a risk or threat to the health, safety or welfare of any resident and provide written documentation of findings and the outcome in the employee's file.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.312 Quality Assessment

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

(a) conducting youth satisfaction surveys at least annually;

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

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

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

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.315 Confidentiality of Records and Information

(1) All records maintained by a program and all personal information made available to a program pertaining to an individual youth must be kept confidential, and are not available to any person, agency or organization except as specified in (2) through (4) .

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

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

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

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

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

(4) Records pertaining to individual youth not placed by or in the custody of the department must be available to the department for the purposes of licensing, relicensing or investigating the program.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.316 Reports

(1) The program shall submit to the department, upon its request, any reports required by federal or state law or regulation.

(2) The program shall report any of the following changes in writing to the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953 prior to the effective date of:

(a) a change of administrator;

(b) a change in location;

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

(3) The program shall report any violation of the requirements of this subchapter to the department within two business days.

(4) Runaways must be reported immediately to law enforcement and within the next working day to the agency or person who placed the youth.

(5) Disasters or emergencies which require closure of a residence unit shall be reported to the department within the next working day.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.319 Child Abuse or Neglect and Serious Incidents

(1) Each program staff member and employee shall read and sign a statement clearly defining child abuse and neglect and explaining the staff member's responsibility to report all known or suspected incidents of child abuse or neglect.

(2) Any program staff member or employee who knows or has reasonable cause to suspect that an incident of child abuse or neglect has occurred shall report within 24 hours the known or suspected incident to the program administrator, or a person designated by the program administrator, and to the state child abuse hotline (1 (866) 820-5437) as required by 41-3-201 , MCA. The program must fully cooperate with any investigation conducted as a result of the report.

(3) Each program shall have written procedures for handling any suspected incident of child abuse or neglect including:

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

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

(i) termination of employment;

(ii) retraining of the staff member; or

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

(4) Any serious incident involving a youth must be reported within the next working day to the person or agency which placed the youth and to the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

(5) The report must be in writing, and must include:

(a) the date and time of the incident;

(b) the youth and any staff member(s) involved;

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

(6) A copy of the report must be maintained at the program.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.4 Staff Provisions

Mont. Admin. R. 37.98.401 Administrator Qualifications

(1) Each program shall employ an administrator. The administrator is responsible for operation of the program at all times and shall ensure 24-hour supervision of the residents. The program administrator is the person ultimately responsible for ensuring that the program is in compliance with applicable licensing rules and ensuring that staff are familiar with and comply with all program policies and procedures.

(2) The administrator shall meet, at a minimum, the following qualifications:

(a) a bachelors degree in a relevant discipline;

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

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

(3) A staff member must be designated to oversee the operation of the facility during the administrator's absence. The administrator or designee shall be in charge, on call and physically available on a daily basis as needed, and shall ensure there are sufficient, qualified staff so that the care, well being, health and safety needs of the residents are met at all times.

(a) A designee shall:

(i) be age 18 or older; and

(ii) have demonstrated competencies required to assure protection of the safety and physical, mental and emotional health of the residents.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.403 Staff

(1) A program shall have written personnel policies covering the following items:

(a) job qualifications;

(b) job descriptions;

(d) fringe benefits;

(e) insurance;

(f) hours of work; and

(g) performance evaluations.

(2) A program shall maintain records for each employee regarding the following:

(a) application for employment;

(b) reports from references;

(d) reports of health examinations;

(e) periodic performance evaluations;

(f) copy of current licenses and certifications; and

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

(3) All program staff shall meet the following general qualifications:

(a) understand the purpose of the program and be willing to carry out its policies and programs;

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

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

(a) an overview of the facility's policies and procedures manual in areas relevant to the employee's job responsibilities;

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

(d) youth rights as discussed in ARM 37.98.702.

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

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

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

(8) Any staff member, intern, volunteer or other person having direct contact with the youth whose behavior or health status endangers the residents may not be allowed at the program.

(9) The personal references of all staff must be verified and documented in writing.

(10) Program volunteers and interns shall:

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

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

(d) be under the direct and constant supervision of program staff.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.404 Program Professional Staff and Qualifications

(1) Each program shall employ or contract with professionals to serve as program professional staff members. Program professional staff members must have knowledge of the physical and emotional demands of the program and provide professional services including, but not limited to:

(a) admission evaluations;

(b) case plan development;

(d) treatment; and

(e) rehabilitation.

(2) At a minimum, each program professional staff must consist of:

(a) a licensed health care professional;

(b) a licensed mental health professional who may be either a licensed clinical psychologist, a licensed clinical social worker or a licensed clinical professional counselor; and

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.405 Program Expedition Field Director Qualifications

(1) The staff of each program expedition must include a field director.

(2) The field director shall be primarily responsible for:

(a) the quality of the field activities;

(b) coordinating field operations;

(d) managing the field office;

(e) ensuring compliance with applicable licensing rules; and

(f) ensuring that staff members are familiar with all program policies and procedures.

(3) The field director shall meet, at a minimum, the following qualifications:

(a) a bachelors degree in a relevant discipline and a minimum of 30 semester or 45 quarter hours of education in recreational therapy or in a related field, or one year outdoor youth program field experience;

(b) a minimum of 40 24-hour field days of program experience or equivalent experience in outdoor programs documented in the individual's personnel file;

(c) be capable of preparing reports required by this subchapter, documenting interactions of youth and staff, and ensuring compliance with applicable licensing rules;

(d) hold a first response license or equivalent and have additional wilderness first responder training; and

(e) completion of an initial staff training.

(4) If qualified, the administrator may serve as field director.

(5) Each program shall have a senior field staff member working directly with each group of program youths. Each senior field staff member shall meet the following minimum qualifications:

(a) be at least 22 years of age;

(b) have an associate degree or high school diploma with 30 semesters or 45 quarter hours education and training or comparable experience and training in a field related to recreation and adventure activities;

(c) have six months, or 130 24-hour field days of outdoor youth program field experience or comparable experience serving youth with behavior problems that endanger the youth's health, interpersonal relationships, or educational functioning. Such experience must be documented in the individual's personnel file;

(d) hold a wilderness first responder license or equivalent and have additional wilderness first responder training; and

(e) have completed initial staff training.

(6) Field staff working directly with the youth shall meet, at a minimum, the following qualifications:

(a) be at least 22 years of age;

(b) have a high school diploma or equivalent;

(d) be certified in CPR annually and currently certified in first aid.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.406 Program Staff Background Checks

(1) The administrator, staff, volunteers and interns must have a state criminal, a child protective services/adult protective services and if applicable, a tribal criminal and child protective services background check conducted.

(a) The department may not grant approval or licensure nor allow a license if the administrator, staff member, volunteer or intern has been convicted by a court of competent jurisdiction of a felony or misdemeanor involving:

(i) child abuse or neglect;

(ii) spousal abuse;

(iii) a crime against a child or children (including child pornography) ; or

(iv) a crime involving violence, including rape, sexual assault or homicide, but not including other physical assault or battery.

(b) The department shall not grant approval or licensure nor allow a license if any administrator, staff member, volunteer or intern has, within the last five years, been convicted by a court of competent jurisdiction of a felony or misdemeanor involving:

(i) physical assault;

(ii) battery; or

(iii) a felony drug related offense.

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

(3) No administrator, staff member, volunteer or intern shall have been named as a perpetrator:

(a) in a substantiated report of child abuse or neglect;

(b) in a report substantiating abuse or neglect of a person protected under the Montana Elder and Developmentally Disabled Abuse Prevention Act; or

(4) No administrator, staff member, volunteer or intern shall be identified through a department licensing investigation to have negligently or intentionally violated a licensing regulation which results in child abuse or neglect.

(5) The program is responsible for assuring that the persons covered by this subchapter have met these requirements before providing care.

(6) No staff member, aide, volunteer or other person having direct contact with the youth in the facility shall pose any potential threat to the health, safety and well being of the youth in care.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.411 Staff Training

(1) A program shall have written policies, procedures and training curriculum regarding minimum requirements for initial and ongoing training.

(2) All direct care staff shall complete a minimum of 40 hours of initial staff training.

(3) Initial staff training must consist of the following minimum requirements:

(a) the program's policy, procedures, organization and services;

(b) mandatory child abuse reporting laws;

(d) fire safety, including emergency evacuation routes;

(e) confidentiality;

(f) first aid and CPR;

(g) suicide prevention;

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

(i) therapeutic de-escalation of crisis situations and passive physical restraint techniques to ensure the protection and safety of the youth and staff. Training must include the use of physical and non-physical methods of managing youth and must be updated, at least every 12 months, to ensure that necessary skills are maintained.

(4) Initial staff training shall be completed and documented before the staff person may count in the youth/staff ratio as specified in ARM 37.98.415 and 37.98.1805.

(5) The program shall provide ongoing training for staff to maintain certifications and improve proficiency in knowledge and skills. Training must be a minimum of 20 hours annually.

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

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.415 Youth/Staff Ratios

(1) A program shall maintain the following minimum staff ratios:

(a) Youth/staff ratio must be no more than 4:1 each day for a 15-hour period beginning at, or between, 7 a.m. and 7:30 a.m., (or beginning at, or between, some other reasonable morning half hour which is approximately 15 hours prior to the bedtime of the youth) , when youth are in care.

(b) Youth/staff ratio for residential outdoor services may not be more than 8:1 each night for a nine-hour period beginning no earlier than 15 hours from the time daytime staffing of 4:1 starts. Staff must be awake during the nine-hour period.

(2) A program must use the actual number of youth in care each day to compute the youth/staff ratio.

(3) The youth/staff ratio requirement for the expedition components of the program is contained in ARM 37.98.1805.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.7 Youth Records and Program Entrance Provisions

Mont. Admin. R. 37.98.701 Youth Case Records

(1) A program shall maintain a written case record for each youth which must include administrative, treatment and educational data from the time of the youth's admission until the time the youth leaves the program. A youth's case record must include the following:

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

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

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

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

(f) documentation of the current custody and legal guardianship as provided by the placing agency;

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

(h) consent forms signed by the parents or guardian prior to placement that allow the program to authorize all necessary medical care, routine tests, immunization and emergency medical or surgical treatment;

(i) health records including medical history and vaccination record as provided by the placing agency;

(j) education records and reports;

(k) treatment or clinical records and reports;

(l) records of special or serious incidents;

(m) case plans and related material;

(n) social summary current to date of placement;

(o) report stating reason for placement;

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

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

(r) all other youth records and documentation as required by these rules.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.702 Youth Rights

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

(a) each youth has the right to be free from abuse, neglect and unnecessary physical or chemical restraint;

(b) if the program operates during the school year, every youth has the right to educational services in accordance with Montana state law;

(d) each youth has the right to receive care according to individual need;

(e) service must be provided within the most appropriate setting;

(f) each youth has the right to personal privacy, and the program must allow privacy for each youth when not contrary to treatment and safety of the youth;

(g) contact with the family will be maintained by mail and phone, if accessible, as long as this contact is not contrary to the treatment and safety needs of the youth; and

(h) each youth has the right to have his or her opinions and recommendations considered and documented in the development of his or her case plan.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.705 Physical Examination

(1) All physical examinations must be completed by an appropriate licensed practitioner. A youth must have a physical examination:

(a) within 30 days prior to admission into the program;

(b) at least annually after entering the program; and

(2) The result of the physical examination must be recorded on a standard form provided by the program. The form shall clearly identify to the examining practitioner the type and extent of physical activity which the youth will be asked to participate in.

(3) The physical examination must include:

(a) a complete blood count (CBC) , a urinalysis and an electrolyte screen, if deemed necessary by the examining practitioner;

(b) a pregnancy test for each female if deemed necessary by the examining practitioner;

(c) a physical assessment to determine the youth's fitness for the climate and temperature in which the youth will be participating and the youth's age, weight and physical condition;

(d) a determination of whether detoxification is indicated for the youth prior to entrance into the program;

(e) identification of any physical problems which would limit the youth's physical activity;

(f) identification of any special care which the youth will need;

(g) a record of immunizations as defined in ARM 37.114.701 through 37.114.716. In addition the immunization record must include:

(i) evidence of hepatitis A series, if deemed necessary by a practitioner;

(ii) evidence of hepatitis B series, if deemed necessary by a practitioner;

(h) a history of communicable diseases and serious illnesses or operations the youth has had;

(i) identification of any known drug reactions and allergies;

(j) identification of medications being taken during the six months prior to the examination, and a description of any possible special needs due to the use of medication in an outdoor, high impact environment;

(k) identification of any necessary special dietary requirements; and

(l) identification of any hereditary health issues that may affect the youth.

(4) If a youth is in a risk group for circulatory or auto-immune syndrome disorder, written approval must be included on the physical examination form by the practitioner for participation in the program.

(5) The practitioner conducting the examination must give written approval on the examination form for participation in the program, taking into consideration the factors specified in this rule and any other factors the practitioner deems to be relevant to the youth's participation in the program. The practitioner conducting the physical examination must give separate written approval on the examination form for the youth's participation in the following situations or activities:

(a) strenuous exercise;

(b) exposure to cold and hot temperatures; and

(6) A program may not admit a youth who is not approved by the examining practitioner for admission to the program. The program shall comply with all restrictions or limitations placed on a youth by the examining practitioner.

(7) The original physical examination form must be maintained at the field office and a copy must be carried by staff in a waterproof container when the youth is away from the field office. The physical examination form must be maintained in a manner that assures the confidentiality of all medical and identification information.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.706 Assessments

(1) A program shall have written admission and assessment policies, procedures and forms.

(2) Prior to enrollment in the program, an admission assessment must be done for each youth by a program professional staff member. This admission assessment must include a review of the youth's social history, psychological history, medical history and physical examination. The assessment must review the following topics:

(a) allergies;

(b) medications;

(c) a record of immunizations as defined in ARM 37.114.701, 37.114.702, 37.114.704, 37.114.705, 37.114.708, 37.114.709, 37.114.710, 37.114.715 and 37.114.716;

(d) hospitalizations;

(e) medical diagnoses;

(f) medical problems that run in the family;

(g) pregnancy status and any complications;

(h) special dietary needs;

(i) illnesses;

(j) injuries;

(k) dental problems;

(l) mental health issues;

(m) emotional problems;

(n) ongoing medical care needs;

(o) history of aggressive or violent behavior;

(p) substance abuse history;

(q) sexual history or behavior patterns that may place the youth or other youth at risk;

(r) known or suspected suicide or self-injury attempts or gestures;

(s) emotional history indicating a predisposition for self-injury or suicide; and

(t) history of fire setting.

(3) The program shall establish a minimum body mass index. Body mass for each youth must be assessed to assure that the youth has sufficient body mass to fully participate in the strenuous elements of the program.

(4) A program professional staff member shall determine at the time of admission if the youth is currently appropriate for placement in the program. The youth may not be admitted if the youth:

(a) is determined to be an unsuitable candidate because of a limiting medical factor;

(b) requires secure psychiatric attention;

(d) is an imminent risk of being a danger to self or others.

(5) A subsequent assessment must be done before the youth leaves for the expedition portion of the program. The subsequent assessment must include the following evaluations:

(a) Each youth must be observed by an appropriate program professional staff member trained to identify noticeable evidence of any illness, communicable disease or signs of abuse.

(b) Youths that have special medications or treatment procedures, dietetic restrictions, known allergic reactions or any known physical limitation must meet with senior field staff and an appropriate program professional staff member to define special needs and services required while on expedition. On the basis of this evaluation, the program professional staff member shall decide whether the youth will be allowed to enter the expedition portion of the program. A written summary of this evaluation, including special needs of the youth and services required of the expedition staff, must be placed in the youth's file before the youth enters the field.

(c) For a youth with a history of mental illness, a psychological assessment must be prepared by an appropriate program professional staff member prior to the youth's entrance into the expedition portion of the program. On the basis of this psychological assessment, the program professional staff member shall decide whether the youth will be allowed to enter the expedition portion of the program. A written summary of this assessment, including special needs of the youth and services required of the expedition staff, must be placed in the youth's file before the youth enters the field.

(d) The senior field staff member assigned to the outdoor experience shall interview the youth prior to entrance into outdoor activities to determine the youth's suitability for planned outdoor activities. On the basis of this evaluation, the senior field staff member shall decide whether the youth will be allowed to enter the expedition portion of the program. A written summary of this evaluation must be placed in the youth's file before the youth enters the field.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.707 Development and Content of the Case Plan

(1) A case plan for each youth must be developed within 14 days of admission and prior to entering into the expedition portion of the program. The case plan team must include at minimum the appropriate members of the program professional staff and the field director. Members of the case plan team shall develop and sign the case plan. The youth's parent, guardian and/or the placing agency staff, along with the youth, if appropriate, must be encouraged to participate in the development of the case plan

(2) The case plan must address, at a minimum, the following:

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

(b) behavior management issues;

(d) addictive disorder treatment methods;

(e) education plans;

(f) measurable goals and objectives;

(g) the responsibilities of the youth and staff for meeting the goals and objectives;

(h) the minimum number of hours per week the youth will receive individual and/or group counseling;

(i) discharge and aftercare planning, to include referrals to other agencies;

(j) type and frequency of therapeutic intervention activities;

(k) interventions to be used should the youth refuse to participate in any prescribed activity; and

(l) interventions to be used should the youth become a danger to self or others.

(3) The case plan must be reviewed and updated by the case plan team every 90 days or whenever there is a significant change in the youth's condition. The youth's parent, guardian, and/or the placing agency must be informed that case plan reviews are available for inspection.

(4) Copies of the case plan must be provided to the senior field staff and placed in the youth's file immediately upon completion or update.

(5) Copies of the case plan must be sent to the placing agency, and to the parents or legal guardians within 10 days of completion or update.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.715 Discharge Summary

(1) Within 10 business days of the discharge of a youth from the program, a discharge report must be completed, including:

(a) a written summary of services provided, the youth's participation and progress, results of evaluations, condition of the youth, briefings and debriefings, compliance with program policies, procedures and recommendations; and

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

(2) The original discharge report must be maintained by the program in the youth's file, and a copy shall be provided to the placing agency and to the parents or legal guardians within 10 days of completion.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.8 Program Policy Requirements

Mont. Admin. R. 37.98.801 Behavior Management Policies

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

(2) The program shall document that a copy of the written policies has been provided and explained to each youth. A copy of the policies must also be provided to parents, guardians and referral sources upon request.

(3) The behavior management policies must prohibit:

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

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

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

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

(f) locked confinement or seclusion;

(g) withholding of necessary food, water, clothing, shelter, bedding, rest, medical care or toilet use;

(h) denial of visits or communication with the youth's family as punishment or discipline. Visits or communication with the youth's family may be limited as specified in the program's design and planned activities, in accordance with the youth's service plan, or by court order;

(i) isolation as punishment, except as provided for in the time out provisions of ARM 37.98.803; and

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

(4) If program policies allow for disciplining a group of youth for actions of one youth, the organization's policies and procedures for behavior management or discipline must clearly prescribe the circumstances and safeguards under which disciplining the group is allowed.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.802 Use of Nonviolent Crisis Intervention Strategies

(1) The program shall have written policies and procedures governing the appropriate use of nonviolent crisis intervention strategies, including:

(a) the use of de-escalation techniques;

(b) physical assists; and

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

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

(b) Appropriate use of physical assists occurs when staff members physically aid, support or redirect youth who are not physically resisting. Physical assists include staff leading youth along the trail or moving youth to his or her campsite by gently pulling on a backpack strap, guiding him or her by the hand or elbow, or placing a hand on the youth's back. If a youth resists reasonable staff direction, staff must assess whether the use of physical restraint is warranted based on the program's written physical restraint policy.

(c) Physical restraint must be used to safely control a youth until he or she can regain control of his or her own behavior. Physical restraint must only be used in the following circumstances:

(i) when the youth has failed to respond to de-escalation techniques and/or physical assists;

(ii) when necessary to prevent harm to the youth or others, or to prevent the substantial destruction of property; or

(iii) when a youth's behavior puts himself/herself or others at substantial risk of harm and he/she must be forcibly moved.

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

(e) Physical restraint may be used only by employees documented to have been specifically trained in nonviolent crisis intervention techniques.

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

(g) Program policies must require documentation of:

(i) the behavior which required the physical restraint;

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

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

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

(v) the type of physical restraint used;

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

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

(h) Program policies must require that whenever a physical restraint has been used on a youth more than two times in one week, there is a review by lead clinical staff members to determine the suitability of the youth remaining in the program, whether modification to the youth's plan are warranted, or whether staff need additional training in alternative therapeutic behavior management techniques. The program shall take appropriate action as a result of the review.

(3) The program shall train staff in the therapeutic de-escalation of crisis situations provided through a nationally recognized training system to ensure the protection and safety of the youth and staff. The training must include the use of physical and non-physical methods of managing youth, and must be updated at least annually to ensure the maintenance of necessary skills.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.803 Time Out

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

(2) A staff member must be designated to be responsible for visually observing the youth at random intervals at least every 15 minutes.

(3) For each time out, a report must be written and placed in the client's file in sufficient detail to provide a clear understanding of the occurrence or behavior which resulted in the youth being placed in time out, and staff's attempts to help the youth avoid time out.

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

(5) If there are more than 10 one hour time outs for a youth in a 24-hour period, or the separation lasts for 24 hours, appropriate lead clinical staff members must conduct a review to determine the suitability of the youth remaining in the program, whether modifications to the youth's plan are warranted, and whether staff need additional training in alternative therapeutic behavior management techniques. The results of the review must be documented and placed in the youth's file. The program shall take appropriate action as a result of the review.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.806 Animals and Pets

(1) A program may make use of domesticated animals or pets as part of a youth's treatment plan, provided that animals and pets are vaccinated, free from disease, not a danger to the youth, and cared for in a safe and clean manner. The program shall have documentation of current vaccinations, including rabies, as appropriate for all animals and pets.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.811 Potential Weapons

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

(2) Firearms must not be allowed in programs.

(3) Program staff shall inventory knives, hatchets, other edged tools or any item which might pose a danger to youth and complete a daily count of these items against the inventory. Program staff shall supervise youth possession and use of knives, hatchets, other edged tools or any item which might pose a danger to self or others.

(4) Large animal repellants must be stored under lock and key when not being carried by program staff, and be safeguarded from youth. Youth shall only use large animal repellants under the supervision of staff.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.812 Contraband

(1) A program shall define prohibited contraband in a written policy.

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

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

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.813 Program Requirements: Searches

(1) The provisions of this rule apply to all searches by program staff of youth and their personal property, including searches of personal correspondence.

(2) Youth may not be subjected to a search of the youth's person, personal property or correspondence unless there is reasonable cause to believe that the search will result in discovery of contraband, or unless there is reasonable cause to believe that the search is necessary to alleviate a threat of harm to the youth, other youths, or staff. The facts and circumstances supporting a determination of reasonable cause for the search must be documented in the youth's file.

(3) Any correspondence search must be conducted in the presence of the youth.

(4) The program shall adopt policies relating to searches, including pat down searches, personal property searches and correspondence searches. The policies must include the following:

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

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

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

(a) strip searches;

(b) body cavity searches; or

(6) Youth may be not subjected to urinalysis testing unless the testing has been ordered by a court, is required pursuant to a case plan for monitoring drug or alcohol use, as approved by the parent or legal guardian, or requested by the youth's parent or legal guardian. The following requirements must be met by the program utilizing urinalysis testing:

(a) Prior to any testing, the program shall adopt policies which address, at a minimum, procedures for obtaining samples for urinalysis testing.

(b) Staff shall document compliance with program policies in connection with each testing.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.10 Program Emergency and Health Provisions

Mont. Admin. R. 37.98.1001 Emergency and Evacuation Plans

(1) A program shall have and follow a written emergency plan developed in conjunction with emergency services in the community which provides specific procedures for evacuations, disasters, medical emergencies, hostage situations, casualties, missing youth and other serious incidents identified by the program.

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

(a) designation of authority and staff assignment;

(b) a specific evacuation plan;

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

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

(f) provisions for arranging medical care and notifying a youth's physician and parent or guardian.

(3) When youth are on an expedition:

(a) Emergency plan drills must be practiced with youth and staff immediately upon entering the outdoor location and monthly thereafter. Results of the drill must be recorded, showing date, time, staff and youth present with problem areas noted in the log.

(b) A program shall have support vehicles for transport of youth from expedition sites during emergencies. The support vehicles and field office must be equipped with first aid equipment.

(c) A program shall have provisions for notifying the field office about the nature of the emergency and an accounting of each participant's location and status.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1003 Health Care

(1) Medical, dental, psychiatric, psychological, chemical dependency care and counseling must be obtained for the youth as needed.

(2) Each youth in care must receive an annual physical examination.

(3) Each youth in care must receive an annual dental examination.

(4) Provisions for treatment of diseases, remedial defects or deformities, and malnutrition must be made by the program immediately upon the physician's recommendation with notification of the placing agency and parent or legal guardian.

(5) The program shall develop and follow written policies and procedures to keep youth healthy while in the program. Medical care must be provided to all youth as needed and must be documented in the youth's case records. A signed release for emergency medical treatment from the parent or guardian must be documented in the youth's file.

(6) First aid treatment must be provided in as prompt a manner as the location and circumstances allow.

(7) The program shall transport any youth with an illness or physical complaint that needs immediate care or treatment to appropriate medical care.

(8) Complaints or reports by a youth of illness and injuries must be documented in a daily log along with any treatment provided.

(9) There may not be any negative consequence imposed on a youth for reporting an injury or illness or for requesting to see a health care professional.

(10) Youth must be instructed and monitored regularly by staff in matters of personal hygiene.

(11) The program shall develop and follow written policies and procedures governing emergency medical and dental care.

(12) The program shall develop a written plan to prohibit:

(a) the use of tobacco, alcohol or illegal drugs by youth; and

(b) all use of tobacco, alcohol or illegal drugs by employees, volunteers and visitors in any program building or vehicle used by youth and in the presence of youth.

(13) A program shall develop and follow written policies and procedures governing all aspects of suicide prevention and intervention, which must meet the following criteria:

(a) The suicide prevention and intervention policies must be reviewed and approved by professional staff members.

(b) All staff with responsibility for the supervision of youth must be trained in the implementation of the policies. Documentation of training must be in the staff personnel file.

(14) Depending on the length of the program and/or whether these needs have been documented to have been met elsewhere, youth must receive age-appropriate health education and instruction regarding teen pregnancy prevention, HIV education and prevention and general information about the prevention and treatment of sexually transmitted diseases. The program shall be in compliance with federal and state guidelines governing sexually transmitted diseases.

(15) Staff must be trained to recognize eating disorders. This training must be documented in staff records. If the staff suspects the youth has an eating disorder, staff shall report the suspicions immediately to the appropriate program professional staff members.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1004 Infection Control

(1) Each program shall provide, develop and implement an effective infection prevention and control program. The program must develop policies and procedures to evaluate all factors, including, although not limited to, risk evaluations, education and TB screening of employees and residents. The decision to perform regular repeat testing of some employees or residents must be based on data from within the facility, the risk associated with certain procedures performed and the number of infectious cases reported within the county and state.

(2) A program shall provide a sanitary environment to avoid sources and transmission of infections which must include:

(a) separation of infected individuals from other group members;

(b) notification of a parent or legal guardian;

(d) notification or consultation with the program's medical director; and

(e) proper disinfection of all items used by the infected individual before use by any other person.

(3) A program shall maintain a record of incidents and corrective actions related to infections.

(4) A program shall prohibit staff with symptoms or signs of a communicable disease from direct contact with the youth and their food.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1005 Medication Storage and Administration

(1) A program shall have and follow policies and procedures regarding the storage, administration and disposal of prescription and nonprescription medication.

(2) Prescription and nonprescription medication must be stored under lock and key and safeguarded from youth in their original containers, labeled with the original prescription label. For medications taken on field outings, all medication must be in the possession of a staff member qualified to assist with the self administration of medications.

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

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

(5) Psychotropic medication is prohibited unless a licensed health care professional working within the scope of his or her practice determines that the medications are clinically indicated. Under no circumstances may psychotropic medication be given for disciplinary purposes, for the convenience of the staff, or as a substitute for appropriate treatment services.

(6) There must be a written record of all medications self administered by a youth. The record must include:

(a) youth's name;

(b) name and dosage of the medication;

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

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

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

(8) All unused and expired medication must be disposed of. The disposal of unused medication must be done by two licensed health care professionals, and the disposal must be recorded in a medication destruction log.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1010 Safety Policy

(1) A program shall have appropriate written safety procedures and equipment.

(2) Each youth must have instruction on environmental hazards and precautions.

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

(a) be readily available on site as well as in all vehicles;

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

(d) be reviewed at least annually by the field director with all staff for contents and use; and

(e) be inventoried by the field director after each expedition and restocked as needed.

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

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

(a) All medicines, alcohol, detergents, chemical sanitizers and related cleaning compounds and other chemicals must be stored in a safe location that is inaccessible to youth.

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

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

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

(6) Emergency information for youth must be easily accessible at the field office and on an expedition. Emergency information for each youth must include:

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

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

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

(d) a copy of the youth's most recent health examination;

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

(f) a copy of the youth's current medical insurance card.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1016 Transportation

(1) Any person transporting youth must possess a valid Montana driver's license for the type of vehicle used in transporting the youth.

(2) Any person transporting youth must comply with applicable traffic laws while transporting youth.

(3) The vehicle used in transporting youth must at a minimum:

(a) have proper Montana registration;

(b) have insurance coverage;

(d) be equipped with a red triangle reflector device for use in a emergency; and

(e) be equipped with a first aid kit.

(4) The driver and all of the passengers must ride in a vehicle manufactured seat. Each person shall use a seat belt.

(5) No person can ride in the bed of or on the back of a truck.

(6) Youth may ride in a snowmobile or on a sled pulled by a snowmobile driven by a staff member. The youth must wear a helmet and be instructed on safety procedures.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.12 Youth Rights and Care Program Requirements

Mont. Admin. R. 37.98.1201 Therapeutic Treatment Program

(1) A program shall provide therapeutic treatment to youth.

(2) A program shall appoint one or more lead clinical staff (LCS) members from the licensed mental health professionals of the program as professional staff.

(3) Each LCS shall be responsible for no more than 16 youth.

(4) The LCS must oversee all therapeutic treatment needs for the youth which at a minimum shall consist of:

(a) one individual treatment session per week per youth;

(b) two group treatment sessions per week per youth;

(d) family therapy when appropriate.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1202 Social Services

(1) A program shall employ an adequate number of trained professionals to provide the following services for each youth in care:

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

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

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

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

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

(2) Those persons providing social services shall meet the following qualifications in addition to the general qualifications for direct care staff:

(a) have a bachelors degree in a behavioral science and experience in areas related to youth care or services;

(b) have two years of equivalent social services experience for each year of college education; or

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1203 Care and Guidance

(1) A program shall provide to each youth in the program the following:

(a) appropriate personal care, supervision and attention;

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

(2) A program shall ensure the following practices:

(a) cooperation with the placing agency and participation in case conferences; and

(b) cooperation with the placing agency in arranging for contact with each youth's own family when appropriate.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1204 Nutrition

(1) A program shall serve three regular, well balanced meals per day and snacks. The meals and snacks must be appropriate to the nutritional needs of the youth and must include the four basic food group requirements.

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

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

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

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

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

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1208 Religion and Culture

(1) The program shall provide youth with a reasonable opportunity to practice their respective religions. Youth must be permitted to have religious materials of their choice.

(2) The program shall document giving encouragement and opportunity to each youth to identify with his or her cultural heritage.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1209 Personal Needs

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

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

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

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1210 Privacy and Individualism

(1) A program shall allow youth to have privacy.

(2) A program shall provide a separate bed, separate storage space for clothing and personal articles, and a place for each youth to display his or her socially appropriate creative works and symbols of identity.

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

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1215 Money

(1) Money earned by a youth or received as a gift or allowance must be part of the youth's personal property and accounted for separately from the program funds.

(2) If the program is partly supported by institutional production on a commercial basis, compliance with state and federal child labor laws and minimum wage laws must be assured.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1216 Training and Employment

(1) For youth age 16 and older a program may assist in:

(a) preparing youth for economic independence; and

(b) obtaining the skills necessary for employment as determined to be appropriate to meet the individual's needs. Such skills include:

(i) completing applications;

(ii) personal appearances for employment situations;

(iii) attitudes toward employment; and

(iv) interviewing for jobs.

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

(3) Youth may be given an age appropriate, non-vocational work assignment within the youth's capabilities as a constructive experience. The work assignment must be in compliance with all state and federal labor laws.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1220 Youth Orientation

(1) A program shall have a written orientation policy for admission to the program including:

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

(b) inventory of each youth's belongings;

(d) information on privilege systems;

(e) health and safety procedures;

(f) program rules;

(g) information on intrusive measures; and

(h) emergency evacuation procedures, including escape routes.

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

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1221 Placement Agreements

(1) When a youth is admitted to a program, the program shall enter into a written placement agreement with the placing agency.

(2) The placement agreement must set forth the terms of the youth's placement, the responsibilities of the program, the placing agency's responsibilities and, when appropriate, the parent's responsibilities.

(3) No youth from out-of-state shall be accepted into the program without the approval of the interstate compact administrator pursuant to 41-4-101 through 41-4-109 , MCA.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1225 Education

(1) A program shall provide an educational program appropriate to the needs of each youth and in compliance with compulsory school attendance laws. However, no youth shall receive special education services until a child study team (CST) has performed an appropriate comprehensive assessment which yields evidence that the youth has learning and/or behavioral problems requiring a specialized service not offered by the regular school program. Any youth who is receiving special educational services must have an individualized education program (IEP) in accordance with ARM 10.16.3340.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1226 Recreation

(1) The program may have an on grounds recreation program that is operated by the program's staff. However, when available, the program shall provide the youth access to community recreation and cultural events when they are appropriate to the youth's needs, interests and abilities.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.15 Residential Outdoor Services

Mont. Admin. R. 37.98.1503 Residential Outdoor Services: Fire Safety Requirements

(1) Residential outdoor services programs shall comply with all fire, life safety, and building regulations as determined by the local building official and fire authority for all buildings serving youth.

(2) Residential outdoor services programs shall have an annual fire inspection conducted by the appropriate local fire authority or the state fire marshal's office for all buildings serving youth. The program shall maintain a record of such inspection for at least three years following the date of the inspection.

(3) All exits must be marked and be clear and unobstructed at all times.

(4) Paint, flammable liquids and other combustible material must be kept in locked storage away from heat sources or in outbuildings not used by the youth.

(5) Residential outdoor services staff and residents must be instructed during orientation in the procedure for evacuation in case of fire. The procedure and evacuation maps must be posted in conspicuous places.

(6) Residential outdoor services programs shall conduct evacuation and disaster drills and document results in a program file. The documented results must include but are not limited to the following:

(a) date and time of the drill;

(b) the names of staff involved in the drill;

(d) the names of other persons involved in the drill;

(e) a description of all phases of the drill procedure and suggestions for improvement; and

(f) the signature of the person conducting the drill.

(7) Fire drills for residential outdoor services in all buildings serving youth must include the transmission of fire alarm and simulation of emergency fire conditions. Drills must be conducted quarterly on each shift to familiarize staff with the signals and emergency action required under varied conditions. When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement may be used instead of an audible alarm.

(8) Smoke detectors approved by a recognized testing laboratory must be located at stairways and in any areas requiring separation as set forth in the uniform building codes.

(9) Smoke detector batteries must be checked by the residential outdoor services staff at least once each month and the batteries replaced at least once each year. The date and signature of the person checking the batteries in the smoke detector must be recorded and filed at the program office.

(10) A fire extinguisher approved by a recognized testing laboratory with a minimum rating of 2A10BC must be located on each floor of any residential outdoor services building.

(11) A fire extinguisher approved by a recognized testing laboratory with a minimum rating of 2A10BC must be readily accessible to the kitchen area.

(12) Fire extinguishers must be checked by the residential outdoor services staff at least quarterly. The date and signature of the person checking the fire extinguisher shall be recorded on the attached tag. Portable fire extinguishers must be inspected, recharged and tagged at least once a year by a person certified by the state to perform such services.

(13) Residential outdoor services staff must be trained in the proper use of the fire extinguisher and the training recorded in the files.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1504 Residential Outdoor Services: Water

(1) A residential outdoor services program shall provide an adequate and potable supply of water. The residential outdoor services program shall:

(a) connect to a public water supply system approved by the Montana Department of Environmental Quality; or

(b) if a nonpublic water system is used by a residential outdoor services program, the water system must comply with the standards outlined in Department of Environmental Quality circular 3 (DEQ-3) and Department of Environmental Quality circular 4 (DEQ-4) . The department adopts and incorporates by reference department of environmental quality circular 3 (DEQ-3) (2002) and department of environmental quality circular 4 (DEQ-4) (2002) . Copies may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

(2) When a nonpublic water supply is used, the residential outdoor services program shall submit a water sample at least quarterly to a laboratory licensed by the department of environmental quality in order to determine that the supply does not contain microbiological contaminants.

(3) The water system must be repaired or replaced if the supply:

(a) contains unacceptable levels of microbiological contaminants; or

(b) does not have the capacity to provide adequate water for drinking, cooking, personal hygiene, laundry, and water-carried waste disposal.

History

Authorizing statute(s): 50-5-220, MCA
Implementing statute(s): 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1505 Residential Outdoor Services: Sewage and Waste Disposal

(1) To ensure sewage is safely disposed of, the residential outdoor services program shall either:

(a) connect to a public sewer approved by the Montana department of environmental quality; or

(b) connect to a private septic system that is approved by the local sanitarian.

(2) The sewage system must be repaired or replaced whenever:

(a) it fails to accept sewage at the rate of application;

(b) seepage of effluent from or ponding of effluent on or around the system occurs;

(d) a mechanical failure occurs.

(3) Residential outdoor services programs shall:

(a) store all solid waste in containers which have lids and are corrosion-resistant, fly tight, watertight, and rodent-proof;

(b) clean all solid waste containers frequently; and

(c) transport or utilize a private or municipal hauler to transport the solid waste at least weekly to a landfill site approved by the department of environmental quality in a covered vehicle or covered containers.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1506 Residential Outdoor Services: Physical Environment

(1) A residential outdoor services program shall provide a minimum of 10 foot-candles of light in all rooms and hallways, with the following exceptions:

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

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

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

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

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

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

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

(6) The program shall provide:

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

(b) one bathing facility for every six residents.

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

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

(9) Bathrooms must have a toilet with a sink in each toilet area. The toilet and sink must be cleaned thoroughly with a germicidal cleaner at least weekly and more often if needed.

(10) Hot and cold water must be available. Water temperature for hot water must be limited to 120° F or below.

(11) A washing machine and dryer must be available.

(12) The program shall have a telephone. Telephone numbers of the hospital, police department, fire department, ambulance, and poison control center must be posted by each telephone. Telephone numbers of the parent(s) and placing agency must be readily available.

(13) A program shall provide ongoing appropriate maintenance of program buildings.

(14) A program shall ensure its facilities, buildings, homes, equipment, and grounds are clean and maintained in good repair at all times for the safety and well being of youth, staff and visitors. Program buildings may not have any peeling paint, cracked mirrors, broken furniture or damaged floor covering.

History

Authorizing statute(s): 50-5-220, MCA
Implementing statute(s): 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.17 High Adventure Requirements

Mont. Admin. R. 37.98.1701 Outdoor Behavioral Program: High Adventure General Requirements

(1) High adventure activities may include the following:

(a) target sports;

(b) aquatics;

(d) adventure challenge courses;

(e) climbing and rappelling;

(f) all season camping;

(g) soloing;

(h) spelunking;

(i) expeditioning;

(j) swimming in a river, stream, lake or pond;

(k) white water activities;

(l) animal related activities;

(m) skiing;

(n) orienteering;

(o) trampoline; or

(p) other activities approved by the department.

(2) For the high adventure activities identified in (1) and for any activity identified by the program or the department as a high adventure activity, the program shall adopt and follow written policies and procedures that address:

(a) minimum training, experience and qualifications for leaders and staff which must be documented in personnel records;

(b) specific staff-to-participant ratios appropriate to the activity;

(d) arrangement, maintenance and inspection of the activity area;

(e) appropriate equipment and the inspection and maintenance of the equipment;

(f) safety precautions to reduce the possibility of an accident or injury; and

(g) an explanation of the purpose of each high adventure activity.

(3) A program shall designate a high adventure activity leader for each expedition or high adventure outing or activity. The high adventure leader must be at least 21 years of age and have documented training and experience for conducting the specific activity. Training and experience must be documented and kept on file for each high adventure leader.

(4) High adventure activity policies and procedures must comply with the minimum standards required by other rules in this subchapter pertaining to the specific high adventure activities.

(5) Youth may not be forced to participate in any high adventure activity.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1703 High Adventure Requirements: Swimming

(1) All swimming activities must be supervised by a swimming supervisor who, at a minimum, holds a current American red cross life guard training certificate or equivalent, such as a YMCA or boy scout aquatics instructor's certificate. If the program is offering swimming instruction, the swimming supervisor must also hold an American red cross water safety instructor certificate or equivalent.

(2) At any time the swimming area is open, there must be at least one staff member for each 10 youths in the water present at the swimming area. At all times, at least one staff member who holds a current American red cross life guard training certificate or equivalent, such as a YMCA or boy scout aquatics instructor's certificate, must be present for each 30 youths in the water.

(3) The swimming area must be off limits when the required numbers of qualified staff members are not present.

(4) If the program uses a pool for which the program is not responsible, the program need not provide a lifeguard if there is a qualified lifeguard provided by the pool. There must be at least one program staff member at the pool for each 10 youths in the water.

(5) Swimming area rules and emergency procedures must be posted in a visible location at the swimming area.

(6) The swimming pool or swimming area must be in compliance with all applicable provisions of Montana law.

(7) If youths are permitted to swim in a lake or pond, the swimming areas must be clearly designated.

(8) Before youths are permitted to swim in deep water, swimming skills must be tested by properly trained staff members.

(9) There must be a system known to youth and lookout staff for checking the youth when youths are in the water.

(10) The following equipment must be available for use at the pool side or the lake shore in which swimming is permitted:

(a) a rescue tube;

(b) a reach pole; and

(11) Where the size of the body of water makes it impossible to reach victims by a reach pole, rescue tube or other rescue device, a rescue boat shall be available at all times.

(12) If a program has shoreline activities such as wading, fishing, ecology or nature studies, the program must have a written policy which defines qualifications of persons accompanying the group and safety factors to be followed. Staff members must be acquainted with the policy.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1705 High Adventure Requirements: Boating, Canoeing, Sailing, Tubing, Kayaking and White Water Rafting

(1) All boating, canoeing, sailing, tubing, kayaking and white water rafting activities must be supervised by a boating supervisor meeting the following qualifications:

(a) a current American red cross life guard training certificate or equivalent, such as a YMCA or boy scout aquatics instructor's certificate; and

(b) a basic small craft certificate for the type of craft which is to be supervised.

(2) Other staff members present during boating, canoeing, sailing, tubing, kayaking and white water rafting activities must have appropriate experience and training for the type of craft to be utilized.

(3) Whenever youths are on the water they must be wearing a United States coast guard approved personal flotation device appropriate to the weight of the youth.

(4) The boating supervisor shall determine the number and location of lookout staff necessary to protect the safety of the youths, taking into consideration such factors as the type of activity and water craft, the size and condition of the body of water, water temperature, and the skill of the youths involved, provided that, at a minimum, two lookout staff members shall always be present on the shoreline or in the water.

(5) At no time may the occupancy of any craft exceed the capacity established for the craft by the United States coast guard standards.

(6) There must be a warning device, such as a loud whistle, air horn, or other audible signal device, which can readily be heard or seen by persons on the water that indicates the need for youths and staff to return to the shore.

(7) As determined by the boating supervisor, there must be a rescue boat in close proximity to where the activity takes place in accordance with the size and depth of the body of water. This rescue boat shall be in good repair and shall contain a rescue tube, reach pole and an extra oar or paddle.

(8) Water craft may not enter a swimming area when swimmers are in the water unless the craft is utilized in rescue operations.

(9) The following requirements are specific to canoeing, tubing or kayaking on moving water:

(a) Canoeing, tubing or kayaking must be limited to class II or less water (as defined by the international scale of river difficulty) .

(b) Supervising staff must be experienced and knowledgeable about the river being used, including the height and speed of the river.

(c) The program shall develop and follow a written policy on evaluating the safety of the river. Supervising staff must be trained on the policy.

(d) The supervisor must be familiar with rescue techniques with canoes, kayaks and tubes on moving water and shall train youths in these techniques.

(e) Rescue equipment appropriate to the activity must be available, such as rope throw bag and rescue tubes.

(10) The following rules are specific to white water rafting:

(a) White water rafting must be limited to class III or less water. Rafting on class IV water is prohibited.

(b) Supervising staff must be experienced and knowledgeable regarding white water rafting and about the river being used, including the height and speed of the river.

(d) Rescue equipment appropriate to the activity must be available, such as rope throw bag and rescue tubes.

(e) There must be sufficient food storage, adequate to keep food dry and large enough to store food for the size of the raft and the length of the trip.

(f) Waterproof dunnage bags must be provided for passengers and be secured to the raft.

(g) A youth must be at least 50 pounds to ride a paddle raft or an oar raft in a class III river.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1707 High Adventure Requirements: Archery

(1) All archery activities must be supervised by an experienced archery supervisor.

(2) The archery range must be free from hazards and well marked. There must be a clear path to the target which is not obstructed by such things as rocks, trees or branches. Traffic, trail or other program activities may not be placed in the direction of the flight of the arrows.

(3) Equipment must be maintained in safe condition. Bows and arrows must be inspected for fractures, splinters or cracks before each use. Damaged bows and arrows may not be utilized.

(4) Equipment must be stored under lock and key when not in use. Bows and arrows must be used only in the specified archery area.

(5) All archers shall use the same firing line. Arrows must be issued only at the firing line.

(6) Arrows must be nocked to bow string after shooters are on the firing line and after the signal to shoot has been given.

(7) Before arrows are released, shooters must have a definite target.

(8) Movement must be controlled by a supervising staff member. All persons shall stay behind the firing line until the signal to retrieve arrows is given. All arrows must be retrieved at the same time.

(9) If the program has field archery, a procedure must be established and posted to provide for the safety of the archers, including issuance of arrows at the check-in point of the archery trail, the check in of an archer at the beginning of the archery trail and the check out when archer has completed the trail.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1709 High Adventure Requirements: Horseback Riding

(1) All horseback riding activities must be supervised by a horseback riding supervisor who must have at least one of the following:

(a) a certificate from a nationally recognized horseback riding organization or riding school; or

(b) written verification of successful experience in formal horseback riding instruction or equivalent horseback riding experience.

(2) The horseback riding supervisor shall train a sufficient number of riding staff members in the supervision of youth in the horseback riding program for the anticipated size of the riding program.

(3) Riding staff must be trained by the horseback riding supervisor in emergency procedures appropriate to the horseback riding activity.

(4) Any trail excursion must comply with the following:

(a) At least two trained riding staff members, one of whom holds a current American red cross community first aid and safety certificate or equivalent, shall accompany each trail excursion.

(b) If the horseback ride is for seven or more nights or is more than one hour away from emergency medical services, there must be at least one staff member with each group of youth with wilderness first responder training, CPR and medication administration training.

(c) If more than 20 youth participate in the trail excursion, in addition to the two trained riding staff members required by (4) (a) , there must be an additional trained riding staff member assigned for each additional 10 or fewer riders.

(5) First aid supplies must be carried on each trail excursion and available at each horseback riding ring/arena.

(6) No person is allowed in the riding area unless the horseback riding supervisor or a trained riding staff member is present.

(7) The riding supervisor shall determine each youth's riding experience and level of skills and shall take these into account in assigning which horse each youth should ride and determining the type of riding activity in which each youth should engage.

(8) Youth must be given instruction in basic safety, which must include at least the following:

(a) riding rules in the ring and on the trail; and

(b) how to approach, mount and dismount.

(9) Youth must be appropriately dressed for riding, including wearing appropriate shoes or boots. The riding supervisor shall evaluate the footgear of each youth and make the stirrups safe for each youth's shoe or boot.

(10) Helmets are mandatory for youths engaged in ring riding and trail rides.

(11) The horseback riding equipment must be in good condition, properly sized and adjusted for each rider.

(12) The horse barn or stable, ring and commonly used trails must be in good repair and free of dangerous obstructions.

(13) Horses must be cared for with evidence of an adequate feeding schedule and a means to care for sick horses.

(14) Horses may not be permitted in the other designated activity areas.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1711 High Adventure Requirements: Trampoline

(1) All trampoline activities must be supervised by a trampoline supervisor who shall have documented formal training and experience in the use of trampoline and be knowledgeable about safety and spotting techniques.

(2) Trampolines must be equipped with pads along the sides, which must be kept in good repair.

(3) No person may be on the trampoline unless a trampoline supervisor is present and spotters are present on all four sides of the trampoline. If youth are utilized as spotters, the youth must be of sufficient age and physical size to be effective as spotters, and they must be instructed by the trampoline supervisor regarding what is expected. Spotters may not stand, sit or lie on the trampoline, but they must stand in a position of readiness, watching the jumper at all times.

(4) Trampolines must be secured from unauthorized use by any person.

(5) The youth may dismount the trampoline by sitting on the edge and sliding off. No youth shall jump off the trampoline.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1713 High Adventure Requirements: Requirements for All Rock Climbing

(1) All rock climbing activities must be supervised by a climbing supervisor meeting the requirements of this rule and ARM 37.98.1715 and 37.98.1717. The climbing supervisor must be assisted by climbing instructors meeting the requirements of this rule and ARM 37.98.1715 and 37.98.1717.

(2) The following requirements apply to all rock climbing activities:

(a) Prior to participating in rock climbing, all youth must be instructed in the care and use of basic equipment, knots, anchors and belays, verbal signals, safety measures, basic climbing holds and moves, and techniques of rappelling.

(b) The climbing supervisor and at least one climbing instructor must be present at the climbing site during all climbing activities.

(d) A staff member who holds at least a current American red cross community first aid and safety certificate or equivalent shall be present at the climbing site.

(e) First aid supplies, put together by a person knowledgeable in first aid supplies needed for climbing activities and possible injuries, must be present at the climbing site.

(f) No youth may be forced to participate in climbing activities.

(g) The climbing supervisor shall be responsible for the proper maintenance of all equipment used. Equipment must be checked by the supervisor immediately prior to use.

(h) All rock climbing equipment must meet industry standards and must be maintained, visually and physically inspected and replaced on a timely basis.

(i) Climbers shall wear helmets at all times.

(j) The program may not permit an unsupervised climb.

(k) Youth must be connected to a safety rope during rock climbing.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1715 High Adventure Requirements: Basic/Single-Pitched Rock Climbing and Rappelling

(1) The following requirements apply to basic/single-pitched rock climbing and rappelling:

(a) The climbing supervisor and the climbing instructors must have verified knowledge of technical climbing by completion of a course, a climbing school or a minimum of 10 hours of instruction.

(b) Each rock climber must be visually supervised by the climbing supervisor or a climbing instructor.

(d) A belay must be used during rappelling, and all climbers must be belayed in a top rope manner by a climbing supervisor, climbing instructor or by another staff member trained by the climbing supervisor or a climbing instructor as a belayer.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1717 High Adventure Requirements: Advanced/Multi-Pitched Rock Climbing

(1) The following requirements apply to advanced/multi-pitched climbing:

(a) The climbing supervisor must:

(i) hold a current American red cross community first aid and safety certificate or equivalent and a current certificate for CPR;

(ii) have been an instructor, under supervision, for two seasons with verifiable experience and a review of any serious accidents;

(iii) have completed a technical climbing school or training in technical climbing with written evidence of such completion;

(iv) have led 10 additional multi-pitched class V climbs (as defined by the American alpine club) within the last two years; and

(v) have knowledge of mountain rescue techniques. If the climb is more than 60 minutes from emergency medical services, the climbing supervisor shall also hold a current wilderness first responder training certificate or equivalent.

(b) The climbing instructors shall:

(i) have the same training as the climbing supervisor;

(ii) have been an instructor, under supervision, for one season with verifiable experience and a review of any serious accidents;

(iii) have completed a technical climbing school or training in technical climbing;

(iv) have led five additional multi-pitched climbs; and

(v) have knowledge of mountain rescue techniques. No instructor may take youths on a climb the instructor has not previously completed.

(d) The climbing supervisor shall assess the ability of the youth as to the difficulty of the climb.

(e) There must be one rope leader to each three climbers in an extended climb.

(f) First aid equipment must be carried with the staff on each climb.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1719 High Adventure Requirements: Rope Courses

(1) All rope course activities must be supervised by a rope course supervisor with training and experience on the type of rope course being used. The rope course supervisor must hold a current American red cross community first aid safety certificate or equivalent. The rope course supervisor shall be present during all rope course activities.

(2) The program shall have written safety procedures for use of the rope courses. Staff must be trained on the safety procedures.

(3) Rope courses must be inspected annually by knowledgeable personnel.

(4) Bolts must be tight and cables must be in good condition at all times.

(5) Rope courses must be inspected before use by the rope course supervisor.

(6) The integrity of all the trees in the rope course must be inspected regularly.

(7) Ropes, cables and bolts must be maintained, visually and physically inspected and replaced on a timely basis.

(8) Youth shall wear helmets when using the rope course.

(9) Rope courses must be off limits to youth when a rope supervisor or rope instructor is not present.

(10) Access to rope courses must be controlled by education, signs and whatever other means are necessary to control unsupervised access.

(11) Youth must be connected to a safety rope during all activities on a rope course.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1721 High Adventure Requirements: Hiking and Backpacking

(1) All hiking or backpacking trips and activities shall be supervised by a hiking or backpacking supervisor meeting the requirements of this rule.

(2) The hiking or backpacking supervisor shall:

(a) hold a current American red cross community first aid and safety certificate or equivalent;

(b) have knowledge of outdoor experience and the symptoms and correct treatment procedures for hypothermia and dehydration; and

(3) All staff members involved in hiking or backpacking trips or activities shall:

(a) be trained by the supervisor concerning hypothermia and dehydration;

(b) have knowledge of the symptoms of hypothermia and dehydration and correct treatment procedures; and

(c) continually observe and monitor youths on the trail for early diagnosis and treatment of hypothermia and dehydration.

(4) When a group takes a hiking or backpacking trip where youth are away from the field office, there must be at least one staff member with each group of youth with:

(a) wilderness first responder training;

(b) CPR; and

(5) The hiking or backpacking supervisor shall consider the hiker's age, physical condition and experience, as well as the season, weather trends, evacuation and communication, and water quality and quantity when selecting the area for hiking or backpacking.

(6) Before participation in a hiking or backpacking activity, the youths must have a safety orientation and be instructed at a minimum on:

(a) the fundamental safety procedures on the trail;

(b) procedures for a hiker if they become lost;

(d) sanitation procedures on the trail;

(e) rules governing land to be hiked over;

(f) potential high-risk areas which may be found on the trail;

(g) fire danger precautions;

(h) flash floods;

(i) lightening dangers; and

(j) procedures when encountering wild animals.

(7) Each hiker or backpacker must be equipped with protective clothing and equipment against natural elements such as rain, snow, wind, cold, sun and insects.

(8) The hiking activity may not exceed the physical capability of the weakest member of the group.

(9) When a youth cannot hike, the group may not continue hiking unless it is necessary for compelling safety reasons.

(10) When a youth refuses to hike, a contingency plan, based on pre-approved polices and procedures, must be used. The plan must ensure that if the group is split, there is proper staff coverage for each group and communication between the groups is maintained.

(11) First aid supplies, assembled by a person knowledgeable in first aid supplies needed for hiking and backpacking activities and possible accidents or injuries, must be present on each hike or backpacking trip. The contents of each kit must be adequate for the number of youths, the terrain and the length of the hike or backpacking trip.

(12) An itinerary of the hiking or backpacking trip and a list of all people on the hike or backpacking trip must be kept at the field office.

(13) The program shall have written safety procedures for hiking and backpacking, including a written protocol for evacuating a youth that becomes sick or injured on a hike or backpacking trip. Staff and youths must be trained on the safety procedures and protocol.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1723 High Adventure Requirements: Bicycling

(1) All bicycling trips and activities must be supervised by a bicycling supervisor who meets the requirements and qualifications set forth in this rule.

(2) The bicycling supervisor must:

(a) be familiar with state laws about bicycling;

(b) be knowledgeable about the type of bicycling terrain where the bicycle trips will occur;

(d) be knowledgeable on making simple bicycle repairs; and

(e) hold at least a current American red cross community first aid and safety certificate or equivalent.

(3) A bicycling supervisor and at least one other staff member must accompany each bicycle trip. There must be one staff member at the beginning and end of each bicycle group.

(4) Each bicycler shall wear a helmet.

(5) Bicycles must be in good condition, properly maintained, inspected prior to each bicycling trip and adjusted to the size of the youth riding the bicycle.

(6) A bicycle repair kit and first aid equipment must be taken on each trip. The first aid supplies must be assembled by a person knowledgeable in first aid supplies needed for bike trips and possible accidents or injuries.

(7) The bicycling supervisor must instruct youths as to emergency procedures, safe riding practices and road and trail etiquette.

(8) The bicycling supervisor shall evaluate each youth as to his or her physical capabilities to participate in the planned bicycling trip, keeping in mind the trip length, terrain, altitude of the trip and weather conditions.

(9) Water/fluids must be taken on each bicycle trip.

(10) An itinerary of the biking trip and a list of all people on the biking trip must be kept at the field office.

(11) The program shall have written safety procedures of bike trips, including the written protocol for evacuating a youth that becomes sick or injured on a bike trip. Staff and youths must be trained on the safety procedures and protocol.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Subchapter 37.98.18 Expedition Requirements

Mont. Admin. R. 37.98.1801 Expedition: Field Office Requirements

(1) A program shall have a field office in Montana. A field office may be a vehicle, a camp, a building, or the administrative office.

(2) The field office must be staffed and monitored 24 hours a day when there are youth in care in the field office or on expeditions. Field office staff shall respond immediately to any emergency situation.

(3) When field office staff are not present in the field office, a contact satellite phone number for the responsible on call staff must be posted on the field office door. The field director shall designate responsible on call staff who shall continually monitor communications and will always be on call with a satellite phone within 15 minutes travel time of the field office.

(4) Field office staff shall be responsible for:

(a) training and orientation, management of field personnel, related files and records; and

(b) maintaining communications, equipment inspection and overseeing medical incidents.

(5) The following items must be maintained at the field office:

(a) current staff personnel files;

(b) a current list of the names of staff and youth in each field group;

(d) each group's expeditionary route with its schedule and itinerary, copies of which must be sent to the department and local law enforcement when requested;

(e) current logs of all communications with each field group away from the field office;

(f) an emergency response plan that is reviewed annually;

(g) program participant files, which include:

(i) youth case record including case plan;

(ii) admission and subsequent assessments;

(iii) physical examination completed as part of program admission process and any subsequent physical exams;

(iv) medical treatment authorization;

(v) list of current medications taken by the youth;

(vi) identifying marks of the youth such as scars, tattoos and piercings;

(vii) health insurance information; and

(viii) list of contact persons in case of emergencies.

(6) A program shall comply with federal, state and local laws and regulations and shall maintain proof of compliance at the field office. An arrangement must be made with national or state forest service offices if such land is to be used by the field office. If the field office or the expedition camp is located on or uses national or state lands, the administrator shall familiarize the staff and youth with rules and ethics governing the use of such property and shall be responsible for compliance.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1803 Expedition: Staff

(1) During any expedition:

(a) expedition staff shall carry a copy of the itinerary placed on file at the field office;

(b) expedition staff shall remain in contact with the field office via satellite phone, with contacts occurring at a minimum of once each morning and once each evening;

(d) supplies for providing emergency care must be at each expedition camp;

(e) expedition staff shall maintain the daily expedition log. Entries in the log must be made in permanent ink and signed and dated by the staff member making the entry. The daily expedition log must be filed at the field office upon return from the expedition and maintained as a part of the program's permanent record;

(f) expedition staff and youth shall implement and follow program policies and procedures regarding back country etiquette and leave no trace principles;

(g) expedition staff shall closely monitor participating youth while acclimating to the environment including temperature, climate and altitude; and

(h) when temperatures exceed 95° F or fall below 10° F, expedition staff shall take appropriate preventative measures to ensure participating youth remain free of heat or cold related illness or injuries.

(2) Upon return from any expedition:

(a) the senior field staff member shall debrief each expedition staff member and document this meeting in writing;

(b) the senior field staff member shall debrief each youth. The debriefing shall at a minimum:

(i) include a written summary of the youth's participation and progress achieved; and

(ii) be provided in written form to the placing agency and, upon request, to the youth's parents or legal guardian; and

(c) the field director shall document results of the evaluation of the conditions of the youth, interactions of youth and staff, briefings, de-briefings and compliance with program policies and procedures. The program shall retain evaluations in the youth's record.

History

Authorizing statute(s): 50-5-220, MCA
Implementing statute(s): 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1804 Expedition: Staff Training

(1) All outdoor experience and expedition staff training must be documented and kept on file for each staff member, intern and volunteer.

(2) A program shall have written policies, procedures and training curriculum regarding minimum requirements for orientation, field training and ongoing training.

(3) A program shall provide a minimum of 40 hours initial staff training.

(4) Initial staff training may not be considered completed until the staff members have demonstrated to the field director proficiency in each of the following:

(a) supervision of program participants;

(b) procurement, preparation and conservation of water, food and shelter;

(d) youth management, including containment control, safety, conflict resolution and behavioral management;

(e) instruction in safety procedures and safety equipment, use of fuel, fire and life protection;

(f) instruction in emergency procedures, medical, weather signalization, fire, runaway and lost youth;

(g) sanitation procedures relating to food, water and waste;

(h) knowledge of wilderness medicine, including health issues related to acclimation and exposure to the environmental elements;

(i) CPR, standard first aid, use of first aid kit contents and use of wilderness medicine;

(j) navigation skills including map and compass use, contour and celestial navigation and global positioning system;

(k) local environmental precautions including terrain, weather upsets, poisonous plants, wildlife and proper response to adversarial situations;

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

(m) relevant federal, state and local regulations including those of the department, bureau of land management, United States forest service, Montana fish, wildlife and parks; and

(n) therapeutic de-escalation of crisis situations and passive physical restraint techniques to ensure the protection and safety of the clients and staff. The training must include the use of physical and non-physical methods of managing youth and must be updated at least every 12 months to ensure that necessary skills are maintained.

(5) The field director shall document in each personnel record that each staff member has demonstrated proficiency in each of the required topic areas as listed above.

(6) The initial staff training and demonstration of proficiency must be implemented and documented before the staff member may count in the staff to youth ratio specified in ARM 37.98.415 and 37.98.1805.

(7) A program shall provide, at a minimum, 20 hours annually of ongoing training to staff to improve proficiency knowledge of skills. Additionally, the program shall ensure certifications are maintained by staff.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1805 Expedition: Youth/Staff Ratio

(1) Each group of youth must be staffed as follows:

(a) two staff members for the first four youth or fraction thereof and one additional staff member for every four youth or fraction thereof;

(b) each group of youth must have at least one staff member of the same gender as the genders represented in the youth group; and

(2) The field director has primary responsibility for field activities and must visit the field a minimum of two days a week, with no more than eight days between visits.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1810 Expedition: Basic Requirements

(1) Prior to embarking on an expedition:

(a) An itinerary of the expedition, including a written description and schedule of every planned expedition activity, and the location of each expedition camp site, must be prepared and filed at the field office.

(b) If national, state forest or other public lands will be used, arrangements must be made with the appropriate state or federal officials, and an itinerary of the expedition, including the location of each expedition camp site, must be provided to said officials.

(d) The field director shall brief all participating staff on all expedition details including:

(i) the planned route, time schedule, weather forecast and any potential hazards;

(ii) the rules for use of state or national forest or other public lands if such property will be used during the expedition;

(iii) any procedures or special circumstances unique to the expedition;

(iv) information regarding each participating youth, including background information, potential problems and any other relevant information; and

(v) goals and objectives of the case plan for each participating youth.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1811 Expedition: Policies and Procedures

(1) Policies and procedures must be adopted by the program regarding back country etiquette and the leave no trace principle. Participating staff and youth must be trained on the policies and procedures.

(2) At a minimum, the policies and procedures must include the following principles of leave no trace:

(a) leave what you find because all natural and cultural resources are protected by law;

(b) pack it in, pack it out;

(d) plan ahead and prepare. The staff shall know and respect applicable rules and regulations and understand the risk inherent in back country travel;

(e) travel and camp on durable surfaces;

(f) minimize campfire impact and use;

(g) respect wildlife by never approaching, feeding or harassing wildlife and by securing food and garbage properly; and

(h) be considerate of other visitors by keeping group size small and by minimizing noise.

(3) Policies and procedures must be adopted by the program regarding the use of a daily expedition log which must include:

(a) daily entries regarding health problems, accidents, injuries, near misses, medications used, behavioral problems and unusual occurrences;

(b) daily notations of environmental factors such as weather, temperature, altitude and terrain;

(d) daily entries describing morning and evening contacts between expedition staff and field office staff;

(e) weekly entries assessing each youth's physical condition by a staff member trained as a wilderness first responder;

(f) emergency plan drills, showing date, time, staff and youth present; and

(g) descriptions of pre-site investigations for solo expeditions.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1812 Expedition: Communications

(1) The program shall have written policies and procedures establishing a system of communication that meets the following criteria:

(a) each group away from the field office must have a satellite phone and extra charged battery packs for the satellite phone;

(b) the program must have a reliable back up communication system;

(c) the program must have a back up plan for re-establishing communications to be implemented in the event regular communications fail; and

(d) the program must develop a signal mirror communication system.

(2) The written policies and procedures must be attached to each itinerary, together with any specialized procedures necessitated by the circumstances, taking into consideration such factors as the planned activities and the terrain.

(3) Verbal communication between each field group and the field office must occur on a regularly scheduled basis according to program procedures unless special documented arrangements have been made.

(4) The field office support personnel shall have immediate access to emergency telephone numbers, contact personnel and procedures for an emergency evacuation or field incident requiring emergency medical support.

(5) Morning and evening contacts must be established between expedition staff and support staff in the field office. These contacts must be recorded in the log at both locations.

(6) Contact must be available from expedition staff to field office on a continuous basis.

History

Authorizing statute(s): 50-5-220, MCA
Implementing statute(s): 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04

Mont. Admin. R. 37.98.1815 Expedition: Health Care

(1) Additional health care requirements for youth on expedition include the following:

(a) Each youth's hydration, skin condition, extremities and general physical condition must be monitored and documented by field staff on a daily basis.

(b) Each youth's physical condition must be assessed by a staff member trained as a wilderness first responder at least every seven days while on expedition. The assessments must be documented and must at a minimum include:

(i) blood pressure, if deemed necessary by a licensed health care professional;

(ii) heart rate;

(iii) check of extremities;

(iv) condition of skin;

(v) hydration level;

(vi) allergies if any;

(vii) general physical condition;

(viii) provision of appropriate medical treatment if needed; and

(ix) emotional well being.

(c) A written plan for handling unanticipated allergic reactions while on expedition must be developed. The plan must include:

(i) training and consultation with regard to possible allergic reactions or reactions to snake and insect bites;

(ii) notations in youth records about any medication which might result in allergic reactions or other side effects; and

(iii) identification for all expedition staff about youth needing special precautions.

(2) Copies of the following documentation for each youth must be carried by the staff in a waterproof container when the youth is away from the field office:

(a) physical examination completed as part of the program admission process and any subsequent physical exams;

(b) medical treatment authorization;

(d) identifying marks of the youth such as scars, tattoos and piercings;

(e) health insurance information; and

(f) list of contact persons in case of emergencies.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1816 Expedition: Nutritional Requirements

(1) A program shall have and follow written policies and procedures on nutritional requirements.

(2) Each program shall have a written menu, approved by a qualified dietitian or nutritionist with knowledge of the program activities and levels, describing food supplied to the youth which must provide a minimum of 3000 calories per day.

(3) The menu must be adjusted to provide 29% to 100% increase in minimum dietary needs as energy expenditures such as exercise increases, or as the climate conditions such as cold weather dictate.

(4) Forage items may not be used toward the determination of caloric intake.

(5) Hands must be cleaned after each latrine use and prior to food preparation and food consumption.

(6) Food may not be withheld from a youth for any reason.

(7) If no fire is available for cooking food, other food of equal caloric value which does not require cooking must be available.

(8) Field staff are responsible for maintaining the safety and well being of the youth and shall monitor each youth's food intake to ensure that the youth has adequate nutrition.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1817 Expedition: Water Requirements

(1) A program shall have and follow written policies and procedures on expedition water requirements. At a minimum they must consist of the following:

(a) Youth must have access to potable water while hiking.

(b) The program shall provide each youth with six quarts of potable water a day, unless a youth's weight exceeds 150 pounds, then one additional quart of potable water must be provided for every 25 pounds of body weight over 150 pounds.

(d) Staff shall encourage each youth to consume at least three quarts of potable water per day.

(e) In temperatures above 80° F, adequate water must be available for coating each youth's body for the purpose of cooling when needed.

(f) Water must be available at each expedition camp site. Water cache location information must be verified by field staff before the group leaves expedition camp each day.

(g) Expedition groups may not depend on aerial drops for water supply. Aerial water drops must be used for emergency situations only.

(h) Water taken by staff or youth from a natural source and used for drinking or cooking must be treated to eliminate health hazards.

(i) Each group must have a supply of electrolyte replacement, the quantities to be determined by group size and environment conditions.

History

Authorizing statute(s): 50-5-220, MCA
Implementing statute(s): 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1821 Expedition: Solo Experience

(1) If the program utilizes solo experiences as part of the therapeutic process during expeditions, the program shall have policies and procedures for the utilization of solo experiences. Policies and procedures for solo experiences, at a minimum, must require:

(a) a written solo plan that must include, but is not limited to:

(i) the goals, methods, and techniques to be used and time frames for each participant;

(ii) an evaluation of the maturity level, health and physical ability of the youth, indicating that a solo expedition is reasonable;

(iii) documented instructions on the solo experience, including expectations, restrictions, communication, environment and emergency procedures; and

(iv) documented instructions on a back up plan in case the primary plan does not work; and

(b) a staff member be designated to coordinate and implement the plan.

(2) Staff shall be familiar with the site chosen to conduct solo experiences, and shall conduct a pre-site investigation and preparation. These activities must be documented in the daily expedition log including:

(a) a description of the terrain selected and the appropriateness for the level of participation skill of the youth;

(b) a review of hazardous conditions; and

(3) Youth must be supervised during solo experiences. Written plans for supervision must be drafted prior to the solo, and a copy of these written plans shall be placed in the daily expedition log. A plan of supervision must include at a minimum:

(a) the assignment of a specific staff member responsible for the supervision of the solo participant;

(b) predetermined procedures for:

(i) placing youth at a distance from each other and the central staff site to allow for appropriate supervision and emergency communication;

(ii) placing youth requiring special attention closer to the central staff site;

(d) instruction of youth to not participate in potentially dangerous activities;

(e) notification and check-in systems including a procedure for checking the youth's emotional and physical condition daily;

(f) a requirement that visual checks be conducted at regular intervals, with the actual time between visual checks being dependent upon the youth's maturity, experience and other relevant factors as determined by the youth's condition, provided, however, that the time between visual checks may never exceed 12 hours; and

(g) emergency planning, including:

(i) instructing the youth on safety and emergency procedures, including evacuation routes;

(ii) providing each youth with signaling capabilities, including a whistle, for emergency notification;

(iii) instructing of other youth on how to respond if the emergency notification system is put into use; and

(iv) providing a check-in system should an emergency occur.

(4) The youth must be debriefed immediately after a solo expedition. The debriefing must at a minimum:

(a) include a written summary of the youth's participation and progress achieved; and

(b) be provided in written form to the placing agency and, upon request, to the youth's parents or legal guardian.

History

Authorizing statute(s): Sec. 50-5-220, MCA
Implementing statute(s): Sec. 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Mont. Admin. R. 37.98.1822 Expedition: Participant Clothing, Equipment and Supplies

(1) Each expedition participant must have appropriate clothing, equipment and supplies for the types of activities and for the weather conditions likely to be encountered.

(2) Clothing, equipment and supplies must include at a minimum:

(a) sunscreen, which must be worn during all seasons;

(b) insect repellent if appropriate for the environmental conditions generally expected for the area and season;

(d) personal hygiene items necessary for cleansing;

(e) appropriate feminine hygiene supplies;

(f) wool blankets or an appropriate sleeping bag and a tarp or poncho for when the average nighttime temperature is expected to be 40° F or higher;

(g) shelter from precipitation, appropriate sleeping bag and ground pad when the average nighttime temperature is expected to be 39° F or lower;

(h) clothing appropriate for the temperature changes generally expected for the area; and

(i) a clean change of clothing at least once a week or an opportunity for the participant to wash their clothing at least once a week.

(3) A program may not remove, deny or make unavailable for any reason the appropriate clothing, equipment or supplies.

(4) Field staff shall be responsible for maintaining the safety and well being of youth and shall monitor each youth to make sure that clothing, equipment and supplies are maintained in a manner adequate to ensure the youth's safety.

(5) The field director shall develop a list of items that each youth will be in possession of during the wilderness excursion. Policy shall be in place that ensures only those items are transported into the wilderness.

History

Authorizing statute(s): 50-5-220, MCA
Implementing statute(s): 50-5-220, MCA
History: NEW, 2004 MAR p. 1960, Eff. 8/6/04.

Chapter 37.99 Private Alternative Adolescent Residential Programs or Private Outdoor Programs

Subchapter 37.99.1 Private Alternative Adolescent Residential Programs

Mont. Admin. R. 37.99.101 Private Alternative Adolescent Residential Programs: Purpose

(1) These rules establish licensing procedures and licensing requirements for private alternative adolescent residential or outdoor programs.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-801, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.102 Private Alternative Adolescent Residential Programs: Definitions

(1) "Adolescent" means any person between the ages of 10 and 19 years who is placed in a program by a parent/legal guardian.

(a) Upon admission to the program, the adolescent is considered a program participant.

(b) The adolescent may remain as a program participant up to the age of 20 if they are enrolled in an accredited secondary school.

(2) "Case plan" means a specific plan for providing care, treatment, and services of any kind to a specific program participant.

(3) "Chemical restraint" means the use of a drug or medication that is used to control behavior or restrict the program participant's freedom of movement, and which is not a standard treatment for the program participant's medical or psychiatric condition.

(4) "Correspondence search" means reading a program participant's mail or inspecting the contents of a package.

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

(6) "Direct care staff" or "staff" means program personnel who directly participate in the care, supervision, and guidance of the program participants.

(7) "Discharge plan" means a realistic plan developed to transition the program participant home or to a less restrictive and appropriate placement with specific services identified and available.

(8) "Licensed addiction counselor" means a person licensed under Title 37, chapter 35, MCA.

(9) "Licensed health care professional" means a licensed physician, physician assistant, or advanced practice registered nurse who is practicing within the scope of the license issued by the Department of Labor and Industry.

(10) "Licensure bureau" means the Office of Inspector General Licensure Bureau.

(11) "Mechanical restraint" means the use of devices as a means of restricting a person's freedom of movement.

(12) "Mental health professional" means a person licensed pursuant to Title 37, chapters 22, 23, or 37, MCA, as a clinical professional, social worker, or marriage and family therapist.

(13) "Near miss" means an unplanned, unforeseen, or potentially dangerous situation where safety was compromised but that did not result in injury.

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

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

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

(17) "Physical restraint" means a personal restriction that immobilizes or reduces the ability of the free movement of an individual's arms, legs, or head. Such term does not include physical escort.

(18) "Program participant-to-staff ratio" means the number of program participants in care per each on-duty awake direct care staff member.

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

(20) "Self-administration assistance" means providing necessary assistance to any program participant in taking their medication, including:

(a) removing medication containers from secured storage;

(b) providing verbal suggestions, promoting, reminding, gesturing or providing a written guide for self-administering medications;

(c) handling a prefilled, labeled medication holder, labeled unit dose container, syringe, or original marked, labeled container from the pharmacy;

(d) opening the lid of the above container for the program participant;

(e) guiding the hand of the program participant to self-administer the medication;

(f) holding and assisting the program participant in drinking fluid to assist in the swallowing of oral medications; and

(g) assisting with removal of a medication from a container for program participant with a physical disability which prevents independence in the act.

(21) "Serious incident" means suicide attempt, use of excessive physical force by staff, use of a restraint or seclusion, physical or sexual assault of a program participant by staff, or another program participant, injury to a program participant which requires emergency medical care, known, or suspected abuse or neglect (as defined in 41-3-102, MCA), of a program participant by staff or another program participant, a near miss or the death of a program participant, elopement, or an incident that involves law enforcement.

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-802, 52-2-803, 52-2-805, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.106 Private Alternative Adolescent Residential Programs: Application of Other Rules

(1) Any program that includes in its marketing, advertising, information packet, or other similar document reference to providing primary, inpatient, or residential chemical dependency treatment must be licensed by the Montana Department of Public Health and Human Services under Title 50, chapter 5, MCA.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.107 Private Alternative Adolescent Residential Programs: Licensing Fee Schedule

(1) Programs must submit payment for licensure annually.

(2) Licensing fees are based on the number of participants the program is licensed to serve as shown in the table below.

(3) All fees provided for in this rule are nonrefundable and are not prorated for portions of the licensing period.

(4) All fees must be paid in full by July 1 of each year.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-804, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.109 Private Alternative Adolescent Residential Programs: Procedure for Obtaining a License: Issuance and Renewal of a License

(1) Application for a program license must be made on an application form provided by the department.

(2) Renewal applications must be received within 30 days prior to the expiration date of the current license.

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

(4) Upon receipt of a complete initial or renewal application, the department must conduct an on-site licensing survey to determine if the applicant meets all applicable licensing requirements. The on-site licensing survey may be unannounced.

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

(6) The department must receive all required information and approve the plan of correction prior to issuing a license.

(7) If all licensing requirements are met and the fee has been paid in full, the department will issue a license for a period of up to three years.

(a) A three-year license may be issued to a program that has received no deficiencies within the last licensed period and licensing survey.

(b) A two-year license may be issued to a program that has received minor deficiencies that do not significantly affect or threaten the health, safety, and welfare of any program participant.

(i) that has been in operation for less than one year;

(ii) upon a change in ownership;

(iii) that has received deficiencies within the last licensed period or licensing survey that threaten the health, safety, and welfare of program participants or staff; or

(iv) that has received multiple deficiencies or repeat deficiencies.

(8) The department may in its discretion issue a provisional license for a period not to exceed six months to any license applicant which:

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

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

(9) Licensed premises must be open to inspection by the department or its authorized agent and access to all records must be granted to the department at all reasonable times.

(10) The program will only admit the number of program participants specified on the license.

(11) The current license must be publicly displayed at the program.

(12) A program's license is nontransferable.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-805, 52-2-806, 52-2-807, 52-2-808, 52-2-809, 52-2-810, 52-2-811
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.110 Private Alternative Adolescent Residential Programs: License Denial, Suspension, Restriction, and Revocation

(1) The department, after written notice to the applicant or program, may deny, suspend, cancel, reduce, modify, or revoke a license upon a finding of any of the following:

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

(b) the program is not in substantial compliance with other licensing requirements established by this chapter;

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

(d) the program has failed to use payments for the support of the program participants;

(e) the program, persons associated with the program, any staff member, or persons living at the program have been named as the perpetrator in a substantiated report of abuse or neglect;

(f) the program, persons associated with the program, any staff member or persons living at the program have violated provisions of this chapter that resulted in child abuse or neglect;

(g) the program, persons associated with the program or any staff member do not meet the requirements in ARM 37.99.148;

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

(i) it is determined on the basis of a department or law enforcement investigation that the program, persons associated with the program, any staff member, or anyone living in a program may pose any risk or threat to the safety or welfare of program participants;

(j) the program has failed to provide an acceptable written plan of correction as specified in ARM 37.99.109;

(k) the program did not pay the licensure fee as required in ARM 37.99.107; or

(l) the program employs or has persons living at the program that do not have an approved background check as required in ARM 37.99.126.

(2) At the discretion of the department and for protection of the program participants, program participants may be removed immediately upon receipt of a report of sexual or physical abuse or neglect by the program.

(3) Suspension or revocation of a license may be immediate upon a determination by the department that emergency action is required based on findings including, but not limited to the following situations:

(a) upon referral of suspected child abuse or neglect regarding a program, the initial investigation reveals that there are reasonable grounds to believe that a program participant may be in danger of harm;

(b) the department requests and is denied access to the program, program participants, or staff; or

(c) through a licensing investigation, it is determined that the program, persons associated with the program, any staff member, or persons living at the program have violated a licensing regulation that results in harm to a program participant which falls within the definitions of child abuse and neglect set out in 41-3-102, MCA, whether or not a criminal prosecution is initiated.

(4) Until the issuance of a contrary decision by the department the denial, suspension, cancellation, reduction, modification, or revocation of a license will remain effective and enforceable.

(5) Any person denied a license under the provisions of this subchapter, or whose license has been denied, suspended, canceled, reduced, modified, or revoked may request a hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(6) Nothing in these rules precludes the department from utilizing provisions of the Montana Administrative Procedure Act, including but not limited to summary suspension under 2-4-631(3), MCA.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-804, 52-2-805, 52-2-806, 52-2-807, 52-2-808, 52-2-809, 52-2-810, 52-2-811, MCA, NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.115 Private Alternative Adolescent Residential Programs: Written Policy and Procedure

(1) A current written policy and procedure manual that includes all policies required in this chapter and describes all services provided in the program, must be developed, implemented, and maintained at the program. The manual must be available to staff, program participants, program participants' parent/legal guardian, and the department and must be complied with by all program personnel and its agents.

(2) The policy and procedure manual must be submitted with the initial application for department approval.

(3) Any updates to the policy and procedure manual must be submitted to the department for approval 30 days prior to implementing the policy.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.117 Private Alternative Adolescent Residential Programs: Admissions

(1) The program will admit only those program participants for whom it has an operational program and who meet its admissions policies.

(2) The program must have written policies and procedures for screening all referrals.

(3) The program must have a written admissions policy and procedures which include:

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

(b) verifying of legal authority to place or remove a program participant from the program;

(d) a description of the orientation provided to program participants; and

(e) an initial assessment of the program participant's emotional, medical, developmental, social, and behavioral status that must be conducted at the time of admission.

(4) The admission person or committee must review all preplacement referral information to determine the appropriateness of placement, including age and developmental needs of adolescents accepted into the program.

(5) The program's policies and procedures must provide for and encourage a preplacement process with the program participant and family.

(6) Placements may only be accepted from the parent/legal guardian of the program participant.

(7) The admissions policy may not limit contact with the program participant's family for no more than 7 days after admission.

(8) A program must have written orientation policies and procedures for admission to the program that include:

(a) a procedure for ensuring that each program participant receives a personal orientation to the program as soon as appropriate, but no later than 24 hours after admission;

(b) inventory of each program participant's belongings;

(d) information on privilege systems;

(e) discipline policy;

(f) health and safety procedures;

(g) program rules;

(h) information on the program's search policies, program participant rights, and grievance procedure; and

(i) emergency evacuation procedures, including designated escape routes.

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

(10) A program must maintain a list of current program participants to ensure all participants are accounted for and that staffing requirements are met in all circumstances.

(11) A program must ensure compliance of each participant's placement with the Interstate Compact on the Placement of Children (ICPC), as provided in 41-4-101, MCA, and ARM 37.50.901.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.118 Private Alternative Adolescent Residential Programs: Written Agreement

(1) The program must enter into a written agreement with the program participant's parent/legal guardian at the time of admission into the program. The written agreement must include:

(a) the terms of the placement, the responsibilities of the program, and the responsibility of the parent/legal guardian;

(b) a statement describing specific services the program will provide;

(d) a statement explaining the program participant's responsibilities including house rules;

(e) a statement describing the communication policy, which must include a minimum of one confidential video telephonic communication contact per week between the youth and the youth's parents/legal guardian or foster parent(s), in addition to any therapeutic contact (family therapy), which:

(i) is confidential, i.e., in a private setting with no other individuals in the vicinity of being able to see or hear what is being discussed; and

(ii) is allocated a minimum of 15 minutes for the confidential video communication between youth and the youth's parents/legal guardian;

(f) transportation of the program participant to and from medical appointments and activities;

(g) a statement explaining specific charges for care and an itemized statement of what expenses in addition to the cost for care will be charged, including fines, penalties, or late fees that will be assessed;

(h) a statement that the agreed-upon rate will not be changed unless 30 days' advance written notice is given to the program participant's parent/legal guardian;

(i) criteria for requiring transfer or discharge of the program participant;

(j) the refund policy; and

(k) date and signature of the administrator and program participant's parent/legal guardian.

(2) A copy of the agreement must be filed in the program participant's file and a copy must be provided to the program participant's parent/legal guardian.

(3) When there are changes in services, financial arrangements, or requirements governing the written agreement, a new written agreement must be executed, or the original agreement must be updated by addendum. New agreements and any addenda must be signed and dated by the administrator and program participant's parent/legal guardian.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.119 Private Alternative Adolescent Residential Programs: Discharge

(1) The program must assist the program participant and family in preparing for the participant's discharge from the program.

(2) At the time of discharge of a program participant from the program, a written discharge report must be completed, and include:

(a) the program participant's name, date of birth, admission and discharge dates, reason for placement and discharge, and name of parent/legal guardian;

(b) a written summary of services provided, including the program participant's participation and progress in the program, contact information of persons who conducted evaluations, and condition of the program participant at time of discharge;

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

(e) follow-up health care required;

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

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

(h) recommendations for follow-up services;

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

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

(3) The discharge report must be maintained by the program in the participant's file and a copy must be provided to the parent/legal guardian at the time of discharge. Written documentation that the discharge report was provided to the parent/legal guardian must be maintained in the program participant's file.

(4) A program participant may only be discharged to the parent/legal guardian of the program participant. The program participant may be discharged to individuals other than the parent/legal guardian with written consent from the parent/legal guardian prior to discharge.

(5) Unless otherwise prohibited by law or court order, a program must allow a parent or legal guardian to remove a youth from the program at any time.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.124 Private Alternative Adolescent Residential Programs: Case Plan

(1) Each program must develop and implement a case plan for each program participant in care.

(2) The case plan must include:

(a) the program participant's physical and medical needs;

(b) behavior management issues;

(d) measurable goals and objectives and corresponding time frames;

(e) the responsibilities of the program participant, staff, and parent/legal guardian for meeting the goals and objectives;

(f) education plans; and

(g) discharge plans and estimated discharge date.

(3) The initial case plan must:

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

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

(4) The program participant and the parent/guardian must be involved in developing and updating the case plan.

(5) The program participant, parent/legal guardian, and program staff developing the case plan must sign and date the plan and plan updates.

(6) A copy of the signed case plan must be provided to the parent/legal guardian and maintained in the program participant's file.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.125 Private Alternative Adolescent Residential Programs: Rights and Grievances

(1) The program must have a written program participant rights policy that supports and protects the fundamental human, civil, constitutional, and statutory rights of all program participants. These rights must include:

(a) to be treated with dignity and respect;

(b) freedom from abuse, neglect, exploitation, harassment, and unnecessary physical restraint;

(c) freedom from corporal, cruel, harsh, or unnecessary punishment, name calling, infliction of pain, or excessive physical exercise;

(d) to adequate food, water, clothing, school supplies, and personal hygiene supplies;

(e) to receive care and services according to individual need;

(f) to educational services in accordance with Montana state law, if the program operates during the school year;

(g) freedom from discrimination;

(h) to a safe environment with respect for human dignity;

(i) to the protection of the privacy of information and records regarding each program participant and the participant's family;

(j) to communication and visitation privileges with family in person, by mail, or by phone;

(k) to be allowed to contact the Montana abuse reporting hotline to report allegations of abuse and neglect;

(l) to submit complaints and alleged violations of these rules, including a prohibition on retaliation against a program participant for submitting such a complaint;

(m) to personal privacy, when it is not contrary to the treatment and safety needs of the program participant; and

(n) for consideration of the program participant's opinions and recommendations when developing the case plan.

(2) A program is prohibited from:

(a) using physical discipline or the threat of physical discipline as a punishment, deterrent, or incentive;

(b) unlawfully depriving a program participant of a basic necessity or a fundamental right, including education;

(c) admitting a program participant who is under the age approved on the license or has a condition that the program is not authorized to treat pursuant to the program's admission policy;

(d) using medical, chemical, or mechanical restraints;

(e) using physical restraints, except in emergency circumstances to ensure the immediate physical safety of the program participant, a staff member, or others, when less restrictive interventions have been determined to be ineffective;

(f) using a licensure candidate to provide mental health professional services if the parent/legal guardian of a program participant has not provided written consent;

(g) using seclusion; and

(h) sexually abusing, exploiting, or harassing a program participant.

(3) The program must review the program participant rights policy with the program participant and parent/legal guardian at the time of admission.

(a) The program staff reviewing the policy, the program participant, and parent/legal guardian of the program participant must sign a statement acknowledging the review.

(b) The signed statement must be maintained in the program participant's file.

(4) The program must have a written grievance policy which outlines the procedures to be followed by a program participant or parent/legal guardian in presenting a grievance to the program.

(5) The program must review the grievance policy with the program participant and parent/legal guardian at the time of admission.

(a) The program staff reviewing the policy, the program participant, and parent/legal guardian of the program participant must sign a statement acknowledging the review.

(b) The signed statement must be maintained in the program participant's file.

(6) Any written grievance report must be maintained in the program participant's file. The report must include the nature of the complaint, the date of the complaint, and a statement indicating how the issue was resolved.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.126 Private Alternative Adolescent Residential Programs: Background Checks

(1) All administrators, staff, volunteers, persons associated with the program, and any adult living at the program must complete a National Crime Information Center (NCIC) fingerprint-based background check from the Federal Bureau of Investigation. Results of the fingerprint-based background check must be documented prior to working or living at the program.

(a) A name-based criminal background check may be completed pending the results of the fingerprint background check. The department must receive the request for the fingerprint check and the results of the name-based check must be documented prior to the staff working at the facility.

(2) All administrators, staff, volunteers, person associated with the program, and any adult living at the program must complete a Montana Department of Public Health and Human Services child protective services background check, and, if applicable, a tribal child protective services background check, and a tribal criminal background check prior to working or living at the program.

(3) If an applicant has lived outside the state within the past five years, a criminal and child protective background check must be conducted in every state that the applicant has resided in within the past five years.

(4) All administrators, staff, volunteers, persons associated with the program, and any adult working or living at the program must complete a Montana Sexual and Violent Offender Registry Check (Montana SVOR) at https://app.doj.mt.gov/apps/svow/search.aspx and A National Sexual and Violent Registry Check (NSOPW) at https://www.nsopw.gov/ .

(5) Results of all required criminal and child protective background checks and registry checks must be documented prior to working or living at a program.

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

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

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

(c) any administrator, staff, volunteer, person associated with the program, or any adult living at the program has within the previous five years a felony conviction of a drug-related offense, including but not limited to use, distribution, or possession of manufacture of dangerous drugs, criminal possession of imitation dangerous drugs with the purpose to distribute, criminal possession, manufacture of, or delivery of drug paraphernalia, or driving under the influence of alcohol or other drugs; or

(d) any administrator, staff, volunteer, person associated with the program, or any adult living at the program has within the previous five years a conviction for misdemeanor partner and family member assault, misdemeanor endangering the welfare of a child, misdemeanor unlawful transaction with a child, or a crime involving an abuse of the public trust; or

(e) any administrator, staff, volunteer, person associated with the program, or any adult living at the program has been convicted of abuse, sexual abuse, neglect, or exploitation of an elderly person or a person with a developmental disability.

(7) Any administrator, staff member, volunteer, persons associated with the program, or adult living at the program, who is charged with a crime involving children, physical or sexual violence against any person, or any felony drug-related offense and awaiting trial may not provide care or be present at the program pending the outcome of the criminal proceeding.

(8) No administrator, staff, volunteer, person associated with the program, or any adult living at the program shall have been named as a perpetrator in a substantiated report of child abuse or neglect or listed on the Montana Sexual and Violent Offender Registry or National Sex Offender Public Website.

(9) The program is responsible for assuring that the persons covered by this chapter have met these requirements prior to providing care.

(10) No administrator, staff, volunteer, person associated with the program, or any adult living at the program may pose any potential threat to the health, safety, and well-being of the program participants.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.127 Private Alternative Adolescent Residential Programs: Child Abuse or Neglect and Serious Incidents

(1) A program must require each program participant, person associated with the program and staff member to read and sign a statement that clearly defines child abuse and neglect and outlines the individual's responsibility to report all known or suspected incidents of child abuse or neglect of any program participant to the department within 24 hours.

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

(3) A program must have written policies and procedures for handling any suspected incident of child abuse or neglect, including:

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

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

(c) a procedure for taking appropriate disciplinary measures against any staff member involved in an incident of child abuse or neglect, including termination, retraining, or any other action geared towards the prevention of future incidents; and

(d) sexually abusing, exploiting, or harassing a program participant.

(4) Any serious incident involving a program participant must be reported in writing within one business day to the department's licensure bureau. The report must include:

(a) the date and time of the incident;

(b) all program participants and staff member(s) involved;

(d) a statement written by the staff member that was involved in the incident or witnessed the incident; and

(e) documentation of the date and time the incident was reported to the parent/legal guardian.

(5) A copy of the report must be maintained in the program participant's file.

(6) The program must cooperate with all licensing surveys and investigations, which may include private one-on-one interviews with staff and program participants.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-5-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.132 Private Alternative Adolescent Residential Programs: Physical Environment

(1) Each program must comply with all applicable federal, state, and local regulations, laws, and building codes.

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

(3) Program participants must have indoor areas of at least 40 square feet of floor space per program participant for quiet, reading, study, relaxing, and recreation. The minimum space requirement may not include halls, kitchens, and any rooms not used by program participants.

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

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

(6) Program participants sharing a bedroom must be no more than 3 years in age apart.

(7) The program must provide:

(a) at least one toilet for every eight program participants; and

(b) one bathing facility for every eight program participants.

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

(9) Each program participant must have access to a bathroom without entering another bedroom, the kitchen, or dining areas.

(10) Hot and cold water must be available in all kitchens, bathrooms, and laundry. The temperature of hot water supplied to handwashing and bathing facilities must not exceed 120ºF.

(11) For adequate housekeeping the program must ensure that:

(a) the building and grounds are free, to the extent possible, of harborage for insects, rodents, and other vermin;

(b) all electrical, mechanical, plumbing, fire protection, heating, and sewage disposal systems must be kept in operational condition;

(c) the floors, walls, ceilings, furnishings, and other equipment is clean and in good repair free of hazards, and offensive odors;

(d) cleaning equipment and supplies are provided in sufficient quantity to meet the housekeeping needs of the facility; and

(e) a maintenance policy and schedule, which describes the regular maintenance of the facility, is adhered to.

(12) All rooms and hallways must have adequate lighting.

(13) Programs must post a sign within the facility that is accessible to all program participants and to the public. The sign must provide information on what agency should be contacted to report a violation of law or policy and must include contact information for the Office of Inspector General Licensure Bureau, the Montana Child Abuse and Neglect Hotline (866-820-5437), and local law enforcement.

(14) With respect to any conditions in existence in licensed programs prior to October 1, 2019, the specific requirements in this rule may be modified by the department to allow alternative arrangements that will provide that same level of safety to program participants and staff. In no case will the modification afford less safety than that which, in the discretion of the department, would be provided by compliance with the corresponding requirement in this rule.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, 52-2-810, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.133 Private Alternative Adolescent Residential Programs: Laundry and Bedding

(1) If a program processes its laundry on site, it must:

(a) use areas solely for laundry purposes;

(b) equip the laundry room with at least one mechanical washer and hot-air tumble dryer, handwashing facilities, mechanical ventilation to the outside, a fresh air supply, and a hot water supply system which supplies the washer with water of at least 160ºF (71ºC) during each use. If the laundry water temperature is less than 160ºF, chemical and detergent suitable to the water temperature and the manufacturer's recommended product time of exposure must be utilized;

(d) provide well maintained carts or other containers impervious to moisture to transport laundry, keeping those used for soiled laundry separate from those used for clean laundry;

(e) dry all bed linen, towels, and washcloths in a manner that protects against contamination;

(f) protect clean laundry from contamination; and

(g) ensure that program staff handling laundry cover their clothes while working with soiled laundry, use separate clean covering for their clothes while handling clean laundry, and wash their hands both after working with soiled laundry and before they handle clean laundry.

(2) If laundry is cleaned off-site, the program must utilize a commercial laundry which satisfies the requirements stated in (1).

(3) A program must provide each program participant with:

(a) a bed with a moisture-proof mattress or moisture-proof mattress cover and mattress pad;

(b) clean bed linen in good condition;

(c) a supply of clean bed linen on hand sufficient to change beds often enough to keep them clean, dry, and free from odors;

(d) supply each program participant at all times with clean towels and washcloths; and

(e) enough blankets to maintain warmth while sleeping.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.134 Private Alternative Adolescent Residential Programs: Water Supply

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

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.135 Private Alternative Adolescent Residential Programs: Sewage System and Solid Waste

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.136 Private Alternative Adolescent Residential Programs: Fire Safety

(1) The department adopts and incorporates by reference the current edition of the locally adopted Fire Code (FC), which sets forth the fire safety regulations that apply to all programs.

(2) The local or state fire authority having jurisdiction must annually certify a program for fire and life safety.

(3) Smoke detectors and smoke alarms must be installed and operated in accordance with the FC set forth in the locally adopted FC.

(4) Carbon monoxide detectors must be installed and operated in accordance with the FC.

(5) A workable portable fire extinguisher, with a minimum rating of 2A10BC, must be located on each floor of the facility. Fire extinguishers must be:

(a) mounted on the wall not to exceed five feet from handle to floor and no closer than four inches from the floor;

(b) no more than 75 feet travel distance apart;

(c) inspected, recharged, and tagged at least once a year by a person certified by the state to perform such services; and

(d) not obstructed or obscured from view.

(6) Program staff must check battery operated smoke detectors at least once each month and the batteries must be replaced at least once each year. Documentation, including the date and the signature of the person checking or replacing the batteries, must be maintained at the facility.

(7) Integrated dial-out-smoke detection systems that are monitored from an outside source must have the date showing the most recent maintenance. Maintenance must occur once per year.

(8) Orientation for staff and program participants must include instruction of the program's fire evacuation procedure. The fire evacuation procedure must be posted in a conspicuous place in the program.

(9) All exits must be clear and unobstructed at all times.

(10) Paint, flammable liquids, and other combustible material must be kept in locked storage away from heat sources or in outbuildings not used by the program participants.

(11) The program must conduct at least one fire drill per quarter per each work shift. Drill observations must be documented and maintained in the program files for at least three years. The documentation must include:

(a) time and location of the drill;

(b) identification of participating staff;

(d) steps taken to correct such problems.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, 52-2-810, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.137 Private Alternative Adolescent Residential Programs: Emergency and Evacuation Plans

(1) A program must have and follow a written emergency plan developed in conjunction with emergency services in the community, and it must include specific procedures for evacuations, disasters, medical emergencies, hostage situations, casualties, missing program participants, and other serious incidents identified by the program.

(2) The emergency plan must include:

(a) designation of authority and staff assignment;

(b) a specific evacuation plan;

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

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

(f) provisions for arranging medical care and notifying the program participant's licensed health care professional, and parent/legal guardian; and

(g) maintenance and repair of essential equipment including a two-way radio.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.138 Private Alternative Adolescent Residential Programs: Safety

(1) A program must have written policies and procedures on safety and equipment.

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

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

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

(d) be inventoried on a quarterly basis.

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

(4) Cleaning materials, flammable liquids, detergents, aerosol cans, and other poisonous and toxic materials must be kept in their original containers and in a place inaccessible to program participants. They must be used in such a way that will not contaminate play surfaces, food, food preparation areas, or constitute a hazard to the program participants. Bio-contaminants including blood, bodily fluids, and other infectious materials must be properly disposed of.

(5) No extension cord will be used as permanent wiring. All appliances, lamp cords, and exposed light sockets must be suitably protected to prevent electrocution.

(6) Any pet or animal present at the program indoors or outdoors, must be in good health, show no evidence of carrying disease, and be a friendly companion for the program participants. The provider is responsible for maintaining the animal's vaccinations and vaccination records. These records must be made available to the department upon request. The program must make reasonable efforts to keep stray animals off the premises.

(7) Emergency information for program participants must be easily accessible at the program. Emergency information for each program participant must include:

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

(b) the name, address, telephone number of the program participant's licensed health care professionals or source of health care;

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

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

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.145 Private Alternative Adolescent Residential Programs: Case Records

(1) A program must maintain a written case record for each program participant which contains administrative, treatment, and educational data from the time of admission until the time the program participant is discharged from the program.

(2) The case record must include:

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

(b) the name, address, and telephone number of the parent/legal guardian of the program participant;

(d) current immunization records and documentation of exemptions per program policy;

(e) date of discharge, person and signature whom the program participant was released to, and signed discharge summary;

(f) all documents related to the referral of the program participant to the program;

(g) current custody and parent/legal guardianship documents or other documents verifying legal custody of the parent/legal guardian placing the program participant per program policy;

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

(i) a copy of the program participant's birth certificate;

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

(k) cumulative health records including medical history provided by the parent/legal guardian;

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

(m) treatment or clinical records and reports;

(n) records of physical restraints and special or serious incidents;

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

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

(q) an immediate needs assessment and assigned responsibilities.

(3) A copy of the signed physical examination form must be maintained in the file for outdoor programs.

(4) Program participant records must be maintained at the program for a minimum of six years.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.146 Private Alternative Adolescent Residential Programs: Confidentiality of Records and Information

(1) All records maintained by a program and all personal information made available to a program pertaining to a program participant must be kept confidential and are not available to any person, agency, or organization except as specified in (2) and (3).

(2) All records pertaining to a program participant are available upon request to:

(a) the program participant's parent/legal guardian or attorney absent specific and compelling reasons for refusing such records;

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

(c) a program participant to whom the records pertain, absent specific and compelling reasons for refusing specific records; or

(d) an adult who was formerly the program participant in care to whom the records pertain.

(3) Records pertaining to program participants must be available to the department for the purposes of licensing, relicensing, or investigating a complaint of the program.

(4) Necessary information pertaining to the program participant must be disclosed when program staff are following mandatory reporting requirements as outlined in this rule and within the scope of an individual's license.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, 52-2-811, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.147 Private Alternative Adolescent Residential Programs: Reports

(1) The program must submit to the department, upon its request, any reports required by federal law, state law, or regulations.

(2) The program must report any of the following changes in writing to the department's licensure bureau, prior to the effective date of the change:

(a) a change of administrator;

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

(d) any significant change in the program policies or procedures or services.

(3) Runaways shall be reported immediately to the police and parent/legal guardian and within the next working day to the licensure bureau.

(4) Disasters or emergencies which require relocation of program participants or closure of the program must be reported to the licensure bureau within the next working day.

(5) Any serious incident as defined in this subchapter must be reported in writing to the licensure bureau within 24 hours of the incident.

(6) Any fire or other incident that caused significant damage to the property must be reported to the licensure bureau within 24 hours of the incident.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-808, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.148 Private Alternative Adolescent Residential Programs: General Requirements for All Administrators, Staff Members, and Volunteers

(1) A program must have written personnel and program policies and procedures covering the following items:

(a) screening procedure for all applicants;

(b) job qualifications for all positions;

(d) supervisory structure; and

(e) performance evaluations.

(2) In addition to the specific requirements set out in this chapter, all staff working in a program must:

(a) be at least 20 years of age;

(b) have a high school diploma or GED; and

(3) Any administrator, staff member, volunteer, or other person whose behavior or health status endangers the program participants may not be allowed at the program.

(4) Program volunteers must:

(a) not be included in the program participant-to-staff ratios;

(b) be under the supervision of program staff;

(c) follow written policies and procedures developed by the program defining the responsibilities, limitations, and supervision of volunteers;

(d) complete all required background checks; and

(e) be provided orientation and initial training. The training must include orientation on all program policies and procedures.

(5) All program staff who transport program participants must have a valid driver's license and, while transporting program participants, follow all laws applicable to driving in Montana.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.149 Private Alternative Adolescent Residential Programs: Personnel Records

(1) The program is responsible for maintaining a file on each administrator, person associated with the program, staff member, or volunteer. Files may be inspected by the department at any time. If the file is not maintained at the program it must be available to the department within 24 hours of the request.

(2) The file must contain:

(a) application for employment;

(b) written results of at least two references;

(d) periodic performance evaluations;

(e) a copy of current credentials, certification, or professional licenses required to perform the duties described in the job description;

(f) documentation of criminal background check as specified in ARM 37.99.126;

(g) documentation of child protective services background checks as specified in ARM 37.99.126;

(h) documentation of Montana and National registry checks as specified in ARM 37.99.126;

(i) a copy of current driver's license for employees transporting program participants; and

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.150 Private Alternative Adolescent Residential Programs: Quality Assessment

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

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

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.151 Private Alternative Adolescent Residential Programs: Administrator

(1) Each program must employ an administrator that is responsible for the day-to-day operation of the program.

(2) The administrator must have formal training and/or experience in residential or outdoor programs and demonstrates the ability to perform the functions and duties required in these rules.

(3) In the absence of the administrator, a staff member must be designated to oversee the operation of the program during the administrator's absence. The administrator or designee must be in charge, on call, and physically available on a daily basis as needed, and must ensure there are sufficient, qualified staff so that the care, well-being, health, and safety needs of the program participants are met at all times.

(a) If the administrator will be absent from the program for more than 30 continuous days, the department must be given written notice of the individual who has been appointed the designee. The appointed designee must meet the requirements for an administrator.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.152 Private Alternative Adolescent Residential Programs: Staff

(1) Each program must maintain the minimum program participant to awake-staff ratios:

(a) from 7:00 a.m. to 11:00 p.m., eight program participants to one staff;

(b) from 11:00 p.m. to 7:00 a.m., or any other reasonable eight-hour period of time when program participants are generally sleeping, 16 program participants to one staff; and

(c) programs must have at least one awake night staff in each building housing program participants regardless of the number of participants.

(2) Outdoor programs must meet staff ratios defined in ARM 37.99.210.

(3) During regular school hours when program participants are not normally present, at least one on-call staff must be available for duty within 30 minutes of notification that they are needed.

(4) The program must have a policy that specifies a nighttime safety protocol that outlines program staff responsibility for monitoring the program participants.

(5) Sufficient staff must be employed to meet the supervision needs of the program participants and implement each program participant's individualized case plan.

(6) Mental health professionals must be licensed as defined in this rule and be employed in sufficient number to meet the mental health needs of program participants as outlined in the program description.

(7) A registered nurse or licensed practical nurse must be employed to meet the needs of the program participants as outlined in the program description.

(8) Any program that includes in its program description, marketing, advertising, information packet, or other similar document reference to providing chemical dependency services must employ licensed addiction counselors in sufficient number to meet the needs of the program participants.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.153 Private Alternative Adolescent Residential Programs: Staff Training

(1) A program must have written policies, procedures, and initial and ongoing training curriculum that meets the minimum requirements in this rule.

(2) Programs must provide adequate and timely training to ensure the safety of program participants.

(3) All program staff must complete a minimum of 24 hours of orientation training consisting of the following minimum requirements:

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

(b) mandatory child abuse reporting laws;

(d) fire safety, including emergency evacuation routes;

(e) confidentiality;

(f) suicide prevention;

(g) emergency medical procedures;

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

(i) program participant rights as outlined in ARM 37.99.125; and

(j) hours required for on-the-job training.

(4) Orientation training must be completed and documented before the staff person may count in the staff ratio as specified in ARM 37.99.172 and 37.99.210.

(5) All program staff must complete the following certification training within six months of hire:

(a) the use of de-escalation training and methods of managing program participants as described in the program's policies and ARM 37.99.170;

(b) first aid and hands-on CPR certification; and

(6) Program staff may not work alone without completing the requirements of (5).

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.159 Private Alternative Adolescent Residential Programs: Physical Care

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

(2) Medical, dental, psychiatric, psychological care, and counseling services will be arranged for the program participant as needed.

(3) If a program participant has not received a complete physical examination within a year prior to placement, within 30 days after admission the program must arrange for a complete physical examination and annually thereafter.

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

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

(6) Provisions for medical, dental, or vision care must be made by the provider immediately upon the licensed health care professional's recommendation with notification to the parent/legal guardian.

(7) Documentation of all required services must be in the program participant's file.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.160 Private Alternative Adolescent Residential Programs: Medication Storage and Administration

(1) A program must have written policies and procedures regarding the storage, administration, and disposal of prescription, nonprescription, and over-the-counter medication.

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

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

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

(7) A written record of all medications administered to a program participant must be maintained and include:

(a) program participant's name;

(b) name and dosage of the medication;

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

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

(9) Parent/legal guardian must be notified of all medications prescribed to program participant including medication changes. Documentation of notification must be maintained in the medication record.

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.161 Private Alternative Adolescent Residential Programs: Care and Guidance

(1) A program must provide to each program participant sufficient staff to ensure:

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

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

(2) A program must arrange for contact with each program participant's parent/legal guardian and approved family members.

(3) The program must assist the parent/legal guardian with referral for support services.

(4) The provider must assist the program participant and, when appropriate, the family, in preparing for the program participant's discharge.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.162 Private Alternative Adolescent Residential Programs: Nutrition

(1) A program must provide for or serve three regular, well-balanced meals per day, and snacks. Foods must be served in amounts and a variety sufficient to meet the nutritional needs of each program participant.

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

(3) Food may not be altered, modified, restricted, or prohibited as a means of punishment, discipline, or as a behavioral modification technique.

(4) Records of menus as served must be filed at the program for three months after the date of service for review by the department.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.163 Private Alternative Adolescent Residential Programs: Food Preparation and Handling

(1) Safe food handling and preparation practices must be followed in all programs. All food must be from an approved source and must be transported, labeled, stored, covered, prepared, and served in a sanitary manner to prevent contamination.

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

(3) Any staff person or program participant handling or preparing food must thoroughly wash hands, wrists, and exposed arms with soap and warm running water for at least 20 seconds:

(a) before and after handling food;

(b) after using the bathroom; and

(4) General food safety requirements must include:

(a) all canned foods and dry ingredients must be stored in a designated area;

(b) food cannot be stored on the floor;

(d) food that is not stored in original containers must be dated, labeled, and covered;

(e) all food must be cooked and reheated to the recommended temperature;

(f) milk and other dairy products must be pasteurized;

(g) use of home canned foods other than jams, jellies, and fruits is prohibited;

(h) use of thermometers is required to check food temperatures;

(i) cold storage of potentially hazardous food must be at 41°F or below;

(j) frozen food must be kept frozen;

(k) hot storage of potentially hazardous food must be 135°F or above;

(l) each type of food must be stored and arranged so that cross-contamination of one type with another is prevented; and

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

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

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

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

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

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

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

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

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

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.164 Private Alternative Adolescent Residential Programs: Personal Needs

(1) The program must ensure that each program participant has clothing suitable to the program participant's age and size and comparable to the clothing of other adolescents in the community.

(2) Program participants must have some choice in the selection of their clothing.

(3) A program must provide necessary supplies and train program participant's in personal care, hygiene, and grooming.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.170 Private Alternative Adolescent Residential Programs: Behavior Management Policies

(1) A program must have written behavior management policies and procedures which include a description of the model, program, or techniques to be used with program participants. The program must have policies addressing discipline, therapeutic de-escalation in crisis situations, crisis intervention and physical restraint, and time-out. Behavior management must be based on an individual assessment of each program participant's needs, stage of development, and behavior. It must be designed with the goal of teaching the program participant to manage their own behavior and be based on the concept of providing effective treatment by the least restrictive means.

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

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

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

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

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

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

(g) locked confinement or seclusion;

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

(i) denial of visits or communication with the program participant's family;

(j) isolation as punishment; and

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

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

(5) A copy of the incident report must be placed in the program participant's file and the incident must be reported to the licensure bureau and parent/legal guardian within 24 hours of its occurrence.

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

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

(b) complete a written report and submit it to the licensure bureau within two days of completion of the investigation.

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.171 Private Alternative Adolescent Residential Programs: Time-Out

(1) A program must develop a written time-out policy and procedures which clearly provide:

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

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

(d) purpose of time-out; and

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

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

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

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.172 Private Alternative Adolescent Residential Programs: Use of Crisis Intervention and Physical Restraint Strategies

(1) The program must have written policies and procedures governing the appropriate use of crisis intervention and physical restraint methods if used by the program.

(2) The crisis intervention and physical restraint policies and procedures must include evidence-based training and include:

(a) suicide prevention training for all staff to include risk identification, screening and assessment, indicated interventions, safety planning, treatment, follow-up care, and documentation;

(b) crisis prevention and verbal and nonverbal de-escalation techniques are the preferred methods and must be used first to manage behavior;

(c) all staff must be trained in the program's crisis intervention, de-escalation techniques, and physical restraint methods;

(d) physical restraint may only be used to safely control a program participant until the program participant can regain control of their own behavior;

(e) physical restraint must only be used in the following circumstances:

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

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

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

(g) physical restraint may be used only by staff who are documented to be specifically trained in crisis intervention and physical restraint techniques.

(3) The program policies and procedures must require the documentation of:

(a) the specific behavior which required the physical restraint;

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

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

(e) the type of physical restraint used;

(f) any injuries to the program participant resulting from the physical restraint;

(g) debriefing completed with the staff and program participant involved in the physical restraint; and

(h) notification of the parent/legal guardian within 24 hours of restraint.

(4) The documentation required in (3) must be submitted in writing to the Office of Inspector General Licensure Bureau within one business day of the physical restraint.

(5) Program policies and procedures must require that whenever a physical restraint has been used on a program participant more than four times within a seven-day period, the program administrator or designee will review the program participant's situation to determine the suitability of the program participant to remain in the program, whether modification of the case plan is warranted, or whether staff need additional training in alternative therapeutic behavior management techniques. The program must take appropriate action as a result of the review.

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.173 Private Alternative Adolescent Residential Programs: Searches

(1) The provisions of this rule apply to all searches by program staff of the program participant's person and personal property, including searches of personal correspondence. The facts and circumstances supporting a determination of reasonable cause for the search must be documented in the program participant's file.

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

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

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

(3) The program must have written policy and procedures relating to searches, including pat-down searches, personal property searches, correspondence searches, urinalysis testing, and breathalyzer testing. The policies must include the following:

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

(b) notification of the search policy to parent/legal guardian and program participant at time of admission;

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

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

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

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

(4) Staff must be trained in the proper protocol for all searches. Training must be documented in staff's personnel record.

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

(a) strip searches;

(b) body cavity searches; or

(6) The program must have written policies and procedures prior to use of urinalysis testing for the purpose of determining drug and alcohol use which include:

(a) procedures for obtaining samples for urinalysis testing;

(b) procedures for processing urinalysis testing; and

(7) The program must have written policies and procedures prior to use of breathalyzer testing for the purpose of determining drug and alcohol use which include:

(a) procedures for operating the breathalyzer; and

(b) consequences to the program participant when a breathalyzer is positive.

(8) Program participants may not be subjected to urinalysis or breathalyzer testing unless the testing:

(a) has been ordered by a court;

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

(9) The program must notify the program participant's parent/legal guardian within 24 hours of every search, urinalysis testing, or breathalyzer testing performed on the program participant and the results.

(10) Staff shall document compliance with program policies and procedures in connection with each search, urinalysis testing, or breathalyzer testing.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.174 Private Alternative Adolescent Residential Programs: Contraband and Potential Weapons

(1) A program must define prohibited contraband in a written policy.

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

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

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

(5) A program must have written policy and procedure on management of weapons and potential weapons.

(6) Guns and ammunition must be kept in locked storage with guns stored separately from the ammunition. Guns kept in vehicles must have a staff member present and be locked in the glove compartment or gun rack, must be unloaded, and ammunition must be kept locked in a separate location in the vehicle.

(7) A program participant must have one on one supervision when handling a weapon or gun.

(8) Staff shall supervise a program participant's possession and use of knives, hatchets, other edged tools, or any item which may pose a danger to self or others.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.175 Private Alternative Adolescent Residential Programs: Money and Adolescent Training and Employment

(1) Money earned or received as a gift or allowance must be part of the program participant's personal property and accounted for separately from the program funds.

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

(3) For program participants aged 16 and older, a program may assist in:

(a) preparing the program participant for economic independence;

(b) referring the program participant to the appropriate independent living program if applicable; and

(c) obtaining skills necessary for employment as determined to be appropriate to meet the individual's needs. Such skills include:

(i) completing applications;

(ii) personal appearances for employment situations;

(iii) attitudes toward employment; and

(iv) interviewing for jobs.

(4) A program must distinguish between tasks which program participants are expected to perform as part of living together, jobs to earn spending money, and jobs performed for vocational training. Program participants may not be compelled to work for the program without prior approval of the parent/legal guardian.

(5) Program participants may be given age appropriate, non-vocational work assignments within the program participant's capabilities as a constructive experience. The work assignment must comply with all state and federal labor laws, and regulations.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.176 Private Alternative Adolescent Residential Programs: Recreation

(1) The program may have an on-grounds recreation program that is operated by the program staff. However, when available, the program must provide the program participant access to community recreation and cultural events when appropriate to the program participant's needs, interests, and abilities.

(2) Program participants must have the opportunity to participate in age appropriate recreational activities on a regular basis.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.181 Private Alternative Adolescent Residential Programs: Infection Control

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

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.182 Private Alternative Adolescent Residential Programs: Religion and Culture

(1) The program must have written policies and procedures on how the program participant's individual religious and cultural beliefs will be addressed.

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

(3) The program must document its efforts in providing opportunity and encouragement to each program participant to identify with their cultural heritage.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.183 Private Alternative Adolescent Residential Programs: Transportation

(1) All staff transporting program participants must possess a valid driver's license for the type of vehicle used in transporting the program participants.

(2) Any person transporting program participants must comply with applicable traffic laws while transporting.

(3) All vehicles used in transporting program participants must:

(a) have proper Montana registration;

(b) have insurance coverage;

(d) be equipped with a red triangle reflector device for use in an emergency; and

(e) be equipped with a first aid kit.

(4) The driver and all of the passengers must ride in a vehicle manufactured seat. Each person must use a seat belt.

(5) Program participants must not ride in the bed of, or in the back of a truck.

(6) Program participants utilizing off highway or all terrain recreational vehicles must wear a helmet and be instructed on safety procedures.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Subchapter 37.99.2 Private Outdoor Programs

Mont. Admin. R. 37.99.201 Private Outdoor Programs: Definitions

(1) "Administrative office" means the office where business operations, public relations, and management procedures take place.

(2) "Expedition" means an excursion undertaken for specific treatment purposes that takes the program participant away from the field office.

(3) "Expedition camp" means a nonpermanent campsite. Program participants and staff may move from one expedition camp to another when on expedition.

(4) "Field office" means the office where all coordination of expedition operations takes place.

(5) "Global position system (GPS) receiver" means a receiver which receives signals from a network of satellites known as the global positioning system, or GPS, which identifies the receiver's location by:

(a) latitude;

(b) longitude; and

(6) "High adventure activity" means an outdoor activity provided to program participants for the purposes of behavior management or treatment and that requires specially trained staff and special safety precautions to reduce the possibility of an accident or injury.

(7) "Leave no trace principles" means wilderness and land use ethics designed to minimize the impact of visitors on back country areas.

(8) "Residential outdoor program" means a program at designated stationary sites including permanent buildings where the program participants reside.

(9) "Solo experience" means separation of a program participant from the group as part of the outdoor therapeutic process, not including a time-out.

(10) "Water cache" means storing away water in hiding or for future use.

(11) "Wilderness first responder" means a licensed first responder with the medical training course for outdoor professionals as offered by the National Association for Search and Rescue.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-802, 52-2-803, 52-2-805, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.202 Private Outdoor Programs: Application of Other Rules

(1) In addition to requirements established in this subchapter a private outdoor program must meet the requirements for all private alternative adolescent residential programs established in ARM Title 37, chapter 99, subchapter 1.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.206 Private Outdoor Programs: Physical Examination

(1) All physical examinations must be completed by an appropriate licensed health care professional.

(2) A program participant must have a physical examination:

(a) within 30 days prior to admission into the program;

(b) at least annually after entering the program; and

(3) The result of the physical examination including restrictions must be recorded on a standard form provided by the program and signed by the licensed health care professional performing the examination. The form must clearly identify the type and extent of physical activity which the program participant will be participating in.

(a) The program must comply with all restrictions or limitations placed on the program participant by the examining practitioner.

(4) The original physical examination form must be maintained at the field office and a copy must be carried by staff in a waterproof container when the program participant is away from the field office.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.208 Private Outdoor Programs: Field Director Requirements

(1) Each program expedition must include a field director responsible for:

(a) the quality of the field activities;

(b) coordinating field operations;

(d) managing the field office; and

(e) ensuring compliance with applicable licensing rules.

(2) The field director must have the following:

(a) a bachelor's degree in a relevant discipline or 12 months of outdoor program field experience; and

(b) a current wilderness first responder certification.

(3) The administrator of the program may serve as the field director if qualified for both positions.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.209 Private Outdoor Programs: Additional Staff Training

(1) In addition to training requirements in ARM 37.99.153, staff orientation training must include:

(a) supervision of program participants;

(b) procurement, preparation, and conservation of water, food, and shelter;

(d) instruction in emergency procedures, medical, weather signalization fire, runaway and lost program participant;

(e) sanitation procedures relating to food, water, and waste;

(f) knowledge of wilderness medicine, including health issues related to acclimation and exposure to the environmental elements;

(g) local environmental precautions including terrain, weather upsets, poisonous plants, wildlife, and proper response to adversarial situations;

(h) high adventure activities; and

(i) avoiding potential hazards of expedition areas.

(2) All program staff must complete first aid training within six months of hire and prior to working without a staff member trained in wilderness first aid.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.210 Private Outdoor Programs: Residential Outdoor Program Participant-to-Staff Ratio

(1) A residential outdoor program must maintain the following program participant to awake staff ratios:

(a) from 7:00 a.m. to 11:00 p.m., eight program participants to one staff;

(b) from 11:00 p.m. to 7:00 p.m., or any other reasonable eight-hour period of time when program participants are generally sleeping, 16 program participants to one staff; and

(c) programs must have at least one awake night staff in each building housing program participants regardless of the number of participants.

(2) When participating in high adventure activities the program must meet expedition staffing requirements in ARM 37.99.211.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.211 Private Outdoor Programs: Expedition and High Adventure Activity Program Participant-to-Staff Ratio

(1) Each expedition group of program participants must have the following:

(a) two staff members for the first four program participants and one additional staff member for each four program participants;

(b) each group must have at least one staff member of the same gender as the genders represented in the program participant group; and

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-810, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.212 Private Outdoor Programs: Outdoor Behavioral Program: High Adventure General Requirements

(1) High adventure activities may include the following:

(a) target sports;

(b) aquatics;

(d) climbing and rappelling;

(e) spelunking;

(f) white water activities;

(g) use of horses or other animals for riding or packing;

(h) skiing; or

(i) other activities defined in program policy as a high adventure activity.

(2) For the high adventure activities, the program must have written policies and procedures that include:

(a) minimum training, experience, and qualifications for leaders and staff which must be documented in personnel records;

(b) classification and limitations for each program participant participation;

(d) appropriate equipment and the inspection and maintenance of the equipment; and

(e) safety precautions to reduce the possibility of an accident or injury.

(3) Program participants must not be forced to participate in any high adventure activity.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.213 Private Outdoor Programs: Expedition: Field Office Requirements

(1) A program must have a field office in Montana. A field office may be a vehicle, a camp, a building, the residential program, or the administrative office.

(2) The field office must be staffed and monitored 24 hours a day when there are program participants on expeditions or have staff continually monitoring communications and available by satellite phone within 15 minutes of the field office.

(3) Field office staff must respond immediately to any emergency situation.

(4) The following items must be maintained at the field office:

(a) a current list of the names of staff and program participants in each group;

(b) a master map of all activity areas used by a program;

(c) each group's expeditionary route with its schedule and itinerary, copies of which must be sent to the department and local law enforcement when requested;

(d) current logs of all communications with each expedition group away from the field office;

(e) program participant's emergency information required in ARM 37.99.138;

(f) physical examination completed as part of program admission process and any subsequent physical exams;

(g) medical treatment authorization;

(h) list of current medications taken by the program participant;

(i) identifying marks of the program participants such as scars, tattoos, and piercings;

(j) health insurance information;

(k) list of contact persons in case of emergencies; and

(l) a copy of the program participant's case plan.

(5) The program must comply with federal, state, and local laws and regulations and must maintain proof of compliance at the field office.

(6) An arrangement must be made with national or state forest service offices if such land is to be used by the field office.

(a) If the field office or the expedition camp is located on or uses national or state lands, the administrator must familiarize the staff and program participants with rules and ethics governing the use of such property.

(7) If private property will be used, arrangements must be made with the property owners.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.214 Private Outdoor Programs: Outdoor Program Expedition Staff

(1) During any expedition:

(a) expedition staff must carry a copy of the itinerary placed on file at the field office;

(b) expedition staff must remain in contact with the field office via satellite phone, with contacts occurring at a minimum of once each morning and once each evening;

(d) supplies for providing emergency care must be at each expedition camp;

(e) expedition staff must maintain the daily expedition log. Entries in the log must be made in permanent ink and signed and dated by the staff member making the entry. The daily expedition log must be filed at the field office upon return from the expedition and maintained as part of the program's permanent record;

(f) expedition staff and program participants must implement and follow program policies and procedures regarding back country etiquette and leave no trace principles;

(g) expedition staff must closely monitor program participants while acclimating to the environment including temperature, climate, and altitude; and

(h) when temperatures exceed 95°F or fall below 10°F, expedition staff must take appropriate preventative measures to ensure program participants remain free of heat or cold related illness or injuries.

(2) Expedition staff must maintain a daily log that includes:

(a) daily entries regarding health programs, accidents, injuries, near misses, medications used, behavioral problems, and unusual occurrences;

(b) daily notations of environmental factors such as weather, temperature, altitude, and terrain;

(c) daily entries assessing each program participant's hydration, skin condition extremities, and general physical condition;

(d) daily entries describing morning and evening contacts between expedition staff and field office staff;

(e) weekly entries assessing each program participant's physical condition by the field director or other trained as a wilderness first responder;

(f) emergency plan drills, showing date, time, staff, and program participants present; and

(g) descriptions of pre-site investigations for solo expeditions if applicable.

(3) Entries in the log must be made in permanent ink and signed and dated by the staff member making the entry.

(4) The daily expedition log must be filed at the field office upon return from the expedition and maintained as part of the program's permanent record.

(5) Upon return from any expedition the field director must debrief each program participant and staff member and document the debriefing in writing.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.215 Private Outdoor Programs: Communications

(1) The program must have written policies and procedures establishing a system of communication that meets the following criteria:

(a) each group away from the field office must have a satellite phone and extra charged battery packs for the satellite phone;

(b) a global positioning system; and

(2) Verbal communication between each group and the field office must occur once each morning and once each evening.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.216 Private Outdoor Programs: Expedition: Nutritional Requirements

(1) A program must have and follow written policies and procedures on nutritional requirements.

(2) Each program must have a written menu that is approved by a qualified dietitian or nutritionist with knowledge of the program activities and levels.

(3) Foods must be served in amounts and a variety sufficient to meet the nutritional needs of each program participant.

(4) Hands must be cleaned after each latrine use and prior to food preparation and food consumption.

(5) Food may not be withheld from a program participant for any reason.

(6) If no fire is available for cooking food, other food of equal caloric value which does not require cooking must be available.

(7) Field staff are responsible monitoring each program participant's food intake to ensure that the program participants have adequate nutrition.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19; AMD, 2024 MAR p. 2155, Eff. 9/7/24.

Mont. Admin. R. 37.99.217 Private Outdoor Programs: Expedition: Water Requirements

(1) A program must have written policies and procedures on expedition water requirements to include:

(a) program participants must have access to potable water at all times;

(b) water must be available at each expedition camp site. Water cache location information must be verified by field staff before the group leaves expedition camp each day;

(c) expedition groups may not depend on aerial drops for water supply. Aerial water drops must be used for emergency situations only; and

(d) water taken by staff or program participants from a natural source and used for drinking or cooking must be treated to eliminate health hazards.

(2) Each group must have a supply of electrolyte replacement, the quantities to be determined by group size and environmental conditions.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.218 Private Outdoor Programs: Expedition: Participant Clothing, Equipment, and Supplies

(1) Each expedition participant must have appropriate clothing, equipment, and supplies for the types of activities and for the weather conditions likely to be encountered.

(2) Clothing, equipment, and supplies must include:

(a) sunscreen, which must be worn during all seasons;

(b) insect repellent, if appropriate, for the environmental conditions generally expected for the area and season;

(d) personal hygiene items necessary for cleansing;

(e) appropriate feminine hygiene supplies;

(f) wool blankets or an appropriate sleeping bag and a tarp or poncho for when the average nighttime temperature is expected to be 40°F or higher;

(g) shelter from precipitation, appropriate sleeping bag and ground pad when the average nighttime temperature is expected to be 39°F or lower;

(h) clothing appropriate for the temperature changes generally expected for the area;

(i) a clean change of clothing at least once a week or an opportunity for the participant to wash their clothing at least once a week; and

(j) a handbook for staff and program participants describing expedition requirements and expectations.

(3) A program may not remove, deny, or make unavailable, for any reason, the appropriate clothing, equipment, or supplies.

(4) There must be a first aid kit with sufficient supplies on all expeditions and high adventure activities. A kit must:

(a) be readily available on site as well as in all vehicles;

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

(d) be inventoried by the field director after each expedition and restocked as needed.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Mont. Admin. R. 37.99.219 Private Outdoor Programs: Outdoor Program Solo Experience

(1) If an outdoor program uses a solo experience as part of the therapeutic or educational process during expeditions, the program must have written policy and procedures for the utilization of the solo experience. Policy and procedures must include:

(a) purpose of solo experience;

(b) a solo experience must never be used as a punishment or negative consequence;

(d) assessment of program participant readiness for the experience; assessment must be documented in the daily expedition log book;

(e) documented instructions on the solo experience, including expectations, restrictions, communication, environment, and emergency procedures;

(f) notification and check-in systems including a procedure for checking the program participant's emotional and physical condition daily;

(g) risk management procedures; and

(h) a staff member be designated to coordinate and implement the plan.

(2) Staff must be familiar with the site chosen to conduct solo experiences and must conduct a pre-site investigation and preparation. These activities must be documented in the daily expedition log including:

(a) a description of the terrain selected and the appropriateness for the level of participation skill of the program participants;

(b) a review of hazardous conditions; and

(3) Program participants must be supervised during a solo experience. Written plans for supervision must be drafted prior to the solo experience, and a copy of these written plans must be placed in the daily expedition log. A plan of supervision must include at a minimum:

(a) the assignment of a specific staff member responsible for the supervision of the solo participant;

(b) predetermined procedures for placing program participants at a distance from the assigned staff to allow for appropriate supervision and emergency communication;

(d) instruction of program participants to not participate in potentially dangerous activities;

(e) notification and check-in systems including a procedure for checking the program participant's emotional and physical condition daily; and

(f) emergency planning, including:

(i) instructing the program participants on safety and emergency procedures,

including evacuation routes;

(ii) providing each program participant with signaling capabilities, including a whistle, for emergency notification;

(iii) instructing of other program participants on how to respond if the emergency notification system is put into use; and

(iv) providing a check-in system should an emergency occur.

(4) The program participants must be debriefed immediately after a solo expedition. The debriefing must at a minimum:

(a) include a written summary of the program participant's participation and progress achieved; and

(b) be provided in written form to the placing agency and, upon request, to the program participant's parent/legal guardian.

History

Authorizing statute(s): 52-2-803, 52-2-805, MCA
Implementing statute(s): 52-2-803, 52-2-805, 52-2-809, MCA
History: NEW, 2019 MAR p. 2029, Eff. 11/9/19.

Chapter 37.100 Licensure of Community Residences

Subchapter 37.100.1 Adult Foster Care Homes

Mont. Admin. R. 37.100.101 Adult Foster Care Homes (afch): Purpose

(1) The purpose of these rules in this subchapter is to establish licensing requirements for adult foster care homes (AFCH).

(2) The purpose of an AFCH is to offer in a home-like safe environment, light personal care, custodial care, and supervision to aged or disabled adults who require assistance in meeting their basic needs. Residents' needs are to be addressed in a manner that supports and enables residents to maximize their ability to function at the highest level of independence possible.

(3) An AFCH is limited to light personal care, custodial care, and supervision and does not provide skilled nursing care except as provided for in ARM 37.100.136.

(4) The licensing requirements for operating an AFCH do not apply to persons in a mutual or shared living arrangement.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-101, 50-5-103, 50-5-215, 50-5-216, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.102 Adult Foster Care Homes (afch): Definitions

(1) "Abuse" means any willful, negligent, or reckless mental, physical, sexual, or verbal mistreatment, or the misappropriation of personal property of any person receiving care in an AFCH.

(2) "AFCH" means a private home or other facility that offers, except as provided in 50-5-216, MCA and ARM 37.100.136, only light personal care, custodial care, and supervision to four or fewer disabled adults, or aged persons who are not related to the owner or manager of the home by blood, marriage, adoption, or who are not under full guardianship of the owner or manager.

(3) "Aged person" means a person who is at least 60 years old.

(4) "Applicant" means a person who is applying for an AFCH license.

(5) "Case plan" means a document created by the resident's case manager, or a representative from a placement agency which identifies supports and services that are necessary for the resident to achieve independence, dignity, and personal fulfillment while in the AFCH.

(6) "Custodial care" means providing a sheltered, family-type setting for an aged person or disabled adult to provide for the basic needs of food and shelter and having a specific person available to help the adult meet these basic needs.

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

(8) "Disabled adult" means a person 18 years of age or older who has been determined to be disabled as defined by ARM 37.100.302, 37.100.402, and 37.86.3503.

(9) "Exploitation" means an act taken by a person who has the trust of an AFCH resident to obtain control of or to divert to the advantage of another, the ownership, use, benefit, or possession of the resident's money, assets, or property by means of deception, duress, menace, fraud, undue influence, or intimidation with the intent or result of depriving the AFCH resident of the ownership, use, benefit, or possession of his or her money, assets, or property.

(10) "Incident report" means a written report documenting an unusual occurrence, accident, or illness involving a resident.

(11) "License" means the document issued by the department that authorizes a person to operate an AFCH.

(12) "Light personal care" means assisting the aged person or disabled adult in accomplishing such personal hygiene tasks as bathing, dressing, hair grooming, and supervision of self-medication.

(a) "Assisting" means supervision of the resident in personal hygiene tasks with only occasional "hands on" assistance.

(b) "Supervision" means guidance of a person as he carries out activities of daily living, including reminding a resident to maintain his medication schedule as directed by his practitioner, reminding him of important activities to be carried out, assisting him in keeping appointments, and being aware of his general whereabouts even though he may travel independently about the community.

(13) "Mutual or shared living" means that each party shares in the monetary and household responsibilities.

(14) "Neglect" means failure to provide for the biological and psychosocial needs of any person receiving care in an AFCH, failure to report abuse, or failure to exercise supervisory responsibilities to protect patients from abuse and neglect. The term includes, but is not limited to:

(a) deprivation of food, shelter, appropriate clothing, medical care, or other services;

(b) failure to follow a prescribed care plan or medical treatment; or

(15) "Practitioner" means an individual licensed by the Department of Labor and Industry who has assessment, admission, and prescription authority.

(16) "PRN medication" means an administration scheme, in which a medication is not routine, is taken as needed, and requires the licensed practitioner or individual resident's cognitive assessment and judgment for need and effectiveness.

(17) "Provider" means a person who operates or is licensed to operate an AFCH. The provider may be involved in the direct care of residents in the AFCH.

(18) "Resident" means anyone accepted for care in an AFCH.

(19) "Resident agreement" means a signed, dated, written document drawn up between the resident, the resident's legal representative or caseworker, and the provider. The resident agreement lists all charges, services, refunds, and discharge criteria.

(20) "Resident's legal representative" or "resident's representative" means the resident's guardian, or, if no guardian has been appointed, then the resident's family member or other appropriate person acting on the resident's behalf.

(21) "Responsible person" means the resident, resident's legal representative, or any other person identified by the resident or resident's legal representative, as specified in the resident's agreement.

(22) "Restraint" means a personal restriction that immobilizes or reduces the freedom of movement of an individual's arms, legs, or head.

(23) "Serious incident" means:

(a) a suicide attempt;

(b) use of excessive physical force by the provider or staff;

(d) injury to a resident which requires emergency medical care;

(e) falls or accidents that injure a resident;

(f) known or suspected abuse or neglect of a resident by the provider or staff;

(g) unusual behavioral episodes; or

(h) the death of a resident.

(24) "Skilled nursing care" means the provision of nursing care services, health-related services, and social services under the supervision of a licensed registered nurse on a 24-hour basis.

(25) "Staff" means any person whether paid or unpaid, other than the provider, who is employed by the provider and is providing care to residents in an AFCH.

(26) "Survey" means a detailed study to determine if applicant or provider meets all applicable licensing requirements.

(27) "Third party services" means care and services provided to a resident by individuals or entities who have no fiduciary interest in the facility.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-101, 50-5-103, 50-5-215, 50-5-216, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.105 Procedures for Obtaining Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-5-304, MCA
Implementing statute(s): 53-5-303, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1990 MAR p. 2278, Eff. 12/28/90; TRANS, from DFS, 1998 MAR p. 667; REP, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.110 General

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-5-304, MCA
Implementing statute(s): 53-5-303, MCA
History: NEW, Eff. 12/31/72; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1990 MAR p. 2278, Eff. 12/28/90; TRANS, from DFS, 1998 MAR p. 667; REP, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.119 Adult Foster Care Homes (afch): Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter apply to an AFCH.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.120 Adult Foster Care Homes (afch): License Required

(1) Every AFCH must be licensed by the department.

(2) Any person, group, or corporation that establishes or operates an AFCH without a license from the department is in violation of law and subject to prosecution.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-111, 50-5-112, 50-5-113, 50-5-201, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.121 Adult Foster Care Homes (afch): Licenses

(1) The department may issue a license for a period of one to three years in duration for an AFCH, under ARM 37.100.121, to any license applicant meeting all of the requirements established by these rules and the governing statutes.

(2) The department will determine whether an applicant meets the requirements after conducting a licensing survey.

(3) The department will renew the license on the expiration date of the current license if:

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

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

(4) An AFCH may be licensed to care for four or fewer aged persons or disabled adults in need of such care, and must not care for more residents than the number allowed by their license.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1990 MAR p. 2278, Eff. 12/28/90; AMD, 1996 MAR p. 921, Eff. 4/5/96; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.122 Adult Foster Care Homes (afch): License Restrictions

(1) A license is not subject to sale, assignment, or other transfer, voluntary or involuntary.

(2) A license is valid only for the premises and person covered under ARM 37.100.136, for which the original license was issued.

(3) The license remains the property of the department and should be returned to the department upon closing or transfer of ownership.

(4) The address for returning the license is Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-215, 50-5-216, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.125 Adult Foster Care Homes (afch): Licensing Procedures

(1) An applicant must apply for an AFCH license prior to the operation of such home or prior to the expiration of a current license.

(2) Application for a license upon forms provided by the department and accompanied by the required fee must be made to the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59602-2953.

(3) Upon receipt of an application for license or renewal of license, the department will conduct a licensing survey to determine if the home and applicant meet all licensing requirements for licensure as established by these rules. Within 45 days of receipt of a complete application the department will make a final determination of whether the home will be licensed.

(4) If the department determines that an application or accompanying information is incomplete or erroneous, the department will notify the applicant of the specific deficiencies or errors. The department will not issue a license until it receives all required information.

(5) Upon completion of the licensing survey, the department will notify the applicant or provider, in writing, whether they have met the licensing requirements. If the facility has any deficiencies that need to be corrected, the applicant or provider must submit an acceptable plan of correction within ten business days.

(6) Each applicant or provider must report to the department any changes which would affect the current accuracy of information provided on the application prior to the effective date of the change.

(7) If an initial application is denied, an applicant who does not meet the standards set forth in these rules can reapply when those standards are met.

(8) A provider must report a change of address to the department at least three weeks prior to moving. The department will then evaluate whether the new residence meets the licensing requirements before the provider may operate an AFCH in the new residence.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-203, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.130 Adult Foster Care Homes (afch): License Denial, Revocation, or Suspension

(1) The department may deny, revoke, or suspend an AFCH license by written notification to the provider for any of the following reasons:

(a) the provider is not in compliance with licensing requirements established by this subchapter;

(b) the provider has made misrepresentations to the department, either negligent or intentional;

(c) the provider, staff, or other persons in the home have been named as a perpetrator in a substantiated report of abuse, neglect, or exploitation of a child or adult;

(d) the provider, staff, or other persons in the home pose a risk or threat to the safety or welfare of any resident of the home;

(e) any AFCH resident requires physical restraint;

(f) any AFCH resident will need to be carried from the home during any emergency that requires evacuation unless under the direct care of a hospice provider; or

(g) any AFCH resident is totally incontinent or is incontinent and unable to manage their incontinence with more than minimal supervision.

(2) If any violation of the licensing requirements by a provider, staff, or person in the home places a resident in imminent risk of injury or harm, the license may be immediately revoked.

(3) If the department finds that a current provider who is operating an AFCH is out of compliance with the standards set forth in these rules, the department will not revoke or deny renewal of the license if all the following conditions are met:

(a) the standards out of compliance do not eminently threaten the life or health of the residents;

(b) the standards out of compliance can be corrected within 30 days;

(c) the provider submits a written corrective action plan within ten days of the department's notification of noncompliance specifying how compliance will be made within 30 days of receipt of the notification of noncompliance; and

(d) the department approves the corrective action plan.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-207, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.135 Adult Foster Care Homes (afch): Fair Hearing

(1) Any person aggrieved by an adverse department action denying, revoking or suspending a license may request a fair hearing in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(2) The provider will cease operation of the AFCH pending the fair hearing in those instances where the revocation or suspension of the license is based upon actions that the department has determined places any resident in imminent risk of harm or injury.

History

Authorizing statute(s): 2-4-201, 50-1-202, 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-208, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1988 MAR p. 1254, Eff. 6/24/88; TRANS, from DFS, 1998 MAR p. 667; AMD, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.136 Adult Foster Care Homes (afch): Limitations on Care Provided

(1) Except as provided in this rule and pursuant to 50-5-216, MCA, the types of care offered by Adult Foster Care Homes (AFCH) are limited to light personal care, custodial care, and supervision. An adult in the care of an AFCH must not be:

(a) in need of skilled nursing care;

(b) in need of medical, physical, or chemical restraint;

(d) incontinent to the extent that bowel or bladder control is absent; or

(e) unable to self-administer medications.

(2) To continue the continuity of care, an AFCH may be licensed to provide care for an adult receiving state-funded services through the developmental disabilities program of the department or an adult who resided in the home before reaching 18 years of age, even though the adult is:

(a) in need of skilled nursing care;

(b) in need of medical, physical, or chemical restraint;

(d) incontinent to the extent that bowel or bladder control is absent; or

(e) unable to self-administer medications.

(3) A resident of an AFCH licensed under (2) must have a certification in the form of a signed statement, renewed on an annual basis, from a physician, a physician's assistant-certified, a nurse practitioner, or a registered nurse, whose work is unrelated to the operation of the home and who has actually visited the home within the year covered by the statement and certifies that:

(a) the services available to the resident in the home or in the community, or services that may be brought into the home from the community, including nursing services or therapies, are appropriate for meeting the health care or other needs of the resident; and

(b) the health care status of the resident does not necessitate placing the resident in a more intensive residential service setting.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-101, 50-5-103, 50-5-215, 50-5-216, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.137 Adult Foster Care Homes (afch): Resident Rights

(1) The facility must comply with the Montana Long-Term Care Residents' Bill of Rights, found at 50-5-1101 through 50-5-1107, MCA. This includes the posting of the facility's statement of resident rights in a conspicuous place. Prior to or upon admission of a resident, the AFCH must explain and provide the resident with a copy of the Montana Long-Term Care Residents' Bill of Rights.

(2) The provider will write and adhere to a statement applicable to all residents in the AFCH, including as a minimum the rights listed in 50-5-1104, MCA. This statement will be provided to each resident and his or her legal representative upon admission to the AFCH. Signed copies must be retained in the resident file and copies made available to the resident and resident's legal representative, if applicable.

(3) This written statement must include information that all residents have the right to:

(a) be treated as an adult with respect and dignity;

(b) be informed of their medical condition and the right to consent to or refuse treatment;

(d) participate in community organizations and activities;

(e) have medical and personal information kept confidential;

(f) a safe and secure environment;

(g) be free from discrimination in regards to race, color, national origin, sex, or religion;

(h) be provided the opportunity to voluntarily practice their own religion, attend religious services of their choice in the community, and to visit with representatives of their faith;

(i) identify with their cultural heritage;

(j) the opportunity for bathing and personal grooming, as desired;

(k) dress according to personal taste;

(l) write and send mail at their own expense without censorship and receive unopened mail;

(m) daily private access to a telephone;

(n) have visitors within reasonable visiting hours; and

(o) be encouraged and assisted to exercise constitutional and legal rights including the right to vote.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.138 Adult Foster Care Homes (afch): Background Checks

(1) The provider, staff, and any adult residing in the home must have a state of Montana criminal background check, and, if applicable, a tribal criminal background check and state protective service background check prior to receiving an AFCH license or working at the AFCH.

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

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

(a) the provider, staff member, or anyone residing in the AFCH has been convicted by a court of competent jurisdiction of a felony or misdemeanor involving homicide, sexual intercourse without consent, sexual assault, aggravated assault, assault on a minor, assault on an officer, assault with a weapon, kidnapping, aggravated kidnapping, prostitution, robbery, or burglary;

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

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

(d) the provider, staff member, or anyone residing in the home has been named as a perpetrator in a substantiated report of child abuse or neglect; or

(e) the provider, staff member, or anyone residing in the home has been convicted of abuse, sexual abuse, neglect, or exploitation of an elderly person or a person with a developmental disability.

(4) The department may deny or revoke a license upon finding that the provider, staff member, or anyone residing in the home has a conviction for a misdemeanor partner and family member assault, misdemeanor endangering the welfare of a child, misdemeanor unlawful transaction with a child, or a crime involving an abuse of the public trust.

(5) The provider or staff member or anyone residing in the home who is charged with physical or sexual violence against any person, or any felony drug- related offense and awaiting trial may not provide care or be present in the facility pending the outcome of the criminal proceeding.

(6) The AFCH is responsible for assuring that the persons covered by this rule have met these requirements before providing care.

(7) The provider, staff member, or anyone residing in the home must not pose any potential threat to the health, safety, and well-being of the residents in care.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.139 Discharge Criteria

(1) The provider will not discharge or transfer a resident from the AFCH without prior planning, including:

(a) providing a written 30-day prior notice to the resident or resident's legal representative; and

(b) maintaining a record that includes:

(i) the date of discharge;

(ii) the reason for discharge;

(iii) the disposition of money, valuables, and medications held for safekeeping; and

(iv) a forwarding address of the resident or the resident's legal representative.

(2) A resident may be involuntarily discharged in less than 30 days for the following reasons:

(a) the resident has a medical emergency;

(b) the resident exhibits behavior that poses an immediate danger to self or others; or

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.140 Adult Foster Care Homes (afch): Environmental Requirements

(1) The AFCH must be located close to community resources.

(a) The AFCH must be accessible to transportation (e.g., bus, train, or car).

(b) The AFCH must be in reasonable proximity to shopping areas, churches, senior centers, medical and dental clinics, and hospitals.

(2) The AFCH must have an adequate and safe water supply. A public water supply must be used, if available.

(a) If a nonmunicipal water source is used, coliform sampling must be done before licensing and, at least, two separate times per year. The sampling schedule must include collection in the two time periods that the water source is most likely to be contaminated, such as in April through June and September through October or as directed by the local health authority.

(b) The water samples must be tested for coliform bacteria and action taken to ensure potability.

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

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

(3) The AFCH must be connected to a public sewer system, if available. If septic tanks or other nonmunicipal sewage systems are used, they must be in good working order.

(a) The AFCH must repair or replace the sewage system whenever:

(i) it fails to accept sewage at the rate of application;

(ii) seepage of effluent from or ponding of effluent on or around the system occurs;

(iii) contamination of a potable water supply or state waters is traced to the system; or

(iv) a mechanical failure occurs.

(4) Mop water or soiled cleaning water must be disposed of immediately after use in a utility sink or a toilet.

(5) The AFCH must be equipped with a telephone landline. Telephone numbers of the hospital, police department, fire department, ambulance, and poison control center must be posted by each telephone. The provider must notify the department, the residents' case managers, and the residents' legal representative within 24 hours any time the AFCH phone number is changed.

(6) The provider must keep the home clean and in good repair and the premises must be kept free from objects, materials, and conditions which constitute a danger to the residents.

(7) All operable windows that may be left open must be fitted with insect screens.

(8) A minimum of ten foot-candles of light must be available in all rooms and hallways, with the following exceptions:

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

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

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

(9) The AFCH must make adequate provisions for laundering of residents' personal laundry.

(a) A mechanical washer and a hot air dryer must be available.

(b) Soiled linens and clothing must be stored in closed containers prior to laundering in an area that is separate from food, storage, kitchen, and dining areas.

(d) All bed linens, towels, and washcloths must be dried in the dryer.

(e) Clean laundry must be protected from contamination from soiled laundry.

(f) Anyone who handles soiled laundry must wash their hands before handling clean laundry.

(10) The facility must be equipped to provide an adequate amount of hot water for a resident's use between the temperature range of 110° through 120° F at the fixture.

(11) There must be no more than three residents in any bedroom and each room must include:

(a) floor to ceiling walls;

(b) one door which can be closed to allow privacy for residents;

(c) exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, each resident's bedroom must have 80 square feet per each bed placed in that bedroom;

(d) at least one window which can be opened from the inside without the use of tools;

(e) a mirror appropriate for grooming;

(f) an adequate closet or wardrobe, lighting sufficient for reading and other resident activities, bureau or dresser or equivalent, and at least one chair with arms in each bedroom for every two residents;

(g) an individual bed for each resident at least 36 inches wide and 72 inches long with comfortable springs in good condition, a clean protected mattress not less than 5 inches thick or 4 inches if of a synthetic construction and a pillow;

(h) a provider must provide washable bedding for each bed, which includes two sheets, a pillow case, minimum of one blanket, and a bedspread; and

(i) a provider must have a linen supply for twice the number of beds in the home.

(12) An AFCH must provide distinct living and sleeping areas. All areas must be well lighted, heated, and ventilated.

(a) The home must have a living or day room area for use by a resident and his visitors.

(b) The living and sleeping areas for a resident must not be in separate wings, units, or buildings.

(c) A living room, dining room, or other room not ordinarily used for sleeping must not be used for sleeping by residents, providers, or other persons living in the home.

(13) One toilet, sink, and bath or shower must be provided for each six individuals in the AFCH. At least one toilet and sink must be available on each floor where residents' bedrooms are located.

(a) Light switches must be located by the door in all bathrooms.

(b) Bathrooms must be vented to outside or have an outside window.

(d) Bathtubs and showers must be equipped with a nonskid surface and sturdy grips.

(e) The use of a commode/movable toilet must only be temporary, less than 30 days, and be accompanied by the resident′s practitioner′s order. Commodes/movable toilets must be emptied frequently and cleaned and sanitized daily, or more often if necessary.

(14) The kitchen must be equipped properly to prepare and serve adequate meals.

(a) Waste must be kept in leakproof, nonabsorbent containers with close fitting covers for garbage, refuse, and other solid waste.

(b) Waste must be removed from the kitchen daily and from the premises at least weekly.

(d) The kitchen must be maintained in a clean and sanitary condition.

(15) The AFCH must be heated by centralized heating or its equivalent. Temperature of all rooms must be between 68° F through 76° F in the daytime and 60° F through 76° F during sleeping hours.

(a) If the heating mechanism is located in the basement of the home, the separation must include at least a 1 3/4 inch solid wood core door or equivalent to create a floor separation between the basement and the first floor.

(b) Flame producing water heaters must be installed with the same protection as the heating mechanism.

(d) Factory mutual and underwriter's laboratories approved permanent, fixed type electrical heating, such as recognized panel or baseboard fixed type may be utilized in any location.

(e) In existing homes where an American Gas Association (AGA) approved sealed combustion wall heater has been installed in accordance with both the AGA and the manufacturer's recommendations, approval will be given if the unit is located on an outside wall, obtains combustion air directly from the outside, and vents products of combustion directly to the outside.

(f) The use of wood burning stoves or fireplaces is prohibited unless documentation is available showing that proper installation and inspection have taken place by a qualified inspector.

(i) Documentation will be required upon initial licensure or initial installation and annually, thereafter.

(ii) Documentation must be kept for three years and be available for inspection.

(g) Storage of combustible materials is prohibited in areas containing the heating mechanism, water heater, or incinerator.

(h) The heating mechanism must be inspected by the provider at least yearly and necessary maintenance and repairs made.

(i) At least one carbon monoxide detector is required on each level of the AFCH.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; AMD, 1996 MAR p. 921, Eff. 4/5/96; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.141 Adult Foster Care Homes (afch): Fire Safety

(1) A smoke detector approved by a recognized testing laboratory, which is properly maintained and regularly tested, must be located on each level of the AFCH and in all sleeping areas and common living areas with the exception of the kitchen and bathrooms.

(2) If individual battery-operated smoke detectors are used, the following maintenance is required:

(a) smoke detectors must be tested at least once a month to ensure that they are operating correctly;

(b) new operating batteries must be installed at least once each calendar year; and

(3) A workable portable fire extinguisher, with a minimum rating of 2A10BC, must be located on each floor of the home. Fire extinguishers must be:

(a) mounted on the wall not to exceed five feet from handle to floor and no closer than four feet from the floor;

(b) no more than 75 feet from each other;

(c) inspected, recharged, and tagged at least once a year by a person certified by the state to perform such services; and

(d) not obstructed or obscured from view.

(4) No unvented fuel-fired heating devices are allowed in the home.

(5) No stove or combustion heater will be so located as to block escape or be located under a stairway in case of malfunctioning of the stove or heater.

(6) Exits are defined as a means of egress or passage to safe ground outside a building.

(a) Every room used for sleeping, living, or dining must have at least two exits that are remote from one another, at least one of which must be a door or stairway providing a means of unobstructed travel to the street or ground level outside of the building. Of these two exits, one may be an egress window which meets the criteria in (6)(c)(i) through (iv).

(b) All exits must be maintained in unobstructed, easily traveled condition at all times, free of ice and snow on the outside.

(c) Every floor of the AFCH that is utilized for resident activities will have two remote exits. Of these two exits, one may be a window which meets the following criteria found in the National Fire Protection Association Unified Facilities Criteria (NFPA UFC) 101 or Section 1025 International Building Code (IBC) (2006):

(i) emergency escape and rescue openings must be a minimum net clear opening of 5.7 square feet;

(ii) minimum net clear opening of not less than 24 inches in height and 20 inches in width;

(iii) window openings must not be greater than 44 inches from the floor; and

(iv) window openings must be operational from the inside without use of keys or tools.

(d) Stairways in a basement may only be used as an exit if they provide a means of unobstructed travel to the outside of the building.

(e) Doors which form a part of a required exit must be at least 36 inches in width in new construction and at least 30 inches in width in existing facilities. In all cases, exit doors must be of adequate width for wheelchairs.

(f) Traffic to and from any room must not be through a resident's bedroom.

(g) The first floor of an AFCH must have at least two separate and independent exits leading to the outside.

(h) Homes accommodating residents, who regularly require wheelchairs, must be equipped with ramps located at each exit to the outside. A ramp must not exceed 1 foot of rise in 12 feet of run.

(i) The required path of travel to the outside must not be through rooms that are subject to locking or otherwise controlled by a person other than the person seeking to escape.

(7) Access to rooms that are occupied by residents must not be by means of a trap door, ladder, or folding stairs.

(8) Every door that can be locked must have a means to open the door from the outside in case of emergencies. Locks on closet doors must be openable from both sides.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.145 Adult Foster Care Homes (afch): Other Safety Requirements

(1) Rugs must be attached to the floor or made of nonskid material.

(2) Corridors must be well lighted, uncluttered, and at least three feet wide.

(3) Stairways and ramps must have sturdy banisters.

(a) Open stairways should be protected by gates unless gates do not enhance the safety of the residents.

(b) Stairs and ramps must be provided with nonslip tread and will be at least three feet wide.

(4) A provider or staff must have either visual or auditory contact, at least every 30 seconds, with any resident who is able to bathe unassisted but has a condition which may render them physically or mentally helpless, or both.

(5) Extension cords may not be used as permanent wiring.

(6) All appliances, lamp cords, and exposed light sockets must be suitably protected to prevent accidents or electrocution.

(7) All areas occupied by residents must be well lighted. Night lights must be provided for each resident. Light switches must be located at the door.

(8) The yard area must be kept free from all hazards, nuisances, refuse, and litter.

(9) All guns must be kept in locked storage and ammunition must be kept in locked storage separate from the gun.

(10) The provider must ensure the residence is equipped with accessible first-aid supplies including a first-aid kit with sufficient supplies available at all times. A first-aid kit must:

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

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

(d) be inventoried on a quarterly basis and restocked as needed.

(11) Policies and procedures must be in place for the safe use and storage of fuels and all heat sources.

(a) All alcohol, detergents, chemical sanitizers, and related cleaning compounds and other chemicals must be stored in their original properly labeled container in a safe location.

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

(c) Poisonous compounds such as insecticides, rodenticide, and other chemicals bearing the EPA toxicity labels "warning" or "danger" must be kept in their original properly labeled container and under lock and key.

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

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.146 Adult Foster Care Homes (afch): Emergency Preparedness

(1) Each AFCH must have written policy and procedures for emergency evacuation to be followed in the case of fire or other emergency. A provider and resident evacuation drill must be conducted at least two times annually, no closer than four months apart.

(a) All household members must participate in an evacuation drill.

(b) The provider will retain a written report including, but not limited to the date and time of the drill and those involved in the drill. The provider must retain a copy of the written report, on-site, for a period of 24 months.

(2) A new resident will be instructed in emergency evacuation upon admission.

(3) Emergency procedures must include a plan for removing all residents, including residents who need assistance in exiting.

(4) New staff members must also be oriented in how to conduct an evacuation within one week of employment and before being scheduled as the only staff in the home. Documentation of this orientation must be maintained in the staff member's personnel record.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.149 Adult Foster Care Homes (afch): Additional Requirements for an Afch Licensed to Serve Individuals with Mental Illess

(1) An AFCH licensed to serve individuals with mental illness must admit only those residents that meet the following admission criteria:

(a) be diagnosed with a severe disabling mental illness as defined in ARM 37.86.3503;

(b) be medically stable;

(d) be able to take medications when prompted.

(2) Documentation of the resident meeting admission criteria in (1) must be in the resident's file.

(3) The AFCH must contract with a licensed mental health center that has an adult foster care endorsement pursuant to ARM 37.106.1906 or have a formal working relationship with a case management team providing mental health services to the resident.

(4) The AFCH provider contracting with a mental health center must participate in residents' treatment planning as required in ARM 37.106.2016.

(5) In addition to requirements in ARM 37.100.162, a placement agreement must set forth the terms of the resident's placement, the responsibilities of the foster care provider, the responsibilities of the mental health center or case management team, the responsibilities of the resident, and when appropriate, the responsibilities of the resident's legal guardian.

(6) The AFCH provider contracting with a mental health center must participate in orientation as required in ARM 37.106.2004.

(7) The AFCH will assign chores to residents only as outlined in the resident's treatment plan.

(8) AFCH providers must have a written policy describing the consequences to the resident when violating any rules which the AFCH itself establishes.

(9) If the house rules are violated by the resident the AFCH will submit an incident report to the mental health center or case management team within 24 hours.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.150 Adult Foster Care Homes (afch): Program

(1) The provider must provide light personal care, custodial care, and supervision for residents, including:

(a) A minimum of three regular, nutritious, and well-balanced meals must be served family style per day and a minimum of two snacks offered to residents per day.

(b) Not more than 15 hours can elapse between the evening and morning meal.

(c) All perishable foods must be stored at such temperatures as will protect against spoilage. Temperatures must not register over 41º F for refrigeration and 0º to 10º F in the freezer.

(d) Thermometers must be kept in freezer and refrigerator compartments.

(e) All foods, while being stored, prepared, or served must be protected against contamination and be kept safe for human consumption.

(f) Home canned foods must not be used for resident's meals.

(g) The provider must prepare meals which comply with the special dietary needs of the resident as prescribed by the resident's practitioner.

(2) If a resident requires assistance in bathing, the person assisting should be of the same sex whenever possible. If not possible, appropriate covering must be used to ensure the resident's privacy.

(3) A provider, staff member, or adult member of the AFCH must always be present when a resident is in the home. Only if stated in the resident's case plan or resident's agreement can a resident be left in the home alone. This time must be no longer than four hours in a 24-hour period.

(4) Residents must not be used as employees of the AFCH or be coerced into performing tasks such as housekeeping, laundering, and yard work for the provider or others.

(5) The provider will transport residents to medical, dental, mental health, and other appointments related to the resident's care plan, unless the resident, case manager, or guardian has arranged for other transportation.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.151 Adult Foster Care Homes (afch): Medication

(1) All residents must self-administer their own medications.

(2) The provider is responsible for providing assistance to the resident in taking his medications, including:

(a) removing medication from secured storage;

(b) providing verbal suggestions, prompting, reminding, gesturing, or providing a written guide for self-administering medications;

(c) handling a prefilled, labeled medication holder, labeled unit dose container, syringe or original marked, labeled container from the pharmacy, or a medication organizer;

(d) opening the lid of the container for the resident;

(e) guiding the hand of the resident to self-administer the medication;

(f) holding and assisting the resident in drinking the fluid to assist in the swallowing of oral medications; and

(g) assisting with removal of a medication from a container for residents with a physical disability which prevents independence in the act.

(3) Resident medication organizers may be prepared up to four weeks in advance and injectable medications as specified in (4)(c) by the following individuals:

(a) a resident or a resident's legal representative;

(b) a resident's family caregiver, who is a person related to the resident by blood or marriage or who has full guardianship; or

(4) The individual referred to in (3) must adhere to the following protocol:

(a) verify that all medications to be set up carry a practitioner's current order;

(b) set up medications only from prescriptions in labeled containers dispensed by a registered pharmacist or from over-the-counter drug containers with intact, clearly readable labels; and

(c) set up injectable insulin up to seven days in advance by drawing insulin into syringes identified for content, date, and resident. Other injectable medications must be set up according to the recommendations provided by the pharmacy.

(5) An accurate medication record for each resident must be kept of all medications, including over-the-counter medications, for those residents who require monitoring or assistance or both by the provider. The record must include:

(a) name of medication, reason for use, dosage, route, and date and time taken;

(b) name and telephone number of the prescribing practitioner;

(c) any adverse reaction, unexpected effects of medication, or medication error, which must also be reported to the resident's practitioner;

(d) allergies and sensitivities, if any; and

(e) resident specific parameters and instructions for PRN medications.

(6) The medication record must indicate the reason for the omission of any dose of medication.

(7) A medication record need not be kept for those residents for whom written authorization has been given by their practitioner to keep their medication, including over-the-counter medication, in their rooms and to be fully responsible for taking the medication in the correct dosage and at the proper time. The authorization must be renewed on an annual basis.

(8) Prescription drugs must be purchased from a licensed pharmacy, labeled with the name, address, and telephone number of the pharmacy, name of the resident, name and strength of the drug, direction for use, date filled, prescription number, name of the practitioner, and expiration date. Controlled substances must have a warning label on the bottle.

(9) All prescription and nonprescription medication must be contained in a locked storage area.

(10) Medications requiring refrigeration must be separated from food in a clearly labeled, designated locked container.

(11) If the resident is not able to do so, the provider must destroy all discontinued prescriptions.

(a) The provider will maintain a record of all destroyed or returned medications in the resident record.

(b) Documentation of disposition including resident's name, name of drug, quantity, and prescription number must be signed by the individual disposing of the medication.

(12) No resident, provider, or staff member may be permitted to use another resident's medication.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.152 Adult Foster Care Homes (afch): Illnesses, Accidents, Serious Incidents, Absences, or Death

(1) In case of an accident or sudden illness, the provider must immediately obtain needed care for the resident and notify the resident's legal representative within 24 hours.

(2) Any serious incident must be reported to the department's quality assurance licensing surveyor and the resident's legal representative within 24 hours or the next business day following the incident.

(3) The incident report must be in writing and include the following information:

(a) name of the resident involved in the incident;

(b) date, hour, place, and cause of the incident;

(d) effect of the incident on the resident involved and type of care given;

(e) name of practitioner notified and time of notification, if necessary;

(f) practitioner's statement regarding extent of injuries, treatment ordered, and disposition of resident involved;

(g) time and date guardian notified;

(h) time and date of notification of case manager, if the resident has a case manager; and

(i) corrective measures taken to avoid repetition of accident or incident.

(4) As required by 52-3-811, MCA, any person who operates or is employed by an AFCH must report any suspected abuse, neglect, or exploitation of a resident to adult protective services.

(5) If a resident is unexpectedly absent from the home without explanation for a period of four hours or more, the provider must notify local law enforcement, case managers, and relatives or legal representatives of the resident.

(6) When a resident dies, the provider must immediately notify the resident's practitioner and the resident's legal representative.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.153 Adult Foster Care Homes (afch): Records

(1) The provider must submit to the department, upon its request, any reports required by federal or state law or regulation.

(2) The provider must maintain a record regarding each resident in the home which contains at least the following information:

(a) name, address, and telephone number of next of kin or legal guardian;

(b) name, address, and telephone number of person or agency responsible for placing the resident in the home and a copy of the resident agreement;

(d) the name and address of the resident's practitioner and hospital;

(e) any incident reports regarding the resident;

(f) any grievance lodged by the resident;

(g) medication records as described in ARM 37.100.151;

(h) a signed medical authorization form by the resident or resident's legal representative allowing the provider to obtain needed medical information regarding the resident;

(i) documentation of medical appointments or consultations and results;

(j) a signed copy of the resident rights statement as required in ARM 37.100.137; and

(k) a copy of the resident's treatment plan or case plan, if placed through the Mental Health Foster Care Program or the department's Developmental Services Division.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.157 Adult Foster Care Homes (afch): Third Party Providers

(1) It is recognized that residents may require temporary in-home services from third party providers. The following third party services are allowed in an AFCH:

(a) If the provider who is the only service provider in the home becomes temporarily incapacitated for two weeks or less, a home attendant, personal care attendant, or other qualified person may come into the home to provide the needed services.

(b) If a resident's practitioner prescribes temporary in-home skilled nursing services for less than 30 days to prevent the resident's hospital confinement, skilled nursing services may be provided in the AFCH for a period not to exceed 30 days.

(2) The third party in-home skilled nursing services as outlined in (b) must not exceed two hours per day per resident.

(3) The day and hour limits established in this rule are not limitations on the availability of services from any state or federally funded in-home service programs, but are established to ensure that AFCHs provide light personal care and custodial services, not skilled nursing services.

(4) Payment from third party in-home services is the responsibility of the resident.

(5) Documentation of the services provided to the resident must be retained in the resident record.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.161 Adult Foster Care Homes (afch): Resident's Funds

(1) Residents must have access to and use of their personal funds. Exceptions are subject to provisions of the resident's case plan.

(2) A provider may handle a resident's finances only if no other responsible person is available and willing to do so.

(a) The maximum value of money accepted by the provider for safekeeping must not exceed $100.00 per resident.

(b) A resident's funds must be kept separate and apart from all funds and monies of the provider and treated as a trust obligation of the provider.

(3) The provider is responsible for maintaining a written record of each resident's personal property and personal financial transactions, except for those residents who are capable of handling their own financial affairs or those residents whose financial affairs are handled by a relative, guardian, or conservator.

(4) A current monthly record of the income, source of income, and expenses for each resident, except those residents who are capable of handling their own financial affairs, must be maintained by the AFCH provider.

(a) The provider must ensure that the resident's personal money and personal property is not appropriated or misused by any person. Any unethical use of a resident's money or property by another must be reported to adult protective services pursuant to 52-3-811, MCA.

(5) Transactions prohibited:

(a) A provider, staff, or any person living in the home must not borrow money, property, or other valuables from a resident.

(b) Sales or other financial transactions between a provider, staff, or any person living in the home are prohibited.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.162 Adult Foster Care Homes (afch): Resident Agreement

(1) The provider must enter into a written agreement with the prospective resident or the resident's legal representative prior to admission to the home. The provider must give the prospective resident or the resident's legal representative a copy of the agreement and must explain the agreement in full. The agreement must include at least the following items:

(a) a statement explaining light custodial care provided to the resident, as well as the limitations of an AFCH;

(b) a statement describing specific services the AFCH will provide;

(d) a statement explaining the resident's responsibilities including, but not limited to house rules, the grievance policy, and policy regarding pets;

(e) a statement explaining specific charges that will be made to the resident for care and an itemized statement of what expenses in addition to the cost for care will be charged to the resident including fines, penalties, or late fees that will be assessed against the resident;

(f) a statement that the agreed-upon provider rate will not be changed unless 30 days advance written notice is given to the resident or resident's legal representative, or both;

(g) criteria for requiring transfer or discharge of the resident;

(h) the provider's policy for refunding payment in the event of the resident's absence, discharge, or transfer from the AFCH and the provider's policy for refunding security deposits; and

(i) signature of AFCH provider, resident, and legal representative.

(2) A copy of the agreement must be filed in the resident's file.

(3) When there are changes in services, financial arrangements, or requirements governing the resident's conduct and care, a new resident agreement must be executed or the original agreement must be updated by addendum. New agreements and any addenda must be signed and dated by the provider, the resident, and the resident's legal representative.

(4) If there is a question as to whether the aged or disabled adult can be adequately cared for in an AFCH, the provider must contact the resident's practitioner for an evaluation and written recommendation stating that placement in the AFCH is the most appropriate level of care for the resident and that the resident meets the criteria set in ARM 37.100.136.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.165 Adult Foster Care Homes (afch): General Requirements for Providers and Staff

(1) Providers and staff must be at least 18 years of age or older.

(2) Providers and staff must be in good physical and mental health.

(3) An applicant, provider, staff, and each adult living in the AFCH must complete a "personal statement of health for licensure" form provided by the department. Forms must be submitted to the department with the initial application for licensure or application for license renewal.

(4) The department may request an evaluation of the applicant, provider, staff, or any person living in the home if there are grounds to believe they have engaged in behaviors which may place residents at risk of harm.

(5) An applicant, provider, staff, or any adult living in the home must complete a "release of information" form provided by the department to conduct a criminal, protective services, and, if applicable, a tribal criminal and protective services background check.

(6) No individual in the AFCH may pose a risk to the safety and well-being of the residents.

(7) A provider must maintain a current CPR/First-Aid Certification.

(a) Staff must obtain a current CPR/First-Aid Certification within 30 days of hire. Certification must be kept current.

(8) An AFCH must include at least one adult who lives in the home on a permanent basis and who is not engaged in employment outside the home. Exceptions may be granted by the department if there is adequate provision for alternative care.

(9) The provider and staff must:

(a) share information about the residents with the department and the resident's legal representation; and

(b) cooperate with any resident's practitioner in assisting the resident in following the practitioner's recommendations for the resident.

History

Authorizing statute(s): 50-5-103, 50-5-215,MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1989 MAR p. 2207, Eff. 12/22/89; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.170 Adult Foster Care Homes (afch): Grievances

(1) The provider must have a written grievance policy which outlines the procedures to be followed by a resident in presenting a grievance to the family concerning his care in the home.

(2) A resident's written grievance report must be maintained in the resident's record.

(3) The report must include the nature of the complaint, the date of the complaint, and a statement indicating how the issue was resolved.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.171 Adult Foster Care Homes (afch): Communicable Disease Control

(1) The AFCH must develop and implement an infection prevention and control program. At a minimum:

(a) The provider will develop, implement, and review, at least annually, written policies and procedures regarding infection prevention and control which must include, but not be limited to, procedures to identify high-risk individuals and what methods are used to protect, contain, or minimize the risk to residents, staff, and visitors.

(b) The provider is responsible for the direction, provision, and quality of infection prevention and control services.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.172 Adult Foster Care Homes (afch): Pets

(1) When pets are kept on the premises, the provider must write and adhere to procedures for their care and maintenance. The AFCH will consult with the local health department and care for all pets as recommended by them.

(2) When animals are kept at the AFCH, the following conditions must be met:

(a) proof of current vaccinations must be kept on file at the AFCH;

(b) pets not confined in enclosures must be under control;

(d) pets may not be permitted in food preparation, storage, or dining areas during meal preparation time or during meal service or in an area where their presence would create a significant health or safety risk to others; and

(e) caregivers and residents must wash their hands after handling animal food and animal waste.

(3) The AFCH will not keep or bring in ferrets, turtles, iguanas, lizards, or other reptiles, psittacine birds (birds of the parrot family), or any wild or dangerous animals.

(4) The AFCH may allow exceptions for reptiles if the animals are kept behind a glass wall in a tank or container where the animal cannot be easily touched while inside the tank.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, MCA
History: NEW, 2014 MAR p. 1098, Eff. 5/23/14.

Mont. Admin. R. 37.100.175 Adult Foster Care Homes (afch): Prohibited Practices

(1) An AFCH must not subject any resident to restraint, isolation, corporal punishment, personal humiliation, or the withholding of meals, water, clothing, mail, or visits.

(2) A provider, staff, or any person living in the home is prohibited from providing skilled nursing care except as provided for in ARM 37.100.136.

(3) Licensed day care services provided to adults or children cannot be provided in the AFCH.

(4) Foster care services to children cannot be provided in the AFCH with the following exceptions:

(a) the AFCH resident lived in the home prior to the age of 18;

(b) services are provided pending adoption as defined in 41-1-103, MCA; or

(5) Smoking is prohibited in an AFCH by residents or individuals residing or visiting in the home pursuant to the Montana Indoor Clean Air Act, 50-40-104, MCA.

History

Authorizing statute(s): 50-5-103, 50-5-215, MCA
Implementing statute(s): 50-5-103, 50-5-215, 50-5-216, MCA
History: NEW, 1985 MAR p. 289, Eff. 3/29/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1990 MAR p. 2278, Eff. 12/28/90; AMD, 1992 MAR p. 800, Eff. 4/17/92; TRANS, from DFS, 1998 MAR p. 667; AMD, 2014 MAR p. 1098, Eff. 5/23/14.

Subchapter 37.100.3 Community Homes for Persons with Developmental Disabilities

Mont. Admin. R. 37.100.301 Community Homes for Persons with Developmental Disabilities: Purpose

(1) The purpose of these rules is to establish licensing requirements for community homes for developmentally disabled persons.

(2) The purpose of a community home is to provide a family-oriented, home-like residence and related residential services to persons with developmental disabilities so as to enable those persons to enjoy a manner of living that is as close as possible to that considered to be normal in the community.

(3) Residents will reside in the least restrictive environment. Intervention will be the least intrusive into, and the least disruptive of, the person's life and represent the least departure from normal patterns of living that can be effective in meeting developmental needs. The person's developmental needs will be met through domiciliary services, personal-social assistance and program plans and training. Residents will be encouraged to engage in meaningful activity, to develop techniques to become increasingly more independent, and to interact with the community in which they reside.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.302 Community Homes for Persons with Developmental Disabilities: Definitions

For purposes of this subchapter, the following definitions apply:

(1) "Applicant" means a non-profit or state-operated entity which has completed and submitted to the department a license application/renewal request for the operation of a community home for persons with developmental disabilities.

(2) "Community home" means a family-oriented residence or home designed to provide facilities for persons with developmental disabilities, as defined in 53-20-302 , MCA.

(3) "Community home staff" means those persons employed by a provider to directly participate in the care, supervision and guidance of the residents in a community home for persons with developmental disabilities.

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

(5) "Developmentally disabled person" means a person who has a developmental disability as defined in 53-20-202 (3) , MCA.

(6) "Habilitation" means the process by which the staff assists developmentally disabled persons to acquire and maintain skills, to enable them to cope with their own demands, and to raise the level of their physical, mental and social functioning.

(7) "Individual habilitation plan (IHP) " means a written plan of intervention and action developed as provided for in ARM 46.8.105 by an interdisciplinary team of persons on the basis of a skill assessment and determination of the status and the needs of a developmentally disabled person.

(8) "Provider" means the person, corporation or other entity furnishing community home services to developmentally disabled persons.

(9) "Resident" means a developmentally disabled person who lives in and receives services from a community home.

(10) "Training" means an organized program for assisting developmentally disabled persons in acquiring, improving or maintaining particular skills.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.307 Community Homes for Persons with Developmental Disabilities: License Required

(1) The department will issue a license for a community home to any license applicant meeting requirements established by these rules. However, the department may waive in whole or in part procedures for verifying compliance with the requirements of these rules upon receiving written documentation that:

(a) another state agency has already licensed or otherwise approved the operation of the community home, or

(b) a national or state recognized certification process has already been completed and has resulted in certification, accreditation, or other approval of the operation of the community home.

(c) Waiver of procedures for checking compliance as provided in this subsection may occur only where procedures proposed to be waived are clearly already provided for in the accreditation or approval process relied on by the licensing representative. Waiver of procedures must not result in the reduction of standards imposed through licensing requirements.

(2) The department will determine based upon a licensing study whether an applicant meets the requirements.

(3) The department will deny a license to any applicant that fails to meet the requirements established by these rules unless circumstances require that a temporary license be issued or the department determines it is appropriate to issue a provisional license.

(4) The department will issue a license annually on the expiration date of the previous year's license if:

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

(b) the provider continues to meet all standards established by these rules, as determined by the department after a licensing study and upon receipt of certification by the state fire marshal and local health authority.

(5) A community home may be licensed for two or more residents not to exceed eight and, with special written permission from the department, may be licensed for nine to twelve residents.

(6) The department may give special permission for a community home license for 9 to 12 residents if the state fire marshal verifies in writing that:

(a) a manually operated fire alarm system is installed;

(b) all sleeping rooms below street floor level have direct access to the outside of the building; and

(d) there are suitable alternatives to (a) , (b) or (c) already in place and approved in writing by the state fire marshal.

(7) The department may issue a temporary license not to exceed 60 days to any applicant or provider who has not received a fire marshal or health department certification because of unavoidable delays in the certification process.

(8) The department may in its discretion issue a provisional license for any period, not to exceed 6 months, to any license applicant that has met all applicable requirements for fire safety and has submitted a written plan approved by the department to comply fully with all minimum requirements established by these rules within the time period covered by the provisional license.

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

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1992 MAR p. 2277, Eff. 10/16/92; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.308 Community Homes for Persons with Developmental Disabilities: Licensing Procedures

(1) An applicant shall apply for a community home license prior to the operation of such home or to the expiration of a current license. Application shall be made to the department upon forms provided by the department.

(2) The department will upon receipt of the application, conduct a study and evaluation of the applicant.

(3) If the department determines that an application or accompanying information is incomplete or erroneous, the applicant will be notified of the specific deficiencies or errors and shall submit the required or corrected information within 60 days. The department will not issue a license until it receives all required information.

(4) Each applicant shall promptly report to the department changes which would affect the current accuracy of information provided on the application.

(5) The department may waive in whole or in part the requirements of (2) of this rule, and/or any other procedures for checking compliance with the requirements of this subchapter, based on a proper waiver of such procedures under (1) of ARM 37.100.307 .

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1653, Eff. 7/1/87; AMD, 1992 MAR p. 2277, Eff. 10/16/92; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.312 Community Homes for Persons with Developmental Disabilities: License Revocation, Denial or Suspension

(1) The department may deny, revoke or suspend a community home license by written notification to the provider if the department determines that:

(a) the facility is not in compliance with fire safety requirements as evidenced in writing by the state fire marshal; or

(b) the program is not in substantial compliance with health rules or any other licensing requirements established by this subchapter; or

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

(2) If any violation places a resident in a life threatening situation the license may be immediately revoked.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.313 Community Homes for Persons with Developmental Disabilities: Persons Affected by Department Records

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 2-4-201 and 53-20-305, MCA
Implementing statute(s): Sec. 2-4-201 and 53-20-305, MCA
History: NEW, 1994 MAR p. 2939, Eff. 11/11/94; TRANS, from DFS, 1998 MAR p. 667; REP, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.100.316 Fair Hearing

(1) Any person, corporation or other entity aggrieved by an adverse department action denying, revoking or suspending a license may request a fair hearing in accordance with ARM 37.5.304 , 37.5.305 , 37.5.307 , 37.5.310 , 37.5.311 , 37.5.313 , 37.5.316 , 37.5.318 , 37.5.322 , 37.5.325 , 37.5.328 , 37.5.331 , 37.5.334 and 37.5.337 .

(2) The provider shall cease operation of the community home pending the fair hearing in those instances where the revocation or suspension of the license is based upon actions that the department has determined are imminent life or health endangering situations.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS & AMD, from DFS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.100.320 Community Homes for Persons with Developmental Disabilities: Fire, Health and Safety Certification

(1) Community homes are required by the Montana department of justice to comply with the fire safety requirements and procedures found in ARM 23.7.110 . A community home must comply with the certification requirements of ARM 23.7.110 to obtain licensure, and during licensure, the community home must remain current on its fire safety certification under ARM 23.7.110 .

(2) A community home will only be licensed by the department if there is written certification from the local or state health authority that the home meets the following requirements:

(a) For an adequate and potable water supply, a community home must:

(i) connect to a public water supply system approved by the department of environmental quality; or

(ii) for community homes utilizing a non-public water system, the department hereby adopts and incorporates by reference the following circulars prepared by the department of environmental quality:

(A) circular #11 for springs;

(B) circular #12 for water wells;

(D) the circulars mentioned in (A) , (B) and (C) set forth the relevant water quality standards and are available from the Department of Environmental Quality, 1520 East Sixth Avenue, Helena, Montana 59620.

(iii) if a non-public water supply is used, submit a water sample for analysis at least quarterly to a laboratory licensed by the department of environmental quality;

(iv) repair or replace the water system when the supply:

(A) contains microbiological contaminants; or

(B) does not have the capacity to provide adequate water for drinking, cooking, personal hygiene, laundry, and water carried waste disposal.

(b) For sewage to be safely disposed of, a community home must:

(i) connect to a public sewage system approved by the department of environmental quality; or

(ii) if a non-public system is utilized, the department hereby adopts and incorporates by reference bulletin 332, which sets forth standards for sewage disposal. A copy of bulletin 332 may be obtained from the Department of Environmental Quality, 1520 East Sixth Avenue, Helena, Montana 59620; and

(iii) repair or replace the sewage system whenever:

(A) it fails to accept sewage at the rate of application;

(B) seepage of effluent from or ponding of effluent on or around the system occurs;

(D) a mechanical failure occurs.

(i) store all solid waste between collections in containers which have lids and are corrosion-resistant, flytight, watertight, and rodent-proof;

(ii) clean all solid waste containers as needed; and

(iii) utilize a private or municipal hauler to transport the solid waste at least weekly to a landfill site approved by the department of environmental quality.

(d) For safety and sanitation a provider must comply with the following structural requirements:

(i) All rooms and hallways must be provided with at least 10 footcandles of light, and bathrooms and areas used for reading must be provided with at least 30 footcandles of light.

(ii) Floors and walls of rooms subject to large amounts of moisture must be smooth and non-absorbent.

(iii) Floor and wall mounted furnishings must be easily moved or mounted in such a way as to allow for easy cleaning.

(iv) Adequate toilet and bathing facilities must be provided:

(A) one toilet and one sink for every six residents;

(B) one tub and shower for every eight residents;

(D) bathing facilities and stairs must be provided with anti-slip surfaces.

(v) Food preparation facilities must be equipped with at least the following:

(A) facilities to adequately wash utensils and equipment;

(B) refrigeration equipment capable of maintaining foods at or below 45 E F;

(D) adequate and clean food preparation and storage areas;

(E) equipment to insure all food is transported, stored, covered, prepared and served in a sanitary manner.

(vi) Separate storage of clean and dirty linen shall be provided.

(vii) Storage space shall be available for the personal belongings of residents and for food, linen, equipment and other household supplies.

(viii) There shall be hot and cold water available in the home. Water temperature for hot water must be limited to 120 E F or below.

(e) For adequate housekeeping a provider must insure that:

(i) the building and grounds are free, to the extent possible, of harborage for insects, rodents, and other vermin;

(ii) the floors, walls, ceilings, furnishings, and equipment are in good repair, free of hazards, clean and free from offensive odors;

(iii) cleaning equipment and supplies are provided in sufficient quantity to meet housekeeping needs of the facility; and

(iv) every provider must have and adhere to a maintenance policy and schedule which describes the regular maintenance of the home and yard. The maintenance policy shall include type of duties, methods and timelines relating to housekeeping, repairs, and general prevention of accidents and health dangers.

(f) Poisonous compounds shall not be stored in food preparation areas or food storage areas or in any areas where residents may initiate unsupervised contact.

(g) Drugs shall be stored under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security. Outdated and deteriorated drugs and drugs not being used must be removed and disposed of.

(h) Use of home canned products other than jams, jellies and fruits is prohibited unless the home is approved as a commercial food processor.

(3) Local health sanitarians are permitted to charge a reasonable fee for their inspection services to the applicant.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1993 MAR p. 149, Eff. 1/29/93; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.321 Community Homes for Persons with Developmental Disabilities: Physical Site Requirements

(1) The community home shall be located to facilitate the use of community resources. If the home is not within walking distance of community shopping, recreational and other community services; transportation shall be available at no cost or an affordable cost to the resident.

(2) The design, construction and furnishings of the home shall be home-like and encourage a personalized atmosphere for residents.

(3) Each bedroom shall be limited to not more than three persons and shall include:

(a) floor to ceiling walls;

(b) one door which can be closed to allow privacy for residents;

(c) a minimal clear floor space of 7 feet x 9 feet shall be provided for a single bedroom; 13 feet x 9 feet for a double room; and 13 feet x 17 feet for a three-bed room. The space does not include closet space; and

(d) at least one window which can be opened.

(4) Lighting shall be available in all living areas as needed.

(5) A comfortable temperature shall be maintained.

(6) The building exterior and yard shall be in good repair and free from hazards such as protruding sharp objects, uncovered wells and cellars and yard maintenance equipment which may be used inappropriately.

(7) All plumbing fixtures shall be in good repair and properly functioning.

(8) Inspection of the heating system and hot water tank shall be made regularly.

(9) For community homes caring for wheelchair and/or other physically handicapped residents, the department hereby adopts and incorporates by reference the American National Standards: specifications for making buildings and facilities accessible to and usable by physically handicapped people. A copy of the specifications is available from the Department of Public Health and Human Services, Child and Family Services Division, Program Management Bureau, P.O. Box 202951, Helena, Montana 59620-2951.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.322 Community Homes for Persons with Developmental Disabilities: Staffing; Staff Responsibilities and Qualifications

(1) The provider shall have a sufficient number of appropriately qualified staff to supervise, care for, and train residents.

(2) There shall be a minimum of one staff person present who is directly responsible for resident care and activities when any resident is in the home. This requirement is not applicable if the resident or residents present in the home have been determined by their individual habilitation planning team to be competent in self-care in such situations.

(3) There shall be a minimum of one appropriately trained person who is directly responsible for planning, implementing and reviewing each community home service and residents' program.

(4) The provider shall employ no staff person who has impairments to his/her ability to protect the health and safety of the residents or who would endanger the physical or psychological well being and progress of the residents.

(5) The provider shall provide an orientation for each new employee during the first week of employment. This orientation shall include familiarization with the residents and the rules of the home, behavior deceleration programs, medical concerns of clients and emergency procedures.

(6) The provider shall provide training for each new employee within the first 30 days of employment. This training shall include:

(a) familiarization with the residents and the community home's philosophy, organization, policies, activities, programs, practices and goals;

(b) first aid, emergency procedures and accident prevention techniques;

(d) knowledgeably and tactfully dealing with residents, relatives or guardians and visitors;

(e) meeting needs of residents through care, supervision, and training skills;

(f) attaining skill areas in which the employee has not reached the level of competence for the job;

(g) description of duties, responsibilities, limitations of authority and principal measures of accountability and performances;

(h) rights of residents which include at a minimum those rights as defined by the client's rights policy of the developmental disabilities program of the department of public health and human services (DD 441) ; and

(i) aversive and deprivation procedures policy as defined by the developmental disabilities program of the department of public health and human services (DD 442) .

(7) The provider annually shall provide or obtain continuing training and education of the information listed in (5) and (6) (a) through (i) above for each direct care staff.

(8) The provider shall provide documentation and attendance records of training and orientation provided for all new and continuing employees. Agendas, general outlines, narratives and other descriptions may be provided to describe the type of content of said training activities.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.325 Community Homes for Persons with Developmental Disabilities: Resident Supplies and Equipment

(1) The provider shall provide the following:

(a) a separate bed of proper size and height for the resident;

(b) clean, comfortable mattress and appropriate bedding which shall be changed as needed and at least once a week;

(d) access to a mirror;

(e) curtains or window shades which provide privacy;

(f) tables, chairs, sofas, lamps and other furnishings in a common living area for family-like comfort and use;

(g) at least two towels and wash cloths per resident, which are changed as needed and at least twice a week; and

(h) personal supplies and other hygienic necessities whenever the resident does not have the ability to provide these supplies.

(2) The provider shall insure that clothing purchase and care includes:

(a) clothing which is appropriate to the chronological ages considering personal choice; and

(b) clothing which is of good quality, appropriate size, seasonable and in good repair.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.330 Community Homes for Persons with Developmental Disabilities: Rights

(1) Intervention for the purposes of training shall be the least intrusive into, and the least disruptive of, the person's life and represent the least departure from normal patterns of living that can be effective in meeting developmental needs.

(2) The residents shall not be subjected to treatment of a manner which:

(a) includes abuse or neglect; and/or

(b) limits individual rights without due process.

(3) The utilization in training of aversive procedures or of procedures infringing upon individual rights must meet the approval of the developmental disabilities program of the department of public health and human services and must be presented in writing to the licensing worker.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.331 Community Homes for Persons with Developmental Disabilities: Health Care

(1) The provider shall assure each individual of appropriate health care by providing or arranging for:

(a) a primary physician for each resident to provide for health needs;

(b) at least an annual health check-up;

(d) family planning, counseling, mental health and other consultation when appropriate;

(e) medication administration through the procedures listed in 53-20-204 (2) , MCA, and as prescribed;

(f) modified and therapeutic diets as prescribed;

(g) procedures for the detection of signs of injury, disease, abuse and emergency medical care;

(h) drinking water throughout each day;

(i) a variety of foods which meet the nutritional needs of the residents adjusted for age, sex and activity;

(j) developing, reviewing and recording weekly menus of meals served;

(k) adequate meals in a family style manner, as appropriate to the individual residents, three times a day;

(l) snacks at appropriate times each day;

(m) a shower or tub bath daily at the most independent level possible and with due regard for privacy;

(n) residents to brush their teeth daily; and

(o) written procedures for emergency medical care.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.335 Community Homes for Persons with Developmental Disabilities: Resident's Money and Personal Property

(1) The provider shall insure that the resident's personal money and personal property is not appropriated or misused by any other person or by the provider and its staff.

(2) The provider is responsible for the accurate preparation and maintenance of a written record of each resident's personal property and personal money.

(3) The provider will keep a current monthly record of each resident's income and sources of income. The monthly expenses, including room and board, for the provider will be determined at the time of admission and will be shown monthly as a deduction from the resident's income received.

History

Authorizing statute(s): 53-20-305, MCA
Implementing statute(s): 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.340 Community Homes for Persons with Developmental Disabilities: Record Keeping

(1) The provider shall maintain a written record at the community home for each resident which shall include detailed administrative, training, and educational data. The resident's record shall include at least the following:

(a) name, sex, birthdate, address, parents/relatives, guardianship, other vital statistics, admission and discharge;

(b) nature of the resident's difficulties;

(d) the treatment plan, goals of the plan, and anticipated duration of treatment and training;

(e) measures taken to implement the plan, i.e. individual training programs;

(f) evaluation of the services the resident received;

(g) health records, psychiatric and psychological reports, educational information, assessments, official documentation and financial arrangements including resident's income and expenditures related to services provided to resident;

(h) resident's activities and incident reports;

(2) Other written records kept at the community home shall include:

(a) fire safety requirements and compliance; evacuation of residents and staff; fire safety plans and results of monthly fire drills; and

(b) a list of social service and other service personnel involved with the residents.

(3) The provider administrative file shall be maintained and shall be available upon request of the department. It shall contain at least the following current information and documents:

(a) governing structure including articles of incorporation and by-laws or other legal basis of existence;

(b) name and position of persons authorized to sign agreements of official documentation;

(d) existing purchase of service agreements;

(e) insurance coverage;

(f) procedure for notifying parties of changes in facility's policy and programs;

(g) a current organizational chart;

(h) current written job descriptions for all employees, and the names of persons presently employed in those positions;

(i) records of orientation and training for each employee;

(j) personnel and programmatic policies and procedures; and

(k) written grievance procedures which are available to residents and staff.

(4) All entries shall be in ink or indelible pencil, prepared at the time or immediately following the occurrence of the event being recorded, be legible, dated and signed by the person making the entry.

(5) The provider is responsible for the accurate preparation, maintenance and storage of all resident, personal and home records.

(6) The provider shall assure that all resident records are confidential in accordance with all applicable laws and rules and departmental policy.

(7) Records for residents who have been released from the home shall be transferred with the resident or stored by the provider for a period of 5 years following the release.

(8) When the home ceases operation, the provider shall notify the department in writing as to the location and storage of resident records.

History

Authorizing statute(s): Sec. 53-20-305, MCA
Implementing statute(s): Sec. 53-20-305, MCA
History: NEW, 1983 MAR p. 1839, Eff. 12/16/83; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Subchapter 37.100.4 Community Homes for Persons with Physical Disabilities

Mont. Admin. R. 37.100.401 Community Homes for Persons with Physical Disabilities: Purpose

(1) The purpose of these rules is to establish licensing requirements for community homes for physically disabled persons.

(2) The purpose of a community home is to provide a family-oriented, home-like residence and related residential services to persons with physical disabilities so as to enable those persons to enjoy a manner of living that is as close as possible to that considered to be normal in the community.

(3) Residents will reside in the least restrictive environment. Intervention will be the least intrusive into, and the least disruptive of, the person's life and represent the least departure from normal patterns of living that can be effective in meeting the resident's needs. The resident's needs will be met through domiciliary services, personal-social assistance and program plans and training. Residents will be encouraged to engage in meaningful activity, to develop techniques to become increasingly more independent, and to interact with the community in which they reside.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-101 and 53-19-103, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.402 Community Homes for Persons with Physical Disabilities: Definitions

For purposes of this subchapter, the following definitions apply:

(1) "Community home for persons with physical disabilities" means a family-oriented residence designed to provide residential services for two to eight physically disabled persons that does not provide skilled or intermediate nursing care. This definition does not preclude the provision of skilled or intermediate nursing care by third-person providers.

(2) "Department" means the department of public health and human services established in 2-15-2201 , MCA.

(3) "Physically disabled" means a disabled person with a permanent impairment that substantially limits major life activity, such as walking, self-care, seeing, hearing, speaking, learning, reasoning, judgement, or memory, and that can be diagnosed by a physician.

(4) "Provider" means the person, corporation or other entity furnishing community home services to physically disabled persons.

(5) "Resident" means a physically disabled person who lives in and receives services from a community home.

(6) "Training" means an organized program for assisting physically disabled persons in acquiring, improving or maintaining particular skills.

(7) "License" means a written document issued by the department that the holder has complied with the applicable rules for a community home for the physically disabled.

(8) "Provisional license" means a written document issued by the department on a time limited basis at the department's discretion or at the initial start-up of a community home if the home is either not in compliance with all licensing requirements but will be in compliance within 6 months. A provisional license includes a temporary or a probationary license.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-102, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.407 Community Homes for Persons with Physical Disabilities: License Required

(a) another state agency has already licensed or otherwise approved the operation of the community home, or

(b) a national or state recognized certification process has already been completed and has resulted in certification, accreditation, or other approval of the operation of the community home.

(2) The department will determine based upon a licensing study whether an applicant meets the requirements.

(3) The department will deny a license to any applicant that fails to meet the requirements established by these rules unless the department determines it is appropriate to issue a provisional license.

(4) The department will issue a license annually on the expiration date of the previous year's license if:

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

(b) the provider continues to meet all requirements established by these rules, as determined by the department after a licensing study and upon receipt of certification by the state fire marshal and local health authority.

(5) A community home may be licensed for two through eight residents.

(6) The department may in its discretion issue a provisional license for any period, not to exceed 6 months, to any license applicant that has met all applicable requirements for fire safety and has submitted a written plan approved by the department to comply fully with all minimum requirements established by these rules within the time period covered by the provisional license.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-111, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1992 MAR p. 2277, Eff. 10/16/92; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.408 Community Homes for Persons with Physical Disabilities: Licensing Procedures

(2) The department will upon receipt of the application, conduct a study and evaluation of both the applicant and the facility within 60 days.

(4) Each applicant shall promptly report to the department changes which would affect the current accuracy of information provided on the application.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-111, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1992 MAR p. 2277, Eff. 10/16/92; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.412 Community Homes for Persons with Physical Disabilities: License Revocation, Denial or Suspension

(1) The department may deny, revoke or suspend a community home license by written notification to the provider if the department determines that:

(a) the facility is not in compliance with fire safety requirements as evidenced in writing by the state fire marshal; or

(b) the program is not in substantial compliance with health rules or any other licensing requirements established by this subchapter; or

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

(2) If any violation places a resident in a life threatening situation the license may be immediately revoked.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-111, 53-19-112 and 53-19-113, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.413 Community Homes for Persons with Physical Disabilities: Persons Affected by Department Records

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 2-4-201 and 52-4-205, MCA
Implementing statute(s): Sec. 2-4-201 and 52-4-203, MCA
History: NEW, 1994 MAR p. 2939, Eff. 11/11/94; TRANS, from DFS, 1998 MAR p. 667; REP, 2004 MAR p. 2409, Eff. 10/8/04.

Mont. Admin. R. 37.100.416 Physically Disabled Group Homes, Fair Hearing

(1) Any person, corporation or other entity aggrieved by an adverse department action denying, revoking or suspending a license may request a fair hearing in accordance with ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS & AMD, from DFS, 2000 MAR p. 1653, Eff. 6/30/00.

Mont. Admin. R. 37.100.420 Community Homes for Persons with Physical Disabilities: Fire Safety Certification

(1) Community homes are required by the Montana department of justice to comply with the fire safety requirements and procedures found in ARM 23.7.110. A community home must comply with the certification requirements of ARM 23.7.110 to obtain licensure, and during licensure, the community home must remain current on its fire safety certification under ARM 23.7.110.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112 and 53-19-113, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1993 MAR p. 149, Eff. 1/29/93; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.421 Community Homes for Persons with Physical Disabilities: Health and Safety Certification

(1) A community home will only be licensed by the department if there is written certification from the local or state health authority that the home meets the following requirements:

(a) For an adequate and potable water supply, a community home must:

(i) connect to a public water supply system approved by the state department of environmental quality; or

(ii) meet the standards set forth in the appropriate circular listed below if the community home utilizes a non-public water system. The department hereby adopts and incorporates by reference the following circulars prepared by the department of environmental quality which set forth the relevant water quality standards. These circulars are available from the Department of Environmental Quality, 1520 East Sixth Avenue, Helena, Montana 59620.

(A) circular #11 for springs;

(B) circular #12 for water wells;

(D) community homes using a non-public water supply must submit a water sample for analysis at least quarterly to a laboratory licensed by the department of public health and human services;

(iii) repair or replace the water system when the supply:

(A) contains microbiological contaminants; or

(B) does not have the capacity to provide adequate water for drinking, cooking, personal hygiene, laundry, and water carried waste disposal.

(b) For sewage to be safely disposed of, a community home must:

(i) connect to public sewage system approved by the department of environmental quality; or

(ii) meet the standards set by department of environmental quality bulletin 332 if a non-public system is utilized. The department hereby adopts and incorporates by reference bulletin 332, prepared by the Montana department of environmental quality, which sets forth standards for sewage disposal. A copy of bulletin 332 may be obtained from the Department of Environmental Quality, 1520 East Sixth Avenue, Helena, Montana 59620; and

(iii) repair or replace the sewage system whenever:

(A) it fails to accept sewage at the rate of application;

(B) seepage of effluent from or ponding of effluent on or around the system occurs;

(D) a mechanical failure occurs.

(i) store all solid waste between collections in containers which have lids and are corrosion-resistant, flytight, watertight, and rodent-proof;

(ii) clean all solid waste containers as needed; and

(iii) utilize a private or municipal hauler to transport the solid waste at least weekly to a landfill site approved by the department of environmental quality.

(d) For safety and sanitation a provider must comply with the following structural requirements:

(i) All rooms and hallways must be provided with at least 10 footcandles of light, and bathrooms and areas used for reading must be provided with at least 30 footcandles of light.

(ii) Floors and walls of rooms subject to large amounts of moisture must be smooth and non-absorbent.

(iii) Floor and wall mounted furnishings must be easily moved or mounted in such a way as to allow for easy cleaning.

(iv) Adequate toilet and bathing facilities must be provided:

(A) one toilet and one sink for every four residents;

(B) one tub or shower for every four residents;

(D) bathing facilities and stairs must be provided with anti-slip surfaces.

(v) Food preparation facilities must be equipped with at least the following:

(A) facilities to adequately wash utensils and equipment;

(B) refrigeration equipment capable of maintaining foods at or below 45 E F;

(D) adequate and clean food preparation and storage areas;

(E) equipment to insure all food is transported, stored, covered, prepared and served in a sanitary manner.

(vi) Separate storage of clean and dirty linen shall be provided.

(vii) Storage space shall be available for the personal belongings of residents and for food, linen, equipment and other household supplies.

(viii) There shall be hot and cold water available in the home. Water temperatures for hot water must be limited to 120 E F or below.

(e) For adequate housekeeping a provider must insure that:

(i) the building and grounds are free, to the extent possible, of harborage for insects, rodents, and other vermin;

(ii) the floors, walls, ceilings, furnishings, and equipment are in good repair, free of hazards, clean and free from offensive odors;

(iii) cleaning equipment and supplies are provided in sufficient quantity to meet housekeeping needs of the facility; and

(iv) a maintenance policy and schedule is adhered to which describes the regular maintenance of the home and yard. The maintenance policy shall include type of duties, methods and timelines relating to housekeeping, repairs, and general prevention of accidents and health dangers.

(f) Poisonous compounds shall not be stored in food preparation areas or food storage areas or in any areas where residents may initiate unsupervised contact.

(h) Use of home canned products other than jams, jellies and fruits is prohibited unless the home is approved as a commercial food processor.

(2) Local health sanitarians are permitted to charge a reasonable fee for their inspection services to the applicant.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112 and 53-19-113, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.422 Community Homes for Persons with Physical Disabilities: Staffing; Staff Responsibilities and Qualifications

(1) The provider shall have a sufficient number of appropriately qualified staff to supervise, care for, and train residents.

(a) During the hours of 7 a.m. to 10 p.m. there shall be a minimum of one staff member per every four residents.

(b) During the hours of 10 p.m. to 7 a.m. there shall be a minimum of one staff member for every eight residents.

(d) There shall be a minimum of one staff person present who is directly responsible for resident care and activities when any resident is alone in the home. This requirement is not applicable if the resident or residents present in the home have been determined by the interdisciplinary team to be competent in self-care in such situations.

(2) There shall be a minimum of one appropriately trained person who is directly responsible for planning, implementing and reviewing each community home service and resident's program.

(3) The provider shall employ no staff person who has impairments to his/her ability to protect the health and safety of the residents or who would endanger the physical or psychological well being and progress of the residents.

(a) Any applicant, provider or staff person may be required by the department to obtain and release a psychological evaluation or medical examination.

(b) Any applicant, provider or staff person may be required to sign an authorization for the release to the department of the required psychological or medical records.

(4) The provider shall provide an orientation for each new employee during the first week of employment. This orientation shall include familiarization with the residents and the rules of the home, clients' specific programs, medical concerns of clients and emergency procedures.

(5) The provider shall provide training for each new employee within the first 30 days of employment. This training shall include:

(a) familiarization with the residents and the community home's philosophy, organization, policies, activities, programs, practices and goals;

(b) first aid, emergency procedures and accident prevention techniques;

(d) meeting needs of residents through care, supervision, and training skills;

(e) attaining skill areas in which the employee has not reached the level of competence for the job;

(f) description of duties, responsibilities, limitations of authority and principal measures of accountability and performances.

(6) The provider annually shall provide or obtain continuing training and education of the information listed in (5) (a) through (f) above for each direct care staff.

(7) The provider shall provide documentation of training and orientation provided for all new and continuing employees. Agendas, general outlines, narratives and other descriptions may be provided to describe the type of content of said training activities.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.423 Community Homes for Persons with Physical Disabilities: Physical Site Requirements

(1) The community home shall be located to facilitate the use of community resources. If the home is not within walking distance of shopping, recreational and other community services, transportation shall be available either at no cost or at an affordable cost to the resident.

(2) The design, construction and furnishings of the home shall be home-like and encourage a personalized atmosphere for residents.

(3) Each bedroom shall be limited to not more than three persons and shall include:

(a) floor to ceiling walls;

(b) one door which can be closed to allow privacy for residents;

(c) a minimal clear floor space of 7 feet x 9 feet for a single bedroom; 13 feet x 9 feet for a double room; and 13 feet x 17 feet for a three-bed room. The above space requirements do not include closet space; and

(d) at least one window which can be opened.

(4) Lighting shall be available in all living areas as needed.

(5) A comfortable temperature shall be maintained.

(7) All plumbing fixtures shall be in good repair and properly functioning.

(8) The heating system and hot water tank shall be kept in good working order.

(9) All client accessible areas should be located on the ground level or shall be accessible at ground level by floors, ramps and doorways with a clear unobstructed width of not less than 32 inches.

(10) Community homes shall meet the American National Standards for access by handicapped persons. The department hereby adopts and incorporates by reference the American National Standards: specifications for making buildings and facilities accessible to and usable by physically handicapped people. These standards set forth building specifications for access by physically disabled persons. A copy of the standards is available from the Department of Public Health and Human Services, Child and Family Services Division, P.O. Box 8005, Helena, Montana 59604.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.427 Community Homes for Persons with Physical Disabilities: Resident Supplies and Equipment

(1) The provider shall provide the following:

(a) a separate bed of proper size and height for the resident;

(b) clean, comfortable mattress and appropriate bedding which shall be changed as needed and at least once a week;

(d) access to a mirror;

(e) curtains or window shades which provide privacy;

(f) tables, chairs, sofas, lamps and other furnishings in a common living area for family-like comfort and use;

(g) at least two towels and wash cloths per resident, which are changed as needed and at least twice a week; and

(h) personal supplies and other hygienic necessities whenever the resident does not have the ability to provide these supplies.

(2) The provider shall insure that clothing purchase and care includes:

(a) clothing which is appropriate to the chronological ages considering personal choice; and

(b) clothing which is of good quality, appropriate size, seasonable and in good repair.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.430 Community Homes for Persons with Physical Disabilities: Rights

(1) Intervention for the purposes of assisting and training residents shall be the least intrusive into, and the least disruptive of, the person's life and represent the least departure from normal patterns of living that can be effective in meeting residential needs.

(2) The residents shall not be subjected to treatment of a manner which:

(a) includes abuse or neglect; or

(b) limits individual rights without due process.

(3) The provider shall adopt a client's rights policy that is agreed to by the department.

(4) The utilization in training of aversive procedures or of procedures infringing upon individual rights must be presented in writing to the licensing worker and meet with the approval of the community staffing team and the department prior to implementation for each client.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.431 Community Homes for Persons with Physical Disabilities: Health Care

(1) The provider shall assure each individual of appropriate health care by providing or arranging for:

(a) a primary physician for each resident to provide for health needs;

(b) at least an annual health check-up;

(d) family planning, counseling, mental health and other consultation when appropriate;

(e) medication administration as authorized by 53-19-112 (3) , MCA, and as prescribed;

(f) modified and therapeutic diets as prescribed;

(g) procedures for the detection of signs of injury, disease, abuse;

(h) drinking water throughout each day;

(i) a variety of foods which meet the nutritional needs of the residents adjusted for age, sex and activity;

(j) developing, reviewing and recording weekly menus of meals served;

(k) adequate meals in a family style manner, as appropriate to the individual residents, three times a day;

(l) snacks at appropriate times each day;

(m) a shower or tub bath daily at the most independent level possible and with due regard for privacy;

(n) residents to brush their teeth daily; and

(o) written procedures for emergency medical care.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.435 Community Homes for Persons with Physical Disabilities: Resident's Money and Personal Property

(1) The provider shall insure that the resident's personal money and personal property is not appropriated or misused by any other person or by the provider and its staff.

(2) The provider is responsible for the accurate preparation and maintenance of a written record of each resident's personal property and personal money.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Mont. Admin. R. 37.100.440 Community Homes for Persons with Physical Disabilities: Record Keeping

(a) name, sex, birthdate, address, parents/relatives, guardianship, other vital statistics, admission and discharge;

(b) nature of the resident's difficulties;

(d) the treatment plan, goals of the plan, and anticipated duration of treatment and training;

(e) measures taken to implement the plan, i.e., individual training programs;

(f) evaluation of the services the resident received;

(h) resident's activities and incident reports.

(2) Other written records kept at the community home shall include:

(a) fire safety requirements and compliance, evacuation of residents and staff, fire safety plans and results of monthly fire drills; and

(b) a list of social service and other service personnel involved with the residents.

(3) The provider administrative file shall be maintained and shall be available upon request of the department. It shall contain at least the following current information and documents:

(a) governing structure including articles of incorporation and by-laws or other legal basis of existence;

(b) name and position of persons authorized to sign agreements of official documentation;

(d) existing purchase of service agreements;

(e) insurance coverage;

(f) procedure for notifying parties of changes in facility's policy and programs;

(g) a current organizational chart;

(h) current written job descriptions for all employees, and the names of persons presently employed in those positions;

(i) records of orientation and training for each employee;

(j) personnel and programmatic policies and procedures; and

(k) written grievance procedures which are available to residents and staff.

(5) The provider is responsible for the accurate preparation, maintenance and storage of all resident, personal and home records.

(6) The provider shall assure that all resident records are confidential in accordance with all applicable laws and rules and departmental policy.

(7) Records for residents who have been released from the home shall be transferred with the resident or stored by the provider for a period of 5 years following the release.

(8) When the home ceases operation, the provider shall notify the department in writing as to the location and storage of resident records.

History

Authorizing statute(s): Sec. 53-19-112, MCA
Implementing statute(s): Sec. 53-19-112, MCA
History: NEW, 1985 MAR p. 1774, Eff. 11/15/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; TRANS, from DFS, 1998 MAR p. 667.

Chapter 37.104 Emergency Medical Services

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-324, MCA
History: NEW, 1989 MAR p. 2212, Eff. 1/1/90; TRANS, from DHES, 2001 MAR p. 2305; REP, 2023 MAR p. 1020, Eff. 9/9/23.

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 1989 MAR p. 2212, Eff. 1/1/90; TRANS, from DHES, 2001 MAR p. 2305; AMD, 2005 MAR p. 2681, Eff. 12/23/05; AMD, 2006 MAR p. 2420, Eff. 10/6/06; REP, 2010 MAR p. 535, Eff. 2/26/10.

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 1989 MAR p. 2212, Eff. 1/1/90; TRANS, from DHES, 2001 MAR p. 2305; AMD, 2005 MAR p. 2681, Eff. 12/23/05; REP, 2023 MAR p. 1020, Eff. 9/9/23.

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 1989 MAR p. 2212, Eff. 1/1/90; TRANS, from DHES, 2001 MAR p. 2305; REP, 2023 MAR p. 1020, Eff. 9/9/23.

Subchapter 37.104.5 Ambulance Service Licensing and Advisory Committee

Mont. Admin. R. 37.104.501 Definitions

As used in this subchapter, the following definitions apply:

(1) "Accrediting body" means a national or international organization which:

(a) reviews the facilities, vehicles, equipment, and operations of an ambulance service;

(b) uses trained site-surveyors with experience in medical transport at the level of accreditation and license;

(c) provides ambulance service accreditation for no more than three consecutive years without an updated inspection and reaccreditation;

(d) assures that ambulance services with identified deficiency standards will implement corrective action or improvement plans to correct any deficiencies; and

(e) provides transparency by making publicly available its standards, policies, procedures, and a list of accredited programs.

(2) "Advanced emergency medical technician" has the meaning provided for under 37-3-102, MCA.

(3) "Advanced life support (ALS)" means a level of care provided by an EMT with any endorsement issued by the board, an AEMT, or a paramedic.

(4) "Advanced life support (ALS) kit" means, at a minimum, the equipment and supplies set forth under Table 5 of the Emergency Medical Services Rule Appendix.

(5) "Advanced life support emergency medical service" means an ambulance service or nontransporting medical unit having capacity and licensed by the department to provide advanced life support 24 hours a day, seven days a week.

(6) "Advisory committee" means the advisory committee specified in 50-6-324, MCA.

(7) "Ambulance service" means an emergency medical service licensed by the department to utilize an ambulance for the transportation of patients.

(8) "Automated external defibrillator (AED)" has the meaning provided for under 50-6-501, MCA.

(9) "Basic life support (BLS)" means a basic life support level of care provided by an EMR or EMT that does not meet Advanced Life Support qualification.

(10) "Basic life support emergency medical service" means an ambulance service or nontransporting medical unit capable of providing care at the basic life support level and licensed as a provider under ARM 37.104.509.

(11) "Basic life support kit" means the equipment and supplies set forth under Table 4 of the Emergency Medical Services Rule Appendix.

(12) "Board" means the Montana Board of Medical Examiners administratively attached to the Department of Labor and Industry.

(13) "Emergency care provider (ECP)" has the meaning provided for under 37-3-102, MCA, and for the purposes of this chapter, includes registered nurses with supplemental training.

(14) "Emergency medical responder (EMR)" has the meaning provided for under 37-3-102, MCA.

(15) "Emergency medical service incident" means an instance in which an ambulance service or nontransporting medical unit is requested to provide services, including community integrated health or a mutual aid request, and with respect to which any of the following occur:

(a) a patient was assessed;

(b) medical care was rendered;

(d) a patient was pronounced dead at the scene;

(e) a patient was transferred to another licensed service;

(f) a patient was transferred from one medical facility to another; or

(g) the person or persons for whom emergency medical service was dispatched refused treatment, transport, or both.

(16) "Emergency Medical Services Rule Appendix" means the department's Emergency Medical Services Rule Appendix (Version 1.1), which sets forth operational requirements for Emergency Medical Service providers. The department adopts and incorporates by reference the Appendix. A copy of the Appendix is available electronically at https://dphhs.mt.gov/publichealth/EMSTS/ems/resources and may also be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(17) "Emergency medical technician (EMT)" has the meaning provided for under 37-3-102, MCA.

(a) An EMT is equivalent to the emergency medical technician-basic as required under 50-6-322, MCA.

(18) "FAA" means the Federal Aviation Administration.

(19) "Level of emergency medical service" means basic life support, basic life support with authorization for limited advanced life support, or advanced life support.

(20) "Montana ECP Practice Guidelines" means the board-approved guidelines in ARM 24.156.2701.

(21) "Montana EMS Registry" means the electronic repository of data submitted by Montana emergency medical service agencies that is administered by the department for quality improvement and public health reporting purposes.

(22) "Paramedic" has the meaning provided for under 37-3-102, MCA.

(23) "Patient care report" means an accurate and complete record of the response by an ambulance service or nontransporting medical unit to each emergency medical service incident.

(24) "Permit" means the sticker affixed to a ground ambulance or a certificate placed in an air or ground ambulance indicating the ambulance vehicle has met the requirements of these rules.

(25) "Provisional license" means a temporary emergency medical service license granted by the department that is valid for a maximum of 90 days.

(26) "RN with supplemental training" means a registered nurse who has completed the supplemental training required to work on an ambulance or nontransporting medical unit.

(27) "Safety and extrication equipment kit" means the equipment and supplies set forth under Table 6 of the Emergency Medical Services Rule Appendix.

(28) "Service manager" means the individual identified on the Emergency Medical Services license application as the service manager and who is responsible for ensuring service operations are conducted in compliance with all applicable statutory and regulatory requirements.

(29) "Service medical director" means a person who meets the requirements of a medical director as provided in ARM 24.156.2701 and provides offline medical direction for an emergency medical service pursuant to ARM 24.156.2732.

(30) "Stipulations" mean those conditions specified by the department at the time of licensing which must be met by the applicant in order to be licensed as an emergency medical service.

(31) "Supplemental training" means training for registered nurses approved by the service manager of an emergency medical service licensed at the basic life support level of service, or the service medical director for all other levels of service. A list of suggested training is set forth in Table 11 of the Emergency Medical Services Rule Appendix.

(a) The training must recognize the registered nurse's education and experience and result in emergency medical competency at the emergency medical service's license level.

(32) "Temporary permit" means a written, non-transferable authorization of limited duration indicating an ambulance vehicle may be used by a licensed ambulance service until a permit can be issued.

(33) "Transportation equipment kit" means the equipment and supplies set forth under Table 7 of the Emergency Medical Services Rule Appendix.

(34) "Type of emergency medical service" means either an air ambulance fixed wing, air ambulance rotor wing, ground ambulance, or nontransporting medical unit.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23; AMD, 2025 MAR, Notice No. 2025-528, Eff. 11/22/25.

Mont. Admin. R. 37.104.504 Ems Agency Service Manager Duties

(1) The service manager of an emergency medical service must ensure:

(a) when the service is a BLS service, the care provided by ECP conforms to the general standard of care promulgated by the board;

(b) when the service is an ALS service, the service medical director fulfills the requirements of offline medical direction as defined in ARM 24.156.2732 and 50-6-302, MCA;

(d) required basic life support, advanced life support, transportation equipment, and safety and extrication kits are available as described in Table 3 of the Emergency Medical Services Rule Appendix;

(e) service staffing meets minimum requirements set forth under ARM 37.104.508;

(f) the service meets communication, reporting, and sanitation requirements set forth under this subchapter;

(g) the service establishes written policies and procedures and maintains written documentation for the preventive maintenance of ambulances and emergency medical equipment;

(h) the service personnel are alert and capable during an emergency response;

(i) ambulance vehicles and all emergency medical services equipment are maintained in a safe and operating condition;

(j) all personnel functioning on the emergency medical service have documentation of appropriate licensure to function;

(k) service personnel use only that equipment and perform those skills for which they are trained, certified, or licensed and legally permitted to use or perform;

(l) communication items set forth in Table 2 of the Emergency Medical Services Rule Appendix are always available.

(2) When functioning under the conditions defined in ARM 24.156.2771(7), a licensed service may use ECPs licensed in another state.

(3) All ambulances must have at least one of the required personnel attending the patient, and when providing care at an ALS level, the person licensed at the corresponding level must attend the patient.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.505 Ems Agency Service Medical Director Duties

(1) The service medical director must:

(a) perform all duties and responsibilities consistent with ARM 24.156.2732 and offline medical direction under 50-6-302, MCA;

(b) ensure that care provided by ECP staff conforms to the service's board-approved guidelines or the Montana ECP Practice Guidelines;

(c) ensure that the service is operated in a manner that does not threaten or endanger the public health, safety, or welfare; and

(d) ensure the minimum content requirements for the Advanced Life Support Kit are met and that the kit contains any additional supplies necessary to support the level of care and endorsements authorized by the service medical director consistent with board-approved service guidelines or the Montana ECP Practice Guidelines.

History

Authorizing statute(s): 50-6-323, MCA
History: 50-6-323, MCA; NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.506 Ems Agency Records and Reports

(1) Each emergency medical service must maintain a patient care record for every emergency medical service incident.

(a) In incidents where more than one patient is encountered, one patient care record shall be completed for each patient.

(b) In the event more than one emergency medical service arrives at the scene of an emergency medical service incident, each service having actual contact with a patient is responsible for completing a patient care record on the patient.

(2) Every ambulance service must electronically submit data to the department for each emergency medical service incident within 48 hours of the conclusion of the emergency medical service incident. The department may extend this timeframe in cases of unusual circumstances.

(3) Electronic data submitted to the department must be in the format prescribed by the National Emergency Medical Services Information System (NEMSIS) and include all NEMSIS state and national data elements. The department adopts and incorporates by reference the National Emergency Medical Services Information System (NEMSIS) Uniform Pre-Hospital Emergency Medical Services Dataset, Version 3.5.0 (March 17, 2023) published by the National Highway Traffic Safety Administration (NHTSA). A copy may be obtained at https://nemsis.org/media/nemsis_v3/release-3.5.0/DataDictionary/PDFHTML/EMSDEMSTATE/NEMSISDataDictionary.pdf or from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(a) For ambulance services directly using the reporting system provided by the department, the data is considered submitted to the department as soon as it has been entered or updated in the department-provided system.

(b) For ambulance services using third-party software, the data is considered submitted to the department as soon as it has been uploaded or updated into the department-provided system.

(4) Ambulance services are not required to submit other NEMSIS data elements but may do so. Non-transporting medical units are not required to submit NEMSIS data but may do so.

(5) Other software may be used to submit required data, but agencies must consult with the department before purchasing such software to ensure that the system is capable of submitting data to the Montana EMS Registry.

(6) Patient care reports may be reviewed by the department.

(7) Patient care reports must be maintained by the emergency medical service for a minimum of seven years.

(8) Immediately or as soon as possible upon arrival, but no later than 24 hours after the end of the patient transport, an ambulance service must provide a copy of the patient care report to the health care facility that receives the patient.

(a) If a completed patient care report cannot be left at the health care facility at the end of the patient transfer, an abbreviated patient encounter form containing information essential to continued patient care as set forth under Table 8 of the Emergency Medical Services Rule Appendix shall be provided until a patient care record can be provided to the health care facility.

(b) If an immediate response to another patient is required of an ambulance delivering a patient to a health care facility, a complete oral report on the patient being delivered must be given to the receiving health care facility until an abbreviated patient encounter form or patient care record can be provided.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.507 Ems Agency General Service Requirements

(1) Except as otherwise specifically provided in this subchapter, no person may:

(a) advertise the provision of an emergency medical service without first having obtained a license from the department; or

(b) advertise, allow advertisement of, or otherwise imply provision of emergency medical services at a level of care higher than that for which the service is licensed.

(2) An emergency medical service must store, handle, and dispose of infectious waste in accordance with the Infectious Waste Management Act, 75-10-1001, et seq., MCA.

(3) Each emergency medical service must develop and adhere to a written sanitation policy that includes at least a method to dispose of contaminated materials meeting the requirements set forth in (2) and the following standards:

(a) Products used for cleaning must be EPA registered disinfectants.

(b) Disposable equipment must be disposed of after use.

(c) Any equipment that comes into contact with body fluids or secretions must be cleaned using an EPA registered disinfectant.

(d) Linens must be changed after each use.

(e) Oxygen humidifiers must be single service and disposable.

(f) Needles must not be recapped, bent, or broken, and must be disposed of in a container that provides protection to personnel from a needle puncture.

(4) The use of smoking and vaping products is prohibited in all ambulances.

(5) With the exception of a physician or the circumstances described in ARM 37.104.514, individual personnel must not provide a level of care higher than the level and type for which the emergency medical service is licensed. The emergency medical service must be licensed or authorized to operate at the highest level it plans to allow individuals to provide care.

(6) Each emergency medical service approved for a BLS license with authorization for advanced life support or advanced life support level shall have a service medical director. The requirements and responsibilities of the service medical director are described in ARM 37.104.505.

(7) An emergency medical service must have a two-way communication system that enables online medical direction.

(8) If a licensed ambulance service is not reasonably available, occasional and infrequent transportation by other means is permitted.

(9) In a disaster or major emergency when licensed ambulances are insufficient to render services required, non-licensed emergency medical services may be used.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.508 Ems Agency Minimum Staffing Requirements

(1) Except as provided in (a) through (d), ambulance services shall adhere to the minimum staffing requirements set forth in Table 1 of the Emergency Medical Services Rule Appendix when responding to a request for service that has not been medically triaged:

(a) An ambulance service medical director may authorize a process for medical evaluation of a patient and the use of a basic life support crew configuration if that configuration meets the clinical needs of the patient.

(b) During periods of extraordinary call volume, a service licensed at the advanced life support level of service may temporarily utilize a crew configuration equal to the minimum staffing standard for a service licensed at the basic life support level of service.

(c) During inter-facility transfers by air ambulance, the service medical director may alter the crew configuration to match the medical needs of the patient, so long as one of the personnel is an ECP, a physician, or a physician assistant.

(d) An air ambulance may transport a patient with only one ECP crew member in addition to the pilot when advisable for weather, weight, or other extenuating circumstances on a case-by-case basis.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.509 Ems Agency License Types and Levels

(1) A license will be issued for, and authorize performance of, emergency medical services for the following types of service:

(a) air ambulance fixed wing;

(b) air ambulance rotor wing;

(d) nontransporting medical unit.

(2) A license will be issued for, and authorize performance of, emergency medical services for the following levels of service:

(a) basic life support;

(b) basic life support with authorization for limited advanced life support; or

(3) An emergency medical service that seeks to provide advanced life support but cannot reasonably provide it 24 hours per day, seven days per week, may request a basic life support license with authorization for limited advanced life support.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-306, 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.510 Ems Agency License Application Requirements

(1) Applications for licensing and renewal of licensing must be made using department-approved electronic forms. Except as provided under (10), the term of an EMS license is two years. Applications must be accompanied by the license fee and proof of current single occurrence malpractice insurance and liability insurance coverage. Copies of the accrediting body certifications must be included if the application is for renewal of a license and the service is accredited by an accrediting body without variance or limitations. The application, license fee, and all required supporting documents must be received by the department not less than 30 days prior to the commencement of a new emergency medical service or 15 days prior to the expiration of the license, in the case of an application for renewal.

(2) An application for a ground ambulance service license, including for renewal of a license, must include documentation of current single occurrence automobile vehicle liability insurance coverage, unless exempt under 61-6-303, MCA.

(3) An application for an air ambulance service, including the renewal of a license, must include documentation of current and unrestricted FAA air medical ambulance certification and an attestation that the operations comply with FAA Regulations at 14 CFR Part 135 and related circulars in effect as of the date of application. If the applicant intends to provide rotor wing service, the applicant must also submit an attestation that the operations comply with FAA regulations at 14 CFR Part 135, Subpart L, and related circulars in effect as of the date of the application. The same documentation and attestation requirements also apply to contractor operations if the applicant contracts for service with another provider.

(4) Within 30 working days after an emergency medical service application has been initiated, the emergency medical service's manager must complete the required fields in the department's licensing management system.

(5) Within 30 days from receipt of an emergency medical service license application or, if the department requests additional information about the application, within 30 days from receipt of that information, the department shall:

(a) issue the license;

(b) issue the license with stipulations;

(d) deny the license.

(6) The department may deny an emergency medical service license if:

(a) the application does not provide all of the requested information; or

(b) there is evidence that the applicant is not complying with these rules.

(7) If the department does not take action on the application within 30 days after its receipt, the emergency medical services license must be issued unless the applicant is known to be in violation of these rules.

(8) Except as provided under (9), the department shall inspect each emergency medical service prior to issuing a license. If an inspection cannot be conducted, the department may issue a provisional license until an inspection can be completed.

(9) An ambulance service renewing its service license at the same level of service that holds valid and current accreditation without variance or limitations from an accrediting body is exempt from vehicle, equipment, and operation inspections. The ambulance service must still request, pay for, and display state-issued permits for each ambulance.

(10) To establish staggered terms of licensing:

(a) when the department receives a completed license application for a new emergency medical service, it will assign that service a number; and

(b) if the department grants the license:

(i) an odd-numbered service will be issued a license expiring December 31 of the year in which it was issued; and

(ii) an even-numbered service will be issued a license expiring December 31 of the year following the year in which it was issued.

(11) The service license must be updated within ten days when any information contained in the service license application changes.

(12) If an emergency medical service from another state identifies Montana as part of its service area, and if it regularly provides an initial emergency medical services response into Montana, the emergency medical service must obtain a Montana emergency medical services license as provided by these rules, unless the other state's licensing standards are substantially comparable to those of Montana, in which case the department may license these services through a reciprocal agreement with the other state.

(13) An emergency medical service responding into Montana to transfer patients from a Montana medical facility to a non-Montana medical facility is not required to obtain a Montana license if it is licensed in its state of origin.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-306, 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.513 Nontransporting Medical Unit Service Requirements

(1) A nontransporting medical unit must have an agreement with a licensed ambulance service to ensure continuity of care and adequate transportation for its patients. An ambulance service is not required to approve of, or enter into an agreement with, a nontransporting medical unit.

(2) A law enforcement agency, fire department, search and rescue unit, ski patrol, or mine rescue unit which does not hold itself out as a provider of emergency medical care to the public and does not routinely offer to provide services to the general public beyond the boundaries of a single recreational site, work site, school, or other facility shall not be considered a nontransporting medical unit solely because members of the unit provide medical care at the scene of a medical emergency to which they were dispatched for other purposes.

(3) A nontransporting medical unit must:

(a) ensure that patients are transported by a licensed ambulance service, unless a licensed service is not reasonably available;

(b) ensure either that the patient is transported by an ambulance service licensed to provide at least the same level of patient care commenced by the nontransporting medical unit or that the ambulance service carries the personnel and equipment of the nontransporting medical unit with the patient to the hospital if a level of care has commenced which the ambulance service cannot legally continue; and

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.514 Ground Ambulance Service Requirements

(1) The interior of an ambulance, including all storage areas, must be kept clean and free from dirt, grease, and other contaminants.

(2) Persons utilized as drivers of ambulances must have a valid driver's license and have completed the service's vehicle operations training.

(3) If an ambulance service publicly advertises a telephone number to receive calls for emergency assistance, that telephone number must be answered 24 hours a day, seven days per week.

(4) An ambulance service may transport patients who are receiving care at a higher level than the level for which the service is licensed if:

(a) the higher level of care is initiated by a licensed emergency medical service authorized to perform that level of care; and

(b) the personnel and the equipment of the emergency medical services licensed at the higher level accompany the patient in the ambulance.

(5) An ambulance service may perform inter-facility (including between a physician's office and hospital) transfers at a higher level of care than the level to which the service is licensed if personnel trained and legally authorized to provide the higher level of care, as well as appropriate equipment, accompany the patient in the ambulance to ensure continuity of patient care.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.515 Ground Ambulance Specifications

(1) All ground ambulances must have or meet the following specifications:

(a) the word "ambulance" must be affixed in mirror image in reflectorized lettering at least four inches tall, centered above the grill on the front of the vehicle; and

(b) the word "ambulance" must be affixed to the rear of the vehicle in reflectorized lettering at least four inches tall.

(2) The required markings may not appear on nonlicensed ambulances, with the exception of those ambulances temporarily in transit within the state.

(3) All oxygen cylinders must be secured so that they will not roll, tip over, or become projectiles in the event of a sudden vehicular maneuver.

(4) All ground ambulances must meet the requirements set forth under Table 9 of the Emergency Medical Services Rule Appendix.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.516 Ambulance Permits

(1) Except as provided in (7), no ambulance may be utilized by an ambulance service until the department has found it is, at the time of inspection, in compliance with these rules and issued a permit to the ambulance service for the ambulance. The department may issue a temporary permit, by mail or otherwise, until an inspection can be completed.

(2) Effective March 8, 2025, all ground ambulances, including remounts, that have not previously been permitted by the department must meet ambulance design criteria from:

(a) The Commission on Accreditation of Ambulance Services Ground Vehicle Standard for Ambulances (GVS), Version 3.0, effective July 1, 2022; or

(b) The National Fire Protection Association (NFPA) 1917 Standard for Automotive Ambulances - 2019 Edition.

(3) Vehicles that do not meet these standards may be permitted by the department if the ambulance service can demonstrate that the vehicle meets substantially similar standards in effect on the year of the vehicle's manufacture.

(4) A decal or letter of verification from the manufacturer certifying that the vehicle meets the standard shall be made available upon inspection.

(5) The department adopts and incorporates by reference the GVS Version 3.0 and the NFPA 1917 Standard for Automotive Ambulances 2019 Edition. The GVS Version 3.0 is available at https://www.groundvehiclestandard.org/ . The NFPA 2019 Edition is available at https://www.nfpa.org/ . Copies of each standard are available for review by contacting the Department of Public Health and Human Services, Public Health and Safety, Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(6) Any ambulance that has a salvage title must undergo an inspection pursuant to 49 CFR 396.17 before the vehicle may be permitted or returned to service.

(7) If an ambulance service has current accreditation without variance or limitations from an accrediting body, inspection of ambulances may be waived; however, the ambulance service must submit current accreditation documentation and attest that each ambulance is compliant with the ambulance specifications. Accredited ambulance services must request, pay for, and display state-issued permits for each ambulance.

(8) The ambulance permit must be displayed either on or in the ambulance as the department directs.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.517 Ground and Air Ambulance Inspections

(1) Each ambulance must be inspected every 24 months unless:

(a) the ambulance service has current and valid ambulance accreditation without variance or limitations from an accrediting body and provides the department with documentation of current accreditation; or

(b) the ambulance service has current and valid documentation that the vehicle has passed an inspection within the past 12 months pursuant to 49 CFR 396.17.

(2) Ground ambulance service providers must comply with applicable motor vehicle laws under Title 61, MCA.

(3) The inspector will provide a written or electronic inspection record for each vehicle upon completion of a ground ambulance inspection.

(4) If the inspector identifies and lists a minor defect in the ground ambulance inspection report, the inspector will issue a permit. The ambulance service manager has 180 days to repair the defect and notify the department that the repair has been accomplished.

(5) If the inspector identifies and lists a major defect in the ground ambulance inspection report, a vehicle permit will be issued only after the ambulance service manager notifies the inspector that the major defect has been repaired.

(6) Major and minor defects for ground ambulances are described under Table 10 of the Emergency Medical Services Rule Appendix.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-323, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23.

Mont. Admin. R. 37.104.518 Advisory Committee

(1) The purpose of the advisory committee is to advise the department consistent with 50-6-323, MCA, on matters including:

(a) the equipment and materials required for an emergency medical service;

(b) the data to be collected and submitted to the department;

(d) in consultation with the Department of Labor and Industry or the board, patient care standards and guidelines and guidance on supplemental training for registered nurses.

(2) The membership of the advisory committee consists of 18 individuals appointed by the department director, taking into consideration the geography and demography of Montana, as follows:

(a) an emergency medical services fellowship trained or national board-certified emergency medical services physician who will serve as chair;

(b) two service medical directors, one of whom is employed by an emergency medical service serving a population greater than 20,000 persons;

(d) a representative from the department's Emergency Medical Services for Children Committee;

(e) a representative from the department's State Trauma Advisory Council;

(f) a service manager from a government-owned ground ambulance service;

(g) a service manager from a privately owned ground ambulance service;

(h) a service manager from a hospital-owned ground ambulance service;

(i) a service manager from a not-for-profit ground ambulance service;

(j) an ECP service manager of a nontransporting medical unit;

(k) an ECP service manager of an air ambulance;

(l) an ECP from a tribal emergency medical service provider;

(m) an ECP from a volunteer emergency medical service provider;

(n) an RN with supplemental training that is on an emergency medical service roster;

(o) a sworn officer representative from a law enforcement agency;

(p) a representative of a 9-1-1 dispatch organization who is trained in emergency medical dispatch; and

(q) a member of the public not affiliated with the emergency medical service system.

(3) Individuals who are interested in serving on the advisory committee must submit to the department an application that is available on the department's web site along with a resume and letter of interest.

(4) The membership term is three years with the initial terms of membership randomly assigned for the purpose of ensuring staggered terms. Members of the advisory committee may seek reappointment to serve additional terms.

(5) The advisory committee will meet publicly at least twice each year and will conduct its business in person or, when appropriate, by electronic means.

History

Authorizing statute(s): 50-6-323, MCA
Implementing statute(s): 50-6-324, MCA
History: NEW, 2023 MAR p. 1020, Eff. 9/9/23; AMD, 2025 MAR, Notice No. 2025-528, Eff. 11/22/25.

Authorizing statute(s): 50-6-503, MCA
Implementing statute(s): 50-6-503, MCA
History: NEW, 1999 MAR p. 1913, Eff. 9/10/99; TRANS, from DHES, 2001 MAR p. 2305; AMD, 2005 MAR p. 2681, Eff. 12/23/05; AMD, 2020 MAR p. 2146, Eff. 11/21/20; REP, 2026 MAR, Notice No. 2025-175, Eff. 1/24/26.

Subchapter 37.104.8 Notification of Exposure to Infectious Disease

Mont. Admin. R. 37.104.801 Transmittable Infectious Diseases

(1) The following infectious diseases are designated as having the potential of being transmitted to emergency services providers through an exposure described in ARM 37.104.804:

(a) human immunodeficiency virus infection (AIDS or HIV infection);

(b) hepatitis B;

(d) hepatitis D;

(e) communicable pulmonary tuberculosis;

(f) meningococcal meningitis; and

(g) any disease attributed to a specific bacterial, parasitic, or other agent recognized by "The Control of Communicable Diseases Manual" as transmittable person to person by any of the exposures listed in ARM 37.104.804.

(2) For purposes of the reporting requirements of 50-16-702 (2), MCA, communicable pulmonary tuberculosis and meningococcal meningitis are considered airborne infectious diseases.

(3) For the purpose of (1)(g) above, the department hereby adopts and incorporates by reference the "The Control of Communicable Diseases Manual" published by American Public Health Association, 16th edition, 1995, which contains a list of transmission and control measures for communicable diseases. A copy of the manual may be obtained from the American Public Health Association, 1015 15th Street NW, Washington, DC 20005.

History

Authorizing statute(s): 50-16-701, 50-16-705, MCA
Implementing statute(s): 50-16-701, 50-16-705, MCA
History: NEW, 1989 MAR p. 2229, Eff. 12/22/89; EMERG, AMD, 1994 MAR p. 1704, Eff. 6/24/94; AMD, 1999 MAR p. 1127, Eff. 5/21/99; TRANS, from DHES, 2001 MAR p. 2305.

Mont. Admin. R. 37.104.804 Reportable Exposure

(1) The types of exposures that a designated officer shall report to a health care facility upon the request of an emergency services provider are:

(a) any person to person contact in which a co-mingling of respiratory secretion (saliva and sputum) of the patient and the emergency services provider may have taken place;

(b) transmittal of the blood or bloody body fluids of the patient onto the mucous membranes of the emergency services provider (mouth, nose, eyes) and/or into breaks in the skin of the emergency services provider;

(c) transmittal of other body fluids (semen, vaginal secretion, amniotic fluid, feces, wound drainage, or cerebral spinal fluid) onto the mucous membranes of the emergency services provider;

(d) any non-barrier protected contact of the emergency services provider with the mucous membranes or non-intact skin of the patient.

History

Authorizing statute(s): 50-16-705, MCA
Implementing statute(s): 50-16-701, 50-16-705, MCA
History: NEW, 1989 MAR p. 2229, Eff. 12/22/89; EMERG, AMD, 1994 MAR p. 1704, Eff. 6/24/94; TRANS, from DHES, 2001 MAR p. 2305.

Mont. Admin. R. 37.104.805 Exposure Form

(1) A report of exposure must be filed with the health care facility by the designated officer on a form developed and approved by the department, entitled "Report of Exposure".

(2) The report form will require the following, at a minimum:

(a) name, address, and phone numbers of the emergency services provider who sustained an exposure;

(b) date and time of the exposure;

(c) a narrative description of the type of exposure that occurred, a detailed description of how the exposure took place, and a description of any precautions taken;

(d) the name and, if available, the date of birth of the patient;

(e) the name of the health care facility receiving the patient and the health care facility's infectious disease control officer;

(f) the name of the emergency services organization with which the health care provider was officially responding;

(g) the names and phone numbers of the designated officer and the alternate;

(h) the address of the designated officer to which the written notification required by 50-16-702 (2)(c), MCA, is to be sent; and

(i) the signature of the designated officer filing the report.

(3) A copy of the required form is available from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951, telephone: (406)444-3895.

(4) An emergency service provider should, but is not required to, notify his designated officer within 72 hours after the exposure if he wishes a report of exposure to be filed.

(5) It is the department's interpretation that the information in 50-16-702 (2)(c), MCA requires a health care facility to provide to a designated officer in response to the filing with the facility of a report of exposure is limited to information related to the health care facility stay directly resulting from the incident that generated the exposure, and not to any subsequent emergency transport to that facility involving the same patient and the same emergency medical service. This interpretation is advisory only and not binding upon anyone.

History

Authorizing statute(s): 50-16-705, MCA
Implementing statute(s): 50-16-702, 50-16-705, MCA
History: NEW, 1989 MAR p. 2229, Eff. 12/22/89; EMERG, AMD, 1994 MAR p. 1704, Eff. 6/24/94; AMD, 1999 MAR p. 1127, Eff. 5/21/99; TRANS, from DHES, 2001 MAR p. 2305; AMD, 2005 MAR p. 2681, Eff. 12/23/05.

Mont. Admin. R. 37.104.810 Recommended Medical Precautions and Treatment

(1) At a minimum, a health care facility that notifies the designated officer of the emergency services provider who attended a patient prior to or during transport or who transported a patient who has been diagnosed as having one of the infectious diseases listed in ARM 37.104.801 must recommend that the exposed emergency services provider take the medical precautions and treatment:

(a) specified in "The Control of Communicable Diseases Manual", published by the American Public Health Association, 16th Edition, 1995; and

(b) other additional medical precautions and treatment recommended by the health care facility.

(2) The designated officer must then forward these recommendations to the emergency medical services provider(s) who was/were exposed.

(3) The department hereby adopts and incorporates by reference "The Control of Communicable Diseases Manual", published by the American Public Health Association, 16th Edition, 1995, which lists and specifies control measures for communicable diseases. A copy of "The Control of Communicable Diseases Manual" may be obtained from the American Public Health Association, 1015 15th Street NW, Washington, DC 20005.

History

Authorizing statute(s): 50-16-705, MCA
Implementing statute(s): 50-16-703, 50-16-705, MCA
History: NEW, 1989 MAR p. 2229, Eff. 12/22/89; EMERG, AMD, 1994 MAR p. 1704, Eff. 6/24/94; AMD, 1999 MAR p. 1127, Eff. 5/21/99; TRANS, from DHES, 2001 MAR p. 2305.

Subchapter 37.104.30 Trauma Facility Designation

Mont. Admin. R. 37.104.3001 Definitions

In addition to the definitions in 50-6-401, MCA, the following definitions apply to this subchapter:

(1) "Application" means the submission of written information by a health care facility, on forms required by the department, requesting designation as a specific level of trauma facility and providing information regarding its compliance with the Montana Trauma Facility Designation Criteria concerning the resources a facility must have to qualify as that level of trauma facility.

(2) "Area trauma hospital" means a health care facility that is designated by the department as having met the essential standards for area trauma hospitals as specified in the Montana Trauma Facility Designation Criteria.

(3) "Community trauma facility" means a health care facility that is designated by the department as having met the standards for a community trauma facility as described in the Montana Trauma Facility Designation Criteria.

(4) "Comprehensive trauma center" means a health care facility that is designated by the department as having met the standards for a comprehensive trauma center as described in the Montana Trauma Facility Designation Criteria.

(5) "Corrective action plan" means the specific actions that are required of a health care facility by the department in order to be in compliance with trauma facility requirements and that are included in a plan written by the health care facility and approved by the site review team.

(6) "Designated facility" refers to a health care facility that has been determined by the department to satisfy the requirements of one of the four categories of trauma facilities as described in the Montana Trauma Facility Designation Criteria.

(7) "Designation" means a formal determination by the department that a health care facility has met the requirements for a level of trauma facility as described in the Montana Trauma Facility Designation Criteria.

(8) "Designation subcommittee" means members of the State Trauma Care Committee's Performance Improvement Subcommittee that are selected by the Trauma Care Committee's chairperson to evaluate a site review team's report and who make recommendations to the department concerning a health care facility's designation.

(9) "Emergency department" means an area of a licensed health care facility that customarily receives patients in need of emergency evaluation or care.

(10) "Focused review" means a method established by the department to assess a health care facility's compliance with a corrective action plan to meet the resource criteria in the Montana Trauma Facility Designation Criteria.

(11) "Montana Trauma Facility Designation Criteria" means the document within the Montana Trauma System Plan that contains the requirements for a facility to meet in order to be designated as a particular type of trauma care facility. The department adopts and incorporates by reference the department's Montana Trauma Facility Designation Criteria (2024). A copy of the Montana Trauma Facility Designation Criteria (2024) may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951 or electronically at

https://dphhs.mt.gov/publichealth/emsts/Trauma/Regulation .

(12) "Nurse practitioner" means a person who is licensed as a professional registered nurse and approved by the Montana Board of Nursing as a nurse practitioner.

(13) "Peer review" means the confidential review by health care practitioners from multiple disciplines of provider performance in order to reduce morbidity and mortality and to improve the care of patients.

(14) "Physician" means a person licensed to practice medicine in Montana by the Montana Board of Medical Examiners.

(15) "Physician's assistant" means a person who is licensed to practice as a physician assistant by the Montana Board of Medical Examiners.

(16) "Practitioner" means a physician, nurse practitioner, or physician's assistant.

(17) "Provisional designation" means that a health care facility has substantially, although not completely, complied with the requirements for a given level of trauma facility, that a corrective action plan has been submitted by the facility to the department, and that the facility has been authorized by the department to serve as a trauma facility on a temporary basis.

(18) "Regional trauma center" means a health care facility that is designated by the department as having met the criteria for a regional trauma center as described in the Montana Trauma Facility Designation Criteria.

(19) "Regional Trauma Care Advisory Committee" means a regional committee composed of representatives from each of the region's trauma facilities established pursuant to 50-6-411, MCA.

(20) "Site review team" means a group of individuals selected by the department who have expertise in trauma care and trauma program administration and that evaluates a medical facility's compliance with required trauma facility criteria.

(21) "Site survey" means the process by which the site review team visits a health care facility that has applied for trauma facility designation, reviews the compliance of the medical facility with the applicable trauma facility criteria, and makes recommendations regarding designation to the department.

(22) "Trauma diversion" means a health care facility that temporarily does not have all the resources available to optimally resuscitate a seriously injured patient, with the result that such a patient is diverted from that hospital prior to arrival there and arrangements are made simultaneously for the patient to be received and treated at another facility that can provide more readily available and appropriate medical care.

(23) "Trauma patient" means an individual suffering from a trauma as defined in 50-6-401, MCA.

(24) "Trauma receiving facility" means a health care facility that is designated by the department as having met the criteria for a trauma receiving facility as described in the Montana Trauma Facility Designation Criteria.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-401, 50-6-402, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2014 MAR p. 2792, Eff. 1/1/15; AMD, 2019 MAR p. 1170, Eff. 8/10/19; AMD, 2023 MAR p. 1622, Eff. 1/1/24.

Mont. Admin. R. 37.104.3002 Trauma Regions

(1) The following regions are designated as trauma regions:

(a) the western trauma region, consisting of Beaverhead, Deer Lodge, Flathead, Granite, Lake, Lincoln, Mineral, Missoula, Powell, Ravalli, Sanders, and Silver Bow counties;

(b) the central trauma region, consisting of Blaine, Broadwater, Cascade, Chouteau, Glacier, Hill, Jefferson, Judith Basin, Lewis and Clark, Liberty, Meagher, Pondera, Teton, and Toole counties; and

(c) the eastern trauma region, consisting of Big Horn, Carbon, Carter, Custer, Daniels, Dawson, Fallon, Fergus, Gallatin, Garfield, Golden Valley, Madison, McCone, Musselshell, Park, Petroleum, Phillips, Powder River, Prairie, Richland, Roosevelt, Rosebud, Sheridan, Stillwater, Sweet Grass, Treasure, Valley, Wheatland, Wibaux, and Yellowstone counties.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06.

Mont. Admin. R. 37.104.3006 Regional Trauma Care Advisory Committees

(1) In addition to the requirements specified in 50-6-412, MCA, each Regional Trauma Care Advisory Committee must do the following:

(a) meet quarterly to identify specific regional trauma needs and to define corrective strategies;

(b) propose trauma care guidelines or protocol, backed by evidence and research showing their efficacy, to the State Trauma Care Committee;

(i) prehospital trauma communications and dispatch;

(ii) medical control and treatment protocols for prehospital caregivers;

(iii) triage and transportation of trauma victims;

(iv) facility resources in the region for trauma patients;

(v) interfacility transfer of trauma patients;

(vi) rehabilitation resources;

(vii) criteria to determine what the composition of a patient's trauma team should be given the nature of the patient's trauma;

(viii) trauma performance improvement; and

(ix) disaster management; and

(d) keep minutes of each Regional Trauma Care Advisory Committee meeting and submit a copy to the State Trauma Care Committee.

(2) Each Regional Trauma Care Committee must have a structure that addresses each of the following elements:

(a) trauma performance improvement;

(b) the Regional Trauma Plan;

(d) prehospital trauma issues; and

(e) injury prevention and control.

(3) In accordance with 50-6-415, MCA, Regional Trauma Care Advisory Committee and subcommittee meetings must be open to the public, and the information presented at such meetings is public as well, unless the committee or subcommittee determines that the meeting, or a portion thereof, will perform peer review and performance improvement activities, in which case:

(a) the meeting, or the relevant portion thereof, is limited to:

(i) members of the committee or subcommittee; and

(ii) guests who further the process of performance improvement, are invited by the performance improvement subcommittee chairperson, and are approved by the Regional Trauma Care Advisory Committee chairperson in advance;

(b) each committee or subcommittee member and guest must sign a form indicating they will not divulge any proceedings of the closed meeting, conversations during the meeting, or documents used during the meeting; and

(c) the minutes and the information presented, including all records and deliberations of the meeting, are confidential and not discoverable.

(4) If a meeting is closed pursuant to (3), the Regional Trauma Care Advisory Committee may still develop summary reports, findings, and recommendations to the State Trauma Care Committee, Regional Trauma Care Advisory Committee, an Individual Trauma Facility Trauma Program, or an individual health care practitioner.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, 50-6-412, 50-6-415, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2016 MAR p. 1461, Eff. 8/20/16.

Mont. Admin. R. 37.104.3007 State Trauma Care Committee

(1) The State Trauma Care Committee shall:

(a) meet quarterly to identify specific statewide trauma needs and to define corrective strategies;

(b) keep minutes and provide copies of those minutes to each Regional Trauma Care Advisory Committee;

(d) assist in the development and oversight of the State Trauma System Plan; and

(e) approve the State Trauma System plan.

(2) The Trauma Care Committee must have a structure that addresses each of the following:

(a) trauma performance improvement;

(b) organization and emergency preparedness;

(d) injury prevention and control;

(e) public advocacy and legislation; and

(f) designation of trauma facilities.

(3) The subcommittee of the State Trauma Care Committee responsible for designation of trauma facilities must review the site survey report and make a recommendation to the department regarding actions to be taken on the trauma designation application of a potential trauma facility.

(4) In accordance with 50-6-415, MCA, State Trauma Care Committee and subcommittee meetings are open to the public and the information presented is considered public information unless the committee or subcommittee determines that the meeting, or a portion thereof, will perform peer review and performance improvement activities, in which case:

(a) the meeting, or the relevant portion thereof, is limited to:

(i) members of the committee or subcommittee; and

(ii) guests who further the process of performance improvement, are invited by the Performance Improvement Subcommittee chairperson, and are approved by the Trauma Care Committee chairperson in advance;

(b) each committee or subcommittee member and guest must sign a form indicating they will not divulge any proceedings of the meeting, conversations during the meeting, or documents used during the meeting; and

(c) the minutes and the information presented, including all records and deliberations of the meeting pertaining to the peer review and performance improvement activities, are confidential and not discoverable.

(5) If a meeting is closed pursuant to (4), the committee or subcommittee may still develop summary reports, findings, and recommendations to the State Trauma Care Committee, Regional Trauma Care Advisory Committee, an individual Trauma Facility Trauma Program, or an individual health care practitioner.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, 50-6-415, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2016 MAR p. 1461, Eff. 8/20/16.

Mont. Admin. R. 37.104.3012 Levels of Trauma Facilities

(1) The department may designate a health care facility as belonging to one of the following levels of trauma facilities:

(a) comprehensive trauma center;

(b) regional trauma center;

(d) community trauma facility; or

(e) trauma receiving facility.

(2) Requirements for each level are contained in the Montana Trauma Facility Designation Criteria.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2014 MAR p. 2792, Eff. 1/1/15; AMD, 2023 MAR p. 1622, Eff. 1/1/24.

Mont. Admin. R. 37.104.3013 Trauma Facility Requirements

(1) A designated trauma facility must:

(a) adhere to these rules;

(b) continue to be a health care facility; and

(c) continue to provide the resources required for its designated level of trauma facility, as described in the Montana Trauma Facility Designation Criteria of the State Trauma Plan.

(2) If the designated facility is unable to provide the care required by (1), it must:

(a) observe the trauma diversion plan required by the Montana Trauma Facility Designation Criteria of the State Trauma Plan for its facility; and

(b) immediately notify the department if the facility becomes unable to provide trauma services commensurate with its designation level for a period of more than one week.

(3) A designated facility may, without cause, terminate its trauma designation after giving 90 days written notice to the department, the State Trauma Care Committee, and the Regional Trauma Care Advisory Committee.

(4) If, following its voluntary termination of trauma designation, a health care facility wishes to be reinstated as a trauma facility, the facility must reapply for designation by completing the requirements of ARM 37.104.3021 or 37.104.3022, whichever is applicable.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, 50-6-410, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2014 MAR p. 2792, Eff. 1/1/15.

Mont. Admin. R. 37.104.3014 Trauma Registries and Data Reporting

(1) For the purpose of improving the quality of trauma care, all Montana health care facilities, as defined in 50-6-401, MCA, must participate in the state trauma register by collecting and reporting to the department the data listed in (4), on the schedule required by (2).

(2) Within 60 days after the end of each quarter, each health care facility that provides service or care to trauma patients within Montana must submit to the department the information required by (4) concerning any trauma patient that it serves during any month of the quarter and who meets the criteria for inclusion in the trauma register that are set forth in the State Trauma Plan.

(3) The data must be submitted to the department's trauma register in the same format as the state register uses, unless the department allows an alternate means of submission if use of the department's prescribed format would impose a severe hardship on the reporting facility. All health care facilities must submit the data electronically.

(4) The following data fields must be reported to the department:

(a) patient information that includes:

(i) a unique trauma patient identifier;

(ii) date of birth;

(iii) age;

(iv) sex;

(v) race; and

(vi) address;

(b) injury information that includes:

(i) date, time, and location of injury;

(ii) trauma injury diagnostic codes;

(iii) injury cause;

(iv) protective devices used by the patient, if any;

(v) results of alcohol or drug testing, if any; and

(vi) trauma injury diagnoses;

(i) prehospital transport agencies;

(ii) patient extrication time;

(iii) emergency medical service (EMS) dispatch date;

(iv) EMS notification time;

(v) time of arrival at scene;

(vi) departure time from scene;

(vii) time of arrival at the facility;

(viii) triage criteria, including physiologic and anatomic conditions, injury circumstances, and comorbid factors;

(ix) EMS activation of trauma team;

(x) vital and neurologic signs;

(xi) treatment and procedures provided; and

(xii) whether a prehospital report is included in the facility patient medical record;

(d) interfacility transfer information that includes:

(i) the names of the referring and receiving facilities;

(ii) trauma team activation;

(iii) patient arrival and discharge date and times from the referring facility;

(iv) vital and neurologic signs;

(v) date, time, and results of tests and procedures performed;

(vi) treatment at the referring facility;

(vii) payor source; and

(e) inpatient care information that includes:

(i) the name of the facility;

(ii) emergency department admission and discharge dates and times;

(iii) trauma team activation;

(iv) emergency department vital and neurologic signs;

(v) status of intubation and ventilation;

(vi) date, time, and results of tests and procedures performed;

(vii) post emergency department destination;

(viii) admitting service;

(ix) previous admission for the injury in question, if any;

(x) total days in the intensive care unit;

(xi) total days on ventilator;

(xii) date for rehabilitation consult;

(xiii) date nutrition addressed;

(xiv) substance counseling, if applicable;

(xv) use of blood products, if applicable;

(xvi) facility discharge date and time;

(xvii) discharge disposition;

(xviii) functional ability at discharge;

(xix) payor source;

(xx) hospital charges and payments received;

(xxi) for all deaths, if an autopsy was performed; and

(xxii) for all deaths, whether there was any donation of tissue or organs.

(5) Failure of a designated trauma facility to timely and accurately report to the department all data required by these rules is grounds for revocation of designation status.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-401, 50-6-402, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2016 MAR p. 1461, Eff. 8/20/16.

Mont. Admin. R. 37.104.3020 Composition of Site Review Teams

(1) The site review team for comprehensive trauma centers, regional trauma centers, area trauma hospitals, and community trauma facilities must be composed of either out-of-state or in-state surveyors from a trauma center that is not owned or operated by the same entity as the applicant and must include a general surgeon, a trauma nurse coordinator, department staff, and other members determined to be necessary by the department or requested by the health care facility being reviewed.

(2) The site review team for a trauma receiving facility must be composed of either out-of-state or in-state surveyors from a trauma center that is not owned or operated by the same entity as the applicant and must include a physician, a trauma nurse coordinator, department staff, and other members determined to be necessary by the department or requested by the health care facility being reviewed.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2016 MAR p. 1461, Eff. 8/20/16; AMD, 2023 MAR p. 1622, Eff. 1/1/24.

Mont. Admin. R. 37.104.3021 Designation Procedures for Facilities Not Verified by American College of Surgeons

(1) A Montana health care facility that is not currently verified by the American College of Surgeons as meeting the American College of Surgeons' criteria to qualify for verification as a trauma facility and that wishes a designation or renewal of designation as a Montana trauma facility must submit to the department an application for trauma facility designation, supplied by the department.

(2) The application must:

(a) specify the level of designation for which the facility is applying; and

(b) provide information about the facility's compliance with the Montana Trauma Facility Designation Criteria of the State Trauma Plan that are required for that level of trauma facility.

(3) The department will review the application for completeness and within 30 days, after receiving the application, notify the health care facility that:

(a) the application is complete; or

(b) the application is incomplete and request additional information.

(4) When the application is complete, the department will:

(a) select a site review team; and

(b) with a minimum of 60 days advance notice, notify the facility of the scheduled dates for the site survey and of the site review team members.

(5) The health care facility must:

(a) notify the department in writing within ten working days if it objects to one or more members of the site review team due to a perceived conflict of interest, and provide documentation of clear and convincing evidence for its concern including, but not limited to, the member's past or potential financial or personal gain, past or potential employment, or gain from the use of confidential information; and

(b) prohibit its administration, faculty, medical staff, employees, and representatives from having any contact with site review members prior to the site survey, except as directed by the department.

(6) The site review team will:

(a) review the commitment and capabilities of the applicant health care facility to meet the resource criteria described in the Montana Trauma Facility Designation Criteria of the State Trauma Plan for the level of designation sought, based upon consideration of all pertinent information, including:

(i) review of the application for designation;

(ii) inspection of the facility and required equipment;

(iii) interview with appropriate individuals;

(iv) review of medical records;

(v) review of inpatient logs and hospital emergency department logs;

(vi) review of hospital trauma registry entries and reports;

(vii) review of documentation of trauma performance improvement;

(viii) review of call rosters, staffing schedules, and meeting minutes;

(ix) review of injury prevention and education programs; and

(x) other documentation as necessary to assess the facility's compliance with these rules;

(b) make a verbal report of its findings through an exit interview to the applicant upon completion of the site survey and prior to leaving the facility; and

(c) make a written report of its findings and recommendations to the department within 30 days following the on-site survey of the facility.

(7) The department will review the report of the site review team and forward a copy to the designation subcommittee.

(8) The designation subcommittee will review the report of a site review team at the next quarterly State Trauma Care Committee meeting and make a recommendation to the department regarding the trauma designation of the applicant facility.

(9) The department must:

(a) determine the final designation of the facility based on consideration of the application, the recommendations of the site review team, and the recommendations of the designation subcommittee; and

(b) notify the applicant of its decision in writing within 30 days after receiving the recommendation from the designation subcommittee.

(10) The department will take one of the following actions:

(a) designate the applicant as qualifying for the trauma facility level requested, providing there is compliance with the trauma facility resource criteria in the Montana Trauma Facility Designation Criteria of the State Trauma Plan;

(b) issue a provisional designation to the applicant provided:

(i) there are deficiencies noted but the facility is substantially compliant with the resource criteria and any deficiencies will not have an immediate detrimental impact on trauma patient care; and

(ii) the applicant has submitted to the site review team a corrective action plan, acceptable to the team, for the correction of the identified deficiencies;

(c) designate the applicant as a trauma facility at a different level from that for which the applicant applied, provided that:

(i) the applicant meets all of the requirements of the alternative trauma facility designation level; and

(ii) the applicant agrees to be designated at the alternative trauma facility designation level; or

(d) deny any trauma facility designation if:

(i) there is substantial noncompliance with the requirements; or

(ii) the deficiencies are fundamental or may have an immediate detrimental impact on trauma patient care.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, 50-6-410, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2014 MAR p. 2792, Eff. 1/1/15.

Mont. Admin. R. 37.104.3022 Designation Procedures for Facilities Verified as a Trauma Facility by the American College of Surgeons

(1) A health care facility with a current certificate of verification from the American College of Surgeons as a trauma facility qualifies as one of the following types of Montana trauma facility as set out in (2), providing it submits an application, department staff attend the on-site or virtual review conducted by the American College of Surgeons, and the facility demonstrates compliance with all requirements described in the Montana Trauma Facility Designation Criteria that may differ from the American College of Surgeons' standards in the college's document entitled "Resources for Optimal Care of the Injured Patient: 2022 standards." A copy of this document may be obtained as set forth in (8).

(2) A current certificate of verification for the following levels established by the American College of Surgeons qualifies a health care facility as the following type of Montana trauma facility:

(a) a level I trauma center qualifies as a comprehensive trauma center;

(b) a level II trauma center qualifies as a regional trauma center;

(d) a level IV trauma center qualifies as a community trauma facility.

(3) A Montana health care facility that is seeking verification or reverification by the American College of Surgeons as a trauma center and wishes to be designated as a Montana trauma facility must submit to the department:

(a) an application for designation, on a form approved by the department, that:

(i) specifies the level of designation for which the facility is applying; and

(ii) includes a copy of the American College of Surgeons' prereview questionnaire;

(b) any additional information required by the department to verify compliance with any requirements described in the Montana Trauma Facility Designation Criteria that differ from the American College of Surgeons' standards;

(c) notification of the scheduled dates of the American College of Surgeons' site survey to allow for department participation in the site review; and

(d) upon receipt, a copy of the American College of Surgeons' letter indicating if the facility was successfully verified as a trauma facility.

(4) The department will review the application for completeness and within 30 days after receiving the application:

(a) notify the facility that the application is complete; or

(b) notify the facility that the application is incomplete and request additional information.

(5) When the application and the site review are complete, and the American College of Surgeons' letter is received that indicates whether the facility is verified as a trauma facility, the department will provide a copy of the application and the letter to the designation subcommittee at the next quarterly State Trauma Care Committee meeting.

(6) The designation subcommittee will review the application and American College of Surgeons' letter at the next quarterly State Trauma Care Committee meeting and make a recommendation to the department regarding the trauma designation of the applicant facility.

(7) Within 30 days after receiving a recommendation from the designation subcommittee, the department will take one of the following actions:

(a) designate the applicant at the trauma facility level requested providing there is compliance with these rules;

(b) issue a provisional designation to the applicant provided that:

(i) there are deficiencies noted but the facility is substantially compliant with the resource criteria and the deficiencies will not have an immediate detrimental impact on trauma patient care; and

(ii) the applicant has submitted to the department a corrective action plan, acceptable to the department, for the correction of the deficiencies;

(c) designate the applicant as a trauma facility at a different level from that for which the applicant applied, provided that:

(i) the applicant meets all of the requirements of the alternative trauma facility designation level; and

(ii) the applicant agrees to be designated at the alternative trauma facility designation level; or

(d) deny any designation if there is substantial noncompliance with the requirement, or the deficiencies may be a threat to public health and safety.

(8) The department adopts and incorporates by reference "Resources for Optimal Care of the Injured Patient: 2022 standards," published by the American College of Surgeons. The document contains the trauma facility criteria used by the American College of Surgeons in its process for verification of trauma facilities. A copy may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, 50-6-410, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2014 MAR p. 2792, Eff. 1/1/15; AMD, 2023 MAR p. 1622, Eff. 1/1/24.

Mont. Admin. R. 37.104.3025 Designation Period

(1) When a trauma facility is designated as such pursuant to ARM 37.104.3021, the period of designation is for three years beginning from the date the notice of designation is issued.

(2) When a trauma facility is designated as such pursuant to ARM 37.104.3022, the expiration date of the designation shall coincide with the expiration date of the American College of Surgeons' Certificate of Verification. Upon expiration of the Certificate of Verification, the facility may be granted a Montana designation extension of up to six months if the department receives documentation that an American College of Surgeons' verification survey is anticipated.

(3) A provisional designation imposed pursuant to ARM 37.104.3030 is valid for a period determined by the department in consultation with the designation subcommittee, but not longer than 12 months. The provisional designation expires on the date set by the department unless the provisionally designated trauma facility:

(a) receives a focused review by the department in consultation with the designation subcommittee to determine if the corrective action plan has resulted in compliance with the required criteria; and

(b) the department determines that the corrective action plan has resulted in the facility successfully meeting the required criteria, in which case the department shall issue a designation as a trauma facility.

(4) A trauma facility may renew its designation by completing the requirements of ARM 37.104.3021 or 37.104.3022.

(5) The department may waive any designation expiration dates if the facility provides sufficient written justification and/or the department determines a waiver is necessary due to an emergency or disaster declaration by the governor, county, or city, or in the event of an unforeseen natural disaster. A waiver will be issued only if the following criteria are met:

(a) the waiver is necessary to avoid significant financial or other hardship to the facility; and

(b) granting the waiver would not jeopardize patient care or public health and safety.

(6) A waiver issued under (5) will be issued on a temporary basis not to exceed a period of 12 months.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06; AMD, 2020 MAR p. 1845, Eff. 10/10/20.

Mont. Admin. R. 37.104.3030 Complaint Investigation, Revocation, or Emergency Suspension

(1) The department may review, inspect, evaluate, and audit trauma patient medical records, inpatient logs, hospital emergency department logs, trauma performance improvement documentation, and any other documents relevant to trauma care by any trauma facility at any time to verify compliance with these rules.

(2) The confidentiality of such records will be maintained by the department in accordance with state and federal law.

(3) The department will investigate written complaints alleging violation of these rules in the following manner:

(a) The department will request and the designated facility shall provide information that the department determines necessary to the investigation of the complaint.

(b) The results of a department investigation will be reviewed with the designation subcommittee.

(4) Following the completion of the investigation and review, the department may:

(a) take no action;

(b) initiate an emergency suspension of the facility's trauma designation;

(d) change the designation of a trauma facility to provisional; or

(e) revoke the designation of the designated facility.

(5) The department will suspend the designation of a designated trauma facility on an emergency basis if the violation of these rules creates a substantial threat to public health or if the designated facility ceases to be a health care facility. The designated facility may appeal the emergency suspension pursuant to 50-6-410 , MCA, but the emergency suspension shall remain in effect until a final decision is made by the department.

(6) The department may revoke a trauma facility designation if the facility:

(a) fails to comply with these rules;

(b) no longer is a health care facility;

(c) makes a false statement of a material fact in the application for designation, in any record required by these rules, or in a matter under investigation;

(d) prevents, interferes with, or attempts to impede in any way, the work of a department representative in the lawful enforcement of these rules; or

(e) falsely advertises or in any way misrepresents the facility's ability to care for trauma patients based on its trauma designation status.

(7) If a designated facility notifies the department that it will be temporarily noncompliant with its trauma facility designation criteria for longer than one week, the department, after consultation with the designation subcommittee, may take one or more of the following actions:

(a) conduct a focused review;

(b) modify the facility's designation status to provisional and require that a plan of correction be submitted to the department outlining how the deficiency will be corrected;

(c) change its designation level to be consistent with the trauma facility level for which it has the required resources; or

(d) suspend the trauma facility's designation on an emergency basis.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, 50-6-410, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06.

Mont. Admin. R. 37.104.3031 Denial Modification, Suspension, or Revocation of Designation, and Appeal

(1) If the department proposes to deny, modify, suspend, or revoke a facility's trauma designation, the department shall notify the health care facility of that fact by registered or certified mail at the last address shown in the department records.

(2) The notice shall state the alleged facts that warrant the action and that the facility has an opportunity to request a hearing before the department to contest the decision.

(3) If the facility wants to appeal the department's decision, it must request a hearing in writing within 30 calendar days after the date of receipt of the notice. The request must be in writing and submitted to the Department of Public Health and Human Services, Office of Fair Hearings, P.O. Box 202953, Helena, MT 59620-2953.

(4) If a hearing is requested, the hearing will be held in accordance with the informal hearing procedures described in 2-4-604 , MCA, and ARM 37.5.117 and 37.5.311.

(5) If the facility does not request a hearing by the deadline cited in (3), after being sent the notice of opportunity for hearing, the facility will be deemed as to have waived the opportunity for a hearing, and the department's decision to deny, modify, or revoke a facility's trauma designation will be final.

(6) As provided in ARM 37.104.3030, suspension of a trauma designation on an emergency basis is effective immediately upon receipt by the trauma facility of the notice required by (1), and remains in effect unless the facility files an appeal with the department and the suspension is lifted after a hearing.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 2-4-604, 50-6-402, 50-6-410, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06.

Mont. Admin. R. 37.104.3034 Reapplication for Designation

(1) Six months after the denial of its request for designation, a health care facility may reapply for trauma facility designation pursuant to ARM 37.104.3021 or 37.104.3022.

(2) If a health care facility's trauma designation has been revoked, one year after the revocation was final, the facility may petition the department, in writing, to be allowed to reapply to be designated a trauma facility once again. The department may deny the opportunity to reapply if, after investigation, the department determines that the reason for the revocation continues to exist. If the application is allowed, the hospital or facility must meet the requirements of ARM 37.104.3021 or 37.104.3022, whichever is relevant.

History

Authorizing statute(s): 50-6-402, MCA
Implementing statute(s): 50-6-402, 50-6-410, MCA
History: NEW, 2006 MAR p. 1896, Eff. 7/28/06.

Chapter 37.106 Health Care Facilities

Subchapter 37.106.1 Certificate of Need

Mont. Admin. R. 37.106.101 Definitions

(1) For the purpose of this subchapter:

(a) "Capital expenditure" is defined as provided in 50-5-101, MCA.

(b) "Long-term care facilities plan" means the plan prepared by the department containing guidelines for determining need for long-term care facilities and services subject to certificate of need review that is most recently approved by the Governor and a statewide health coordinating council appointed by the director of the department.

(d) "Swing-bed" means a licensed hospital, medical assistance facility, or critical access hospital bed that is also certified for the provision of long-term care pursuant to 42 CFR 482.58.

(2) The following term appears in the Montana Code Annotated, is not defined in the statutes, and is interpreted by the department to mean the following:

(a) The phrase "enforceable capital expenditure commitment," as used in 50-5-305, MCA, means an obligation incurred by or on behalf of a long-term care facility when:

(i) an enforceable contract is entered into by such facility or its agent for the construction, acquisition, lease or financing of a capital asset;

(ii) a formal internal commitment of funds by such a facility which constitutes a capital expenditure; or

(iii) in the case of donated property, the date on which the gift vested.

History

Authorizing statute(s): 50-5-103, 50-5-302, MCA
Implementing statute(s): 50-5-101, 50-5-301, 50-5-302, 50-5-304, 50-5-305, 50-5-306, 50-5-307, 50-5-308, 50-5-309, 50-5-310, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.103 Long-Term Care: Where Allowed

(1) A health care facility, as defined in 50-5-301 , MCA, may provide long-term care only if:

(a) it is licensed to provide the level of care in question; or

(b) it has received certificate of need approval pursuant to ARM 37.106.126 for the establishment of swing beds, is certified to provide long-term care in such swing beds, and the provision of long-term care is limited to such swing beds.

(2) A hospital may provide long-term care only if:

(a) it has received certificate of need approval from the department for the establishment of swing beds, is certified to provide long-term care in such swing beds, and the provision of long-term care is limited to such swing beds; or

(b) whenever the number of beds in which long term care is provided is five or fewer, the facility is certified to provide long-term care in those beds as swing beds, and the provision of long-term care is limited to such swing beds.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-302, MCA
Implementing statute(s): Sec. 50-5-201 and 50-5-301, MCA
History: NEW, 1986 MAR p. 38, Eff. 1/17/86; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.106 Submission of Letter of Intent

(1) Any person proposing an activity other than those to which (2) and (3) apply and that is subject to review under 50-5-301 , MCA, and not exempt under 50-5-309, MCA, shall submit to the department a letter of intent that contains the following:

(a) name of applicant;

(b) proposal title;

(i) the addition of a new service that is offered by or on behalf of the long-term care facility that was not offered by or on behalf of the long-term care facility within the 12-month period before the month in which the service would be offered, and, if so, an estimate of the annual operating and amortization expenses required to provide it;

(ii) the construction, development, or other establishment of a long-term care facility that did not previously exist or is being replaced;

(iii) a change in bed capacity through an increase in the number of beds or a relocation of beds from one facility or site to another;

(iv) the use of hospital beds to provide nursing or intermediate developmental disability care and, if so, the number of beds involved;

(v) the provision of hospital beds to provide long-term care; or

(vi) other (explain);

(d) a narrative summary of the proposal;

(e) an itemized estimate of proposed capital expenditures, including a list of proposed major medical equipment with a description of each and the cost of the construction of any building, including remodeling, necessary to house it;

(f) anticipated methods and terms of financing the proposal;

(g) effects of the proposal on the cost of patient care in the service area affected;

(h) projected dates for commencement and completion of the proposal;

(i) the proposed geographic area to be served;

(j) an itemized estimate of increases in annual operating and/or amortization expenses resulting from new health services;

(k) the location of the proposed project, including its street address;

(l) if the person desires comparative review of their proposal with that of another applicant, the name of the other applicant;

(m) the name of the person to contact for further information, including city, state, zip code and telephone number; and

(n) the dated signature of an authorized representative of the applicant.

(2) Any person or persons desiring to acquire or enter into a contract to acquire 50% or more of an existing long-term care facility (whether through a single transaction or by adding to a portion already owned) must submit to the department a written letter noting intent to acquire the facility and containing the following:

(a) the services currently provided by the long-term care facility and the present and proposed bed capacity of the facility;

(b) any additions, deletions, or changes in such services which will result from the acquisition; and

(c) the projected cost of care at the facility compared to the cost under the current ownership, as well as any other factors which may cause an increase in the cost of care.

(3) Any person proposing to increase or relocate from one facility or site to another 10 beds or less or 10% or less of the licensed beds, and no beds have been added or relocated in the two years prior, must submit to the department a letter of intent containing the following as one of the conditions that 50-5-301(1)(b), MCA, requires to be met in order to be exempt from certificate of need review for the change:

(a) the licensed capacity of the facility, the number of beds to be added or relocated, and in the latter case, the facilities or sites in question; and

(b) the cost of the addition or relocation and its likely effect on the cost of patient care.

(4) When a person incurs an obligation by or on behalf of a long-term care facility for a capital expenditure that exceeds $5 million and does not otherwise require a certificate of need, the person shall upon completion of the project:

(a) notify the department of the total amount of the expenditure; and

(b) provide the department a description of the project.

(5) Persons who acquire 50% or more of an existing long-term care facility but who do not file the notice of intent required by (2) and 50-5-302(2), MCA, are subject to certificate of need review for the purposes of this subchapter and as required by 50-5-301(1)(c), MCA.

(6) The person must send a letter of intent to the Department of Public Health and Human Service, Office of Inspector General, Certificate of Need Program, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-302, MCA
Implementing statute(s): 50-5-301, 50-5-302, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.107 Submission of Applications

(1) An application will be accepted only after submission of a letter of intent.

(2) The deadline set by the department for submission of an application will not exceed 90 days unless the department and all affected applicants agree to a longer period.

(3) No application for a proposal will be accepted earlier than the deadline set by 50-5-302(5), MCA, for receipt of a letter of intent requesting comparative review with that proposal, with the exception of a proposal for which a letter of intent was submitted requesting comparative review with an earlier proposal.

(4) The application must contain, at a minimum, the information as specified by the department pursuant to ARM 37.106.133 and 37.106.134.

(5) The original and two copies of the application must be submitted to the department.

(6) If the application is received without the full fee ($500 or 0.3% of the application's projected capital expenditure, whichever is larger) , it will not be considered submitted to the department until the date the full fee due is received by the department. The fee must be paid by check made out to the department of public health and human services.

(7) Within 20 working days after receipt of an application, if the application is determined to be incomplete, the department shall notify the applicant in writing by mail of that fact and of the specific information that is necessary to complete the application. The department shall also indicate a time, which may be no less than 15 calendar days, within which the department must receive the additional information requested. Within 15 working days after receipt of the additional information, the department shall determine whether the application is complete.

(8) If an applicant does not submit adequate information within the time specified, their application will be considered withdrawn.

(9) If the applicant materially changes the proposal or the capital expenditures projected are increased by 15% or $150,000, whichever is greater, after the department declares the application complete, the department may cease review of the original application and require the applicant to begin the process again by filing a new letter of intent for the revised proposed project if it desires a certificate of need for it. If, after the department gives the applicant notice that the department considers the original proposal so altered that the review process must begin again, the department will continue on the original review schedule if the applicant notifies the department that it chooses to have review continue on the original application, rather than to commence a new review process on the revised application.

(10) The department may, in its discretion, conduct a comparative review of competing applications if such applications are being reviewed concurrently, if such comparative review can be conducted consistently with all other time constraints imposed by Title 50, chapter 5, part 3, MCA, and this subchapter, and if, as required by 50-5-302(12), MCA, they pertain to similar types of facilities or equipment affecting the same health service area, subject to the limitation that a proposal for which a letter of intent is submitted requesting comparative review, pursuant to 50-5-302(5), MCA, will not be reviewed comparatively with a proposal for which a letter of intent is filed after the 30-day deadline referred to in 50-5-302(5), MCA.

History

Authorizing statute(s): 2-4-201, 50-5-103, 50-5-302, MCA
Implementing statute(s): 50-5-302, 50-5-310, MCA
History: NEW, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.108 Notice of Acceptance or Effective Withdrawal of Application

(1) When an application is determined to be complete, the department shall issue a letter of acceptance.

(2) When an application is determined to be incomplete after the applicant has been given an opportunity to submit additional information, the department will issue the applicant a letter declaring the application is effectively withdrawn.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-302, MCA
Implementing statute(s): Sec. 50-5-302, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.112 Informational Hearing Procedures

(1) Any affected person may request an informational hearing to be held during the course of the review period by writing to the department. The department may also hold a hearing on its own initiative.

(2) Whenever an application is received by the department, the department will publish a notice of that fact in a newspaper of general circulation in the area to be served by the proposal, unless the application is subject to comparative review with another, in which case the newspaper notice will be published after receipt of all of the applications to be comparatively reviewed. A hearing request must be received by the department within 30 calendar days after the date the newspaper notice is published.

(3) Notice of the informational hearing will be given at least 14 calendar days before the hearing date by the following means:

(a) Written notice must be sent by mail to the person requesting the hearing, the applicant, and all other applicants assigned for comparative review with the applicant, if any. Other persons who have requested notice will be notified by mail.

(b) Notice to all other affected persons will be by legal advertisement in a newspaper with general circulation in the service area affected by the application.

(i) the date of the hearing;

(ii) the time of the hearing;

(iii) the location of the hearing; and

(iv) the person to whom written comments may be sent prior to the hearing.

(4) Whenever a hearing is held for an application which is being comparatively reviewed with another application, the hearing will be conducted as a joint hearing on all such applications.

(5) Any person may comment during the hearing, and all comments made at the hearing will be tape-recorded and retained by the department until the project is completed or the certificate of need expires.

(6) The hearing will be informal, and neither the Montana Administrative Procedure Act nor the Rules of Civil Procedure will apply.

(7) Any person wishing to make a factual allegation at the hearing must first swear or affirm that his testimony is true.

(8) No person other than the department may conduct reasonable questioning of any person who makes relevant factual allegations.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-302, MCA
Implementing statute(s): Sec. 50-5-302, MCA
History: NEW, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.113 Criteria and Findings

(1) The criteria listed in (a) through (k) are statutory criteria required by 50-5-304, MCA, and will be considered by the department in making its decision:

(a) the degree to which the proposal being reviewed:

(i) demonstrates that the service is needed by the population within the service area defined in the proposal;

(ii) provides data that demonstrates the need for services contrary to the current state long-term care facilities plan, including waiting lists, projected service volumes, differences in cost and quality of services, and availability of services; or

(iii) is consistent with the current state long-term care facilities plan.

(b) the need that the population served or to be served by the proposal has for the services;

(d) the immediate and long-term financial feasibility of the proposal as well as the probable impact of the proposal on the costs of and charges for providing long-term care services by the person proposing the long-term care service;

(e) the relationship and financial impact of the services proposed to be provided to the existing health care system of the area in which such services are proposed to be provided;

(f) the consistency of the proposal with joint planning efforts by health care providers in the area;

(g) the availability of resources, including health manpower, management personnel, and funds for capital and operating needs, for the provision of services proposed to be provided and the availability of alternative uses of the resources for the provision of other health services;

(h) the relationship, including the organizational relationship, of the long-term care services proposed to be provided to ancillary or support services;

(i) in the case of a construction project, the costs and methods of the proposed construction, including the costs and methods of energy provision, and the probable impact of the construction project reviewed on the costs of providing long-term care services by the person proposing the construction project;

(j) the distance, convenience, cost of transportation, and accessibility of services offered by long-term care facilities for persons who live outside urban areas in relation to the proposal; and

(k) in the case of a project to add long-term care facility beds:

(i) the need for the beds that takes into account the current and projected occupancy of long-term care beds in the community;

(ii) the current and projected population over 65 years of age in the community; and

(iii) other appropriate factors.

(2) In addition to the statutory criteria cited in (1), the department will consider the following in making its decision:

(a) whether the medically underserved population, as well as all other people within the geographical area documented as served by the applicant, will have equal access to the subject matter of the proposal; and

(b) whether patients will experience problems including cost, availability, or accessibility in obtaining care of the type proposed in the absence of the proposed new service.

History

Authorizing statute(s): 50-5-103, 50-5-304, MCA
Implementing statute(s): 50-5-304, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1988 MAR p. 2484, Eff. 11/24/88; AMD, 1994 MAR p. 1296, Eff. 5/13/94; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.114 Department Decision

(1) If the department fails to reach and issue a decision within the deadlines established by 50-5-302 , MCA, a certificate of need will not automatically issue unless the delay is due to an abuse of discretion by the department and the applicant obtains a writ of mandamus ordering the department to issue the certificate.

(2) If the certificate of need is issued with conditions, the conditions must be directly related to the project under review, and to the criteria listed in 50-5-304 , MCA, and ARM 37.106.113, and cannot increase the scope of the project.

(3) The basis for the decision of the department must be expressed in written findings of fact and conclusions of law, which must be sent via certified mail to the applicant and all other applicants assigned for comparative review with the applicant, along with a notice of the right to a reconsideration hearing pursuant to 50-5-306 , MCA, and the deadline for requesting such a hearing. The findings, conclusions, and notice will be made available, upon request, to others for cost.

(4) Notice, in summary form, of the department's decision, the right to request a reconsideration hearing, and the deadline for such a request will also be sent to each health care facility of the type affected by the application or applications in question within the geographic area affected by the application(s) .

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-302, MCA
Implementing statute(s): Sec. 50-5-302 and 50-5-304, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.115 Appeal Procedures

(1) Any affected person who requests a hearing to reconsider the department's decision must submit a check for $500 to the department along with the request. No hearing will be scheduled or held unless the department has received the fee.

(2) Immediately after receipt of a request for a hearing, a copy of the request will be sent to all affected persons, as defined in 50-5-101 , MCA, who participated in any informational hearing that was held concerning the affected proposal.

(3) Notice of the date and time of a reconsideration hearing will be sent to the affected person requesting the hearing and, if the applicant did not request the hearing, the applicant as well.

(4) If a hearing to reconsider a decision is requested, any affected person, other than the requestor of the hearing, who wishes to participate in the hearing must, at least two weeks after the date the request for hearing is received, submit a written notice of intent to participate to the department along with a check for $500, unless the affected person is an applicant whose proposal was approved and is the subject of the hearing, in which case only the notice of intent must be received by the department.

(5) The fees required by (1) and (4) above must be paid by check made out to the department of public health and human services.

(6) Counsel for the department and the health planning staff may participate in the hearing to provide testimony and exhibits, and to cross-examine witnesses, but are not considered parties for the purposes of 2-4-613 , MCA.

(7) A copy of any pre-hearing motion filed by an affected person must be served by mail upon the department and any other affected person participating in the hearing.

(8) The department's hearing officer may require the direct testimony of the witnesses of each affected person participating in the hearing to be in writing and filed prior to hearing with the department, with copies served upon the department and every other participating affected person.

(9) At the reconsideration hearing, the parties or their counsel will be given the opportunity to present written or oral evidence or statements concerning the department's action and the grounds upon which it was based.

(10) The department shall send the written findings of fact and conclusions of law that state the basis for its decision to all parties participating in the hearing. Any other person upon request may receive a copy for cost.

(11) The decision of the department following the reconsideration hearing shall be considered the department's final decision for the purpose of appealing the decision to district court.

(12) The hearing, any discovery, and other related matters are subject to the Montana Administrative Procedure Act, Title 2, chapter 4, part 6, MCA, and ARM 1.3.215 through 1.3.225 and ARM 1.3.230 through 1.3.233.

(13) The department hereby adopts and incorporates by reference ARM 1.3.215 through 1.3.225 and ARM 1.3.230 through 1.3.233, which contain attorney general's model rules for contested cases, implementing the Montana Administrative Procedure Act. Copies of the rules may be obtained from the Department of Public Health and Human Services, Office of Legal Affairs, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951, phone: (406)444-9503.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-306, MCA
Implementing statute(s): Sec. 50-5-306 and 50-5-310, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.120 Duration of Certificate: Termination; Extension

(1) The department may, after notice and opportunity for a hearing, suspend or revoke a certificate of need upon a finding that the holder of the certificate is in violation of the certificate of need law, this chapter, or the terms of the certificate of need. The notice and hearing provisions of the Montana Administrative Procedure Act (Title 2, chapter 4, part 6, MCA) will apply.

(2)

(a) A holder of a certificate of need may submit to the department a written request for a 6-month extension of his certificate of need, for good cause. The request must set forth the reasons constituting good cause for the extension and must be received by the department by 5:00 p.m. on the expiration date if it is to be considered.

(b) Within 20 days after receipt of the request, the department must issue its written decision granting or denying the extension. The decision must be sent to the applicant by certified mail, and distributed at cost to others who request it.

(i) presents significant relevant information not previously considered by the department; or

(ii) demonstrates that there have been significant changes in factors or circumstances relied upon by the department in reaching its decision.

(d) "Good cause" for the purpose of (2) (a) includes, but is not limited to, emergency situations which prevent the recipient of the certificate of need from obtaining necessary financing, commencing construction, or implementing a new service.

(3) A certificate of need, once granted to an applicant, may not be transferred to another person. In addition to a transfer from one person to another, such a transfer will be considered to have taken place if the applicant to which the certificate was granted is an organization and there is a change of ownership of 50% or more of that organization.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-302 and 50-5-305, MCA
Implementing statute(s): Sec. 50-5-302 and 50-5-305, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1983 MAR p. 732, Eff. 7/1/83; AMD, 1985 MAR p. 602, Eff. 5/31/85; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.121 Increase in Certified Cost

(1) The recipient of a certificate of need shall report to the department any increase in the cost of an approved project in excess of $150,000 or 15% of the approved budget for the project, whichever is greater. Any cost increase that exceeds the foregoing threshold must be approved by the department.

History

Authorizing statute(s): Sec. 50-5-302, MCA
Implementing statute(s): Sec. 50-5-106 and 50-5-301, MCA
History: NEW, 1979 MAR p. 1670, Eff. 12/28/79; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.126 Swing-Beds: Review Criteria

(1) A certificate of need may be issued to a hospital, medical assistance facility, or critical access hospital to establish swing-beds only if, in addition to compliance with all other applicable provisions of 50-5-304, MCA, and ARM 37.106.113:

(a) existing licensed long-term care facilities in the service area, which provide the level of care proposed to be provided by the hospital or medical assistance facility, have an aggregate average occupancy level of at least 95% during the three years prior to the date of the application for certificate of need; and

(b) no more than 50% of the excess bed capacity of the hospital, medical assistance facility, or critical access hospital will be approved as swing-beds. Excess bed capacity is the difference between the number of licensed beds in the facility and the average acute care occupancy level of the facility over the three years prior to the date of the application for certificate of need.

(2) The utilization of swing-beds by a medical assistance facility or critical access hospital is subject to certificate of need review only if, as required by 50-5-301(1)(b), MCA, the facility did not offer long-term care during the 12 months prior to the month the service is scheduled to commence and the service will add annual operating and amortization expenses of $150,000 or more.

History

Authorizing statute(s): 50-5-304, MCA
Implementing statute(s): 50-5-304, MCA
History: NEW, 1986 MAR p. 38, Eff. 1/17/86; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.133 Certificate of Need Application: Introduction and Cover Letter

(1) It is suggested that the applicant contact the health planning program before completing and submitting the necessary information. If an early contact is made, the applicant will be made aware of what will be required in specific cases before a formal application is completed and submitted.

(2) The applicant must send a cover letter, containing the information included in the original letter of intent with any pertinent revisions, to the Department of Public Health and Human Services, Office of Inspector General, Certificate of Need Program, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953. The cover letter must accompany the original and each of the two copies of the information required by ARM 37.106.134.

History

Authorizing statute(s): 2-4-201, 50-5-302, MCA
Implementing statute(s): 50-5-302, MCA
History: NEW, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.134 Certificate of Need Application: Required Information

The following must be included in a certificate of need application:

(1) An explanation of the need for the facility or service, including the following information:

(a) the geographic area the proposed project will serve and the criteria being used for determining this service area;

(b) the current population of that service area (identify the source of information) ;

(d) the percent of the population in that service area expected to be served;

(e) in terms of age, ethnic background and economic status, a description of the specific population which will be served by the proposed new institution or service. The applicant shall indicate the number of people matching this description in the service area (general public should be indicated if the facility is for non-specific population) ;

(f) an explanation of current and projected future trends in health care which might affect facility usage which were given consideration in the development of this project (identify source of information) ;

(g) a patient origin study for the last three years of operation;

(h) why the service or institution is needed in the identified service area;

(i) the purposes and goals of the project;

(j) whether there is a waiting list of persons desiring the proposed services. If so, a copy of the list must be provided.

(2) A description of the project's accessibility to the public. In particular, the following information must be included:

(a) the location of the proposed long-term care facility;

(b) the manner in which the architectural plan promotes access for the physically handicapped;

(c) other health care institutions which serve this area or portions thereof and provide similar services to those proposed in this application;

(d) if there are no similar services in the area, the nearest facility or facilities providing these services must be identified.

(3) A discussion of planning and environmental considerations, including the following information:

(a) an explanation of how the proposed service or facility is compatible with the current state long-term care facilities plan (a copy of which may be obtained from the Department of Public Health and Human Services, Office of Inspector General, Certificate of Need Program, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953). If it is not compatible, an explanation of why it should be approved must be included;

(b) whether a short, long-range, master plan or capital expenditure plan is available for the facility. If so, a copy must be provided. The applicant shall also provide applicable city, county or regional land use, zoning, transportation, utilities or parking plans;

(c) a description of existing or proposed working relationships or joint planning efforts with other providers or services in the community or service area. If there are no such efforts, an explanation must be provided;

(d) whether the affected consumer/provider and related groups in the service area have indicated support for the proposal (agencies, groups, and their reactions must be listed) ;

(e) a discussion of environmental considerations, including architectural compatibility, waste disposal, traffic impacts, economic and social impacts on the area, etc.

(4) A discussion of the organizational aspects of the project, including the following information:

(a) the type of organization or entity responsible for the day-to-day operation of the facility (e.g., state, county, city, federal, hospital district, church related, nonprofit corporation, individual, partnership, business corporation) ;

(b) whether the controlling organization leases the physical plant from another organization. If so, the name and type of organization that owns the plant;

(d) the name and title of the chief administrator of the applicant's facility, and whether employed by the applicant or another organization as identified in (e) below;

(e) if the controlling organization has placed responsibility for the administration of the facility with another organization, the name and type of organization that manages the facility;

(f) if the facility is operated as a part of a multi-facility system (e.g., medical center, chain of hospitals owned by a religious order, etc.) the name and address of the parent organization;

(g) whether the applicant's facility has received or intends to apply for state licensure or federal certification.

(5) A discussion of the program staffing and operational capabilities of the project, including the following information:

(a) an itemized list of full-time-equivalent staff positions (current and after completion of project) , and estimated number of personnel available, including:

(i) administration;

(ii) physician services;

(iii) nursing services;

(iv) social services;

(v) other professional/technical;

(vi) all other (specify) ;

(b) if the applicant operates an existing facility, whether it meets current staffing standards.

(6) A discussion of the physical structure and services to be provided, including the following information:

(a) a narrative description of the project, including:

(i) size, type construction, floor space to be added or renovated, beds, square feet per bed, parking, etc.;

(ii) description of both old and new facilities where applicable;

(iii) time frame(s) for construction;

(iv) a line drawing of proposal;

(b) a discussion of legal considerations, including:

(i) whether the project will correct non-conforming conditions;

(ii) whether the project is in conformance with current local zoning laws (city or county) ;

(iii) whether the structures meet current safety and building codes;

(c) a listing of current licensed beds, certified medicare or medicaid beds, and beds to be added in each of the basic service categories;

(d) for home health agencies, the current and proposed number of patient visits and consultations, and the reporting period;

(e) in order to show utilization levels, indication of each of the following for the applicant's facility, if already in existence, and for every other facility of the same kind within the same service area, for each of the past full three years and the current year, as well as utilization projections for each of the foregoing facilities for one, two, and three years:

(i) average daily census;

(ii) percent occupancy;

(iii) average length of stay;

(iv) total discharges;

(v) outpatient visits;

(vi) home care visits;

(vii) surgical procedures, inpatient and outpatient.

(f) If the applicant's facility is not yet in existence, the applicant must submit all of the above for any other parallel facility in the same service area, along with projections for (i) through (vii) above for the first, second, and third years of operation of the proposed facility.

(7) A discussion of capital expenditure requirements, including the following information:

(a) the approximate date that obligation of funds will be incurred for the proposal;

(b)

(i) the source of funds (specify cash on hand, commercial or government loans, grants, net earnings and reserve, bequests and endorsements, charitable fund raising, revenue bonds, other) ;

(ii) amount available;

(iii) amount to be borrowed;

(d) copies of the complete financial operating statements for the last three years and, if available, audited statements;

(e) copies of the following:

(i) projected revenue and expense statements with supportive population and utilization assumptions both during construction and the first two years of operation;

(ii) utilization projections demonstrating need for the project.

(8) Estimated project costs for each of the following:

(a) consultant, legal, architect, engineering, and construction supervision;

(b) financing fees;

(d) interest, principle to be borrowed, reserves related to public bond issue;

(e) land acquisition, site development, and construction.

(9)

(a) Effect of project on costs and charges for room rates or specific services;

(b) discussion of operating fund demands and budget factors, including the following:

(i) the sources of operating revenue in percentages (specify medicare, medicaid, private pay, or insurance) ;

(ii) if grant support is provided for the project, how the service will be financed upon termination of this support;

(iii) whether depreciation will be funded;

(iv) explanation of plans for meeting possible operating deficits;

(c) effect the proposed capital expenditure will have on annual operating costs. Whether the operating costs will be increased or decreased and by how much;

(10) A discussion of cost containment factors, including the following information:

(a) how the proposal demonstrates superior community cost-benefit or community cost-effectiveness;

(b) description of shared services which are available as an alternative to duplication (explain in detail);

(11) A discussion specifically addressing the review criteria listed in 50-5-304, MCA and ARM 37.106.113.

(12) The signature of a responsible representative of the applicant, the title of the signatory, and the date of signing.

History

Authorizing statute(s): 2-4-201, 50-5-302, MCA
Implementing statute(s): 50-5-302, MCA
History: NEW, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.137 Annual Operational Reports by Hospitals and Critical Access Hospitals

(1) Every hospital and critical access hospital shall submit an annual report to the department on a form provided by the department by the deadline specified on the form. The annual reports must be signed by the hospital administrator and must include whichever of the following information is requested on the form:

(a) whether the hospital has received accreditation, and if so, for what period;

(b) beginning and ending dates of the hospital's reporting period, and whether the facility has been in operation for 12 full months at the end of the most recent reporting period;

(i) the type of organization or entity responsible for the day-to-day operation of the hospital (e.g., state, county, city, federal, hospital district, church related, nonprofit corporation, individual, partnership, business corporation);

(ii) whether the controlling organization leases the physical plant from another organization, and if so, the name and type of organization that owns the plant;

(iii) any changes in the ownership, board of directors or articles of incorporation during the past year;

(iv) the name of the current chairman of the board of directors;

(v) if the controlling organization has placed responsibility for the administration of the hospital with another organization, the name and type of organization that manages the facility. A copy of the latest management agreement must be provided;

(vi) if the hospital is operated as a part of a multi-facility system (e.g., medical center, chain of hospitals owned by a religious order, etc.) the name and address of the parent organization;

(d) whether the hospital provides primarily general medical/surgical services, or specialty services (specify);

(e) specific facilities and services provided by the hospital, bed capacities for each service (where applicable), and whether such services are provided full or part-time, by hospital personnel, or by contracting providers;

(f) newborn nursery statistics, including:

(i) number of bassinets set up and staffed;

(ii) total number of births;

(iii) total newborn days;

(iv) neonatal intensive care admissions and inpatient days;

(g) surgery statistics, including:

(i) number of inpatient and outpatient surgery suites;

(ii) number of inpatient and outpatient operations performed;

(iii) number of adult and pediatric open-heart surgical operations performed;

(iv) total adult and pediatric cardiac catheterization and intracardiac and/or coronary artery procedures;

(h) number of beds set up and staffed and total inpatient days (excluding newborns) in each basic inpatient service category;

(i) inpatient statistics, including:

(i) number of licensed hospital beds (excluding bassinets and long-term care beds);

(ii) number of admissions (excluding newborns);

(iii) number of discharges (including deaths);

(iv) number of deaths (excluding fetal deaths);

(v) census on last day of reporting period (excluding newborns);

(j) information on other services, including number of rooms or units, number of inpatient and outpatient procedures, and number of outpatient visits in at least the following areas:

(i) emergency room;

(ii) organized outpatient department;

(iii) x-ray, ultrasound, nuclear medicine, cobalt therapy, CT scans;

(iv) physical therapy;

(v) respiratory therapy;

(vi) renal dialysis;

(vii) other ancillary services;

(k) information on changes in total number of beds during the reporting period;

(l) whether there is a separate long-term care unit, and if so, how many beds;

(m) patient origin data, including every town of origin and number of discharges;

(n) total medicare and medicaid admissions and inpatient days;

(o) size of medical and non-medical staff, including number of active and consulting physicians, medical residents and trainees, registered and licensed professional or vocational nurses, and all other personnel;

(p) name of person to contact in the event the department has questions concerning the information provided in the annual report.

(2) Any facility failing to timely report such information to the department may be subject to corrective action.

History

Authorizing statute(s): 2-4-201, 50-5-103, 50-5-302, MCA
Implementing statute(s): 50-5-106, 50-5-302, MCA
History: NEW, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.138 Annual Financial Reports by Hospitals, Rural Emergency Hospitals, and Critical Access Hospitals

(1) Every hospital, rural emergency hospital, and critical access hospital shall submit on an annual basis a financial report for its previous fiscal year to the department on a form provided by the department by the deadline specified on the form. The annual financial report must include contact information for the hospital administrator and must include the beginning and end date of the facility's reporting period and whichever of the following information is requested on the form:

(a) hospital revenues for both acute and long-term care units, including:

(i) gross revenue from inpatient and outpatient service;

(ii) deductions for contractual adjustments, bad debts, charity, etc.;

(iii) other operating revenue;

(iv) nonoperating revenue (such as government appropriations, mill levies, contributions, grants, etc.);

(b) hospital expenses for both acute and long-term care units, including:

(i) payroll expenses for all categories of personnel;

(ii) nonpayroll expenses, including employee benefits, professional fees, depreciation expense, interest expense, others;

(i) bad debts;

(ii) contractual adjustments (specifying Medicare, Medicaid, Blue Cross, or other);

(iii) charity/Hill-Burton (such as the amount and category of charity care/financial assistance provided, the number of individuals receiving financial assistance and average amount per person, which services are provided at no or reduced cost);

(iv) other;

(d) medicaid and medicare program revenue for both acute and long-term care units;

(e) unrestricted fund assets, including dollar amounts of:

(i) current cash and short-term investments;

(ii) current receivables and other current assets;

(iii) gross plant and equipment assets; deductions for accumulated depreciation;

(iv) long-term investments;

(v) other;

(f) unrestricted fund liabilities, including dollar amounts of:

(i) current liabilities;

(ii) long-term debts;

(iii) other liabilities;

(iv) unrestricted fund balance;

(g) restricted fund balances, with identification of specific purposes for which funds are reserved, including plant replacement and expansion, and endowment funds;

(h) capital expenditures made during the reporting period, including expenditures, disposals and retirements for land, building and improvements, fixed and moveable equipment, and construction in progress;

(i) whether a permanent change in bed complement or in the number of hospital services offered will result from any capital acquisition projects begun during the reporting period (specify);

(j) whether a certificate of need was received for any projects during the reporting period, and if so, the total capital authorization included in such approvals.

(2) For a hospital, rural emergency hospital, or critical access hospital operating as a nonprofit health care facility, the following are required, consistent with ARM 37.106.204:

(a) a community benefit plan for the current calendar year;

(b) a financial assistance policy for the current calendar year; and

(3) Any facility failing to timely report such information to the department may be subject to corrective action.

(a) Any hospital, rural emergency hospital, or critical access hospital operating as a nonprofit health care facility shall be penalized according to ARM 37.106.205 for noncompliance with (2) of this rule.

History

Authorizing statute(s): 2-4-201, 50-5-103, 50-5-302, MCA
Implementing statute(s): 50-5-106, 50-5-302, MCA
History: NEW, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22; AMD, 2024 MAR p. 2292, Eff. 9/21/24.

Mont. Admin. R. 37.106.139 Annual Reports by Long-Term Care Facilities

(1) Every long-term care facility shall submit an annual report to the department on a form provided by the department by the deadline specified on the form. The annual report must be signed by the facility administrator and must include whichever of the following information is requested on the form:

(a) the facility's reporting period, and whether the facility was in operation for a full 12 months at the end of the reporting period;

(b) a discussion of the organizational aspects of the facility, including the following information:

(i) the type of organization or entity responsible for the day-to-day operation of the facility (e.g., state, county, city, federal, hospital district, church related, nonprofit corporation, individual, partnership, business corporation);

(ii) whether the controlling organization leases the physical plant from another organization. If so, the name and type of organization that owns the plant;

(iii) any changes in the ownership, board of directors or articles of incorporation of the facility during the past year;

(iv) the name of the current chairman of the board of directors of the facility;

(v) if the controlling organization has placed responsibility for the administration of the facility with another organization, the name and type of organization that manages the facility. A copy of the latest management agreement must be provided;

(vi) if the facility is operated as a part of a multi-facility system (e.g., medical center, chain of hospitals owned by a religious order, etc.) the name and address of the parent organization;

(i) licensed bed capacity (skilled and intermediate);

(ii) whether the facility is certified for medicare or medicaid;

(iii) number of beds currently set up and staffed;

(iv) total patient census on first day of reporting period; total admissions, discharges, patient deaths, and patient-days of service during the reporting period;

(v) patient census on last day of reporting period, broken down by sex and age categories;

(d) financial data, including:

(i) total annual operating expenses (payroll and non- payroll);

(ii) closing date of financial statement;

(iii) sources of operating revenue, indicating percent received from medicare, medicaid, private pay, insurance, grants, contributions, and other;

(e) staff information, including number and classification of full and part-time medical personnel, as required on the survey form;

(f) patient origin data, including patients' counties of residence, and number of admissions from state institutions and from out-of-state;

(g) name of person to contact should the department have any questions regarding the information on the report.

(2) Any facility failing to timely report such information to the department may be subject to corrective action.

History

Authorizing statute(s): 2-4-201, 50-5-103, 50-5-302, MCA
Implementing statute(s): 50-5-106, 50-5-302, MCA
History: NEW, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1987 MAR p. 1074, Eff. 7/17/87; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22.

Mont. Admin. R. 37.106.140 Annual Reports by Home Health Agencies

(1) Every home health agency shall submit an annual report to the department on a form provided by the department and no later than the deadline specified on the form. The report must be signed by the administrator of the agency and must include whichever of the following information is requested on the form:

(a) whether the agency has medicare certification, and if so, the term of such certification;

(b) the agency's reporting period, and whether the agency was in operation for a full 12 months at the end of the reporting period;

(i) the type of organization or entity responsible for the day-to-day operation of the agency (e.g., state, county, city, federal, hospital district, church related, nonprofit corporation, individual, partnership, business corporation) ;

(ii) whether the home health agency is owned by the same organization that controls it. If not, the name and type of organization that owns the agency;

(iii) any changes in the ownership, board of directors or articles of incorporation of the agency during the past year;

(iv) the name of the current chairman of the board of directors of the agency;

(v) if the controlling organization has placed responsibility for the administration of the agency with another organization, the name and type of organization that manages the facility. A copy of the latest management agreement must be provided;

(vi) if the agency is operated as a part of a multi-facility system (e.g., medical center, chain of hospitals owned by a religious order, etc.) the name and address of the parent organization;

(d) a listing of specific services provided by the agency, and the number of people served and number of visits made for each service;

(e) a description of the geographic area served by the agency;

(f) the number of persons served by the agency and the number of new cases acquired by the agency during the reporting period;

(g) financial data, including:

(i) payroll and non-payroll expenses;

(ii) closing date of financial statement;

(iii) sources of operating revenue, indicating percentage received from medicare, medicaid, private pay, insurance, grants, contributions, other;

(h) staff information, including number of full, part-time and contracted registered and licensed professional nurses, home health aids, student nurses, and others;

(i) the name of the person to contact should the department have questions regarding the information on the report.

History

Authorizing statute(s): Sec. 2-4-201, 50-5-103 and 50-5-302, MCA
Implementing statute(s): Sec. 50-5-106 and 50-5-302, MCA
History: NEW, 1984 MAR p. 27, Eff. 1/13/84; AMD, 1996 MAR p. 1975, Eff. 7/19/96; TRANS, from DHES, 2002 MAR p. 185.

Subchapter 37.106.2 Community Benefit and Financial Assistance Standards for Nonprofit Hospitals, Critical Access Hospitals, and Rural Emergency Hospitals

Mont. Admin. R. 37.106.201 Purpose of Community Benefits and Financial Assistance Rules

(1) Each hospital, critical access hospital, or rural emergency hospital that operates as a nonprofit health care facility under section 501(c)(3) of the Internal Revenue Code, 26 U.S.C. § 501(c)(3) (referred to in these rules as a nonprofit hospital, critical access hospital, or rural emergency hospital) is expected to provide community benefits and financial assistance by virtue of its nonprofit and tax exempt status.

(2) It is the purpose of this subchapter to clarify and set forth the duties and responsibilities of nonprofit hospitals, critical access hospitals, and rural emergency hospitals with respect to the provision of community benefits and financial assistance in the areas they serve.

(3) Community benefits do not include the cost to the hospital of paying any taxes or governmental assessments.

(4) Financial assistance and other community benefits are reported at cost, not charges, in reports and other documents submitted under this subchapter.

History

Authorizing statute(s): 50-5-106, 50-5-121, MCA
Implementing statute(s): 50-5-106, 50-5-121, MCA
History: NEW, 2024 MAR p. 2292, Eff. 9/21/24.

Mont. Admin. R. 37.106.202 Definitions

For the purposes of this subchapter, the following definitions apply:

(1) "Community benefit" means initiatives and activities undertaken by a nonprofit hospital, critical access hospital, or rural emergency hospital to improve health in the communities it serves. These initiatives and activities should not be of the kind considered to be normal for the day-to-day operation of the hospital or as having benefits to the hospital not in line with recommended patient or population health improvement. Community benefits may include providing free or discounted care to uninsured and low-income patients (i.e., financial assistance), activities to promote and improve population health, prevention activities, programs to support children and families, programs to increase access to care, medical research likely to directly benefit the community in which the nonprofit hospital, critical access hospital, or rural emergency hospital is located, education and training for health care professionals, workforce development, and other activities and contributions associated with the initiatives being undertaken to benefit the community in which the nonprofit hospital, critical access hospital, or rural emergency hospital is located and reported on the annual IRS Form 990 Schedule H.

(2) "Community benefit plan" means the detailed outline of specific initiatives, activities, actions, and/or steps planned to be taken by a nonprofit hospital, critical access hospital, or rural emergency hospital to improve the health of the community(ies) it serves. This plan may include community benefit information contained in the facility's community health needs assessment implementation plan.

(3) "Community benefit policy" is the written policy (i.e., set of principles, guidelines, or rules) that directs how decisions of the nonprofit hospital, critical access hospital, or rural emergency hospital on specific actions to improve the health of the community it serves will be made or carried out.

(4) "Financial assistance" means direct financial assistance to patients. It is commonly understood as the unrecovered costs written off by a provider that results from providing care to individuals who are uninsured or who are otherwise unable to pay for the health care services they receive. Financial assistance was formerly known as charity care.

(5) "Net patient revenue (NPR)" means the aggregate money generated from patient services collected from payors, including private insurance, Medicaid, and Medicare. The calculation for NPR is the total patient revenues minus patient discounts.

History

Authorizing statute(s): 50-5-106, 50-5-121, MCA
Implementing statute(s): 50-5-106, 50-5-121, MCA
History: NEW, 2024 MAR p. 2292, Eff. 9/21/24.

Mont. Admin. R. 37.106.203 Community benefit and financial assistance requirements

(1) The duty of nonprofit hospitals, critical access hospitals, and rural emergency hospitals to provide community benefits and financial assistance is established in 50-5-121, MCA. To satisfy the requirements, a nonprofit hospital, critical access hospital, or rural emergency hospital shall comply with the standards and requirements set forth in this subchapter.

(2) Each nonprofit hospital, critical access hospital, or rural emergency hospital shall:

(a) have in writing a community benefits plan, a community benefits policy; and a financial assistance policy;

(b) adhere to its written community benefit policy and financial assistance policy; and

(c) make its written community benefit and financial assistance policies available to the public, including posting the policies in a prominent location on its website.

(3) With respect to nonprofit hospitals:

(a) the community benefits policy must be consistent with federal standards and the standards established in this subchapter; and

(b) the financial assistance policy must be consistent with federal standards and the standards established in this subchapter, applicable to the area the nonprofit hospital serves.

(4) To establish community benefit and financial assistance standards, the department will do the following:

(a) The department will collect baseline data for a two-year period and utilize existing 2023 data to formulate standards after baseline data is validated/aggregated and a three-year average determined.

(b) The department shall consider the following factors when developing the standards:

(i) hospital size;

(ii) community size and location;

(iii) net patient revenue;

(iv) patient care expenses;

(v) payor mix.

(i) bad debt;

(ii) community health needs assessments; and

(iii) other factors to allow for a level which is reasonable in relation to community needs and the available resources of the hospital.

(d) The department shall consider whether to adopt numerical standards, narrative standards, or a combination of numerical and narrative standards, for community benefit and financial assistance.

(e) Under the standards, the community benefit requirement, including financial assistance, will be set at the beginning of the calendar year.

(5) A nonprofit hospital with operating losses in its fiscal year shall not be required to meet community benefit (including financial assistance) requirements established under the standards for that year.

History

Authorizing statute(s): 50-5-106, 50-5-121, MCA
Implementing statute(s): 50-5-106, 50-5-121, MCA
History: NEW, 2024 MAR p. 2292, Eff. 9/21/24.

Mont. Admin. R. 37.106.204 REPORTING requirements

(1) Each nonprofit hospital, rural emergency hospital, or critical access hospital shall submit to the department, with the annual hospital financial report required in ARM 37.106.138, the following documents within 30 days of its filing of the applicable forms with the Internal Revenue Service:

(a) a copy of Form 990 with Schedule H and associated worksheets. When no Schedule H is available, the methods used to determine community benefit and financial assistance spending and those amounts;

(b) a financial assistance policy and community benefit plan for the current calendar year.

(2) The report must include the following information:

(a) contact information for the hospital administrator and person filing the report should the department have any questions; and

(b) the beginning and end date of the reporting period for the nonprofit hospital, critical access hospital, or rural emergency hospital.

(3) The information and documentation required under (1) shall reflect inpatient and outpatient services, as well as any service provided by an urgent care or other facility operated by the nonprofit hospital, critical access hospital, or rural emergency hospital.

History

Authorizing statute(s): 50-5-106, 50-5-121, MCA
Implementing statute(s): 50-5-106, 50-5-121, MCA
History: NEW, 2024 MAR p. 2292, Eff. 9/21/24.

Mont. Admin. R. 37.106.205 ENFORCEMENT AND Penalties for noNCOMPLIANCE WITH community benefit and financial assistance requirements OR REPORTING requirements

(1) When the department establishes community benefit and financial assistance standards, it will also establish the applicable penalties for noncompliance with such standards in the adoption of community benefit and financial assistance policies or for failure to adhere to such policies by nonprofit hospitals.

(2) If a nonprofit critical access hospital or rural emergency hospital fails to adhere to its community benefit policy or financial assistance policy, the department shall provide technical assistance and may require corrective action.

(3) On proof of noncompliance with its reporting requirements, the department shall impose a fine of $1,000 and allow ten working days for the noncompliant nonprofit hospital, critical access hospital, or rural emergency hospital to take corrective action. If still not in compliance, a $5,000 fine will be assessed in the month following discovery of noncompliance and the first of each month still not in compliance.

History

Authorizing statute(s): 50-5-106, 50-5-121, MCA
Implementing statute(s): 50-5-106, 50-5-121, MCA
History: NEW, 2024 MAR p. 2292, Eff. 9/21/24.

Subchapter 37.106.3 Construction and Minimum Standards for All Health Care Facilities

Mont. Admin. R. 37.106.301 Definitions

(1) The following definitions apply in this subchapter:

(a) "Administrator" means the individual responsible for the day-to-day operation of a health care facility.

(b) "Communicable disease" means a disease that may be transmitted directly or indirectly from one individual to another.

(c) "Inpatient" means a person who has been admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services.

(d) "Medical record" means a written document which is complete, current, and contains sufficient information for planning a patient's, resident's, or client's care, reviewing and evaluating care rendered, evaluating a patient's, resident's, or client's condition, and for providing a means of communication among all persons providing care.

(e) "Observation bed or unit" means a bed or unit within a hospital, critical access hospital, or specialty hospital that includes ongoing short-term treatment, assessment, and reassessment, and is not considered an inpatient bed. Patient stays in observation beds are limited to 48 hours during which time a decision must be made whether a patient requires further treatment as an inpatient.

(f) "Outpatient" means a person receiving health care services and treatment at a facility for a period of less than 24 hours without being admitted as an inpatient to the facility.

(g) "Secured care unit" means a licensed facility or unit of a facility that provides care in an environment where the doors are secured by delayed egress locks 24 hours a day.

(2) For purposes of ARM 37.106.310 and 37.106.330, the following terms shall have the meaning assigned to them in 50-4-1101, MCA:

(a) "Conscience";

(b) "Discriminate" or "Discrimination";

(d) "Medical practitioner";

(e) "Participate in a health care service";

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-4-1101, 50-5-101, 50-5-103, 50-5-104, 50-5-105, 50-5-106, 50-5-107, 50-5-108, 50-5-201, 50-5-202, 50-5-203, 50-5-204, 50-5-207, 50-5-208, 50-5-210, 50-5-211, 50-5-212, 50-5-225, 50-5-226, 50-5-227, 50-5-228, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1984 MAR p. 973, Eff. 6/29/84; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13; AMD, 2022 MAR p. 1876, Eff. 9/24/22; AMD, 2024 MAR p. 2286, Eff. 9/21/24.

Mont. Admin. R. 37.106.302 Minimum Standards of Construction: General Requirements

(1) The provisions of this subchapter apply to all health care facilities licensed or to be licensed by the department. To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of facility-specific rules, the specific facility rules will apply.

(2) The construction of, alteration, or addition to a health care facility shall comply with:

(a) the 2018 edition of the "American Institute for Architects (AIA) Guidelines for Design and Construction of Hospitals and Health Care Facilities," which the department adopts and incorporates by reference, which sets forth the minimum construction equipment requirements deemed necessary by the state Department of Public Health and Human Services to ensure health care facilities can be efficiently maintained and operated to furnish adequate care. Copies of the cited edition are available at the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT, 59620-2953;

(b) "NFPA 101: Life Safety Code Handbook," 2012 edition published by the National Fire Protection Association, which the department adopts and incorporates by reference, which sets forth construction and operation requirements designed to protect against fire hazards. Copies of the cited edition are available at the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT, 59620-2953;

(c) the 2009 "American National Standards Institute A117.1," which the department adopts and incorporates by reference, which sets forth standards for buildings and facilities providing accessibility and usability for physically handicapped individuals. Copies of the cited edition are available at the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT, 59620-2953;

(d) the water supply system requirements of ARM 37.111.115; and

(e) the sewage system requirements of ARM 37.111.116.

(3) A patient or resident may not be admitted, housed, treated, or cared for in an addition or altered area until inspected and approved, or in new construction until licensed.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-204, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1984 MAR p. 929, Eff. 6/15/84; AMD, 1984 MAR p. 1090, Eff. 7/27/84; AMD, 1993 MAR p. 1658, Eff. 7/30/93; AMD, 1995 MAR p. 283, Eff. 2/24/95; AMD, 1997 MAR p. 1993, Eff. 11/4/97; AMD, 2001 MAR p. 1105, Eff. 6/21/01; TRANS & AMD, 2002 MAR p. 192, Eff. 2/1/02; AMD, 2003 MAR p. 1321, Eff. 7/1/03; AMD, 2013 MAR p. 2146, Eff. 11/15/13; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.306 Submission of Plans and Specifications: Health Care Facility New Construction, Alteration or Addition

(1) Prior to beginning construction of a new health care facility or before construction of an addition or alteration to a health care facility, the following plans and specifications must be submitted to the department for approval:

(a) schematic plans which include but are not limited to:

(i) single line drawings of each floor;

(ii) the name of each room and the relationship of the various departments or services to each other and the room arrangement in each department must be noted;

(iii) total floor area and number of beds must be noted on the plans;

(iv) the proposed roads and walks, service and entrance courts, and parking must be shown on the site plan; and

(v) if requested by the department, submission of a narrative regarding a specific schematic function to clarify and provide additional information.

(b) the plans must be complete and adequate for bid, contract, and construction purposes, and include but are not limited to a complete set of the following:

(i) civil;

(ii) landscape;

(iii) architectural;

(iv) structural;

(v) mechanical;

(vi) plumbing;

(vii) electrical; and

(viii) special systems which include, but are not limited to, nurse call systems, fire alarms systems, and secured units.

(c) specifications supplementing the working drawings to fully describe types, sizes, capacities, workmanship, finishes, and other characteristics of all materials and equipment.

(2) All submitted plans and specifications must be stamped by an engineer or architect licensed to practice in Montana.

(3) The department's approval of an alteration or addition to a health care facility shall terminate one year after issuance or upon completion and acceptance of the project.

(a) A six-month extension is permitted upon request. The request must verify that plans are still the same and no changes have been made to the specifications.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-204, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13

Mont. Admin. R. 37.106.310 Licensing: Procedure for Obtaining a License: Issuance and Renewal of a License

(1) A completed license application form must be submitted to the department.

(a) The application must be obtained from the department.

(b) The administrator or designee of the health care facility must sign the completed license application form.

(2) On receipt of a new or renewal license application, the department or its authorized agent will inspect the health care facility to determine if the facility meets the minimum regulatory standards set forth in this subchapter and other rules specific to the facility type as applicable.

(3) If minimum regulatory standards are met and the proposed staff is qualified, the department may issue a license for periods of up to three years.

(a) A three-year license may be offered to any facility:

(i) that has received a deficiency-free survey;

(ii) that has been granted accreditation by an accreditation entity approved by the U.S. Centers for Medicare & Medicaid Services; or

(iii) that has received a survey from another recognized department entity and the results of that survey determine that the facility meets the minimum requirements for issuance of a license.

(b) The facility must submit or make available to the department the full accreditation entity or department inspection report.

(i) that has received minor deficiencies, but those deficiencies do not significantly affect or threaten the health, safety, and welfare of any facility patient or resident.

(d) A one-year license may be offered to any facility:

(i) that has been in operation for less than one year;

(ii) upon a change in ownership; or

(iii) that has received deficiencies within the preceding 12 months that threaten the health, safety, and welfare of residents or staff.

(4) Licensed premises must be open to inspection by the department or its authorized agent and access to all records must be granted to the department at all reasonable times.

(5) The department will not:

(a) require a health care facility to participate in a health care service that violates that facility's conscience;

(b) require that the facilities of a health care facility be made available for uses or purposes, including abortion, contrary to the facility's conscience, religious beliefs, or moral tenets or that of its staff or governing body;

(c) discriminate or take an action that constitutes discrimination (including an adverse licensure or other action) against a health care facility as a result of that facility's exercise of conscience;

(d) deny any health care facility any privileges or immunities, or deny it any public benefits as a result of its exercise of conscience; and/or

(e) discriminate against a health care facility that exercises whistleblower rights with respect to suspected violations of conscience rights or that testifies, assists ,or participates, or intends to testify, assist, or participate, in a proceeding.

(6) For purposes of (5), a health care facility may establish a claim of conscience by reference to its governing documents as identified in 50-4-1101, MCA.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-4-1102, 50-4-1104, 50-5-103, 50-5-202, 50-5-203, 50-5-204, 50-20-111, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13; AMD, 2024 MAR p. 334, Eff. 2/24/24; AMD, 2024 MAR p. 2286, Eff. 9/21/24.

Mont. Admin. R. 37.106.311 Minimum Standards for All Health Care Facilities: Food Service Establishments

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, 50-5-404, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; REP, 2013 MAR p. 2146, Eff. 11/15/13

Mont. Admin. R. 37.106.312 Minimum Standards for All Health Care Facilities: Blood Bank and Transfusion Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

*Authorizing statute(s): *
Implementing statute(s): 50-5-103 and 50-5-404, MCA
History: IMP, Sec. 50-5-103, 50-5-204 and 50-5-404, MCA; NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1984 MAR p. 973, Eff. 6/29/84; TRANS, from DHES, 2002 MAR p. 185; REP, 2005 MAR p. 268, Eff. 2/11/05.

Mont. Admin. R. 37.106.313 Minimum Standards for All Health Care Facilities: Communicable Disease Control

(1) All health care facilities shall develop and implement an infection prevention and control program. At a minimum, the facility must develop, implement, and review, at least annually, written policies and procedures regarding infection prevention and control which must include but are not limited to:

(a) procedures to identify high risk individuals; and

(b) the identification of methods used to protect, contain, or minimize the risk to patients, residents, staff, and visitors.

(2) The administrator or infection control officer will be responsible for the direction, provision, and quality of infection prevention and control services.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; AMD, 2004 MAR p. 582, Eff. 3/12/04; AMD, 2013 MAR p. 2146, Eff. 11/15/13

Mont. Admin. R. 37.106.314 Minimum Standards for All Health Care Facilities: Medical Records

(1) A health care facility must initiate and maintain a safe, secure, and confidential medical record for each patient, resident, or client.

(2) A health care facility, excluding a hospital, shall retain a patient's, resident's, or client's medical records for no less than six years following the date of the patient's, resident's, or client's discharge or death, or upon the closure of the facility.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-106, 50-5-204, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1990 MAR p. 1259, Eff. 6/29/90; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13

Mont. Admin. R. 37.106.315 Minimum Standards for All Health Care Facilities: Employee Files

(1) The facility is responsible for maintaining a file on each employee and substitute personnel. Employee files may be inspected by the department at any time. If the file is not maintained at the facility it must be available to the department within 24 hours of request.

(2) At a minimum, the employee file must contain:

(a) the employee's name;

(b) a job description signed by the employee;

(d) a copy of current credentials, certification, or professional licenses required to perform the duties described in the job description.

(3) Volunteers may be utilized at a health care facility, but may not be included in the facility staffing plan in lieu of employees. All volunteers who are performing duties which are commonly performed by facility staff must have a file which is maintained at the facility and documents the following:

(a) orientation to the facility and its residents; and

(b) orientation to and training of the duties to be performed.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-106, 50-5-204, MCA
History: NEW, 2013 MAR p. 2146, Eff. 11/15/13

Mont. Admin. R. 37.106.316 Minimum Standards for All Health Care Facilities: Secured Care Unit Within a Licensed Long-Term Health Care Facility

(1) All rules in this subchapter apply to secured care units.

(2) Special locking arrangements as specified in the "NFPA 101: Life Safety Code Handbook", 2012 Edition must be utilized, or an acceptable alternative is based on an equivalency for the automatically releasing, panic hardware required by section 7.2.1.6.1 of the "NFPA 101: Life Safety Code Handbook", 2012 Edition. Where local authorities having jurisdiction allow, the following conditions apply to this alternative:

(a) All locks must be electromagnetic. The use of mechanical locks, such as a deadbolt is not permitted;

(b) All of the secured doors must have a manual electronic keypad release. The keypad must release the lock(s) on the door(s) after entry of the proper code sequence;

(d) Provisions must be made for the rapid removal of occupants by such reliable means as the remote control of the locks. Typically this is done by placing a staff-accessible switch at the nurse's station which is capable of releasing all doors; and

(e) All the locks on all secured doors must automatically release upon any of the following conditions:

(i) the actuation of the approved supervised automatic fire alarm system;

(ii) the actuation of an approved supervised automatic sprinkler system; and

(iii) upon the loss of power controlling the lock(s) or locking mechanism.

(3) A secured care unit is considered a separate nursing unit and must have a nurse station located within the secured care unit. At a minimum, the nurse station must provide the following:

(a) provisions for charting;

(b) provisions for hand washing;

(d) telephone access; and

(e) a nurse call system in compliance with table 2.1-4 as found in the 2018 Edition of the AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities.

(4) The nurse call system for the secured care unit must report to the secured care unit nurse station, but may also annunciate the call at another location, such as a main nurse station.

(5) Observation beds cannot be located in secured care units.

(6) Space within the secured care unit used for dining, activities, and day space must be provided at a ratio of 35 square feet per resident, with at least 20 square feet per resident dedicated to the dining space.

(7) No more than two secured care unit residents can reside in a single room.

(8) Each secured care unit resident must have access to a toilet without entering the corridor.

(a) Doors to bathrooms may be removed in private rooms.

(9) A secured care unit must provide for a nourishment station. The minimum standards for a nourishment station as indicated in section 2.5-2.2.6.7 of the 2018 Edition of the AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities include:

(a) a work counter;

(b) a refrigerator;

(d) space for trays and dishes used for nonscheduled meal service;

(e) an icemaker dispenser unit for patient ice consumption within or in close proximity to the secured care unit;

(f) a sink for preparing nourishments between meals; and

(g) hand washing facilities that are in or immediately accessible from the nourishment station.

(10) A secured care unit must provide secured care unit residents access to large group activities when provided for the general population, such as holiday activities and special events as determined appropriate.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2013 MAR p. 2146, Eff. 11/15/13; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.320 Minimum Standards for All Health Care Facilities: Physical Plant and Equipment Maintenance

(1) Each facility must have a written maintenance program describing the procedures to keep the building, grounds, and equipment in good repair and free from hazards.

(2) A health care facility must provide housekeeping services on a daily basis.

(3) All electrical, mechanical, plumbing, fire protection, heating, and sewage disposal systems must be kept in operational condition.

(4) Floors must be kept clean and in good repair at all times.

(5) Walls and ceilings must be kept in good repair and be of a finish that can be easily cleaned.

(6) Every facility must be kept clean and free of odors. Deodorants may not be used for odor control in lieu of proper ventilation.

(7) The temperature of hot water supplied to handwashing and bathing facilities must not exceed 120°F.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1984 MAR p. 973, Eff. 6/29/84; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13

Mont. Admin. R. 37.106.321 Minimum Standards for All Health Care Facilities: Environmental Control

(1) A health care facility must be constructed and maintained so as to prevent entrance and harborage of rats, mice, insects, flies, or other vermin.

(2) Hand cleansing soap or detergent and individual towels must be available at each lavatory in the facility. A waste receptacle must be located near each lavatory.

(3) Cleaners used to clean bathtubs, showers, lavatories, urinals, toilet bowls, toilet seats, and floors must contain fungicides or germicides with current EPA registration for that purpose.

(4) Cleaning devices used for lavatories, toilet bowls, showers, or bathtubs may not be used for other purposes. Those tools used to clean toilets or urinals must not be allowed to contact other cleaning devices.

(5) A minimum of 10 foot-candles of light must be available in all rooms and hallways, with the following exceptions:

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

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

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

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1984 MAR p. 973, Eff. 6/29/84; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13

Mont. Admin. R. 37.106.322 Minimum Standards for All Health Care Facilities: Disaster Plan

(1) All health care facilities must develop a written disaster plan as follows:

(a) skilled nursing facilities (long-term care), outpatient centers for primary care, outpatient centers for surgical services, critical access hospitals, hospitals, residential hospice facilities, inpatient hospice facilities, and infirmaries must develop a written disaster plan in conjunction with other emergency services in the community;

(b) these procedures must be developed such that they can be followed in the event of a natural or man-caused disaster.

(2) The health care facilities identified in (1) must conduct a review or physical exercise of such procedures at least once a year. After a review or exercise a health care facility shall prepare and retain on file for a minimum of three years a written report including but not limited to the following:

(a) date and time of the review or exercise;

(b) the names of staff involved in the review or exercise;

(d) the names of other persons involved in the review or exercise;

(e) a description of all phases of the procedure and suggestions for improvement; and

(f) the signature of the person conducting the review or exercise.

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

(a) plans for remaining at the facility during and subsequent to the disaster. Plans must include such elements as acquisition of additional blankets, water, food, etc.; and

(b) plans for resident evacuation and identification of at least one off-site evacuation point. A written agreement must be maintained in the facility record and updated annually.

(4) Fire drills must be conducted at all health care facilities.

(a) health care facilities that house patients or residents must conduct at least four fire drills annually, no closer than two months apart, with at least one drill occurring on each shift. Drill observations must be documented and maintained at the facility for at least two years. The documentation must include:

(i) location of the drill;

(ii) documentation that identifies participating staff;

(iii) problems identified during the drill;

(iv) steps taken to correct such problems; and

(v) signature of the individual responsible for the day-to-day operation of the health care facility.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13; AMD, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.330 Minimum Standards for All Health Care Facilities: Written Policy and Procedure

(1) A current written policy and procedure manual that describes all services provided in the health care facility must be developed, implemented, and maintained at the facility. The manual must be available to staff, residents, resident family members, resident legal representatives, and the department and must be complied with by all facility personnel and its agents. Policies and procedures must be reviewed at least every other year by either the administrator or the medical director with written documentation of the review.

(2) All health care facilities must develop policies and procedures that, consistent with 50-4-1103, 50-4-1105, and 50-20-111, MCA, require the facility to not discriminate against medical practitioners who exercise their conscience, or First Amendment free speech rights, or take certain whistleblower actions. These policies and procedures must include:

(a) a medical practitioner's right not to participate in health care services that violate the medical practitioner's conscience;

(b) how a medical practitioner can exercise the right to conscience;

(c) that the health care facility will not consider a medical practitioner's refusal to participate in a health care service on the basis of conscience with respect to staff privileges, as a basis for discrimination, other adverse action, and will not discriminate against a medical practitioner for exercise of conscience;

(d) that the health care facility will not discriminate against a medical practitioner who exercises whistleblower rights with respect to suspected violations of conscience rights or who testifies, assists ,or participates, or intends to testify, assist, or participate, in a proceeding;

(e) maintenance and management of information on the exercise of conscience as confidential information, disclosed only on a need to know basis; and

(f) training of all staff on the foregoing.

(3) All hospitals, critical access hospitals, rural emergency hospitals, abortion clinics, outpatient centers for primary care, and outpatient centers for surgical services must develop a policy that if the facility performs abortions, they do not require medical practitioners to participate in such procedures unless such practitioners have affirmatively opted in to participate in such services in writing.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-4-1103, 50-4-1105, 50-5-103, 50-20-111, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13; AMD, 2024 MAR p. 2286, Eff. 9/21/24.

Mont. Admin. R. 37.106.331 Minimum Standards for All Health Care Facilities: Laundry and Bedding

(1) If a health care facility processes its laundry on the facility site, it must:

(a) use rooms solely for laundry purposes;

(b) equip the laundry room with at least one mechanical washer and hot air tumble dryer, handwashing facilities, mechanical ventilation to the outside, a fresh air supply, and a hot water supply system which supplies the washer with water of at least 160 ° F (71 ° C) during each use. If the laundry water temperature is less than 160 ° F, chemicals and detergent suitable to the water temperature and the manufacturer's recommended product time of exposure must be utilized.

(d) provide well maintained carts or other containers impervious to moisture to transport laundry, keeping those used for soiled laundry separate from those used for clean laundry;

(e) dry all bed linen, towels, and washcloths in a manner that protects against contamination;

(f) protect clean laundry from contamination; and

(g) ensure that facility staff handling laundry cover their clothes while working with soiled laundry, use separate clean covering for their clothes while handling clean laundry, and wash their hands both after working with soiled laundry and before they handle clean laundry.

(2) If laundry is cleaned off-site, the health care facility must utilize a commercial laundry which satisfies the requirements stated in (1)(a) through (g).

(3) A health care facility with beds must:

(a) keep each resident bed dressed in clean bed linen in good condition;

(b) keep a supply of clean bed linen on hand sufficient to change beds often enough to keep them clean, dry, and free from odors;

(d) provide each resident bed with a moisture-proof mattress or a moisture-proof mattress cover and mattress pad; and

(e) provide each resident with enough blankets to maintain warmth while sleeping.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1984 MAR p. 973, Eff. 6/29/84; TRANS, from DHES, 2002 MAR p. 185; AMD, 2013 MAR p. 2146, Eff. 11/15/13

Subchapter 37.106.4 Minimum Standards for a Hospital

Mont. Admin. R. 37.106.401 Minimum Standards for a Hospital: General Requirements

(1) A hospital shall comply with the Conditions of Participation for Hospitals in 42 CFR subchapter G part 482.

(2) If a hospital provides skilled nursing care or intermediate nursing care, as those levels of care are defined in 50-5-101 , MCA, the hospital shall comply with the skilled nursing facility requirements listed in 42 CFR subchapter G part 483.

(3) The department adopts and incorporates by reference 42 CFR subchapter G part 482 and 42 CFR subchapter G part 483. 42 CFR subchapter G part 482 sets forth the conditions of participation a hospital must meet to participate in the Medicare program. 42 CFR subchapter G part 483 sets forth the skilled nursing facility requirements a hospital provider of long term care services must meet to participate in the Medicare program. A copy of the regulations may be obtained from the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-404, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1996 MAR p. 3216, Eff. 12/20/96; AMD, 1999 MAR p. 146, Eff. 1/15/99; TRANS, from DHES, 2002 MAR p. 185; AMD, 2003 MAR p. 1321, Eff. 7/1/03; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.402 Minimum Standards for a Hospital: Medical Records

Medical records shall comply with the following requirements:

(1) A patient's entire medical record must be maintained, in either its original form or that allowed by ARM 37.106.314(3) , for not less than 10 years following the date of a patient's discharge or death, or, in the case of a patient who is a minor, for not less than 10 years following the date the patient either attains the age of majority or dies, if earlier.

(2) An obstetrical record shall be developed for each maternity patient and must include the prenatal record, labor notes, obstetrical anesthesia notes and delivery record.

(3) A record must be developed for each newborn, and shall include, in addition to the information in (2) , the following information:

(a) observations of newborn after birth;

(b) delivery room care of newborn;

(d) temperature of newborn;

(e) weight of newborn;

(f) time of newborn's first urination;

(g) number, character and consistency of newborn's stool;

(h) type of feeding administered to newborn;

(i) phenylketonuria report for newborn;

(j) name of person to whom newborn is released.

(4) A patient's entire medical record may be abridged following the dates established in (1) to form a core medical record of the patient's medical record. The core medical record or the microfilmed medical record should be maintained permanently but must be maintained not less than 10 years beyond the periods provided in (1) . A core record shall contain at a minimum the following information:

(a) identification of patient data which includes name, maiden name if relevant, address, date of birth, sex, and, if available, social security number;

(b) medical history;

(d) consultation reports;

(e) report of operation;

(f) pathology report;

(g) discharge summary, except that for newborns and others for whom no discharge summary is available, the final progress note must be retained;

(h) autopsy findings;

(i) for each maternity patient, the information required by (2) ; and

(j) for each newborn, the information required by (3) .

(5) Nothing in this rule may be construed to prohibit retention of hospital medical records beyond the period described herein or to prohibit the retention of the entire medical record.

(6) Diagnostic imaging film and electrodiagnostic tracings must be retained for a period of five years; their interpretations must be retained for the same periods required for the medical record in (1) , but need not be retained beyond those periods.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-106 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1986 MAR p. 1583, Eff. 9/26/86; AMD, 1990 MAR p. 1259, Eff. 6/29/90; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.403 Minimum Standards for a Hospital: Hospital Records

(1) Hospital records must be maintained.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-106 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.404 Minimum Standards for a Hospital: Laboratories

(1) A hospital laboratory shall comply with the Conditions for Coverage of Services of Independent Laboratories as set forth in 42 CFR 405.1310, 405.1311, 405.1314, 405.1316, and 405.1317. A copy of the cited rules is available at the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.405 Minimum Standards for a Hospital: Organ Donation Requests and Protocols

(1) This rule is adopted to implement Chapter 219, Laws of 1987, which amended both the Uniform Anatomical Gift Act, Title 72, chapter 17, MCA, and the Montana Health Care Facility Licensing Act, Title 50, chapter 5, part 2, MCA. Sections (2) through (5) of this rule paraphrase 72-17-211 , MCA of the Uniform Anatomical Gift Act and are included here to clarify the requirements for hospitals in cases of patients who are suitable organ donors. For a full text of the Uniform Anatomical Gift Act, reference should be made to Title 72, chapter 17, MCA.

(2) When, according to generally accepted medical standards, a patient is a suitable candidate for donation of body parts as defined in 72-17-102 (8) , MCA, the hospital administrator or his/her designated representative shall communicate to the next-of-kin (as defined in (3) below) the option of donating all or any part of the patient's body and of the next-of-kin's option to decline. In addition to communicating such options, the hospital administrator or his/her designee must also request the next-of-kin to consent to an anatomical gift. The foregoing obligations of the administrator must be carried out unless the administrator or his/her designee:

(a) has actual notice of opposition to the gift by the decedent or the next-of-kin as defined in (3) below; or

(b) has reason to believe that an anatomical gift is contrary to the decedent's religious beliefs; or

(3) "Next-of-kin" as provided in 72-17-201 (2) , MCA, means one of the following persons in order of priority listed:

(a) the spouse;

(b) an adult son or daughter;

(d) an adult brother or sister; and

(e) a guardian of the person of the decedent at the time of death.

(4) The medical record of each patient who dies in a hospital and who is determined (under the hospital's protocol established under (6) below) to be a suitable candidate for donation of body parts must contain an entry setting forth the following:

(a) the name and affiliation of the individual who communicated the option to donate to the next-of-kin and who made the request for anatomical gift under (1) above;

(b) the name, relationship to the patient, and response of the individual to whom the option to donate was communicated and of whom the request for anatomical gift was made; and

(c) if no communication of an option or if no request for anatomical gift was made, the reason why no such request was made.

(5) An anatomical gift by a next-of-kin may be made in writing or by telegraphic, recorded telephonic, or other recorded message.

(6) By November 1, 1987, every hospital shall establish and have on file a written protocol that:

(a) assures identification of potential organ and tissue donors;

(b) assures that next-of-kin of patients who are suitable candidates for donation of body parts are made aware of their option to make an anatomical gift and are requested to consent to an anatomical gift of all or any part of the patient's body, unless one of the exceptions in (2) (a) , (2) (b) or (2) (c) applies;

(c) encourages discretion and sensitivity with respect to the circumstances, views, and beliefs of families of potential organ donors; and

(d) provides for notification of an appropriate federally approved organ procurement organization when potential organ donors are identified in the hospital.

(7) Upon request, every hospital must make its adopted written protocol available to department personnel for their review.

(8) The protocol must, at a minimum, in addition to the items in (6) above, address and provide for the following aspects of an organ donation notification/request/referral program:

(a) method(s) by which the public is notified that the hospital has an organ procurement program;

(b) determination of medical suitability of potential donors of body parts, including consideration of factors such as donor age, previous disease history, and presence of infection; and documentation of non-suitability of patients initially identified as potential donors;

(c) a training and educational program conducted on a yearly basis in conjunction with a procurement organization (or the equivalent) to instruct appropriate hospital staff or others to convey organ donation information to next-of-kin and to make requests from next-of-kin, which program consists of formal training, seminars, in-service workshops, or other training (or a combination thereof) leading to a knowledge of and familiarity with the following:

(i) general historical, medical, legal and social concepts involved in organ donation and transplantation;

(ii) psychological and emotional considerations when dealing with bereaved families;

(iii) religious, cultural, and ethical considerations associated with organ donation; and

(iv) procedures for approaching donors and/or donors' next-of-kin, including physician notification, timing and location of contact, content(s) of communication concerning donor cards, consent forms, donation costs (if any) , and actual requests for donation;

(d) orientation and instruction on a yearly basis in conjunction with a procurement organization (or the equivalent) in the respective disciplines of hospital staff and/or other personnel who will or may be participating in the hospital's organ procurement program, such as chief of staff, attending physicians, nursing staff, social workers, clergy, or a team combining any of such persons; and

(e) the following forms to be used by the hospital to document that next-of-kin of medically suitable patients have been notified of the option to consent to an anatomical gift and have been requested to authorize such donation(s) as required in (2) above (and, if any such contact has not been made, the reason(s) why not) :

(i) patient authorization;

(ii) consent of next-of-kin; and

(iii) notification of organ procurement organization(s) .

(9) The hospital administrator shall designate a person or persons to represent him/her for the purpose of communicating to the next-of-kin the option of an anatomical gift and to make requests for anatomical gifts, in cases where the administrator is unable or will not be making such requests personally. Such persons shall receive the training specified in (8) above, and a list of such person(s) must be made available upon request to department personnel.

(10) A person who acts in good faith in accordance with the terms of (2) of this rule is not liable for damages in any civil proceeding or subject to prosecution in any criminal proceeding that might result from this action.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1987 MAR p. 1786, Eff. 10/16/87; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.410 Minimum Standards for a Hospital: Coronary Care Unit

If a hospital provides a coronary care unit, the unit shall comply with the following requirements:

(1) When a patient is cared for in a coronary care unit, a licensed registered nurse shall be on duty.

(2) At a minimum, the following equipment and supplies must be available in a coronary care unit:

(a) oxygen, oxygen and suction apparatus;

(b) defibrillator, resuscitator and respirator;

(d) oscilloscope;

(e) heart-rate meter with an alarm system;

(f) an electrocardiograph which is activated simultaneously with the alarm system and which may also be activated manually or at predetermined intervals;

(g) external pacemaker.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.411 Minimum Standards for a Hospital: Intensive Care Unit

If a hospital provides an intensive care unit, the unit shall comply with the following requirements:

(1) When a patient is cared for in an intensive care unit, a licensed registered nurse shall be on duty.

(2) At a minimum, the following equipment and supplies must be available in an intensive care unit:

(a) oxygen, oxygen and suction apparatus;

(b) defibrillator, resuscitator and respirator;

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.420 Minimum Standards for a Hospital: Obstetrical Services

If a hospital provides obstetrical services, the hospital shall comply with the following requirements:

(1) Obstetrical services must be under the supervision of a licensed registered nurse on a 24-hour basis.

(2) A maternity patient shall only be placed in a room with other maternity patients. The use of maternity rooms for other than maternity patients shall be restricted to noninfected gynecological and surgical patients. A maternity patient with infection shall be isolated in a separate room outside of the obstetrical service.

(3) An equipped room must be provided for each patient in labor.

(4) At least one delivery room must be provided.

(5) A delivery record shall be made for a maternity patient delivering and include, but not be limited to, the following information:

(a) starting time of patient's labor;

(b) time of birth of patient's newborn;

(d) whether an episiotomy was performed on patient;

(e) whether forceps were used in delivery;

(f) names of attending physicians;

(g) names of attending nurses;

(h) names of all other persons attending delivery;

(i) sex of the newborn;

(j) time of eye prophylactic treatment and name of drug used.

(6) A newborn must be marked for identification before removal from the delivery area.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.421 Minimum Standards for a Hospital: Newborn Nursery

If a hospital provides a newborn nursery, the nursery shall comply with the following requirements:

(1) The newborn nursery must be under the supervision of a licensed registered nurse on a 24-hour basis.

(2) An individual bassinet must be provided for each newborn.

(3) Each newborn must have separate equipment and supplies for bathing, dressing and other handling.

(4) At least one incubator must be provided in the nursery.

(5) Oxygen, oxygen and suction equipment must be available and adapted to the size of newborns. When oxygen is administered, the concentration within the incubatory and near the newborn's head shall be determined by means of a reliable oxygen analyzer. These measurements shall be recorded on the newborn's chart.

(6) Formula prepared in the hospital shall be prepared by terminal heat method using separate equipment furnished for formula preparation.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.422 Minimum Standards for a Hospital: Pediatric and Adolescent Services

If a hospital provides pediatric and adolescent services, the hospital shall comply with the following requirements:

(1) Pediatric and adolescent services must be under the supervision of a licensed registered nurse.

(2) At a minimum pediatric and adolescent services shall provide the following:

(a) an examination and treatment room with equipment and supplies designed for the care of children;

(b) oxygen and suction equipment designed for children.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.430 Minimum Standards for a Hospital: Psychiatric Services

If a hospital provides psychiatric services, the hospital shall comply with the following requirements:

(1) Psychiatric services must be under the supervision of a licensed psychiatrist on a 24-hour basis.

(2) Psychiatric service staff must include a sufficient number of adjunctive therapists to provide restorative and rehabilitation services for the number of patients accommodated.

(3) A licensed registered nurse or a licensed practical nurse under the supervision of a registered nurse shall be in charge 24 hours a day.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.440 Minimum Standards for a Hospital: Respiratory Therapy

If a hospital provides respiratory therapy, the hospital shall comply with the following requirements:

(1) Respiratory therapy services must be under the supervision of a licensed physician appointed from the active medical staff.

(2) An internal and external quality control program must be provided for all parameters of acid-base testing.

(3) Written policies and procedures must be developed describing the control measures to be followed in order to eliminate the transfer of infection from the use of respiratory equipment.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Subchapter 37.106.5 Minimum Standards for Outpatient Centers for Surgical Services

Mont. Admin. R. 37.106.501 Purpose

(1) The purpose of these rules is to establish the minimum licensing requirements for the licensure of outpatient centers for surgical services.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Mont. Admin. R. 37.106.502 Scope

(1) For purposes of this subchapter, outpatient centers for surgical services include facilities described at 50-5-101(42), MCA.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Mont. Admin. R. 37.106.503 Definitions

(1) "Medical director" means a physician licensed under Title 37, chapter 3 MCA, who oversees the services provided in an outpatient center for surgical services. The medical director may also serve in the outpatient center as a licensed health care professional. The medical director can also serve as the outpatient center administrator.

(2) "Outpatient center" for purposes of this subchapter, refers to an outpatient center for surgical services. Outpatient centers are limited to provide care for periods of less than 24 hours.

(3) "Safe manner" means that physicians and other clinical staff must follow acceptable surgical standards of practice in all phases of a surgical procedure, beginning with the preoperative preparation of the patient, through to the postoperative recovery and discharge.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13; AMD, 2024 MAR p. 334, Eff. 2/24/24.

Mont. Admin. R. 37.106.506 Minimum Standards for Outpatient Centers for Surgical Services

(1) An outpatient center must:

(a) meet the requirements of ARM Title 37, chapter 106, subchapter 3 relating to the minimum standards for all health care facilities;

(b) to the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the rules in this subchapter will apply;

(c) have a written policy and procedure manual as described in ARM 37.106.507 available to, and followed by, all personnel;

(d) establish a coordinated transfer of care for patients who require services longer than 24 hours or for patients requiring care beyond the capabilities of the outpatient center. This coordinated transfer of care must include one of the following:

(i) a written transfer agreement with the receiving hospital;

(ii) one or more physicians with surgical privileges in the outpatient center must have admitting privileges at the receiving hospital and are present in the outpatient center during any surgical procedure; or

(iii) the receiving hospital writes a coordinated transfer policy and specifies the respective roles and responsibilities of the outpatient center upon arrival at the receiving hospital; and

(e) in transferring patients, the outpatient center must:

(i) coordinate and provide notice to the receiving hospital, including the reason for the transfer prior to the patient's transfer; and

(ii) provide the patient's medical records to the receiving hospital during the transfer.

(2) An outpatient center may:

(a) show written evidence of current accreditation by an accreditation entity approved by the U.S. Centers for Medicare & Medicaid Services including recommendations for future compliance as a condition of licensure; or

(b) meet the standards as specified in ARM 37.106.507 through 37.106.515.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13; AMD, 2024 MAR p. 334, Eff. 2/24/24.

Mont. Admin. R. 37.106.507 Written Policies and Procedures

(1) Each outpatient center must maintain a policy and procedure manual. The policy and procedure manual must be reviewed by the medical director or administrator and updated as necessary, but at least annually. The manual must contain policies and procedures for:

(a) preadmission;

(b) patient education;

(d) postoperative assessment;

(e) observation and recovery;

(f) discharge planning;

(g) emergency procedures of the outpatient center to include information on the transfer agreement with the receiving hospital;

(h) anesthesia policies as described in ARM 37.106.514;

(i) business practices; and

(j) patient and staff security.

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

(3) Each outpatient center must have policies and procedures that address the criteria for clinical staff privileges and the process the governing body uses when reviewing physician credentials and determining whether to grant privileges.

(4) The outpatient center must implement a policy and a process which addresses the Food and Drug Administration (FDA) or manufacturer recall of drugs, vaccines, blood and blood products, medical devices, equipment, and supplies. The policy must address:

(a) the sources of information;

(b) methods for notifying staff;

(d) documentation of response to the recalled product;

(e) disposition or return of the recalled product; and

(f) patient notification as appropriate.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Mont. Admin. R. 37.106.508 Operational Standards for Outpatient Centers for Surgical Services

(1) An outpatient center is organized under a governing body that sets policy and is responsible for the organization. This governing body must meet regularly, but at least quarterly.

(2) The outpatient center administration must:

(a) operate under clearly defined mission, goals, and objectives for the organization;

(b) employ qualified personnel, both medical and managerial;

(c) adopt policies and procedures necessary for the orderly conduct of the organization, including the scope of clinical and surgical activities;

(d) ensure that the quality of care is evaluated and that identified problems are appropriately addressed;

(e) maintain effective communication throughout the organization, including ensuring a correlation between quality management and improvement activities and other management functions of the organization; and

(f) follow generally accepted accounting principles.

(3) Facility requirements for an outpatient center include:

(b) an emergency plan for use in the event of fire or natural disaster and documents exercise of the plan on an annual basis. The "exercise" may involve a functional review of the process. That review must be documented accordingly.

(4) Each outpatient center for surgical services will have a quality management and improvement plan which must include:

(a) a peer review process that includes:

(i) at least two licensed health care professionals one of whom is a physician, and operating within their scope of practice; and

(ii) that the results of the peer review are reported to the governing body.

(b) a credentialing process that provides a monitoring function to ensure the continued maintenance of licensure and certification, or both, of professional personnel who provide health care services at the outpatient center;

(i) is ongoing;

(ii) is data-driven;

(iii) is broad in scope;

(iv) addresses clinical and administrative issues as well as actual patient outcomes;

(v) has a defined set of quality improvement goals and objectives;

(vi) actively seeks patient feedback, evaluates complaints and suggestions, and works to improve patient satisfaction;

(vii) includes the active participation of the medical staff;

(viii) respects the health care rights of all patients, including the right to privacy;

(ix) at least annually conducts evaluation of outpatient center effectiveness;

(x) describes to the outpatient center's governing board the reports, findings, and activities relating to quality improvement; and

(xi) analyzes ongoing comprehensive self-assessment of the quality of care, including medical necessity of care or procedures performed and appropriateness of care. The findings from this process should be used to update facility policies and procedures.

(d) a risk management plan that:

(i) has a designated individual or committee that is responsible for the risk management program; and

(ii) addresses safety of patients and other important issues including:

(A) consistent application of the risk management program throughout the organization;

(B) review of all deaths, trauma, or other adverse incidents including reactions to drugs and materials;

(C) review and analysis of all actual and potential infection control occurrences and breaches, surgical site infections, and other health care acquired infections;

(D) review of patient complaints;

(E) impaired health care professionals;

(F) establishment and documentation of coverage after normal working hours;

(G) methods for prevention of unauthorized prescribing; and

(H) periodic review of clinical records and clinical record policies.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Mont. Admin. R. 37.106.511 Staffing and Personnel Requirements

(1) Staffing and personnel requirements for an outpatient center for surgical services include:

(a) professional staff who are licensed under Title 37, MCA, to practice in their profession and have the knowledge and skills required to provide the services offered by the outpatient center;

(b) all personnel assisting in the provision of health care services are appropriately trained, qualified, and supervised according to the policies and procedures of the outpatient center; and

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Mont. Admin. R. 37.106.512 Medical, Clinical, and Health Record Information

(1) An individual clinical record must be established for each person receiving care. Each record must be accurate, legible, and promptly completed. The record must include at least the following:

(a) patient identification;

(b) significant medical history and results of physical examination;

(d) findings and techniques of the operation including a pathologist's report on all tissues removed during surgery, except those exempted by the governing body;

(e) any allergies and abnormal drug reactions;

(f) entries related to anesthesia administration;

(g) documentation of properly executed informed patient consent which includes notice of transfer when deemed appropriate;

(h) discharge diagnosis; and

(i) discharge recommendations and instructions given to the patient.

(2) To ensure confidentiality, security, and physical safety of a patient's medical record, the outpatient center must designate a person to oversee and manage the clinical records.

(3) The outpatient center must have policies concerning clinical records. The policies must include:

(a) the retention of active records;

(b) the retirement of inactive records;

(d) the release of information contained in records.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Mont. Admin. R. 37.106.513 Infection Prevention, Control, and Safety

(1) The outpatient center must maintain an infection control program that seeks to minimize infections and communicable diseases. The outpatient center is responsible for providing a plan of action for preventing, identifying, and managing infections and communicable diseases, and for immediately implementing corrective and preventive measures that result in improvement.

(a) The infection prevention and control program must include documentation that the outpatient center has considered, selected, and implemented nationally recognized infection control guidelines.

(b) The infection prevention and control program is under the direction of a designated and qualified infection control officer who is a licensed health care professional and has training in infection control.

(2) The outpatient center must have written policies that also address cleaning of patient treatment and care areas to include:

(a) cleaning before use; and

(b) cleaning between patients.

(3) The outpatient center will have policies and processes in place for:

(a) the monitoring and documentation of the cleaning, high level disinfection, and sterilization of medical equipment, accessories, instruments, and implants; and

(b) minimizing the sources and transmission of infections, including adequate surveillance techniques.

(4) The outpatient center must designate a safety officer who is responsible for the facility's safety plan.

(5) The outpatient center must have a safety program which addresses the organization's environment of care and safety for all patients, staff, and others. The elements of the safety program include:

(a) a process for identifying hazards, potential threats, near misses, and other safety concerns;

(b) a process for reporting known adverse incidents to proper authorities;

(d) prevention of falls or physical injuries involving patients, staff, and others.

(6) The outpatient center must have a written emergency and disaster preparedness plan. The plan must address both internal and external emergencies and must also address provision for the safe evacuation of individuals during an emergency, especially for individuals who are at greater risk.

(a) The outpatient center must complete a written evaluation of each drill and promptly implement any corrections identified during the drill. This documentation must be on site at the facility for the period of licensure.

(7) The outpatient center must have a policy concerning the training of outpatient center staff in terms of the emergency and disaster plan.

(8) Products, including medications, reagents, and solutions that carry an expiration date are monitored and disposed of accordingly.

(9) Prior to use, appropriate education is provided to intended operators of newly acquired devices or products to be used in the care of patients.

(10) A system must exist for the proper identification, management, handling, transport, storage, and disposal of biohazardous materials and wastes, whether solid, liquid, or gas.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Mont. Admin. R. 37.106.514 Anesthesia Risk and Evaluation

(1) The outpatient center must:

(a) prohibit the use of flammable anesthesia;

(b) have a policy which defines the types of anesthesia that will be used within the facility. Similarly, the outpatient center must address in this policy the level of American Society of Anesthesiologists (ASA) Physical Status Classification System level appropriate to receive surgical services in these types of facilities;

(c) conduct an assessment prior to the patient's admission as well as prior to surgery to evaluate the risk of anesthesia and of the procedure to be performed; and

(d) have policies that address the basis or criteria used in conducting the assessments.

(2) Supplies and exhaust systems for windowless anesthetizing locations must be arranged to automatically vent smoke and products of combustion.

(a) Ventilating systems for anesthetizing locations using general anesthesia must be provided that automatically:

(i) prevent recirculation of smoke originating within the surgical suite; and

(ii) prevent the circulation of smoke entering the system intake, without, in either case, interfering with the exhaust function of the system.

(3) Anesthesia must be administered only by:

(a) a qualified anesthesiologist;

(b) a physician qualified to administer anesthesia; or

(4) Before discharge, each patient must be evaluated by a physician or by an anesthetist in accordance with applicable state health and safety laws, standards of practice, and facility policy. This postanesthesia assessment must include evaluation of:

(a) respiratory function, including respiratory rate, airway patency, and oxygen saturation;

(b) cardiovascular function, including pulse rate and blood pressure;

(d) temperature;

(e) pain;

(f) nausea and vomiting; and

(g) postoperative hydration.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13; AMD, 2014 MAR p. 2974, Eff. 12/12/14.

Mont. Admin. R. 37.106.515 Surgical and Related Services

(1) Surgical procedures must be performed in a safe manner by qualified physicians functioning within their scope of practice and who limit the surgical procedures to those that are approved by the governing body in accordance to the facility policies and procedures.

(2) The outpatient center uses acceptable standards of practice to ensure proper identification of the patient and the surgical site in order to avoid wrong site/wrong person/wrong procedure errors. Generally accepted procedures to avoid such errors include:

(a) a preprocedure verification process to make sure all relevant documents and related information are available, are correctly identified, match the patient, and are consistent with the procedure the patient and the surgical staff are expecting to perform;

(b) marking of the intended procedure site by the physician who will be performing the procedure so that is it is clear where the procedure is to be performed on the patient's body;

(c) verification that a current health history is complete which includes a list of current prescription and nonprescription medications and dosages, physical examination, and pertinent preoperative diagnostic studies have been completed; and

(d) a recheck of the procedures listed in (a) through (c).

(3) Each operating or procedure room is designed and equipped so that the types of surgery conducted can be performed in a manner that protects the lives and ensures the physical safety of all persons in the area. Only nonflammable agents are to be present in the operating or procedure room.

(4) All personnel with direct patient contact will maintain skills in basic cardiac life support and are available whenever there is a patient in the facility.

(5) A safe environment for treating surgical patients, including adequate safeguards to protect the patient from cross-infection, is ensured through the provision of adequate space, equipment, supplies, and personnel including:

(a) all persons entering the operating or procedure room are properly attired as defined by the governing body;

(b) acceptable aseptic techniques are used by all persons in the surgical area;

(d) measures are implemented to prevent skin and tissue injury from chemicals, cleaning solutions, and other hazardous exposure.

(6) The outpatient center has established protocols for instructing patients in self-care following surgery.

(7) The outpatient center has a procedure to address when sponge, sharps, and instrument counts will occur.

(8) Suitable equipment for rapid and routine sterilization is available to ensure the operating room materials are sterile. Sterilized materials are packaged, labeled, and stored in a manner to maintain sterility and identify sterility dates. Sterility requirements also include:

(a) processes for cleaning and sterilization of supplies and equipment must comply with manufacturer's instructions and recommendations; and

(b) internal and external indicators are used to demonstrate the safe processing of items undergoing high level disinfection and sterilization.

(9) Periodic calibration and preventive maintenance, or both of equipment is provided.

(10) An alternate source of power must be available in the event of power shortages, surges, or loss of utility.

(a) In accordance to National Fire Protection Association (NFPA) 110 Standard the outpatient center must have a generator which automatically starts within 10 seconds of loss of the utility. An Uninterrupted Power Supply (UPS) system is not acceptable as a substitute in any location using general anesthesia.

(b) UPS systems are permitted in settings where a patient is not under general anesthesia.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 1626, Eff. 9/6/13.

Subchapter 37.106.6 Minimum Standards for Nursing Facilities

Mont. Admin. R. 37.106.601 Minimum Standards for a Skilled and Skilled/ Intermediate Care Facility: General Requirements

(1) A skilled nursing care facility shall comply with the Conditions of Participation for Skilled Nursing Facilities as set forth in 42 CFR subchapter G part 483. An intermediate care facility shall comply with the requirements set forth in 42 CFR subchapter G subpart I. A copy of the cited requirements may be obtained from the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-404, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.605 Minimum Standards for a Skilled Nursing Care Facility for Each 24 Hour Period: Staffing

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, 50-5-404, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-404, MCA
History: Eff. 12/31/72; TRANS, from DHES, 2002 MAR p. 185; REP, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.606 Minimum Standards for a Skilled and Skilled/ Intermediate Care Facility: Drug Services

(1) Medication shall be released to a patient at discharge only on the written authorization of his licensed physician.

(2) Self-administration of medication by a patient is not permitted except on order of his licensed physician.

(3) Any deviation from the prescribed drug dosage, route or frequency of administration and unexpected drug reactions shall be reported immediately to the patient's licensed physician with an entry made on the patient's medical record and on an incident report.

(4) A current medication reference book must be provided at each nurses station.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.640 Minimum Standards for an Infirmary

(1) The infirmary shall provide patients with licensed physician care.

(2) The infirmary shall provide skilled nursing services. A licensed registered nurse shall serve as charge nurse on the day shift; and a licensed registered or practical nurse shall serve as charge nurse on evening and night shifts.

(3) Nurse staffing schedules must be maintained on file in the infirmary for the preceding six months.

(4) The infirmary shall maintain a medical record for each patient which includes, but is not limited to the following information:

(a) identification data;

(b) chief complaint;

(d) medical history;

(e) physical examination;

(f) laboratory and x-ray reports;

(g) treatment administered;

(h) tissue report;

(i) progress reports;

(j) discharge summary.

(5) If a modified diet is ordered by a physician for a patient, facilities must be available for its preparation and service.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.645 Minimum Standards for an Intermediate Developmental Disability Care Facility

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-204, MCA
History: NEW, 1984 MAR p. 973, Eff. 6/29/84; TRANS, from DHES, 2002 MAR p. 185; REP, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.650 Minimum Standards for a Kidney Treatment Center

(1) A kidney treatment center shall comply with the requirements set forth in 42 CFR 405, Subpart U.

(2) The department hereby adopts and incorporates by reference 42 CFR 405, Subpart U, which sets standards that suppliers of end-stage renal disease services must meet in order to be certified for reimbursement from the federal medicare or medicaid programs. A copy of 42 CFR 405, Subpart U, is available from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1994 MAR p. 3192, Eff. 12/23/94; TRANS, from DHES, 2002 MAR p. 185.

Subchapter 37.106.7 Critical Access Hospital

Mont. Admin. R. 37.106.704 Minimum Standards for a Critical Access Hospital (cah)

(1) A critical access hospital must comply with the conditions of participation for critical access hospitals under 42 CFR 485 Subpart F. The department adopts and incorporates by reference 42 CFR 485 Subpart F. A copy of the cited requirements may be obtained from the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

(2) A critical access hospital may maintain up to 25 inpatient beds that can be used interchangeably for acute care or swing-bed services. A critical access hospital granted a waiver under Section 123(i) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) may maintain an additional ten beds to be used only for skilled nursing facility or nursing facility level services. A critical access hospital may not add the additional beds granted under a waiver through capital expenditure for new construction.

(3) A facility qualifies as a necessary provider of health care services to residents of the area where the facility is located if the facility:

(a) is located in a county with fewer than six residents per square mile;

(b) is a state licensed facility located within the boundaries of an Indian reservation;

(d) has combined inpatient days for Medicare and Medicaid beneficiaries that account for at least 50% of its total acute inpatient days in the last full year for which data is available.

(4) A critical access hospital must provide emergency services meeting the emergency needs of patients following acceptable standards of practice, including the following standards:

(a) Emergency services must be organized under the direction of a practitioner member of the medical staff. A practitioner is a physician, physician's assistant certified, or an advanced practice registered nurse.

(b) The services must be integrated with other departments of the facility.

(c) The medical staff must establish and assume continuing responsibility for policies and procedures governing medical care provided in the emergency services.

(d) A practitioner is on duty or on call and physically available at the facility within one hour at all times, unless the procedures described in (4)(e) are adopted and implemented.

(e) Facilities with ten or fewer beds that are located in frontier areas having fewer than six persons per square mile and who have one medical provider regularly available in the area may provide emergency services through a registered nurse if they have requested and been granted a waiver by the state survey agency for Medicare and Medicaid. In these instances:

(i) an on-call practitioner must be immediately available by phone or radio for the registered nurse to contact, following completion of a nursing assessment, to determine whether the patient requires discharge, further examination, treatment or stabilization, and transfer to a facility capable of providing the appropriate level of care;

(ii) all registered nurses providing emergency service coverage must have documented education and competency in emergency care;

(iii) a registered nurse meeting the qualifications specified in (3)(e)(ii) is either on duty or on call and physically available at the facility within 30 minutes at all times; and

(iv) the facility may not use a registered nurse to provide emergency services coverage for more than a 72-hour continuous period of time.

(5) These requirements are in addition to those licensure rule provisions generally applicable to all health care facilities.

(6) A facility aggrieved by a denial, suspension, or termination of licensure may request a fair hearing under ARM 37.5.117.

History

Authorizing statute(s): 50-5-233, MCA
Implementing statute(s): 50-5-233, MCA
History: NEW, 2002 MAR p. 205, Eff. 2/1/02; AMD, 2003 MAR p. 1992, Eff. 9/12/03; AMD, 2005 MAR p. 2258, Eff. 7/15/05; AMD, 2016 MAR p. 839, Eff. 5/7/16; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Subchapter 37.106.8 Licensing of Specialty Hospitals

Mont. Admin. R. 37.106.801 Purpose

(1) The purpose of these rules is to establish the general requirements for the licensure of specialty hospitals. These rules outline the process for application, including the submission of results of an impact study; and the development and implementation of charity care policies for the nondiscrimination of persons who are unable to pay for health care services provided in specialty hospitals.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-121, 50-5-245, 50-5-246, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.802 Scope

(1) A specialty hospital is a subclass of a hospital that is intended to diagnose, care, or treat patients with:

(a) cardiac conditions;

(b) orthopedic conditions;

(d) patients being treated for cancer-related diseases and receiving oncology services.

(2) A specialty hospital is subject to the general requirements applicable to all hospitals and must be licensed according to the rules as outlined in this subchapter.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-101, 50-5-245, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.803 Definitions

(1) "Administrator" means the individual responsible for the day-to-day operations of a specialty hospital. This individual may also be known as, but not limited to, "chief executive officer," "executive director," or "president."

(2) "Charity care" or financial assistance" means free or discounted health services provided to persons who meet the organization's criteria for financial assistance and are unable to pay for all or a portion of the services.

(3) "Emergency care services" means health care items and services furnished or required to evaluate and treat an emergency medical condition.

(4) "Emergency medical condition" means a condition manifesting itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected to result in any of the following:

(a) the person's health would be in serious jeopardy;

(b) the person's bodily functions would be seriously impaired; or

(5) "Impact study" means the examination and analysis of the financial and operational effects of a proposed specialty hospital on existing health care facilities in the service area.

(6) "Independent consultant" means an individual or group of individuals who for a fee examine and analyze the financial and operational impacts of a proposed specialty hospital on existing health care facilities in the service area. In order to be deemed an independent consultant, the individual or group of individuals must not be an employee of, not otherwise related to, or affiliated with the owners or operators of a proposed specialty hospital or an existing health care facility in the service area.

(7) "Joint venture relationship" means an express agreement or contract between two or more parties to create the joint venture.

(8) "Service area" means that geographic location in which local residents are the primary recipients of provided specialty hospital services. A nonresident is not prohibited from receiving services from the specialty hospital.

(9) "Transfer of care" means relocating an individual to the care of another health care facility or health care provider consistent with federal transfer requirements imposed by EMTALA when an adequate continuum of care is not possible.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-101, 50-5-121, 50-5-245, 50-5-246, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.804 General Requirements

(1) A specialty hospital must comply with the requirements under 42 CFR subchapter G subpart E. The department adopts and incorporates by reference 42 CFR subchapter G subpart E, which sets forth the Centers for Medicare and Medicaid Services Conditions of Participation for Hospitals as the standard for the operation of specialty hospitals in Montana. A copy of the cited requirements may be obtained from the Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-103, 50-5-245, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.805 Impact Study

(1) As indicated in ARM 37.106.804 a condition of application for a proposed specialty hospital is that it must conduct an impact study that analyzes the financial and operational impacts of the proposed specialty hospital on existing health care facilities in the service area. The impact study must be completed prior to submitting the application for licensure.

(2) The impact study process will consist of:

(a) notification of specialty hospital formation intent;

(b) public participation on impact study consultant selection and scope;

(d) impact study completion and submission; and

(e) department review and determination.

(3) The consultant selection process will include:

(a) department review of consultant qualifications;

(b) consideration of public comment on consultants; and

(4) consultant responsibilities include:

(a) measure and analyze changes to health care access in services area; and

(b) prepare and submit report of findings.

(5) The scope of the impact study will focus on health care costs, access, and impact to existing health care facilities.

(6) The applicant for a proposed specialty hospital:

(a) must provide the department with an overview of the proposed specialty hospital including, but not limited to:

(i) type of services to be provided in the proposed specialty hospital;

(ii) the number and type of patients or residents for which care is to be provided; and

(iii) the number of employees in all job classifications.

(b) must provide to the department a list of independent consultants who could conduct the impact study; and

(7) The department must provide for an opportunity for public comment and participation, including opportunity to comment on the list of consultants, into the study process. Prior to designating an independent consultant to conduct the impact study, the department will afford the public an opportunity to provide comment on the independent consultants and scope of the impact study. At the discretion of the department, a public meeting may be held in lieu of a formal hearing as an additional means of soliciting public comment.

(8) The department will determine the scope of the impact study. After the department approves the consultant, the scope of the study will be finalized. The study will assess the potential positive and adverse impacts on access to the health care system in the applicant's service area. The scope of the study may include, but is not limited to:

(a) the impact on health care costs in the service area;

(b) the impacts on access to emergency care, mental health care, and other subsidized services provided in the proposed service area;

(d) the need for the services proposed in the health service area.

(9) The independent consultants utilized in these studies must:

(a) have the necessary resources to conduct and complete the impact study within the required timeframes;

(b) not allow the results of the study or the manner in which the study is conducted to be controlled by the proposed specialty hospital applicant or members of the joint venture;

(d) prepare a written report documenting the findings of the impact study which the applicant will submit to the department with the license application.

(10) The impact study must be completed within 180 days of the date the department finalizes the scope.

(11) If as a result of the impact study, the department finds that a proposed specialty hospital will have an adverse influence on an existing hospital or to the community's health care delivery system, the department will:

(a) impose conditions to mitigate the adverse effect; or

(b) deny the request for license.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-245, 50-5-246, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.806 License Application Process

(1) Application for a specialty hospital must be made on an application form provided by the department. At least 30 days prior to the opening of a facility, an applicant must submit to the department:

(a) a completed license application form which must contain the following information:

(i) the name and address of the applicant if an individual; the name and address of each member of a firm, partnership, or association; or the name and address of each officer if a corporation;

(ii) the location of the proposed specialty hospital facility;

(iii) the name of the person or persons who will administer, manage, or supervise the specialty hospital facility;

(iv) the number and type of patients or residents for which care is to be provided;

(v) the number of employees in all job classifications;

(vi) a copy of the contract, lease agreement, or other document indicating the person legally responsible for the operation of the specialty hospital facility if the specialty hospital is operated by a person other than the owner;

(vii) the designated name of the specialty hospital to be licensed; and

(viii) the owner or operator of a health care facility must sign the completed license application form.

(b) the results of an impact study showing the analysis of the financial and operational impacts of the proposed specialty hospital on existing health care facilities in the area;

(c) a signed transfer of care agreement with a hospital capable of providing emergency care services and acceptable continuum of care services; and

(d) each application form must be accompanied by the applicable license fee:

(i) $20.00 license fee for a specialty hospital with 20 beds or less;

(ii) $1.00 per bed license fee for a specialty hospital with 21 beds or more.

(2) The department will renew the license for a period of one to three years if the specialty hospital:

(a) makes written application for renewal on an application form provided by the department at least 30 days prior to the expiration date of its current license;

(b) meets the minimum licensure standards; and

(3) On receipt of a new or renewal license application, the department or its authorized agent will inspect the specialty hospital to determine if the proposed staff is qualified and the facility meets the minimum standards set forth in this subchapter. If minimum standards are met and the proposed staff is qualified, the department will issue a license for a period of one to three years.

(a) The department may issue a provisional license for a period of less than one year if continued operation of the specialty hospital will not result in undue hazard to patients or if demand for the accommodations offered is not met in the community.

(4) A patient may not be admitted or cared for in a specialty hospital unless the facility is licensed.

(5) Licensed premises must be open to inspection by the department or its authorized agent and access to all records must be granted to the department at all reasonable times.

(6) The designated name of the specialty hospital may not be changed without first notifying the department in writing.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-111, 50-5-201, 50-5-202, 50-5-203, 50-5-204, 50-5-207, 50-5-245, 50-5-246, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.809 Facility Transfer of Care Agreement

(1) Prior to accepting patients, a specialty hospital must have in place a signed transfer of care agreement with a hospital capable of providing emergency care services appropriate to the patient's medical needs. A specialty hospital must also have written policies that result in medically appropriate transfers.

(2) Prior to transferring a patient from a specialty hospital, the specialty hospital must:

(a) notify the receiving hospital before the patient is transferred and receive confirmation from the receiving hospital that services necessary to treat the patient are available;

(b) use medically appropriate life support measures to stabilize the patient before the transfer and to sustain the patient during the transfer;

(d) in cases of nonemergent care services ensure that the patient or legally responsible person acting on the patient's behalf are informed of the risk and benefit of transfer.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-122, 50-5-245, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.810 Administrator

(1) Each specialty hospital must have an administrator who:

(a) maintains daily overall responsibility for the facility operations;

(b) develops and oversees the implementation of all policies and procedures pertaining to the operation of the specialty hospital;

(d) establishes a process for patient complaints and grievances;

(e) establishes a patient incident report file on all patient incidents or allegation of abuse;

(f) develops and maintains an organizational chart that delineates the current lines of authority, responsibility, and accountability for the administration and provision of all facility patient treatment programs and services; and

(g) develops and implements written orientation and training procedures on all facility policies and procedures for all employees or contractors, relief workers, temporary employees, students, interns, volunteers, and trainees to include, but not limited to:

(i) defining responsibilities, limitations, and supervision of students, interns, and volunteers working for the specialty hospital; and

(ii) verifying each professional staff member's credentials, when hired, and annually thereafter, to ensure the continued credentialing of required licenses.

(2) The administrator must develop policies and procedures for screening, hiring, and assessing staff which include practices that assist the employer in identifying employees that may pose a risk or threat to the health, safety, or welfare of any resident and provide written documentation of findings and the outcome in the employees file.

(3) In the absence of the administrator, a staff member must be designated to oversee the operation of the facility during the administrator's absence. The administrator or designee must be in charge, on call, and physically available on a daily basis as needed, and must ensure there are sufficient, qualified staff so that the care, health, safety, and welfare needs of the patient are met at all times.

(4) If the administrator is absent for more than 30 calendar days, the department must be given written notice of the individual who has been appointed as the designee.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.811 Charity Care Policy

(1) Every specialty hospital must have a charity care policy that is actively implemented. The charity care policy should reflect the organization's mission statement, organizational goals and objectives, and legal and resource constraints.

(2) A specialty hospital devising a charity care policy should clearly identify the difference between charity care and bad debt.

(3) For any specialty hospital that has a For Profit tax status, the facility's charity care policy must be commensurate to the policies which exist for any nonprofit hospital in the service area.

(4) In addition to (1), the charity care policy criteria should include a mixture of the following factors:

(a) individual or family income or net worth;

(b) employment status and earning capacity;

(d) other financial obligations;

(e) other sources of payment for the services rendered;

(f) type of services provided, whether elective or emergency;

(g) costs to provide services exceeds third-party payments for services; and

(h) in the case of emergency department visits only, failure of the patient to cooperate with billing inquiries when the patient lives in a zip code known to have a per capita income below the federal poverty level.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-121, 50-5-245, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.812 Joint Venture Relationship Requirements

(1) Each specialty hospital must have a joint venture relationship with a hospital or a signed statement from a nonprofit hospital in the community acknowledging that the hospital declined a bona fide, good faith opportunity to participate in a joint venture with the specialty hospital applicant.

(2) To qualify as a joint venture, the agreements must contain the following four elements:

(a) an express agreement or contract creating and defining the joint venture;

(b) a common purpose among the parties;

(d) equal right to control of the venture.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-245, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Mont. Admin. R. 37.106.815 License Denial

(1) The department may deny an application for a specialty hospital as a result of an adverse impact study or for any reason as outlined in 50-5-207, MCA.

(2) If an application for a specialty hospital is denied for any reason, the department will issue a written denial of the license, the grounds for denial, and the right of the applicant to an appeal pursuant to 50-5-208, MCA.

(3) A decision to deny an application or to impose conditions upon an applicant or licensee may be appealed by the applicant by filing a request for a hearing, in writing, to the department's Office of Fair Hearings.

(4) Hearing requests must be received by the Office of Fair Hearings at P.O. Box 202953, 2401 Colonial Drive, Third Floor, Helena, MT 59620-2953, within 30 days after the date of mailing of notice of the department's decision.

History

Authorizing statute(s): 50-5-103, 50-5-245, MCA
Implementing statute(s): 50-5-207, 50-5-208, 50-5-245, 50-5-246, MCA
History: NEW, 2013 MAR p. 54, Eff. 1/18/13.

Subchapter 37.106.9 Rural Emergency Hospitals

Mont. Admin. R. 37.106.901 Minimum Standards for Rural Emergency Hospitals

(1) A rural emergency hospital shall comply with the conditions of participation for rural emergency hospitals as set forth in 42 CFR Part 485 Subpart E in effect as of January 1, 2024. A copy of the cited requirements may be obtained from the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-234, MCA
Implementing statute(s): 50-5-234, MCA
History: NEW, 2024 MAR p. 1073, Eff. 5/11/24.

Subchapter 37.106.10 Minimum Standards for Outpatient Facilities

Mont. Admin. R. 37.106.1001 Minimum Standards for an Outpatient Facility

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, 50-5-404, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; REP, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1002 Purpose

(1) The purpose of these rules is to establish the licensing requirements for the licensure of outpatient centers for primary care.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, 50-5-114, 50-5-116, 50-5-201, 50-5-204, 50-5-207, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1004 Scope

(1) For purposes of this subchapter, outpatient centers for primary care include the facilities described at 50-5-101(41), MCA, outpatient birth centers and radiological imaging facilities.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, 50-5-114, 50-5-116, 50-5-201, 50-5-204, 50-5-207, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1006 Definitions

(1) "Low risk patient" means a pregnant woman with a normal, uncomplicated prenatal course as determined by adequate prenatal care and prospects for a normal, uncomplicated birth as defined by reasonable and generally accepted criteria of maternal and fetal health.

(2) "Medical director" means a physician licensed under Title 37, MCA, who oversees the services provided in an outpatient center for primary care. The medical director may also serve in the outpatient center for primary care as a licensed health care professional.

(3) "Outpatient birth center" means a facility that provides comprehensive prenatal, delivery, and newborn care to ambulatory, low risk patients under the direction of a health care provider who is licensed under Title 37, MCA, and is operating within the scope of practice allowed by the health care provider's license. Outpatient birthing services are provided on an outpatient basis for a period of generally less than 24 consecutive hours, unless requiring transfer to another level of care if medically indicated.

(4) "Outpatient center for primary care" means a facility that provides, under the direction of a licensed physician, either diagnosis or treatment, or both, to ambulatory patients and that is not an outpatient center for surgical services.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, 50-5-114, 50-5-116, 50-5-201, 50-5-204, 50-5-207, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11; AMD, 2024 MAR p. 334, Eff. 2/24/24.

Mont. Admin. R. 37.106.1008 Minimum Standards for Outpatient Centers for Primary Care

(1) An outpatient center for primary care must meet the requirements of ARM Title 37, chapter 106, subchapter 3 relating to minimum standards for all health care facilities.

(2) An outpatient center for primary care shall have a written policy and procedure manual as described in 37.106.1010 available to and followed by all personnel.

(3) Each outpatient center for primary care shall employ, or contract with, a medical director who shall:

(a) coordinate with and advise the staff of the center on clinical matters;

(b) provide direction, consultation, and training regarding the center operations as needed;

(d) ensure the quality of treatment and related services through participation in the center's quality assurance process as outlined in the center's policies and procedures.

(4) Nursing services must be provided by or under the supervision of a licensed registered nurse.

(5) Standing orders utilized for emergency or post-operative care shall be recorded in each patient's medical record and dated and signed by the patient's licensed health care professional.

(6) An outpatient center for primary care shall maintain a medical record for each patient that includes the following information:

(a) identification data;

(b) chief complaint;

(d) medical history;

(e) physical examination;

(f) laboratory and imaging reports;

(g) treatment administered;

(h) tissue report;

(i) progress reports; and

(j) discharge summary.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, 50-5-114, 50-5-116, 50-5-201, 50-5-204, 50-5-207, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1010 Written Policies and Procedures

(1) Each outpatient center for primary care shall maintain a policy and procedure manual. The policy and procedure manual shall be reviewed and updated as necessary, but at least annually. The manual shall contain policies and procedures for:

(a) notifying staff of all changes in policies and procedures;

(b) addressing patient rights, including a procedure for informing patients of their rights;

(d) addressing and reviewing ethical issues faced by staff and reporting allegations of ethics violations to the applicable professional licensing authority;

(e) emergency procedures of the birth center;

(f) establishing fiscal policies governing the management of organization; and

(g) developing and implementing policy(s) for security.

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

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, MCA, NEW, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1012 Minimum Standards for Outpatient Centers for Primary Care: Birth Centers

(1) If an outpatient center for primary care operates a birth center, the birth center shall:

(a) comply with the requirements of ARM 37.106.1008;

(b) show written evidence of current accreditation by an accreditation entity approved by the U.S. Centers for Medicare & Medicaid Services including recommendations for future compliance or meet the standards as outlined in ARM 37.106.1014; and

(c) establish a coordinated transfer of care through a mutually established agreement to the nearest hospital or critical access hospital that provides obstetrical and surgical services as required by the patient's acuity or the outpatient birth center 24 hour length of stay limitation.

(d) A transfer of care agreement must show that a physician who has admitting privileges at the hospital or critical access hospital that provides obstetrical and surgical services has agreed to admit and treat patients of the birthing center should the need arise. In transferring patients, the birth center shall:

(i) before transfer, coordinate and provide notice to the hospital, including the reason for the transfer; and

(ii) during transfer, provide the medical records related to the patient's current condition.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11; AMD, 2024 MAR p. 334, Eff. 2/24/24.

Mont. Admin. R. 37.106.1014 Operation Standards for Outpatient Centers for Primary Care: Birth Centers

(1) A birth center organization:

(a) maintains a governing body that meets regularly; and

(b) actively seeks and takes appropriate action on feedback from its consumers.

(2) A birth center administration shall:

(a) operate under a clearly defined mission, philosophy, and goals;

(b) follow generally accepted accounting principles and take measures to make sure it is fiscally responsible, including a plan to cover shortfalls; and

(3) Facility requirements for a birth center include:

(a) compliance with regulations established in the local jurisdiction, including applicable local and state codes for construction, fire prevention, public safety and access, annual inspections by the fire department, building inspector, and other officials concerned with public safety as determined by the local jurisdiction; and

(b) an emergency plan in the event of fire and natural disasters and documents practice of the plan on an annual basis.

(4) Equipment requirements for a birth center include:

(a) a readily available emergency cart or tray for the mother and newborn that is equipped to carry out the written emergency procedures of the birth center and securely placed with a written log of routine maintenance; and

(b) regular inspections of all medical equipment and documents accordingly.

(5) A birth center shall maintain sufficient supplies, including basic medical supplies for both mothers and babies, on hand, for the number of childbearing families served at the birth center.

(6) Quality of service requirements for a birth center include:

(a) respect for health care rights of all clients, including privacy;

(b) standard HIPAA practices; and

(i) careful screening for potential complications;

(ii) honoring the mother's needs and desires throughout labor;

(iii) assisting the mother in managing pain; and

(iv) paying close attention to the mother and baby's status in labor.

(d) limits its services to normal labor, therefore it does not utilize interventions such as:

(i) vacuum extraction;

(ii) medications to speed up labor;

(iii) continuous electronic monitoring; and

(iv) epidural nerve block.

(7) The birth center has a specific plan for transferring to a hospital if complications arise before, during labor, or after birth and interventions are required.

(8) Staffing and personnel requirements for a birth center include:

(a) professional staff and consulting specialists licensed to practice their profession and having the knowledge and skills required to provide the services offered by the birth center;

(b) at least two staff members attending every birth who are trained and certified in CPR and newborn resuscitation;

(d) the birth center must keep a schedule for clinical staff on call, to make sure all shifts are covered, day and night, seven days a week; and

(e) the birth center must conduct regular emergency drills to make sure staff members are prepared to manage unexpected situations with laboring mothers and newborns.

(9) Health record requirements for a birth center include:

(a) forms appropriate for use in a birth center, and clinicians document patient care accordingly;

(b) use of the chart supports a full prenatal exam to ensure that all clients are low risk;

(i) nutritional counseling;

(ii) informed decision-making about pain relief in labor; and

(iii) newborn care.

(10) The birth center maintains a plan for coordinating the transfer of the patient chart to another facility if the mother or newborn needs to be transferred and clearly communicates this plan to the mother.

(11) Quality assessment and improvement activity requirements for a birth center include:

(a) a well defined quality improvement program;

(b) reviews of its practices and clinical outcomes on a regular basis to ensure that it follows its own policies;

(c) procedures to actively seek client feedback, and then evaluate complaints and suggestions and work to improve client satisfaction on a regular basis; and

(d) staff must be evaluated on a regular basis to ensure competency and alignment with birth center policies.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-201, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1016 Minimum Standards for Outpatient Facilities: Imaging Services

(1) If an outpatient center for primary care provides diagnostic imaging services, the center must meet the following standards:

(a) a qualified full-time, part-time, or consulting radiologist must be utilized to interpret radiographic tests that are determined by the medical staff to require a radiologist's specialized knowledge;

(b) only personnel designated as qualified by the medical staff, and meeting requirements of state law, may use the radiographic equipment and administer procedures;

(c) each report that contains interpretations must be signed by the radiologist or other practitioner who provided the radiological services; and

(d) the facility must maintain diagnostic imaging film and electrodiagnostic tracings:

(i) for at least five years; and

(ii) interpretations must be retained for the same periods required for the medical records provided by ARM 37.106.402.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, 50-5-201, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1018 Facility Inspections

(1) Outpatient centers for primary care are subject to inspection requirements provided in 50-5-116 and 50-5-204, MCA.

History

Authorizing statute(s): 50-5-103, 53-6-106, MCA
Implementing statute(s): 50-5-103, 50-5-106, MCA
History: NEW, 2011 MAR p. 578, Eff. 4/15/11.

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-101, 50-5-103, 50-5-204, MCA
History: NEW, 1989 MAR p. 663, Eff. 4/28/89; TRANS, from DHES, 2002 MAR p. 185; REP, 2022 MAR p. 1876, Eff. 9/24/22.

Subchapter 37.106.14 Minimum Standards for Chemical Dependency Facilities

Mont. Admin. R. 37.106.1401 Minimum Standards for Chemical Dependency Facilities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, 50-8-101, 50-8-102, 50-8-105, MCA
History: NEW, 1984 MAR p. 1090, Eff. 7/27/84; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 57, Eff. 1/15/22; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1411 Purpose

(1) This subchapter establishes the licensing requirements for substance use disorder facilities (SUDFs) as outlined in the ASAM Criteria.

(2) This subchapter is applicable to treatment levels of care classified as:

(a) ASAM 3.7 Medically Monitored Intensive Inpatient Services;

(b) ASAM 3.7-WM Medically Monitored Withdrawal Management Services;

(d) ASAN 3.3 Clinically Managed Population-Specific High Intensity (adult only) Residential Services;

(e) ASAM 3.2-WM Clinically Managed Residential Withdrawal Management Services;

(f) ASAM 3.1 Clinically Managed Low Intensity (adult or adolescent) Residential Services;

(g) ASAM 2.5 Partial Hospitalization Services; and

(h) Outpatient Substance Use Disorder Facility.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1413 Definitions

In addition to the terms defined in 53-24-103, MCA, the following definitions shall apply in the interpretation and enforcement of the rules in this subchapter:

(1) "Administrator" means the person in charge, care, or control of the substance use disorder facility (SUDF).

(2) "Admission" means specific tasks necessary to admit a person to a SUDF.

(3) "Adolescent" means a person 17 years of age or younger for purposes of receiving services in a SUDF. Persons 18, 19, and 20 may be defined as an adolescent if enrolled in accredited secondary school and the client assessment completed by a LAC or mental health professional determines their appropriateness for adolescent treatment.

(4) "Adult" means a person 18 years of age or older for purposes of receiving services in a SUDF.

(5) "American Society of Addiction Medicine (ASAM) Criteria" means guidelines for placement, continued stay, and transfer/discharge of individuals with addiction and co-occurring conditions, developed by the American Society of Addiction Medicine.

(6) "Biopsychosocial assessment" means a comprehensive multidimensional assessment that includes risk ratings, addresses immediate needs, is organized in accordance with the six dimensions as described in the ASAM Criteria, and includes the following:

(a) presenting problem(s) and history of problem(s);

(b) family history;

(d) substance use history;

(e) personal/social history;

(f) legal history;

(g) psychiatric history;

(h) medical history;

(i) spiritual history;

(j) diagnostic interview and mental status examination;

(k) physical health impressions;

(l) diagnostic impressions;

(m) needs, strengths, skills, and resources in each dimension; and

(n) treatment recommendations.

(7) "Care management" means the management and coordination of services to meet individual treatment needs of a client and includes:

(a) conducting a needs assessment;

(b) developing, implementing, revising, or monitoring the care plan;

(d) continuity of care provided by a designated member of the treatment team.

(8) "Care manager" means a designated staff member on the care team that delivers care management services to clients and works directly with each client to ensure they receive the right care at the right time by coordinating services and referrals and tracking clinical outcomes.

(9) "Clinical director" means a Licensed Addiction Counselor, Licensed Clinical Social Worker, Licensed Clinical Professional Counselor, Licensed Marriage Family Therapist, or Clinical Psychologist responsible for the supervision and provision of skilled treatment services provided in a substance use disorder facility. The clinical director cannot be a licensure candidate.

(10) "Continuing care plan" means a plan outlining anticipated interventions needed at the time of discharge or transfer to another level of care.

(11) "Co-occurring" means an individual that is diagnosed with at least one mental health disorder along with a substance use disorder.

(12) "Critical population" means an individual who may be in need of additional services and is a priority admission to a SUDF in the following order of priority:

(a) pregnant injecting drug users;

(b) pregnant substance abusers;

(d) individuals infected with the etiologic agent for acquired immune deficiency, Hepatitis B and/or C, tuberculosis (TB),or any sexually transmitted infection; and

(e) women with dependent children.

(13) "Diagnostic and Statistical Manual of Mental Disorders or (DSM)" means the American Psychiatric Association's classification of mental disorders manual. The DSM is the standard reference for clinical practice in the mental health field.

(14) "Direct care" means the provision of providing awake supervision, treatment, or services to clients in a SUDF.

(15) "Educational group" means structured service provided in a group setting designed to educate clients about substance abuse and the consequences of substance abuse.

(16) "Guardian" means a person appointed by a court to make medical, and possibly financial, decisions as provided in Title 72, chapter 5, MCA.

(17) "Individualized treatment plan" means a written document as described in ARM 37.106.1440, identifying the client's medical needs, clinical needs, goals, objectives, and interventions.

(18) "Interdisciplinary team" means a group of licensed or certified individuals trained in different professions, disciplines, or service areas who function interactively and interdependently in conducting a client's biopsychosocial assessment, individualized treatment plan, and treatment services.

(19) "Licensed addiction counselor (LAC)" means an individual who meets the requirements set forth in 37-35-202, MCA, and ARM Title 24, chapter 154, rules implementing 37-35-202, MCA, to provide addiction counseling.

(20) "Medical director" means a physician, licensed under requirements set forth in Title 37, chapter 3, MCA, who establishes and oversees written protocols for the provision of medical services and medication management provided in a medically monitored inpatient substance use disorder residential facility.

(21) "Medication administration" means the direct application of a medication or device by ingestion, inhalation, injection, or any other means, whether self-administered by a resident, or administered by a parent or guardian (for a minor), or an authorized health care provider.

(22) "Mental health professional" means a clinical psychologist, licensed clinical social worker (LCSW), licensed clinical professional counselor (LCPC), and licensed marriage and family therapist (LMFT), licensed under requirements pursuant to Title 37, chapters 17, 22, 23, or 37, MCA; or a social worker licensure candidate; professional counselor licensure candidate; or marriage and family therapist licensure candidate, registered under requirements pursuant to Title 37, chapters 22, 23, or 37, MCA. Mental health professionals cannot assume the role of care manager.

(23) "Nurse practitioner" means a person licensed under Title 37, chapter 8, MCA.

(24) "Parent" means the individual who has legal custody of the child.

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

(26) "Physician" means a person licensed under requirements pursuant to Title 37, chapter 3, MCA.

(27) "Physician assistant" means a person licensed under requirements pursuant to Title 37, chapter 20, MCA.

(28) "Progress note" means a written record of a treatment session or service contact. It is individualized to each client for each separate session or service, and includes the following:

(a) date, time in/time out, and duration of session;

(b) participant name;

(d) client's participation;

(e) documentation of measurable progress toward ITP goals and objectives;

(f) the name and signature (with date of completion) of the staff member providing the session or service; and

(g) documentation in the client's file within seven days of the treatment session or service contact, or there must be documentation why this did not occur.

(29) "Psychosocial rehabilitation" means a service that includes assisting adults with restoring skills related to exhibiting appropriate behavior and living with greater independence and personal choice. Services maximize the skills needed to function in the home, workplace, and community setting. Services can be provided by a rehabilitation aide.

(30) "Recovery residence" means a substance-free living environment that supports individuals in recovery from substance use disorders. Recovery residences do not provide clinical services and are excluded from licensure by the department.

(31) "Registered nurse" means a person licensed under requirements pursuant to Title 37, chapter 8, MCA.

(32) "Rehabilitation aide" means a staff member of the SUDF who provides direct services to clients. Rehabilitation aides can provide psychosocial rehabilitation services under the supervision of the LAC or mental health professional staff and has documentation of training in the service provided. Rehabilitation aides must have a minimum of a high school diploma, high school equivalency test (HiSET), or general equivalency diploma (GED).

(33) "Self-administration assistance" means providing necessary assistance to any resident in taking their medication, including:

(a) removing medication containers from secured storage;

(b) providing verbal suggestions, prompting, reminding, gesturing, or providing a written guide for self-administrating medications;

(c) handing a prefilled, labeled medication holder, labeled unit dose container, syringe or original marked, labeled container from the pharmacy, or a medication organizer as described in ARM 37.106.2848 to the resident;

(d) opening the lid of the marked, labeled container for the resident;

(e) guiding the hand of the resident to self-administer the medication;

(f) holding and assisting the resident in drinking fluid to assist in the swallowing of oral medications; and

(g) assisting with removal of a medication from a container for residents with a physical disability which prevents independence in the act.

(34) "Serious incident" means any one of the following events that occurs at the facility or while participating in a facility activity:

(a) death;

(b) suicide attempt;

(d) physical or sexual assault;

(e) use of physical force or restraints;

(f) event that causes or contributes to serious injury, illness, or death of any person or poses a serious risk to the health, safety, or welfare of any person;

(g) serious physical plant damage;

(h) a severe weather event that presents a substantial threat to facility operation or client safety;

(i) bomb threat; and

(j) alleged unlawful conduct or criminal activity.

(35) "Skilled treatment services" means structured services such as individual and group counseling, medication management, family therapy, educational groups, occupational and recreational therapy, and other therapies provided to the client. Skilled treatment services do not include attendance at self/mutual help meetings, volunteer activities, or homework assignments such as watching videos, journaling, and workbooks. Skilled treatment services must be provided by clinical staff licensed pursuant to requirements adopted under Title 37, MCA.

(36) "Staff member" means a person that provides any type of service in the SUDF and is either employed, contracted, a volunteer, or participating in a trainee/intern program.

(37) "Substance use disorder" means chemical dependency, as defined in 53-24-103, MCA.

(38) "Substance use disorder facility (SUDF)" means a chemical dependency facility, as defined in 50-5-101, MCA.

(39) "Treatment plan review" means clinical review of the client's progress in treatment and determination of whether the client meets the continuing, transfer, or discharge criteria outlined in the ASAM Criteria for the current level of care.

(40) "Withdrawal management" means services required for dimension one in the ASAM Criteria; acute intoxication and/or withdrawal potential.

History

Authorizing statute(s): 50-5-103, 53-24-208, 53-24-301, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1415 Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter shall apply to a substance use disorder facility.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1416 Confidentiality

(1) A substance use disorder facility (SUDF) must have a written client confidentiality policy pursuant to 42 CFR Part 2.

(2) The confidentiality policy must be reviewed with the client at the time of admission or as soon thereafter as the client is capable of rational communication.

(3) Policy requirements must include activities to:

(a) inform clients that federal law and regulations protect the confidentiality of alcohol and drug abuse client records; and

(b) provide clients with a summary in writing of the federal law and regulations.

(4) The written summary required in (3)(b) must include:

(a) a general description of limited circumstances under which a SUDF may acknowledge a client is present at a facility or disclose information identifying a client as an alcohol or drug abuser;

(b) a statement that violation of the federal law and regulations by a SUDF is a crime and suspected violations may be reported to appropriate authorities in accordance with these regulations;

(c) a statement that information related to a client's commission of a crime on the premises of the SUDF or against staff members of the SUDF is not protected;

(d) a statement that reports of suspected child abuse or neglect made under state law to appropriate state or local authorities are not protected; and

(e) a citation to the federal law and regulations.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1420 Policy and Procedure Manual Requirements

(1) Each substance use disorder facility (SUDF) must develop and implement a policy and procedure manual that includes:

(a) the philosophy of the SUDF;

(b) the SUDF goals;

(d) a delineation of the services to be provided;

(e) screening procedures for all referrals;

(f) admission criteria which includes addressing priority admission protocols for critical populations;

(g) program limitations and exclusions;

(h) methods to be followed when a person is found ineligible for services including active referral to a level of care deemed appropriate through the biopsychosocial assessment;

(i) steps to follow for a wait list that includes unique client identifiers, referrals to other treatment facilities, and removing clients only when they cannot be located or refuse treatment;

(j) procedures outlining how facilities and services must provide for privacy and separation by sex;

(k) steps to ensure smoking is not permitted, as required under the Montana Clean Indoor Air Act;

(l) the management, storage, and disposal of prescription and over the counter drugs if applicable as stated in ARM 37.106.1457;

(m) client transportation;

(n) drug and alcohol laboratory testing methods, collection, and storage procedures, including:

(i) how testing is used as part of a non-punitive therapeutic process including how the use of testing and results become part of the client's treatment plan; and

(ii) process addressing client refusal to submit for laboratory testing or drug and alcohol screening and confirmation testing;

(o) arranging for medical and mental health services when clinically indicated in the biopsychosocial assessment or treatment plan reviews for all clients and within 48 hours of admission for critical populations;

(p) screening clients for critical populations at the time of admission;

(q) limitations and requirements of group counseling sessions to include client/staff member ratio, appropriate for the level of care being rendered;

(r) provision of services to family members and significant others;

(s) medical emergencies;

(t) youth program policies in ARM 37.106.1455; and

(u) any additional policy and procedures as required by this subchapter.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-207, 53-24-208, 53-24-306, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1425 Governance and Administration

(1) The substance use disorder facility (SUDF) must establish a governing body or oversight committee with responsibility for operating and maintaining the SUDF.

(2) The governing body or oversight committee must provide organizational oversight to ensure that adequate resources are available to ensure staff members provide safe and adequate care.

(3) The governing body or oversight committee must establish written policies and procedures that:

(a) govern the organization and functions of the SUDF;

(b) establish procedures for selecting and periodically evaluating a qualified administrator to ensure the administrator carries out the goals and policies of the governing body or oversight committee;

(d) establish accounting and fiscal procedures;

(e) describe how updates and changes are reviewed with and implemented by staff member(s); and

(f) include annual review of the quality improvement report by the governing body or oversight committee.

(4) Each SUDF must have an administrator that is responsible for, and must be familiar with the daily operation of, the SUDF.

(5) The administrator must;

(a) be qualified through appropriate knowledge, experience, and capabilities to supervise and administer the services properly;

(b) be available, or ensure a designated alternate who has similar qualifications is available, to carry out the goals, objectives, and standards of the governing body or oversight committee and to implement the rules of this subchapter; and(c) review progress on the quality improvement plan with the governing body or oversight committee on a quarterly basis.

(6) The SUDF must maintain professional liability and general liability insurance.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-301, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1426 Reporting Requirements

(1) All serious incidents, as defined in ARM 37.106.1413, must be reported to the Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau, within 24 hours. The report must be in writing and must include:

(a) the date and time of the incident;

(b) all clients and staff members involved; and

(2) A copy of the incident report must be maintained at the SUDF.

(3) A SUDF must report a change in administrator prior to the effective date of change.

(4) Changes in the facility location, use, or number of facility beds cannot be made without written notice to, and written approval received from, the department.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1427 Abuse or Neglect Requirements

(1) A substance use disorder facility (SUDF) must require each staff member to read and sign a statement that:

(a) clearly defines child abuse and neglect as defined in 41-3-102, MCA;

(b) clearly defines abuse, neglect, and exploitation of an older person or a person with a developmental disability as defined in 52-3-803 MCA; and

(c) outlines the individual's responsibility to report all known or suspected incidents of abuse, neglect, or exploitation of any client within 24 hours.

(2) Any SUDF staff member who knows or has reasonable cause to suspect an incident of child abuse or neglect has occurred must make a report within 24 hours of the incident to the SUDF administrator, or a person designated by the SUDF administrator, and to the state child abuse hotline (866) 820-5437 as required in 41-3-201 , MCA.

(3) Any SUDF staff member who knows or has reasonable cause to suspect an incident of abuse, neglect, or exploitation of a vulnerable adult has occurred must make a report within 24 hours of the incident to the SUDF administrator, or a person designated by the SUDF administrator and to Adult Protective Services or other bodies as required in 52-3-811 , MCA.

(4) In addition to reporting requirements in (2) and (3), the SUDF must also make a report to the Office of Inspector General, Licensing Bureau in writing within 24 hours of any allegations of client abuse, neglect, or exploitation within the SUDF.

(5) The SUDF must document, in writing, that the proper authorities have been contacted and the abuse, neglect, or exploitation has been reported.

(6) The SUDF must fully cooperate with any investigation conducted because of the report.

(7) The SUDF must have written policies for handling suspected incidents of abuse, neglect, or exploitation, including:

(a) procedures for ensuring staff members suspected of abuse, neglect, or exploitation do not continue to provide direct care until an investigation is completed;

(b) development of a safety plan, approved by the department, which protects the client and staff member until the investigation is complete; and

(c) procedures for taking appropriate disciplinary measures against any staff member involved in an incident of client abuse, neglect, or exploitation upon validation of the allegation, including:

(i) termination of employment;

(ii) retraining of the staff member; or

(iii) any other appropriate action by the SUDF geared toward the prevention of future incidents of client abuse, neglect, or exploitation.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1430 Personnel Policy Manual Requirements

(1) The substance use disorder facility (SUDF) must have a written personnel policy manual which includes the following:

(a) screening and hiring procedures for all applicants including criminal and protective service history disqualifiers the SUDF uses in making an employment fitness determination;

(b) job qualifications for each position;

(c) job descriptions or contract agreements which describe the nature and extent of client care services of each position;

(d) organizational chart including the supervisory structure;

(e) process for conducting staff member performance evaluations;

(f) actions to be taken if staff members misuse alcohol or other drugs;

(g) defining staff member ethical standards of conduct, including reporting of unprofessional conduct to appropriate authorities;

(h) staff member grievance procedures; and

(i) trainee/intern or volunteer requirements as required in ARM 37.106.1435.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1432 Personnel File Requirements

(1) The substance use disorder facility (SUDF) must maintain a current secured personnel file for each staff member. The file must include:

(a) a criminal history background information check;

(b) a Montana Child Protective Services check for SUDFs serving or housing adolescents;

(d) an annual performance review signed and dated by the staff member and supervisor;

(e) copies of certification or licensure documents necessary for the staff member's position and/or title;

(f) evidence of an independent contractor status and contractual agreements for contracted staff members;

(g) a signed statement acknowledging the staff member has been oriented and agrees to abide by all confidentiality requirements;

(h) resume or job application;

(i) disciplinary actions and grievances; and

(j) a copy of a current job description which includes:

(i) job title;

(ii) minimum qualifications for the position; and

(iii) summary of duties and responsibilities.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1434 Staff Member Training

(1) A substance use disorder facility (SUDF) must have written policies, procedures, and initial and ongoing training curriculum to meet minimum requirements in this rule.

(2) All staff members supervising, or providing, direct contact with clients must complete orientation training prior to supervising, or providing, direct care consisting of the following requirements:

(a) an overview of the SUDF policies, procedures, organization, and services;

(b) mandatory adult and child abuse, neglect, and exploitation reporting laws;

(d) confidentiality;

(e) suicide ideation and referral procedures;

(f) emergency medical procedures;

(g) documentation requirements;

(h) client rights and client grievance process;

(i) blood and air-borne pathogens;

(j) crisis prevention and de-escalation techniques; and

(k) upon completion of the orientation, the SUDF must complete a competency assessment for each staff member's ability to apply knowledge of material learned. Assessment results must be documented in each staff member's personnel file.

(3) Staff members supervising or providing direct care to clients must complete the following certification training within six months of hire:

(a) first aid;

(b) cardio-pulmonary resuscitation (CPR) that includes direct instruction of the practical and demonstrated applications of CPR methods as taught by an instructor from an accredited entity; and

(4) Staff members must maintain and update trainings and certifications in (3) as required.

(5) Staff members providing direct care to clients must not work unsupervised with clients without completing requirements in (3).

(6) The SUDF must ensure 20 hours of annual training is provided for staff members providing direct care to improve proficiency in their knowledge and skills for the level of care provided.

(7) All training must be documented and kept on file for each staff member.

(8) All staff members working with adolescents must have training in adolescent development.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1435 Trainees/Interns or Volunteer Requirements

(1) If the substance use disorder facility (SUDF) participates in a trainee/intern practicum or has volunteers, they must have the following:

(a) policies and practices assuring the safety of clients;

(b) a description of the training or volunteer work to be provided at the SUDF for trainees, interns, or volunteers, respectively, and any limitations;

(d) policies and procedures to ensure trainee/interns or volunteers meet the qualifications of the position to which the person is assigned; and

(e) a written agreement with each educational institution using the SUDF as a setting for student practice, including:

(i) a description of the nature and scope of student activity at the SUDF.

(2) Volunteers must not be part of client/staff ratios or provide unsupervised direct care to clients.

(3) Volunteers must meet the requirements of ARM 37.106.1432(1)(a), (b), (c).

(4) For purposes of this subchapter, trainees/interns are considered to be a staff member of the SUDF.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1440 Clinical Requirements

(1) Each client must have an individualized treatment plan (ITP) developed by an interdisciplinary treatment team.

(2) ITPs must include:

(a) the client's name, diagnoses, treatment plan date, and treatment plan review dates;

(b) the names of treatment team members who are involved in the client's treatment;

(d) the problem area(s) that will be the focus of treatment to include symptoms, behaviors, and/or functional impairments;

(e) the treatment goals, objectives, and interventions that are person centered and recovery oriented;

(f) the description of the type, duration, and frequency of the intervention(s) and services(s);

(g) expected dates of completion;

(h) an educational plan for youth; and

(i) the client's level of functioning that will indicate when a service is no longer required.

(3) ITPs and treatment plan reviews must be completed with the client and include the client's legal guardian and at least one qualified licensed professional. The treatment plan and treatment plan reviews must be signed and dated by interdisciplinary team members, the client, and the client's legal guardian (if applicable).

(a) Additional service providers must be contacted and encouraged to participate as clinically indicated.

(4) ITPs must be completed within:

(a) 24 hours of admission for ASAM 3.7, 3.7-WM and 3.2-WM;

(b) 48 hours of admission for ASAM 3.5;

(d) five contacts or 21 days from the first contact, whichever is later, for outpatient facilities.

(5) Treatment plan reviews must be completed:

(a) every three days from the admission date for ASAM 3.7, 3.7-WM and 3.2-WM.

(b) every seven days from the admission date for ASAM 3.5;

(d) every 14 days for from the admission date for ASAM 2.5; and

(e) every 90 days from the admission date for outpatient facilities.

(6) Treatment plan reviews must include:

(a) documentation regarding the client's response to treatment;

(b) review of the client's progress in all six dimensions; and

(c) progress towards goals and objectives that result in either an amended ITP or a statement of the continued appropriateness of the existing plan.

(7) A continuing care plan must be given to the client and, if applicable, the client's legal guardian/parent, representative or guardian at the time of discharge and must include, if applicable:

(a) client's name, date of birth, admission and discharge dates, and reason for placement and discharge;

(b) a written summary of services provided, including the client's participation and progress in the SUDF, contact information of licensed health care providers who conducted evaluations and treatment, and condition of the client at the time of discharge;

(d) community substance use treatment provider's contact name, contact number, and time and date of an initial appointment;

(e) health care follow-up including provider's contact name, contact number, and initial appointment (if necessary);

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

(g) name and contact number of the client's recovery supports;

(h) housing and employment plan;

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

(j) adolescent's educational status (if applicable); and

(k) signature of the client and of the staff member who prepared the plan.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-207, 53-24-208, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1450 Client Rights

(1) The substance use disorder residential facility (SUDF) must develop and maintain a client rights policy that supports and protects the state and federal constitutional and statutory rights, including civil rights, of all clients. These must include the right to:

(a) receive treatment free of unlawful discrimination;

(b) receive reasonable accommodations, consistent with federal and state law;

(c) receive treatment in the least restrictive environment, consistent with law, in a manner sensitive to individual needs and which promotes dignity and self-respect;

(d) have clinical and personal information treated in accordance with state and federal statutes and regulations;

(e) the opportunity to review their own treatment records in the presence of the administrator or designee, consistent with 45 CFR 164.524 and other state and federal confidentiality statutes and regulations;

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

(g) be free from abuse, neglect, harassment, and financial exploitation by staff members or clients;

(h) have grievances considered in a fair and timely manner, with respect to infringements of rights described in this rule;

(i) educational services provided to adolescents within inpatient/residential settings in accordance with Montana state law;

(j) client orientation to SUDF rules, responsibilities, and any sanctions that may be imposed for failure to comply with the SUDF rules;

(k) reasonable visitation and access to telephone communication within inpatient/residential settings;

(l) send and receive mail within inpatient/residential settings;

(m) regular physical exercise several times per week within inpatient/residential settings; and

(n) be given a 30-day notice in the event of a SUDF closure or treatment service cancellation and:

(i) provided assistance with relocation into similar treatment services, if available;

(ii) be given refunds to which the client is entitled; and

(iii) be advised how to access records to which the client is entitled.

(2) The SUDF must inform each client and his or her representative, in an understandable manner, of the rights policy, treatment methods, and rules applicable to the client, at the time of admission or as soon thereafter as the client is capable of rational communication.

(3) The client and staff member reviewing the policy must sign a statement acknowledging the review. The statement must be maintained in the client's record.

(4) The SUDF must post a copy of clients' rights in a conspicuous place in the facility accessible to clients and staff members.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-306, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1452 Client Record Maintenance and System Requirements

(1) Each substance use disorder facility (SUDF) must have a comprehensive secure client record system maintained in accordance with 42 CFR Part 2.

(2) Each SUDF must have written procedures which regulate and control access to and use of client records.

(3) In case of a SUDF closure, the SUDF closing its treatment agency must arrange for continued management of all client records.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-306, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1454 Client Record Content Requirements

(1) The substance use disorder residential facility (SUDF) must develop and implement procedures to ensure each client record is available on-site and includes:

(a) demographic information;

(b) a substance related disorder diagnosis and supporting documentation for diagnosis;

(d) signed documentation the client was informed of federal confidentiality requirements and received a copy of the client notice as required in ARM 37.106.1416;

(e) signed documentation the client received orientation to the SUDF's treatment services, infectious disease information, and disaster plan described in ARM 37.106.322;

(f) a voluntary consent to treatment signed and dated by the client or legal guardian;

(g) individualized treatment plan and treatment plan reviews;

(h) progress notes;

(i) clinical notes;

(j) continuing care plan;

(k) medication records, if applicable;

(l) laboratory reports, if applicable;

(m) authorizations for release of information, as needed;

(n) copies of all correspondence related to the client, including any court orders and reports of noncompliance; and

(o) documentation pertaining to client receipt of grievance policies and procedures.

(p) documentation of any client-filed written grievances and resolution;

(q) documentation the client received a copy of the client rights policy and the client's signature indicating he/she received the policy; and

(r) documentation of school educational courses attended or provided.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 2040, Eff. 9/24/22.

Mont. Admin. R. 37.106.1455 Adolescent Facilities

(1) In addition to policies required throughout this rule, a SUDF licensed to serve adolescents must have written policies and procedures that address:

(a) limiting admission to adolescents 17 years of age or younger or adolescents 18, 19, and 20 years of age if a client is enrolled in certified secondary school, and the assessment completed by a LAC or mental health professional with substance use in the scope of their license determines their appropriateness for adolescent treatment;

(b) age-appropriate treatment;

(d) separation of adolescents from adults in all non-treatment aspects including eating, sleeping, bathing, and recreation activities; and

(e) staffing patterns to ensure staff members of the same sex as clients are present at all times.

(2) The SUDF must maintain the minimum client to direct care staff

ratios:

(a) from 7:00 a.m. to 11:00 p.m.: eight adolescents to one direct care staff;

(b) from 11:00 p.m. to 7:00 a.m.: 12 adolescents to one direct care staff; and

(3) The SUDF must:

(a) allow communication between the adolescent and the adolescent's parent or legal guardian a minimum of one time per week and facilitate the communication when clinically appropriate;

(b) provide family therapy as indicated in the individualized treatment plan or document reasons why family therapy may not be provided;

(c) notify the parent or legal guardian within two hours of any serious incident as defined in ARM 37.106.1413 involving the adolescent;

(d) discharge the adolescent to the care of the adolescent's parent or legal guardian. For emergency discharge and when the parent or legal guardian is not available, the program must contact the appropriate authority; and

(e) only admit adolescents with the written consent of the adolescent's parent or legal guardian.

(4) The SUDF must have protocols for evaluating the treatment implications and safety concerns for determining whether being placed in a room with another specific adolescent is appropriate.

(5) In no circumstances should adolescents of more than three years age difference be placed in the same room.

(6) Adolescent facilities utilizing physical restraints must have written policies and procedures governing the appropriate use of crisis intervention and physical restraint strategies including:

(a) training for all staff in crisis intervention, de-escalation, and physical restraint by a state approved or nationally recognized program;

(b) that crisis prevention and de-escalation techniques are the preferred methods and must be used first to manage behavior;

(c) physical restraint must only be used to safely control an adolescent until the adolescent can regain control of the adolescent's own behavior;

(d) prohibit the use of physical restraint if an adolescent has a documented physical condition that would contradict its use unless a health care professional has previously and specifically authorized its use in writing. Documentation must be maintained in the adolescent's client record; and

(e) prohibiting the use of prone physical restraints.

(7) Physical restraint must only be used in the following circumstances:

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

(b) when an adolescent's behavior puts themselves or others at substantial risk of harm and the adolescent must be forcibly moved.

(8) Physical restraint must be used only by staff members who are specifically trained and certified in physical restraint techniques.

(9) The SUDF must document the following for each physical restraint:

(a) adolescent's behavior which required the physical restraint;

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

(c) length of time the physical restraint was applied, including documentation of the time the restraint began and ended;

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

(e) type of physical restraint used;

(f) any injuries to the adolescent resulting from the physical restraint; and

(g) a face-to-face debriefing completed within 24 hours of the restraint, including:

(i) the staff member(s) and adolescent involved in the physical restraint;

(ii) providing the adolescent and staff involved the opportunity to discuss the circumstances resulting in the use of the restraint; and

(iii) strategies that could be used by the staff, the adolescent, and/or others that could prevent the future use of restraint.

(10) The SUDF must provide access to an educational program appropriate to the needs of the youth and comply with state school attendance laws, as provided in Title 20, chapter 5, MCA.

(11) Group counseling sessions must be provided by a licensed addiction counselor or mental health professional and must not exceed eight adolescents to one adult staff member.

(12) All staff members working directly with adolescents must be at least 21 years of age.

(13) The SUDF must not employ any staff member that has a substantiation of child abuse or neglect.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1456 Care Management

(1) In addition to the requirements established in this subchapter, each SUDF must provide care management services and comply with the requirements established in this rule.

(2) A care manager must have a bachelor's degree in a human services field, an equivalent combination of education and experience, or a minimum of two years of experience serving individuals with behavioral health issues. Evidence of experience must be documented in the employee personnel record.

(3) Care management services must be provided by staff whose primary duty is the provision of care management services.

(4) The SUDF must develop written policies and procedures addressing the independence of the care manager and care management program. At a minimum, the policies and procedures must address:

(a) the care manager's role in conflicts between the client and the SUDF or other agencies;

(b) the ability of the care manager to freely advocate for services from the SUDF or other agencies on behalf of the client;

(d) the obligation to report information to the SUDF staff that the client has requested to be kept confidential; and

(e) the ability of the care manager to contact an advocacy organization if the care manager believes the SUDF is unresponsive to the needs of the client.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1457 Medication Storage and Administration

(1) A substance use disorder facility (SUDF) must have a written policy addressing requirements for the storage, administration, and disposal of prescription, nonprescription, and over-the-counter medication.

(a) Policies must include protocols for daily monitoring, counting of stored narcotics and other medication that has the potential for abuse.

(2) All medication must be:

(a) kept in a locked non-portable container or in a locked medical room; and

(b) stored in its original container with the original prescription label.

(3) For assistance with self-administration of medications outside of the facility, all medications must be in the possession of a staff member trained to assist with the self-administration of medications.

(4) Staff members assisting with medication self-administration must be trained to assist in proper medication procedures.

(a) Upon completion of the training, the SUDF must test each staff member's knowledge and observe staff demonstrating the skills of such materials. Test results must be documented in each staff member's personnel file.

(5) All medications must be ordered by a licensed health care professional working within the scope of his/her practice. All prescription orders must contain the dosage to be given.

(6) A written record of all medications self-administered by a client must be maintained. The record must include:

(a) client's name;

(b) name and dosage of medication;

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

(e) documentation of any medication error, the results of such error, any effects observed, and any action taken to address such error.

(7) A written record of all medications administered by a licensed health care professional must be maintained and meet documentation requirements for medication administration under the professional's individual license.

(8) Prescribed medication must not be stopped or changed in dosage or administration without first consulting a licensed health care professional, as defined in ARM 37.106.2805. Consultation results must be recorded in the client's record. The licensed health care professional must document, in writing, any changes to medication. This documentation must be kept as part of the client's record.

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

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

(11) A SUDF cannot require clients to discontinue the use of any medication prescribed by a licensed health care professional for admission.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1458 Communicable Disease Control

(1) The SUDF must develop and implement an infection prevention and control program and review the program annually.

(2) The SUDF must have written policies and procedures regarding infection prevention and control which include:

(a) procedures to identify high risk individuals;

(b) specific procedures to address tuberculosis (TB), Hepatitis A, Hepatitis C, sexually transmitted infections (STI), and human immunodeficiency virus (HIV); and

(c) the identification of methods used to protect, contain, or minimize the risk to clients, staff members, and visitors.

(3) The administrator or designated person is responsible for the direction, provision, and quality of infection prevention and control services.

(4) Facilities must implement TB screening for all staff members and clients based upon an annual TB Risk assessment as set forth by the Montana Tuberculosis Prevention and Control Program pursuant to ARM Title 37, chapter 114, subchapter 10. Risk assessment and TB manuals are found at https://dphhs.mt.gov/publichealth/cdepi/diseases/Tuberculosis/ .

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 2025, Eff. 9/24/22.

Mont. Admin. R. 37.106.1460 Quality Management Requirements

(1) The substance use disorder facility (SUDF) must have a quality management committee that is representative of the SUDF's administration and staff members.

(2) The quality management committee must meet on a quarterly basis and is responsible for:

(a) developing a written plan for a continuous quality improvement program that is applicable to the entire organization;

(b) implementing the quality improvement plan and monitoring the quality and appropriateness of services;

(d) at least annually, reviewing and updating the quality improvement plan.

(3) The quality improvement program must include at a minimum:

(a) administrative processes;

(b) fiscal processes;

(d) client outcomes; and

(e) a process for reviewing serious incidents, grievances and complaints, and medication errors.

(4) The SUDF must prepare and maintain on file an annual report including improvements made as a result of the quality management plan.

History

Authorizing statute(s): 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1462 Required Outcome Measures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1466 Pets

(1) When pets are kept on the premises, the SUDF must write and adhere to procedures for their care and maintenance.

(2) When animals are kept on the premises, the following conditions must be met:

(a) proof of current vaccinations must be kept on file at the facility;

(b) pets not confined in enclosures must be under control;

(d) pets are not permitted in food preparation, storage, or dining areas during meal preparation time or during meal service or in an area where their presence would create a significant health or safety risk to others;

(e) staff members and clients must wash their hands after handling animal food and animal waste;

(f) pets must be kept clean and disease-free;

(g) pet enclosures, bedding, equipment, and supplies are kept clean and in good repair; and

(h) protocols are in place to address how reasonable accommodations will be made for clients and staff members with allergies to animals housed in the facility or who may visit the facility as part of a therapeutic treatment program.

(3) The SUDF will not keep or bring in ferrets, turtles, iguanas, lizards, or other reptiles, psittacine birds (birds of the parrot family), or any wild or dangerous animals.

(4) This rule does not apply to service animals.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1467 Food Service

(1) An inpatient or residential SUDF must establish policies and procedures for standards relative to safe food handling, storage, preparation, and serving, to prevent food spoilage and the transmission of infectious disease. The policies and procedures must include provisions that:

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

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

(d) milk and other dairy products must be pasteurized;

(e) use of home canned foods other than jams, jellies, and fruits is prohibited;

(f) use of thermometers is required to check food temperatures;

(g) cold storage of potentially hazardous food must be at 41°F or below;

(h) frozen food must be kept frozen;

(i) hot storage of potentially hazardous food must be 135°F or above;

(j) each type of food must be stored and arranged so that cross-contamination of one type with another is prevented;

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

(l) food packages must be in good condition and protect their contents, so that the food is not exposed to adulteration or potential contaminants; and

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

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

(3) Staff handling or preparing food shall thoroughly wash hands, wrists, and exposed arms with soap and warm running water for at least 20 seconds:

(a) before touching anything used to prepare food;

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

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

(e) after using the toilet facilities;

(f) after eating or drinking;

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

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

(i) after touching any soiled object.

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

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

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

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

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

(d) sinks used for food preparation must be cleaned before beginning the preparation of the food.

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

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

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

(9) Food must be served in amounts and variety sufficient to meet the nutritional needs of each client.

(10) At least three meals must be offered daily and at regular times, with not more than a 12-hour span between an evening meal and breakfast unless a nutritious snack is available in the evening, then up to 14 hours may lapse between a substantial evening meal and breakfast.

(11) Records of menus as served must be on file for three months after the date of service for review by the department.

(12) The SUDF must provide for therapeutic or special diets ordered by the client's licensed health care professional.

(13) A minimum of a one-week supply of non-perishable foods and a two-day supply of perishable foods must be available on the premises.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 2040, Eff. 9/24/22.

Mont. Admin. R. 37.106.1468 Outpatient Substance Use Disorder Facility

(1) To be licensed to provide SUD services in an outpatient setting, a SUDF must meet the following staffing requirements:

(a) clinical director;

(b) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to patients with substance use disorders as described by this chapter and in accordance with the patients' individualized treatment plans; and

(c) care managers in sufficient numbers to provide services to patients required by this chapter and in accordance with the patients' individualized treatment plans.

(2) Skilled treatment services must be provided by an interdisciplinary team of appropriately licensed, certified, and/or trained staff.

(3) An outpatient substance use disorder facility must provide crisis telephone services and comply with the following requirements:

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

(b) answering services or other individuals may be used to transfer calls to individuals trained to respond to crisis calls.

(4) The facility must have written policies and procedures outlining crisis telephone services that include:

(a) training requirements for individuals responding to crisis calls;

(b) ensuring a licensed addition counselor or mental health professional provides consultation and backup, as indicated, for unlicensed individuals responding to crisis calls; and

(5) The facility must maintain documentation for each crisis call that includes:

(a) the date and time of the call;

(b) the staff involved;

(d) the nature of the emergency, including a screening of safety and risk, strengths and resources, and medical concerns related to the crisis; and

(e) the result of the intervention.

(6) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care and supportive housing services must be available through direct affiliation or referral processes.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1469 Asam 2.5 Partial Hospitalization Substance Use Disorder Facility

(1) To be licensed to provide ASAM 2.5 services as outlined in the ASAM Criteria, a SUDF must meet the following staffing requirements:

(a) clinical director;

(b) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to clients with substance use disorders as described by this chapter and in accordance with the clients' individualized treatment plans;

(c) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans; and

(d) rehabilitation aides in sufficient number to provide direct care services and supervision of clients.

(2) The SUDF must have direct access by consultation or referral to medical and psychiatric services within eight hours by telephone or 48 hours in person.

(3) Weekly scheduled skilled treatment services must be provided by an interdisciplinary team of appropriately licensed and trained staff a minimum of 20 hours per week.

(4) If treatment services cannot be provided a minimum of 20 hours in a given week due to unforeseen issues such as illness, medical appointments, or other similar circumstances, the program must document the following:

(a) reason for not meeting the minimum hourly requirements; and

(b) attempts to follow-up and reschedule client treatment services.

(5) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care and supportive housing services must be available through direct affiliation or referral processes.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1470 Facility Requirements

(1) In addition to requirements found in ARM 37.106.320, substance use disorder facilities (SUDF) must comply with additional requirements in this rule.

(2) Facilities must be accessible to a person with a physical disability. If a SUDF is unable to provide access to a person with a physical disability, the program must make arrangements for a referral or other accommodations to assure the person receives appropriate services.

(3) Facilities must meet all applicable building and fire codes and be approved by the authority having jurisdiction to determine if the appropriate building and fire codes are met.

(4) An inpatient or residential SUDF must have an annual fire inspection conducted by the state fire marshal or by the authority having jurisdiction, and must maintain a record of the inspection for at least three years following the date of the inspection.

(5) Exit doors shall not include locks which prevent evacuation, except as approved by the fire marshal and building codes agency having jurisdiction.

(6) Stairways, halls doorways, passageways and exits from rooms and from the facility must be kept unobstructed at all times.

(7) All exterior pathways, entrances, and exit ways shall be of hard, smooth material, and be unobstructed and in good repair at all times.

(8) A 2A10BC portable fire extinguisher shall be available on each floor of the facility or as required by the fire authority having jurisdiction.

(9) Portable fire extinguishers must be inspected, recharged, and tagged at least once a year by a person certified by the state to perform these services.

(10) A smoke detector, approved by a recognized testing laboratory, which is properly maintained and regularly tested, must be located on each level and in all sleeping areas, bedroom hallways, and common living areas, with the exception of the kitchen and bathrooms of a SUDF or as required by the fire authority having jurisdiction.

(11) If individual battery-operated smoke detectors are used, the following maintenance is required:

(a) smoke detectors must be tested at least once a month to ensure that they are operating correctly;

(b) new operating batteries must be installed at least once each calendar year; and

(12) Garbage and refuse must be:

(a) kept in durable, easily cleanable, insect and rodent proof containers that do not leak and do not absorb liquids. Plastic bags and wet strength paper bags may be used to line these containers; and

(b) disposed of daily and removed from the property at least weekly to prevent the development of odor and attraction of insects and rodents.

(13) Refuse and recycling containers stored outside the facility, dumpsters, compactors, and compactor systems must be easily cleanable, must be provided with tight-fitting lids, doors, or covers, and must be kept covered when not in actual use.

(14) All operable windows must have a screen in good repair.

(15) Each room or area occupied by children under age five or clients with unsafe behaviors must have tamper resistant electrical outlets and hardware.

(16) Facilities must have adequate private space for personal consultation with a client, staff member charting, and therapeutic and social activities, as appropriate.

(17) Poison control and emergency contacts must be posted at each telephone.

(18) Facilities must have a first aid kit readily available on each floor.

(19) Measures must be in place to ensure containers of poisonous and toxic materials are stored safely and contain a legible manufacturer's label or material safety data (MSD) sheets.

(20) Maintenance and cleaning tools must be maintained and stored in a safe and orderly manner.

(21) Bathroom requirements include the following:

(a) a minimum of one toilet and hand washing sink for every four clients;

(b) a sink located in or immediately accessible to each toilet room;

(d) hand cleansing soap or detergent must be available. The use of a communal bar soap is prohibited;

(e) individual towels must be available; and

(f) a waste receptacle must be located in each bathroom.

(22) Bedroom requirements include the following:

(a) single occupancy rooms must be at least 100 square feet;

(b) multiple person bedrooms must be at least 60 square feet per person (includes children in parent and children recovery homes);

(d) direct access to a hallway, living room, lounge, the outside, or other common use area without going through a laundry or utility area, a bath or toilet room, or another client's bedroom;

(e) each bedroom has one outside window with visual privacy;

(f) a bed for each client;

(g) one noncombustible waste container; and

(h) a wardrobe, dresser, or closet with shelving for storing a reasonable amount of clothing.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1471 Asam 3.1 Clinically Managed Low Intensity Residential (adult or Adolescent) Substance Use Disorder Facility

(1) To be licensed to provide ASAM 3.1 services as outlined in the ASAM Criteria, a SUDF must meet the following staffing requirements:

(a) clinical director;

(c) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans;

(d) rehabilitation aides in sufficient numbers to provide direct care support services as outlined in the clients' individualized treatment plans; and

(e) on-site awake staffing whenever clients are present in the facility.

(2) Weekly scheduled clinical skilled treatment services in addition to other scheduled psychosocial rehabilitation services must be provided on-site or off-site a minimum of five hours per week. Documentation of skilled treatment services provided both on-site and off-site must be available at the facility.

(3) Life skills training provided in a one on one or classroom setting, as part of the daily living regiment, must utilize an evidence-based practice addressing independent living skills, vocational skills, and parenting skills.

(4) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 2040, Eff. 9/24/22.

Mont. Admin. R. 37.106.1472 Asam 3.3 Clinically Managed Population-Specific High Intensity Residential (adult Only) Substance Use Disorder Facility

(1) To be licensed to provide ASAM 3.3 services as outlined in the ASAM Criteria, a SUDF must provide on-site 24-hour awake staffing and meet the following staffing requirements:

(a) a physician, physician assistant, or advanced practice registered nurse acting within the scope of the license issued by the Department of Labor and Industry available for consultation within 24 hours in person or by telephone;

(b) clinical director;

(c) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to clients with substance use and mental disorders as described by this chapter and in accordance with the clients' individualized treatment plans;

(d) a licensed addiction counselor or mental health professional must be on-site or on call 24 hours a day, seven days a week;

(e) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans; and

(f) rehabilitation aides in sufficient number to provide direct care support services as outlined in the clients' individualized treatment plans.

(2) Daily clinical skilled treatment services in addition to other scheduled psychosocial rehabilitation services must be provided on-site. Services must be adapted to the client's developmental stage and level of comprehension in accordance with the client's individualized treatment plan.

(3) Individuals with significant cognitive deficits require specialized services to be offered at a slower, repetitive pace.

(4) The SUDF must provide recreational activities daily.

(5) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1473 Asam 3.5 Clinically Managed High Intensity Residential (adult)/Medium Intensity Residential (adolescent) Substance Use Disorder Facility Requirements

(1) To be licensed to provide ASAM 3.5 services as outlined in the ASAM Criteria, a SUDF must provide on-site 24-hour awake staffing and meet the following staffing requirements:

(b) clinical director;

(d) a licensed addiction counselor or mental health professional must be on-site or on call 24 hours a day, seven days a week;

(e) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans; and

(f) rehabilitation aides in sufficient number to provide direct care support services as outlined in the clients' individualized treatment plans.

(2) Daily clinical skilled treatment services, in addition to other scheduled psychosocial rehabilitation services, must be provided on-site a minimum of 30 hours per week.

(3) The SUDF must provide recreational activities daily.

(4) The SUDF must coordinate transfers with other licensed health care facilities or correctional facilities.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1475 Asam 3.7 Medically Monitored Intensive Inpatient Requirements

(1) To be licensed to provide ASAM 3.7 services, as outlined in the ASAM criteria, a substance use disorder facility (SUDF) must meet the following staffing requirements:

(a) a medical director that oversees the treatment process, medication management, and all medical services;

(b) a physician, nurse practitioner, or physician assistant licensed under Title 37, chapters 3 or 20, MCA, available on-call 24 hours a day, seven days a week to provide medical consultation, evaluate clients, and prescribe medications;

(c) a registered nurse (RN) licensed under Title 37, MCA, on-site or on call 24 hours a day, seven days a week to supervise nursing services;

(d) a RN or licensed practical nurse (LPN) on-site 24 hours a day, seven days a week;

(e) additional RNs, LPNs or certified nurse aides (CNA) in sufficient numbers to assist in the administration of medical protocols and assure the client's safety. LPNs and CNAs must be under the supervision of the RN;

(f) licensed addiction counselors or mental health professionals in sufficient numbers to provide therapeutic services to clients with substance use and mental disorders, as described by this chapter and in accordance with the clients' individualized treatment plans;

(g) a licensed addiction counselor or mental health professional must be on-site or on-call 16 hours a day, seven days a week;

(h) care managers in sufficient numbers to provide adequate services to clients; and

(i) rehabilitation aides in sufficient number to provide on-site 24 hours a day, seven days a week staffing patterns to ensure the safety of clients and to provide direct care services and appropriate supervision of clients.

(2) Medical service must be provided, according to written physician approved protocols, 24 hours a day, seven days a week and must include:

(a) a physical examination and screening conducted by a physician, nurse practitioner, or a physician assistant of clients on-site within 24 hours of admission, to identify medical needs for health problems and screen for communicable diseases;

(b) a comprehensive nursing assessment that includes a mental health screening and evaluates the need for acute intoxication and withdrawal management services completed by a registered nurse at the time of admission; and

(3) Daily clinical skilled treatment services and medical services must be provided on-site by an interdisciplinary team seven days a week.

(4) The SUDF must provide recreational activities seven days a week.

(5) All progress notes must be completed in a timely manner and before the next session of the same type or there must be documentation why this did not occur.

(6) The SUDF must ensure a coordinated transfer to an acute care hospital or other licensed health care facilities.

(7) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1480 Withdrawal Management Program Requirements

(1) To be licensed to provide clinically managed residential withdrawal management defined as ASAM 3.2-WM, a provider must be licensed as an inpatient or residential health care facility program pursuant to 50-5-101, MCA, and meet the following:

(a) The facility must be equipped for clients who are impaired due to substances and may require safety rails on beds pursuant to ARM Title 37, chapter 106, subchapter 29, handrails on showers, and other related equipment to assure the safety of impaired clients.

(b) The SUDF must have physician approved protocols for the monitoring of clients in withdrawal including when and under what circumstances clients should be transferred to another health care facility.

(c) The SUDF must have a written agreement with the health care facility or physician providing for emergency services when needed.

(d) The SUDF must have written procedures specifying how staff will respond to emergencies and for the transfer of medically unstable clients.

(e) The SUDF must have sufficient staff on duty 24 hours a day, seven days a week to supervise, observe, and support clients who are intoxicated or experiencing withdrawals.

(f) The SUDF must train staff in physician approved protocols for monitoring clients in withdrawal and in medication management if medication is administered.

(g) The SUDF must have licensed addiction counselors (LAC) or mental health professionals in sufficient numbers to provide counseling and therapy services as described in this chapter and in accordance with the client's individualized treatment plan.

(h) The initial biopsychosocial assessment indicating this level of care must be reviewed by a licensed physician, nurse practitioner, or physician assistant during the admission process.

(i) The SUDF must provide daily clinical skilled treatment services to address the needs of each client. Clinical skilled treatment services may include medical services, individual and group therapy, and withdrawal support as required in the client's individualized treatment plan.

(j) The SUDF must ensure regular vital signs are taken and recorded by staff trained to recognize symptoms indicating the client is becoming physically unstable.

(k) All progress notes must be completed in a timely manner and before the next session of the same type, or there must be documentation why this did not occur.

(l) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.

(2) The facility providing clinically managed residential withdrawal management (ASAM 3.2) must not exceed the number of inpatient or residential beds licensed for pursuant to 50-5-101 MCA.

(3) To be licensed to provide medically managed inpatient withdrawal, as defined as ASAM Level 3.7-WM, a provider must be licensed as an inpatient substance use disorder facility and meet the requirements under ARM 37.106.1475 and the following:

(a) a RN must be on-site 24 hours a day, seven days a week to monitor clients receiving acute intoxication or withdrawal management services and administer services according to physician approved protocols;

(b) the facility must be equipped for clients who are impaired due to substances and who require assistive safety devices, as written in the physician approved protocols;

(d) emergency equipment to include:

(i) oxygen;

(ii) automatic external defibrillator (AED);

(iii) suction machine; and

(iv) other emergency equipment according to the physician approved protocols for responding to client health emergencies.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1482 Halfway House Community-Based Residential Program Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1485 Single Sex Parent and Children Requirements

(1) In addition to the licensing requirements in ARM 37.106.1471, a SUDF operating as a single sex parent and children ASAM 3.1 facility, must meet the following requirements:

(a) care management services must address the needs of the client's children in care;

(b) parenting skills must be addressed with evidence-based models that focus on the demands of being a parent in recovery; and

(c) the SUDF must provide age-appropriate services to meet the children's needs. Services include childcare, medical appointments, legal services, transportation, educational services, and recreational services.

(2) Cleaning materials, flammable liquids, detergents, aerosol cans, and other poisonous and toxic materials must be kept in their original containers and in a place inaccessible to children. The materials must be used in such a way that will not contaminate play surfaces, food, food preparation areas, or constitute a hazard to the children.

(3) No extension cords can be used as permanent wiring. All appliances, lamp cords, and exposed light sockets must be suitably protected to prevent electrocution.

(4) Indoor and outdoor play areas must be clean, reasonably neat, and free from accumulation of dirt, rubbish, or other health hazards.

(5) Any outdoor play area must be maintained free from hazards such as wells, machinery, and animal waste. If any part of the play area is adjacent to a busy roadway, drainage or irrigation ditch, stream, large holes, or other hazardous areas, the play area must be enclosed with a fence in good repair that is at least four feet high without any holes or spaces greater than four inches in diameter or natural barriers to restrict children from these areas.

(6) Outdoor play areas must be designed to ensure all areas are always visible and easily supervised by staff members.

(7) Outdoor equipment, such as climbing apparatus, slides, and swings, must be anchored firmly, and placed in a safe location according to manufacturer's instructions. Recommended ground covers under these items include sand, fine gravel, or woodchips with a depth of the ground cover being at least six inches.

(8) Trampolines are prohibited for use by children in care.

(9) Toys, play equipment, and any other equipment used by children must be of substantial construction and free from rough edges, sharp corners, splinters, unguarded ladders on slides, and must be kept in good repair and well maintained.

(10) Toys and objects with a diameter of less than one inch (2.5 centimeters), objects with removable parts with a diameter of less than one inch (2.5 centimeters), plastic bags, Styrofoam objects, and balloons must not be accessible to children who are still placing objects in their mouths.

(11) The Emergency Montana Poison Control Center number, (800) 222-1222, must be posted at all telephone locations in the facility.

(12) Use of waterbeds, water mattresses, gel pads, or sheepskin covers for children's sleeping surfaces is prohibited.

(13) Each infant under 18 months of age must be provided with a crib for sleeping.

(14) Each child 18 months of age and older must be provided with a bed for sleeping.

(15) Cribs must be made of durable, cleanable, nontoxic material, and have secured latching devices.

(16) Cribs must have no more than 2 and 3/8 inches of space between vertical slats.

(17) Cribs must meet requirements for full-size baby cribs and non-full-size baby cribs as specified by the Consumer Product Safety Commission at 16 CFR Part 1219 and 16 CFR Part 1220 (2011), incorporated by these references. Copies of the requirements for full-size baby cribs and non-full-size baby cribs are available at https://www.cpsc.gov/SafeSleep .

(18) Crib mattresses must fit snugly to prevent the infant from being caught between the mattress and crib siderail. Crib mattresses must be waterproof and easily sanitized.

(19) Cribs, cots, or mats must be thoroughly cleansed before assignment to another infant or toddler.

(20) Age-appropriate feeding equipment must be provided for every four infants or toddlers. This includes safe high-chairs, baby feeding tables, booster seats, and child-size tables and chairs. This equipment must be used in accordance with the manufacturer's instructions and must be appropriate for the age of the child using the equipment. Portable high-chairs that hook onto tables are prohibited.

(21) If the SUDF chooses to lock the facility door to prevent unauthorized access to the facility or to prevent a child from escaping, the facility must have no lock or fastening device which prevents free escape from the interior. Requirements include:

(a) locking devices must not require a key, a tool, or special knowledge or effort to open the door from the inside; and

(b) locked doors must be easily opened with one motion from the inside of the facility.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; AMD, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1487 Halfway House Single Gender Residential Homes (asam Level Iii.5 – High Intensity)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Mont. Admin. R. 37.106.1489 Halfway House Single Gender Community-Based Residential Homes (asam Level Iii.3 – Medium Intensity)

(1) Community-based single gender residential homes for individuals with substance use disorders may be located in residential neighborhoods, comparable to other homes in the neighborhood, and shall reflect the environment of a home. To be licensed to provide community-based residential homes for individuals with substance use disorders ASAM Level III.3 medium intensity treatment, a provider must meet the following:

(a) staffing or security measures sufficient to assure the safety of residents, staffing requirements may include but are not limited to:

(i) licensed addiction counselor (LAC);

(ii) individuals trained in managing co-occurring disorders;

(iii) case managers that have a minimum of two years of higher education or four or more years of related work experience and orientation to the facility's policies and procedures; and

(iv) rehabilitation aides that have a minimum of a high school diploma or GED and orientation to the facilities policies and procedures.

(b) service requirements including but not limited to the following program policies must address:

(i) these homes as transitional versus permanent living environments and how they provide interim supports and services for persons with substance use disorders and related problems;

(ii) admission criteria indicating that the individual is appropriate for these settings;

(iii) define the criteria for the length of stay in the facilities;

(iv) how clinical treatment is provided either on- or off-site; and

(v) how life skills training including vocational services is incorporated into daily residential living to prepare residents to assume permanent housing and independent living.

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10.

Mont. Admin. R. 37.106.1491 Halfway House Community-Based Single Gender Residential Homes (asam Level Iii.1 – Low Intensity)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, 53-24-208, MCA
Implementing statute(s): 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
History: NEW, 2010 MAR p. 2975, Eff. 12/24/10; REP, 2022 MAR p. 1889, Eff. 9/24/22.

Subchapter 37.106.15 Minimum Standards for Specialty Care Health Care Facilities

Mont. Admin. R. 37.106.1505 Minimum Standards for a Home Health Agency

(1) A home health agency shall comply with the Conditions of Participation for Home Health Agencies as set forth in 42 CFR subchapter G part 484. A copy of the cited requirements may be obtained from the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-404, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Mont. Admin. R. 37.106.1506 Minimum Standards for a Health Maintenance Organization

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-404, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-204 and 50-5-404, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 185; REP, 2004 MAR p. 338, Eff. 2/13/04.

Subchapter 37.106.16 Minimum Standards for a Forensic Mental Health Facility

Mont. Admin. R. 37.106.1601 Purpose

(1) These rules establish minimum standards for a licensed mental health center to operate a secured forensic mental health facility (FMHF) for adults who are committed for custody, care, treatment, or evaluation pursuant to Title 46, chapter 14, MCA, or who are inmates of a correctional facility receiving treatment in a separate mental health setting.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1602 Scope

(1) A forensic mental health facility (FMHF) of a licensed mental health center provides twenty-four hour, seven days a week, secured nonhospital-based forensic mental health services for adults who are:

(a) committed to a mental health facility for evaluation of fitness to proceed pursuant to 46-14-202(2), MCA;

(b) committed to the custody of the director of the department to be placed for treatment to gain fitness to proceed pursuant to 46-14-221, MCA;

(c) committed to the custody of the director of the department to be placed for custody, care, and treatment under 46-14-301, MCA;

(d) admitted to an FMHF under a court order for a mental evaluation to be included in a pre-sentence investigation under 46-14-311, MCA;

(e) sentenced to be committed to the custody of the director of the department to be placed for custody, care, and treatment under 46-14-312, MCA;

(f) in the custody of the Department of Corrections and transferred to an FMHF under 53-21-130, MCA, or accepted for voluntary admission following such a transfer under 53-21-111, MCA; or

(g) committed to the Montana State Hospital under 53-21-127, MCA, while serving a sentence at a correctional facility.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1603 Application of Rules

(1) In addition to the requirements established in this subchapter, a licensed mental health center operating a forensic mental health facility (FMHF) must have an FMHF program endorsement issued by the department. To receive an FMHF program endorsement, the licensed mental health center must establish, to the department's satisfaction, that it meets the requirements stated in these rules.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1604 Application of Other Rules

(1) In addition to the requirements established in this subchapter, each licensed mental health center operating a forensic mental health facility (FMHF) must comply with all the requirements established in ARM Title 37, chapter 106, subchapter 3, with the exception of ARM 37.106.302 and 37.106.316.

(2) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter will apply to an FMHF.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1605 Definitions

(1) "Adult" means an individual 18 years of age and older.

(2) "Emergency situation" has the meaning given to it by 53-21-102, MCA.

(3) "Forensic mental health services" means mental health services for persons referred for care, custody, treatment, or evaluation by or through the criminal justice system.

(4) "Immediate emergency" means a situation involving a client that jeopardizes the immediate physical safety of a client, a staff member, or others.

(5) "Involuntary medication" means medication administered to a client when one or more of the following circumstances are present:

(a) administration of medication is against the specific wish of a client, made evident by verbal or nonverbal behavior reasonably interpreted as an objection;

(b) a client who does not have a legally appointed guardian lacks capacity to give informed consent; or

(6) "Licensed health care practitioner" means a licensed physician, physician assistant, or advanced practice registered nurse who is practicing within the scope of the license issued by the Department of Labor and Industry under Title 37 of the MCA.

(7) "Licensed health care professional" means a licensed physician, physician assistant, advanced practice registered nurse, or registered nurse who is practicing within the scope of the license issued by the Department of Labor and Industry under Title 37 of the MCA.

(8) "Medication administration" means an act in which a prescribed drug or biological is given to a client by an individual who is authorized under state laws and regulations governing such acts.

(9) "Restraint" means:

(a) any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a client to move his or her arms, legs, body, or head freely;

(b) a drug or medication when it is used to restrict the patient's behavior or freedom of movement and is not a standard treatment or dosage for the patient's condition;

(c) restraint does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a client for the purpose of conducting routine physical examinations or tests, or to protect the client from falling out of bed, or to permit the client to participate in activities without the risk of physical harm (this does not include a physical escort); or

(d) restraint does not include medications administered during an immediate emergency which are individually prescribed to assist a client to regain control of the client's dangerous behavior.

(10) "Sally port" means a secure entry way that consists of a series of doors or gates.

(11) "Seclusion" means the involuntary confinement of a client alone in a room or area from which the client is physically prevented from leaving. Confining clients to his or her bedrooms during medication administration, shift changes, or facility emergencies does not constitute seclusion for the purposes of this rule.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1608 Construction Requirements

(1) Prior to construction or operation of a forensic mental health facility (FMHF), floor plans for the FMHF must be submitted to the department for review, comment, and approval. The department must also inspect and approve any new construction or any addition or alteration to an FMHF prior to occupancy.

(2) Prior to occupancy of an FMHF, or any addition or alteration to an FMHF, the FMHF must undergo an onsite inspection and receive the approval of the department's License Bureau, Construction Consultant.

(3) Any building used as an FMHF must be classified at a minimum as International Conference of Building Officials (ICBO) Construction type I-FR, or greater.

(4) All areas of an FMHF must be protected by automatic fire suppression. In unsupervised client areas, sprinkler heads must be recessed or of a design to restrict client access. An FMHF must provide the following:

(a) an operable UL listed fire alarm system with automatic response notification on alarm; and

(b) supervised smoke detectors throughout the facility reporting to the fire alarm system.

(5) An FMHF must meet the water supply system requirements of ARM 37.111.115.

(6) An FMHF must meet the sewage system requirements of ARM 37.111.116.

(7) An FMHF must have a double fence installed around any client accessible area.

(8) Each fence must be a minimum of 12 feet high, and

(a) have unclimbable security mesh fabric installed on the top five feet;

(b) have concertina wire installed on the top; and

(9) There must be a minimum 12 feet between the two fences that is free of all above ground obstructions.

(10) An FMHF must have an outside assembly area of refuge for facility evacuation during an emergency. The area must be:

(a) fenced and secured and large enough to safely hold all clients and staff; and

(b) far enough from the building to be considered a safe public way.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1609 Secured Units

(1) A forensic mental health facility (FMHF) must have one or more separate secured unit(s) within the facility for housing clients that includes bedrooms and common space.

(2) A secured unit must be staffed at all times clients are present in the unit.

(3) A secured unit must have a staff station to include the following:

(a) provisions for charting;

(b) provisions for hand washing;

(d) telephone access.

(4) A secured unit must have access to a nourishment station or to a kitchen that must include the following:

(a) a work counter;

(b) a refrigerator;

(d) a sink;

(e) space for trays and dishes used for nonscheduled meal service;

(f) hand washing facilities immediately accessible to clients and staff; and

(g) ice for client consumption provided by icemaker-dispenser units or periodically made available during the day.

(5) A common space within each secured unit must be provided at a ratio of 35 square feet per client.

(6) The corridors of a secured unit must have general illumination with provisions for reducing light levels at night.

(7) No more than one client must reside in a bedroom.

(8) Client bedrooms must be at a minimum of 70 square feet and must include the following:

(a) a bed with a waterproof mattress;

(b) a small wardrobe, dresser, shelves, or bed compartment for storage of clients' personal items;

(c) general lighting and night lighting, control for night lighting may be located outside the room at the room entrance;

(d) electrical outlets that are tamper-resistant and GFI-protected, outlets may be controlled from outside of the room;

(e) a window with a minimum of 248 square inches of glazing which must be designed to limit the opportunity for clients to inflict serious harm as a result of breaking the window and using pieces to inflict harm on themselves or others. Windows:

(i) must be of tempered glass or laminated safety glass to resist impact loads; and

(ii) if operable, must have security locks.

(9) Sinks and toilets may be provided in client rooms. The fixtures may be controlled from outside of the room.

(10) An FMHF must not use automatic door closures unless required. If required, such closures must be mounted on the public side of the door within view of a staff work station or under video surveillance.

(11) An FMHF must use doors that:

(a) have door hinges designed to minimize points for hanging (i.e., cut hinge type); and

(b) have tamper-resistant fasteners.

(12) An FMHF must provide:

(a) at least one toilet for every eight clients;

(b) at least one bathing unit for every twelve clients, a shower or tub is not required if the FMHF utilizes a central bathing unit for all clients; and

(c) doors to toilet rooms or bathing units that swing out or slide into the wall and which must be capable of being unlocked from the outside.

(13) Toilet rooms and bathing units may be under key control by staff.

(14) An FMHF must not use towel bars, clothing rods, hooks, or lever handles.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1610 Common Use Areas

(1) A forensic mental health facility (FMHF) must have an area for social activities at a minimum of 25 square feet per client.

(2) An FMHF must have a quiet area for clients to utilize according to facility policy.

(3) An FMHF must have a dining space at a minimum of 35 square feet per client. The dining space may be located off a secured unit in a central area.

(4) An FMHF must have a minimum of two classrooms with work tables or desks for client use.

(5) If an FMHF has a vocational training area, it must be equipped with appropriate tools and code-compliant equipment for client use.

(6) An FMHF must have a gymnasium and a separate client exercise room which includes appropriate exercise equipment in sufficient quantity for client use.

(7) An FMHF must have a secured outside recreational exercise area with both an enclosed individual client area and a large fenced group area.

(8) An FMHF must have examination or treatment rooms for private consultation. These rooms must have at a minimum the following:

(a) 100 square foot floor area;

(b) a hand-washing station;

(d) a desk, counter, or shelf space for writing or electronic documentation.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 53-5-201, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1611 Observation and Seclusion Room(s)

(1) A forensic mental health facility must designate specific room(s) designed for observation, seclusion, and restraint purposes.

(2) The location of these rooms must facilitate staff observation and monitoring of clients in these areas.

(3) The room must be equipped with video and audio monitoring equipment.

(4) The room must have a minimum of 60 square feet and a ceiling height of nine feet. Ceilings in seclusion rooms must be monolithic.

(5) Rooms used for observation, seclusion, and restraint must be designed to prevent injury to clients. All finishes, light fixtures, vents and diffusers, and sprinklers must be tamper resistant. These rooms must not have: electrical outlets, medical gas outlets or similar devices; sharp corners, edges, or protrusions. The wall must be free of objects or accessories of any kind. Doors must swing out or be a slide in pocket door and have hardware on the exterior side only. The door must be a minimum width of 44 inches and include an impact resistant view panel for discreet staff observation of the client. The use of impact resistant one-way observation windows is permitted.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1614 Written Policies and Procedures

(1) As required in ARM 37.106.1908, a forensic mental health facility (FMHF) must maintain a policy and procedure manual. The policy and procedure manual must be reviewed and updated as necessary, but at a minimum annually.

(2) In addition to the other requirements of ARM 37.106.1908, the manual must include policies and procedures for:

(a) security;

(b) involuntary administration of medication;

(d) client rights and grievances;

(e) client admission criteria;

(f) restraint and seclusion;

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

(h) establishing and maintaining staffing requirements;

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

(j) food services; and

(k) the detection, reporting, and investigation of abuse and neglect.

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

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1615 Security

(1) A forensic mental health facility (FMHF) must develop security policies and procedures. At a minimum the policies and procedures must address the following:

(a) securing the facility;

(b) summoning outside assistance in the event of an emergency;

(d) contraband searches.

(2) An FMHF must have security vestibules or secured car ports or Sally Ports at all facility entrances.

(3) An FMHF security system must be capable of containing clients within secured units when necessary according to FMHF policy.

(4) An FMHF security system must be designed to prevent contraband smuggling and must include provisions for monitoring and controlling visitor access and egress.

(5) All openings into and out of and within the FMHF, e.g., windows, doors, and gates, must be equipped with manual, electric, or magnetic locks.

(6) An FMHF must provide visual control, i.e., electronic surveillance, of all FMHF corridors, dining areas, classrooms, and social areas.

(7) Except for use in seclusion or observation rooms, electronic surveillance is not permitted in client bedrooms, bathing units, or toilets.

(8) Electronic surveillance of a secured unit does not substitute for direct supervision where required by facility policy.

(9) Special design considerations for injury or suicide prevention must be given to all facility details, finishes, and equipment.

(10) An FMHF must provide an enclosed secured car port for the receiving, discharge, transfer, or the transportation of clients. The car port must be separated using Underwriters Laboratory or Factory Mutual rated construction providing a minimum of two-hour fire resistance.

(11) Staff may confine clients to their rooms for all scheduled medication passes, for all staff shift changes, and during any facility emergency. Medication administration and shift changes will last no longer than 30 minutes, and must be limited to no more than three 30-minute periods in a 24-hour period.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1616 Involuntary Medication Administration

(1) A forensic mental health facility (FMHF) must develop and implement a policy for involuntary medication administration that includes:

(a) procedures for use in an immediate emergency or an emergency situation to ensure the physical safety of the client, a staff member, or others;

(b) an administrative review process for use when involuntary medication is clinically indicated for a client who is gravely disabled or poses a likelihood of serious harm to themselves, others, or property as a result of a mental disease or disorder. The process must include:

(i) a formal review within five working days of beginning the involuntary administration of medication, by a medication review committee which includes the medical director of the FMHF, the designee, or both and at least one qualified psychiatrist who is not employed at the FMHF. No committee member may be directly involved in the client's care;

(ii) an opportunity for the client to appear before the panel in person and with a representative of the client's choice, and to provide testimony and evidence;

(iii) written advance notice of the review and the right to participate which must be given to the client, guardian, and Mental Disabilities Board of Visitors;

(iv) an opportunity for review of the decision of the panel by the director of the licensed mental health center;

(v) review by the committee at 14 and 90 days after the initial authorization of involuntary administration of medication.

(c) procedures for seeking and implementing a court order authorizing involuntary administration of medication for clients who are placed at the FMHF under 46-14-221, MCA, and for whom the sole purpose of involuntary medication is to gain fitness to proceed.

(2) Attempts must be made to administer medications with the full consent of the client receiving those medications. Such attempts must be documented.

(3) Involuntary medications must be discontinued when no longer necessary as determined by a licensed health care practitioner.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1617 Restraint and Seclusion

(1) A forensic mental health facility (FMHF) must be capable of providing restraint or seclusion and must ensure that such restraint or seclusion is performed in compliance with 53-21-146, MCA.

(2) The use of medication solely for restraint is prohibited.

(3) Restraint or seclusion may only be used when less restrictive interventions have been determined to be ineffective to protect the client, staff, or others from harm.

(4) The type and technique of restraint or seclusion must be the least restrictive intervention that will be effective to protect the client, staff, or others from harm.

(5) The use of restraint or seclusion must be implemented in accordance with safe and appropriate restraint and seclusion techniques as determined by facility policy.

(6) Orders for the use of restraint or seclusion must never be written as a standing order or on an as-needed basis (PRN).

(7) A verbal or written order must be obtained from the licensed health care practitioner prior to initiation or as soon as possible after emergency initiation of seclusion or restraint.

(8) A licensed health care practitioner or registered nurse, in accordance with facility policy, must see the client face-to-face within one hour of the initiation of restraint or seclusion to evaluate:

(a) the client's immediate situation;

(b) the client's reaction to the intervention;

(d) the need to continue or terminate the restraint or seclusion.

(9) Each original order and renewal order authorizing the use of restraint or seclusion is limited to eight hours, up to a total of 24 hours. After 24 hours and before writing a new order, a licensed health care practitioner must see and assess the client.

(10) Staff must provide clients in restraint or seclusion with constant in-person observation for the first hour; after the first hour in-person observation can be replaced by audio and visual equipment according to facility policy.

(11) Restraint or seclusion must be discontinued at the earliest possible time, regardless of the length of time identified in the order.

(12) A licensed health care professional must monitor the condition of the client who is restrained or secluded at an interval determined by facility policy.

(13) Each incident of restraint or seclusion must be documented in the client's medical record and must include:

(a) each order and renewal order;

(b) the one-hour face-to-face medical and behavioral evaluation;

(d) start and end times of the restraint or seclusion and the names of staff implementing interventions;

(e) alternatives or other less restrictive interventions attempted, as applicable;

(f) the client's condition or symptom(s) that warranted the use of restraint or seclusion;

(g) the client's response to the intervention(s) used, including the rationale for continued use of the intervention; and

(h) monitoring of the client in restraint or seclusion as required by facility policy.

(14) Staff must be trained and able to demonstrate competency in the application of restraints, implementation of seclusion, monitoring, assessment, and providing care for a client in restraint or seclusion. The training must include:

(a) techniques to identify staff and client behaviors, events, and environmental factors that may trigger circumstances that require the use of a restraint or seclusion;

(b) the use of nonphysical interventions skills;

(c) choosing the least restrictive interventions based on an individual assessment of the client's medical or behavioral status or condition;

(d) the safe application and use of all types of restraint or seclusion used in the facility, including training in how to recognize and respond to signs of physical and psychological distress; and

(e) clinical identification of specific behavioral changes that indicate restraint or seclusion is no longer necessary.

(15) Staff must receive training prior to performing any actions specified in this rule and annually thereafter.

(16) An FMHF must document in the staff personnel records that training and demonstration of competency was successfully completed.

(17) The use of simultaneous restraint and seclusion is prohibited.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1618 Staffing Requirements

(1) Employees of a forensic mental health facility (FMHF) must be 18 years of age and possess a high school diploma or general equivalency diploma (GED) at a minimum.

(2) Employees must receive orientation and training in areas relevant to the employee's duties and responsibilities including:

(a) an overview of the FMHF policy and procedure manual in areas relevant to the employee job responsibilities;

(b) a review of the employee job description;

(d) rights of persons served; and

(e) safety and emergency response procedures;

(f) basic first aid; and

(g) certification in cardiopulmonary resuscitation (CPR).

(3) All direct-care staff must receive full orientation before providing direct client care or treatment. In addition to meeting these requirements, direct-care staff must be trained to perform the services established in each client's treatment plan.

(4) CPR certification must be kept current.

(5) Direct-care staff must have knowledge of each client's needs and any events about which the employee should notify the administrator or the administrator's designated representative.

(6) An FMHF must have a sufficient number of qualified staff on duty 24 hours a day to meet the scheduled and unscheduled needs of each client, to respond in emergency situations, and to provide all related services including:

(a) maintenance of order, safety, and cleanliness;

(b) assistance with medication regimens;

(d) housekeeping services and assistance with laundry; and

(e) assurance that each client receives the supervision and care required by the treatment plan.

(7) Site-based supervisors must be on-duty 24 hours a day, seven days per week.

(8) An FMHF must be staffed by a registered nurse (RN) 24 hours a day, seven days per week. The RN may also serve as a supervisor.

(9) An FMHF must provide access to ancillary services such as laboratory or radiological services directly or by contracting with a facility licensed to provide such services.

(10) An FMHF must employ at least one licensed health care practitioner to monitor and evaluate the client's medical and psychiatric treatment. At all times, a licensed health care practitioner must be on duty or on call and available physically to the facility within one hour. The licensed health care practitioner may also be the medical director.

(11) An FMHF must have a sufficient number of qualified licensed mental health professionals on staff to meet the needs of the clients as outlined in facility policies and the clients' individualized treatment plans.

(12) An individual on each work shift must have keys to all relevant client care areas and access to all items needed to provide appropriate client treatment and care.

(13) An FMHF must provide ongoing staff training a minimum of 20 hours annually.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1621 Client Admission

(1) A forensic mental health facility (FMHF) must develop and implement a written policy regarding admission into the facility for the persons identified in ARM 37.106.1602. The policy must include a screening process to identify and exclude from admission persons who need a hospital level of care.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1622 Client Discharge and Transfer

(1) A forensic mental health facility (FMHF) must develop and implement a discharge and transfer policy for discharging a client from the FMHF to another facility.

(2) The policy must include procedures for secure transportation of clients.

(3) The facility must ensure coordinated transfers with other licensed health care facilities or correctional facilities.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1623 Client Rights and Grievances

(1) Clients admitted to a forensic mental health facility (FMHF) must be afforded all of the rights provided for persons admitted to a mental health facility in Title 53, chapter 21, part 1, MCA.

(2) A copy of these rights must be posted in each secure unit of the facility.

(3) These rights must also be explained at the time of admission to the client in terms that the client can understand.

(4) An FMHF must develop a written client grievance policy to include:

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

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

(i) the name of the facility contact person;

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

(iii) the results of the grievance process; and

(iv) the date of completion.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1624 Food Service

(1) A forensic mental facility (FMHF) must establish and maintain standards relative to food sources, refrigeration, refuse handling, pest control, storage, preparation, procuring, serving, handling food, and dish washing procedures that are sufficient to prevent food spoilage and the transmission of infectious disease. These standards must include the following:

(a) a requirement that food must be obtained from sources that comply with all laws relating to food and food labeling;

(b) a prohibition of the use of home-canned foods;

(c) a requirement that food subject to spoilage is removed from its original container and kept sealed, labeled, and dated.

(2) Foods must be served in amounts and with enough variety to meet the nutritional needs of each client. An FMHF must provide therapeutic diets when prescribed by the client's practitioner. At least three meals must be offered daily and at regular times, with not more than a 12-hour span between an evening meal and breakfast unless a nutritious snack is available in the evening, then up to 16 hours may lapse between a substantial evening meal and breakfast.

(3) Records of menus as served must be filed on the premises for three months after the date of service.

(4) An FMHF must have an approved dietary manual for reference when preparing meals for clients requiring therapeutic or special diets. Dietitian consultation must be provided as necessary and documented for clients requiring therapeutic or special diets.

(5) Potentially hazardous food, such as meat and milk products, must be stored at 41° F or below. Hot food must be kept at 140° F or above during preparation and serving.

(6) Freezers must be kept at a temperature of 0° F or below and refrigerators must be kept at a temperature of 41° F or below. Thermometers must be placed in the warmest area of the refrigerator and freezer to ensure proper temperature. Temperatures must be monitored and recorded at least once a month and records must be maintained at the facility for one year.

(7) Employees must maintain a high degree of personal cleanliness and must conform to good hygienic practice and food handling requirements when working in food service.

(8) Food service employees must not work in the FMHF food service area while infected with a communicable disease that can be transmitted by foods.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2016 MAR p. 144, Eff. 1/23/16.

Subchapter 37.106.17 Behavioral Health Inpatient Facilities

Mont. Admin. R. 37.106.1701 Scope

(1) A behavioral health inpatient facility (BHIF) is intended to provide secured inpatient psychiatric treatment for up to 16 persons, 18 years of age or older, involuntarily committed or detained, or to persons seeking treatment voluntarily. While a BHIF is defined at 53-21-102, MCA, as a mental health facility, a BHIF shall be subject to all health care facility/service standards found at Title 50, chapter 5, parts 1 and 2, MCA, in order to be licensed.

History

Authorizing statute(s): 50-5-103, 53-21-194, MCA
Implementing statute(s): 50-5-103, 53-21-101, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1702 Purpose

(1) The purpose of these rules is to establish minimum state health care facility/service licensing standards for secured nonhospital based inpatient psychiatric treatment for persons who may also have co-occurring substance use disorders; who are involuntarily committed or detained; or to persons seeking behavioral health treatment voluntarily. While a BHIF is not a hospital, it may be collocated with a hospital.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1703 Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter shall apply to a behavioral health inpatient facility.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1704 Definitions

For the purposes of this subchapter, the following definitions apply:

(1) "Administrator" means the person designated on the facility application or by written notice to the department as the person responsible for the daily operation of the facility and for the daily inpatient treatment provided in the facility.

(2) "Assessment" means an active process that utilizes a multidisciplinary team throughout the care and treatment of an individual.

(3) "BHIF" means behavioral health inpatient facility as defined at 53-21-102, MCA.

(4) "Clinical record" means a written document which is complete, current, and contains the information required by 53-21-165, MCA.

(5) "Emergency situation" has the meaning assigned to it by 53-21-102, MCA.

(6) "Governing body" means a group of designated persons functioning as a governing body, that is legally responsible for establishing and implementing policies regarding the management and operations of the facility.

(7) "Licensed health care professional" means a licensed health care professional as defined at 50-5-101, MCA.

(8) "Medical director" means a physician, psychiatrist, or advanced practice registered nurse who oversees the medical care and other designated care and services in a behavioral health inpatient facility. The medical director is responsible for coordinating medical care and helping to develop, implement, and evaluate patient care policies and procedures that reflect current standards of practice.

(9) "Mental health professional" means a mental health professional as defined at 53-21-102, MCA.

(10) "Professional person" means a professional person as defined at 53-21-102, MCA.

(11) "Supervisor" means a site based certified mental health professional person.

(12) "Treatment plan" means a planned program of active treatment developed by a multidisciplinary team to meet an individual's recovery and care.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 50-5-101, 53-21-102, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1705 License Application Process

(1) Application for a health care facility/service license accompanied by the required fee shall be made to the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953 upon forms provided by the department and shall include full and complete information as to:

(a) the name and address of the applicant if an individual, the name and address of each member if a firm, partnership, or association; or the name and address of each officer if a corporation;

(b) the location of the facility;

(d) the number and type of patients or residents for which care is provided;

(e) any information which the department may require pertaining to the number, experience, and training of employees; and

(f) information on ownership, contract, or lease agreement if operated by a person other than the owner.

(2) The fee for licensure is $20.00.

(3) Every facility shall have a distinct identification or name and shall notify the department in writing within 30 days prior to changing such identification or name, changing ownership, or relocating the facility.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1708 Governing Body

(1) The licensee must establish a governing body with responsibility for operating and maintaining the BHIF. The governing body must include the facility's medical director and the facility administrator. The governing body provides organizational guidance and oversight to ensure the provision of safe, effective patient treatment and care to include but not limited to:

(a) adopting, reviewing, and updating as necessary, at least on an annual basis, policies that:

(i) govern the organization and functions of the BHIF;

(ii) provide a process for grievance and conflict resolution for both staff and patients; and

(iii) provide clear lines of authority for administering, managing, and operating the facility.

(b) establishing procedures for recruiting, hiring, and at least annually evaluating the qualified administrator to assure implementation of the facility goals, objectives, and policies and procedures as approved by the governing body;

(c) review all written facility policies and procedures, to ensure they implement all rules and regulations; are current; known to all staff, and available to all staff, patients, law enforcement, or the public; and

(d) approving facility human resource procedures to assure the facility establishes safe hiring and continued employment practices.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1709 Medical Director

(1) Each facility shall employ or contract with a medical director who shall:

(a) coordinate with and advise the staff of the facility on clinical matters;

(b) provide direction, consultation, and training regarding the facility programs and operations as needed;

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

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

(2) The facility physician, psychiatrist, or advanced practice registered nurse may also serve as the facility medical director.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1710 Administrator Responsibilities

(1) Each facility shall employ an administrator who shall:

(a) be responsible for operation of the facility at all times and shall ensure 24-hour supervision of the patients;

(b) maintain daily overall responsibility for the facility operations;

(c) develop and oversee the implementation of all policies and procedures pertaining to the operation and services of the facility;

(d) establish written policies and procedures for all facility human resource services;

(e) establish a process for patient complaints and grievances, to include an opportunity for appeal, and to inform patients of the availability of advocacy organizations to assist them;

(f) establish a patient incident report file on all patient incidents or allegation of abuse;

(g) develop and maintain an organizational chart that delineates the current lines of authority, responsibility, and accountability for the administration and provision of all facility patient treatment programs services; and

(h) develop and implement written orientation and training procedures on all facility policies and procedures for all employees or contractors, relief workers, temporary employees, students, interns, volunteers, and trainees to include but not limited to:

(i) defining the responsibilities, limitations, and supervision of students, interns, and volunteers working for the BHIF; and

(ii) verifying each professional staff member's credentials, when hired, and annually thereafter, to ensure the continued credentialing of required licenses.

(2) The administrator shall develop policies and procedures for screening, hiring, and assessing staff which include practices that assist the employer in identifying employees that may pose risk or threat to the health, safety, or welfare of any resident and provide written documentation of findings and the outcome in the employee's file.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1711 Administrator Absence

(1) In the absence of the administrator, a staff member must be designated to oversee the operation of the facility during the administrator's absence. The administrator or designee shall be in charge, on call and physically available on a daily basis as needed, and shall ensure there are sufficient, qualified staff so that the care, active treatment, health, welfare, and safety needs of the residents are met at all times.

(2) If the administrator will be absent from the facility for more than 30 consecutive calendar days, the department shall be given written notice of the individual who has been appointed the designee.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1712 Direct Care and Other Employees

(1) Employees shall receive orientation and training in areas relevant to the employee's duties and responsibilities including:

(a) an overview of the facility's policies and procedure manual in areas relevant to the employee's job responsibilities;

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

(d) rights of persons served; and

(e) safety and emergency response procedures.

(2) In addition to meeting the requirements of (4), direct care staff shall be trained to perform the services established in each patient treatment plan.

(3) All direct care staff must receive full orientation before providing direct patient care or treatment.

(4) The following must be met in staffing the facility:

(a) direct care staff shall have knowledge of the patient's needs and any events about which the employee should notify the administrator or the administrator's designated representative;

(b) the facility shall have a sufficient number of qualified staff on duty 24 hours a day to meet the scheduled and unscheduled needs of each patient, to respond in emergency situations, and to provide active treatment and provision of all related services including but not limited to:

(i) maintenance of order, safety, and cleanliness;

(ii) assistance with medication regimens;

(iii) preparation and service of meals;

(iv) housekeeping services and assistance with laundry; and

(v) assurance that each patient receives the supervision and care required by the treatment plan to meet the patient's basic needs.

(c) an individual on each work shift shall have keys to all relevant patient care areas and access to all items needed to provide appropriate patient treatment and care.

(5) The facility will employ registered nurses. The facility must be staffed by a registered nurse 24 hours a day, seven days per week. The RN may also serve as a supervisor.

(6) Ancillary services such as laboratory or radiological services must be available to BHIF patients. A BHIF may either provide ancillary services directly or contract with a facility licensed to provide such services. If the ancillary services are not provided in the BHIF, the BHIF must make arrangements with the ancillary service provider for each individual patient prior to the patient's ancillary services.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-161, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1713 Personnel Records

(1) The facility is responsible for establishing, maintaining, and securing a file on each employee, substitute personnel, intern, volunteer, and contractor.

(2) The following documentation from personnel files must be made available to the department at all reasonable times, but shall be made available to the department within 24 hours after the department requests to review the files.

(a) the employee's name;

(b) a copy of current credentials, certifications, or professional licenses as required to perform the job description;

(d) initialed documentation of employee orientation and ongoing training.

(3) The facility shall keep a personnel file that meets the requirements set forth in (2) for the administrator of the facility, even when the administrator is also the facility owner.

History

Authorizing statute(s): 53-21-106, 53-21-194, MCA
Implementing statute(s): 53-21-106, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1717 Written Policies and Procedures

(1) Each BHIF shall maintain a policy and procedure manual. The policy and procedure manual shall be reviewed and updated as necessary, but at least annually.

(2) The manual shall contain but not be limited to policies and procedures for:

(a) notifying staff of all changes in policies and procedures;

(b) addressing patient rights, including a procedure for informing patients of their rights;

(d) addressing and reviewing ethical issues faced by staff and reporting allegations of ethics violations to the applicable professional licensing authority;

(e) admitting criteria and process to initiate behavioral treatment services to patients;

(f) developing procedures for the transfer of a patient to another hospital or facility;

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

(h) developing and implementing policy(s) for security;

(i) establishing and maintaining a facility staffing procedure;

(j) assessment criteria for new admissions;

(k) informing patients of policies pertaining to secured treatment, suspension of treatment, transfer to other facilities, or discontinuation of services for voluntary patients;

(l) suspending or discontinuing facility services with the following information to be provided to the patient:

(i) the reason for suspending or discontinuing services or access to programs;

(ii) the conditions that must be met to resume services or access to programs;

(iii) the grievance procedure that may be used to appeal the suspension or discontinuation; and

(iv) what services, if any, will be continued to be provided even though participation in a particular service or program may be suspended or discontinued.

(m) referring patients to other providers or services that the facility does not provide; and

(n) conducting quality assessment and improvement activities.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: AMD, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1718 Clinical Records

(1) A patient clinical record shall be created upon the patient's admission to the BHIF. The clinical records must comply with the requirements of 53-21-165 and 53-21-166, MCA. Clinical records must be retained for five years following the date of discharge or death. However, facilities that participate in Medicaid or Medicare programs must keep the clinical records for the applicable minimum retention period.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-165, 53-21-166, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1719 Patient Assessments

(1) The facility shall utilize a multidisciplinary team which may include but is not limited to the patient, social workers, addiction counselors, licensed mental health professionals, licensed practical nurses, mental health technicians, peer support staff, registered nurses, psychologists, case managers, certified mental health professional persons, clergy, and family members.

(2) Each facility shall initiate a clinical intake assessment within 12 hours after admission for program services. Intake assessments must be conducted by a licensed mental health professional or licensed health care professional trained in clinical assessments and must include the following information in a narrative form to substantiate the patient's diagnosis and provide sufficient detail to individualize treatment plan goals and objectives:

(a) presenting problem and history of problem;

(b) mental status;

(d) initial treatment plan goals;

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

(f) psychiatric history;

(g) substance use/abuse and history;

(h) current medication and medical history;

(i) financial resources;

(j) family relationships;

(k) housing history and housing arrangements;

(l) nutritional needs;

(m) cultural and spiritual needs;

(n) education and/or work history;

(o) legal history relevant to history of illness, including guardianships, civil commitments, criminal mental health commitments, current and prior criminal background, and current legal status; and

(p) anticipated discharge needs.

(3) Based on the patient's clinical needs, the facility shall conduct additional assessments which may include, but are not limited to, physical, psychological, emotional, behavioral, psychosocial, recreational, vocational, psychiatric, and chemical dependency evaluations.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1720 Individualized Treatment Planning

(1) Based upon the findings of the assessment(s), the facility shall initiate an individualized treatment plan for each patient within 24 hours of admission. The treatment plan must conform to requirements outlined in 53-21-162, MCA, be completed within ten days of admission, and:

(a) identify treatment team members, from within and outside of the facility, who are involved in the patient's treatment or care;

(b) specifically state measurable treatment plan objectives that serve the patient in the least restrictive and most culturally appropriate therapeutic environment;

(c) describe the service or intervention with sufficient specificity to demonstrate the relationship between the service or intervention and the stated objective;

(d) identify the staff person and program responsible for each treatment service to be provided;

(e) include the patient's guardian or power of attorney's signature indicating participation in the development of the treatment plan. If the patient's or guardian's participation is not possible or inappropriate, written documentation must indicate the reason;

(f) include the signature and date of the facility's licensed mental health professional and of the person(s) with primary responsibility for implementation of the treatment plan indicating development and ongoing review of the plan; and

(g) state the criteria for discharge, including the patient's level of functioning which will indicate when a particular service is no longer required.

(2) The treatment plan must be reviewed at least every 30 days for each patient and whenever there is a significant change in the patient's condition. A change in level of care or referrals for additional services must be included in the treatment plan.

(3) The treatment plan review must be conducted by at least one licensed mental health professional from the facility and include persons with primary responsibility for implementation of the plan. Other staff members must be involved in the review process as clinically indicated.

(4) A treatment team meeting for establishing an individual treatment plan and for treatment plan review must be conducted face-to-face and include:

(a) the patient as clinically appropriate;

(b) the patient's guardian or the holder of the patient's power of attorney if applicable;

(d) peer support, or adult friend or family member may be invited to participate in the treatment planning or treatment plan review meeting, at the request of and upon written consent of the patient, and as deemed clinically appropriate by the patient's treatment team, prior to the scheduling of the meeting.

(5) The treatment plan review must be comprehensive with regard to the patient's response to treatment and result in either an amended treatment plan or a statement of the continued appropriateness of the existing plan. The results of the treatment plan review must be entered into the patient's clinical record. The documentation must include a description of the patient's functioning and justification for each patient goal.

(6) If the facility develops separate treatment plans for each service, the treatment plans must be integrated with one another and a copy of each treatment plan must be kept in the patient's record.

(7) Minimum components of treatment plans include:

(a) assessment, medication administration and management;

(b) discharge planning;

(d) patient education;

(e) individual, group, and family therapies; and

(f) physical activity.

(8) Patient need and the patient's treating psychiatrist or mental health professional determine the length of stay.

(a) The maximum length of stay for a patient who is involuntarily committed is limited to the period authorized by the court order of commitment. Extension of commitment to a BHIF pursuant to 53-21-128, MCA, is not permitted.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-128, 53-21-162, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1724 Restraint and Seclusion

(1) The facility must be capable of providing restraint or seclusion and must ensure that the restraint or seclusion is performed in compliance with 53-21-146, MCA.

(2) Restraint and seclusion must be performed in a manner that is safe, proportionate and appropriate to the severity of the behavior, the patient's size, gender, physical, medical, and psychiatric condition, and personal history.

(3) Restraint or seclusion may be used in emergency situations when needed to ensure the physical safety of the individual patient or other patients or staff of the facility and when less restrictive measures have been found to be ineffective to protect the resident or others from harm.

(4) Restraint and seclusion procedures must be implemented in the least restrictive manner possible in accordance with a written modification to the patient's health care/treatment plan and discontinued when the behaviors that necessitated the restraint or seclusion are no longer in evidence.

(5) "Whenever needed" or "as needed" PRN standing orders for use of restraint or seclusion are prohibited.

(6) A physician or other authorized health care provider must authorize use of the restraint or seclusion within one hour of initiating the restraint or seclusion.

(7) Each order of restraint or seclusion is limited in length of time to four hours.

(8) A facility will have at a minimum one "comfort/safe" room per 16 beds for use for patient seclusion as prescribed by the facility's policy and procedures, and in accordance with applicable state and federal standards.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-146, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1725 Patient Rights

(1) Patients admitted to a behavioral health inpatient facility shall be afforded all of the rights of a patient provided for in Title 53, chapter 21, part 1, MCA, Treatment of the Seriously Mentally Ill.

(2) A copy of these rights shall be posted in a conspicuous place within the facility.

(3) These rights will also be explained to the patient in terms that the patient can understand.

History

Authorizing statute(s): 53-21-101, 53-21-194, MCA
Implementing statute(s): 53-21-101, 53-21-168, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1726 Security

(1) The facility shall develop security policies which address the following:

(a) securing the treatment unit;

(b) development of an emergency, fire, disaster, evacuation, and response plan; and

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1727 Quality Assessment

(1) Each facility shall implement and maintain an active quality assessment program using information collected to make improvements in the facility's policies, procedures, and services. At a minimum, the program must include procedures for:

(a) conducting patient satisfaction surveys, at least annually, for all facility programs. The survey must address:

(i) whether the patient, parent, or guardian is adequately involved in the development and review of the patient's treatment plan;

(ii) whether the patient, parent, or guardian was informed of patient's rights and the facility's grievance procedure;

(iii) the patient's, parent's, or guardian's satisfaction with all facility programs in which the patient participated; and

(iv) the patient's, parent's, or guardian's recommendations for improving facility's services.

(b) maintaining records on the occurrence, duration, and frequency of seclusion and physical restraints used; and

(c) reviewing, on an ongoing basis, incident reports, grievances, complaints, medication errors, and the use of seclusion and/or physical restraint with special attention given to identifying patterns and making necessary changes in how services are provided.

(2) Each facility shall prepare and maintain on file an annual report of improvements made resulting from the quality assessment program.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1730 Discharge

(1) The patient must be provided with an aftercare plan upon discharge.

(2) Each facility shall prepare a discharge plan for each patient no longer receiving services. The discharge plan must include:

(a) the reason for discharge;

(b) a summary of the services provided by the facility including recommendations for aftercare services and referrals to other services, if applicable;

(c) an evaluation of the client's progress as measured by the treatment plan and the impact of the services provided by the facility;

(d) diagnosis and response to medications; and

(e) the signature of the staff member who prepared the report and the date of preparation.

(3) The discharge summary must be filed in the clinical record within 72 hours after patient is discharged from the BHIF.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-180, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1731 Transfer/Discharge to Another Facility

(1) A patient may be discharged and transferred to another facility pursuant to 53-21-111, MCA, at any time. Transfer protocols include but are not limited to:

(a) transferring facility will contact the receiving facility to determine if a bed is available;

(b) transferring facility will contact the receiving facility to determine if appropriate staff are or will be available to treat incoming individual;

(d) an individual's available medical documentation will accompany the individual to the receiving facility.

(2) A patient who has been involuntarily committed to a BHIF pursuant to 53-21-127, MCA, may be transferred to another facility if the court which committed the patient to the BHIF has issued an order to transfer or an order committing the patient to the other facility.

(3) A patient for whom a petition for extension of commitment has been filed pursuant to 53-21-128, MCA, may be transferred to another facility if the court in which the petition is filed has issued an order to transfer or an order committing the patient to the other facility.

(4) If an emergency situation exists, the patient may be involuntarily transferred for admission to Montana State Hospital without a court order in accordance with 53-21-129, MCA, until the next business day.

(5) The patient's medical information and commitment order must accompany the patient.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-111, 53-21-128, 53-21-129, 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1735 Physical Plant

(1) The building shall be considered an I - 2 occupancy for purpose of issuing a building permit.

(2) The building shall be classified as a New Health Care Occupancy or Existing Health Care Occupancy as found in Chapter 18 or Chapter 19 of the 2001, NFPA 101 - Life Safety Code. Copies of the codes may be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471, phone 1-617-770-3000.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1736 Common Use Areas

(1) At least two separate social spaces, one appropriate for noisy activities and one for quiet activities, shall be provided. The combined area shall be at least 25 square feet for each of the two spaces. This space may be shared by dining activities if an additional 15 square feet per patient is added; otherwise, provide 20 square feet for patient dining. Dining facilities may be located off the nursing unit in a central area.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1737 Patient Toilets and Bathing

(1) There must be at least one toilet available for every four patients in the facility.

(2) There must be at least one bathing unit for every six patients in the facility. A shower or tub is not required if the facility utilizes a central bathing unit for every six patients.

(3) All doors to toilet rooms or bathing unit must swing out or slide into the wall and shall be able to be unlocked from the outside. Toilet rooms and bathing facilities may be under key control by staff.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1738 Infection Control

(1) The facility must establish and maintain infection control policies and procedures sufficient to provide a safe environment and to prevent the transmission of disease. Such policies and procedures must, at a minimum, include the following:

(a) any employee contracting a communicable disease that is transmittable to residents through food handling or direct care must not appear at work until the infectious disease(s) can no longer be transmitted;

(b) diagnosis and treatment of communicable or infectious disease occurrence and that appropriate safety measures are taken on behalf of that patient, of other patients, staff, and visitors; and

(2) The facility shall comply with statutes and rules regarding the handling and disposal of biohazardous waste.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1739 Food Service

(1) Facilities shall comply with the regulations concerning food service establishments which are located at ARM Title 37, chapter 110, subchapter 2.

(2) Facilities shall provide for the patient's nutritional needs as prescribed by the patient's doctor.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Mont. Admin. R. 37.106.1740 Laundry and Housekeeping

(1) Laundry and housekeeping services must be provided by the facility. A contracted service provider or the facility directly may provide laundry and housekeeping services.

(2) Facility administrators will ensure that provisions are made to accommodate patient laundry and housekeeping to assure a safe and clean environment.

History

Authorizing statute(s): 53-21-194, MCA
Implementing statute(s): 53-21-194, MCA
History: NEW, 2009 MAR p. 1801, Eff. 10/16/09.

Subchapter 37.106.18 Licensure of Specialty Mental Health Facilities

Mont. Admin. R. 37.106.1801 Specialty Mental Health Facility: Application of Other Rules

(1) To the extent that other licensure rules in this chapter conflict with the terms of ARM 37.106.1802, 37.106.1805, 37.106.1810 through 37.106.1814, 37.106.1820, 37.106.1821, 37.106.1825 through 37.106.1829, 37.106.1831 through 37.106.1833, 37.106.1841 through 37.106.1845, 37.106.1851 through 37.106.1853, the terms of ARM 37.106.1802, 37.106.1805, 37.106.1810 through 37.106.1814, 37.106.1820, 37.106.1821, 37.106.1825 through 37.106.1829, 37.106.1831 through 37.106.1833, 37.106.1841 through 37.106.1845, 37.106.1851 through 37.106.1853 will apply to specialty mental health facilities.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1802 Specialty Mental Health Facility: Definitions

As used in ARM 37.106.1801, 37.106.1802, 37.106.1805, 37.106.1810 through 37.106.1814, 37.106.1820, 37.106.1821, 37.106.1825 through 37.106.1829, 37.106.1831 through 37.106.1833, 37.106.1841 through 37.106.1845, 37.106.1851 through 37.106.1853, the following definitions apply:

(1) "Specialty mental health facility" means a health care facility that provides specialty mental health services in a residential setting to patients with mental health conditions associated with eating disorders, pathological gambling, and sexual disorders and may include a specialty unit attached to another type of licensed health care facility.

(2) "Addiction" includes habituation, and means a psychological dependence upon a substance or behavior for the purpose of achieving euphoria or temporary relief from painful stimuli, whether or not the stimuli are internal or external in origin, and which is associated with an eating disorder, pathological gambling, or a sexual disorder.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1805 Specialty Mental Health Facility: Medical Records

(1) A specialty mental health facility must maintain a medical records system in accordance with written policies and procedures, as well as meet the following standards:

(a) Employ adequate personnel to ensure prompt and systematic completion, filing, and retrieval of records.

(b) Create and maintain a record for each person receiving specialty mental health care services from the facility that includes, if applicable:

(i) identification and social data;

(ii) admitting diagnosis;

(iii) pertinent medical history;

(iv) properly executed consent forms;

(v) reports of physical examinations, diagnostic and laboratory test results, and consultation findings;

(vi) all physician's orders, nurses' notes, and reports of treatments and medications;

(vii) final diagnosis;

(viii) discharge summary; and

(ix) any other pertinent information necessary to monitor the patient's prognosis.

(c) Include in each record the signatures of the physician or other health care professional authoring the record entries.

(d) Complete records of a discharged patient within 30 days after the discharge date and include, in addition to the information cited in (b) above, a recapitulation of the patient's period of treatment, a recommendation of the appropriate follow up or aftercare services for the patient, and a brief summary of the patient's medical and mental condition on discharge.

(e) Have written policies and procedures ensuring the confidentiality of patient records, and safeguards against loss, destruction or unauthorized use, in accordance with applicable state and federal law and including policies and procedures which:

(i) govern the use and removal of records from the record storage area;

(ii) specify the conditions under which information may be released and by whom;

(iii) specify when the patient's consent is required for release of information, in accordance with Title 50, chapter 16, part 5, MCA, the Uniform Health Care Information Act.

(f) In addition to the above, adhere to the provisions of ARM 37.106.314.

(2) The department hereby adopts and incorporates by reference ARM 37.106.314, which contains medical records requirements for types of health care facilities other than hospitals. Copies may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1810 Specialty Mental Health Facility: Organizational Structure; Governing Body

(1) A specialty mental health facility must have a governing body that is legally responsible for the conduct of the facility and that:

(a) Ensures that the medical and professional staff of the facility:

(i) are appointed by the governing body to the medical staff after the governing body considers the recommendations of the existing members of the medical staff;

(ii) have bylaws and written policies that are approved by the governing body;

(iii) are accountable to the governing body for the quality of care provided to patients; and

(iv) are selected on the basis of individual character, competence, training, experience, judgment, and professional qualifications according to the specific areas in which they are to provide medical treatment.

(b) Appoints a chief executive officer who is responsible for managing the facility.

(i) every patient is under the care of a psychiatrist; and

(ii) whenever a patient is admitted to the facility, the admission procedures required by ARM 37.106.1851 are followed.

(d) Prepares, adopts, reviews, and updates annually an overall institutional plan that includes the following:

(i) a system of financial management and accountability; and

(ii) a system that assures that members of the governing body and appropriate administrative and professional staff have adequate and comprehensive liability insurance.

(e) Maintains a list of all contracted services, including the scope and nature of the services provided, and ensures that a contractor providing services to the facility:

(i) furnishes services that permit the facility, including the contracted services, to comply with all applicable licensure standards; and

(ii) provides the services in a safe and effective manner that will ensure that a patient may be able to return to a community setting as soon as possible.

(f) Ensures that the medical and nursing staff of the facility are licensed, certified, or registered in accordance with Montana law and rules and that each staff member provides health services within the scope of his or her license, certification, or registration.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1811 Specialty Mental Health Facility: Administrator

(1) A specialty mental health facility must have an administrator who has formal training and/or experience, preferably in the administration of a mental health facility, which demonstrates an ability to perform the functions and duties required by these licensure rules.

(2) The facility must ensure that the administrator is on the premises the number of hours necessary to manage and administer the facility in compliance with these licensure rules.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1812 Specialty Mental Health Facility: Medical and Professional Staff

(1) A specialty mental health facility must:

(a) Have a single, organized professional staff with overall responsibility for the quality of all clinical care provided to patients and the professional practices of its members;

(b) Employ or contract with the numbers of qualified mental health professional and support staff necessary to adequately evaluate patients and to sufficiently participate in each individual treatment plan to its completion; thoroughly document such participation; formulate written, individualized, and comprehensive treatment plans; provide active treatment measures; and engage in discharge planning.

(i) a description of the qualifications a medical and professional staff candidate must meet in order to be recommended to the governing body for appointment;

(ii) a statement of the duties and privileges of each category of medical and professional staff.

(iii) a requirement that a physical examination be made and medical history taken of a patient by a member of the medical staff no more than seven days before or 24 hours after the patient's admission to the facility.

(d) Ensure that the medical staff includes at least one Montana-licensed psychiatrist.

(e) Ensure that a staff psychiatrist does the following:

(i) Provides medical direction for the facility's residential mental health care activities and consultation for, and medical supervision of, mental health professional and non-physician health care staff;

(ii) Reviews and signs the records of each patient admitted; and

(iii) is directly involved with the mental health treatment of each admitted patient as determined in each individual treatment plan and documents that direct involvement.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1813 Specialty Mental Health Facility: Staff Development

(1) A staff development program must be provided for administrative, professional, and support personnel, and must be supervised and directed by a staff committee or qualified person.

(2) Staff development programs must be outlined in the facility's policies and procedures, with annual updates.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1814 Specialty Mental Health Facility: Treatment Team

(1) A specialty mental health facility must have a multi-disciplinary treatment team supervised and directed by the admitting psychiatrist, and consisting of adequate numbers of individuals licensed, registered, or certified in the mental health disciplines appropriate to the condition of each patient.

(2) The treatment team for each patient must meet at least weekly with the supervising psychiatrist and document the progress of each patient according to each patient's individual treatment plan.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1820 Specialty Mental Health Facility: Quality Assurance

(1) The governing body of the facility must ensure that there is an effective, ongoing, facility wide written quality assurance program and implementation plan in effect which ensures, monitors, and evaluates the quality of the patient care provided there and which includes the following:

(a) Identification of all health and safety aspects of each patient's individual treatment plan;

(b) Development and documentation of indicators that are used to monitor and evaluate the health and safety aspects of patient treatment and care;

(c) Documentation and evidence that the findings, conclusions, and results of corrective actions to improve patient care which are identified through the quality assurance program are applied in a manner which improves patient treatment and care.

(d) Consideration and documentation by the facility's medical and professional staff of the findings of the evaluation and the taking of subsequent remedial action, if necessary.

(e) Evaluation, with complete documentation, of all services provided by contractors.

(f) The taking and documentation of appropriate remedial action to address deficiencies found through the quality assurance program, as well as documentation of the outcome of the remedial action.

(g) Periodic review of all quality assurance activities, at least semi-annually, which is submitted in writing to the governing body and also made a part of the facility's medical records file.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1821 Specialty Mental Health Facility: Utilization Review

(1) A specialty mental health facility must have in effect a utilization review plan to review services furnished by the facility to patients, either through contracted services or by members of its medical staff to patients, in order to determine through semi-annual review, whether utilization of services was appropriate, established policies were followed, and any changes are needed.

(2) Such a review mechanism shall consider, during each semi-annual review period, at least the following:

(a) the utilization of facility services, including at least the number of patients served and the volume of services;

(b) sample facility cases consisting of not less than 10% of both active and closed patient records;

(c) review of the sample cases to determine the medical necessity of the medical and professional services furnished, including drugs and biologicals; and

(d) the facility's health care policies.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1825 Specialty Mental Health Facility: Physical Plant

(1) Each patient room in a specialty mental health facility must meet the following standards:

(a) No more than four patients may be housed in a room.

(b) Patient room areas, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, must be at least 100 square feet (9.29 square meters) in single-bed rooms and 80 square feet (7.43 square meters) per bed in multiple-bed rooms; minor encroachments, including columns and lavatories, that do not interfere with functions, may be ignored when determining space requirements for patient rooms.

(c) Multiple-bed rooms must allow a minimum clearance of 3 feet 8 inches (1.12 meters) at the foot of each bed to permit the passage of equipment and beds.

(d) Each room must have a window in accordance with section 7.28A(11) of the Guidelines for Construction and Equipment of Hospital and Medical Facilities (1992-1993 edition) published by the American institute of architects.

(e) In new construction, handwashing facilities must be provided.

(f) If a room is renovated and/or modernized, the lavatory must be added if it does not already exist, unless, in the case of a single bed room or a two-bed room, a water closet and lavatory are provided in a toilet room designed to serve that room.

(g) Each patient must have within his/her room a separate wardrobe, locker, or closet suitable for hanging full-length garments and for storing personal effects.

(2) A toilet room must:

(a) serve no more than four beds and not more than two patient rooms.

(b) contain a water closet and a door that either swings outward or is double-acting.

(d) have a floor area of not less than 15 square feet if it has one toilet and one lavatory.

(3) Separate toilet facilities and lockers shall be provided for employees.

(4) The facility's water supply system must meet the standards contained in ARM 17.38.207 and 37.111.115.

(5) The facility's wastewater system must meet the standards contained in ARM 16.20.636.

(6) Fixtures must meet the following standards:

(a) Toilets must be:

(i) provided in numbers ample for use according to the number of residents, at least one toilet for every four residents or fraction thereof.

(ii) if for resident use, provided with grab bars of a type approved by the department on at least one side.

(iii) ventilated, with a mechanical system vented to the outdoors that provides a minimum of four air changes per hour.

(iv) where more than one toilet is provided in the same room, partitioned each from the other, including a door capable of remaining closed which affords full visual privacy.

(v) be accessible to each resident without the resident having to enter a kitchen, dining room, living area, or another resident's room.

(b) Sinks and handwashing fixtures must be:

(i) provided close to each work station and in each utility room;

(ii) if used by staff, equipped with valves which can be operated without the use of hands;

(iii) provided separately in the main kitchen and located so that the person in charge may supervise handwashing by food service personnel; and

(iv) supplied with a paper towel dispenser, soap dispenser, and a covered wastebasket.

(7) A bathroom must:

(a) when individual bathing facilities are not provided in patient rooms, include a bathtub or shower with approved grab bars and serve no more than 12 licensed beds or fraction thereof.

(b) be ventilated by a mechanical system to the outdoors providing a minimum of 10 air changes per hour.

(c) have a floor entirely covered with a non-absorbent covering approved by the department. [Note: A continuous solid covering is preferred over block tile, but is not mandatory.]

(d) contain an adequate supply of toilet tissue, towels, soap, and wastebaskets.

(e) if it contains a shower or bath serving more than one patient, provide a private area for bathing, drying, and dressing.

(8) At least one resident bathroom for residents with physically handicapping conditions must be provided that has space for a wheelchair and an assisting attendant, whether or not any of the residents are classified as handicapped.

(9) Service areas must meet the following standards:

(a) The services noted below must be located in or readily available to each nursing unit.

(i) Administrative center or nurses' station.

(ii) Nurses' office for floor staff.

(iii) Administrative supplies storage.

(iv) A lavatory for handwashing.

(v) Charting facilities.

(vi) Toilet room(s) for staff.

(vii) Staff lounge facilities; these may be on another floor so long as they are centrally located.

(viii) Closets or cabinet compartments for the personal effects of nursing personnel; however, coats may be stored in closets or cabinets on each floor or in a central staff locker area.

(ix) Multipurpose room(s) for staff and patient conferences, education, demonstrations, and consultation; such a room may be on another floor if convenient for regular use and may serve several nursing units and/or departments.

(x) Examination and treatment room(s) , unless all rooms in the facility are single-bed patient rooms; the room(s) may serve several nursing units and may be on a different floor if conveniently located for routine use.

(xi) Clean workroom or clean holding room.

(xii) Soiled workroom.

(xiii) Drug distribution station.

(xiv) Clean linen storage in each nursing unit.

(xv) Nourishment station.

(xvi) An ice machine in each nursing unit to provide ice for treatments and nourishment.

(xvii) Equipment storage room.

(xviii) Showers, bathtubs, and sitz baths.

(xix) Emergency equipment storage space.

(xx) At least two separate social spaces, one appropriate for noisy activities and one for quiet activities.

(xxi) Space for group therapy.

(xxii) Occupational therapy unit.

(b) The size and location of each service area will depend upon the numbers and types of beds served.

(c) Identifiable spaces are required for each of the service areas listed in (a) above, but where the area is described as a room or office, a separate, enclosed space for the area is required; otherwise, the described area may be a specific space in another room or common area.

(d) Each service area may be arranged and located to serve more than one nursing unit but, unless noted otherwise in this subsection, at least one of each type of service area must be provided on each nursing floor.

(e) Examination rooms must have a minimum floor area of 120 square feet (11.2 square meters) excluding space for vestibule, toilets, and closets, and contain a lavatory or sink equipped for handwashing, storage facilities, and a desk, counter, or shelf space for writing.

(f) A clean workroom or clean holding room used must contain:

(i) a work counter and handwashing and storage facilities if it is used for preparing patient care items.

(ii) storage facilities alone if the room is used only for storage and holding as part of a system to distribute clean and sterile supply materials.

(g) A soiled work room must contain:

(i) a clinical sink or equivalent flushing-rim fixture, a sink equipped for handwashing, a work counter, waste receptacles, and a linen receptacle. Rooms used only for temporary holding of soiled material need not contain handwashing sinks or work counters. However, if the flushing-rim sink is omitted, other provisions for disposal or liquid waste at each unit may be added.

(h) A drug distribution station must:

(i) be made for 24-hour distribution of medications, for example, by distributing medications from a medicine preparation room or unit or utilizing a self-contained medicine dispensing unit, or by another system;

(ii) if a medicine preparation room or unit, be under visual control of nursing staff; contain a work counter, sink, refrigerator, and locked storage for controlled drugs; and have a minimum area of 50 square feet (4.65 square meters) ;

(iii) if a self-contained medicine dispensing unit, be located at the nurses station, in the clean workroom, or in an alcove.

(iv) have convenient access to handwashing facilities; handwashing facilities do not include cup-sinks.

(i) Clean linen storage must:

(i) be located either within the clean workroom, a separate closet, or some other distribution system on each floor that is approved by the department; and

(ii) if a closed cart system is used, be out of the path of normal traffic, e.g. in an alcove.

(j) A nourishment station must:

(i) contain a sink, work counter, refrigerator, storage cabinets, and equipment for serving nourishment between scheduled meals;

(ii) include provisions and space for separate temporary storage of unused and soiled dietary trays not picked up at meal time; and

(iii) have convenient access to a lavatory.

(k) Ice-making equipment must:

(i) either be located in the clean work room or at the nourishment station under staff control; and

(ii) if producing ice for human consumption, be a self-dispensing ice maker.

(l) Emergency equipment storage space must meet the following standards:

(i) The space, such as a cardiopulmonary resuscitation (CPR) cart, must be under direct control of the nursing staff;

(ii) The space must be directly accessible from the unit or floor and may serve more than one nursing unit on a floor;

(iii) In addition to separate janitor's closets that may be required for the exclusive use of specific services, at least one janitor's closet per floor must contain a service sink or receptor and provisions for storage of supplies.

(m) Social spaces:

(i) must contain at least 40 square feet (3.72 square meters) per patient in their combined area;

(ii) must contain at least 120 square feet (11.1 square meters) in each; and

(iii) may share space with dining activities.

(n) Group therapy space may be combined with the social space designated for quiet activities when the treatment unit accommodates no more than 12 patients, and when the space in question contains at least 225 square feet (21 square meters) in an enclosed private area.

(o) An occupational therapy unit:

(i) must contain 15 square feet (1.39 square meters) of separate space per patient in a treatment unit for occupational therapy, with a minimum total area of at least 200 square feet (18.6 square meters) , whichever is greater;

(ii) must provide handwashing facilities, work counters, and storage;

(iii) may serve more than one nursing unit; and

(iv) may perform its functions within the noisy activities area, if at least an additional 10 square feet (0.9 square meters) per patient served is included and the treatment unit contains less than 12 beds.

(p) One lavatory may serve the nurses' station, drug distribution station, and nourishment center so long as it is convenient to each.

(q) Closets or cabinets for the personal effects of nursing personnel must be securable and, at a minimum, large enough for purses and billfolds.

(10) Where the requirements of this section appear in conflict with those of NFPA 101, chapters 22 and 23, the requirements of this section shall apply.

(11) The department hereby adopts and incorporates by reference:

(a) section 7.28A(11) of the Guidelines for Construction and Equipment of Hospital and Medical Facilities (1992-1993 edition) published by the American Institute of Architects, a manual which specifies architectural requirements to ensure comfort, aesthetics, and safety in hospital and medical facilities. A copy of section 7.28A(11) or the entire manual may be obtained from the American Institute of Architects Press, 1735 New York Avenue NW, Washington, DC 20006.

(b) ARM 17.38.207, stating maximum microbiological contaminant levels for public water supplies, and ARM 37.111.115, which outlines the department construction, operation, and maintenance standards for springs, wells, and cisterns and other water supply system minimum requirements. Copies of the rules may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

(c) ARM 16.20.636, outlining department construction and operation standards and other minimum requirements for sewage systems. A copy of the rule may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; AMD, 1995 MAR p. 851, Eff. 5/12/95; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1826 Specialty Mental Health Facility: Life Safety and Building Code

(1) A specialty mental health facility must be in compliance with the provisions of the 1994 National Fire Protection Association (NFPA) 101 Life Safety Code, chapters 22 and 23, residential occupancy.

(2) The department hereby adopts and incorporates by reference the 1994 NFPA 101 Life Safety Code, chapters 22 and 23, residential occupancy. Copies of the codes may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; AMD, 1995 MAR p. 851, Eff. 5/12/95; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1827 Specialty Mental Health Facility: Physical Environment

(1) The facility must maintain adequate facilities for its services, the extent and complexity of facilities being determined by the services offered.

(2) The facility must be constructed, equipped, and maintained to protect the health and safety of patients, personnel, and the public.

(3) The facility must be constructed to prevent vermin problems.

(4) The facility must be kept clean and free of odors.

(5) Daily housekeeping services must be provided.

(6) Walls, ceilings, floors, and furniture must be kept clean and in good repair.

(7) Electrical, mechanical, plumbing, and heating systems must be in good, safe condition.

(8) Facilities, supplies, and equipment must be maintained to ensure an acceptable level of safety and quality.

(9) The facility must establish a written preventive maintenance program to ensure that all equipment is operative.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1828 Specialty Mental Health Facility: Environmental Control

(1) A specialty mental health facility must be constructed and maintained so as to prevent entrance and harborage of rats, mice, insects, flies or other vermin.

(2) Hand cleansing soap or detergent and individual towels must be available at each lavatory in the facility. A waste receptacle must be located near each lavatory.

(3) The facility must develop and follow a written infection surveillance program describing the procedures that must be utilized by the entire facility staff in the identification, investigation, and mitigation of infections acquired in the facility.

(4) Cleaning devices used for lavatories, toilet bowls, urinals, showers, or bathtubs may not be used for other purposes, and those utensils used to clean toilets or urinals must not be allowed to contact other cleaning devices.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1829 Specialty Mental Health Facility: Infection Control

(1) A specialty mental health facility must ensure that:

(a) the facility has an effective facility wide infection control surveillance program developed for the identification, investigation, prevention and control of nosocomial infections.

(b) the facility has written policies and procedures that describe the types of surveillance carried out to monitor the rates of nosocomial infections, the systems used to collect and analyze data, and the activities carried out to prevent and control infection.

(c) A staff member is designated as a manager of the infection control program who has education, training or experience related to infection control, that facility records contain documented evidence of the manager's qualifications, and that the manager participates in continuing education in the area of infection control.

(d) A multidisciplinary committee oversees the program for surveillance, prevention, and control of infection, a committee that includes the designated infection control manager and representatives from the professional staff; administration; and housekeeping, laundry, dietary, maintenance and pharmacy services; and meets whenever the committee members determine the facility needs such a meeting.

(e) Each department, including housekeeping, laundry, dietary, maintenance, pharmacy, and nursing/medical, develops and implements policies and procedures which reflect current and accepted infection control standards of practice, and that these policies are updated and reviewed annually by the infection control committee.

(2) The facility must be in compliance with Title 75, part 10, MCA, the Infectious Waste Management Act.

(3) The department hereby adopts and incorporates by reference Title 75, part 10, MCA, containing requirements for health care facilities in handling of infectious wastes. A copy of the law may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1831 Specialty Mental Health Facility: Emergency Services

(1) The facility must ensure that patients have access to emergency services and to more intensive levels of care, including acute or inpatient psychiatric care.

(2) The facility must have an agreement with an outside source for emergency medical and inpatient psychiatric services to ensure that they are immediately available to patients who may need such services.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1832 Specialty Mental Health Facility: Disaster Plan

(1) A specialty mental health facility must develop a disaster plan in conjunction with other emergency services in the community which includes a procedure that will be followed in the event of a natural or man-caused disaster.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1833 Specialty Mental Health Facility: Laundry and Bedding

(1) If a specialty mental health facility processes its own laundry on the facility site, it must:

(a) Set aside a room for laundry and utilize it solely for that purpose.

(b) Equip the laundry with a mechanical washer and dryer (or additional machines if necessary to handle the laundry load) , handwashing facilities, mechanical ventilation to the outside, a fresh air supply, and a hot water supply system which supplies the washer with water of at least 160 º F (71 º C) during each use for 25 minutes, or, if lower temperatures are used, with chemicals suitable for low temperature washing.

(d) Provide well maintained carts or other containers impervious to moisture to transport laundry, keeping those used for soiled laundry separate from those used for clean laundry.

(e) Dry all bed linen, towels, and washcloths in a mechanical dryer.

(f) Protect clean laundry from contamination.

(g) Ensure that facility staff use hygienic techniques while handling soiled and clean laundry, including:

(i) covering their clothing while working with soiled laundry;

(ii) using separate clean covering for their clothes while handling clean laundry; and

(iii) washing their hands both after working with soiled laundry and before they handle clean laundry.

(2) The facility must maintain a linen supply adequate to provide changes of bed and bath linens at appropriate intervals.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1841 Specialty Mental Health Facility: Required Treatment Services

(1) A specialty mental health facility must:

(a) Provide an individually planned regimen of 24-hour evaluation, care, and treatment for each patient with mental health conditions associated with the addiction that the regimen is designed to treat, prepared and delivered by mental health professionals, pursuant to a defined set of written policies and procedures;

(b) Have permanent facilities that include, at least, inpatient beds;

(c) Utilize a multi-disciplinary mental health staff appropriate and sufficient to care for patients whose emotional/behavioral problems are severe enough to require specialty mental health treatment services as determined through individual psychiatric evaluations and detailed admission criteria; and

(d) Provide 24-hour staff observation to patients, and have medical and/or mental health monitoring and treatment available to them by qualified professionals on a 24-hour basis;

(2) If medical monitoring and treatment is necessary for a patient on a continuous basis, then that individual must be transferred to an appropriate inpatient facility immediately.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1842 Specialty Mental Health Facility: Food and Nutrition Services

(1) A specialty mental health facility must have nutrition services that are directed and staffed by adequate personnel and meet the following standards:

(a) The facility must assign an employee or contract with a consultant who is qualified by experience and training as a food service supervisor to direct the food and nutrition service and to be responsible for the daily management of the nutrition service.

(b) The facility must utilize a nutritionist licensed in Montana, on a full-time, part-time, or consultant basis.

(d) Nutritional needs must be met in accordance with recognized dietary and nutrition practices and, at a minimum, the recommended daily dietary allowances established by the Food and Nutritional Board of the National Research Council, National Academy of Sciences, 10th edition, 1989.

(2) The department hereby incorporates by reference the recommended daily dietary allowances established by the Food and Nutritional Board of the National Research Council, National Academy of Sciences, 10th edition, 1989, which set minimum nutrition requirements for human beings. A copy of the above dietary allowances may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1843 Specialty Mental Health Facility: Nursing Services

(1) A specialty mental health facility must provide 24-hour nursing services and meet the following standards:

(a) The director of nursing services must be a licensed registered nurse and must:

(i) determine the types and numbers of nursing personnel and staff necessary to provide nursing care; and

(ii) schedule adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel to provide nursing care as needed.

(b) A registered nurse must be on duty at least eight hours per day, and the director of nursing or another registered nurse designated as the director's alternate must be on call and available within 20 minutes at all times.

(c) The nursing service must have a procedure to ensure that all nursing personnel have valid and current Montana nursing licenses.

(d) The nursing staff must develop and keep current a nursing care plan for each patient when a nursing care plan is required.

(e) Upon admission of a patient to the facility, a registered nurse must assign the nursing care of that patient to other nursing personnel in accordance with the patient's needs as determined by the admitting psychiatrist and the specialized qualifications and competence of the nursing staff.

(f) All drugs and biologicals must be administered by, or under the supervision of, nursing or other qualified medical personnel in accordance with federal and state law and rules, including applicable licensing requirements, and in accordance with medical staff policies and procedures which have been approved by the governing body.

(g) Each order for drugs and biologicals must be consistent with federal and state law and be in writing and signed by the practitioner who is both responsible for the care of the patient and legally authorized to prescribe.

(h) When an oral or telephonically-transmitted order must be used, it must be:

(i) accepted only by personnel that are authorized to do so by the medical staff policies and procedures, consistent with federal and state law; and

(ii) signed or initialed by the prescribing practitioner as soon as possible and in conformity with state and federal law.

(i) The facility must adopt a procedure for reporting to the attending practitioner adverse drug reactions and errors in administration of drugs.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1844 Specialty Mental Health Facility: Pharmaceutical Services

(1) A specialty mental health facility must have pharmaceutical services that meet the needs of the patients and include either a pharmacy directed by a registered pharmacist or a drug storage area under the supervision of a consulting pharmacist who develops, supervises, and coordinates all the facility's pharmacy services.

(2) The facility must ensure that:

(a) The pharmacy or drug storage area is administered in accordance with accepted professional principles.

(b) When a pharmacist is not available, drugs and biologicals are removed from the pharmacy or storage area solely by the personnel designated in writing in medical staff and pharmaceutical services policies, and in a manner consistent with federal and state law.

(c) All compounding, packaging, and dispensing of drugs and biologicals is under the supervision of a pharmacist and performed in a manner consistent with federal and state law and rules.

(d) Drugs and biologicals are kept in a locked storage area.

(e) Outdated, mislabeled, or otherwise unusable drugs and biologicals are removed from the facility and destroyed.

(f) Drug administration errors, adverse reactions, and incompatibilities are immediately reported to the attending practitioner.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1845 Specialty Mental Health Facility: Outpatient Services

(1) If the specialty mental health facility provides outpatient services, each outpatient must be examined by a psychiatrist licensed in Montana and the services must meet the standards contained in ARM 37.106.1008.

(2) The department incorporates by reference ARM 37.106.1008, which contains minimum licensure standards for outpatient facilities. Copies of ARM 37.106.1008 may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185; AMD, 2011 MAR p. 578, Eff. 4/15/11.

Mont. Admin. R. 37.106.1851 Specialty Mental Health Facility: Admission Procedures

(1) A specialty mental health facility must develop, maintain, and implement admission procedures designed to ensure that no client is admitted prior to the facility's documented determination of its ability to meet the needs of the client based on a documented appraisal of the client's individual service needs.

(2) The facility must assign a psychiatrist licensed in Montana to admit all patients according to a defined set of admission criteria based upon the Diagnostic and Statistical Manual III-R (DSM III-R) of the American Psychiatric Association and may admit only those patients whose mental health conditions are associated with addictions related to eating disorders (codes 307.10, 307.50, 307.51, 307.52, and 307.53 in the DSM III-R), pathological gambling (code 312.31 in the DSM III-R), or sexual disorders (codes 302.20, 302.30, 302.40, 302.71, 302.72, 302.79, 302.81, 302.82, 302.83, 302.84, 302.89, and 302.90 in the DSM III-R).

(3) Whenever a patient is admitted to the facility by a physician other than a psychiatrist, the facility must assure that the physician consults with the facility psychiatrist, by phone or otherwise, within 12 hours after admission, that a written notation of that consultation and the psychiatrist approval of the admission for a mental health condition or suspected mental health condition is made and kept in the patient's records, and that a psychiatric evaluation is conducted in accordance with the standards in (4) below prior to admission.

(4) Each patient must receive a psychiatric evaluation that must be completed by a psychiatrist licensed in Montana prior to admission unless (5) below applies; include a medical history; contain a record of mental status; note the onset of illness and the circumstances leading to admission; describe attitudes and behavior; estimate intellectual functioning, and orientation; and include an inventory of the patient's assets in descriptive rather than interpretive fashion.

(5) If an individual seeks admission or is referred to the facility outside of the hours of 6:00 a.m. to 7:00 p.m., Monday through Friday, or during national holidays, then the facility may allow that person temporary occupancy under the direction of a Montana licensed physician or Montana licensed psychiatrist until the psychiatric evaluation can be conducted during the facility's next regularly scheduled business day.

(6) If an individual is referred to the facility by a licensed psychiatrist or licensed physician who is not affiliated with the facility, the psychiatric evaluation must still be completed by the facility's staff psychiatrist within the time frame otherwise prescribed for such an evaluation. If a psychiatric evaluation has been conducted by a Montana-licensed psychiatrist not affiliated with the facility, the staff psychiatrist must review and approve the evaluation and note such review and approval in the patient's records.

(7) When indicated, a complete neurological examination must be conducted within 72 hours of admission.

(8) A licensed physician must conduct a physical examination of each patient within 24 hours after or seven days prior to that patient's admission.

(9) The department hereby incorporates by reference codes 302.20, 302.30, 302.40, 302.71, 302.72, 302.79, 302.81, 302.82, 302.83, 302.84, 302.89, 302.90, 307.10, 307.50, 307.51, 307.52, 307.53, and 312.31 of the DSM III-R of the American Psychiatric Association, which contain descriptions of various diagnoses of mental disorders associated with eating disorders, pathological gambling, and sexual disorders. A copy of the manual may be obtained from the American Psychiatric Association, 1700 18th Street NW, Washington, D.C. 20009.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1852 Specialty Mental Health Facility: Prohibitions

(1) A specialty mental health facility may not admit as a patient any person who:

(a) does not voluntarily seek admission;

(b) requires physical or chemical restraints;

(d) may have impaired judgment or is incapable of appropriate physical action for self-preservation under emergency conditions;

(e) requires a medication regime:

(i) to orient him or her to reality;

(ii) for stabilization or any other purpose related to behavior modification;

(iii) for a mental health condition unrelated to an eating disorder, pathological gambling, or sexual dysfunction; or

(iv) that would otherwise suggest that the person is in need of inpatient psychiatric treatment on such medications;

(f) requires intensive supervision or specialized therapeutic interaction where medical or psychiatric attention or monitoring and treatment is necessary on a continuous basis as determined through a medical or psychiatric evaluation;

(g) requires a treatment that focuses on management of a psychiatric condition that may endanger the person, facility, staff, or others, as determined through a psychiatric evaluation prior to admission;

(h) requires electro-convulsive therapy;

(i) requires a locked environment; or

(j) requires treatment for a mental health condition other than one associated with an addiction.

(2) For purposes of this rule, a person is ambulatory if he or she is capable of self-mobility, either with or without mechanical assistance; if mechanical assistance is necessary, a person is considered ambulatory only if he or she can, without help from another person, utilize the mechanical assistance, exit and enter the facility, or access all common areas in the facility.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1853 Specialty Mental Health Facility: Treatment Program

(1) Each patient must have an individual comprehensive treatment plan that must be based on an inventory of the patient's strengths and disabilities or mental impairment as defined by the mental health professionals on the multi-disciplinary treatment team and approved by the evaluating or staff psychiatrist.

(2) An initial treatment plan for each patient must be formulated, written and interpreted to the staff by the staff psychiatrist as a part of the admission process.

(3) A comprehensive treatment plan for each patient must be formulated no later than three full working days after admission by a multi-disciplined treatment team and the staff psychiatrist, and placed in the patient's records immediately following approval by the evaluating or staff psychiatrist. The staff psychiatrist and multi-disciplinary professional staff must also participate in the preparation of any major revisions of the comprehensive plan.

(4) The comprehensive treatment plan must:

(a) be based on the patient's psychiatric evaluation;

(b) include clinical consideration of the patient's physical, developmental, psychological, age appropriate, family, educational, social, and recreational needs;

(c) specify the reason for admission and specific treatment goals, stated in measurable terms, including a projected timeframe for completed treatment; treatment modalities to be used; staff who are responsible for coordinating and carrying out the treatment; and expected length of stay and appropriate aftercare planning.

(5) The facility must supply, to each individual being admitted and his or her family, significant other, or referral source, a description, in writing or publication form, of the treatment modalities it provides, including content, methods, equipment, and personnel involved. Each treatment program must conform to the stated purpose and objectives of the facility.

(6) A multi-disciplinary treatment team must provide:

(a) daily clinical services to each patient to assess and treat the person's individual needs, services including appropriate medical, psychological, and health education services; and

(b) individual, family and group psychological counseling; and

(c) access to family members or spouses as part of the treatment plan of each patient when such involvement can be beneficial.

(7) Upon admission of each patient, implementation of a discharge planning program must begin which will ensure that:

(a) discharge planning is documented in the individual treatment plan for each patient; and

(b) each patient, along with the necessary medical and other treatment information, is transferred or referred to appropriate facilities, agencies, or outpatient services, as needed, for continued, follow up, or ancillary care.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.1854 Specialty Mental Health Facility: Patient Rights

(1) A specialty mental health facility shall have written policies and procedures to assure the individual patient the right to dignity, privacy, and safety, and shall support and protect the basic human, civil, and constitutional rights of the individual patient.

(2) A written policy and procedure approved by the governing body shall provide a description of the patient's rights and the means by which these rights are protected and exercised.

(3) At the point of admission, the facility shall provide the patient and family, designated relative, guardian, or custodian, with a clearly written and readable statement of patients' rights and responsibilities. The statement shall be read to the patient and family, guardian, or custodian if any cannot read, and shall cover, at a minimum:

(a) each patient's access to treatment, regardless of race, religion or ethnicity;

(b) each patient's right to recognition and respect of his or her personal dignity in the provision of all treatment and care;

(d) each patient's right to an individualized treatment plan;

(e) each patient's and family's participation in planning for treatment;

(f) the nature of care, procedures, and treatment that he or she will receive;

(g) the risks, side effects, and benefits of all medications and treatment procedures used;

(h) the right, to the extent permitted by law, to refuse the specific medications or treatment procedures and the responsibility of the facility when the patient refuses treatment, or, in accordance with legal and professional standards, to terminate the relationship with the patient upon reasonable notice; and

(i) the patient and family members' right to access to a patient advocate.

(4) The rights of patients must be written in language which is understandable to the patient, his or her family, custodian, or guardian, and must be posted in appropriate areas of the facility.

(5) The policy and procedure concerning patient rights shall assure and protect the patient's personal privacy within the constraints of his or her treatment plan. These rights to privacy shall at least include:

(a) visitation by the resident's family, relatives, guardian, or custodian in a suitable private area of the facility;

(b) sending and receiving mail without hindrance or censorship; and

(6) If any rights to privacy must be limited, the patient and his or her family, guardian, or custodian shall receive a full explanation. Limitations must be documented in the patient's record and their therapeutic effectiveness must be evaluated and documented by professional staff every seven days.

(7) The right to initiate a complaint or grievance procedure and the means for requesting a hearing or review of a complaint must be specified in a written policy approved by the governing body and made available to patients, family, guardians, and custodians responsible for the patient. The procedure shall indicate:

(a) to whom the grievance is to be addressed; and

(b) steps to be followed for filing a complaint, grievance, or appeal.

(8) The patient and his or her family, guardian, or custodian must be informed of the current and future use and disposition of products of special observation and audio visual techniques such as one-way vision mirrors, tape recorders, television, movies, or photographs.

(9) The policy and procedure regarding patient's rights shall ensure the patient's right to confidentiality of all information recorded in his record maintained by the facility. The facility shall ensure the initial and continuing training of all staff in the principles of confidentiality and privacy.

(10) The patient may be allowed to work for the facility only under the following conditions:

(a) the work is part of the individual treatment plan;

(b) the work is performed voluntarily;

(d) the work project complies with applicable law and regulations; and

(e) the performance of tasks related to the responsibilities of family-like living, such as laundry and housekeeping, are not considered work for the facility and need not be compensated or voluntary.

(11) Measures utilized by the facility to discipline patients must be:

(a) established by written policy and procedure developed in consultation with professional and direct care staff and approved by the governing body;

(b) fully explained to each patient and the patient's family, guardian, or custodian;

(12) The facility shall prohibit all cruel and unusual disciplinary measures, including but not limited to the following:

(a) corporal punishment;

(b) forced physical exercise;

(d) group punishment for individual actions:

(e) verbal abuse, ridicule, or humiliation;

(f) denial of three balanced nutritional meals per day;

(g) denial of clothing, shelter, bedding or personal hygiene needs;

(h) denial of access to educational services;

(i) denial of visitation, mail, or phone privileges for punishment;

(j) exclusion of the patient from entry to his or her assigned living quarters; and

(k) restraint or seclusion as a punishment or employed for the convenience of the staff.

(13) Written policy shall prohibit patients from administering disciplinary measures upon one another and shall prohibit persons other than professional or direct care staff from administering disciplinary measures to patients.

(14) Written rules of patient conduct must be:

(a) developed in consultation with the professional and direct care staff and approved by the governing body;

(b) developed with the participation of patients to a reasonable and appropriate extent; and

(15) The application of disciplinary measures should correlate with the violation of established rules.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1991 MAR p. 2454, Eff. 12/13/91; TRANS, from DHES, 2002 MAR p. 185.

Subchapter 37.106.19 Minimum Standards for Mental Health Centers

Mont. Admin. R. 37.106.1901 Mental Health Center: Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3, conflict with the terms of this subchapter, the terms of this subchapter will apply to licensed mental health centers.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS, from DHES, 2002 MAR p. 916; AMD, 2016 MAR p. 144, Eff. 1/23/16.

Mont. Admin. R. 37.106.1902 Mental Health Center: Definitions

In addition to the definitions in 50-5-101, MCA, the following definitions apply to this subchapter:

(1) "Administrator" means a designated individual having daily overall management responsibility for the operation of a mental health center.

(2) "Adult day treatment" means a program which provides a variety of mental health services to adults with mental illnesses.

(3) "Chemical dependency services" means:

(a) screening of a client for substance abuse issues by the mental health center through its clinical intake assessment;

(b) as indicated by the substance abuse screening, the provision or arrangement by the mental health center for a client to be evaluated by a licensed addiction counselor;

(c) in accordance with the evaluation by a licensed addiction counselor, the provision or arrangement by the mental health center of chemical dependency treatment by a licensed addiction counselor or state-approved chemical dependency treatment program; and

(d) the integration and coordination by the mental health center of the client's mental health treatment with the chemical dependency treatment.

(4) "Client" means an adult, child or adolescent, or resident receiving services from a mental health center.

(5) "Community-based psychiatric rehabilitation and support" has the same meaning as provided in ARM 37.87.702.

(6) "Community residential facility" has the same meaning as provided in 76-2-411, MCA.

(7) "Comprehensive school and community treatment program (CSCT)" means a comprehensive, planned course of community mental health outpatient treatment provided in cooperation and under written contract with the school district where the youth attends school. The program must be provided by a licensed mental health center with an endorsement under ARM 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965.

(8) "Crisis telephone services" means 24 hour telephone response to mental health emergencies for the mental health center's clients.

(9) "Department" means the Department of Public Health and Human Services.

(10) "Forensic mental health facility" (FMHF) means 24-hour, seven days a week, secured nonhospital-based forensic psychiatric treatment for criminal justice involved adults who are committed by a court of competent jurisdiction for the purpose of psychiatric treatment or evaluation.

(11) "Guardian" means a person appointed by a court to make medical, and possibly financial, decisions as provided in Title 72, chapter 5, MCA.

(12) "Individualized education program" (IEP) means a written plan developed and implemented for each student with a disability in accordance with 34 CFR 300.320 through 300.325 amended as of October 30, 2007. The department adopts and incorporates by reference that version of 34 CFR 300.320 through 300.325. A copy of the regulations may be obtained from the Department of Public Health and Human Services, Office of Inspector General, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

(13) "Individualized treatment plan" means a written plan that outlines individualized treatment activities for maximum reduction of mental disability and restoration of the client's ability to function adequately in the family, at work or school, and as a member of the community.

(14) "Inpatient crisis stabilization facility" means 24 hour supervised treatment for adults with a mental illness for the purpose of stabilizing the individual's symptoms.

(15) "In-training mental health professional" means an individual providing services in accordance with in-training mental health professional services as defined in ARM 37.87.702.

(16) "In-training mental health professional services" has the same meaning as provided in ARM 37.87.702.

(17) "Licensed health care professional" means a licensed physician, physician assistant, advanced practice registered nurse, or registered nurse who is practicing within the scope of the license issued by the Department of Labor and Industry.

(18) "Licensed mental health professional" means:

(a) a physician, clinical psychologist, licensed clinical social worker, licensed marriage and family therapist, or professional counselor licensed to practice in Montana;

(b) an occupational therapist licensed to practice in Montana who has had at least three years' experience dedicated substantially to serving persons with serious mental illnesses and is working in a youth day treatment program or adult day treatment program; or

(c) a registered nurse who has had at least three years experience dedicated substantially to serving persons with serious mental illnesses and is licensed to practice in Montana.

(19) "Medical director" means a physician licensed by the Montana Board of Medical Examiners who oversees the mental health center's clinical services and who has:

(a) at least a three-year residency in psychiatry; or

(b) at least three years' post-graduate psychiatric training in a program approved by the Counsel on Medical Evaluation of the American Medical Association; or

(c) at least three years of experience in a medical practice dedicated substantially to serving persons with serious mental illnesses.

(20) "Mental health group home" means a community residential facility as defined in ARM 37.88.901.

(21) "Mental illness" means that condition of an individual in which there is either psychological, physiological, or biochemical imbalance which has caused impairment in functioning and/or behavior.

(22) "Outpatient therapy services" means the provision of psychotherapy and related services by a licensed mental health professional acting within the scope of the professional's license or these same services provided by an in-training mental health professional in a mental health center.

(23) "Program supervisor" means a designated licensed mental health professional having daily overall responsibility for the operation of a mental health center area of endorsement.

(24) "Program therapist" means a licensed mental health professional with the training and knowledge to provide psychotherapy.

(25) "Representative payee" means a payee appointed by the Social Security Administration when a beneficiary is unable to manage their social security benefits, supplementary security income or Medicare benefits.

(26) "Seclusion" means staff initiating or escorting a youth to a seclusion time-out room to calm down and appropriately manage their behavior.

(27) "Severe disabling mental illness" means, with respect to a person who is 18 or more years of age, that the person meets the requirements defined in ARM 37.86.3502.

(28) "Serious emotional disturbance" means, with respect to a youth, that the youth meets the requirements defined in ARM 37.87.303.

(29) "Site based" means a specific location where the treatment services are consistently provided.

(30) "Targeted case management " means the activities of a single person or team that assists individuals with mental illness to make informed choices for community services which seek to maximize their personal abilities and enable growth in some or all aspects of the individual's vocational, educational, social, and health related environments.

(31) "Time-out" means staff or youth initiating a time-out generally away from the group activity to enable the youth to calm down and appropriately manage their behavior.

(32) "Youth" means a person up to 20 years of age.

(33) "Youth day treatment" means a program which provides an integrated set of mental health, education, and family intervention services to youth with a serious emotional disturbance.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02; AMD, 2005 MAR p. 2260, Eff. 9/23/05; AMD, 2006 MAR p. 1285, Eff. 5/19/06; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2016 MAR p. 144, Eff. 1/23/16; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2024 MAR p. 2014, Eff. 8/10/24; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Mont. Admin. R. 37.106.1906 Mental Health Center: Services and Licensure

(1) Each applicant for licensure must submit a license application to the department requesting approval to provide the services in (3) and may request approval to provide one or more of the services in (4).

(2) Services provided by a mental health center must be rendered by a single administration in a discrete physical facility or multiple facilities or by written agreement or contract with licensed health care professionals, licensed mental health professionals or other facilities such as hospital, clinics, or educational institutions which may combine to provide services.

(3) For a mental health center to be licensed, it must provide to its clients all of the following services:

(a) crisis telephone services;

(b) medication management services;

(d) community-based psychiatric rehabilitation and support; and

(e) chemical dependency services.

(4) A licensed mental health center, with the appropriate license endorsement, may provide one or more of the following services:

(a) youth targeted case management;

(b) adult targeted case management;

(d) adult day treatment;

(e) adult foster care;

(f) mental health group home;

(g) an inpatient crisis stabilization facility;

(h) an outpatient crisis response facility;

(i) a comprehensive school and community treatment program; or

(j) a forensic mental health facility.

(5) Each service listed in (4) that is endorsed by the department must be recorded on the mental health center's license.

(6) A mental health center may not condition a client's access to one of its services upon the client's receipt of another service provided by the mental health center unless continuity and quality of care require that services be provided by the same agency.

(7) Mental health center services must be available to recipients continuously throughout the year.

(8) A mental health center must report to the department, in writing, any of the following changes within at least 30 days before the planned effective date of the change:

(a) a change of administrator;

(b) a change of medical director;

(d) a change in the name of the agency;

(e) the addition of any endorsement service site; or

(f) the discontinuation of providing a service for which the mental health center has an area of endorsement.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2006 MAR p. 1285, Eff. 5/19/06; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2016 MAR p. 144, Eff. 1/23/16; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.106.1907 Mental Health Center: Organizational Structure

(1) Each mental health center shall employ or contract with an administrator who shall:

(a) maintain daily overall responsibility for the mental health center's operations;

(b) develop and oversee the implementation of policies and procedures pertaining to the operation and services of the mental health center;

(c) establish written orientation and training procedures for all employees including new employees, relief workers, temporary employees, students, interns, volunteers, and trainees. The training must include orientation on all the mental health center's policies and procedures;

(d) establish written policies and procedures:

(i) defining the responsibilities, limitations, and supervision of students, interns, and volunteers working for the mental health center;

(ii) for verifying each professional staff member's credentials, when hired, and thereafter, to ensure the continued validity of required licenses; and

(iii) for client complaints and grievances, to include an opportunity for appeal, and to inform clients of the availability of advocacy organizations to assist them.

(e) develop an organizational chart that accurately reflects the current lines of administration and authority; and

(f) maintain a file for all client incident reports.

(2) Each mental health center shall employ or contract with a medical director who shall:

(a) coordinate with and advise the staff of the mental health center on clinical matters;

(b) provide direction, consultation, and training regarding the mental health center's programs and operations as needed;

(c) act as a liaison for the mental health center with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services; and

(d) ensure the quality of treatment and related services through participation in the mental health center's quality assurance process.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1908 Mental Health Center: Policies and Procedures

(1) Each mental health center shall maintain a policy and procedure manual. The manual must be reviewed and approved, at least annually, by the medical director and administrator. The manual must contain policies and procedures for:

(a) notifying staff of all changes in policies and procedures;

(b) addressing client rights, including a procedure for informing clients of their rights;

(c) addressing and reviewing ethical issues faced by staff and reporting allegations of ethics violations to the applicable professional licensing authority;

(d) informing clients of the policy and procedures for client complaints and grievances;

(e) initiating services to clients;

(f) informing clients of rules governing their conduct and the types of infractions that can result in suspension or discontinuation of services offered by the mental health center;

(g) suspending or discontinuing program services with the following information to be provided to the client:

(i) the reason for suspending or discontinuing services or access to programs;

(ii) the conditions that must be met to resume services or access to programs;

(iii) the grievance procedure that may be used to appeal the suspension or discontinuation; and

(iv) what services, if any, will be continued to be provided even though participation in a particular service or program may be suspended or discontinued.

(h) referring clients to other providers or services that the mental health center does not provide; and

(i) conducting quality assessment and improvement activities.

(2) If the mental health center provides representative payee services, the center must comply with the accounting and reporting procedures established by the Commissioner of Social Security as identified in section 1631 (a) (2) of the Social Security Act and must further ensure that clients are involved in budgeting their money and that budget sheets be used which require client signatures.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1909 Mental Health Center: Clinical Records

(1) Each mental health center shall:

(a) collect assessment data and maintain clinical records on all clients who receive services and ensure the confidentiality of clinical records in accordance with the Uniform Health Care Information Act, Title 50, chapter 16, part 5, MCA. At a minimum, the clinical record must include:

(i) a clinical intake assessment;

(ii) additional assessments or evaluations, if clinically indicated;

(iii) a copy of the client's individualized treatment plan and all modifications to the treatment plan;

(iv) progress notes which indicate whether or not the stated treatment plan has been implemented, and the degree to which the client is progressing, or failing to progress, toward stated treatment objectives;

(v) medication orders from the prescribing physician and documentation of the administration of all medications;

(vi) signed orders by a licensed mental health professional for any restrictions of rights and privileges accorded clients of the mental health center including the reason(s) for the restriction; and

(vii) a discharge summary when the client's file is closed.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1915 Mental Health Center: Client Assessments

(1) Each mental health center shall complete a clinical intake assessment within 12 hours after admission for crisis stabilization program services and within three contacts, or 14 days from the first contact, whichever is later, for other services. Intake assessments must be conducted by a licensed mental health professional trained in clinical assessments and must include the following information in a narrative form to substantiate the client's diagnosis and provide sufficient detail to individualize treatment plan goals and objectives:

(a) presenting problem and history of problem;

(b) mental status;

(d) initial treatment plan goals;

(e) risk factors to include suicidal or homicidal ideation;

(f) psychiatric history;

(g) substance use/abuse and history;

(h) current medication and medical history;

(i) financial resources and residential arrangements;

(j) education and/or work history; and

(k) legal history relevant to history of illness, including guardianships, civil commitments, criminal mental health commitments, and prior criminal background.

(2) Based on the client's clinical needs, each mental health center shall conduct additional assessments which may include, but are not limited to, physical, psychological, emotional, behavioral, psychosocial, recreational, vocational, psychiatric, and chemical dependency evaluations.

(3) Each mental health center shall maintain a current list of providers who accept referrals for assessments and services not provided by the center.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1916 Mental Health Center: Individualized Treatment Plans

(1) Based upon the findings of the assessment(s) conducted in accordance with ARM 37.106.1915, each mental health center must establish an individualized treatment plan for each client within 24 hours after admission for crisis stabilization program services and within five contacts, or 21 days from the first contact, whichever is later, for other services. The treatment plan must:

(a) identify treatment team members, from within and outside of the mental health center, who are involved in the client's treatment or care;

(b) specifically state measurable treatment plan objectives that serve the client in the least restrictive and most culturally appropriate therapeutic environment;

(c) for each objective, describe the service(s) or intervention(s) with sufficient specificity to demonstrate the relationship between the service(s) or intervention(s) and the stated objective;

(d) identify the staff person and program responsible for each treatment service to be provided;

(e) include the signature of the client or parent/legal representative/guardian and date indicating participation in the development of the treatment plan. If participation of the client or parent/legal representative/guardian is not possible or inappropriate, written documentation must indicate the reason such participation is not possible;

(f) include the signature and date of the mental health center's licensed mental health professional and of the person(s) with primary responsibility for implementation of the plan, indicating development and ongoing review of the plan. If intensive care management is the only service being received by the client from the mental health center, a program supervisor must sign the treatment plan indicating the supervisor's review and approval for appropriateness; and

(g) state the criteria for discharge, including the client's level of functioning which will indicate when a particular service is no longer required.

(2) The treatment plan must be reviewed at least every 90 days for each client and whenever there is a significant change in the client's condition. A change in level of care or referrals for additional mental health services must be included in the treatment plan.

(3) The treatment plan review must be conducted by at least one licensed mental health professional from the mental health center, and include persons with primary responsibility for implementation of the plan. Other staff members must be involved in the review process as clinically indicated. Outside service providers must be contacted and encouraged to participate in the treatment plan review, as clinically indicated.

(4) If a client is receiving case management and/or medication management services along with one or more other services from the mental health center, the treatment plan review must be conducted by at least one licensed mental health professional from the mental health center and include persons with primary responsibility for implementing the treatment plan. Other staff members must be involved in the review process as clinically indicated. Outside service providers must be contacted and encouraged to participate in the treatment plan review, as clinically indicated.

(5) A treatment team meeting for establishing an individual treatment plan and for treatment plan review must be conducted and include:

(a) the client as clinically appropriate;

(b) the client's legal representative/guardian if applicable;

(c) the client's parents or legal representative/guardian if the client is a youth and the involvement by the parent or legal representative/guardian is clinically appropriate;

(d) case manager, if the client has one; and

(e) in the case of an adult client, an adult friend or family member may be invited to participate in the treatment planning or treatment plan review meeting, at the request of and upon written consent of the client, and as deemed clinically appropriate by the client's treatment team, prior to the scheduling of the meeting.

(6) The treatment plan review must be comprehensive with regard to the client's response to treatment and result in either an amended treatment plan or a statement of the continued appropriateness of the existing plan. The results of the treatment plan review must be entered into the client's clinical record. The documentation must include a description of the client's functioning and justification for each client goal.

(7) If the mental health center develops separate treatment plans for each service, the treatment plans must be integrated with one another and a copy of each treatment plan must be kept in the client's record.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2024 MAR p. 611, Eff. 3/23/24.

Mont. Admin. R. 37.106.1917 Mental Health Center: Client Discharge

(1) Each mental health center shall prepare a discharge summary for each client no longer receiving services. The discharge summary must include:

(a) the reason for discharge;

(b) a summary of the services provided by the mental health center including recommendations for aftercare services and referrals to other services, if applicable;

(c) an evaluation of the client's progress as measured by the treatment plan and the impact of the services provided by the mental health center; and

(d) the signature of the staff member who prepared the report and the date of preparation.

(2) Discharge summaries reports must be filed in the clinical record within one month of the date of the client's formal discharge from services or within three months of the date of the client's last service when no formal discharge occurs.

(3) For cases left open when a client has not received services for over 30 days, documentation must be entered into the record indicating the reason for leaving the case open.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1918 Mental Health Center: Personnel Records

(1) For each employee or contracted individual, the mental health center shall maintain the following information on file:

(a) a current job description;

(b) if a licensed mental health professional, documentation of current licensure and certification; and

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS, from DHES, 2002 MAR p. 916.

Mont. Admin. R. 37.106.1919 Mental Health Center: Quality Assessment

(1) Each mental health center shall implement and maintain an active quality assessment program using information collected to make improvements in the mental health center's policies, procedures and services. At a minimum, the program must include procedures for:

(a) conducting client satisfaction surveys, at least annually, for all mental health center programs. The survey must address:

(i) whether the client, parent or guardian is adequately involved in the development and review of the client's treatment plan;

(ii) whether the client, parent or guardian was informed of client rights and the mental health center's grievance procedure;

(iii) the client's, parent's or guardian's satisfaction with all mental health center programs in which the client participated; and

(iv) the client's, parent's, or guardian's recommendations for improving mental health center's services.

(b) maintaining records on the occurrence, duration and frequency of seclusion and physical restraints used;

(d) a quarterly review with the appropriate school district of the effectiveness, financial status, staffing patterns, and staff caseload of any CSCT program provided pursuant to an endorsement under ARM 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961 and 37.106.1965.

(2) Each mental health center shall prepare and maintain on file an annual report of improvements made as a result of the quality assessment program.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02; AMD, 2005 MAR p. 1787, Eff. 9/23/05.

Mont. Admin. R. 37.106.1925 Mental Health Center: Compliance with Building and Fire Codes, Fire Extinguishers, Smoke Detectors, and Maintenance

(1) Each mental health center shall ensure that its facilities, buildings, and homes:

(a) meet all applicable state and local building and fire codes;

(b) have a workable portable fire extinguisher on each floor, with a minimum rating of 2 A10BC. Extinguishers must be readily accessible at all times; and

(c) have a properly maintained and regularly tested smoke detector, approved by a recognized testing laboratory, on each floor. Building exits must be unobstructed and clearly marked.

(2) Each mental health center shall ensure its facilities, buildings, homes, equipment, and grounds are clean and maintained in good repair at all times for the safety and well being of its clients, staff, and visitors.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS, from DHES, 2002 MAR p. 916.

Mont. Admin. R. 37.106.1926 Mental Health Center: Physical Environment

(1) Each mental health center providing a mental health group home or a crisis intervention stabilization facility must ensure that no more than four residents reside in a single bedroom. Each multi-bedroom must contain at least 80 square feet per bed, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules. Each center must further provide:

(a) one toilet for every four residents;

(b) a toilet and sink in each toilet room;

(d) showers and tubs with non-slip surfaces.

(2) Any provision of this rule may be waived at the discretion of the department if conditions in existence prior to the adoption of this rule or construction factors would make compliance extremely difficult or impossible and if the department determines that the level of safety to residents and staff is not diminished.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS, from DHES, 2002 MAR p. 916.

Mont. Admin. R. 37.106.1927 Mental Health Center: Emergency Procedures

(1) Each mental health center shall develop a written plan for emergency procedures. At a minimum, the plan must include:

(a) emergency evacuation procedures to be followed in the case of fire or other emergency;

(b) procedures for contacting emergency service responders; and

(2) Telephone numbers of the hospital, police department, fire department, ambulance, and poison control center must be posted by each telephone.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS, from DHES, 2002 MAR p. 916.

Mont. Admin. R. 37.106.1935 Mental Health Center: Youth and Adolescent and Adult Targeted Case Management

(1) In addition to the requirements established in this subchapter, each mental health center providing youth and adolescent and adult targeted case management services shall comply with the requirements established in this rule.

(2) Each mental health center providing targeted case management program services shall:

(a) ensure each targeted case manager is meeting with a supervisor at least once per month, as necessary based on the case manager's documented skills and skill sets such as developing treatment plans, facilitating family or caregivers treatment team meetings, and educating the youth and the youth's family or caregivers about the mental health system. In addition, targeted case managers must have access to clinical consultation through the treatment team meeting;

(b) employ or contract with case managers who have the knowledge and skills needed to effectively perform targeted case management duties. Minimum qualifications for a case manager are a bachelor's degree in a human services field with at least one year of full-time experience serving people with mental illnesses. Individuals with other educational backgrounds who, as providers, consumers, or advocates of mental health services have developed the necessary skills, may also be employed as targeted case managers. The mental health center's targeted case management position description must contain equivalency provisions;

(c) train the supervisor and program staff in the therapeutic de-escalation of crisis situations to ensure the protection and safety of the clients and staff. The training must include the use of physical and non-physical methods of managing clients and must be updated, at least annually, to ensure the maintenance of necessary skills;

(d) develop a written protocol for case managers and supervisors that includes a minimum of 20 hours of initial training, and 20 hours of annual continuing education. Areas of focus should include:

(i) competencies in key skill sets such as developing treatment plans, facilitating treatment team meetings, and educating the youth and the youth's family or caregivers about the mental health system; and

(ii) training on suicide prevention, including crisis and safety planning.

(e) maintain progress notes for each client. The progress notes must be entered into the client's clinical record at least every 30 days and upon the occurrence of any significant change in the client's condition;

(f) ensure caseload sizes are sufficiently small to permit case managers to respond flexibly to differing service needs of youth and families, including frequency of contact;

(g) develop written policies and procedures addressing the independence of the targeted case manager and targeted case management program. At a minimum, the policies and procedures must address:

(i) the targeted case manager acting as a client's advocate in involuntary commitment proceedings;

(ii) the targeted case manager's role in conflicts between the client and the mental health center or other agencies;

(iii) the ability of the targeted case manager to freely advocate for services from or outside of the mental health center on behalf of the client;

(iv) the relationship between the primary therapist, if the client has one, and the case manager;

(v) the obligation to report information to the mental health center staff that the client has requested to be kept confidential; and

(vi) the ability of the targeted case manager to contact an advocacy organization if the case manager believes the mental health center is unresponsive to the needs of the client.

(3) The availability of targeted case management services may not be made contingent upon a client's willingness to receive other services. A client suspended or excluded from other programs or services provided by the mental health center may not be restricted or suspended from targeted case management services solely due to the action involving the other program or services.

(4) Targeted case management services are largely provided throughout the community rather than in an office or a facility. All contacts with clients must occur in a place that is convenient for the client. More than 50% of a case manager's in person contacts with clients must be outside of the mental health center's facility. Restrictions may not be placed on a case manager's ability to meet with a client in any reasonable location.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02; AMD, 2020 MAR p. 691, Eff. 11/1/20.

Mont. Admin. R. 37.106.1936 Mental Health Center: Child and Adolescent Day Treatment

(1) In addition to the requirements established in this subchapter, each mental health center providing a child and adolescent day treatment program shall comply with the requirements established in this rule.

(2) The Child and Adolescent Day Treatment program must be site based and occur in a location separate from the child and adolescent's regular classroom. Appropriate, supplemental day treatment services may be delivered off site. The program shall:

(a) operate at least five days per week for at least three hours per day, unless school holidays preclude day treatment activities. Preschool day treatment programs shall operate at least three days a week, three hours a day, unless school holidays preclude day treatment activities;

(b) employ or contract with a program supervisor who is knowledgeable about the service and support needs of children and adolescents with serious emotional disturbances. The program therapist or program supervisor must be site based;

(c) establish admission criteria which assess the child or adolescent's needs and the appropriateness of the services to meet those needs. Students still in school, 18 years of age or older, remain eligible for the program;

(d) provide mental health services according to the individualized treatment plan which may include individual therapy, family and group therapy, social skills training, life skills training, pre-vocational training, therapeutic recreation services and ensure access to emergency services;

(e) coordinate its services with educational services provided through full collaboration with a school district recognized by the office of public instruction;

(f) provide referral and aftercare coordination with inpatient facilities, residential treatment programs, or other appropriate out-of-home placement programs;

(g) establish policies and procedures regarding the use of time-out and seclusion. Time-out and seclusion may not be used with a locked door. Mechanical restraints may not be used. If time-out is used, intermittent to continuous staff observation is required, as clinically indicated. If seclusion is used, continuous staff observation is required. Written permission from the parent or legal guardian must be obtained for the use of non-aversive and aversive interventions and must be placed in the client's clinical record. The clinical record must include signed orders by a licensed mental health professional for use of seclusion, a detailed description of the circumstances warranting such action, and the date, time and duration of the seclusion;

(h) require and ensure that the program supervisor and all staff shall each have a minimum of six contact hours of annual training relating to child and adolescent mental illnesses and treatment; and

(i) maintain progress notes for each client. The progress notes must be entered into the client's clinical record at least every 30 days and upon the occurrence of any significant change in the client's condition.

(3) The day treatment staff shall attend all child study team (CST) meetings and individual education planning meetings when clinically indicated and permission has been granted by the parent or legal guardian or child, when age appropriate. If the client requires an individualized education program (IEP) , a copy of the IEP must be included in the client's treatment plan unless the parent or legal guardian or child, when age appropriate, refuses to authorize release to the mental health center.

(4) The program supervisor and day treatment program staff must be trained in the therapeutic de-escalation of crisis situations to ensure the protection and safety of the clients and staff. The training must include the use of physical and non-physical methods of managing children and adolescents and must be updated, at least annually, to ensure that necessary skills are maintained.

(5) Each program therapist or in-training mental health professional in the program shall carry an active caseload not to exceed 12 day treatment clients. The therapist or mental health professional who carries the caseload must also provide the therapy and must be on site during the entire day treatment hours of operation unless the therapist is attending a meeting offsite that pertains to one of the day treatment client's treatment. The program supervisor may carry a caseload of up to six day treatment clients.

(6) There must be at least one full-time equivalent (FTE) clinical or mental health staff member for every six clients in the program. Support staff means an adult, under the supervision of the program supervisor or therapist, with experience in working with children and adolescents with severe emotional disturbances. For the purpose of this ratio, the number of participants in the program must be based on the average daily attendance. This ratio includes the site based therapist or program supervisor, if the therapist or supervisor spends at least half of the time with the class and is readily available at other times when the need arises. The program therapist's office must be in close proximity to the day treatment classroom to provide timely interventions to clients. Mental health staff must not be shared with other programs. Either the mental health support staff member, the therapist or the supervisor must be in the classroom at all times during operation of the program.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS and AMD, 2002 MAR p. 916, Eff. 3/29/02; AMD, 2024 MAR p. 2014, Eff. 8/10/24.

Mont. Admin. R. 37.106.1937 Mental Health Center: Adult Day Treatment

(1) In addition to the requirements established in this subchapter, each mental health center providing adult day treatment shall comply with the requirements established in this rule.

(2) The adult day treatment program shall:

(a) operate at least two days a week, for at least four hours a day;

(b) employ or contract with a program supervisor who is knowledgeable about the service and support needs of individuals with a mental illness, day treatment programming and psychosocial rehabilitation. The program supervisor or program therapist must be site based;

(c) provide, by means of a variety of individual and group treatment modalities, therapy and rehabilitation in the areas of independent living skills, crisis intervention, pre-vocational and vocational skill building, socialization, and recreational activities;

(d) structure its treatment activities to promote increasing levels of independence in the client's functioning;

(e) require the program supervisor and all program staff to each have a minimum of six contact hours of annual training relating to adult mental illness and treatment;

(f) maintain progress notes for each client. The progress notes must be entered into the client's clinical record at least every 30 days and upon the occurrence of any significant change in the client's condition; and

(g) maintain a client to staff ratio that may not exceed ten clients to one staff member.

(3) The program supervisor and day treatment program staff must be trained in the therapeutic de-escalation of crisis situations to ensure the protection and safety of the clients and staff. The training must include the use of physical and non-physical methods of managing clients, and must be updated, at least annually, to ensure that necessary skills are maintained.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1938 Mental Health Center: Mental Health Group Home

(1) In addition to the requirements established in this subchapter, each mental health center providing a mental health group home shall comply with the requirements established in this rule.

(2) The purpose of a mental health group home is to provide residential treatment for adults with a mental illness.

(3) The mental health group home is considered to be a community residential facility for the purposes of local zoning and building codes reviews.

(4) The mental health group home must be annually inspected for compliance with fire codes by the state fire marshal or the marshal's designee. The home shall maintain a record of such inspection for at least one year following the date of the inspection.

(5) The mental health group home shall:

(a) employ or contract with a program supervisor who is knowledgeable about the service and support needs of individuals with mental illnesses;

(b) maintain staffing at least eight hours daily. Additional staff hours and supervision shall be dictated by the needs of the group home residents;

(c) ensure that 24 hour a day emergency mental health care is available through the mental health center or other contracted entities;

(d) structure its treatment activities to promote increasing levels of independence in the client's functioning;

(e) establish admission criteria which assess the individual's needs and the appropriateness of the services to meet those needs. At a minimum, admission criteria must require that the person:

(i) be 18 years of age or older and be unable to maintain the stability of their mental illness in an independent living situation;

(ii) be diagnosed with a mental illness;

(iii) be medically stable;

(iv) not be an immediate danger to self or others;

(v) requires a transitional residential level of care from a short acute hospital stay or long-term commitment, or requires some ongoing residential structure or supervision;

(vi) sign a contract to follow group home rules.

(f) assess new admissions to the mental health group home and offer ongoing treatment and training in the following areas:

(i) community adjustment (ability to use community resources such as stores, professional services, recreational facilities, government agencies, etc.) ;

(ii) personal care (grooming, food preparation, housekeeping, money management, etc.) ;

(iii) socialization; and

(iv) recreation/leisure.

(g) maintain progress notes for each client. The progress notes must be entered into the client's clinical record at least every 30 days and upon the occurrence of any significant change in the client's condition.

(6) Staff working in the mental health group home must:

(a) be 18 years of age;

(b) possess a high school diploma or GED;

(d) be capable of implementing each resident's treatment plan; and

(e) be trained in the Heimlich maneuver and maintain certification in cardiopulmonary resuscitation (CPR) .

(7) The program supervisor shall orient new staff on how to deal with client rule violations, new admissions, emergency situations, after hour admissions and client incident reports. Written policies and procedures for handling day-to-day operations must be available at the group home.

(8) The program supervisor and all program staff must each have a minimum of six contact hours of annual training relating to adult mental illness and treatment.

(9) The program supervisor and group home program staff must be trained in the therapeutic de-escalation of crisis situations to ensure the protection and safety of the residents and staff. The training must include the use of physical and nonphysical methods of managing residents, and must be updated, at least annually, to ensure that necessary skills are maintained.

(10) Upon admission, each resident must be provided with:

(a) a written statement of resident rights which, at a minimum, include the applicable patient rights in 53-21-142 , MCA;

(b) a copy of the mental health center grievance procedure; and

(11) At the time of a resident's discharge from the group home, the staff shall assist the resident in making arrangements for housing, employment, education, training, treatment, and/or other services needed for adequate adjustment to community living.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1945 Mental Health Center: Crisis Telephone Services

(1) In addition to the requirements established in this subchapter, each mental health center shall provide crisis telephone services and comply with the following requirements:

(a) ensure that crisis telephone services are available 24 hours a day, seven days a week. Answering services and receptionists may be used to transfer calls to individuals who have been trained to respond to crisis calls;

(b) employ or contract with appropriately trained individuals, under the supervision of a licensed mental health professional, to respond to crisis calls. An appropriately trained individual is one who has received training and instruction regarding:

(i) the policies and procedures of the mental health center for crisis intervention services;

(ii) crisis intervention techniques;

(iii) conducting assessments of risk of harm to self or others, and prevention approaches;

(iv) the process for voluntary and involuntary hospitalization;

(v) the signs and symptoms of mental illness; and

(vi) the appropriate utilization of community resources.

(c) ensure that a licensed mental health professional provides consultation and backup, as indicated, for unlicensed individuals responding to crisis calls;

(d) establish written policies and procedures governing in-person contacts between crisis responders and crisis callers. The policies and procedures must address the circumstances under which the contacts may or may not occur and safety issues associated with in-person contacts;

(e) maintain documentation for each crisis call. The documentation must reflect:

(i) the date of the call;

(ii) the staff involved;

(iii) identifying data, if possible;

(iv) the nature of the emergency, including an assessment of dangerousness/lethality, medical concerns, and social supports; and

(v) the result of the intervention.

(2) No individual may respond to crisis calls until the mental health center documents in writing in the individual's personnel file that the individual has received the training and instruction required in (1) (b) above. Additional training and instruction must be provided to crisis responders based upon an ongoing assessment of presenting problems and responder needs and to ensure that necessary crisis intervention skills are maintained.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1946 Mental Health Center: Inpatient Crisis Stabilization Program

(1) In addition to the requirements established in this subchapter, each mental health center providing an inpatient crisis stabilization program shall comply with the requirements established in this rule.

(2) The facility must be annually inspected for compliance with fire codes by the state fire marshal or the marshal's designee. The facility shall maintain a record of such inspection for at least one year following the date of the inspection.

(3) The inpatient crisis stabilization program shall:

(a) employ or contract with a program supervisor knowledgeable about the service and support needs of individuals with mental illness experiencing a crisis. The program supervisor or a licensed mental health professional must be site based;

(b) require staff working in the crisis stabilization program:

(i) be 18 years of age;

(ii) possess a high school diploma or GED; and

(iii) be capable of implementing each resident's treatment plan;

(c) ensure that the program supervisor and all staff each have a minimum of six contact hours of annual training relating to the service and support needs of individuals with mental illness experiencing a crisis;

(d) orient staff prior to assuming the duties of the position on:

(i) the types of mental illness and treatment approaches;

(ii) suicide risk assessment and prevention procedures; and

(iii) program policies and procedures, including emergency procedures;

(e) orient staff within eight weeks from assuming the duties of the position on:

(i) therapeutic communications;

(ii) the legal responsibilities of mental health service providers;

(iii) mental health laws of Montana regarding the rights of consumers;

(iv) other services provided by the mental health center; and

(v) infection control and prevention of transmission of blood borne pathogens;

(f) maintain written program policies and procedures at the facility;

(g) train staff in the abdominal thrust maneuver and ensure staff maintain current certification in cardiopulmonary resuscitation (CPR);

(h) maintain 24 hour awake staff;

(i) maintain a staff-to-patient ratio dictated by resident need. A procedure must be established to increase or decrease staff coverage as indicated by resident need;

(j) establish admission criteria which assess the individual's needs and the appropriateness of the services to meet those needs. At a minimum, admission criteria must require that the person:

(i) be at least 18 years of age;

(ii) be medically stable (with the exception of the person's mental illness);

(iii) be willing to enter the program, follow program rules, and accept recommended treatment;

(iv) be willing to sign a no-harm contract, if clinically indicated;

(v) not require physical or mechanical restraint;

(vi) be in need of frequent observation on a 24-hour basis;

(k) establish written policies and procedures:

(i) for completing a medical screening and establishing medical stabilization, prior to admission;

(ii) to be followed should residents, considered to be at risk for harming themselves or others, attempt to leave the facility without discharge authorization from the licensed mental health professional responsible for their treatment; and

(iii) for the secure storage of toxic household chemicals and sharp household items such as utensils and tools;

(l) when clinically appropriate, provide each resident upon admission, or as soon as possible thereafter:

(i) a written statement of resident rights which, at a minimum, include the applicable patient rights in 53-21-142, MCA;

(ii) a copy of the mental health center grievance procedure; and

(iii) the written rules of conduct including the consequences for violating the rules;

(m) ensure hospital care is available through a transfer agreement for residents in need of hospitalization;

(n) maintain progress notes for each resident. The progress notes must be entered at least daily into the resident's clinical record. The progress notes must describe the resident's physical condition, mental status, and involvement in treatment services; and

(o) make referrals for services that would help prevent or diminish future crises at the time of the resident's discharge. Referrals may be made for the resident to receive additional treatment or training or assistance such as securing housing.

(4) The program supervisor and program staff must be trained in the therapeutic de-escalation of crisis situations to ensure the protection and safety of the residents and staff. The training must include the use of physical and nonphysical methods of managing residents and must be updated, at least annually, to ensure that necessary skills are maintained.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 1998 MAR p. 539, Eff. 2/27/98; TRANS & AMD, 2002 MAR p. 916, Eff. 3/29/02; AMD, 2006 MAR p. 1285, Eff. 5/19/06; AMD, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.1950 Mental Health Center: Medication Management Services

(1) Each mental health center shall make medication management services available to the clients it serves for medications needed to treat their mental illnesses.

(2) Medication management services shall be provided by licensed health care professionals, acting within the scope of their licenses, who are either employed by or contracted with the mental health center.

(3) A mental health center shall have medication management policies and procedures in its policy procedure manual which include, at minimum, the following:

(a) maintaining a current, chronological and dated record of medication orders by the client's licensed health care professional in the client's clinical records;

(b) self-administration of medications by clients;

(d) adjusting dosages or prescribing new medications for clients to include the rationale for the use of and changes in the client's medication;

(e) monitoring the client's response to medication or dosage changes;

(f) maintaining a medication administration record for each client documenting medications and dosages prescribed, the client's compliance in taking prescribed medications, doses taken or not taken, any measure taken to obtain compliance, and the reason for omission of any scheduled dose of medication;

(g) documenting any medication errors;

(h) reporting and addressing in a timely manner, any medication errors and adverse drug reactions to the licensed health care professional who prescribed the client's medication, and to the program supervisor and medical director;

(i) providing and documenting education about the effects, side effects, contraindications and management procedures of the client's medication;

(j) providing safe and secure storage of all medications;

(k) providing refrigeration for medication segregated from food items, within the temperature range specified by the manufacturer for medication that requires refrigeration; and

(l) storing medication in the container dispensed by the pharmacy or in the container in which it was purchased in the case of over-the-counter medication, with the label intact and clearly legible.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-204, MCA
History: NEW, 2002 MAR p. 916, Eff. 3/29/02.

Mont. Admin. R. 37.106.1955 Mental Health Center: Comprehensive School and Community Treatment Program (csct) Endorsement Requirements

(1) In addition to the requirements established in this subchapter, a licensed mental health center providing a comprehensive school and community treatment program (CSCT) must have a CSCT program endorsement issued by the department. To receive a CSCT program endorsement, the licensed mental health center must establish to the department's satisfaction that it meets the requirements stated in ARM 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965.

(2) The licensed mental health center's CSCT program must have written admission and discharge criteria.

(3) The licensed mental health center must have a written contract with the school district in accordance with ARM 37.87.1802.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1787, Eff. 12/1/05; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2014 MAR p. 1401, Eff. 6/27/14; AMD, 2016 MAR p. 1706, Eff. 9/24/16; AMD, 2022 MAR p. 159, Eff. 1/29/22.

Mont. Admin. R. 37.106.1956 Mental Health Center: Comprehensive School and Community Treatment Program (csct), Services and Staffing

(1) For any youth receiving CSCT services, the CSCT program must be able to provide the following services to each youth as specified in that youth's individualized treatment plan (ITP):

(a) individual, group, and family therapy;

(b) behavioral intervention;

(c) other evidence and research-based practices effective in the treatment of youth with a serious emotional disturbance (SED);

(d) direct crisis intervention services during the time the youth is present in a school-owned or operated facility;

(e) a crisis plan that identifies a range of potential crisis situations with a range of corresponding responses including physically present face-to-face encounters and telephonic responses 24/7, as appropriate;

(f) treatment plan coordination with substance use disorder and mental health treatment services the youth receives outside the CSCT program;

(g) access to emergency services;

(h) referral and aftercare coordination with inpatient facilities, psychiatric residential treatment facilities, or other appropriate out-of-home placement programs; and

(i) continuous treatment that must be available twelve months of the year. The program must provide a minimum of 16 hours per month of CSCT services in summer months. For any youth who does not receive CSCT services in the summer, providers must document in the youth's medical record the reason why the youth did not receive such services, as well as a summary of attempts to engage the youth and family.

(2) If the sum total of daily units per youth is over 20 units, the claim will suspend for clinical review. Providers must submit documentation to the department demonstrating medical necessity of service.

(3) CSCT services for youth with SED must be provided according to an ITP designed by a licensed or in-training mental health professional who is a staff member of a CSCT program team.

(4) The CSCT ITP team must include:

(a) licensed or in-training mental health professional;

(b) school administrator or designee;

(d) the youth, as appropriate; and

(e) other person(s) who are providing services, or who have knowledge or special expertise regarding the youth, as requested by the parent(s), legal representative/guardian, or the agencies.

(5) Providers must inform the youth and the parent(s)/legal representative/guardian that Medicaid requires coordination of CSCT with home support services and outpatient therapy.

(6) The CSCT program must employ sufficient qualified staff to deliver all CSCT services to the youth as outlined in the ITP for the youth and in accordance with the contract between the school and the licensed mental health center.

(7) The CSCT team may be assigned to provide services in two schools if the CSCT team responds to crisis situations for youth enrolled in CSCT in each school building during typical school hours.

(8) The CSCT program must employ or contract with a program supervisor who has daily overall responsibility for the CSCT program and who is knowledgeable about the mental health service and support needs of the youth. The program supervisor may provide direct CSCT services, but this position may not fill the functions of the staff positions described in (9) and (10) for more than six months.

(9) Each CSCT team must include a mental health professional, who may be a licensed or in-training mental health professional, as defined in ARM 37.87.702. In-training mental health professionals must be:

(a) supervised by a licensed mental health professional; and

(b) supervised in accordance with ARM Title 24, chapter 219.

(10) Each CSCT team may include up to two behavioral aides. A behavioral aide must work under the clinical oversight of a licensed mental health professional and provide services for which they have received training that do not duplicate the services of the licensed or in-training mental health professional. All behavioral aides initially employed after July 1, 2013 must have a high school diploma or a GED and at least two years:

(a) experience working with emotionally disturbed youth;

(b) providing direct services in a human services field; or

(11) The licensed mental health center CSCT program supervisor and an appropriate school district representative must meet regularly, at least four times per calendar year, during the time period CSCT services are provided to mutually assess program effectiveness utilizing the following indicators:

(a) progress on the individual treatment plan of each youth receiving CSCT services;

(b) attendance;

(d) contact with law enforcement;

(e) referral to a higher level of care; and

(f) discharges from the program.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2022 MAR p. 159, Eff. 1/29/22; AMD, 2024 MAR p. 2014, Eff. 8/10/24; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Mont. Admin. R. 37.106.1960 Mental Health Center: Comprehensive School and Community Treatment (csct) Program, Personnel Training

(1) The CSCT program must be delivered by adequately trained staff. Training should be competency-based and must be documented and maintained in personnel files.

(2) All CSCT program staff are required to receive a minimum of 18 hours of orientation training during the first three months of employment which addresses all of the following:

(a) certified de-escalation training inclusive of physical and nonphysical methods;

(b) child development;

(d) crisis planning;

(e) roles and responsibilities of CSCT staff in the school setting;

(f) school culture;

(g) confidentiality requirements;

(h) staff and program supervision; and

(i) CSCT program procedures.

(3) All CSCT program staff are required to receive a minimum of 18 hours training per year in topics that support staff competency in working with youth with serious emotional disturbance (SED) to decrease severity of presenting symptoms. Training must include:

(a) positive behavioral intervention planning and support;

(b) classroom and youth behavior management techniques that include certified de-escalation training inclusive of physical and nonphysical methods;

(d) progress monitoring techniques to inform treatment decisions; and

(e) trauma-informed practices.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2022 MAR p. 159, Eff. 1/29/22.

Mont. Admin. R. 37.106.1961 Mental Health Center: Comprehensive School and Community Treatment (csct) Program, Record Requirements

(1) In addition to any clinical records required in ARM 37.85.414 or elsewhere in these rules, the licensed mental health center's CSCT program must maintain the following records for youth with serious emotional disturbance (SED):

(a) a signed verification indicating the parent(s), legal representative, or guardian has been informed by the licensed mental health center that Medicaid requires coordination between CSCT, home support services, and outpatient therapy;

(b) a copy of the clinical assessment which documents the presence of SED;

(d) daily progress notes from each team member that document individual therapy sessions and other direct services provided to the youth and family throughout the day including:

(i) when any therapy or therapeutic intervention begins and ends; and

(ii) the sum total number of minutes spent each day with the youth.

(e) 90-day treatment plan reviews;

(f) discharge plan; and

(g) the Comprehensive School and Community Treatment Data Collection Template, that must be completed each March and September for each youth enrolled in CSCT and submitted to the Children's Mental Health Bureau by the licensed mental health center. The department adopts and incorporates by reference the Comprehensive School and Community Treatment Data Collection Template (form). A copy of this form may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT, 59604-4210 or at found at https://dphhs.mt.gov/dsd/CMB/.

(2) In addition to any clinical records required in ARM 37.85.414 or elsewhere in these rules, records for youth referred to CSCT regardless of their diagnosis as described in ARM 37.87.1803(4) must include the following:

(a) progress notes for each individual therapy session and other direct services provided to the youth and family throughout the day; and

(b) discharge plan with referral to additional services, if appropriate.

(3) Records for youth referred to CSCT and denied acceptance into the program must include documentation detailing the reason for the denial.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2014 MAR p. 1401, Eff. 6/27/14; AMD, 2016 MAR p. 1706, Eff. 9/24/16; AMD, 2022 MAR p. 159, Eff. 1/29/22; AMD, 2026 MAR, Notice No. 2026-525, Eff. 8/22/26.

Mont. Admin. R. 37.106.1965 Mental Health Center: Comprehensive School and Community Treatment (csct) Program, Special Education Requirements

(1) The licensed mental health center's CSCT program must be coordinated with the individualized education program (IEP) of the youth, if the youth is identified as a child with a disability and is receiving special education services under the Individuals with Disabilities Education Act (IDEA).

(2) The licensed or in-training mental health professional or behavioral aide, as appropriate, must attend the IEP meeting when requested by the parent(s)/legal representative/guardian or the school.

History

Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
History: NEW, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2022 MAR p. 159, Eff. 1/29/22.

Mont. Admin. R. 37.106.1975 Outpatient Crisis Response Facility: Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3, conflict with the terms of this subchapter, the terms of this subchapter will apply to outpatient crisis response facilities.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1976 Outpatient Crisis Response Facility: Definitions

In addition to the definitions in 50-5-101 , MCA, the following definitions apply to this subchapter:

(1) "Inpatient crisis stabilization program" means 24-hour supervised treatment for adults with a mental illness for the purpose of stabilizing the individual's symptoms.

(2) "Outpatient crisis response facility" means an outpatient facility operated by a licensed hospital or a licensed mental health center that provides evaluation, intervention, and referral for individuals experiencing a crisis due to serious mental illness or a serious mental illness with a co-occurring substance use disorder. The facility may not provide services to a client for more than 23 hours and 59 minutes from the time the client arrives at the facility. The facility must discharge or transfer the client to the appropriate level of care.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1979 Outpatient Crisis Response Facility: Services and Licensure

(1) Each applicant for licensure shall submit a license application to the department requesting approval to provide outpatient crisis services.

(a) A licensed hospital does not have to comply with the requirements found at ARM 37.106.1906(3) to provide outpatient crisis response services.

(2) Services provided by an outpatient crisis response facility must be rendered by:

(a) a single administration in a discrete physical facility or multiple facilities; or

(b) written agreement or contract with:

(i) licensed health care professionals;

(ii) licensed mental health professionals; or

(iii) other facilities such as hospital, clinics, or educational institutions which may combine to provide crisis services.

(3) Outpatient crisis response facility services must be available to clients continuously throughout the year.

(4) An outpatient crisis response facility must report to the department, in writing, any of the following changes within at least 30 days before the planned effective date of the change:

(a) a change of administrator;

(b) a change of medical director;

(d) a change in the name of the agency; or

(e) the discontinuation of services.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, 50-5-203, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1980 Outpatient Crisis Response Facility: Organizational Structure

(1) Each crisis response facility shall employ or contract with an administrator who shall:

(a) maintain daily overall responsibility for the crisis response facility's operations;

(b) develop and oversee the implementation of policies and procedures pertaining to the operation and services of the crisis response facility;

(d) develop an organizational chart that accurately reflects the current lines of administration and authority; and

(e) maintain a file for all client incident reports.

(2) Each outpatient crisis response facility shall employ or contract with a medical director who shall:

(a) coordinate with and advise the staff of the outpatient crisis response facility on clinical matters;

(b) provide direction, consultation, and training regarding the outpatient crisis response facility's programs and operations as needed;

(c) act as a liaison for the outpatient crisis response facility with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric or hospital services; and

(d) ensure the quality of treatment and related services through participation in the outpatient crisis response facility's quality assurance process.

(3) Each outpatient crisis response facility shall employ or contract with a program supervisor knowledgeable about the service and support needs of individuals with co-occurring mental illness and intoxication/addiction disorders who may be experiencing a crisis. The program supervisor must be site based.

(4) Each outpatient crisis response facility shall employ or contract with a licensed health care professional as defined in 50-5-101 (34) , MCA for all hours of operation. The licensed health care professional may be the program supervisor.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1981 Outpatient Crisis Response Facility: Staffing and Operations

(1) In addition to the requirements established in this subchapter, each outpatient crisis response facility shall comply with the requirements established in this rule. The outpatient crisis response facility shall require staff working in the facility:

(a) to be at least 18 years of age;

(b) possess a high school diploma or GED; and

(2) The facility must ensure the program supervisor and all staff each have a minimum of six contact hours of annual training relating to the service and support needs of individuals with mental illness experiencing a crisis.

(3) The facility must orient direct care staff, prior to their contact with clients, on the following:

(a) the types of mental illness and treatment approaches;

(b) alcohol and drug intoxication treatment approaches;

(d) suicide risk assessment and prevention procedures; and

(e) program policies and procedures, including emergency procedures.

(4) The facility must orient staff within four weeks of employment on the following:

(a) therapeutic communications;

(b) legal responsibilities of mental health service providers;

(d) other services provided by mental health centers and substance abuse providers; and

(e) infection control and prevention of transmission of blood borne pathogens.

(5) The facility must annually train staff in the abdominal thrust maneuver and ensure staff maintain current certification in cardiopulmonary resuscitation (CPR) .

(6) The facility must maintain locked and secured storage for all medications kept on site.

(7) The facility must maintain 24-hour awake staff.

(8) The facility must maintain staff-to-patient ratio dictated by client need.

(9) The facility must establish admission criteria that assess the individual client's needs and the appropriateness of the services to meet those needs. At a minimum, admission criteria must require that the client:

(a) be at least 18 years of age;

(b) be medically stable, with the exception of the person's mental illness or serious mental illness with a co-occurring substance use disorder; and

(10) The facility must provide each client upon admission, or as soon as possible if not clinically appropriate upon admission with:

(a) a written statement of client rights which, at a minimum, includes the applicable patient rights in 53-21-142 , MCA;

(b) a copy of the crisis response facility grievance procedure; and

(11) The facility must ensure inpatient care is available through a transfer agreement for clients in need of a higher level of care.

(12) The facility must maintain progress notes for each client. The progress notes must be entered following the clinical intake assessment and updated by the end of each shift into the client's clinical record. The progress notes must describe the client's physical condition, mental status, and involvement in treatment services.

(13) The facility must make referrals for services that would help prevent or diminish future crises at the time of the client's discharge. Referrals include, but are not limited to, additional treatment or training or assistance such as securing housing.

(14) The program supervisor and program staff must be trained in the therapeutic de-escalation of crisis situations to ensure the protection and safety of clients and staff. The training must:

(a) include the use of physical and nonphysical methods of managing clients; and

(b) be updated at least annually to ensure that necessary skills are maintained.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1982 Outpatient Crisis Response Facility: Policies and Procedures

(1) Each outpatient crisis response facility shall maintain a policy and procedure manual. The manual must be reviewed and approved, at least annually, by the medical director and administrator. The manual must, at a minimum, contain policies and procedures for:

(a) defining the responsibilities, limitations, and supervision of students, interns, and volunteers working for the crisis response facility;

(b) verifying each professional staff member's credentials, when hired, and annually thereafter, to ensure the continued validity of required licenses;

(c) client complaints and grievances, to include an opportunity for appeal, and to inform clients of the availability of advocacy organizations to assist them;

(d) completing a medical screening and determining methods for medical stabilization and criteria for transfer to appropriate level of medical care that may include emergency care in a hospital;

(e) interacting with clients considered to be at risk for harming themselves or others who attempt to leave the facility without discharge authorization from the licensed mental health professional responsible for their treatment;

(f) increasing or decreasing staff coverage as indicated by client need;

(g) identifying client rights, including a procedure for informing clients of their rights;

(h) addressing and reviewing ethical issues faced by staff and reporting allegations of ethics violations to the applicable professional licensing authority;

(i) informing clients of the policy and procedures for client complaints and grievances;

(j) initiating services to clients;

(k) informing clients of rules governing their conduct and the types of infractions that can result in suspension or discontinuation of services offered by the crisis response facility;

(l) suspending or discontinuing program services with the following information to be provided to the client:

(i) the reason for suspending or discontinuing services or access to programs;

(ii) the conditions that must be met to resume services or access to programs;

(iii) the grievance procedure that may be used to appeal the suspension or discontinuation; and

(iv) what services, if any, will be continued to be provided even though participation in a particular service or program may be suspended or discontinued.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1983 Outpatient Crisis Response Facility: Clinical Records

(1) Each crisis response facility shall collect assessment data and maintain clinical records on all clients who receive services.

(2) Each facility must ensure the confidentiality of clinical records in accordance with the Health Information Portability and Accountability Act (HIPAA) .

(3) At a minimum, the clinical record must include:

(a) a clinical intake assessment;

(b) additional assessments or evaluations, if clinically indicated;

(d) progress notes which indicate whether or not the stated treatment plan has been implemented, and the degree to which the client is progressing, or failing to progress, toward stated treatment objectives;

(e) medication orders from the prescribing physician and documentation of the administration of all medications;

(f) signed orders by a licensed mental health professional for any restrictions of rights; and, privileges accorded clients of the crisis response facility including the reasons for the restriction; and

(g) a discharge summary which must be completed within one week of the date of discharge.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1987 Outpatient Crisis Response Facility: Client Assessments

(1) Each outpatient crisis response facility shall employ or contract with licensed mental health professionals to conduct clinical intake assessments which may be abbreviated assessments focusing on the crisis issues and safety.

(a) Abbreviated intake assessments must be conducted by a licensed mental health professional trained in clinical assessments including chemical dependency screening. The clinical intake assessment must include sufficient detail to individualize crisis plan goals and objectives.

(2) Based on the client's clinical needs, each crisis response facility will refer any necessary additional assessments to appropriate and qualified providers. Additional assessments may include, but are not limited to, physical, psychological, emotional, behavioral, psychosocial, recreational, vocational, psychiatric, and chemical dependency evaluations.

(3) Each crisis response facility shall maintain a current list of providers who accept referrals for assessments and services not provided by the facility.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1989 Outpatient Crisis Response Facility: Client Discharge

(1) Each outpatient crisis response facility shall prepare a discharge summary for each client no longer receiving services. The discharge summary must include:

(a) the reason for discharge;

(b) a summary of the services provided by the crisis response facility including recommendations for aftercare services and referrals to other services, if applicable;

(c) an evaluation of the client's progress as measured by the treatment plan and the impact of the services provided by the facility; and

(d) the signature of the staff member who prepared the report and the date of preparation.

(2) Discharge summary reports must be filed in the clinical record within one week of the date of the client's formal discharge from services.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1990 Outpatient Crisis Response Facility: Management of Inappropriate Client Behavior

(1) The facility must develop and implement written policies and procedures that govern the management of inappropriate client behavior only as allowed in 42 CFR 482.13(f) (1) through (6) .

(2) The department adopts and incorporates by reference 42 CFR 482.13(f) (1) through (6) (July 2, 1999) , which contains standards for use of seclusion and restraint for behavioral management.

(3) The policies and procedures must:

(a) specify all facility-approved interventions to manage inappropriate client behavior and designate these interventions on a hierarchy to be implemented, ranging from most positive or least intrusive, to least positive or most intrusive;

(b) ensure, prior to the use of more restrictive techniques, that the client's record documents that programs incorporating the use of less intrusive or more positive techniques have been tried systematically and demonstrated to be ineffective; and

(i) the use of observation and seclusion rooms;

(ii) the use of time-out procedures;

(iii) the use of appropriate medication to manage inappropriate behavior;

(iv) the staff members who may authorize the use of specified interventions; and

(v) a mechanism for monitoring and controlling the use of such interventions.

(4) Interventions to manage inappropriate client behavior must be employed with sufficient safeguards and supervision to ensure that the safety, welfare, and civil and human rights of each client are adequately protected.

(5) Techniques to manage inappropriate client behavior must never be used for disciplinary purposes, for the convenience of staff or as a substitute for a treatment and habilitation program.

(6) The use of systematic interventions to manage inappropriate client behavior must be incorporated into the client's crisis facility treatment plan.

(7) Standing or as needed programs to control inappropriate behavior are not permitted.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1993 Outpatient Crisis Response Facility: Personnel Records

(1) For each employee or contracted individual, the outpatient crisis response facility shall maintain the following information on file:

(a) a current job description;

(b) if a licensed mental health professional, documentation of current licensure and certification; and

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1994 Outpatient Crisis Response Facility: Quality Assessment

(1) Each outpatient crisis response facility shall implement and maintain an active quality assessment program using information collected to make improvements in the facility's policies, procedures and services. At a minimum, the program must include procedures for:

(a) conducting client satisfaction surveys, at least annually;

(b) maintaining records on the occurrence, duration, and frequency of seclusion and physical restraints used; and

(2) Each crisis response facility shall prepare and maintain on file an annual report of improvements made as a result of the quality assessment program.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1995 Outpatient Crisis Response Facility: Compliance with Building and Fire Codes, Fire Extinguishers, Smoke Detectors, and Maintenance

(1) Each outpatient crisis response facility shall ensure that its facilities, buildings, and homes:

(a) meet all applicable state and local building and fire codes. The facility must be annually inspected for compliance with fire codes by the state fire marshal or the marshal's designee, and the facility shall maintain a record of such inspection for at least one year following the date of the inspection;

(b) have a workable portable fire extinguisher on each floor, with a minimum rating of 2A10BC. Extinguishers must be readily accessible at all times;

(c) have a properly maintained and monthly tested smoke detector, approved by a recognized testing laboratory, on each floor of the facility; and

(d) have building exits which must be unobstructed and clearly marked.

(2) Each facility shall ensure its facilities, buildings, homes, equipment, and grounds are clean and maintained in good repair at all times for the safety and well being of its clients, staff, and visitors.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1996 Outpatient Crisis Response Facility: Physical Environment

(1) Each outpatient crisis response facility must ensure that no more than four clients reside in a single treatment room. Each treatment room must contain at least 80 square feet per client, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules. Each center must further provide:

(a) one toilet for every four clients;

(b) a hand washing sink in each toilet room;

(d) showers and tubs with nonslip surfaces and handicap grab bars capable of supporting a sustained weight of 250 lbs.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Mont. Admin. R. 37.106.1997 Outpatient Crisis Response Facility: Emergency Procedures

(1) Each outpatient crisis response facility shall develop a written plan for emergency procedures. At a minimum, the plan must include:

(a) emergency evacuation procedures to be followed in the case of fire or other emergency;

(b) procedures for contacting emergency service responders; and

(2) Telephone numbers of the hospital, police department, fire department, ambulance, and poison control center must be posted by each telephone.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2006 MAR p. 1285, Eff. 5/19/06.

Subchapter 37.106.20 Mental Health Center: Foster Care for Adults With Mental Illnesses

Mont. Admin. R. 37.106.2001 Mental Health Center: Foster Care for Adults with Mental Illnesses

(1) In addition to the requirements established in this subchapter, each mental health center providing foster care for mentally ill adults shall utilize only foster care providers licensed by the department pursuant to ARM Title 37, chapter 100, subchapter 1.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2004 Mental Health Center: Foster Care for Adults with Mental Illnesses, Policy and Procedures

(1) Each mental health center that has a foster care program endorsement shall have policy and procedures in place to make initial and periodic assessment of the foster care provider's ability to meet the following criteria:

(a) ability to provide necessary services and supports to the client; and

(b) ability to support the client's rights as outlined in 53-21-142 , MCA.

(2) The mental health center shall provide an orientation session prior to the mental health center entering into a client placement agreement with the foster care provider, and at least annually on issues that at minimum address the following:

(a) the types of mental illnesses, etiology of mental illnesses, treatment approaches and recovery from mental illnesses;

(b) community resources and available mental health center services;

(d) program policies and procedures, including emergency procedures;

(e) legal responsibilities of mental health service providers and client rights;

(f) infection control and prevention of transmission of blood borne pathogens; and

(g) cardiopulmonary resuscitation (CPR) and Heimlich maneuver.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2005 Mental Health Center: Foster Care for Adults with Mental Illnesses, Records

(1) For each foster care provider, the mental health center shall maintain the following information on file:

(a) initial and annual assessments of the provider's ability to provide necessary services and supports to the client and ability to support the client's rights as outlined in 53-21-142 , MCA; and

(b) documentation of the orientation session prior to entering into a client placement agreement, and annually thereafter.

(2) For each client, the mental health center shall maintain the following information on file:

(a) the mental health center's individual placement agreement with each client which sets forth the terms of the client's placement and the responsibilities of the foster care provider, the mental health center, the client, and when appropriate the guardian as defined in ARM 37.106.1902; and

(b) documentation that the client has received an assessment to ensure the appropriateness of foster care services in meeting the client's needs as provided in ARM 37.106.2015.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2006 Mental Health Center: Foster Care for Adults with Mental Illnesses, Staff Supervision and Training

(1) A mental health center providing foster care shall employ a program supervisor who is experienced in providing services to individuals with mental illnesses. The program supervisor shall supervise all foster care specialists and ensure the program complies with the requirements of this subchapter. The program supervisor may perform the duties of an adult foster care specialist if the mental health center has not more than 10 adult foster care clients.

(2) A mental health center providing foster care shall train the program supervisor and adult foster care specialists in the therapeutic de-escalation of crisis situations. The training must include the use of physical and non-physical methods of managing clients and must be updated, at least annually.

(3) The mental health center shall provide periodic training to reinforce and update the initial training outlined in this rule.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2011 Mental Health Center: Foster Care for Adults with Mental Illnesses, Adult Foster Care Specialist

(1) A mental health center providing foster care shall employ or contract with at least one adult foster care specialist.

(2) The adult foster care specialist shall have the knowledge and skills needed to effectively perform foster care specialist duties. Minimum qualifications for a foster care specialist are a bachelor's degree in a human services field with one year of full time experience serving people with mental illnesses. Individuals with other educational backgrounds who, as providers, consumers or advocates of mental health services have developed the necessary skills, may also be employed as foster care specialists. The mental health center's foster care specialists position description may contain equivalency provisions.

(3) The adult foster care specialist shall:

(a) implement and coordinate mental health services to clients;

(b) carry a case load of not more than 16 foster care clients;

(c) meet with the foster care provider at least weekly in his or her home or whenever there is a significant change in the client's condition, to assess, at a minimum, the following:

(i) the provider's ability to continue to meet the needs of the client as determined by the treatment plan; and

(ii) whether supports for the foster care provider are adequate; and

(d) document bi-weekly summaries or sooner if there is a significant change in the client's condition regarding the client's treatment in the client's clinical record.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2015 Mental Health Center: Foster Care for Adults with Mental Illnesses, Client Admission Criteria and Needs Assessment

(1) A mental health center providing foster care shall establish admission criteria which assesses the client's needs and the appropriateness of foster care services to meet those needs. At a minimum, the admission criteria must require that a client:

(a) be 18 years of age or older;

(b) be unable to maintain the stability of their mental illness in an independent living situation;

(d) be medically stable;

(e) not be an immediate danger to self or others; and

(f) be able to take medications when prompted.

(2) A mental health center providing foster care shall assess the needs of each newly-admitted client in the following areas:

(a) the client's ability to appropriately use community resources to access professional services, and to obtain services from public agencies;

(b) the client's personal care skills;

(d) the likelihood the client will benefit from adult foster care.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2016 Mental Health Center: Foster Care for Adults with Mental Illnesses, Treatment Plan

(1) A mental health center providing foster care shall implement a treatment plan for each client that:

(a) structures rehabilitation and treatment activities to promote increasing levels of independence;

(b) articulates a detailed crisis plan; and

(i) housing;

(ii) employment;

(iii) education and training;

(iv) treatment; and

(v) any other services needed for independent living.

(2) A mental health center providing foster care shall maintain progress notes for each client. The progress notes must be entered into the client's clinical record at least every 30 days, and upon the occurrence of any significant change in the client's condition.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2017 Mental Health Center: Foster Care for Adults with Mental Illnesses, Client Placement Agreements

(1) The mental health center shall enter into an individual placement agreement which sets forth the terms of the client's placement, the responsibilities of the foster care provider, the mental health center, the client, and when appropriate, the guardian.

(2) The placement agreement must be signed with copies dispersed to all parties who are a part of the agreement.

(3) The placement agreement shall be reviewed quarterly by all parties who are part of the agreement to determine the need for any amendments to the agreement.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2018 Mental Health Center: Foster Care for Adults with Mental Illnesses, Client Rights and Responsibilities

(1) Upon admission a mental health center providing foster care shall provide each client with:

(a) a written statement of the client's rights which, at a minimum, include the rights found in 53-21-142 , MCA;

(b) a copy of the mental health center grievance procedure; and

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-204, MCA
History: NEW, 2002 MAR p. 1092, Eff. 3/29/02.

Mont. Admin. R. 37.106.2025 Application of Other Rules

(1) In addition to the requirements established in this subchapter, each mental health center providing a secured inpatient crisis stabilization program shall comply with all the requirements established in ARM 37.106.1945 and 37.106.1946 with the exclusion of ARM 37.106.1946(3)(j).

(2) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter will apply to secured crisis stabilization facilities.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2026 Scope of This Rule

(1) This rule is intended to apply to all state licensed mental health centers or hospitals providing a secured crisis stabilization service as part of the crisis service continuum.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2027 Definitions

In addition to the definitions in 50-5-101, MCA, the following definitions apply to this subchapter:

(1) "Crisis plan" means an initial, brief, individualized plan that:

(a) lists client problems identified by the secured crisis stabilization facility's mental health crisis assessment;

(b) lists the individual's strengths and resources;

(d) identifies support network options; and

(e) identifies referral and transition activities that will occur at discharge.

(2) "In-patient crisis stabilization program" means 24-hour supervised treatment for adults with a mental illness for the purpose of reducing the severity of an individual's mental illness symptoms.

(3) "Secured crisis stabilization facility (SCSF)" means a secure in-patient facility operated by a licensed hospital, critical access hospital, or a licensed mental health center that provides evaluation, intervention, and referral for individuals experiencing a crisis due to serious mental illness or a serious mental illness with a co-occurring substance use disorder. The facility may only provide secured services to a client when a detention exists as defined in 53-21-129, MCA.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2031 Construction Requirements

(1) Prior to construction, floor plans for the secured in-patient crisis stabilization facility must be submitted to the Licensure Bureau of the Department of Public Health and Human Services for review, comment, and approval.

(a) Prior to occupancy, the facility shall undergo an onsite inspection and receive the written approval of all authorities having jurisdiction.

(2) A SCSF is considered a separate mental health unit requiring a staff station located within the secured unit.

(a) The unit shall be staffed at all times patients are placed in the secured unit.

(3) The SCSF staff station (at a minimum) will provide the following:

(a) provisions for charting;

(b) provisions for hand washing;

(d) telephone access.

(4) The SCSF will provide access to a nourishment station or kitchen as required in 2001 Edition of the Guidelines for the Design and Construction of Hospitals and Health Care Facilities, Section 8.2.C9, For Serving Nourishments Between Meals. A copy of this publication can be obtained from the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena MT 59620-2953.

(5) A nourishment station will contain the following:

(a) a work counter;

(b) refrigerator;

(d) a sink;

(e) space for trays and dishes used for nonscheduled meal service;

(f) hand washing facilities in or immediately accessible; and

(g) ice for patient consumption will be provided by icemaker-dispenser units or periodically set up individually during the day.

(6) A dining/activities/day space within the unit must be provided at a ratio of 35 square feet per resident, with at least 14 square feet dedicated to dining space.

(7) Patient rooms will be at a ratio of 80 square feet for single bedrooms. The room square footage does not include bathrooms, door swings, alcoves, or vestibules. No more than one patient shall reside in a single room in a secured unit.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2032 Patient Toilets and Bathing

(1) There will be at least one toilet available for every four patients in the facility.

(2) There will be at least one bathing unit for every six patients in the facility. A shower or tub is not required if the facility utilizes a central bathing unit for every six patients.

(3) All doors to toilet rooms or bathing units must swing out or slide into the wall and shall be unlockable from the outside.

(4) Toilet rooms and bathing facilities may be under key control by staff.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2033 Special Locking Arrangements

(1) The facility must follow the provisions of the 2000 Edition of the NFPA 101, Life Safety Code, (LSC). A copy of this publication can be obtained from the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena MT 59620-2953.

(2) The 2000 Edition of the NFPA 101, Life Safety Code, (LSC), has the following requirements for special locking arrangements for a secured SCSF unit. LSC 5- 2.1.6 .1 states:

(a) In buildings protected throughout by an approved supervised automatic fire detection system or approved supervised automatic sprinkler system and when permitted by chapters 8 through 30, doors in low or ordinary hazard areas, as defined by LSC 4-2.2, may be equipped with approved, listed, locking devices which shall:

(i) unlock upon actuation of an approved supervised automatic fire detection system or approved supervised automatic sprinkler system installed in accordance with LSC 7-6 or 7-7; and

(ii) unlock upon loss of power controlling the lock or locking mechanism; and

(iii) initiate an irreversible process which will release the lock within 15 seconds whenever a force of not more than 15 pounds (67N) is continuously applied, for a period of not more than three seconds to the release device required in LSC 5-2.1.5.3. Relocking of such doors shall be by manual means only. Operation of the release device shall activate a signal in the vicinity of the door for assuring those attempting to exit that the system is functional. Exception to this subsection: The authority having jurisdiction may approve a delay not to exceed 30 seconds provided that reasonable life safety is assured pursuant to LSC 5-2.1.6.2. A sign shall be provided on the door adjacent to the release device which reads:

PUSH UNTIL ALARM SOUNDS DOOR CAN BE OPENED IN 15 SECONDS

(A) Sign letters shall be at least one inch (2.5cm) high and one eighth inch (0.3cm) wide stroke.

(3) The department shall grant an SCSF exception to the LSC code - Special Locking Arrangements, based on an equivalency for the automatically releasing, panic hardware required by LSC 5- 2.1.6 .1. All of the following conditions shall apply to granting the exception:

(a) the use of mechanical locks, such as dead bolt, is not permitted. All locks used must be electromagnetically controlled;

(b) all secured doors in the unit must have a manual electronic key pad which must release the door after entry of the proper code sequence;

(i) the actuation of the approved supervised automatic fire alarm system;

(ii) the actuation of an approved supervised automatic sprinkler system;

(iii) loss of the public utility power controlling locks; and

(iv) a staff accessible switch at the staff station which is capable of releasing all doors.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2034 Seclusion and Restraint

(1) A SCSF must be capable of providing restraint or seclusion and must ensure that the restraint or seclusion is performed in compliance with 42 CFR 482.13(f)(1) through (7). The department adopts and incorporates by reference 42 CFR 482.13(f)(1) through (7) (July 2, 1999), which contains standards for use of seclusion and restraint for behavioral management.

(2) Restraint and seclusion must be performed in a manner that is safe, proportionate, and appropriate to the severity of the behavior, the patient's size, gender, physical, medical, and psychiatric condition and personal history.

(3) Seclusion or restraint may only be used in emergency situations needed to ensure the physical safety of the individual patient, other patients, or staff of the facility and when less restrictive measures have been found to be ineffective to protect the resident or others from harm.

(4) Seclusion and restraint procedures must be implemented in the least restrictive manner possible in accordance with a written modification to the patient's health care/treatment plan and discontinued when the behaviors that necessitated the restraint or seclusion are no longer in evidence.

(5) "Whenever needed" or "prescribed as needed" standing orders for use of seclusion or restraint are prohibited.

(6) A physician or other authorized health care provider must authorize use of the restraint or seclusion within one hour of initiating the restraint or seclusion. Each original order and renewal order is limited to four hours.

(7) Each order of restraint or seclusion is limited in length of time to a total of 24 hours.

(8) A SCSF will have a minimum one "comfort/safe" room for use for patient seclusion as prescribed by the facility's policy and procedures, and in accordance with applicable state and federal standards.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2038 Admissions Procedures

(1) The facility will develop and implement a written policy outlining the admission criteria for placing a client into the secured service.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2039 Discharge Procedures

(1) The facility shall develop and implement discharge and transfer criteria for discharging a client from the secured setting. At the end of the detention the facility must:

(a) discharge the patient;

(b) refer the patient to a licensed nonsecured inpatient stabilization program;

(d) transfer the client to an appropriate level of acute in-patient treatment.

(2) The facility must ensure in-patient care is available through a critical access hospital or hospital transfer agreement for clients in need of an acute level of medical treatment.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-201, 50-5-202, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2042 Staff Qualifications and Organizational Structure

(1) Each SCSF shall employ or contract with a site based administrator who has daily overall management responsibility for the operation of the SCSF. The administrator of the mental health center or hospital if they are site based to the secured crisis stabilization or, if the SCSF is part of a hospital per ARM 37.106.2027(2) may assume this responsibility.

(2) Each SCSF facility shall employ or contract with a program supervisor knowledgeable about the service and support needs of individuals with co-occurring mental illness and intoxication/addiction disorders who may be experiencing a crisis. The program supervisor must be site based.

(3) Each SCSF shall employ or contract with a licensed health care professional as defined in 50-5-101 (34), MCA, for all hours of operation. The licensed health care professional may be the program supervisor.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2046 Secured Crisis Stabilization Facility: Client Assessments

(1) Each SCSF shall employ or contract with licensed mental health professionals to conduct clinical intake assessments which may be abbreviated assessments focusing on the crisis issues and safety.

(2) Based on the client's clinical needs, each SCSF will refer any necessary additional assessments to appropriate and qualified providers. Additional assessments may include, but are not limited to:

(a) physical;

(b) psychological;

(d) behavioral;

(e) psychosocial;

(f) recreational;

(g) vocational;

(h) psychiatric; and

(i) chemical dependency evaluations.

(3) Each SCSF shall maintain a current list of providers who accept referrals for assessments and services not provided by the facility.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2047 Secured Crisis Stabilization Facility: Client Discharge

(1) Each SCSF shall prepare a discharge summary for each client no longer receiving services. The discharge summary must include:

(a) the reason for discharge;

(b) a summary of the services provided by the SCSF including recommendations for aftercare services and referrals to the other services, if applicable;

(c) an evaluation of the client's progress as measured by the treatment plan and the impact of the services provided by the facility; and

(d) the signature of the staff member who prepared the report and the date of preparation.

(2) Discharge summary reports must be filed in the clinical record within one week of the date of the client's formal discharge from services.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Mont. Admin. R. 37.106.2048 Secured Crisis Stabilization Facility: Emergency Procedures

(1) Each SCSF shall develop a written plan for emergency procedures. At a minimum, the plan must include:

(a) emergency evacuation procedures to be followed in the case of fire or other emergency;

(b) procedures for contacting emergency service responders; and

(2) Telephone numbers of the hospital, police department, ambulance, and poison control center must be posted by each telephone.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2008 MAR p. 1993, Eff. 9/12/08.

Subchapter 37.106.21 Intermediate Care Facilities for the Developmental Disabled ( ICF /DD)

Mont. Admin. R. 37.106.2101 Intermediate Care Facilities for the Developmentally Disabled ( Icf /Dd) : Application of Other Rules: Court Orders

(1) To the extent that other licensure rules in ARM Title 37 conflict with the provisions of this subchapter, the provisions of this subchapter will apply to intermediate care facility for the developmentally disabled ( ICF /DD) .

(2) Notwithstanding the requirements of this chapter, the facility shall comply with the terms and conditions of an order issued by a court of competent jurisdiction, including, but not limited to, the observance of any limitations placed upon a client's rights by the court.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2102 Definitions

(1) "Abuse" is defined at 52-3-803 , MCA.

(2) "Administrator" means a designated individual having daily overall management responsibility for the operation of a facility.

(3) "Client" means an adult resident, 18 years of age or older, receiving services from a facility.

(4) "Comprehensive functional assessments" identify the client's presenting problems, disabilities, specific developmental strengths, specific developmental and behavioral management needs, and need for services. This assessment must take into consideration the client's age and the implications for treatment and habilitation at each stage.

(5) "Department" means the department of public health and human services.

(6) "Direct care staff" means present on-duty staff that provide personal care and habilitation services in each defined residential living unit as well as client support services.

(7) "Direct care services" are services provided by direct care staff of the facility.

(8) "Exploitation" is defined at 52-3-803 , MCA.

(9) "Facility" means an intermediate care facility for the developmentally disabled.

(10) "Guardian" means a person or entity appointed by a court in a proceeding under Title 72, chapter 5, MCA, to make decisions on behalf of an incapacitated adult.

(11) "Habilitation" is defined at 53-20-102 , MCA.

(12) "Individual treatment plan" means a written plan that outlines individualized treatment activities for the treatment and habilitation of the client.

(13) "Interdisciplinary team" means individuals representing the professions, disciplines or service areas that are relevant to identifying and serving the client's needs. The team uses comprehensive functional assessments to develop and maintain the individual treatment plan for each client.

(14) "Intermediate care facility for the developmentally disabled ( ICF /DD) " means a long term care facility that provides intermediate developmental disability care.

(15) "Intermediate developmental disability care" is defined at 50-5-101 , MCA.

(16) "Long term care facility" is defined at 50-5-101 , MCA.

(17) "Neglect" is defined at 52-3-803 , MCA.

(18) "Preliminary evaluation" means evaluation of client's background information as well as currently valid assessments of functional, developmental, behavioral, social, health and nutritional status to determine if the facility can provide for the client's needs and if the client is likely to benefit from placement in the facility.

(19) "Program staff" means facility staff serving the needs of the client within the scope of their education and training.

(20) "Sexual abuse" is defined at 52-3-803 , MCA.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2105 Governing Body and Management

(1) The facility must identify an individual or individuals to constitute the governing body of the facility. The governing body must:

(a) exercise general policy, budget, and operating direction over the facility; and

(b) appoint the administrator of the facility.

(2) The administrator appointed by the governing body shall, at a minimum:

(a) hold a current Montana nursing home administrator license;

(b) be a licensed health care professional; or

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2106 Compliance with Applicable Laws

(1) The facility must be in compliance with all applicable provisions of state and local laws, regulations and codes.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2109 Client Records

(1) The facility must develop and maintain a recordkeeping system that includes a separate record for each client and that documents the client's health care, treatment and habilitation, including preliminary evaluation, comprehensive functional assessments, individual treatment plan, progress notes, social information, and protection of the client's rights.

(2) The facility must keep confidential all information contained in the client's records, regardless of the form or storage method of the records.

(3) The facility must develop and implement policies and procedures governing the release of any client information, including consents necessary from the client or legal guardian.

(4) Any individual who makes an entry in a client's record must make it legibly, date it, and sign it.

(5) The facility must provide a legend to explain any symbol or abbreviation used in a client's record.

(6) The facility must provide each identified residential living unit with appropriate aspects of each client's record.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2110 Services Provided Under Agreements with Outside Providers

(1) If a service required under this subchapter is not provided directly, the facility must have a written agreement with an outside program, resource, or service to furnish the necessary service, including emergency and other health care.

(2) The agreement must:

(a) contain the responsibilities, functions, objectives, and other terms agreed to by both parties; and

(b) provide that the facility is responsible for assuring that the outside services meet the standards for quality of services contained in this subchapter.

(3) The facility must assure that outside services meet the needs of each client.

History

Authorizing statute(s): Sec. 50-5-103, and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2115 Client Protections, the Protection of Residents' Rights

(1) The facility must ensure the rights of all of the clients and must:

(a) inform each client or legal guardian of the client's rights and the rules of the facility;

(b) inform each client or legal guardian of the client's medical condition, developmental and behavioral status, attendant risks of treatment, and of the right to refuse treatment;

(c) inform the individual client of their rights as a client of the facility, including the right to file complaints, the right to protection against any retaliation when filing a complaint and the right to due process;

(d) allow the individual client to manage their financial affairs and teach them to do so to the extent of their capabilities;

(e) ensure that each client is not subjected to abuse, sexual abuse, neglect, exploitation or punishment;

(f) ensure that each client is free from unnecessary drugs and unnecessary physical restraints;

(g) provide each client with the opportunity for personal privacy and ensure privacy during treatment and care of personal needs;

(h) ensure that each client is not compelled to perform services for the facility and ensure that each client who does work for the facility is compensated for their efforts at prevailing wages and commensurate with their abilities;

(i) ensure each client the opportunity to communicate, associate and meet privately with individuals and to send and receive unopened mail, except that these rights may be restricted as provided in Title 53, part 20, MCA;

(j) ensure that each client has access to telephones with privacy for incoming and outgoing local and long distance calls, except that these rights may be restricted as provided in Title 53, part 20, MCA;

(k) ensure that each client has the right to retain and use appropriate personal possessions and clothing, and ensure that each client is dressed in their own clothing each day, except that these rights may be restricted as provided in Title 53, part 20, MCA;

(l) ensure the client the opportunity to participate in social, religious and community group activities, except that these rights may be restricted as provided in Title 53, part 20, MCA; and

(m) permit a husband and wife who both reside in the facility to share a room. This right may only be limited by written order of the individual treatment planning team when there is no less restrictive means for preventing imminent bodily harm to either partner, or when either partner requests a separate room. The written order must explain the reason for the restriction and must be reviewed monthly by the individual treatment planning team if the restriction is to be continued.

(2) Any rights to which residents are entitled under this subchapter may be limited as provided in Title 53, part 20, MCA.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2116 Client Finances

(1) The facility must establish and maintain a system that:

(a) assures a full and complete accounting of each client's personal funds entrusted to the facility on behalf of each client; and

(b) precludes any commingling of a client's funds with facility funds or with the funds of any person other than another client.

(2) The client's financial record must be available on request to the client or legal guardian.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2117 Communication with Clients, Parents, and Guardians

(1) The facility must:

(a) promote participation of the legal guardian in the process of providing treatment and habilitation to a client unless their participation is unobtainable or inappropriate;

(b) answer communications from the client's family and friends promptly and appropriately;

(c) permit visits by the guardian to any area of the facility that provides direct client care services to the client, consistent with the right of that client's and other clients' privacy;

(d) notify the client or client's guardian of changes in the client's condition including, but not limited to, serious illness, accident, death, abuse, or unauthorized absence in a timely manner as indicated by an assessment of the individual incident.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2118 Prevention, Investigation, and Reporting of Client Abuse, Sexual Abuse, Neglect and Exploitation

(1) The facility must develop and implement written policies and procedures to prevent abuse, sexual abuse, neglect, or exploitation of the client.

(2) Facility staff must report all known or suspected incidents of client abuse, sexual abuse, neglect or exploitation to the facility administrator, and the facility administrator or his or her designee shall report said incidents to the department in accordance with the requirements of Title 52, chapter 3, part 8, MCA.

(3) The facility must develop and implement written policies and procedures for the investigation of allegations of client abuse, sexual abuse, neglect or exploitation.

(4) The results of all facility investigations of client abuse, sexual abuse, neglect or exploitation must be reported to the department when the investigation has been initiated and upon completion. If an allegation of client abuse, sexual abuse, neglect or exploitation is verified, appropriate corrective action must be taken.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2119 Professional Program Services

(1) Each client must receive the professional program services necessary to implement the treatment and habilitation program defined by each client's individual treatment plan. In providing these services, professional program staff must work directly with each client and with paraprofessional, nonprofessional and other professional program staff who work with each client.

(2) The facility must have available program staff to carry out and monitor the interventions in accordance with the stated goals and objectives of every individual treatment plan.

(3) Program staff must participate as members of the interdisciplinary team in relevant aspects of the treatment and habilitation process.

(4) Professional program staff must be licensed, certified, or registered, as applicable, by the state of Montana to provide professional services.

(5) Program staff must serve the special needs of the client as defined by the individual treatment plan.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2125 Facility Staffing

(1) The facility must not depend upon the client or volunteers to perform direct care services for the facility.

(2) There must be responsible direct care staff on duty and awake on a 24 hour basis, when any client is present, to take prompt, appropriate action in case of injury, illness, fire or other emergency.

(3) The facility must provide sufficient support staff so that direct care staff are not required to perform support services to the extent that these duties interfere with the exercise of their primary direct client care duties.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2126 Direct Care Staff

(1) The facility must provide sufficient direct care staff to manage and supervise each client in accordance with their individual treatment plan.

(2) Direct care staff must be provided by the facility in the following minimum ratios of direct care staff to clients:

(a) a staff to client ratio of 1 to 3.2 for each defined residential living unit serving:

(i) any severely and profoundly retarded client;

(ii) a client with severe physical disabilities;

(iii) any client who is aggressive, assaultive , or a security risk; or

(iv) any client who manifests severely hyperactive or psychotic-like behavior.

(b) for each defined residential living unit who serves any moderately retarded client, the staff to client ratio is 1 to 4.

(c) for each defined residential living unit who serves any client who functions within the range of mild retardation, the staff to client ratio is 1 to 6.4.

(3) The above staff to client ratios shall be calculated for each defined residential living unit based on the number of direct care staff who are present and on-duty during all shifts in a 24 hour period.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2127 Staff Training

(1) The facility must provide each staff member with initial and continuing training that enables the employee to perform his or her duties effectively, efficiently, and competently.

(2) For staff members who work with any client, training must focus on skills and competencies directed toward the client's developmental, behavioral, and health needs.

(3) Staff must be able to demonstrate the skills and techniques necessary to administer interventions to manage the inappropriate behavior of any client.

(4) Staff must be able to demonstrate the skills and techniques necessary to implement the individual treatment plan for each client for whom they are responsible.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2131 Individual Residential Treatment and Habilitation Needs

(1) Each client must be offered a treatment and habilitation program which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services and related services described in this subchapter, that is directed toward:

(a) the acquisition of the behaviors necessary for the client to function with as much self determination and independence as possible; and

(b) the prevention or deceleration of regression or loss of current optimal functional status.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2132 Admissions, Transfers, Discharge and Fair Hearing

(1) Admission decisions must be based on a preliminary evaluation of the client that is conducted or updated by the facility or by outside sources, except that admission procedures regarding clients which have been committed to the facility by a court of competent jurisdiction shall be conducted pursuant to Title 53, chapter 20, part 1, MCA.

(2) A preliminary evaluation must contain background information as well as currently valid assessments of functional, developmental, behavioral, social, health and nutritional status to determine if the facility can provide for the client's needs and if the client is likely to benefit from placement in the facility.

(3) If a client is to be either transferred or discharged from the facility, the facility must:

(a) have documentation in the client's record that the client was transferred or discharged for good cause; and

(b) provide a reasonable time to prepare the client or guardian for the transfer or discharge (except in emergencies) .

(4) At the time of the discharge, the facility must:

(a) develop a final summary of the client's developmental, behavioral, social, health and nutritional status and, with the consent of the client or legal guardian, provide a copy to authorized persons and agencies; and

(b) provide a post-discharge plan of care that will assist the client in adjusting to the new living environment.

(5) A resident has a right to a fair hearing to contest an involuntary transfer or discharge as provided at ARM 37.5.116.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2133 Individual Treatment Plans

(1) Each client must have an individual treatment plan developed by an interdisciplinary team that represents the professions, disciplines or service areas that are relevant to:

(a) identifying the client's needs, as described by the comprehensive functional assessments required in (3) ; and

(b) designing programs that meet the client's needs.

(2) Appropriate facility staff must participate in interdisciplinary team meetings. Participation by other agencies serving the client is encouraged. Participation by the client or the client's legal guardian is required unless that participation is unobtainable or inappropriate.

(3) Within 30 days after admission, the interdisciplinary team must perform accurate assessments or reassessments as needed to supplement the preliminary evaluation conducted prior to admission. The comprehensive functional assessment must take into consideration the client's age (for example a young adult, an elderly person) and the implications for treatment and habilitation at each stage, as applicable, and must:

(a) identify the presenting problems and disabilities and where possible, their causes;

(b) identify the client's specific developmental strengths;

(d) identify the client's need for services without regard to the actual availability of the services needed; and

(e) include physical development and health, nutritional status, sensory motor development, affective development, speech and language development and auditory functioning, cognitive development, social development, adaptive behaviors or independent living skills necessary for the client to be able to function in the community, and as applicable, vocational skills.

(4) Within 30 days after admission, the interdisciplinary team must prepare for each client an individual treatment plan that states the specific objectives necessary to meet the client's needs, as identified by the comprehensive assessment required by (3) , and the planned sequence for dealing with those objectives. These objectives must be:

(a) stated separately, in terms of a single behavioral outcome;

(b) assigned projected completion dates;

(d) organized to reflect a developmental progression appropriate to the individual; and

(e) assigned priorities.

(5) Each written training program designed to implement the objectives in the individual treatment plan must specify:

(a) the methods to be used;

(b) the schedule for use of the method;

(d) the type of data and frequency of data collection necessary to be able to assess progress toward the desired objectives;

(e) the inappropriate client behavior(s) , if applicable; and

(f) provision for the appropriate expression of behavior and the replacement of inappropriate behavior, if applicable, with behavior that is adaptive or appropriate.

(6) The individual treatment plan must also:

(a) describe relevant interventions to support the individual toward independence;

(b) identify the location where program strategy information (which must be accessible to any person responsible for implementation) can be found;

(c) include, for each client who lacks them, training in personal skills essential for privacy and independence (including, but not limited to, toilet training, personal hygiene, dental hygiene, self-feeding, bathing, dressing, grooming, and communication of basic needs) until it has been demonstrated that the client is developmentally incapable of acquiring them;

(d) identify mechanical supports, if needed, to achieve proper body position, balance, or alignment. The plan must specify the reason for each support, the situations in which each is to be applied, and a schedule for the use of each support;

(e) provide that each client who has multiple disabling conditions spend a major portion of each waking day out of bed and outside the bedroom area, moving about by various methods and devices whenever possible; and

(f) include opportunities for client choice and self-management.

(7) Relevant portions of each client's individual treatment plan must be made available to appropriate staff, including staff of other agencies who work with the client and to the client or legal guardian.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2136 Program Implementation

(1) As soon as the interdisciplinary team has formulated a client's individual treatment plan, each client must be offered a continuous treatment and habilitation program consisting of needed interventions and services in sufficient number and frequency to support the achievement of the objectives identified in the individual treatment plan.

(2) Except for those facets of the individual treatment plan that must be implemented only by licensed personnel, each client's individual treatment plan must be implemented by all staff who work with the client.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2137 Program Documentation

(1) Data relative to accomplishment of the criteria specified in client individual treatment plan objectives must be documented in measurable terms.

(2) The facility must document significant events that are related to the client's individual treatment plan and assessments and that contribute to an overall understanding of the client's ongoing level and quality of functioning.

(3) The facility staff must prepare progress notes which indicate whether or not the stated individual treatment plan has been implemented, and the degree to which the client is progressing, or failing to progress, toward stated treatment objectives. The progress notes must be entered into the client's clinical record at least weekly and upon the occurrence of any significant change in the client's condition.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2138 Program Monitoring and Change

(1) At least annually the comprehensive functional assessment of each client must be reviewed by the interdisciplinary team for relevancy and updated as needed, and the individual treatment plan must be revised, as appropriate, repeating the process set forth in ARM 37.106.2133(3) .

(2) The individual treatment plan for each client must be reviewed by the interdisciplinary team every 90 days and whenever there is a significant change in the client's condition. The individual treatment plan must be revised, as appropriate.

(3) The facility must designate and use a specially constituted committee or committees consisting of members of facility staff, legal guardians, clients (as appropriate) , qualified persons who have either experience or training in contemporary practices to change inappropriate client behavior, and persons with no ownership or controlling interest in the facility to:

(a) review, approve, and monitor individual treatments designed to manage inappropriate behavior and other treatments that, in the opinion of the committee, involve risks to client protection and rights;

(b) ensure that these treatments are conducted only after the client or legal guardian has been informed; and

(i) drug usage;

(ii) physical restraints;

(iii) time out rooms;

(iv) application of painful or noxious stimuli;

(v) control of inappropriate behavior;

(vi) protection of client rights and funds; and

(vii) any other area that the committee believes needs to be addressed.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2139 Management of Conduct Between Staff and the Client

(1) The facility must develop and implement written policies and procedures for the management of conduct between staff and the client. These policies and procedures must:

(a) promote the growth, development and independence of the client;

(b) address the extent to which the client's choice will be accommodated in daily decision-making, emphasizing self-determination and self-management, to the extent possible;

(d) be available to all staff, the client and the legal guardian.

(2) To the extent possible, each client must participate in the formulation of these policies and procedures.

(3) The client must not discipline any other client, except as part of an organized system of self-government, as set forth in facility policy.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2140 Management of Inappropriate Client Behavior

(1) The facility must develop and implement written policies and procedures that govern the management of inappropriate client behavior only as allowed in 53-20-146 , MCA. These policies and procedures must be consistent with the provisions of ARM 37.106.2139, and must:

(a) specify all facility-approved interventions to manage inappropriate client behavior;

(b) designate these interventions on a hierarchy to be implemented, ranging from most positive or least intrusive, to least positive or most intrusive;

(c) ensure, prior to the use of more restrictive techniques, that the client's record documents that programs incorporating the use of less intrusive or more positive techniques have been tried systematically and demonstrated to be ineffective; and

(d) address the following:

(i) the use of secured units;

(ii) the use of observation and seclusion rooms;

(iii) the use of physical restraints;

(iv) the use of time out procedures;

(v) the use of appropriate medication to manage inappropriate behavior;

(vi) the application of painful or noxious stimuli;

(vii) the staff members who may authorize the use of specified interventions; and

(viii) a mechanism for monitoring and controlling the use of such interventions.

(2) Interventions to manage inappropriate client behavior must be employed with sufficient safeguards and supervision to ensure that the safety, welfare and civil and human rights of each client are adequately protected.

(3) Techniques to manage inappropriate client behavior must never be used for disciplinary purposes, for the convenience of staff or as a substitute for a treatment and habilitation program.

(4) The use of systematic interventions to manage inappropriate client behavior must be incorporated into the client's individual treatment plan.

(5) Standing or as needed programs to control inappropriate behavior are not permitted.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2144 Observation and Seclusion Rooms

(1) A client may be placed in a an observation and seclusion room from which egress is prevented only as allowed in 53-20-146 , MCA and only if the following conditions are met:

(a) The placement is required because of an emergency situation requiring immediate action or for other therapeutic purposes.

(b) The client is under the direct constant visual supervision of designated staff.

(d) A licensed professional shall examine the client and provide written approval within the first three hours of placement unless the client has a long history of episodic violence. In these cases the examination and approval shall be obtained within the first 12 hours of placement.

(2) Placement of a client in an observation and seclusion room must be reassessed and documented in writing every hour. A client cannot be placed in an observation and seclusion room for more than 24 continuous hours.

(3) A client placed in an observation and seclusion room must be protected from hazardous conditions including, but not limited to, presence of sharp corners and objects, uncovered light fixtures, unprotected electrical outlets.

(4) A record of observation and seclusion activities must be kept.

(5) An intermediate care facility for the developmentally disabled shall:

(a) designate specific rooms designed for observation/ seclusion purposes; and

(b) develop policies and procedures for the use and maintenance of the observation/seclusion rooms.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2145 Physical Restraints

(1) The facility may employ physical restraint only as allowed in 53-20-146 , MCA and only as:

(a) an emergency measure, but only if absolutely necessary to protect the client or others from injury; or

(b) a health-related protection prescribed by a physician, but only if absolutely necessary during the conduct of a specific medical or surgical procedure, or only if absolutely necessary for client protection during the time that a medical condition exists.

(2) The facility must not issue orders for restraint on a standing or as needed basis.

(3) A client placed in restraint must be checked at least every 30 minutes by staff trained in the use of restraints, released from the restraint as quickly as possible, and a record of these checks and usage must be kept.

(4) Restraints must be designed and used so as not to cause physical injury to the client and so as to cause the least possible discomfort.

(5) Opportunity for motion and exercise must be provided for a period of not less than 10 minutes during each two hour period in which restraint is employed, and a record of such activity must be kept.

(6) A licensed professional shall examine the client and provide written approval for restraint within the first three hours of placement and shall monitor and record the client's progress every 24 hours thereafter.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2146 Drug Usage

(1) Drugs used for control of inappropriate behavior must be approved by the interdisciplinary team and be used only as an integral part of the client's individual treatment plan that is directed specifically toward the reduction of and eventual elimination of the behaviors for which the drugs are employed.

(2) Drugs used for control of inappropriate behavior must not be used until it can be justified that the harmful effects of the behavior clearly outweigh the potentially harmful effects of the drugs.

(3) Drugs used for control of inappropriate behavior must be monitored closely, in conjunction with the physician and the drug regimen review requirement at ARM 37.106.2153, for desired responses and adverse consequences by facility staff.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2150 Health Care and Physician Services

(1) The facility must ensure the availability of physician services 24 hours a day.

(2) The physician must develop, in coordination with licensed nursing personnel, a medical care plan of treatment for a client if the physician determines that an individual client requires 24 hour licensed nursing care. This plan must be integrated in the individual treatment plan.

(3) The facility must provide or obtain preventive and general medical care as well as annual physical examinations of each client that at a minimum include the following:

(a) evaluation of vision and hearing;

(b) immunizations, using as a guide the recommendations of the public health service advisory committee on immunization practices or of the committee on the control of infectious diseases of the American academy of pediatrics;

(c) routine screening laboratory examinations as determined necessary by the physician, and special studies when needed; and

(d) tuberculosis control, appropriate to the facility's population, and in accordance with the recommendations of the American college of chest physicians or the rule of diseases of the chest of the American academy of pediatrics, or both.

(4) To the extent permitted by Montana law, the facility may utilize physician assistants and nurse practitioners to provide physician services as described in this rule.

(5) A physician must participate in:

(a) the establishment of each newly admitted client's initial individual treatment plan; and

(b) if appropriate, the review and update of an individual treatment plan as part of the interdisciplinary team process either in person or through written report to the interdisciplinary team.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2151 Nursing Services and Staff

(1) The facility must provide each client with nursing services in accordance with their needs, including:

(a) participation as appropriate in the development, review, and update of an individual treatment plan as part of the interdisciplinary team process;

(b) the development, with a physician, of a medical care plan of treatment for a client when the physician has determined that an individual client requires such a plan;

(i) be by a direct physical examination;

(ii) be by a licensed nurse;

(iii) be on a quarterly or more frequent basis depending on client need;

(iv) be recorded in the client's record; and

(v) result in any necessary action (including referral to a physician to address client health problems) ;

(d) other nursing care as prescribed by the physician or as identified by client needs; and

(e) implementation of appropriate protective and preventive health measures that include, but are not limited to:

(i) training any client and staff as needed in appropriate health and hygiene methods;

(ii) control of communicable diseases and infections, including the instruction of other personnel in methods of infection control; and

(iii) training of direct care staff in detecting signs and symptoms of illness or dysfunction, first aid for accidents or illness, and basic skills required to meet the health needs of the client.

(2) The facility must:

(a) employ or arrange for licensed nursing services sufficient to care for the client's health needs including any client with a medical care plan;

(b) utilize registered nurses as appropriate and required by Montana law to perform the health services specified in this rule;

(c) have a formal arrangement with a registered nurse to be available for verbal or on site consultation to the licensed practical or vocational nurses (if utilizing only licensed practical or vocational nurses to provide health services) ; and

(d) permit non-licensed nursing personnel who work with any client under a medical care plan to do so only under the supervision of licensed persons.

(3) Nurses providing services in the facility must have a current license to practice in Montana.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2152 Dental Services and Treatment

(1) The facility must provide or make arrangements for comprehensive dental diagnostic and treatment services for each client from qualified personnel, including licensed dentists and dental hygienists either through organized dental services in-house or through arrangement.

(2) If appropriate, dental professionals must participate in the development, review and update of an individual treatment plan as part of the interdisciplinary process either in person or through written report to the interdisciplinary team.

(3) The facility must provide education and training in the maintenance of oral health.

(4) Comprehensive dental diagnostic services must include:

(a) a complete extraoral and intraoral examination, using all diagnostic aids necessary to properly evaluate the client's oral condition, not later than one month after admission to the facility (unless the examination was completed within 12 months before admission) ;

(b) periodic examination and diagnosis performed at least annually, including radiographs when indicated and detection of manifestations of systemic disease; and

(5) Comprehensive dental treatment services must include:

(a) the availability for emergency dental treatment on a 24 hour basis by a licensed dentist; and

(b) dental care needed for relief of pain and infections, restoration of teeth, and maintenance of dental health.

(6) If the facility maintains an in-house dental service, the facility must keep a permanent dental record for each client with a dental summary maintained in the client's living unit. If the facility does not maintain an in-house dental service, the facility must obtain a dental summary of the results of dental visits and maintain the summary in the client's living unit.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2153 Pharmacy Services and Drug Regimen Review

(1) The facility must provide or make arrangements for the provision of routine and emergency drugs and biologicals to each client. Drugs and biologicals may be obtained from community or contract pharmacists or the facility may maintain a licensed pharmacy.

(2) A pharmacist with input from the interdisciplinary team must review the drug regimen of each client at least quarterly, and:

(a) report any irregularities in the client's drug regimen to the prescribing physician and interdisciplinary team; and

(b) prepare a record of each client's drug regimen reviews which must be maintained by the facility.

(3) As appropriate, the pharmacist must participate in the development, implementation, and review of each client's individual treatment plan either in person or through written report to the interdisciplinary team.

(4) The facility must maintain an individual medication administration record for each client.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2154 Drug Administration, Storage, and Recordkeeping

(1) The facility must have an organized system for drug administration that identifies each drug up to the point of administration. The system must assure that:

(a) all drugs are administered in compliance with the physician's orders;

(b) all drugs, including those that are self-administered, are administered without error;

(c) each client is taught how to administer their own medications if the interdisciplinary team determines that self-administration of medications is an appropriate objective, and if the physician does not specify otherwise;

(d) the client's physician is informed of the interdisciplinary team's decision that self-administration of medications is an objective for the client;

(e) no client self-administers medications until he or she demonstrates the competency to do so;

(f) drugs used by any client while not under the direct care of the facility are packaged and labeled in accordance with Montana law; and

(g) drug administration errors and adverse drug reactions are recorded and reported immediately to a physician.

(2) The facility must:

(a) store drugs under proper conditions of sanitation, temperature, light, humidity, and security;

(b) keep all drugs and biologicals locked except when being prepared for administration, and only permit authorized persons to have access to the keys to the drug storage area, except that any client who has been trained to self-administer drugs may have access to keys to their individual drug supply;

(d) on a sample basis, periodically reconcile the receipt and disposition of all controlled drugs in schedules II through IV of the Comprehensive Drug Abuse Prevention and Control Act of 1970, 21 U.S.C . 801 et seq., as implemented by 21 CFR part 308; and

(e) comply with the regulations of controlled drugs if the facility maintains a licensed pharmacy.

(3) Labeling of drugs and biologicals must:

(a) be based on currently accepted professional principles and practices; and

(b) include the appropriate accessory and cautionary instructions, as well as the expiration date, if applicable.

(4) The facility must remove from use:

(a) outdated drugs; and

(b) drug containers with worn, illegible, or missing labels.

(5) Drugs and biologicals packaged in containers designated for a particular client must be immediately removed from the client's current medication supply if discontinued by the physician.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2160 Laboratory Services

(1) If a facility chooses to provide laboratory services, the laboratory must meet the requirements specified in 42 CFR part 493.

(2) If the laboratory chooses to refer specimens for testing to another laboratory, the referral laboratory must be certified in the appropriate specialties and subspecialities of service in accordance with the requirements of 42 CFR part 493.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2161 Physical Environment

(1) The facility must not:

(a) house any client of a grossly different age, developmental level, and social need in close physical or social proximity unless the housing is planned to promote the growth and development of all those housed together; or

(b) segregate the client solely on the basis of their physical disabilities. It must integrate the client who has ambulation deficits or who is deaf, blind, or has a seizure disorder, etc., with others of comparable social and intellectual development.

(2) Bedrooms must:

(a) be rooms that have at least one outside wall;

(b) be equipped with or located near toilet and bathing facilities;

(d) measure at least 80 square feet per client in multiple client bedrooms and at least 100 square feet in single client bedrooms; and

(e) have walls that extend from floor to ceiling.

(3) If a bedroom is below ground level, it must have a window that is:

(a) usable as a second means of escape by the client occupying the room; and

(b) no more than 44 inches (measured to the window sill) above the floor unless the facility is surveyed under the health care occupancy chapter of the Life Safety Code ( LSC ) , 2000 edition, in which case the window must be no more than 36 inches (measured to the window sill) above the floor.

(4) The facility must provide each client with:

(a) a separate bed of proper size and height for the convenience of the client;

(b) a clean, comfortable mattress;

(d) functional furniture and individual closet space in the client's bedroom with clothes racks and shelves accessible to the client and appropriate to the client's needs.

(5) The facility must provide:

(a) space and equipment for daily out-of-bed activity for each client who is not yet mobile, except those who have a short-term illness or any client for whom out-of-bed activity is a threat to health and safety; and

(b) suitable storage space, accessible to the client, for personal possessions, such as TVs, radios, prosthetic equipment and clothing.

(6) The facility must:

(a) provide toilet and bathing facilities appropriate in number, size and design to meet the needs of the client;

(b) provide for individual privacy in toilets, bathtubs and showers; and

(c) in areas of the facility where the client who has not been trained to regulate water temperature and is exposed to hot water, ensure that the temperature of the water does not exceed 110 ° F.

(7) Each client bedroom in the facility must have:

(a) at least one window to the outside; and

(b) direct outside ventilation by means of windows, air conditioning or mechanical ventilation.

(8) The facility must:

(a) maintain the temperature and humidity within a normal comfort range by heating, air conditioning or other means; and

(b) ensure that the heating apparatus does not constitute a burn or smoke hazard to the client.

(9) The facility must have:

(a) floors that have a resilient, nonabrasive and slip-resistant surface;

(b) nonabrasive carpeting, if the area used by a client is carpeted and serves a client who lies on the floor or ambulates with parts of their bodies, other than feet, touching the floor; and

(c) exposed floor surfaces and floor coverings that promote mobility in an area used by a client and promote maintenance of sanitary conditions.

(10) The facility must:

(a) provide sufficient space and equipment that includes adequately equipped and sound treated areas for hearing and other evaluations if they are conducted in the facility. This enables staff to provide the client with needed services as required by this subchapter and as identified in each client's individual treatment plan in:

(i) dining;

(ii) living;

(iii) health services;

(iv) recreation; and

(v) program areas;

(b) furnish and maintain in good repair and teach the client to use and to make informed choices about the use of:

(i) dentures;

(ii) eyeglasses;

(iii) hearing and other communications aids;

(iv) braces; and

(v) other devices identified by the interdisciplinary team as needed by the client; and

(11) The facility must:

(a) use lead free paint inside the facility; and

(b) remove or cover interior paint or plaster containing lead so that it is not accessible to the client.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2162 Emergency Plan and Procedures

(1) The facility must develop and implement detailed written plans and procedures to meet all potential emergencies and disasters such as fire, severe weather, and a missing client.

(2) The facility must communicate, periodically review, make the plan available and provide training to the staff.

(3) The facility must hold evacuation drills at least quarterly for each shift of personnel and under varied conditions to:

(a) ensure that all personnel on all shifts are trained to perform assigned tasks;

(b) ensure that all personnel on all shifts are familiar with the use of the facility's fire protection features; and

(4) The facility must:

(a) actually evacuate the clients during at least one drill each year on each shift;

(b) make special provisions for the evacuation of a client with a physical disability;

(d) investigate all problems with evacuation drills, including accidents, and take corrective action; and

(e) during fire drills, a client may be evacuated to a safe area in the facility certified under the health care occupancies chapter of the LSC .

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2163 Secured Units

(1) A secured unit within a facility shall have a written policy outlining resident admission criteria, transfer criteria and discharge criteria for the secured unit.

(2) Provisions should be made for secured unit residents to access large group activities when provided by the facility, e.g., holiday activities, etc. except as contraindicated by factors identified within their individual treatment plans.

(3) A secured unit within a facility is considered a separate unit. A staff station shall be located within the secured unit. The station shall provide at a minimum the following:

(a) provisions for charting;

(b) provisions for hand washing;

(d) telephone access; and

(e) a nurse/staff call system as required by the "Guidelines for the Construction and Equipment of Hospital and Medical Facilities", as adopted in ARM 37.106.302.

(4) The nurse/staff call system for a secured unit within a facility shall report to the unit nurse/staff station. The call system may also annunciate the call at another location, such as a main nurse station.

(5) A secured unit within a facility shall provide for a nourishment station. The nourishment station shall contain a work counter, refrigerator, storage cabinets and a sink for serving nourishments between meals. Ice for patient consumption should be provided by icemaker-dispenser units. The nourishment station should include space for trays and dishes used for nonscheduled meal service. Hand washing facilities shall be in or immediately accessible from the nourishment station.

(6) Dining, activities and day space must be provided at a ratio of 30 square feet per resident, with at least 14 square feet dedicated to the dining space.

(7) Resident rooms must be at a ratio of 100 square feet for single bedrooms and 80 square feet for multiple bedrooms. The room square footage should not include bathrooms, door swings, alcoves or vestibules. No more than four residents shall reside in a single room, except in new construction which limits single rooms to two residents.

(8) Each resident must have access to a toilet without requiring them to enter the corridor except as contraindicated by factors identified within their individual treatment plans.

(9) A secured unit within a facility shall comply with the following requirements for special locking arrangements. In buildings protected throughout by an approved supervised automatic fire detection system or approved supervised automatic sprinkler system, the doors in low and ordinary hazard areas may be equipped with approved, listed, locking devices which shall:

(a) unlock upon actuation of an approved supervised automatic fire detection system or approved supervised automatic sprinkler;

(b) unlock upon loss of power controlling the lock or locking mechanism;

(d) all secured doors must have a manual electronic key release;

(e) provisions must be made for the rapid removal of occupants by such reliable means as the remote control of the locks. Typically, this is done by placing a staff accessible switch at the nurses station which is capable of releasing all doors; and

(f) all the locks on all secured doors must automatically release upon any of the following conditions:

(i) the actuation of the approved supervised automatic fire alarm system;

(ii) the actuation of an approved supervised automatic sprinkler system; or

(iii) upon the loss of the power controlling the locks or locking mechanisms.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2164 Fire Protection

(1) The facility must meet the applicable provisions of either the health care occupancies chapters or the residential board and care occupancies chapter of the Life Safety Code ( LSC ) , 2000 edition, of the National Fire Protection Association ( NFPA ) , 2000 edition, which is incorporated by reference. A copy of the LSC , 2000 edition, may be obtained from the National Fire Protection Association, Batterymarch Park, Quincy, MA 02269.

(a) The department may apply a single chapter of the LSC to the entire facility or may apply different chapters to different buildings or parts of buildings as permitted by the LSC .

(b) A facility that meets the LSC definition of a residential board and care occupancy and that has 16 or fewer beds must have its evacuation capability evaluated in accordance with the Evacuation Difficulty Index of the LSC (Appendix F) .

(2) For facilities that meet the LSC definition of a health care occupancy:

(a) the department may waive, for a period it considers appropriate, specific provisions of the LSC if:

(i) the waiver would not adversely affect the health and safety of the clients; and

(ii) rigid application of specific provisions would result in an unreasonable hardship for the facility.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2170 Infection Control

(1) The facility must provide a sanitary environment to avoid sources and transmission of infections. There must be policies and procedures for the prevention, control and investigation of infection and communicable diseases.

(2) The facility must implement successful corrective action in affected problem areas.

(3) The facility must maintain a record of incidents and corrective actions related to infections.

(4) The facility must prohibit employees with symptoms or signs of a communicable disease from direct contact with the client and their food.

(5) All staff shall use the proper hand washing techniques after providing direct care to a resident.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2171 Dietetic Services

(1) Each client must receive a nourishing, well-balanced diet including modified and specially-prescribed diets.

(2) A qualified dietitian must be employed either full-time, part-time or on a consultant basis at the facility's discretion.

(3) If a qualified dietitian is not employed full-time, the facility must designate a person to serve as the director of food services.

(4) The client's interdisciplinary team, including a qualified dietitian and physician, must prescribe all modified and special diets including those used as a part of a treatment to manage inappropriate client behavior.

(5) Foods proposed for use as a primary reinforcement of adaptive behavior are evaluated in light of the client's nutritional status and needs.

(6) Unless otherwise specified by medical needs, the diet must be prepared at least in accordance with the "Nutrition and Your Health: Dietary Guidelines for Americans", 2000, 5th edition of the recommended dietary allowances published by the Food and Nutrition Board of the National Research Council, National Academy of Sciences, adjusted for age, sex, disability and activity.

(7) Each client must receive at least three meals daily, at regular times comparable to normal mealtimes in the community with:

(a) not more than 14 hours between a substantial evening meal and breakfast of the following day, except on weekends and holidays when a nourishing snack is provided at bedtime, 16 hours may elapse between a substantial evening meal and breakfast; and

(b) not less than 10 hours between breakfast and the evening meal of the same day.

(8) Food must be served:

(a) in appropriate quantity;

(b) at appropriate temperature;

(d) with appropriate utensils.

(9) Food served to the client individually and uneaten must be discarded.

(10) Menus must:

(a) be prepared in advance;

(b) provide a variety of foods at each meal;

(d) include the average portion sizes for menu items.

(11) Menus for food actually served must be kept on file for 60 days.

(12) The facility must:

(a) serve meals for each client, including persons with ambulation deficits, in dining areas, unless otherwise specified by the interdisciplinary team or a physician;

(b) provide table service for each client who can and will eat at a table, including a client in a wheelchair;

(c) equip areas with tables, chairs, eating utensils, and dishes designed to meet the developmental needs of each client;

(d) supervise and staff dining rooms adequately to direct self-help dining procedure, to assure that each client receives enough food and to assure that each client eats in a manner consistent with his or her developmental level; and

(e) ensure that each client eats in an upright position, unless otherwise specified by the interdisciplinary team or a physician.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Mont. Admin. R. 37.106.2180 Facility Fair Hearing

(1) A facility has the right to appeal licensure decisions as outlined in 50-5-208 , MCA.

(2) The department shall follow the hearing procedure for fair hearings as outlined at ARM 37.5.117.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-238, MCA
Implementing statute(s): Sec. 53-5-103, 50-5-201 and 50-5-238, MCA
History: NEW, 2003 MAR p. 1322, Eff. 7/1/03.

Subchapter 37.106.22 Residential Treatment Facilities

Mont. Admin. R. 37.106.2201 Residential Treatment Facility: Application of Other Rules

(1) To the extent that other licensure rules in this chapter conflict with the terms of ARM 37.106.2202 and 37.106.2203 , the terms of ARM 37.106.2202 and 37.106.2203 will apply to residential treatment facilities.

AND HUMAN SERVICES

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-201, MCA
History: NEW, 1994 MAR p. 304, Eff. 2/11/94; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2202 Residential Treatment Facility: Licensure Standards

(1) A residential treatment facility must meet the requirements of the following:

(a) the standards for the following categories, contained in the Joint Commission on Accreditation of Health Care Organizations′ 2017 Comprehensive Accreditation Manual for Behavioral Health Care:

(i) Care, Treatment, and Services (CTS);

(ii) Environment of Care (EC);

(iii) Emergency Management (EM);

(iv) Human Resource Management (HRM);

(v) Infection, Prevention, and Control (IC):

(vi) Leadership (LD);

(vii) Life Safety (LS);

(viii) Medication Management (MM):

(ix) National Patient Safety Goals (NPSG);

(x) Performance Improvement (PI);

(xi) Record of Care, Treatment, and Services (RC);

(xii) Rights and Responsibility of the Individual (RI); and

(xiii) Waived Testing (WT).

(2) A residential treatment facility may not share direct care staff or provide joint activities or treatment in conjunction with another type of facility, even if both facilities are under the same management, unless the joint activity involves facilities under a single management and is a specific treatment program that is clinically appropriate for all of the children engaged in it (e.g., appropriate for patients of both a residential treatment facility and an inpatient acute psychiatric facility).

(3) The number of residents admitted to the facility and the number of beds in use and/or ready for use may not exceed the number of beds for which the facility is licensed, as indicated on the face of the license issued to it.

(4) The department adopts and incorporates by reference the Joint Commission on Accreditation of Healthcare Organizations, 2017 Comprehensive Accreditation Manual for Behavioral Health Care.

(5) The department adopts and incorporates by reference Title 42 CFR 440.160 (2010) and Title 42 CFR, part 441, subpart D (2010).

(6) The residential treatment facility must have 24-hour onsite nursing care by a registered nurse.

(7) The youth must be evaluated by a physician within 24 hours of admission.

(8) All legal representatives of the youth must be consulted and invited to participate in the development and review of the treatment plan. Valid reasons must be indicated if such a plan is not clinically appropriate or feasible.

(9) A comprehensive discharge plan directly linked to the behaviors and symptoms that resulted in admission and estimated length of stay must be developed upon admission.

(10) If the youth is a student with disabilities, an individualized education plan (IEP) must be in place that provides programs and services consistent with requirements under the Individuals with Disabilities Education Act (IDEA) and state special education requirements. If the youth is not a student with disabilities, educational services and programs must be designed to meet the educational needs of the youth.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-201, MCA
History: NEW, 1994 MAR p. 304, Eff. 2/11/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2018 MAR p. 848, Eff. 4/28/18.

Mont. Admin. R. 37.106.2203 Residential Treatment Facilities: Separate Licenses

(1) Separate residential treatment facility licenses are not required for separate buildings within the same community if they are utilized to provide residential psychiatric care under the same management.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-201, MCA
History: NEW, 1994 MAR p. 304, Eff. 2/11/94; TRANS, from DHES, 2002 MAR p. 185.

Subchapter 37.106.23 Minimum Standards for Hospice Facilities

Mont. Admin. R. 37.106.2301 Minimum Standards for a Hospice Program: General

(1) The following definitions apply in this rule and ARM 37.106.2305 and 37.106.2311:

(a) "Bereavement" means that period of time during which survivors mourn a death and experience grief.

(b) "Bereavement services" means support services to be offered during the bereavement period.

(c) "Contract services" means persons or organizations who, under written agreement, provide goods and services to the hospice and its patients and their families.

(d) "Core services" means physician services, nursing services, pastoral counseling, services provided by trained volunteers, and counseling services routinely provided by hospice staff.

(e) "Family" means individuals who are closely linked with the hospice patient, including the immediate family, the primary care giver, and individuals with significant personal ties.

(f) "Hospice" or "hospice program" means a public agency or private organization (or a subdivision thereof) as defined in 50-5-101(22), MCA, which is primarily engaged in providing hospice care.

(g) "Hospice care" means palliative and supportive care to meet the needs of a terminally ill patient and the patient's family arising out of physical, psychological, spiritual, social, and economic stresses experienced during the final stages of illness and dying, and that includes a formal bereavement component.

(h) "Hospice staff" means paid or unpaid persons, including volunteers, who are directly supervised by the hospice program.

(i) "Interdisciplinary team" means the number of appropriately qualified interdisciplinary health care professionals and volunteers that are needed to meet the hospice's patients' care needs.

(j) "Managed directly by" means that core services are provided by a hospice program.

(k) "Palliation" means controlling pain and other symptoms which are manifested during the dying process and are consistent with professional practice and regulations of the Montana Board of Pharmacy.

(l) "Respite care" means short-term in-patient care provided to the individual only when necessary to relieve the family members or other persons caring for the individual.

(2) A hospice program may be licensed to operate either:

(a) as a part of a licensed hospital without its own license when the department finds that the hospital's hospice program meets the requirements set forth in this rule; or

(b) with its own hospice license when the department finds that it meets the requirements set forth in this rule.

(3) A hospice program must have the following organizational components:

(a) a formally established governing body, individual, group, or corporation with authority to make decisions affecting the operation of the hospice;

(b) an organization chart defining reporting relationships among hospice workers;

(d) established policies for the administration and operation of the program, including but not limited to:

(i) written criteria for program admission and discharge;

(ii) procedures for bereavement referrals and assistance;

(iii) development of a plan of care;

(iv) agreements with other licensed health care facilities for proper transfer of patients and follow up of plans of care;

(v) system(s) for recordkeeping;

(vi) patient care procedures; and

(vii) in-service education.

(e) development of annual budgets; and

(f) annual evaluation of each aspect of the hospice program, including the program's quality assessment and improvement measures and a system to implement recommendations for future program planning.

(4) A hospice program must have an interdisciplinary team responsible for the provision of hospice care. The interdisciplinary team must:

(a) confer or meet regularly;

(b) have responsibility for implementation of each individual plan of care as directed by an identified coordinator; and

(c) encourage the patient/family to participate in developing the interdisciplinary team plan of care and in the provision of hospice services.

(5) A hospice program must assure that each patient has a physician who is the patient's primary physician and assists in the development of the patient's care plan.

(6) A hospice program must maintain a medical record for every individual accepted as a hospice patient. The medical record must include:

(a) patient identification, diagnosis, and prognosis;

(b) patient's medical history:

(d) a record of doctor's hospice orders;

(e) progress notes, dated and signed; and

(f) evidence of timely action by the patient care team.

(7) A hospice program which utilizes volunteers must provide volunteer training which includes:

(a) information concerning hospice philosophy;

(b) instruction on the volunteer's role, responsibilities, restrictions, and expectations; and

(8) A hospice program must allow the patient and the patient's family to make the decision to participate in a hospice program and shall encourage the patient and the patient's family to assume as much responsibility for care as they choose.

(9) A hospice program must assure that all services identified in the hospice plan of care for a patient, including skilled nursing services, are offered to the patient.

(10) A hospice program must:

(a) have a plan for providing bereavement follow up for families desiring it;

(b) monitor and assess the quality of contract services through annual review;

(d) hire, train, and supervise hospice staff and ensure that hospice staff adhere to hospice policies; and

(e) establish, update, and implement infection control policies and procedures that are sufficient to prevent transmission of disease.

(11) The hospice program must comply with ARM 37.106.2901, 37.106.2902, 37.106.2904, 37.106.2905, and 37.106.2908, pertaining to restraints, safety devices, assistive devices, and postural supports.

History

Authorizing statute(s): 50-5-103, 50-5-210, MCA
Implementing statute(s): 50-5-103, 50-5-204, 50-5-210, MCA
History: NEW, 1983 MAR p. 1460, Eff. 10/14/83; AMD, 1984 MAR p. 879, Eff. 6/1/84; AMD, 1994 MAR p. 2436, Eff. 8/26/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 351, Eff. 3/27/09.

Mont. Admin. R. 37.106.2305 Minimum Standards for an Inpatient Hospice Facility

(1) In addition to complying with the standards contained in ARM 37.106.2301, an inpatient hospice facility must comply with the requirements of the conditions of participation for hospices providing inpatient care directly, as set forth in 42 CFR Part 418, subparts C through E. Those conditions of participation include, but are not limited to, requirements concerning the following:

(a) 24-hour nursing service;

(b) disaster preparedness;

(d) fire protection;

(e) fire protection waivers;

(f) patient areas;

(g) patient rooms and toilet facilities;

(h) bathroom facilities;

(i) linen;

(j) isolation areas;

(k) meal service, menu planning, and supervision; and

(l) pharmaceutical hospice service.

(2) The department hereby adopts and incorporates by reference 42 CFR Part 418, subparts C through E, which contain the conditions that a hospice must meet in order to participate in the medicare program. A copy of the above conditions of participation may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-210, MCA
Implementing statute(s): Sec. 50-5-210, MCA
History: NEW, 1994 MAR p. 2436, Eff. 8/26/94; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2311 Minimum Standards for a Residential Hospice Facility

(1) A residential hospice facility must meet all of the requirements contained in ARM 37.106.2301 in addition to those contained in this rule.

(2) A residential hospice facility must be managed directly by a licensed hospice program.

(3) A residential hospice facility must be staffed with qualified personnel in numbers sufficient to provide required core services and those indicated in each patient's hospice plan of care, including:

(a) nursing services;

(b) therapies;

(d) timely response to emergency situations;

(e) volunteer services; and

(f) recreational and social activities.

(4) A residential hospice must assure that individuals providing personal care to residential hospice patients have received, prior to delivering such care, documented training that includes the following elements, or the documented equivalent of such training:

(a) hospice philosophy and orientation;

(b) basic needs of the frail elderly and/or physically disabled persons;

(d) basic techniques in observation of patient's mental and physical health;

(e) basic personal care procedures, including grooming;

(f) methods of making patients comfortable;

(g) bowel and bladder care;

(h) assisting patient mobility, including transfer (e.g. from bed to wheelchair);

(i) techniques in lifting;

(j) food and nutrition;

(k) basic techniques of identifying and correcting potential safety hazards in the home; and

(l) health oriented record keeping.

(5) A residential hospice facility must meet the life-safety requirements set forth in the 2012 NFPA 101 Life Safety Code for residential board and care occupancies.

(6) In patient areas, a residential hospice must:

(a) provide areas that ensure private patient and patient family visiting;

(b) provide or arrange for accommodations for family members to remain with the patient overnight;

(d) ensure that hospice visiting hours are flexible and that children or pets are not excluded;

(e) provide a handicapped accessible telephone for patient use;

(f) be equipped with furnishings which are home-like in design and function and contribute to a safe environment; and

(g) provide one or more areas for dining, recreation and/or social activities, and refrain from utilizing these areas for corridor traffic.

(7) In patient bedrooms, a residential hospice must:

(a) allow each patient to bring personal items to locate in the patient's bedroom so long as the health and safety of any patient, patient's family members, or hospice staff are not jeopardized;

(b) allow no more than two beds per patient room and ensure that each patient bedroom is located at or above ground level, has a window to the outside of the facility, and has a direct entry from the corridor;

(c) provide at least 100 square feet in one-bed rooms and 80 square feet per bed in two-bed rooms, exclusive of closets, lockers, wardrobes, alcoves, or vestibules;

(d) provide each bedroom with a comfortable, appropriately sized bed for each occupant, equipped with a mattress protected by waterproof material, mattress pad, and comfortable pillow, as well as a comfortable chair and other furniture as appropriate to the decor and patient needs;

(e) provide a separate dresser and wardrobe or closet space for each occupant in a bedroom;

(f) provide clean, flame-resistant shades or the equivalent for every bedroom window;

(g) in each two-bed room, provide either flame-resistant cubicle curtains for each bed or movable flame-resistant screens to provide privacy upon request of a patient; and

(h) if the needs of a patient require a call system or communication device to be in place, make it available; otherwise, the hospice may, but is not required to, provide a patient bedroom with a call system or communication device that is connected to an area in the hospice that is consistently staffed.

(8) A residential hospice must provide the following bathroom and toilet facilities:

(a) a toilet and lavatory in each toilet room and at least one toilet for every four patients;

(b) at least one bathing facility for every 12 patients;

(c) grab bars at each toilet, shower, and tub, with a minimum of 1-1/2 inch clearance between the bar and the wall and strength and anchorage sufficient to sustain a concentrated 250-pound load;

(d) at least one bathroom and one toilet accessible to individuals with mobility impairments;

(e) all doors to resident bathrooms shall open outward or slide into the wall and shall be unlockable from the outside. Dutch doors, bi-folding doors, sliding pocket doors, and other bi-swing doors may be used if they do not impede the bathroom access width and are approved by the department. A shared bathroom with two means of access is also acceptable; and

(f) if the needs of a patient require a call system or communication device to be in place in the patient's bathroom, make it available; otherwise, the hospice may, but is not required to, provide a patient bathroom with a call system or communication device that is connected to an area in the hospice that is consistently staffed.

(9) A residential hospice must do the following for infection control:

(a) either be equipped to provide an isolation area for patients who have diseases with a high risk of transmission or have in place a method to ensure that such patients are transferred to a health care facility which is adequately equipped to admit such a patient;

(b) develop a procedure to monitor the infection control program on a regular basis; and

(10) A residential hospice must meet the following meal service, menu planning, and supervision standards:

(a) foods must be served in amounts and variety to meet the needs of each hospice patient.

(b) the hospice must provide a practical freedom-of-choice diet to patients and assure that patients' favorite foods are included in their diets whenever possible.

(c) the food service must establish and maintain standards relative to food sources, refrigeration, refuse handling, pest control, storage, preparation, procuring, serving, and handling that are sufficient to prevent food spoilage and transmission of infectious disease.

(d) a staff member trained or experienced in food management must be appointed to:

(i) provide diets as indicated on the plan of care for each patient; and

(ii) supervise meal preparation and service.

(e) if a hospice patient or patient's family wishes to provide meal services for an individual independent of the required food service of the hospice, either on a periodic or continuous basis, the hospice and patient, and patient's family when appropriate, must work out reasonable arrangements so that the hospice staff may plan accordingly.

(11) In order to provide pharmaceutical services to patients, a residential hospice must:

(a) develop and maintain a system for the administration and provision of pharmaceutical services that are consistent with the drug therapy needs of the patient as determined by the hospice medical director and patient's primary physician;

(b) ensure that medications ordered are consistent with the hospice philosophy which focuses on palliation;

(c) ensure that all prescription medications are ordered in writing by someone licensed to write prescriptions under Montana state law, dispensed by a licensed pharmacy, received by the patient, the patient's family, or other designated individual(s), and maintained in the hospice;

(d) unless the pharmacy provides a unit dose system, ensure that all prescription drugs are labeled with a label that includes:

(i) name of pharmacy;

(ii) name of patient;

(iii) name of prescribing physician;

(iv) date prescription filled;

(v) prescription number;

(vi) name of medication;

(vii) directions and dosage;

(viii) expiration date; and

(ix) quantity dispensed.

(e) document all medication administration in the patient's record;

(f) ensure that medications are administered only by one of the following individuals:

(i) a licensed nurse, physician, or physician assistant;

(ii) the patient or patient's family if the physician allows them to do so and an order acknowledging that fact is noted in the hospice care plan; and

(iii) anyone authorized to administer medications by 37-8-103, MCA.

(g) allow medications to be left at the bedside of a hospice patient when to do so is approved in the hospice plan of care, and, whenever such approval exists, provide for the storage of such medications in a safe and sanitary manner;

(h) ensure that medications not stored at the bedside are maintained in locked storage in a central location in the hospice that is near or adjacent to an area for medication preparation and has appropriate refrigeration, a sink for handwashing, and locking cabinets;

(i) destroy medications when the label is mutilated or indistinct, the medication is beyond the expiration or shelf life date, or unused portions remain due to discontinuance of use or death or discharge of the patient; and

(j) develop and follow written policies and procedures for destruction of legend drugs that include listing the type of drug(s) destroyed and the amount destroyed.

(12) The department adopts and incorporates by reference the 2012 NFPA 101 Life Safety Code which establishes building construction requirements for residential board and care occupancies. Copies of the above standards may be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, MD 02169, or by using their web site, www.nfpa.org.catalogue .

(13) Respite care may be provided only on an occasional basis for no more than five consecutive days at a time.

History

Authorizing statute(s): 50-5-103, 50-5-210, MCA
Implementing statute(s): 50-5-210, MCA
History: NEW, 1994 MAR p. 2436, Eff. 8/26/94; AMD, 1995 MAR p. 851, Eff. 5/12/95; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 351, Eff. 3/27/09; AMD, 2022 MAR p. 1876, Eff. 9/24/22.

Subchapter 37.106.24 Home Infusion Therapy

Mont. Admin. R. 37.106.2401 Home Infusion Therapy Agency: Definitions

In addition to the definitions in 50-5-101, MCA, the following definitions apply to this subchapter:

(1) "Antineoplastic" means a pharmaceutical that has the capability of killing malignant cells.

(2) "Biological safety cabinet" means a containment unit suitable for the preparation of low to moderate risk agents.

(3) "Critical area" means an area where sterilized products or containers are exposed to the environment during aseptic preparation.

(4) "Enteral" means a preparation compounded in an ISO Class 5 environment, dispensed by a pharmacist, and administered by way of the intestine.

(5) "Home infusion therapy (HIT) services" means the preparation, administration, or furnishing of parenteral medications, or parenteral or enteral nutritional services to an individual in that individual's residence. The services include an educational component for the patient, the patient's caregiver, or the patient's family member.

(6) "ISO Class 5" means a classification of air cleanliness as defined in United States Pharmacopoeia (USP) USP 31 General Chapter 797 Pharmaceutical Compounding - Sterile Preparations.

(7) "Licensed health care professional" means a physician (M.D. or D.O.), a physician assistant-certified, a nurse practitioner, or a registered nurse practicing within the scope of their license.

(8) "Parenteral" means a sterile preparation of drugs for injection through one or more layers of the skin with infusion administration time determined by the recommendation of the pharmaceutical manufacturer.

(9) "Pharmacist" means a person licensed by the state to engage in the practice of pharmacy and who may affix to the person's name the term "R.Ph."

(10) "Pharmacist-in-charge or their designee" means a licensed pharmacist who accepts responsibility for the operation of a pharmacy in conformance with all laws and rules pertinent to the practice of pharmacy and the distribution of drugs, and who is personally in full and actual charge of such pharmacy.

(11) "Pharmacy" means an established location, either physical or electronic, registered by the Board of Pharmacy where drugs or devices are dispensed with pharmaceutical care or where pharmaceutical care is provided.

(12) "Prescribing practitioner" means a licensed health care professional authorized by state statute or federal law to prescribe pharmaceuticals and/or treatments.

(13) "Sterile pharmaceutical or product" means an aseptic dosage form free from living micro-organisms.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2404 Home Infusion Therapy Agency: Responsibility for Services

(1) Where a home infusion therapy agency directly provides either the home infusion therapy services or skilled nursing services and arranges for the provision of the other services, the parties must enter into a written contract defining the nature and scope of the services to be provided by each party. The contract must:

(a) describe the services to be provided by each party; and

(b) specify the responsibilities of each party in the provision, coordination, supervision, and evaluation of the care or services provided. This must include each party's role in:

(i) the patient admission process;

(ii) the patient assessment process;

(iii) the patient education process;

(iv) the development, review, and revision of the patient plan of care;

(v) the development, review, and revision of the patient medical record;

(vi) the provision of clinical services;

(vii) the timely reporting of adverse reactions to treatment, medical symptoms, or abnormal lab values;

(viii) the timely reporting of the patient failing to comply with the home infusion regiment;

(ix) the patient care conferences; and

(x) discharge planning.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2405 Home Infusion Therapy Agency: Administrator and Personnel

(1) Each home infusion therapy agency must employ an administrator who shall:

(a) organize and direct the home infusion therapy agency's ongoing functions;

(b) be responsible for ongoing oversight of the home infusion therapy agency's quality assessment system, including the establishment of policies and procedures which address the safe control, accountability, distribution, and administration of infusion products;

education and evaluation; and

(d) be familiar with and assure compliance with the rules

of this subchapter.

(2) For a pharmacy which is licensed as a home infusion therapy agency, the pharmacist-in-charge may serve as the administrator.

(3) All services provided by the home infusion therapy agency and its employees must be provided in accordance with state laws, regulations, and home infusion therapy agency policies and procedures.

(4) The home infusion therapy agency must maintain, at all times, a pharmacist-in-charge (or designee) and a Montana licensed nurse that are both accessible and physically able to respond 24 hours a day, seven days per week.

(5) The home infusion therapy agency shall document in the employee record:

(a) all professional employee orientation;

(b) competency assessments;

(d) a current license.

(6) The pharmacist-in-charge may be assisted by supportive personnel. Supportive personnel must work under the immediate supervision of a licensed pharmacist and have specialized training in the field of home infusion therapy. The duties and responsibilities of these personnel must be consistent with their training and experience.

(7) The licensed health care professional providing skilled nursing services shall:

(a) provide those services in accordance with the plan of care;

(b) dictate or write clinical notes at the time of service. Clinical notes must be signed, recorded, and incorporated into the patient's medical record within three working days of providing the service;

(d) notify the pharmacist, the prescribing practitioner, and the home infusion therapy agency's personnel responsible for the care of the patient, of any significant changes in the patient's condition.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103 and 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2406 Home Infusion Therapy: Clinical Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; REP, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2407 Home Infusion Therapy Agency: Quality Assessment

(1) Each home infusion therapy agency shall prepare and maintain on file an annual report of improvements made as a result of a quality assessment program.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2411 Home Infusion Therapy Agency: Education Services

(1) Each home infusion therapy agency, and any contracted party providing services to the patient, together, shall:

(a) provide the patient or the patient's caregiver with education and counseling on proper storage, scheduling, and risks associated with specific drugs and infusion therapy in general, the proper disposal of unused or outdated medications, and document the counseling sessions in the patient's medical record;

(b) provide to the patient and/or patient caregiver written educational material which must include at a minimum:

(i) drug information sheets for prescribed therapy;

(ii) compounding, admix technique, adding medications to solutions, and withdrawing medications from vials;

(iii) function, operation, and troubleshooting durable medical equipment when prescribed; and

(iv) supplies and training for safe and proper handling and disposal of antineoplastic, infectious, and hazardous waste.

(c) reassess on an ongoing basis, the patient's competency or the patient's caregiver's competency, in managing home infusion therapy in the home environment and document the reassessment process in the patient's medical.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2412 Home Infusion Therapy Agency: Medical Record

(1) Each home infusion therapy agency shall establish and maintain for each patient accepted for care, a medical record which must be accessible to home infusion therapy personnel and which must include the following information:

(a) admission data, including the:

(i) name;

(ii) current address;

(iii) date of birth;

(iv) sex;

(v) date of admission;

(vi) name and contact information of the patient's caregiver or family member; and

(vii) name and contact information of the pharmacist-in-charge and the prescribing practitioner.

(b) admission diagnosis and pertinent health information relevant to the plan of care;

(c) any allergies and known adverse reactions to drugs and food. This information must be given such prominence in the record so as to make it obvious to any persons who provide food or medication to the patient;

(d) laboratory reports;

(e) documentation that a list of patient rights and responsibilities have been made available to each patient or the patient's caregiver;

(f) the plan of care;

(g) clinical assessments and services documentation;

(h) the prescribing practitioner's order for home infusion therapy;

(i) a monthly clinical therapy summary for any patient receiving services 30 days or longer; and

(j) a discharge summary of therapy at the end of treatment.

(2) The responsibilities of the patient and the home infusion therapy agency, including any contracted parties, in the areas of delivery of care and monitoring of the patient, must be clearly documented in the patient's medical record.

(3) The home infusion therapy agency, and any contracted party providing services to the patient, together, shall develop a plan of care within three working days of the initiation of therapy, which must include:

(a) a diagnosis;

(b) the types of services and equipment required;

(d) the estimated length of service;

(e) a statement of treatment goals;

(f) the regimen and prescription ordered;

(g) the concurrent legend and over the counter drugs;

(h) an assessment of mental status;

(i) permitted activities;

(j) the prognosis, discharge, transfer or referral plan; and

(k) instructions to patient and family.

(4) All records of dispensed sterile pharmaceuticals must be a part of the patient's medical record.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2415 Home Infusion Therapy Agency: Administration of Medication and Treatment

(1) All medications and treatments administered by the home infusion therapy agency's personnel or contracted parties must be administered by a Montana licensed health care professionals.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2416 Home Infusion Therapy Agency: Parenteral or Enteral Solutions

(1) In addition to the minimum requirements for a pharmacist and a pharmacy established by Title 37, chapter 7, MCA, and ARM Title 24, chapter 174, any parenteral or enteral solution provided by the home infusion therapy agency or obtained through contract with a third party pharmacy and provided to patients of the home infusion therapy agency must be dispensed by a licensed pharmacist in a Montana licensed pharmacy, whom and which are in compliance with the requirements of ARM 37.106.2404, 37.106.2407, 37.106.2422, 37.106.2423, and 37.106.2430 through 37.106.2433.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2420 Home Infusion Therapy Agency: Policy and Procedure Manual

(1) The home infusion therapy agency shall develop a policy and procedure manual for the organization and operation of the home infusion therapy agency. A copy of the manual must be kept current at all times, and be readily available at all times, and to all who request it.

(2) The manual must include an organizational chart delineating the lines of authority, responsibility, and accountability for the administration and patient care services of the agency.

(3) The manual must specifically detail the storage, stability, handling, compounding, labeling, dispensing, and delivery of all sterile pharmaceuticals and address requirements relating to:

(a) security measures, which ensure that the premises where sterile pharmaceuticals are present are secured, and which prevent access to patient records by unauthorized personnel;

(b) sanitation, including the methodology of cleaning biological safety cabinets and laminar flow hoods, and of inspecting filters for deterioration and microbial contamination;

(d) the orientation of personnel;

(e) the duties and qualifications of staff;

(f) record keeping requirements;

(g) medication profiles;

(h) the administration of parenteral therapy to include infusion devices, drug delivery systems, and monitoring;

(i) the pharmacy patient evaluation and documentation;

(j) prescription processing;

(k) clinical services;

(l) drug and product selection;

(m) 24-hour emergency access to a pharmacist;

(n) the handling of antineoplastic agents, a description of which must include protective apparel to be worn by compounding personnel;

(o) drug destruction, returns, and proper waste management;

(p) equipment management, including tracking, cleaning, and testing of infusion pumps;

(q) end product testing;

(r) a quality assessment program;

(s) a risk management program including incident reports,

adverse drug reactions, product contamination, and drug recalls;

(t) education and training of the patient or the patient's caregiver;

(u) emergency drug and supply procurement;

(v) guidelines for handling investigational drug administration;

(w) reference materials; and

(x) an emergency preparedness plan.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2421 Home Infusion Therapy Agency: Incorporation by Reference

(1) The department adopts and incorporates by reference United States Pharmacopoeia (USP) 31 General Chapter 797 Pharmaceutical Compounding - Sterile Preparations, June 1, 2008, which sets practice standards to help ensure that compounded sterile preparations are of high quality. A copy of USP 31 General Chapter 797 Pharmaceutical Compounding - Sterile Preparations may be obtained from USP Headquarters, 12601 Twinbrook Parkway, Rockville, MD 20852-1790, telephone (800) 227-8772 or http://www.usp.org/products/797Guidebook.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2422 Home Infusion Therapy Agency: Physical Requirements for Pharmacies

(1) The pharmacy must have a designated area with entry restricted to designated personnel for preparing sterile products. This area must be:

(a) a separate room with a closed door, isolated from other areas with restricted entry or access, and designed to avoid unnecessary traffic and airflow disturbances from activity as required by United States Pharmacopoeia (USP) USP 31 General Chapter 797 Pharmaceutical Compounding - Sterile Preparations;

(b) used only for the preparation of sterile pharmaceuticals;

(c) of sufficient size to accommodate a laminar airflow hood and to provide for the proper storage of drugs and supplies under appropriate conditions of temperature, light, moisture, sanitation, ventilation, and security; and

(d) one with cleanable work surfaces, walls, and floors.

(2) If a home infusion therapy agency elects to use a Compounding Aseptic Isolator (CAI), the "separate room" requirement of (1)(a) is not required, provided that the home infusion therapy agency maintains documentation of meeting the standards for this exception of CAIs set forth in USP 31 General Chapter 797.

(3) The pharmacy preparing the sterile products must have:

(a) appropriate environmental control devices capable of maintaining at least an ISO Class 5 in the workplace where critical activities are performed. The devices must be capable of maintaining this condition during normal activity. Examples of appropriate devices include vertical and horizontal laminar airflow hoods and zonal laminar flow of high efficiency particulate air filtered air. All airflow hoods used by the home infusion therapy agency must be certified as able to maintain an ISO Class 5 environment as required by USP 31 General Chapter 797 Pharmaceutical Compounding - Sterile Preparations;

(b) appropriate disposal containers for used needles, syringes, etc., and if applicable, for antineoplastic waste from the preparation of antineoplastic agents and infectious wastes from patients' homes;

(d) temperature controlled delivery containers, when necessary;

(e) infusion devices, when necessary;

(f) a sink with hot and cold running water which is convenient to compounding area for the purpose of hand scrubs prior to compounding; and

(g) a refrigerator/freezer with a thermometer.

(4) The pharmacy shall maintain supplies and provide attire adequate to maintain an environment suitable for the aseptic preparation of sterile products.

(5) The pharmacy shall maintain sufficient current reference materials relating to sterile products to meet the needs of the pharmacy personnel.

(6) The pharmacy shall document a chain of possession for all controlled substances including return or disposal of unused controlled substances.

(7) All pharmacies utilized by or part of a home infusion therapy agency must be able to deliver to the home infusion therapy agency patient any needed medications and therapies within 24 hours of the need being recognized. If a pharmacy is not able to ensure a 24-hour response time, a current contract with a pharmacy that is able to ensure a 24-hour response time is required, and must be kept at the home infusion therapy agency.

(8) If the home infusion therapy agency utilizes a pharmacy located outside the state of Montana, documentation must be maintained at the home infusion therapy agency site that the pharmacy utilized has a current Montana pharmacy license per Board of Pharmacy requirements, and that it meets the requirements of this rule.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2423 Home Infusion Therapy: Dispensing of Sterile Pharmaceuticals

(1) The pharmacy shall maintain a record of each sterile pharmaceutical dispensed for at least two years after the last dispensing activity. This record must include, but not be limited to:

(a) the products and quantity dispensed;

(b) the date dispensed;

(d) the directions for use;

(e) the identification of the dispensing pharmacist and preparing pharmacy technician, if appropriate;

(f) the manufacturer lot number and expiration date, stability date (or recall policy if the lot number is not recorded);

(g) the compounding or special instructions, if applicable; and

(h) the next scheduled delivery date.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2426 Home Infusion Therapy: Pharmacy Personnel

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; REP, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2430 Home Infusion Therapy Agency: Labeling

(1) Parenteral pharmaceuticals dispensed to patients must have a permanent label with the following information:

(a) the name and contact information of the pharmacy including a phone number which provides access to a pharmacist 24 hours per day, seven days per week;

(b) the date the product was prepared;

(d) the patient's full name;

(e) the name of the prescribing practitioner;

(f) the directions for use including infusion rate and infusion device, if applicable;

(g) the name of each component, its strength, and amount;

(h) the expiration date of the product based on published data;

(i) the appropriate ancillary instructions such as storage instructions or cautionary statements including antineoplastic warning when applicable; and

(j) the identity of the pharmacist compounding and dispensing the product.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2431 Home Infusion Therapy Agency: Antineoplastic Drugs

(1) The following requirements must be met by those pharmacies that prepare antineoplastic drugs to ensure the protection of the personnel involved:

(a) All antineoplastic drugs must be compounded in a vertical flow, Class II, biological safety cabinet.

(b) Protective apparel must be worn by personnel compounding antineoplastic drugs according to the home infusion agency's policies and procedures. This must include gloves, gowns with tight cuffs, and appropriate equipment as necessary.

(c) Appropriate safety and containment techniques for compounding antineoplastic drugs must be used in conjunction with the aseptic techniques required for preparing sterile pharmaceuticals.

(d) Written procedures for handling both major and minor spills of antineoplastic agents must be included in the policy and procedure manual.

(e) Prepared doses of antineoplastic drugs must be dispensed, labeled with proper precautions inside and outside, and shipped in a manner to minimize the risk of accidental rupture of the primary container.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2432 Home Infusion Therapy Agency: Disposal of Antineoplastic, Infectious, and Hazardous Wastes

(1) Disposal of antineoplastic, infectious, and hazardous waste is governed by the Infectious Waste Management Act, Title 75, chapter 10, part 10, MCA.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Mont. Admin. R. 37.106.2433 Home Infusion Therapy Agency: Delivery of Medications

(1) The home infusion therapy agency shall ensure that medications are delivered according to the prescribed start of therapy so that the prescription for sterile pharmaceuticals can be implemented as ordered. Once therapy has been initiated, the home infusion therapy agency shall continue to provide sterile pharmaceuticals in a timely fashion so as not to interrupt ongoing therapy.

(2) If the start of therapy is to be delayed for more than two hours from the prescribed start time, the home infusion agency shall notify both the patient and the prescribing practitioner.

(3) Patients must be notified in advance of delivery of the products. Patients must be provided with a receipt for all sterile products and supplies delivered to them.

(4) The pharmacy shall document a chain of possession for all controlled substances.

(5) The home infusion therapy agency shall ensure the environmental control of all products shipped. All compounded, sterile pharmaceuticals must be shipped or delivered to a patient in appropriate, temperature-controlled delivery containers as defined by the United States Pharmacopeia/National Formulary and stored appropriately in the patient's therapy setting.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-213, MCA
History: NEW, 1996 MAR p. 2587, Eff. 10/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 1668, Eff. 9/25/09.

Subchapter 37.106.25 Retirement Homes

Mont. Admin. R. 37.106.2501 Retirement Homes: Definitions

In addition to those definitions in 50-5-101 , MCA, the following definitions apply to this subchapter:

(1) "Bedding" means mattresses, box springs, mattress covers, mattress pads, sheets, pillow slips, pillows, pillow covers, blankets, comforters, quilts and bedspreads.

(2) "Building authority" means the building codes bureau, Montana department of labor and industry, or a local government building inspector enforcing a local building code enforcement program certified by the department of labor and industry.

(3) "Fire authority" means the state fire marshal or the state fire marshal's authorized agent.

(4) "Fixtures" means a shower, bathtub, toilet, toilet seat, urinal, lavatory, kitchen sink, janitor and custodial sink, utensil sink and all exposed plumbing integral to them.

(5) "Floors" means sub-flooring and floor coverings of all rooms including stairways, hallways, and lobbies.

(6) "Furnishings" includes, but is not limited to, cups, glasses, pitchers, utensils, draperies, curtains, blinds, light fixtures, lamps and lamp shades, chairs, tables, desks, shelves, books, magazines, bookcases, dressers, bedsteads, mattress springs other than box springs, towels, wash cloths, soap, toilet tissue, radios, television sets, coffee makers, water heaters, pictures, mirrors, cabinets, closets and refrigerators.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2502 Retirement Homes: Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter will apply to retirement homes.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1100, Eff. 2/22/25.

Mont. Admin. R. 37.106.2505 Retirement Homes: Fire and Building Codes Approval

(1) The construction of or alteration, addition, or renovation to a retirement home must meet the requirements set forth in ARM 37.106.302.

(2) A retirement home must be inspected and certified on an annual basis for compliance with the local and state fire codes by the fire authority. A retirement home must maintain a record of such inspection and certification for at least one year following the date of the inspection.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1100, Eff. 2/22/25.

Mont. Admin. R. 37.106.2506 Retirement Homes: Pools, Spas, and Other Water Features

(1) The construction and operation of any swimming pool, spa, or other water feature, which serves a retirement home must comply with the licensing procedures and requirements of Title 50, chapter 53, MCA, and ARM 37.115.102, 37.115.103, and 37.115.106.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2018 MAR p. 2216, Eff. 1/1/19.

Mont. Admin. R. 37.106.2510 Retirement Homes: Physical Requirements

(1) A retirement home must comply with the local and state building code and fire code.

(2) A retirement home must comply with the following physical requirements:

(a) There must be adequate and convenient janitorial facilities including a sink and storage area for equipment and chemicals.

(b) Floors and walls in toilet and bathing rooms, laundries, janitorial closets, and other rooms subject to large amounts of moisture, must be smooth and non-absorbent.

(c) The floor mounted and wall mounted furnishings must be easily moveable to allow for cleaning or mounted in such a manner as to allow for cleaning around and under such furnishings.

(d) Bathing facilities must be equipped with:

(i) anti-slip surfaces; and

(ii) handicapped grab bars, capable of supporting a concentrated load of 250 pounds.

(3) Each bedroom in a retirement home must include:

(a) floor to ceiling walls;

(b) one door which can be closed to allow privacy for residents;

(d) access to a toilet room without entering through another resident's room.

(4) If a retirement home elects to provide furnishings as part of its services, the retirement home must provide in each bedroom an adequate closet or wardrobe, bureau or dresser or its equivalent, and at least one armchair, for every two residents.

(5) Traffic to and from any room shall not be through a resident's bedroom.

(6) No occupied room shall have as its means of access a trap door, ladder, or folding stairs.

(7) No required path of travel to the outside shall be through rooms that are subject to locking or otherwise controlled by a person other than the person seeking to escape.

(8) No more than two residents may reside in a single bedroom.

(9) Exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, each single bedroom must contain at least 100 square feet, and each multi-bedroom must contain at least 80 square feet per bed.

(10) With respect to any conditions in existence prior to July 4, 1996, any requirement of this rule may be waived at the discretion of the department if:

(a) physical limitations of the retirement home would require disproportionate expense or effort to comply with a requirement, with little or no increase in the level of safety to the residents and staff; or

(b) compliance with a requirement would involve unreasonable hardship or unnecessary inconvenience, with little or no increase in the level of safety to the residents and staff.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1100, Eff. 2/22/25.

Mont. Admin. R. 37.106.2511 Retirement Homes: Environmental Control

(1) Hand cleansing soap or detergent and individual towels must be available at each sink in food preparation areas and commonly shared areas of the facility. Towels for common use are not permitted.

(2) A waste receptacle must be located near each sink.

(3) A minimum of 10 foot-candles of light must be available in all rooms, with the following exceptions:

(a) All reading lamps must have a capacity to provide a

minimum of 30 foot-candles of light;

(b) All toilet and bathing areas must be provided with a minimum of 30 foot-candles of light;

(d) Hallways must be illuminated at all times by at least a minimum of five foot-candles of light at the floor.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2512 Retirement Homes: Water Supply and Wastewater Systems

(1) The retirement home must meet the water supply and wastewater systems requirements in ARM 37.111.110 and 37.111.116.

(2) If a nonpublic water supply system is used, a retirement home must submit a water sample at least quarterly to a laboratory licensed by the department of environmental quality to perform microbiological analysis of water supplies in order to determine that the water does not exceed the maximum microbiological contaminant levels.

(3) A retirement home must replace or repair the water supply system serving it whenever the water supply:

(a) contains microbiological contaminants in excess of the maximum levels; or

(b) does not have the capacity to provide adequate water for drinking, cooking, personal hygiene, laundry, and water-carried waste disposal.

(4) Hand sinks and bathing facilities must be provided with water at a temperature of at least 100°F and not more than 120°F.

(5) Ice must be:

(a) obtained from a licensed supplier if it is not made from the retirement home's water supply;

(b) manufactured, stored, handled, transported, and served in a manner which is approved by the department or local health authority as preventing contamination of the ice.

(6) Where open bin ice storage is provided, an ice scoop must be readily available for use by residents or the management and stored either inside the bin or in a closed container protected from contamination.

(7) Ice storage bins may not be connected directly to any trap, drain, receptacle sink, or sewer which discharges waste or to any other source of contamination. A minimum of a four inches air gap is required between the ice storage bin drain and any waste discharge.

(8) The department adopts and incorporates by reference ARM 37.111.110, which sets forth requirements for construction and maintenance of water supply systems, and ARM 37.111.116, which sets forth requirements for construction and maintenance of wastewater systems.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1100, Eff. 2/22/25.

Mont. Admin. R. 37.106.2513 Retirement Homes: Sewage System (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; REP, 2025 MAR, Notice No. 37-1100, Eff. 2/22/25.

Mont. Admin. R. 37.106.2514 Retirement Homes: Solid Waste

(1) In order to ensure that solid waste is safely stored and disposed of, a retirement home must:

(a) store all solid waste between collections in containers which have lids and are corrosion resistant, fly tight, watertight, and rodent proof;

(b) utilize exterior collection stands for the storage containers, which prevent them from being tipped, protect them from deterioration, and allow easy cleaning below and around them;

(d) transport or utilize a private or municipal hauler to transport the solid waste at least weekly to an approved landfill site in a covered vehicle or in covered containers.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1100, Eff. 2/22/25.

Mont. Admin. R. 37.106.2520 Retirement Homes: Laundry Facilities

(1) Laundry facilities utilized by a retirement home for laundering of its soiled laundry, including but not limited to bed linen, towels and washcloths, must be provided with:

(a) a mechanical washer and hot air tumble dryer. Manual washing and line drying of bed linen, towels and washcloths is prohibited. Dryers must be properly vented to prevent maintenance problems;

(b) a hot water supply system capable of supplying water at a temperature of 54 E C (130 E F) to the washer during all periods of use, or if a temperature of 54 E C (130 E F) cannot be attained or maintained, manufacturer documentation showing the cleansing products effectiveness at lower water temperatures by exponentially increasing the time laundry is exposed to the product;

(d) separate carts for transporting soiled and cleaned laundry; and

(e) hand washing facilities including a sink, soap, and disposable towels. A soak sink may double as a handwashing sink.

(2) Sheets, pillow covers, towels and washcloths must be dried in a hot air tumble dryer or ironed at a minimum temperature of 150 E C (300 E F) .

(3) Facility staff handling laundry must cover their clothes while working with soiled laundry, use separate clean covering for their clothes while handling clean laundry, and wash their hands both after working with soiled laundry and before they handle clean laundry.

(4) The provisions of ARM 37.106.2520 do not apply to laundry facilities provided by the retirement home for the personal use of its residents.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2521 Retirement Homes: Housekeeping and Maintenance

(1) A retirement home must provide maintenance services. With respect to the provision of maintenance services, and housekeeping services, where a retirement home elects to provide those services to individual residents within their rooms, the retirement home must ensure that:

(a) each janitor room is clean, ventilated and free from odors;

(b) mop heads, when used, are changed frequently using laundered replacements;

(c) toilets, bathtubs, lavatories, and showers are not used for washing and rinsing of mops, brooms, brushes, or any other cleaning devices;

(d) the transporting, handling and storage of clean bedding, where provided by the retirement home, is performed in such a manner as to preclude contamination by soiled bedding or from other sources;

(e) any cleaner used in cleaning bathtubs, showers, lavatories, urinals, toilet bowls, toilet seats, and floors contains fungicides or germicides;

(f) deodorizers and odor-masking agents are not used unless the room in which the agent is used is clean to sight and touch;

(g) cleaning devices used for lavatories, showers and bathtubs are not used for any other purpose;

(h) dry dust mops and dry dust cloths are not used for cleaning purposes. Dusting and cleaning must be accomplished using treated mops, wet mops, treated cloths, or moist cloths to prevent the spread of soil from one place to another;

(i) the retirement home is free of insects, rodents and other vermin;

(j) all bedding, towels, and wash cloths, where provided by the retirement home, are clean and in good repair. Bedding, towels, and wash cloths, where provided by the retirement home, must be made available to each resident on a daily or weekly basis;

(k) all furnishings, where provided by the retirement home, fixtures, floors, walls, and ceilings are clean and in good repair;

(l) cleaning compounds and pesticides are stored, used, and disposed of in accordance with the manufacturer's instructions;

(m) glasses, pitchers, ice buckets, and other utensils used for food or drink and provided in units for use by residents are not washed or sanitized in any lavatory or janitor sink. Approved facilities for washing, rinsing, and sanitizing glasses, pitchers, ice buckets, and other utensils must be provided by the retirement home. In the absence of approved washing facilities, single service utensils must be used; and

(n) all utensils used for food or drink and provided in units for use by residents are stored, handled, and dispensed in a manner which precludes contamination of the utensil prior to use by a resident.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2522 Retirement Homes: Food Service Requirements (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185; REP, 2025 MAR, Notice No. 37-1100, Eff. 2/22/25.

Mont. Admin. R. 37.106.2530 Retirement Homes: Resident Register

(1) A retirement home must maintain a register of all residents currently residing at the retirement home, noting for each resident, at a minimum, the resident's name and:

(a) room or apartment number;

(b) date of arrival; and

(2) The register must be kept on the retirement home premises and be available for review and verification by the department during inspections.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103 and 50-5-214, MCA
History: NEW, 1996 MAR p. 1867, Eff. 7/4/96; TRANS, from DHES, 2002 MAR p. 185.

Subchapter 37.106.26 Adult Day Care

Mont. Admin. R. 37.106.2601 Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of ARM Title 37, chapter 106, subchapter 26, the terms of subchapter 26 will apply to adult day care centers.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1995 MAR p. 853, Eff. 5/12/95; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2602 General Services, Administration and Staffing

(1) An adult day care center shall provide assistance with activities of daily living, including but not limited to eating, walking, and grooming.

(2) If an adult day care center is operated on the premises of another licensed health care facility:

(a) the other facility may provide to day care clients any of the services for which the other facility is licensed, subject to the limitation that overnight service to an adult day care client is prohibited;

(b) adequate facilities and staff must be provided to appropriately serve the clients of each licensed facility; and

(3) An adult day care center may not provide overnight service.

(4) The center must provide recreational and social activities for clients, post a calendar of those activities where clients can see it, and retain a copy of each calendar for at least one year after the date of the last event recorded on it.

(5) An adult day care center must provide an area in which clients desiring to do so may rest. A bed or lounge chair, as well as blankets and pillows, must be available and furnished to those who need them. If the center provides a bed or beds, it must:

(a) keep each bed dressed in clean bed linen in good condition;

(b) keep on hand a supply of clean bed linen sufficient to change beds often enough to keep them clean, dry, and free from odors; and

(6) There must be a written agreement between the center and each client or the client’s legal representative pertaining to cost of care, type of care, services to be provided, and the manner by which the responsible party will be notified of significant changes in the client's condition and the need to seek emergency care for the client.

(7) The legal representative of a client must be notified promptly if the client is removed from the center. A notation of the date of the contact and the person contacted must be made in the client's record.

(8) Each client must have access to a telephone.

(9) The center shall make adequate provisions for identification of client's personal property and for safekeeping of valuables, including keeping an accounting of any personal funds handled for the client by the center.

(10) A client who is ambulatory only with mechanical assistance may only be kept on the ground floor of the center.

(11) Each adult day care center must employ an administrator who must be in good physical and mental health, be of reputable and responsible moral character, and exhibit concern for the safety and well being of clients, and who:

(a) is at all times responsible for the center and ensures appropriate supervision of the clients; and

(b) has knowledge of and the ability to conform to the applicable laws and rules governing adult day care centers.

(12) The owner of an adult day care center who meets the qualifications listed in (11) may serve as the administrator.

(13) The administrator must:

(a) oversee the day to day operation of the center, including, but not limited to:

(i) services to clients;

(ii) record keeping; and

(iii) employing, training and/or supervising employees.

(b) protect the safety of clients;

(d) post the current license at all times at a place in the center that is conspicuous to the public;

(e) provide documented orientation to all employees that includes information on the following:

(i) an overview of the center's policies and procedures manual and a presentation regarding how the policies and procedures are to be used and implemented;

(ii) a review of the employee's job description;

(iii) services provided by the facility;

(iv) simulated fire prevention, evacuation, and disaster drills;

(v) basic techniques of identifying and correcting potential safety hazards in the facility; and

(vi) emergency procedures, such as basic first aid.

(f) review every accident and/or incident causing injury to a client or employee, take appropriate corrective action, and ensure that a record of all accidents and/or incidents and the corrective measures taken is maintained;

(g) comply with the provisions of the Montana Vulnerable Adult Prevention of Abuse Act, 52-3-801 et seq., MCA;

(h) ensure that the center has a policies and procedures manual that governs the operations of the center, that is available to and followed by all employees, and that is available to clients upon request;

(i) maintain a personnel record for each employee, including for substitute personnel, that meets the requirements of ARM 37.106.2620(3), and retain it for at least one year after the employee terminates employment; and

(j) maintain an ongoing census of clients, documenting their attendance, and retain census data covering at least the past 12 months.

(14) At least one employee must be present at the center at all times in which a client is present at the center.

(15) Written daily work schedules for employees showing the personnel on duty at any given time must be kept at least one year.

(16) The individual in charge of each work shift shall have keys to all doors in his/her possession.

(17) The center must at all times employ sufficient staff to provide the services required by the number and characteristics of its clients.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; AMD, 1994 MAR p. 3194, Eff. 12/23/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Mont. Admin. R. 37.106.2603 Policies and Procedures

(1) The center shall have a written policies and procedures manual that must:

(a) be available to and followed by all personnel;

(b) be available to clients upon request;

(i) a description of all services provided to clients;

(ii) policies and procedures ensuring the confidentiality of client records and safeguarding against loss, destruction, or unauthorized use of those records;

(iii) infection control policies and procedures meeting the requirements of ARM 37.106.2609; and

(iv) a disaster and fire plan meeting the requirements of ARM 37.106.322.

(2) If an adult day care center is operated on the premises of another licensed health care facility, the center's manual may refer to the policies and procedures of the other licensed health care facility, as appropriate. The center manual must also include policies and procedures which are applicable to the center itself and which reflect how services between the two facilities are integrated.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Mont. Admin. R. 37.106.2606 Construction

(1) Any construction of or alteration, addition, or renovation to an adult day care center must meet all applicable local building and fire codes and be approved by the officer having jurisdiction to determine if the building codes are met by the facility and by the state fire marshal or his/her designee.

(2) An adult day care center must have an annual fire inspection conducted by the appropriate local authorities and maintain a record of such inspection for at least one year following the date of the inspection.

(3) The department adopts and incorporates by reference ARM 37.111.110, which sets forth requirements for construction and maintenance of water supply systems, and ARM 37.111.116, which sets forth requirements for construction and maintenance of sewage systems.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Mont. Admin. R. 37.106.2607 Environmental Control

(1) An adult day care center must be constructed and maintained so as to prevent as much as is practically possible the entrance and harborage of rats, mice, insects, flies, or other vermin.

(2) Hand cleansing soap or detergent and individual towels must be available at each sink in the center. A waste receptacle must be located near each sink.

(3) A minimum of 10 foot-candles of light must be available in all rooms and hallways, with the following exceptions:

(a) All reading lamps must have a capacity to provide a minimum of 30 foot-candles of light;

(b) All toilet and bathing areas must be provided with a minimum of 30 foot-candles of light;

(d) Hallways must be illuminated at all times by at least a minimum of five foot-candles of light at the floor.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2608 Disaster and Fire Plan (repealed)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Mont. Admin. R. 37.106.2609 Infection Control

(1) The adult day care center must establish and maintain infection control policies and procedures sufficient to provide a safe environment and to prevent the transmission of disease. Such policies and procedures must include, at a minimum, the following guidelines:

(a) Any employee contracting a communicable disease that is transmissible to clients through food handling or personal care may not appear at work until the infectious disease can no longer be transmitted. The decision to return to work must be made by the administrator in accordance with the policies and procedures instituted by the center; and

(b) If, after admission, a client is suspected of having a communicable disease that would endanger the health and welfare of other clients, the administrator shall contact the client's physician and shall ensure that appropriate safety measures are taken on behalf of that client and the other clients.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Mont. Admin. R. 37.106.2610 Maintenance and Housekeeping

(1) Each adult day care center shall have a written maintenance program describing the procedures that must be utilized by maintenance personnel to keep the building and equipment in repair and free from hazards.

(2) All electrical, mechanical, plumbing, fire protection, heating, and sewage disposal systems must be kept in operational condition.

(3) The temperature of hot water supplied to handwashing and bathing facilities must not exceed 120 E F.

(4) An adult day care center shall provide housekeeping services on a daily basis or as needed.

(5) Cleaners used in cleaning bathtubs, showers, sinks, urinals, toilet bowls, toilet seats, and floors must contain fungicides or germicides with current EPA registration for that purpose.

(6) Floors must be covered with an easily cleanable covering.

(7) Carpets are prohibited in bathrooms, kitchens, laundries, or janitor closets.

(8) Walls and ceilings must be kept in good repair and be of a finish that can be easily cleaned.

(9) An adult day care center must be kept clean and free of odors. Deodorants may not be used for odor control in lieu of proper ventilation.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2615 Laundry

(1) If an adult day care center that is not located on the premises of another licensed health care facility elects to process its laundry on the center site, it must:

(a) set aside and utilize an area solely for laundry purposes;

(b) equip the laundry room with a mechanical washer and a dryer vented to the outside, handwashing facilities, a fresh air supply, and a hot water supply system that supplies the washer with water of at least 110 E F during each use;

(c) have a separate area or room designed for use as a laundry, including an area for sorting soiled and clean linen and clothing. No laundry may be done in a food preparation or dishwashing area;

(d) provide well maintained containers to store and transport laundry that are impervious to moisture, keeping those used for soiled laundry separate from those used for clean laundry;

(e) dry all bed linen, towels, and wash cloths in the dryer;

(f) protect clean laundry from sources of contamination; and

(g) ensure that center staff handling laundry cover their clothes while working with soiled laundry, use separate clean covering for their clothes while handling clean laundry, and wash their hands both after working with soiled laundry and before they handle clean laundry.

History

Authorizing statute(s): Sec. 50-5-103, MCA
Implementing statute(s): Sec. 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185.

Mont. Admin. R. 37.106.2616 Food Service

(1) An adult day care center must provide:

(a) at least one meal a day to clients who stay at the center up to 10 hours;

(b) two meals per day to clients who stay at the center over 10 hours;

(2) Snacks must be offered between meals.

(3) The center must establish and maintain standards relative to food sources; refrigeration; refuse handling; pest control; storage, preparation, procuring, serving, and handling food; and dishwashing procedures that are sufficient to prevent food spoilage and the transmission of infectious disease, including the following:

(a) Food must be obtained solely from sources that comply with all laws and rules relating to food and food labeling;

(b) The use of home canned foods is prohibited;

(d) Food subject to spoilage must be dated.

(4) Foods must be served in such amounts and in such variety to meet the nutritional needs of each client.

(5) Foods must be cut, chopped, and ground to meet individual needs.

(6) Potentially hazardous food, such as meat and milk products, must be stored at 41 º F or below. Hot food must be kept at 140 º F or above during preparation and serving.

(7) Freezers must be kept at a temperature of 0 º F or below and refrigerators must be kept at a temperature of 41 º F or below. Thermometers must be placed in the warmest area of the refrigerator and freezer to assure proper temperature.

(8) Produce, food, and containers of food must be stored a minimum of six inches above the floor in a manner that protects the food from splash and other contamination.

(9) Employees shall maintain a high degree of personal cleanliness and shall conform to good hygienic practice during all working periods in food service.

(10) No food service employee who is either infected with a disease in a communicable form that can be transmitted by foods, a carrier of organisms that cause such a disease, or afflicted with a boil, an infected wound, or an acute respiratory infection, may work in the food service area in any capacity in which there is a likelihood of that person contaminating food or food contact surfaces with pathogenic organisms or transmitting disease to other persons.

(11) Tobacco products may not be used in the food preparation area.

(12) If an adult day care center contracts with another establishment to prepare food for the clients, a record of each such contract must be maintained for at least one year.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Mont. Admin. R. 37.106.2620 Client and Personnel Records

(1) An adult day care center shall prepare a record for each client composed of at least the following information: name; address; sex; social security number; date of birth; marital status; insurance or financial responsibility information; religious affiliation; next of kin; the first day of service and the last day of service; the client's physician's name, address, and telephone number, if appropriate; required medications, if applicable; the date and time of visit to or by his/her physician; and a record of medications taken by the client as required in ARM 37.106.2621(3).

(2) The center shall retain all client records for no less than five years following the last day of service to the client or the client's death, whichever date is earlier.

(3) The center must maintain a personnel record for each employee that includes at least the following:

(a) employment application or contract;

(b) orientation;

(d) a description of any significant incident involving both the employee and a client and its consequences.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Mont. Admin. R. 37.106.2621 Medications

(1) If a client is required to take medication while at the center, the client must be capable of taking his/her own medications, with the following assistance from staff:

(a) reminding the client to take the medication at the proper time;

(b) removing medication containers from storage;

(d) guiding the hand of the client; and

(e) observing the client take the medication.

(2) All medications must remain in locked storage until the client is discharged.

(3) The center must maintain for each client a medication administration record listing all medications administered and those that are refused or not administered.

History

Authorizing statute(s): 50-5-103, MCA
Implementing statute(s): 50-5-103, MCA
History: NEW, 1994 MAR p. 1838, Eff. 7/8/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2025 MAR, Notice No. 37-1099, Eff. 1/11/25.

Subchapter 37.106.27 Personal Care

Mont. Admin. R. 37.106.2701 Application of Rules

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2702 Application of Other Rules

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-227, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-227, MCA
History: NEW, 1995 MAR p. 852, Eff. 5/12/95; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2703 Definitions (repealed)

Publisher status: INEFFECTIVE (not currently effective).

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2708 Administration (repealed)

Publisher status: INEFFECTIVE (not currently effective).

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2709 Written Policies and Procedures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2710 Staffing

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2711 Fees

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; AMD, 1994 MAR p. 3193, Eff. 12/23/94; AMD, 1997 MAR p. 1203, Eff. 7/8/97; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2715 Construction

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2716 Physical Plant

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2717 Environmental Control

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2718 Infection Control

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2719 Laundry (repealed)

Publisher status: INEFFECTIVE (not currently effective).

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2725 Residential Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2726 Personal Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2727 Medications and Oxygen

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2728 Food Service

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2729 Social Services

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2730 Recreational Activities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2731 Pets

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2740 Personal Care Facilities: Residency Application Procedures

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; AMD, 2000 MAR p. 1653, Eff. 6/30/00; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2741 Resident Records

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2742 Resident Rights

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2750 Requirements for Category B Facilities Only

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-226 and 50-5-227, MCA
History: NEW, 1994 MAR p. 2306, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 185; REP, 2002 MAR p. 3638, Eff. 12/27/02.

Subchapter 37.106.28 Assisted Living Facilities

Mont. Admin. R. 37.106.2801 Scope

(1) The rules in this chapter pertain to facilities which provide personal care services. These rules constitute the basis for the licensure of assisted living facilities by the Department of Public Health and Human Services (DPPHS).

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2802 Purpose

(1) The purpose of these rules is to establish standards for assisted living facilities categorized as A, B, C, and D facilities. Assisted living facilities are a setting for frail, elderly, or physically disabled persons which provide support in activities of daily living (ADLs), health, and service coordination to maintain the residents' independence, individuality, privacy, and dignity.

(2) An assisted living facility offers a suitable living arrangement for persons with a range of capabilities, disabilities, frailties, and strengths. In general, however, assisted living is not appropriate for individuals who are incapable of responding to their environment, expressing volition, interacting, or demonstrating any independent activity. For example, individuals in a persistent vegetative state who require long term nursing care should not be placed or cared for in an assisted living facility.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2803 Application of Rules

(1) Category A facilities must meet the requirements of ARM 37.106.2801 through 37.106.2866.

(2) Category B facilities must meet the requirements of ARM 37.106.2801 through 37.106.2885.

(3) Category C facilities must meet the requirements of ARM 37.106.2801 through 37.106.2885 and ARM 37.106.2891 through 37.106.2898.

(4) Category D facilities must meet the requirements of ARM 37.106.2801 through 37.106.2885 and ARM 37.106.2899 through 37.106.2899H.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2804 Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of ARM Title 37, chapter 106, subchapter 28, the terms of subchapter 28 will apply to assisted living facilities.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2805 Definitions

The following definitions apply in this subchapter:

(1) "Activities of daily living (ADLs)" means tasks usually performed in the course of a normal day in a resident's life that include eating, walking, mobility, dressing, grooming, bathing, toileting, and transferring.

(3) "Advance directive" means a written instruction, such as a living will, a do-not-resuscitate (DNR) order, or durable power of attorney (POA) for health care, recognized under state law relating to the provision of health care when the individual is incapacitated.

(4) "Ambulatory" means a person is capable of self-mobility, either with or without mechanical assistance. If mechanical assistance is necessary, the person is considered ambulatory only if they can, without help from another person, transfer, safely operate, and utilize the mechanical assistance, exit and enter the facility, and access all common living areas of the facility.

(5) "Assisted living facility" is defined at 50-5-101, MCA.

(6) "Change of ownership" means the transfer of ownership of a facility to any person or entity other than the person or entity to whom the facility's license was issued, including the transfer of ownership to an entity which is wholly owned by the person or entity to whom the facility's license was issued.

(7) "Department" means the Department of Public Health and Human Services (DPHHS).

(8) "Direct care staff" means a person or persons who directly assist residents with personal care services and medication. It does not include housekeeping, maintenance, dietary, laundry, administrative, or clerical staff at times when they are not providing any of the above-mentioned assistance. Volunteers can be used for direct care, but may not be considered part of the required staff.

(9) "Health care plan" means a written resident specific plan identifying what ongoing assistance with ADLs and health care services is provided on a daily or regular basis by a licensed health care professional to a category B, C, or D resident under the orders of the resident's practitioner. Health care plans are developed as a result of a resident assessment performed by a licensed health care professional who may consult with a multi-disciplinary team.

(10) "Health care service" means any service provided to a resident of an assisted living facility that is ordered by a practitioner and required to be provided or delegated by a licensed, registered, or certified health care professional. Any other service, whether or not ordered by a physician or practitioner, that is not required to be provided by a licensed, registered, or certified health care professional is not to be considered a health care service.

(11) "Involuntary transfer or discharge" means the involuntary discharge of a resident from the licensed facility or the involuntary transfer of a resident to a bed outside of the licensed facility. The term does not include the transfer of a resident from one bed to another within the same licensed facility, or the temporary transfer or relocation of the resident outside the licensed facility for medical treatment.

(12) "License" means the document issued by the department that authorizes a person or entity to provide assisted living services.

(13) "Licensed health care professional" means a licensed physician, physician assistant-certified, advanced practice registered nurse, or registered nurse who is practicing within the scope of the license issued by the Department of Labor and Industry.

(14) "Mechanical assistance" means the use of any assistive device that aids in the mobility and transfer of the resident. Assistive devices include braces, walkers, canes, crutches, wheelchairs, and similar devices.

(15) "Medication administration" means an act in which a prescribed drug or biological is given to a resident by an individual who is authorized in accordance with state laws and regulations governing such acts.

(16) “Mental disorder” means a clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior.

(a) For the purpose of this subchapter, the term includes dementia, Alzheimer’s disease, and traumatic brain injury.

(17) "Mental health professional" means:

(a) a certified professional person;

(b) a physician licensed under Title 37, chapter 3, MCA;

(d) a psychologist licensed under Title 37, chapter 17, MCA;

(e) a social worker licensed under Title 37, chapter 22, MCA;

(f) a marriage and family therapist under Title 37, chapter 37, MCA;

(g) an advanced practice registered nurse, as provided for in 37-8-102, MCA, with a clinical specialty in psychiatric mental health and mental disorders nursing; or

(h) a physician assistant licensed under Title 37, chapter 20, MCA, with a clinical specialty in psychiatric mental health.

(18) "Nursing care" means the practice of nursing as governed by 37-8-102(7), MCA and by administrative rules adopted by the Board of Nursing, found at ARM Title 24, chapter 159.

(19) "Personal care" means the provision of services and care for residents who need some assistance in performing ADLs.

(20) "Practitioner" means an individual licensed by the Department of Labor and Industry who has assessment, admission, and prescription authority.

(21) "PRN medication" means an administration scheme, in which a medication is not routine, is taken as needed, and requires the licensed health care professional or individual resident's own cognitive assessment and judgement for need and effectiveness.

(22) "Resident" means anyone at least 18 years of age accepted for care in an assisted living facility.

(23) "Resident agreement" means a signed, dated, written document that lists all charges, services, refunds, and move out criteria and complies with ARM 37.106.2823.

(24) "Resident certification" means written certification by a licensed health care professional that the facility can adequately meet the particular needs of a resident. The licensed health care professional making the resident certification must have:

(a) visited the resident on site; and

(b) determined that the resident's health care status does not require services at another level of care.

(25) "Resident's legal representative" or "resident's representative" means the resident's guardian, or if no guardian has been appointed, then the resident's family member or other appropriate person acting on the resident's behalf.

(26) "Self-administration assistance" means providing necessary assistance to any resident in taking their medication, including:

(a) removing medication containers from secured storage;

(b) providing verbal suggestions, prompting, reminding, gesturing, or providing a written guide for self-administrating medications;

(c) handing a prefilled, labeled medication holder, labeled unit dose container, syringe or other labeled container from the pharmacy or a medication organizer as described in ARM 37.106.2847 to the resident;

(d) opening the lid of the above container for the resident;

(e) guiding the hand of the resident to self-administer the medication;

(f) holding and assisting the resident in drinking fluid to assist in the swallowing of oral medications; and

(g) assisting with removal of a medication from a container for residents with a physical disability which prevents independence in the act.

(27) "Service coordination" means that the facility either directly provides or assists the resident to procure services including, but not limited to:

(a) beauty or barber shop;

(b) financial assistance or management;

(d) laundry;

(e) recreation activities;

(f) shopping;

(g) spiritual services; and

(h) transportation.

(28) "Service plan" means a written plan for services developed by the facility with the resident or resident's legal representative which reflects the resident's capabilities, choices and, if applicable, measurable goals and risk issues. The plan is developed on admission and is reviewed and updated annually and if there is a significant change in the resident's condition. The development of the service plan does not require a licensed health care professional.

(29) "Severe cognitive impairment" means the loss of intellectual functions, such as thinking, remembering, and reasoning, of sufficient severity to interfere with a person's daily functioning. Such a person is incapable of recognizing danger, self-evacuating, summoning assistance, expressing need, and/or making basic care decisions.

(30) "Significant change" means a resident status or condition change that results in a change in service and care needs. This includes:

(a) admission to, or discharge from hospice services;

(b) a change in categorization; or

(31) "Therapeutic diet" means a diet ordered by a physician or practitioner as part of treatment for a disease or clinical condition or to eliminate or decrease specific nutrients in the diet, (e.g., sodium) or to increase specific nutrients in the diet (e.g., potassium) or to provide food the resident is able to eat (e.g., mechanically altered diet).

(32) "Third party services" means care and services provided to a resident by individuals or entities who have no fiduciary interest in the facility.

(33) "Treatment" means a therapy, modality, product, device, or other intervention used to maintain well-being or to diagnose, assess, alleviate, or prevent a disability, injury, illness, disease, or other similar condition.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2003 MAR p. 17, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2809 License Application Process

(1) Application for a license accompanied by the required fee shall be electronically submitted to the Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau, and shall include complete information as to the:

(a) identity of each officer and director of the corporation, if organized as a corporation;

(b) identity of each general partner if organized as a partnership or limited liability partnership;

(d) name, address, and phone number of the management company if applicable;

(e) physical location address, mailing address, and phone number of the facility;

(f) maximum number of A beds, B beds, C beds, and D beds in the facility;

(g) policies and procedures as outlined in ARM 37.106.2815; and

(h) resident agreement, as outlined in ARM 37.106.2823, intended to be used.

(2) Every assisted living facility shall have distinct identification or name and shall notify the department in writing within 30 days prior to changing such identification or name.

(3) Each assisted living facility shall promptly report to the department any plans to relocate the facility at least 30 days prior to effecting such a move.

(4) In the event of an assisted living facility change of ownership, the new owners shall provide the department the following:

(a) a completed application with fee;

(b) a copy of the fire inspection conducted within the past year;

(c) policies and procedures as prescribed in ARM 37.106.2815 or if applicable, a written statement indicating that the same policies and procedures will be used as required;

(d) a copy of the resident agreement as outlined in ARM 37.106.2823 to be used; and

(e) documentation of compliance with ARM 37.106.2814.

(5) Under a change of ownership, the seller shall dispose of or return to the department the assisted living license under which the facility had been previously operated. This information may be sent to the Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2810 License Restrictions

(1) A license is not subject to sale, assignment, or other transfer, voluntary or involuntary.

(2) A license is valid only for the premises for which the original license was issued.

(3) The license remains the property of the department and shall be disposed of or returned to the department upon closing or transfer of ownership.

(a) The address for returning the license is Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau, P.O. Box 202953, Helena, MT 59620-2953.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2814 Administrator

(1) Each assisted living facility shall employ an administrator. The administrator is responsible for operation of the assisted living facility at all times and shall ensure 24-hour supervision of the residents.

(2) The administrator must meet the following minimum requirements:

(a) be currently licensed as a nursing home administrator in Montana or another state;

(b) has successfully completed all of the self-study modules of "A Management Reference for Executive Directors - Admin Level 1 Certificate Program," a component of the assisted living training system published by the Senior Living University (SLU) or an alternate, approved program; or

(3) The administrator must show evidence of at least 16 contact hours of annual continuing education relevant to the individual's duties and responsibilities as administrator of the assisted living facility.

(a) A nursing home administrator license or the SLU certification may count as 16 hours of annual continuing education but only for the calendar year in which the license or certification was initially obtained.

(4) In the absence of the administrator, a staff member must be designated to oversee the operation of the facility. The administrator or designee shall be in charge, on call, and physically available on a daily basis as needed, and shall ensure there are sufficient, qualified staff so that the care, well-being, health, and safety needs of the residents are met at all times.

(a) If the administrator will be absent from the facility for more than 30 continuous days, the department shall be given written notice of the individual who has been appointed the designee. The appointed designee must meet all the requirements of (1) and (2).

(5) The administrator or designee may not be a resident of the facility.

(a) A designee must:

(i) be age 18 or older; and

(ii) have demonstrated competencies required to assure protection of the safety and physical, mental, and emotional health of residents.

(6) The administrator or designee shall:

(a) ensure that the current facility license or licenses are posted at a place in the facility that is accessible to the public at all times;

(b) oversee the day-to-day operation of the facility including:

(i) all personal care services for residents;

(ii) the employment, training, and supervision of staff and volunteers;

(iii) maintenance of buildings and grounds; and

(iv) record keeping; and

(7) The facility shall notify the department within five days of an administrator's departure or a new administrator's employment.

(8) The administrator or designee shall initiate transfer of a resident through the resident and/or the resident's practitioner, appropriate agencies, or the resident's legal representative when the resident's condition is not within the scope of services of the assisted living facility.

(9) The administrator or designee shall accept and retain only those residents whose needs can be met by the facility and who meet the acceptance criteria found in 50-5-226, MCA.

(10) The administrator or designee must ensure that a resident who is ambulatory only with mechanical assistance is:

(a) able to safely and independently evacuate the facility without the aid of an elevator or similar mechanical lift;

(b) have the ability to independently move past a building code-approved occupancy barrier or smoke barrier into an adjacent wing or building section; or

(11) The administrator or designee shall ensure and document that orientation is provided to all employees at a level appropriate to the employee's job responsibilities.

(12) The administrator or designee shall review every accident or incident causing injury to a resident and document the appropriate corrective action taken to avoid a reoccurrence.

(13) The owner of an assisted living facility may serve as administrator, or in any staff capacity, if the owner meets the qualifications specified in these rules.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2815 Written Policies and Procedures

(1) A policies and procedures manual for the organization and operation of the assisted living facility shall be developed, implemented, kept current, reviewed every other year and as necessary to assure the continuity of care and day to day operations of the facility. Each review of the manual shall be documented, and the manual shall be available in the facility to staff, residents, residents' legal representatives, and representatives of the department at all times.

(2) The manual must include an organizational chart delineating the lines of authority, responsibility, and accountability for the administration and resident care services of the facility.

(3) New policies, as developed, must be submitted to the department for review.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2003 MAR p. 17, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2816 Assisted Living Facility Staffing

(1) The administrator shall develop minimum qualifications for the hiring of direct care staff and support staff.

(2) The administrator shall develop policies and procedures for conducting criminal background checks, hiring, and assessing staff, which include practices that assist the employer in identifying employees who may pose risk or threat to the health, safety, or welfare of any resident and provide written documentation of findings and the outcome in the employee's file.

(a) A name-based or FBI fingerprint background check shall be conducted on all employees who have accepted employment at an assisted living facility.

(i) If an applicant has lived outside the state within the past five years, the assisted living facility must complete background checks in every state in which the applicant has resided within the past five years unless the name-based background check yields nationwide results, or the facility may conduct a FBI fingerprint background check.

(b) The administrator may allow an employee to work provisionally pending the background check results so long as there are no indications the employee poses a risk or threat to the health, safety, or welfare of the residents in the facility.

(3) New employees shall receive orientation and training in areas relevant to the employee's duties and responsibilities, including:

(a) an overview of the facility's policies and procedures manual in areas relevant to the employee's job responsibilities;

(b) a review of the employee's job description;

(d) the Montana Vulnerable Adult Prevention of Abuse Act found in Title 52, chapter 3, part 8, MCA;

(e) the Montana Long-Term Care Resident Bill of Rights Act found in Title 50, chapter 5, part 11, MCA;

(f) staff who are responsible for assisting with self-administration of medication will receive orientation and training on resident Medication Administration Records (MARs) and the five rights of medication administration; and

(g) all direct care staff will receive, at minimum, two hours of training in dementia care upon hire and annually thereafter.

(4) In addition to meeting the requirements of (3), direct care staff shall be trained to perform the services established in each resident service plan.

(a) Direct care staff will review each resident's current service plan or health care plan and document that they have reviewed the plan and can perform the services required.

(5) Direct care staff shall be trained in the use of the abdominal thrust maneuver and basic first aid. If the facility offers cardiopulmonary resuscitation (CPR), at least one person per shift shall hold a current CPR certificate.

(6) The following rules must be followed in staffing the assisted living facility:

(a) direct care staff shall have knowledge of the resident's needs and any events about which the employee should notify the administrator or the administrator's designated representative;

(b) the facility shall have a sufficient number of qualified staff on site 24 hours a day to meet the scheduled and unscheduled needs of each resident, to respond in emergency situations, and all related services, including:

(i) maintenance of order, safety, and cleanliness;

(ii) assistance with medication regimens;

(iii) preparation and service of meals;

(iv) housekeeping services and assistance with laundry; and

(v) assurance that each resident receives the supervision and care required by the service or health care plan to meet the resident's basic needs;

(c) an individual on each work shift shall have keys to all relevant resident care areas and access to all items needed to provide appropriate resident care;

(d) direct care staff may not perform any service for which they have not received appropriate documented training; and

(e) facility staff may not perform any health care service that has not been appropriately delegated under the Montana Nurse Practice Act or in the case of licensed health care professionals, that is beyond the scope of their license.

(7) Employees and volunteers may perform support services, such as cooking, housekeeping, laundering, general maintenance and office work after receiving an orientation to the appropriate sections of the facility's policy and procedure manual. Any person providing direct care, however, is subject to the orientation and training requirements for direct care staff.

(8) Volunteers may be utilized in the facility, but may not be included in the facility's staffing plan in lieu of facility employees. In addition, the use of volunteers is subject to the following:

(a) volunteers must be supervised and be familiar with resident rights and the facility's policies and procedures which apply to their duties as a volunteer; and

(b) volunteers shall not assist with medication administration, delegated nursing tasks, bathing, toileting, or transferring.

(9) Residents may participate voluntarily in performing household duties and other tasks suited to the individual resident's needs and abilities, but residents may not be used as substitutes for required staff or be required to perform household duties or other facility tasks.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2817 Employee Files

(1) The facility is responsible for maintaining a file on each employee and substitute personnel.

(2) The following documentation from employee files must be made available to the department at all reasonable times, but shall be made available to the department within 24 hours after the department requests to review the files:

(a) the employee's name;

(b) a copy of current credentials, certifications, or professional licenses as required to perform the job description;

(d) initialed documentation of employee orientation and ongoing training including documentation of abdominal thrust maneuver training, basic first aid, and CPR; and

(e) the result of the employee's criminal background check.

(3) The facility shall keep an employee file that meets the requirements set forth in (2) for the administrator of the facility, even when the administrator is the owner.

(4) The employer must have evidence of contact to verify that each certified nursing assistant has no adverse findings entered on the nurse aid registry maintained by the department in the certification bureau.

(a) A facility may not employ or continue employment of any person who has adverse findings on the nurse aide registry maintained by the department's certification bureau.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2821 Resident Application and Needs Assessment Procedure

(1) All facilities must develop a written application procedure for admission to the facility which includes the prospective resident's name and address, sex, date of birth, marital status, and religious affiliation (if volunteered).

(2) The facility shall determine whether a potential resident meets the facility's admission requirements and that the resident is appropriate to the facility's license endorsement as either a category A, category B, category C, or category D facility, as specified in 50-5-226, MCA.

(3) Prior to admission, the facility shall conduct an initial resident needs assessment to determine the prospective resident's needs.

(4) The initial resident's needs assessment must include documentation of the following:

(a) cognitive patterns to include short-term memory, long term memory, memory recall, decision making, and change in cognitive status/awareness, or thinking disorders;

(b) sensory patterns to include hearing, ability to understand others, ability to make self understood, and ability to see in adequate light;

(c) activities of daily living (ADL) functional performance to include ability to transfer, locomotion, mobility devices, dressing, eating, use of toilet, bladder continence, bowel continence, continence appliance/programs, grooming, and bathing;

(d) mood and behavior patterns, sadness or anxiety displayed by resident, wandering, verbally abusive, physically abusive, and socially inappropriate/disruptive behavior;

(e) health problems/accidents;

(f) weight/nutritional status to include current weight and nutritional complaints;

(g) skin problems;

(h) current medication use including over-the-counter and/or prescription medications; and

(i) use of restraints, safety, or assistive devices.

(5) The department shall collect a fee of $100 from a prospective resident, resident or facility appealing a rejection, or relocation decision made pursuant to ARM 37.106.2821, to cover the cost of the independent nurse resident needs assessment.

(6) The resident's needs assessment shall be reviewed and updated annually or at any time the resident's needs change significantly.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2822 Resident Service Plan: Category a

(1) Based on the initial resident's needs assessment, an initial service plan shall be developed for all category A residents within 24 hours of admission. The initial service plan shall be reviewed or modified within 60 days of admission to assure the service plan accurately reflects the resident's needs and preferences.

(2) The service plan shall include a written description of:

(a) what the service is;

(b) who will provide the service;

(d) where and how often the service is provided;

(e) changes in service and the reasons for those changes;

(f) if applicable, the desired outcome;

(g) an emergency contact with phone number; and

(h) the prospective resident's practitioner's name, address, and telephone number and whether there are any health care decision making instruments in effect if applicable.

(3) The resident service plan shall be reviewed and updated annually, or at any time the resident has a significant change.

(4) A copy of the resident service plan shall be given to the resident or resident's legal representative and be made part of the resident file.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2823 Resident Agreement

(1) An assisted living facility shall enter into a written resident agreement with each prospective resident prior to admission to the assisted living facility. The agreement shall be signed and dated by a facility representative and the prospective resident or the resident's legal representative. The facility shall provide the prospective resident or the resident's legal representative and the resident's practitioner, if applicable, a copy of the agreement and shall explain the agreement to them. The agreement shall include at least the following items:

(a) the criteria for requiring transfer or discharge of the resident to another facility providing a different level of care;

(b) a statement explaining the availability of skilled nursing or other professional services from a third party provider to a resident in the facility;

(d) a statement explaining the resident's responsibilities including house rules, the facility grievance policy, facility smoking policy, facility policy regarding pets, and the facility policy on medical and recreational marijuana use;

(e) a listing of specific charges to be incurred for the resident's care, frequency of payment, facility rules relating to nonpayment of services, and security deposits, if any are required;

(f) a statement of all charges, fines, penalties, or late fees that shall be assessed against the resident;

(g) a statement that the agreed upon facility rate shall not be changed unless 30 days' advance written notice is given to the resident and/or the resident's legal representative; and

(h) an explanation of the assisted living facility's policy for refunding payment in the event of the resident's absence, discharge, or transfer from the facility and the facility's policy for refunding security deposits.

(2) When there are changes in services, financial arrangements, or in requirements governing the resident's conduct and care, a new resident/provider agreement must be executed or the original agreement must be updated by addendum and signed and dated by the resident or the resident's legal representative and by the facility representative.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2824 Involuntary Discharge Criteria

(1) Residents shall be given a written 30-day notice when they are requested to move out. The administrator or designee shall initiate transfer of a resident through the resident's physician or practitioner, appropriate agencies, and the resident's legal representative, as applicable, when:

(a) the resident's needs exceed the level of ADL services the facility provides;

(b) the resident exhibits behavior or actions that repeatedly and substantially interfere with the rights, health, safety, or well-being of other residents and the facility has tried prudent and reasonable interventions;

(i) documentation of the interventions attempted by the facility shall become part of the resident's record;

(c) the resident, due to severe cognitive decline, is not able to respond to verbal instructions, recognize danger, make basic care decisions, express needs, or summon assistance, except as permitted by ARM 37.106.2891 through 37.106.2898;

(d) the resident has a medical condition that is complex, unstable, or unpredictable and treatment cannot be appropriately developed in the assisted living environment;

(e) the resident has had a significant change in condition that requires medical or psychiatric treatment outside the facility and at the time the resident is to be discharged from that setting to move back into the assisted living facility, appropriate facility staff have re-evaluated the resident's needs and have determined the resident's needs exceed the facility's level of service. Temporary absence for medical treatment is not considered a move out;

(f) the resident has failed to pay charges after reasonable and appropriate notice; or

(g) the facility ceases to operate.

(2) The resident's 30-day written move out notice shall, at a minimum, include the following:

(a) the reason for transfer or discharge;

(b) the effective date of the transfer or discharge;

(d) a statement that the resident has the right to appeal the action to the department; and

(e) the name, address, and telephone number of the state long term care ombudsman.

(3) A written notice of discharge in less than 30 days may be issued for the following reasons:

(a) if a resident has a medical emergency;

(b) the resident exhibits behavior that poses an immediate danger to self or others; or

(4) A resident has a right to a fair hearing to contest an involuntary transfer or discharge.

(a) Involuntary transfer or discharge is defined in ARM 37.106.2805.

(b) A resident may exercise his or her right to appeal an involuntary transfer or discharge by submitting a written request for fair hearing to the Department of Public Health and Human Services, Office of Administrative Hearings, P.O. Box 202922, Helena, MT 59620-2922, within 30 days of notice of transfer or discharge.

(c) The parties to a hearing regarding a contested transfer or discharge are the facility and the resident contesting the transfer or discharge. The department is not a party to such a proceeding, and relief may not be granted to either party against the department in a hearing regarding a contested transfer or discharge.

(d) Hearings regarding a contested transfer or discharge shall be conducted in accordance with ARM Title 37, chapter 5, subchapter 3, and a resident shall be considered a claimant for purposes of these rules.

(f) The hearing officer's decision following a hearing shall be the final decision for the purposes of judicial review under ARM 37.5.334.

(5) The facility must assist with discharge to ensure safe and appropriate placement of the resident.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2003 MAR p. 17, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2828 Resident Rights

(1) The facility shall comply with the Montana Long-Term Care Residents' Bill of Rights, found at 50-5-1101 , et seq., MCA. This includes the posting of the facility's statement of resident rights in a conspicuous place. Prior to or upon admission of a resident, the assisted living facility shall explain and provide the resident with a copy of the Montana Long-Term Care Residents' Bill of Rights.

(2) Residents have the right to execute living wills and other advance health care directives, and to have those advance directives honored by the facility in accordance with law.

(3) Prior to admission of a resident, the assisted living facility must inform a potential resident in writing of:

(a) their right (at the individual's option) to make decisions regarding medical care, including the right to accept or refuse medical treatment, and the right to formulate an advance directive; and

(b) explain and provide a copy of the facility's policies regarding advance directives, including a policy that the facility cannot implement an advance directive, either because of a conscientious objection (under 50-9-203 , MCA) , or, for some other reason as stated in facility policy (under 50-9-203 , MCA) .

(4) If the facility policy is not to implement an advanced directive the facility shall:

(a) take all reasonable steps to transfer the resident to a facility which has no prohibition against implementation of advance directives; or

(b) shall inform the resident in writing of any limitations placed upon implementation of the resident's advance directive by the facility.

(5) An assisted living facility may not require an execution of an advance directive as a condition for admission.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2829 Resident File

(1) At the time of admission, a separate file must be established for each category A, category B, category C, or category D resident. This file must be maintained on site in a safe and secure manner and must preserve the resident's confidentiality.

(2) The file shall include at least the following:

(a) a completed resident agreement, in accordance with ARM 37.106.2823;

(b) updates of resident/provider agreements, if any;

(d) resident's weight on admission and at least annually thereafter for category A residents or more often as the resident, or the resident's licensed health care professional, determine a weight check is necessary;

(i) a weight loss of 5% or more must be reported to the practitioner and the notification documented;

(e) reports of significant events including:

(i) documentation of the notice to the resident's practitioner;

(ii) steps taken to safeguard the resident; and

(iii) facility contacts with family members or another responsible party;

(f) a record of communication between the facility and the resident or their representative if there has been a change in the resident's status or a need to discharge; and

(g) the date and circumstances of the resident's final transfer, discharge, or death, including notice to responsible parties and disposition of personal possessions.

(3) The resident file must be kept current. The file must be retained for a minimum of three years following the resident's discharge, transfer, or death.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2830 Third Party Services

(1) A resident may purchase third party services provided by an individual or entity, licensed if applicable, to provide health care services under arrangements made directly with the resident or resident's legal representative under the provisions of 50-5-225 (2) (a) and (b) , MCA.

(2) The resident or resident's legal representative assumes all responsibility for arranging for the resident's care through appropriate third parties.

(3) Third party services shall not compromise the assisted living facility operation or create a danger to others in the facility.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2831 Resident Activities

(1) A planned, diversified program of resident activities shall be offered daily for residents, including individual or group activities, on or off site, to meet the individual needs and well being of residents. Resident activities should promote and encourage self care and continuity of normal activities.

(2) The activities program shall be developed based on the activity needs and interest of residents as identified through the service plan.

(3) The facility shall provide directly, or by arrangement, local transportation for each resident to and from health care services provided outside the facility and to activities of social, religious or community events in which the resident chooses to participate according to facility policy.

(4) The activities program shall develop and post a monthly group activities calendar, which lists social, recreational, and other events available to residents. The facility shall maintain a record of past monthly activities, kept on file on the premises for at least three months.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2835 Resident Units

(1) A resident of an assisted living facility who uses a wheelchair or walker for mobility, or who is a category B, category C, or category D resident, must not be required to use a bedroom on a floor other than the first floor of the facility that is entirely above the level of the ground, unless the facility is designed and equipped in such a manner that the resident can move between floors or to an adjacent international conference of building code officials approved occupancy/fire barrier without assistance and the below grade resident occupancy is or has been approved by the local fire marshal.

(2) Each resident bedroom must satisfy the following requirements:

(a) in a previously licensed facility, no more than four residents may reside in a single bedroom;

(b) in new construction and facilities serving residents with severe cognitive impairment, occupancy must be limited to no more than two residents per room;

(c) exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, each single bedroom must contain at least 100 square feet, and each multi-bedroom must contain at least 80 square feet per resident;

(d) each resident must have a wardrobe, locker, or closet with minimum clear dimensions of 1 foot 10 inches in depth by 1 foot 8 inches in width, with a clothes rod and shelf placed to permit a vertically clear hanging space of 5 feet for full length garments;

(e) a sufficient number of electrical outlets must be provided in each resident bedroom and bathroom to meet staff and resident needs without the use of extension cords;

(f) each resident bedroom must have operable exterior windows which meet the approval of the local fire or building code authority having jurisdiction;

(g) the resident's bedroom door may be fitted with a lock if approved in the resident service plan, as long as facility staff have access to a key at all times in case of an emergency. Deadbolt locks are prohibited on all resident bedrooms. Resident bedroom door locks must be operable, on the resident side of the door, with a single motion and may not require special knowledge for the resident to open;

(h) kitchens or kitchenettes in resident bedrooms are permitted if the resident's service plan permits unrestricted use and the cooking appliance can be removed or disconnected if the service plan indicates the resident is not capable of unrestricted use.

(3) A hallway, stairway, unfinished attic, garage, storage area or shed, or other similar area of an assisted living facility must not be used as a resident bedroom. Any other room must not be used as a resident bedroom if it:

(a) can only be reached by passing through a bedroom occupied by another resident;

(b) does not have an operable window to the outside; or

(4) Any provision of this rule may be waived at the discretion of the department if conditions in existence prior to the adoption of this rule or construction factors would make compliance extremely difficult or impossible and if the department determines that the level of safety to residents and staff is not diminished.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2836 Furnishings

(1) Each resident in an assisted living facility must be provided the following at a minimum by the facility:

(a) an individual towel rack;

(b) a handicap accessible mirror mounted or secured to allow for convenient use by both wheelchair bound residents and ambulatory persons;

(c) clean, flame-resistant, or non-combustible window treatments or equivalent, for every bedroom window. In a category D facility or unit, the use of blinds or curtains is not permissible. A flame-resistant or non-combustible window valence, not exceeding 14 inches in length, may be used;

(d) an electric call system comprised of a fixed manual, pendant cordless or two way interactive, UL or FM listed system which must connect resident rooms to the care staff center or staff pagers, and must only be silenced at the point of activation. A resident room that is designated as double occupancy must be equipped with a call system for both occupants. In category D facilities or units, resident bedroom call cords or strings in excess of 6 inches shall not be permitted; and

(e) for each multiple-bed room, either flame-resistant privacy curtains for each bed or movable flame-resistant screens to provide privacy upon the request of a resident.

(2) Following the discharge of a resident, all of the equipment and bedding used by that resident and owned by the facility must be cleaned and sanitized.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2837 Common Use Areas

(1) The facility must provide:

(a) a dining room of sufficient size to accommodate all the residents comfortably with dining room furnishings that are well constructed and tables designed to accommodate the use of wheelchairs;

(b) at least one centrally located common area in which residents may socialize and participate in recreational activities. A common area may include, without limitation, a living room, dining room, enclosed porch or solarium. The common area must be large enough to accommodate those to be served without overcrowding; and

(2) All common areas must be furnished and equipped with comfortable furniture and reading lights in quantities sufficient to accommodate those to be served.

(3) Any provision of this rule may be waived at the discretion of the department if conditions in existence prior to the adoption of this rule or construction factors would make compliance extremely difficult or impossible and if the department determines that the level of safety to residents and staff is not diminished.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2838 Resident Toilets and Bathing

(1) The facility shall provide:

(a) at least one toilet for every four residents;

(b) one bathing facility for every 12 residents; and

(2) All resident rooms with toilets or shower/bathing facilities must have an operable window to the outside or must be exhausted to the outside by a mechanical ventilation system.

(3) Each resident room bathroom shall:

(a) be in a separate room with a toilet. A sink need not be in the bathroom but shall be in close proximity to the toilet. A shower or tub is not required if the facility utilizes a central bathing unit or units; and

(b) have at least one towel bar per resident, one toilet paper holder, one accessible mirror and storage for toiletry items.

(4) All doors to resident bathrooms shall open outward or slide into the wall and shall be unlockable from the outside.

(a) Dutch doors, bi-folding doors, sliding pocket doors and other bi-swing doors may be used if they do not impede the bathroom access width and are approved by the department. A shared bathroom with two means of access is also acceptable.

(b) Resident bathroom door locks must be operable, on the resident side of the door, with a single motion and may not require special knowledge for the resident to open.

(5) In rooms used by category C or other special needs residents, the bathroom does not have to be in a separate room and does not require a door.

(6) Each resident must have access to a toilet room without entering another resident's room or the kitchen, dining, or living areas.

(7) Each resident bathroom or bathing room shall have a fixed emergency call system accessible to an individual collapsed on the floor that reports to the staff location with an audible signal. The device must be silenced at that location only. Vibrating systems are acceptable.

(8) In category D facilities or units, bathroom call cords or strings in excess of 6 inches shall not be permitted.

(9) Any provision of this rule may be waived at the discretion of the department if conditions in existence prior to December 27, 2002, or construction factors would make compliance extremely difficult or impossible and if the department determines that the level of safety to residents and staff is not diminished.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2839 Environmental Control

(1) The assisted living facility shall provide a clean, comfortable, and well-maintained home that is safe for residents and employees at all times.

(2) A minimum of 10-foot candles of light must be available in all rooms, with the following exceptions:

(a) all reading lamps must have a capacity to provide a minimum of 30-foot candles of light;

(b) all toilet and bathing areas must be provided with a minimum of 30-foot candles of light;

(d) hallways must be illuminated at all times by at least a minimum of 5-foot candles of light at the floor.

(3) Temperature in resident rooms, bathrooms, and common areas must be maintained at a minimum of 68°F and may not exceed 85oF.

(4) A resident's ability to smoke safely shall be evaluated and addressed in the resident's service or health care plan. If the facility permits resident smoking:

(a) the rights of non-smoking residents shall be given priority in settling smoking disputes between residents; and

(b) if there is a designated smoking area within the facility, it shall be designed to keep all contiguous, adjacent, or common areas smoke free.

(5) An assisted living facility may designate itself as non-smoking provided that adequate notice is given to all residents or all applicants in the facility residency agreement.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2843 Personal Care Services

(1) Personal care assistance must be provided to each resident in accordance with their established agreement and needs. Assistance must include, but is not limited to assisting with:

(a) personal grooming such as bathing, hand washing, shaving, shampoo and hair care, nail filing or trimming and dressing;

(b) oral hygiene or denture care;

(d) eating;

(e) the use of crutches, braces, walkers, wheelchairs or prosthetic devices, including vision and hearing aids; and

(f) self-medication.

(2) Evidence that the facility is meeting each resident's needs for personal care services include the following outcomes for residents:

(a) physical well being of the resident means the resident:

(i) has clean and groomed hair, skin, teeth and nails;

(ii) is nourished and hydrated;

(iii) is free of pressure sores, skin breaks or tears, chaps and chaffing;

(iv) is appropriately dressed for the season in clean clothes;

(v) risk of accident, injury and infection has been minimized; and

(vi) receives prompt emergency care for illnesses, injuries and life threatening situations;

(b) behavioral and emotional well being of the resident includes:

(i) an opportunity to participate in age appropriate activities that are meaningful to the resident if desired;

(ii) a sense of security and safety;

(iii) a reasonable degree of contentment; and

(iv) a feeling of stable and predictable environment;

(i) free to go to bed at the time desired;

(ii) free to get up in the morning at the time desired;

(iii) free to have visitors;

(iv) granted privacy;

(v) assisted to maintain a level of self care and independence;

(vi) assisted as needed to have good oral hygiene;

(vii) made as comfortable as possible by the facility;

(viii) free to make choices and assumes the risk of those choices;

(ix) fully informed of the services that are provided by the facility;

(x) free of abuse, neglect and exploitation;

(xi) treated with dignity; and

(xii) given the opportunity to participate in activities, if desired.

(3) In the event of accident or injury to a resident requiring emergency medical, dental or nursing care or, in the event of death, the assisted living facility shall:

(a) immediately make arrangements for emergency care or transfer to an appropriate place for treatment;

(b) immediately notify the resident's practitioner and the resident's legal representative.

(4) A resident shall receive skin care that meets the following standards:

(a) the facility shall practice preventive measures to identify those at risk and maintain a resident's skin integrity. Risk factors include:

(i) skin redness lasting more than 30 minutes after pressure is relieved from a bony prominence, such as hips, heels, elbows or coccyx; and

(ii) malnutrition/dehydration, whether secondary to poor appetite or another disease process; and

(b) an area of broken or damaged skin must be reported within 24 hours to the resident's practitioner. Treatment must be provided as ordered by the resident's practitioner.

(5) A person with a stage 3 or 4 pressure ulcer may not be admitted or permitted to remain in a category A facility.

(6) The facility shall ensure records of observations, treatments and progress notes are entered in the resident's record and that services are in accordance with the resident health care plan.

(7) Direct care staff shall receive training related to maintenance of skin integrity and the prevention of pressure sores by:

(a) keeping residents clean and dry;

(b) providing residents with clean and dry bed linens;

(d) maintaining or restoring healthy nutrition; and

(e) keeping the residents physically active and avoiding the overuse of wheelchairs, sitting no longer than one hour or remaining in one position for longer than two hours at one time, and other sources of skin breakdown in ADLs.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2846 Medications: Storage and Disposal

(1) With the exception of resident medication organizers as discussed in ARM 37.106.2848, all medication must be stored in the container dispensed by the pharmacy or in the container in which it was purchased in the case of over-the-counter medication, with the label intact and clearly legible.

(2) Medications that require refrigeration must be segregated from food items and stored within the temperature range specified by the manufacturer.

(3) All medications administered by the facility shall be stored in locked containers in a secured environment such as a medication room or medication cart. Residents who are responsible for their own medication administration must be provided with a secure storage place within their room for their medications. If the resident is in a private room, locking the door when the resident leaves will suffice.

(4) Over-the-counter medications or home remedies requested by the resident shall be reviewed by the resident's practitioner or pharmacist as part of the development of a resident's service plan. Residents may keep over-the-counter medications in their room with a written order by the residents' practitioners.

(5) The facility shall develop and implement a policy for lawful disposal of unused, outdated, discontinued or recalled resident medications. The facility shall return a resident's medication to the resident or resident's legal representative upon discharge.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2847 Medications: Practitioner Orders

(1) Medication and treatment orders shall be carried out as prescribed. The resident has the right to consent to or refuse medications and treatments. The practitioner shall be notified if a resident refuses consent to an order. Subsequent refusals to consent to an order shall be reported as required by the practitioner.

(2) A prescription medication for which the dose or schedule has been changed by the practitioner must be noted in the resident's medication administration record.

(3) Current practitioners' orders shall be documented and kept in all resident files.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2848 Medications: Administration and Preparation

(1) All category A facility residents must self-administer their medication. Those category B facility residents that are capable of, and who wish to self-administer medications, shall be encouraged by facility staff to do so.

(2) Any direct care staff member who is capable of reading medication labels may be made responsible for providing necessary assistance to any resident in taking their medication, as defined in ARM 37.106.2805.

(3) Resident medication organizers may be prepared up to four weeks in advance and injectable medications as specified in (4) (c) by the following individuals:

(a) a resident or a resident's legal representative;

(b) a resident's family care giver, who is a person related to the resident by blood or marriage or who has full guardianship; or

(4) The individual referred to in (3) must adhere to the following protocol:

(a) verify that all medications to be set up carry a practitioner's current order;

(b) set up medications only from prescriptions in labeled containers dispensed by a registered pharmacist or from over-the-counter drug containers with intact, clearly readable labels; and

(c) set up injectable insulin up to seven days in advance by drawing insulin into syringes identified for content, date and resident. Other injectable medications must be set up according to the recommendations provided by the pharmacy.

(5) The facility may require residents to use a facility approved medication dispensing system or to establish medication set up criteria, but shall not require residents to purchase prescriptions from a specific pharmacy.

(6) No resident or staff member may be permitted to use another resident's medication.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2849 Medications: Records and Documentation

(1) An accurate medication record for each resident shall be kept of all medications, including over-the-counter medications, for those residents whose self-administration of medication requires monitoring and/or assistance by the facility staff.

(2) The record shall include:

(a) name of medication, reason for use, dosage, route, and date and time given;

(b) name of the prescribing practitioner and their telephone number;

(c) any adverse reaction, unexpected effects of medication, or medication error, which must also be reported to the resident's practitioner;

(d) allergies and sensitivities, if any;

(e) resident specific parameters and instructions for PRN medications;

(i) documentation of when and why a PRN was administered or self-administered and follow up documentation as to the effectiveness of the PRN;

(f) documentation of treatments with resident specific parameters;

(g) documentation of doses missed or refused by resident and why;

(h) initials of the person monitoring and/or assisting with self-administration of medication; and

(i) review date and name of reviewer.

(3) When using paper Medication Administration Records (MARs), the facility shall maintain legible signatures of staff who monitor and/or assist with the self-administration of medication, either on the medication administration record or on a separate signature page. Electronic MARs must include the names associated with the initials of those staff documenting administration of medications.

(4) A medication record need not be kept for those residents for whom written authorization has been given by their practitioner to keep their medication in their rooms and to be fully responsible for taking the medication in the correct dosage and at the proper time. The authorization must be renewed on an annual basis.

(5) The facility shall maintain a record of all destroyed or returned medications in the resident's record or closed resident file in the case of resident transfer or discharge.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2853 Oxygen Use

(1) A resident who requires the use of oxygen:

(a) shall be permitted to self-administer the oxygen if the resident is capable of:

(i) determining their need for oxygen; and

(ii) administering the oxygen to themselves or with assistance.

(2) The direct care staff employed by the facility shall monitor the ability of the resident to operate the equipment in accordance with the orders of the practitioner.

(3) The facility shall ensure that all direct care staff who may be required to assist resident's with administration of oxygen have demonstrated the ability to properly operate the equipment.

(4) The following rules must be followed when oxygen is in use:

(a) oxygen tanks must be secured and properly stored at all times;

(b) no smoking or open flames may be allowed in rooms in which oxygen is used or stored, and such rooms must be posted with a conspicuous "No Smoking, Oxygen in Use" sign;

(c) a backup portable unit for the administration of oxygen shall be present in the facility at all times when a resident who requires oxygen is present in the facility, this includes when oxygen concentrators are used;

(d) the equipment used to administer oxygen must be in good working condition; and

(e) the equipment used to administer oxygen is removed from the facility when it is no longer needed by the resident.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2854 Use of Restraints, Safety Devices, Assistive Devices, Postural Supports, and Seclusion Rooms

(1) The facility shall comply with the rules governing the use, in long term care facilities, of restraints, safety devices, assistive devices, postural supports, and seclusion rooms. The provisions of ARM 37.106.2901, 37.106.2902, 37.106.2904, 37.106.2905, and 37.106.2908 shall apply.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2855 Infection Control

(1) The assisted living facility must establish and maintain infection control policies and procedures sufficient to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections. Such policies and procedures must include, at a minimum, the following requirements:

(a) a system for preventing, identifying, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, and visitors;

(b) standard and transmission-based precautions to be followed to prevent spread of infections;

(i) the type and duration of the isolation, depending upon the infectious agent or organism involved; and

(ii) a requirement that the isolation should be the least restrictive possible for the resident under the circumstances;

(d) any other circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit disease;

(e) if, after admission to the facility, a resident is suspected of having a communicable disease that would endanger the health and welfare of other residents, the administrator or designee must contact the resident's practitioner and assure that appropriate safety measures are taken on behalf of that resident and the other residents; and

(f) all staff shall use proper hand washing technique after providing direct care to a resident.

(2) The facility, where applicable, shall comply with applicable statutes and rules regarding the handling and disposal of hazardous waste.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2859 Pets

(1) Unless the facility disallows it, residents in an assisted living facility may keep household pets, as permitted by local ordinance, subject to the following provisions:

(a) pets must be clean and disease-free;

(b) the immediate environment of pets must be kept clean;

(c) birds must be kept in appropriate enclosures, unless the bird is a companion breed maintained and supervised by the owner; and

(d) pets that are kept at the facility shall have documentation of current vaccinations, including rabies, as appropriate.

(3) Facilities that allow birds shall have procedures that protect residents, staff and visitors from psittacosis, ensure minimum handling of droppings and require droppings to be placed in a plastic bag for disposal.

(4) Prior to admission of companion birds, documentation of the import, out-of-state veterinarian health certificate and import permit number provided by the pet store or breeder will be provided and maintained in the owners records. If the health certificate and import permit number is not available, or if the bird was bred in-state, a certificate from a veterinarian stating that the bird is disease free is required prior to residency. If the veterinarian certificate cannot be obtained by the move-in date the resident may keep the bird enclosed in a private single occupancy room, using good hand washing after handling the bird and bird droppings until the veterinarian examination is obtained.

(5) Pets may not be permitted in food preparation, storage or dining areas during meal preparation time or during meal service or in any area where their presence would create a significant health or safety risk to others.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2860 Food Service

(1) The facility must establish and maintain standards relative to food sources, refrigeration, refuse handling, pest control, storage, preparation, procuring, serving and handling food, and dish washing procedures that are sufficient to prevent food spoilage and the transmission of infectious disease. These standards must include the following:

(a) food must be obtained from sources that comply with all laws relating to food and food labeling;

(b) the use of home-canned foods is prohibited;

(2) Foods must be served in amounts and a variety sufficient to meet the nutritional needs of each resident. The facility must provide therapeutic diets when prescribed by the resident's practitioner. At least three meals must be offered daily and at regular times, with not more than a 14-hour span between an evening meal and breakfast unless a nutritious snack is available in the evening, then up to 16 hours may elapse between a substantial evening meal and breakfast.

(3) Records of menus as served must be filed on the premises for three months after the date of service for review by the department.

(4) The facility shall take into consideration the preferences of the residents and the need for variety when planning the menu. Either the current day or the current week's menu shall be posted for resident viewing.

(5) The facility shall employ food service personnel suitable to meet the needs of the residents.

(a) Foods must be cut, chopped, and ground to meet individual needs or as ordered by the resident's physician or practitioner.

(b) If the cook or other kitchen staff must assist a resident with direct care outside the food service area, they must properly wash their hands before returning to food service.

(d) A facility, whose kitchen and dining services are inspected by the local county health department, must provide the department a copy of their most recent inspection at the time of survey.

(6) If the facility admits residents requiring therapeutic or special diets, the facility shall have an approved dietary manual for reference when preparing a meal. Dietitian consultation shall be provided as necessary and documented for residents requiring therapeutic diets.

(7) A minimum of a one-week supply of non-perishable foods and a two-day supply of perishable foods must be available on the premises.

(8) Potentially hazardous food, such as meat and milk products, must be stored at 41°F or below. Hot food must be kept a 140°F or above during preparation and serving.

(9) Freezers must be kept at a temperature of 0°F or below and refrigerators must be kept at a temperature of 41°F or below. Thermometers must be placed in the warmest area of the refrigerator and freezer to assure proper temperature. Temperatures shall be monitored and recorded at least once a month in a log maintained at the facility for one year.

(10) Employees shall maintain a high degree of personal cleanliness and shall conform to good hygienic practice during all working periods in food service.

(11) A food service employee, while infected with a disease in a communicable form that can be transmitted by foods may not work in the food service area.

(12) Tobacco products may not be used in the food preparation and kitchen areas.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2861 Laundry

(1) Laundry service must be provided by the facility, either on the premises or off the facility site.

(2) If an assisted living facility processes its laundry on the premises it must:

(a) equip the laundry room with a mechanical washer and a dryer vented to the outside, hand washing facilities, a fresh air supply and a hot water supply system which supplies the washer with water of at least 110°F during each use;

(b) have ventilation in the sorting, holding and processing area that shall be adequate to prevent heat and odor build-up;

(d) ensure that facility staff handling laundry wash their hands both after working with soiled laundry and before they handle clean laundry.

(3) Resident's personal clothing must be laundered by the facility unless the resident or the resident's family accepts this responsibility. If the facility launders the resident's personal clothing, the facility is responsible for returning the clothing. Residents capable of laundering their own personal clothing and wishing to do so shall be provided the facilities and necessary assistance by the facility.

(4) The facility shall provide a supply of clean linen in good condition at all times that is sufficient to change beds often enough to keep them clean, dry and free from odors. Facility provided linens must be changed at least once a week and more often if the linens become dirty. In addition, the facility must ensure that each resident is supplied with clean towels and washcloths that are changed at least twice a week, a moisture-proof mattress cover and mattress pad, and enough blankets to maintain warmth and comfort while sleeping.

(5) Residents may use their own linen in the facility if they choose.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2862 Housekeeping

(1) The following housekeeping rules must be followed:

(a) Supplies and equipment must be properly stored and must be on hand in a quantity sufficient to permit frequent cleaning of floors, walls, woodwork, windows and screens;

(b) Housekeeping personnel must be trained in proper procedures for preparing cleaning solutions, cleaning rooms and equipment and handling clean and soiled linen, trash and trays;

(c) Cleaners used in cleaning bathtubs, showers, lavatories, urinals, toilet bowls, toilet seats and floors must contain fungicides or germicides with current EPA registration for that purpose; and

(d) Garbage and trash must be stored for final disposal in areas separate from those used for preparation and storage of food and must be removed from the facility daily. Garbage containers must be kept clean.

(i) Containers used to store garbage in the kitchen and laundry room of the facility must be covered with a lid unless the containers are kept in an enclosed cupboard that is clean and prevents infestation by vermin. These containers shall be emptied daily and kept clean.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2865 Physical Plant

(1) An assisted living facility must be constructed and maintained so as to prevent as much as possible the entrance and harborage of rats, mice, insects, flies and other vermin.

(2) The facility and facility grounds shall be kept orderly and free of litter and refuse and secure from hazards.

(3) When required by the building code authority having jurisdiction, at least one primary grade level entrance to the facility shall be arranged to be fully accessible to disabled persons.

(4) All exterior pathways or accesses to the facility's common use areas and entrance and exit ways shall be of hard, smooth material, accessible and be maintained in good repair.

(5) All interior or exterior stairways used by residents shall have sturdy handrails on one side installed in accordance with the uniform building code with strength and anchorage sufficient to sustain a concentrated 250-pound load to provide residents safety with ambulation.

(6) All interior and exterior materials and surfaces (e.g., floors, walls, roofs, ceilings, windows and furniture) and all equipment necessary for the health, safety and comfort of the resident shall be kept clean and in good repair.

(7) Carpeting and other floor materials shall be constructed and installed to minimize resistance for passage of wheelchairs and other ambulation aids. Thresholds and floor junctures shall also be designed and installed for passage of wheelchairs and to prevent a tripping hazard.

(8) The facility shall install grab bars at each toilet, shower, sitz bath and tub with a minimum of one and one half inches clearance between the bar and the wall and strength and anchorage sufficient to sustain a concentrated 250-pound load. If a toilet grab bar assist is used over a toilet, it must be safely stabilized and secured in order to prevent mishap.

(9) Any structure such as a screen, half wall or planter which a resident could use for support while ambulating shall be securely anchored.

(10) The bottoms of tubs and showers must have surfaces that inhibit falling and slipping.

(11) Hand cleansing soap or detergent and single use individual towels must be available at each sink in the commonly shared areas of the facility. A waste receptacle must be located near each sink. Cloth towels and bar soap for common use are not permitted.

(12) Hot water temperature supplied to hand washing, bathing and showering areas may not exceed 120°F.

(13) The facility shall provide locked storage for all poisons, chemicals, rodenticides, herbicides, insecticides and other toxic material. Hazardous material safety sheets and labeling shall be kept available for staff for all such products used and stored in the facility.

(14) Flammable and combustible liquids shall be safely and properly stored in original or approved, properly labeled containers in areas inaccessible to residents in accordance with the uniform fire code in amounts acceptable to the fire code authority having jurisdiction.

(15) Containers used to store garbage in resident bedrooms and bathrooms are not required to be covered unless they are used for food, bodily waste or medical waste. Resident containers shall be emptied as needed, but at least weekly.

(16) If the facility utilizes a non-municipal water source, the water source is tested at least once every 12 months for total coliform bacteria and fecal coliform or E. coli bacteria and corrective action is taken to assure the water is safe to drink. Documentation of testing is retained on the premises for 24 months from the date of the test.

(17) If a non-municipal sewage system is used, the sewage system must be in working order and maintained according to all applicable state laws and rules.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2866 Construction, Building, and Fire Codes

(1) Any construction of or alteration, addition, modification, or renovation to an assisted living facility must meet the requirements of the building code and fire marshal agencies having jurisdiction and be approved by the officer having jurisdiction to determine if the building and fire codes are met by the facility.

(2) When a change in use, ownership, or building code occupancy classification occurs, licensure approval shall be contingent on meeting the building code and fire marshal agencies' standards in effect at the time of such a change. Changes in use include adding a category B, C, or D license endorsement to a previously licensed category A facility.

(3) Changes in the facility location, use or number of facility beds cannot be made without written notice to, and written approval received from, the department.

(4) Exit doors must be operable on the resident side of the door with a single motion and may not require special knowledge for the resident to open, except as approved by the fire marshal and building codes agencies having jurisdiction or in a secured unit or building that services category C or category D residents. Deadbolt locks are prohibited on all doors.

(5) Stairways, halls, doorways, passageways, and exits from rooms and from the building, shall be kept unobstructed at all times.

(6) All operable windows and outer doors that may be left open shall be fitted with insect screens.

(7) An assisted living care facility must have an annual fire inspection conducted by the appropriate local fire authority or the state fire marshal's office and maintain a record of such inspection for at least three years following the date of the inspection.

(8) An employee and resident fire drill must be conducted at least two times annually, no closer than four months apart, and include residents, employees and support staff on duty and other individuals in the facility. A resident fire drill includes making a general announcement throughout the facility that a resident fire drill is being conducted or sounding a fire alarm.

(9) Records of employee and resident fire drills must be maintained on the premises for 24 months from the date of the drill and include the date and time of the drill, names of the employees participating in the drill, and identification of residents needing assistance for evacuation.

(10) A 2A10BC portable fire extinguisher shall be available on each floor of a facility licensed for 20 or more residents. Facilities licensed for less than 20 residents shall comply with the requirements of the fire authority having jurisdiction with respect to the number and location of portable fire extinguishers.

(11) Portable fire extinguishers must be inspected, recharged, and tagged at least once a year by a person certified by the state to perform such services.

(12) Smoke detectors installed and maintained pursuant to the manufacturer's directions shall be installed in all resident rooms, bedroom hallways, living room, dining room, and other open common spaces or as required by the fire authority having jurisdiction. An annual maintenance log of battery changes and other maintenance services performed shall be kept in the facility and made available to the department upon request.

(13) If there is an inside designated smoking area, it shall be separate from other common areas, and provided with adequate mechanical exhaust vented to the outside.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2872 Requirements for Category B Facilities Only

(1) An assisted living category B endorsement to the license shall be made by the licensing bureau of the department only after:

(a) initial department approval of the facility's category B policy and procedures;

(b) evidence of the administrator's and facility staff qualifications; and

(2) An assisted living category B facility shall employ or contract with a registered nurse to provide or supervise nursing service to include:

(a) general health monitoring on each category B resident;

(b) performing a nursing assessment on category B residents when and as required;

(c) assistance with the development of the resident health care plan and, as appropriate, the development of the resident service plan; and

(d) routine nursing tasks, including those that may be delegated to licensed practical nurses (LPN) and unlicensed assistive personnel in accordance with the Montana Nurse Practice Act.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2873 Administrator Qualifications: Category B

(1) An assisted living category B facility must be administered by a person who, in addition to the requirements found in ARM 37.106.2814, has one or more years experience working in the field of geriatrics or caring for disabled residents in a licensed facility.

(2) Providers in existence on the date of the final adoption of this rule will be granted one year to meet the category B administrator requirements found in (1) .

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2874 Direct Care Staff Qualifications: Category B

(1) In addition to the requirements found in ARM 37.106.2816, each nonprofessional staff providing direct care in an assisted living category B facility shall show documentation of in-house training related to the care and services they are to provide under direct supervision of a registered nurse or supervising nursing service providing category B care, including those tasks that may be delegated to licensed practical nurses (LPN) and unlicensed assistive personnel in accordance with the Montana Nurse Practice Act.

(2) Staff members whose job responsibilities will include supervising or preparing special or modified diets, as ordered by the resident's practitioner, shall receive training prior to performing this responsibility.

(3) Prior to providing direct care, direct care staff must:

(a) work under direct supervision for any direct care task not yet trained or properly oriented; and

(b) not take the place of the required certified person.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2875 Resident Health Care Plan: Category B

(1) Within 21 days of admission to a category B status, the administrator or designee shall assure that a written resident health care assessment and resident certification is performed on each category B resident.

(2) Each initial health care assessment by the licensed health care professional shall include, at a minimum, evaluation of the following:

(a) cognitive status;

(b) communication/hearing patterns;

(d) physical functioning and structural problems;

(e) continence;

(f) psychosocial well being;

(g) mood and behavior patterns;

(h) activity pursuit patterns;

(i) disease diagnosis;

(j) health conditions;

(k) oral nutritional status;

(l) oral dental status;

(m) skin condition;

(n) medication use; and

(o) special treatment and procedures.

(3) A written resident health care plan shall be developed. The resident health care plan shall include, but not be limited to the following:

(a) a statement which informs the resident and the resident's practitioner, if applicable, of the requirements of 50-5-226 (3) and (4) , MCA;

(b) orders for treatment or services, medications, and diet, if needed;

(d) the specific goals of treatment or services, if appropriate;

(e) the time intervals at which the resident's response to treatment will be reviewed; and

(f) the measures to be used to assess the effects of treatment;

(g) if the resident requires care or supervision by a licensed health care professional, the health care plan shall include the tasks for which the professional is responsible.

(4) The category B resident's health care plan shall be reviewed quarterly, and if necessary revised upon change of condition.

(5) The health care plan shall be readily available to and followed by those staff and licensed health care professionals providing the services and health care.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2879 Incontinence Care: Category B

(1) In order to maintain normal bladder and bowel functions, the facility shall provide individualized attention to each resident that meets the following minimum standards:

(a) the facility shall provide a resident who is incontinent of bowel or bladder adequate personal care services to maintain the person's skin integrity, hygiene and dignity and to prevent urinary tract infections.

(2) Evidence that the facility is meeting each resident's needs for maintaining normal bowel and bladder functions include the following outcomes for residents at risk for incontinence:

(a) the resident is checked during those periods when they are known to be incontinent, including the night;

(b) the resident is kept clean and dry;

(d) if the resident can benefit from scheduled toileting, they are assisted or reminded to go to the bathroom at regular intervals.

(3) Indwelling catheters are permissible, if the catheter care is taught and supervised by a licensed health care professional under a practitioner's order. Observations and care must be documented.

(4) Facility staff shall not:

(a) withhold fluids from a resident to control incontinence; or

(b) have a resident catheterized to control incontinence for the convenience of staff.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2880 Prevention and Care of Pressure Sores: Category B

(1) A resident shall receive skin care that meets the following standards:

(a) the facility shall practice preventive measures to identify those at risk and maintain a resident's skin integrity; and

(b) an area of broken or damaged skin must be reported within 24 hours to the resident's practitioner. Treatment must be as ordered by the resident's practitioner.

(2) A person with an open wound or having a pressure or stasis ulcer requiring treatment by a health care professional may not be admitted or permitted to remain in the facility unless:

(a) the wound is in the process of healing, as determined by a licensed health care professional, and is either:

(i) under the care of a licensed health care professional; or

(ii) can be cared for by the resident without assistance.

(3) The facility shall ensure records of observations, treatments and progress notes are entered in the resident record and that services are in accordance with the resident health care plan.

(4) No over the counter products such as creams, lotions, ointments, soaps, iodine or alcohol shall be put on an open pressure or stasis wound unless ordered by the resident's practitioner after an appropriate evaluation of the wound.

(5) Evidence the facility is meeting those resident's identified as a greater risk for skin care needs include the following outcomes for residents:

(a) the facility has identified those residents who are at greater risk of developing a pressure or stasis ulcer. Primary risk factors include but are not limited to:

(i) continuous urinary incontinence or chronic voiding dysfunction;

(ii) severe peripheral vascular disease (poor circulation to the legs) ;

(iii) diabetes;

(iv) chronic bowel incontinence;

(v) sepsis;

(vi) terminal cancer;

(vii) decreased mobility or confined to bed or chair;

(viii) edema or swelling of the legs;

(ix) chronic or end stage renal, liver or heart disease;

(x) CVA (stroke) ;

(xi) recent surgery or hospitalization;

(xii) any resident with skin redness lasting more than 30 minutes after pressure is relieved from a bony prominence, such as hips, heels, elbows or coccyx, is at extremely high risk in that area; and

(xiii) malnutrition/dehydration whether secondary to poor appetite or another disease process.

(b) direct care staff have received training related to maintenance of skin integrity and the prevention and care of pressure sores from a licensed health care professional who is trained to care for that condition;

(d) the resident is kept clean and dry;

(e) the resident is provided clean and dry bed linens;

(f) the resident is kept hydrated;

(g) the resident is turned and repositioned;

(h) the wound is getting smaller;

(i) there is no evidence of infection;

(j) wound bed is moist, not dried out or scabbed over;

(k) the resident has less restriction of movement; and

(l) the resident's pain level has diminished.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02.

Mont. Admin. R. 37.106.2884 Severe Cognitive Impairment: Category B

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226 and 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; REP, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2885 Administration of Medications: Category B

(1) Written, signed practitioner orders shall be documented in all category B resident facility records by a legally authorized person for all medications and treatments which the facility is responsible to administer. Medication or treatment changes shall not be made without a practitioner's order. Order changes obtained by phone must be confirmed by written, signed orders within 21 days.

(2) All medications administered to a category B resident shall be administered by a licensed health care professional or by an individual delegated the task under the Nurse Practice Act and ARM Title 24, chapter 159. Those category B residents, who are capable of medication self-administration shall be given the opportunity and encouraged to do so.

(3) Residents with a standing PRN medication order, who cannot determine their own need for the medication by making a request to self-administer the medication or in the case of the cognitively impaired cannot respond to caretaker's suggestions for over-the-counter PRN pain medications shall:

(a) have the medication administered by a licensed health care professional after an assessment and the determination of need has been made; and

(b) be classified as a category B resident because a nursing decision to determine the resident's need for the medication was required.

(4) Medication and treatment orders shall be carried out as prescribed. The resident or the person legally authorized to make health care decisions for the resident has the right to consent to, or refuse medications and treatments. The practitioner shall be notified if a resident refuses consent to an order. Subsequent refusals to consent to an order shall be reported as required by the practitioner.

(5) Only the following individuals may administer medications to residents:

(a) a licensed physician, physician's assistant, certified nurse practitioner, advanced practice registered nurse, or a registered nurse;

(b) licensed practical nurse working under supervision;

(c) an unlicensed individual who is either employed by the facility or is working under third party contract with a resident or resident's legal representative and has been delegated the task under ARM Title 24, chapter 159; and

(d) a person related to the resident by blood or marriage or who has full guardianship.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2886 Medications: Records and Documentation: Category B

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2002 MAR p. 3638, Eff. 12/27/02; REP, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2891 Administrator Qualifications: Category C

(1) An assisted living category C facility must be administered by a person who meets the conditions of ARM 37.106.2814 and has:

(a) three or more years experience in working in the field of geriatrics or caring for disabled residents in a licensed facility; or

(b) a documented combination of education and training that is equivalent to the experience required in (1) , as determined by the department.

(2) At least eight of the 16 hours of annual continuing education the administrator must complete under ARM 37.106.2814(3) shall pertain to caring for persons with severe cognitive impairments.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-223 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226, 50-5-227 and 50-5-228, MCA
History: NEW, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2892 Direct Care Staff: Category C

(1) In addition to meeting all other requirements for direct care staff stated in this subchapter, assisted living category C facility direct care staff must receive additional documented training in:

(a) the facility or unit's philosophy and approaches to providing care and supervision for persons with severe cognitive impairment;

(b) the skills necessary to care for, intervene and direct residents who are unable to perform activities of daily living;

(i) wandering;

(ii) hallucinations, illusions and delusions; and

(iii) impairment of senses;

(d) therapeutic programming to support the highest possible level of resident function including:

(i) large motor activity;

(ii) small motor activity;

(iii) appropriate level cognitive tasks; and

(iv) social/emotional stimulation;

(e) promoting residents' dignity, independence, individuality, privacy and choice;

(f) identifying and alleviating safety risks to residents;

(g) identifying common side effects and untoward reactions to medications; and

(h) techniques for dealing with bowel and bladder aberrant behaviors.

(2) Staff must remain awake, fully dressed and be available in the facility or on the unit at all times to provide supervision and care to the resident as well as to assist the residents in evacuation of the facility if a disaster occurs.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-223 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226, 50-5-227 and 50-5-228, MCA
History: NEW, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2895 Health Care Plan: Category C

(1) Within 21 days of admission of a resident to an assisted living category C facility, a resident certification must be conducted, and a written health care plan shall be developed which meets the requirements of ARM 37.106.2875, and which also includes detailed assessment, therapeutic management and intervention techniques for the following behaviors and resident needs:

(a) memory;

(b) judgement;

(d) ability to solve problems;

(e) mood and character changes;

(f) behavioral patterns;

(g) wandering; and

(h) dietary needs.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-223 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226, 50-5-227 and 50-5-228, MCA
History: NEW, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2896 Disclosures to Residents: Category C

(1) Each assisted living category C facility or unit must, prior to admission, inform the resident's legal representative in writing of the following:

(a) the overall philosophy and mission of the facility regarding meeting the needs of residents afflicted with severe cognitive impairment and the form of care or treatment offered;

(b) the process and criteria for move-in, transfer, and discharge;

(d) the process used to establish and implement a health care plan, including how the health care plan will be updated in response to changes in the resident's condition;

(e) staff training and continuing education practices;

(f) the physical environment and design features appropriate to support the functioning of cognitively impaired residents;

(g) the frequency and type of resident activities;

(h) the level of involvement expected of families and the availability of support programs; and

(i) any additional costs of care or fees.

(2) The facility must provide a resident or a resident's legal representative with written documentation of the information specified in (1). A copy of this exchange must be kept as part of the resident file.

History

Authorizing statute(s): 50-5-103, 50-5-223, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, 50-5-228, MCA
History: NEW, 2004 MAR p. 1146, Eff. 5/7/04; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2898 Requirements for Secured Units: Category C

(1) In addition to meeting all other requirements for assisted living facilities stated in this subchapter, if a secured distinct part or locked unit within a category C assisted living facility is designated for the exclusive use of residents with severe cognitive impairment, the facility must:

(a) staff the unit with direct care staff at all times there are residents in the unit;

(b) provide a separate dining area, at a ratio of 30 square feet per resident on the unit; and

(c) provide a common day or activities area, at a ratio of 30 square feet per resident on the unit. The dining area listed in (1) (b) or day rooms, sun porches and common areas accessible to all residents, may serve this purpose.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-223 and 50-5-227, MCA
Implementing statute(s): Sec. 50-5-225, 50-5-226, 50-5-227 and 50-5-228, MCA
History: NEW, 2004 MAR p. 1146, Eff. 5/7/04.

Mont. Admin. R. 37.106.2899 Category D: Construction

(1) All category D services must be provided in a secured care unit and meet all requirements in ARM 37.106.316.

(2) A category D facility or unit must not use automatic door closures unless required. If required, such closures must be mounted on the public side of the door.

(3) All hardware and lights used in a category D facility or unit must be tamper-proof.

(4) All resident room doors must include a sight window.

(5) No more than one client must reside in a resident room.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2899A CATEGORY D: ADMINISTRATOR QUALIFICATIONS

37.106.2899A CATEGORY D: ADMINISTRATOR QUALIFICATIONS

(1) In addition to requirements in ARM 37.106.2873, an administrator for a category D facility must have at least three years of experience in the field of mental health and mental disorders.

(2) Of the 16 hours of annual continued education training required in ARM 37.106.2814, eight hours must be in the field of mental health and mental disorders.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2899B CATEGORY D: DISCLOSURE TO CATEGORY D RESIDENTS

37.106.2899B CATEGORY D: DISCLOSURE TO CATEGORY D RESIDENTS

(1) Each assisted living category D facility or unit must, prior to admission, inform the resident or resident's legal representative in writing of the following:

(a) the overall philosophy and mission of the facility regarding meeting the needs of residents with mental illness and the form of care or treatment offered;

(b) the process and criteria for admission and discharge;

(d) the process used to establish and implement a health care plan, including how the health care plan will be updated in response to changes in the resident's condition;

(e) staff training and continuing education practices;

(f) the physical environment and design features appropriate to support the functioning of mentally disabled residents;

(g) the frequency and type of resident activities; and

(h) any additional costs of care or fees.

(2) The facility must obtain from the resident or resident's legal representative a written acknowledgment that the information specified was provided. A copy of this written acknowledgment must be kept as part of the permanent resident file.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2899C CATEGORY D: STAFF

37.106.2899C CATEGORY D: STAFF

(1) All category D facilities must have direct care staff in sufficient number to meet the needs of the residents.

(2) In addition to requirements in ARM 37.106.2816, all staff must:

(a) be at least 18 years old;

(b) complete an FBI fingerprint background check upon hiring;

(d) complete training on de-escalation techniques and methods of managing resident behaviors.

(3) All staff must remain awake, fully dressed, and available on the unit at all times when they are on duty.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2899D CATEGORY D: RESIDENT ASSESSMENTS

37.106.2899D CATEGORY D: RESIDENT ASSESSMENTS

(1) All category D facilities must obtain or conduct three types of resident assessments for each resident:

(a) Prior to move in, the facility shall obtain the court determination documentation required in 53-21-199, MCA, as applicable, as well as a full medical history and physical and mental health and mental disorders assessment.

(b) A resident needs assessment must be completed within seven days prior to admission to facility. The assessment must be reviewed/updated quarterly, and upon significant change in status.

(c) The administrator, or designee, will request and retain copies of the healthcare assessment and written order for care completed monthly by the practitioner as defined in 50-5-226(5), MCA.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2899E CATEGORY D: HEALTH CARE PLAN

37.106.2899E CATEGORY D: HEALTH CARE PLAN

(1) In addition to requirements in ARM 37.106.2875, the health care plan for category D residents must include de-escalation techniques individualized to the resident.

(2) The health care plan must be reviewed and updated quarterly and upon significant change in status.

(3) Each direct care staff must document that they have reviewed and are capable of implementing each resident's health care plan.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2899F CATEGORY D: MEDICATION USE AND PHYSICIAN ORDERS

37.106.2899F CATEGORY D: MEDICATION USE AND PHYSICIAN ORDERS

(1) All category D residents must be assessed on their ability and be encouraged to self-administer their own medication. If a resident is unable or unwilling to self-administer his or her medication, a licensed nurse shall administer all medication and the resident must be classified as a category B resident.

(2) When a resident refuses a medication, the resident's practitioner shall be notified within 24 hours and notification documented.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2899G CATEGORY D: DISCHARGE

37.106.2899G CATEGORY D: DISCHARGE

(1) A comprehensive discharge plan directly linked to the behaviors and symptoms that resulted in admission and estimated length of stay must be developed upon admission.

(2) A resident's diversion order is discontinued when:

(a) the resident and facility choose to allow continued residency; a resident needs assessment must be completed to determine category and placement within the facility;

(b) the resident chooses not to remain in the facility; the facility shall issue a 30-day notice and conduct discharge planning. Discharge planning must include involvement from community resources.

(3) A resident may be involuntarily discharged in less than 30 days if the resident:

(a) has a medical emergency;

(b) is suffering from an acute psychotic episode; or

(4) All discharges must be discussed with the resident or resident's legal representative and the resident's practitioner to ensure collaboration on a safe and appropriate discharge location.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2899H CATEGORY D: SECLUSION ROOM REQUIREMENTS

37.106.2899H CATEGORY D: SECLUSION ROOM REQUIREMENTS

(1) A category D facility or unit providing D1 level of care must have at least one room designated to be used for seclusion for every 24 beds.

(2) The location of these rooms must facilitate staff observation and monitoring of residents in these rooms.

(3) Seclusion rooms may only be used by one resident at a time.

(4) Seclusion rooms must:

(a) be a minimum of 60 square feet, and a minimum of 80 square feet if restraint beds are used;

(b) be a minimum length of 7 feet and maximum wall length of 11 feet;

(d) be accessed by an anteroom or vestibule that provides direct access to a toilet room;

(e) have door openings to the anteroom and toilet room with a minimum clear width of 3 feet 8 inches;

(f) be constructed to prevent hiding, escape, injury, or suicide;

(g) have walls designed to withstand direct and forceful impact and have materials that meet Class A or Class B finishes as defined by the 2012 National Fire Protection Association (NFPA) 101;

(h) have monolithic ceilings;

(i) not contain outside corners or edges;

(j) have doors that swing out, have a clear opening of 3 feet 8 inches, and permit staff observation through a vision panel, while maintaining provisions for privacy;

(k) have tamper resistant fixtures, such as light fixtures, vent covers, and cameras;

(l) have electrical switches and outlets that are restricted within the seclusion room; and

(m) have door lever handles that point downward when in the latched or unlatched position, except for specifically designed anti-ligature hardware.

(5) A licensed nurse must provide residents with constant one-on-one supervision when in the seclusion room.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, MCA
Implementing statute(s): 50-5-225, 50-5-226, 50-5-227, MCA
History: NEW, 2022 MAR p. 1857, Eff. 9/24/22; AMD, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Mont. Admin. R. 37.106.2899I CATEGORY D1: LEVEL OF CARE AND SERVICES TO RESIDENTS

37.106.2899I CATEGORY D1: LEVEL OF CARE AND SERVICES TO RESIDENTS

(1) A facility that chooses to admit or retain category D residents who have practitioner orders for restraint or seclusion or who are involuntarily admitted must apply as a category D1 assisted living facility.

(2) In addition to the requirements set forth in ARM 37.106.2899, a category D1 facility must:

(a) either be a stand-alone secured facility or a separate, secured unit attached to a category A, B, and/or C facility;

(i) a category D1 unit attached to a category A, B, and/or C facility must have a separate entrance/exit and impenetrable doors used to separate the category D1 unit from the other units;

(b) devise a policy on how it plans to maintain security of the facility or unit; and

(c) have at least one seclusion room for every 24 residents. The room must meet the requirements set forth in ARM 37.106.2899H.

(3) In addition to the requirements set forth in ARM 37.106.2899B, each category D1 facility or unit must, prior to admission, inform the resident or resident’s legal representative of the circumstances and protocols for restraint and seclusions.

(4) In addition to the requirements set forth in ARM 37.106.2899C, a category D1 facility must have:

(a) a registered nurse (RN) on duty or on call and available physically to the facility within one hour;

(b) a licensed mental health professional who must be site-based;

(d) completed training requirements in ARM 37.106.2908.

(5) In addition to the requirements set forth in ARM 37.106.2899E, a health care plan for a category D1 resident must include:

(a) circumstances when the resident may need to be isolated from other residents;

(b) behaviors and/or situations in which a staff member may need to obtain orders for restraints and/or seclusion; and

History

Authorizing statute(s): 50-5-101, 50-5-201, 50-5-203, 50-5-204, 50-5-207, 50-5-226, 50-6-401, 50-5-226, MCA
Implementing statute(s): 50-5-101, 50-5-201, 50-5-203, 50-5-204, 50-5-207, 50-5-226, 50-6-401, 50-5-226, MCA
History: NEW, 2026 MAR, Notice No. 2026-323, Eff. 9/26/26.

Subchapter 37.106.29 Restraints, Safety Devices, Assistive Devices, and Postural Supports

Mont. Admin. R. 37.106.2901 Rule Applicability

(1) The provisions of the rules in this subchapter that govern the use of restraints do not apply to a category A personal care facility as defined in 50-5-227 (2) (a) , MCA, because such a facility is prohibited by law from accepting and serving any resident who is in need of medical, chemical or physical restraint.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227 and 50-5-1205, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227, 50-5-1202 and 50-5-1203, MCA
History: NEW, 2002 MAR p. 3159, Eff. 11/15/02.

Mont. Admin. R. 37.106.2902 Definitions

The following definitions, in addition to those contained in 50-5-1202 , MCA, apply to this chapter:

(1) "Assistive device" means any device whose primary purpose is to maximize the independence and the maintenance of health of an individual who is limited by physical injury or illness, psychosocial dysfunction, mental illness, developmental or learning disability, the aging process, cognitive impairment or an adverse environmental condition. If the device is primarily used to restrict an individual's movement, it is considered a safety device or restraint rather than an assistive device.

(2) "Licensed health care professional" means a physician, a physician assistant-certified, a nurse practitioner or a registered or practical nurse licensed in the state of Montana.

(3) "Medical symptom", as defined in 50-5-1202 , MCA, means an indication of a physical or psychological condition or of a physical or psychological need expressed by the patient. For example, a concern for the resident's physical safety by any person listed in 50-5-1201 (1) , MCA, or a resident's fear of falling may constitute a medical symptom.

(4) "Postural support" means an appliance or device used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement, including, but not limited to, preventing a resident from falling out of a bed or chair. A postural support does not include tying a resident's hands or feet or otherwise depriving a resident of their use.

(5) "Restraint" means any method (chemical or physical) of restricting a person's freedom of movement that prevents them from independent and purposeful functioning. This includes seclusion, controlling physical activity, or restricting normal access to the resident's body that is not a usual and customary part of a medical diagnostic or treatment procedure to which the

resident or the authorized representative has consented.

(6) "Safety devices", as defined in 50-5-1202 , MCA, means side rails, tray tables, seat belts and other similar devices. The department interprets that definition to mean that a safety device is used to maximize the independence and the maintenance of health and safety of an individual by reducing the risk of falls and injuries associated with the resident's medical symptom.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227 and 50-5-1205, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227, 50-5-1202 and 50-5-1203, MCA
History: NEW, 2002 MAR p. 3159, Eff. 11/15/02.

Mont. Admin. R. 37.106.2904 Use of Restraints, Safety Devices, Assistive Devices, and Postural Supports

(1) The application or use of a restraint, safety device, or postural support is prohibited except to treat a resident's medical symptoms and may not be imposed for purposes of coercion, retaliation, discipline, or staff convenience.

(2) A restraint may be a safety device when requested by the resident or the resident's authorized representative or physician to reduce the risk of falls and injuries associated with a resident's medical symptoms and used in accordance with 50-5-1201, MCA.

(3) To the extent that a resident needs emergency care, restraints may be used for brief periods:

(a) to permit medical treatment to proceed unless the health care facility has been notified that the resident has previously made a valid refusal of the treatment in question; or

(b) if a resident's unanticipated violent or aggressive behavior places the resident or others in imminent danger, in which case the resident does not have the right to refuse the use of restraints. In this situation:

(i) the use of restraints is a measure of last resort to protect the safety of the resident or others and may be used only if the facility determines and documents that less restrictive means have failed;

(ii) the size, gender, physical, medical, and psychological condition of the resident must be considered prior to the use of a restraint;

(iii) a licensed nurse shall contact a resident's physician for restraint orders within one hour of application of a restraint;

(iv) the licensed nurse shall document in the resident's file the circumstances requiring the restraints and the duration;

(v) a restrained resident must be monitored as their condition warrants, and restraints must be removed as soon as the need for emergency care has ceased, and the resident's safety and the safety of others can be assured; and

(vi) a licensed nurse must provide one on one supervision to a resident who has a restraint applied for the reasons listed in (3).

(4) In accordance with the Montana Long-Term Care Residents' Bill of Rights, the resident or authorized representative is allowed to exercise decision-making rights in all aspects of the resident's health care or other medical regimens, with the exception of the circumstances described in (3) (b) .

(5) Single or two quarter bed rails that extend the entire length of the bed are prohibited from use as a safety or assistive device; however, a bed rail that extends from the head to half the length of the bed and used primarily as a safety or assistive device is allowed.

(6) Physician-prescribed orthopedic devices used as postural supports are not considered safety devices or restraints and are not subject to the requirements for safety devices and restraints contained in these rules.

(7) Whenever a restraint, safety device, or postural support is used that restricts or prevents a resident from independent and purposeful functioning, the resident must be provided the opportunity for exercise and elimination needs at least every two hours, or more often as needed, except when a resident is sleeping.

(8) All methods of restraint, safety devices, assistive devices, and postural supports must be properly fastened or applied in accordance with manufacturer's instructions and in a manner that permits rapid removal by the staff in the event of fire or other emergency.

History

Authorizing statute(s): 50-5-103, 50-5-226, 50-5-227, 50-5-1205, MCA
Implementing statute(s): 50-5-103, 50-5-226, 50-5-227, 50-5-1201, 50-5-1202, 50-5-1204, MCA
History: NEW, 2002 MAR p. 3159, Eff. 11/15/02; AMD, 2022 MAR p. 1857, Eff. 9/24/22.

Mont. Admin. R. 37.106.2905 Documentation in Resident's Medical Records

(1) Prior to the use of a restraint or safety device, the following items must be included in the resident's record:

(a) a consent form signed by the resident or authorized representative that includes documentation that:

(i) the resident or the resident's authorized representative was given a written explanation of the alternatives and any known risks associated with the use of the restraint or safety device;

(ii) cites any pre-existing condition that may place a patient at risk of injury; and

(b) written authorization from the resident's primary physician that specifies the medical symptom that the restraint or safety device is intended to address and the type of circumstances and duration under which the restraint or safety device is to be used.

(2) When a restraint or safety device is used, the following items must be documented in the resident's record:

(a) frequency of monitoring in accordance with documented facility policy;

(b) assessment and provision of treatment if necessary for skin care, circulation and range of motion; and

(3) During a quarterly re-evaluation, a facility must consider:

(a) using the least restrictive restraint or safety device to restore the resident to a maximum level of functioning;

(b) causes for the medical symptoms that led to the use of the restraint or safety device; and

(c) alternative safety measures if a restraint or safety device is removed. Before removing a restraint or safety device, the resident or the authorized representative and the attending physician must be consulted.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227 and 50-5-1205, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227, 50-5-1201, 50-5-1203 and 50-5-1204, MCA
History: NEW, 2002 MAR p. 3159, Eff. 11/15/02.

Mont. Admin. R. 37.106.2908 Staff Training

(1) Restraints, safety devices or postural supports may only be applied by staff who have received training in their use, as specified below and appropriate to the services provided by the facility.

(2) Staff training shall include, at a minimum, information and demonstration in:

(a) the proper techniques for applying and monitoring restraints, safety devices or postural supports;

(b) skin care appropriate to prevent redness, breakdown and decubiti;

(d) assessment of blood circulation to prevent obstruction of blood flow and promote adequate circulation to all extremities;

(e) turning and positioning to prevent skin breakdown and keep the lungs clear;

(f) potential risk for residents to become injured or asphyxiated because the resident is entangled in a bed rail or caught between the bed rail and mattress if the mattress or mattress pad is ill-fitted or is out of position;

(g) provision of sufficient bed clothing and covering to maintain a normal body temperature;

(h) provision of additional attention to meet the physical, mental, emotional and social needs of the resident; and

(i) techniques to identify behavioral symptoms that may trigger a resident's need for a restraint or safety device and to determine possible alternatives to their use. These include:

(i) observing the intensity, duration and frequency of the resident's behavior;

(ii) identifying patterns over a period of time and factors that may trigger the behavior; and

(iii) determining if the resident's behavior is:

(A) new or if there is a prior history of the behavior;

(B) the result of mental, emotional, or physical illness;

(3) Training described in (2) must meet the following criteria:

(a) training must be provided by a licensed health care professional or a social worker with experience in a health care facility; and

(b) a written description of the content of this training, a notation of the person, agency, organization or institution providing the training, the names of staff receiving the training, and the date of training must be maintained by the facility for two years.

(4) Refresher training for all direct care staff caring for restrained residents and applying restraints, safety devices or postural supports must be provided at least annually or more often as needed. The facility must:

(a) ensure that the refresher training encompasses the techniques described in (2) of this rule; and

(b) for two years after each training session, maintain a record of the refresher training and a description of the content of the training.

History

Authorizing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227 and 50-5-1205, MCA
Implementing statute(s): Sec. 50-5-103, 50-5-226, 50-5-227, 50-5-1204 and 50-5-1205, MCA
History: NEW, 2002 MAR p. 3159, Eff. 11/15/02.

Subchapter 37.106.30 Eating Disorder Centers

Mont. Admin. R. 37.106.3001 Eating Disorder Centers (edc): Application of Other Rules

(1) In addition to these rules, an EDC must comply with licensure rules in ARM Title 37, chapter 106, subchapter 3. To the extent that licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of ARM Title 37, chapter 106, subchapter 12, the terms of subchapter 12 will apply to an EDC.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3002 Eating Disorder Centers (edc): Definitions

(1) "Clinical director" means a social worker, psychologist, or clinical professional counselor licensed under Title 37, MCA, who oversees an EDC's clinical services. A clinical director cannot be a licensure candidate.

(2) "Eating disorder" means any of several psychological disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder, or other specific feeding or eating disorders characterized by serious disturbances to a person's eating behaviors.

(3) "Intensive outpatient program" means a program that provides more structure and support than standard outpatient therapy.

(4) "Meal support" means the provision of support during meal times, focused specifically on helping the individual to consume the food on their meal plan and redirecting behaviors that sabotage eating and recovery.

(5) "Medical director" means a psychiatrist licensed under Title 37, MCA, who oversees an EDC's services.

(6) "Mental health professional" means a psychologist, social worker, or professional counselor licensed under Title 37, MCA, or a licensure candidate registered under Title 37, MCA.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3005 Eating Disorder Centers (edc): Licenses

(1) The department shall issue a license from one to three years in duration for an EDC to any applicant meeting all the requirements established by these rules and the governing statutes, as determined by the department after a licensing survey.

(2) The department will issue a renewal license for a period of one to three years in duration for an EDC if:

(a) the EDC makes written application for renewal at least 30 days prior to the expiration date of the current license; and

(b) the EDC continues to meet all requirements established by these rules and governing statutes, as determined by the department after a licensing survey.

(3) If an EDC makes timely application for renewal of a license, but the department does not complete the relicensing survey before the expiration date of the previous year's license, the previous year's license will continue in effect for the time necessary for the department to complete the relicensing survey and to determine compliance with licensing requirements.

(4) The department may in its discretion issue a provisional license for any period up to six months to any applicant which:

(a) has met all licensing requirements for fire safety; and

(b) has agreed in writing to comply fully with all licensing requirements established by these rules within the time covered by the provisional license.

(c) the department may, in its discretion, renew a provisional license if the applicant shows good cause for failure to comply fully with all licensing requirements within the time covered by the prior provisional license, but the total time covered by the initial provisional license and renewals may not exceed one year.

(5) The department may consider as eligible for licensure, during the accreditation period, an EDC that furnishes written evidence, including the recommendation for future compliance statements, of accreditation of its programs by the Commission on Accreditation of Rehabilitation Facilities or The Joint Commission. The department may inspect an EDC considered eligible for licensure to ensure compliance with state licensure standards.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3006 Eating Disorder Centers (edc): Licensing Procedures

(1) An application for an EDC license must be made on an application form provided by the department and include plans required by ARM 37.106.306.

(2) The EDC must submit all written program management policies and procedures to the department for approval with the initial application. Policies and procedures must comply with requirements outlined in this subchapter. The EDC shall submit to the department any significant changes to policies and procedures for approval.

(3) Upon receipt of a complete application for license or renewal of license and applicable fees pursuant to 50-5-202, MCA, the department will conduct a licensing survey to determine if the applicant meets applicable licensing requirements.

(4) If the department determines during the survey that the applicant is out of compliance with applicable licensing requirements, the department will notify the applicant of the specific deficiencies, and the applicant must submit a written plan of correction within ten working days of the department's notification of noncompliance specifying how compliance will be achieved.

(5) The department must approve the plan of correction prior to issuing a license.

(6) The department will not issue a license or renew a license until it receives all required or corrected information.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3009 Eating Disorder Centers (edc): Written Policies and Procedures

(1) In addition to requirements in ARM 37.106.330, the EDC policy and procedure manual must include information for:

(a) eligibility for services;

(b) client screenings and assessments;

(d) client rights and grievances;

(e) monitoring the client's weight and food related behaviors;

(f) maintaining clinical records;

(g) establishing fiscal policies governing the management of organizational funds;

(h) establishing and maintaining orientation and ongoing staffing requirements;

(i) informing clients of policies pertaining to the EDC;

(j) screening, hiring, and assessing staff which include conducting practices that assist the EDC in identifying employees that may pose a risk or threat to the health, safety, or welfare of any resident, and provide written documentation of the findings and the outcome in the employee's file;

(k) reporting suspected abuse or neglect in accordance with Title 52, chapter 3, part 8, MCA, for adults; and in accordance with Title 41, chapter 3, part 2, MCA, for children.

(l) reporting requirements to notify the department's Quality Assurance Division, by e-mail or fax within 24 hours, of a client, staff, volunteer, or visitor death where the death occurs on-site or in service related activities; of any fire, accident, or other incident resulting in significant damage to the service site;

(m) defining staff ethical standards and conduct, including investigating and reporting of unprofessional conduct to the applicable professional licensing authority;

(n) discharge;

(o) meal support, if applicable;

(p) the management, storage, and disposal of any prescription and over-the-counter drugs;

(q) client transportation, if provided by the EDC;

(r) crisis intervention services; and

(s) conducting staff criminal background checks including convictions that disqualify individuals from employment.

(2) The policy and procedure manual must include a current organizational chart delineating the current lines of authority, responsibility, and accountability for the administration and provision of all client services.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3011 Eating Disorder Centers (edc): Services Required

(1) An EDC must provide the follow services:

(a) outpatient therapy;

(b) family therapy;

(d) nutritional counseling; and

(e) crisis services.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3013 Eating Disorder Centers (edc): Eligibility for Services

(1) An EDC must have written policies and procedures for determining eligibility for services that include:

(a) the criteria to determine eligibility for services;

(b) the information required to be collected to determine eligibility for services;

(d) the procedures for accepting referrals.

(2) The EDC must have a policy and procedures for managing wait lists for services.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3015 Eating Disorder Centers (edc): Client Screening and Assessments

(1) An EDC must have a screening procedure for the early detection of risk of imminent harm to self or others. The procedure must:

(a) be completed on the first contact; and

(b) include a process for responding when an immediate risk of harm is identified.

(2) An EDC must complete a clinical intake assessment within three contacts, for each client, and must be updated annually.

(3) Clinical intake assessments must be conducted by a licensed mental health professional trained in clinical assessments and must include the following information in a narrative form to substantiate the client's diagnosis and provide sufficient detail to plan of care goals and objectives:

(a) presenting problem and history of problem;

(b) mental status;

(d) initial plan of care goals;

(e) risk factors to include suicidal or homicidal ideation;

(f) psychiatric history;

(g) substance use/abuse and history;

(h) current medication and medical history;

(i) financial resources and residential arrangements;

(j) education and/or work history; and

(k) legal history relevant to history of illness, including guardianships, civil commitments, criminal mental health commitments, and prior criminal background.

(4) The clinical intake assessment must include an assessment of the client's food-related behaviors including the client's beliefs, perceptions, attitudes, and behavior regarding food. The assessment may include family observations regarding the individual's food-related behavior when available.

(5) Within two weeks of admission into the program the EDC must perform or make a documented referral for the following tests, screenings, and procedures based on the needs of the client:

(a) complete blood count;

(b) comprehensive serum metabolic profile, including phosphorus and magnesium;

(d) electrocardiogram (ECG), if clinically indicated;

(e) body mass index;

(f) screenings for eating disorder behaviors; and

(g) any additional laboratory testing, as determined appropriate.

(6) The EDC may accept test results required in (5) from other health care professionals completed within two weeks prior to acceptance for services.

(7) The EDC must maintain a current list of providers who accept referrals for assessments and services not provided by the EDC.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3017 Eating Disorder Centers (edc): Plan of Care

(1) An EDC must have a multi-disciplinary plan of care that is supervised and directed by the admitting psychiatrist, and consisting of adequate numbers of individuals licensed, registered, or certified in the physical and mental health disciplines appropriate to the condition of each client.

(2) Based upon the findings of an assessment, the EDC must establish an individualized plan of care for each client within five contacts or 21 days from the first contact, whichever is later. The plan of care must:

(a) specify a diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), or the International Classification of Diseases, Tenth Revision (ICD-10);

(b) identify plan of care team members, from within and outside of the EDC, who are involved in the client's treatment and care;

(d) include objectives that include identified steps to achieve the goal;

(e) include nutritional rehabilitation to support regular and consistent weight when indicated;

(f) include measurable improvement in eating disorders behavior;

(g) identify projected timeframe for completion of goals and objectives as determined by the behavioral health needs of the client;

(h) identify the staff person responsible for each treatment service to be provided;

(i) include family participation in treatment unless such participation is contraindicated. Written documentation must indicate the reason participation is contraindicated;

(j) include signatures from the client, the client's legal guardian (if applicable), the licensed mental health professional and any other person responsible in implementation of the plan; and

(k) describe how the EDC will monitor the client's weight and food-related behaviors.

(3) The plan of care must be reviewed face-to-face at least every:

(a) 90 days for outpatient therapy;

(b) 30 days for intensive outpatient programs; or

(4) Plan of care reviews must include:

(a) the client;

(b) the client's legal guardian (if applicable);

(d) any person with responsibility in implementation of the plan;

(e) documentation on progress towards objectives and goals; and

(f) date and signature of all persons indicating participation in the review.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3019 Eating Disorder Centers (edc): Governing Body and Management

(1) An EDC must identify an individual or individuals to constitute its governing body. The governing body must:

(a) exercise general policy, budget, and operating direction over the EDC; and

(b) appoint an administrator of the EDC.

(2) The administrator appointed by the governing body must:

(a) have the minimum qualifications for hire as determined by the governing body;

(b) maintain daily overall management responsibility for the operation of the EDC; and

(c) develop and oversee the implementation of policies and procedures pertaining to the operation and services of the EDC.

(3) The administrator may also serve as the medical director or clinical director if the administrator meets the qualifications of the respective position.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3020 Eating Disorder Centers (edc): Staffing Requirements

(1) An EDC shall employ or contract with a medical director who must:

(a) coordinate with and advise EDC staff on medical services provided;

(b) participate in the development and approval of the program's policy and procedure manual;

(c) act as a liaison for the EDC with community physicians, hospital staff, and other professionals and agencies regarding psychiatric services; and

(d) ensure the quality of treatment and related services through participation in the EDC's quality assurance process.

(2) The EDC must:

(a) employ a clinical director;

(b) employ a registered nurse licensed under Title 37, MCA;

(d) employ the number of qualified mental health professionals and support staff necessary to adequately evaluate clients and to sufficiently participate in each individual plan of care; and

(e) employ or contract with a registered dietitian to provide for the client's nutritional needs, including assessing, educating, and counseling individuals, parents and/or legal guardians, and staff on food and nutritional related issues.

(3) The EDC must develop minimum qualifications for the hiring of all employed or contracted staff.

(4) All staff must receive orientation and training in areas relevant to the employee's duties and responsibilities, including:

(a) an overview of the EDC's policy and procedure manual in areas relevant to the staff's job responsibilities;

(b) a review of the staff's job description; and

(5) Documentation of orientation and ongoing training must be placed in the staff's personnel record.

(6) The EDC must conduct criminal background checks on all staff in accordance with EDC policy.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3022 Eating Disorder Centers (edc): Discharge or Transfer

(1) An EDC must have written policies and procedures for discharge.

(2) The EDC must develop a discharge summary for each client no longer receiving services. The discharge summary must include:

(a) reason for discharge;

(b) a summary of services provided;

(d) level of care recommendations;

(e) specific recommendations for aftercare and follow-up treatment;

(f) contact information for follow-up appointments;

(g) medication education as needed; and

(h) the signature of the staff person who prepared the report and date the summary was completed.

(3) Discharge summaries must be developed within 30 days of formal discharge from services or within 90 days of the client's last day of service when no formal discharge occurs.

(4) A copy of the discharge summary must be provided to the client or the client's legal guardian.

(5) The EDC must have a written policy and procedure to share information about the client served to facilitate coordination and continuity when the client is referred to other providers.

(6) If during the course of treatment or services the client is transferred to a hospital or inpatient program, the EDC must provide the hospital or inpatient program with the client's current condition.

(7) The EDC must establish a coordinated transfer of care through a mutually established agreement with a hospital or inpatient program.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3025 Eating Disorder Centers (edc): Clinical Records

(1) An EDC's clinical records must contain the following:

(a) the name, address, date of birth, and gender of the client;

(b) the name and contact information for the client's family and any legally authorized representative;

(d) a reason of admission for care, treatment, or services;

(e) an initial screening assessment;

(f) a clinical intake assessment;

(g) medical information including results of physical exam and laboratory testing;

(h) an initial plan of care and plan of care reviews;

(i) documentation of individual, family, and group therapy;

(j) documentation of family involvement or reason why involvement is contraindicated;

(k) documentation of consultations with a registered dietitian;

(l) documentation of monitoring the client's weight and food related behaviors as outlined in the plan of care; and

(m) a discharge summary.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3030 Eating Disorder Centers (edc): Quality Assessment

(1) An EDC shall implement and maintain an active quality assessment program using information collected to make improvements in the EDC's policies, procedures, and services. The program must include procedures for:

(a) conducting client satisfaction surveys, at least annually, for all eating disorder services.

(2) The client satisfaction survey must address:

(a) whether the client, parent, or legal guardian is adequately involved in the development and review of the client's plan of care;

(b) whether the client, parent, or legal guardian was informed of client rights and the EDC's grievance procedure;

(d) the client's, parent's, or legal guardian's recommendations for improving the EDC's services; and

(e) reviewing, on an ongoing basis, incident reports, grievances, complaints, medication errors with special attention given to identifying patterns and making necessary changes in how services are provided.

(3) The EDC shall prepare and maintain on file an annual report of improvements made as a result of the quality assessment program.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3033 Eating Disorder Centers (edc): Crisis Telephone Services

(1) An EDC must provide crisis telephone services and comply with the following requirements:

(a) ensure that crisis telephone services are available 24 hours a day, seven days a week;

(b) an answering service or receptionists may be used to transfer calls to individuals who have been trained to respond to crisis calls;

(c) employ or contract with appropriately trained individuals, under the supervision of the medical director or clinical director, to respond to crisis calls; and

(d) ensure that a licensed mental health professional provides consultation and backup, as indicated, for unlicensed individuals responding to crisis calls.

(2) An appropriately trained individual listed in (1)(c) is one who has received training and instruction regarding:

(a) the policies and procedures of the EDC for crisis intervention services;

(b) crisis intervention techniques;

(d) the process for voluntary and involuntary hospitalization; and

(e) the appropriate utilization of community resources.

(3) The EDC must maintain documentation for each crisis call. The documentation must include:

(a) the date and time of the call;

(b) crisis responder;

(d) the nature of the emergency;

(e) risk assessment; and

(f) the result of the intervention.

(4) No individual may respond to crisis calls until the EDC documents in the individual's personnel file that the individual has received the training and instruction required in (2).

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3036 Eating Disorder Centers (edc): Client Rights and Grievances

(1) An EDC must develop and maintain a rights policy that supports and protects the fundamental human, civil, constitutional, and statutory rights of all clients. These rights must include:

(a) clients are admitted to treatment without regard to race, color, creed, national origin, religion, sex, sexual orientation, age, or disability, except for bona fide program criteria;

(b) clients are reasonably accommodated in case of sensory or physical disability, limited ability to communicate, limited English proficiency, or cultural differences;

(d) all clinical and personal information is treated in accordance with state and federal confidentiality regulations;

(e) clients can review their own treatment records in the presence of the administrator or designee;

(f) clients are fully informed of fees charged, including fees for copying records to verify treatment and methods of payment available; and

(g) clients are protected from abuse, harassment, and exploitation by staff or from other clients who are on agency premises.

(2) The EDC must post a copy of client rights in a conspicuous place in the facility accessible to clients and staff.

(3) These rights must be explained at the time of admission to the client and/or legal representative in terms that the client can understand.

(4) The EDC must develop a written client grievance policy that includes:

(a) a procedure for the submission of the client's written or verbal grievance to the EDC;

(b) time frames in which the EDC must review a grievance and reach a decision;

(i) the name of the EDC's contact person;

(ii) the steps taken on behalf of the client to investigate the grievance;

(iii) the results of the grievance process; and

(iv) the date of completion.

(d) clients will receive a copy of client grievance procedures describing the submission and disposition of complaints by the client and right to appeal without threat of reprisal; and

(e) client consent must be obtained for each release of information to any other person or entity.

(5) The grievance policy must be explained at the time of admission to the client in terms that the client and/or legal representative can understand.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3037 Eating Disorder Centers (edc): Intensive Outpatient Program

(1) In addition to the requirements established in this subchapter, an EDC providing intensive outpatient programs must comply with the requirements established in this rule.

(2) Intensive outpatient programs must be available three days per week for at least three hours per day.

(3) Intensive outpatient programs must include:

(a) individual and family therapy as required by the plan of care;

(b) group therapy; and

(4) Group therapy sessions must include at least two staff members, one of which must be a mental health professional, registered nurse, or registered dietitian.

(5) Intensive outpatient programs must have:

(a) a licensed mental health professional on-site during hours of operation; and

(b) additional support staff as needed in accordance with the EDC policy.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Mont. Admin. R. 37.106.3038 Eating Disorder Centers (edc): Partial Hospitalization Program

(1) In addition to the requirements established in this subchapter, an EDC providing partial hospitalization programs must comply with the requirements established in this rule.

(3) Partial hospitalization programs must operate five days per week for at least five hours per day.

(4) Partial hospitalization programs must include:

(a) individual and family therapy as required by the plan of care;

(b) group therapy;

(d) weekly medical consultations with a psychiatrist, advanced practice registered nurse, or registered nurse; and

(e) laboratory testing in accordance with the EDC's policy.

(5) Group therapy sessions must include at least two staff members, one of which must be a mental health professional, registered nurse, or registered dietitian.

(6) Partial hospitalization program staff must include:

(a) a licensed mental health professional on-site during hours of operation;

(b) a registered nurse available for consultation and treatment planning during hours of operation;

(c) a licensed psychiatrist or advanced practice registered nurse available for consultation and treatment planning during hours of operation;

(d) a registered dietitian available for consultation and treatment planning during hours of operation; and

(e) additional support staff as needed in accordance with the EDC policy.

History

Authorizing statute(s): 50-5-247, MCA
Implementing statute(s): 50-5-247, MCA
History: NEW, 2018 MAR p. 2214, Eff. 11/3/18.

Subchapter 37.106.31 Minimum Standards for Abortion Clinics

Mont. Admin. R. 37.106.3101 Purpose

(1) The purpose of these rules is to establish the minimum licensing requirements for the licensure of abortion clinics, pursuant to Title 50, chapter 20, part 9, MCA.

(2) For purposes of this subchapter, abortion clinics include facilities described at 50-20-901, MCA.

(3) Terms used in these rules will have the definitions provided in 50-20-901, MCA.

(4) The minimum licensing requirements established by these rules are designed to encompass the requirements which an abortion clinic must meet if it performs or provides all legally permissible abortions.

(5) Certain of these requirements may be waived if not necessary in light of the scope of, and any gestational limits on, the abortions to be performed or provided by the applicant or licensed abortion clinic. The license issued by the department will identify such limitations on the scope and gestational age of abortions for which the abortion clinic is licensed, and the requirements that have been waived as a result of such limitations. The failure to comply with such limitations will constitute a violation of the abortion clinic's license.

(a) Unless otherwise provided in these rules, general requirements and provisions and requirements pertaining to the abortion services provided by the abortion clinic may not be waived.

History

Authorizing statute(s): 50-20-901, 50-20-903, MCA
Implementing statute(s): 50-20-901, 50-20-902, 50-20-903, 50-20-904, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3102 Minimum Standards for Abortion Clinics: Licensing

(1) A clinic or other facility that performs surgical abortions or that provides abortion-inducing drugs to five or more patients each year must be licensed as an abortion clinic.

(a) The following are not abortion clinics and are not required to be licensed as such:

(i) a hospital as defined in 50-5-101, MCA;

(ii) a critical access hospital as defined in 50-5-101, MCA;

(iii) a rural emergency hospital as defined in 50-5-101, MCA;

(iv) an outpatient center for surgical services as defined in 50-5-101, MCA; and

(v) a facility that provides, prescribes, administers, or dispenses an abortion-inducing drug to fewer than five patients each year.

(2) An application for licensure of an abortion clinic must be received by the department, and must include:

(a) name of the applicant;

(b) location of the abortion clinic;

(d) medical director of the abortion clinic;

(e) qualifications of the administrator, medical director, and all professional staff;

(f) disclosures regarding:

(i) whether the applicant, owner, or affiliate has operated an abortion clinic that was closed as a direct result of issues of patient health and safety;

(ii) whether the owner or any clinic staff has been convicted of a felony offense; and

(iii) whether the owner or any clinic staff was ever employed by a facility owned or operated by the applicant that closed because of administrative or legal action;

(g) the type(s) of abortions the abortion clinic will perform or provide, and any gestational limits to such services; and

(h) an attestation that the applicant is of reputable and responsible character and is able to comply with all rules applicable to abortion clinics.

(3) An applicant must submit, with the application, administrative and legal documentation concerning information relating to (f); inspection reports, if any; and violation remediation contracts, if any.

(4) The abortion clinic will submit a license fee of $450 to the department with the initial application, and with each annual renewal application.

(5) The department will conduct inspections of abortion clinics as follows:

(a) Abortion clinics will receive an annual licensure inspection to determine compliance with the applicable Administrative Rules of Montana and Montana Code Annotated related to licensing of abortion clinics.

(b) If the department receives a complaint relating to an abortion clinic, it will conduct an investigation which may include additional inspection of the abortion clinic if needed to resolve the complaint.

(c) Licensed premises must be open to inspection by the department or its authorized representatives, and access to all records must be granted to the department, at all reasonable times.

(6) The department may deny, suspend, or revoke the license of an abortion clinic pursuant to 50-5-207, MCA.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-5-101, 50-20-902, 50-20-903, 50-20-904, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3103 Minimum Standards for Abortion Clinics: Physical Plant

(1) An abortion clinic must be constructed and maintained so as to prevent as much as possible the entrance and harborage of insects, rodents, and other vermin capable of transmitting disease including, without limitation, rats, mice, mosquitos, and flies.

(2) Patient rooms within the abortion clinic must be, at minimum, 100 square feet.

(a) There must be 4-foot available space on 1 side of the examination table and 3-feet on all other sides.

(3) The facility must have, at minimum, 2 exits no more than 80 feet apart.

(a) All exits must have lit egress lighting paths leading to the exits.

(4) All corridors within an abortion clinic must be at minimum 6-foot in width.

(5) Locks are prohibited on all doors to which a patient may have access.

(6) Abortion clinics must comply with all local building authority requirements.

(7) Any provision of this rule may be waived at the discretion of the department if conditions in existence prior to the adoption of this rule or construction factors would make compliance extremely difficult or impossible and if the department determines that the level of safety to patients and staff is not diminished.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3104 Minimum Standards for Abortion Clinics: Policies and Procedures

(1) Each abortion clinic must have a policy and procedure manual that is readily available to all facility staff, the department, and patients.

(2) A documented review/update to the policy and procedure manual must be done biennially by the facility medical director.

(3) The policy and procedure manual must include a current organizational chart.

(4) At minimum, the manual must include policies and procedures on:

(a) the different services that are offered at the clinic;

(b) maintaining and securing medical records;

(d) obtaining consent, including:

(i) informed consent by the patient;

(ii) parental consent and/or parental notification with respect to patients under the age of 18, to the extent legally permissible; and

(iii) wait time between consent and treatment;

(e) follow-up care;

(f) initial and ongoing staff training, including:

(i) training on mandatory reporter requirements; and

(ii) law enforcement training, or if law enforcement training is not available, training acceptable to the department, on identifying and assisting women and girls who are coerced into abortion or who are victims of rape, incest, or sex trafficking;

(g) provision to patients of a hotline telephone number to assist women and girls who are coerced into abortion or who may be victims of rape, incest, or sex trafficking;

(h) staff screening and acquisition of a background check;

(i) patient/clinical files, in accordance with ARM 37.106.3107(3);

(j) emergency procedures, in accordance with ARM 37.106.3109(3);

(k) types of anesthesia to be used by the abortion clinic, the conduct of anesthesia assessments, and the criteria to be used in conducting anesthesia assessments, in accordance with ARM 37.106.3110(1)(b) through (d), (3), and (4)];

(l) infection controls, in accordance with ARM 37.106.3112(2) and (3); and

(m) if the clinic is licensed to perform abortions after the point when an unborn child may survive the procedure, measures to be taken to ensure that an infant that is born alive during an abortion procedure receives appropriate care, including lifesaving measures, consistent with and in compliance with the requirements of federal and state law.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-804, 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3105 Minimum Standards for Abortion Clinics: Medical Director Qualifications

(1) An abortion clinic must have a medical director who has a current physician license in good standing with the Montana Board of Medical Examiners.

(2) The medical director must obtain 8 continuing education units (CEUs) in abortions or a related subject annually.

(3) The medical director is responsible for:

(a) overseeing treatment delivered in the facility;

(b) developing and reviewing facility policies and procedures; and

(4) The medical director participates in establishing competency criteria for medical personnel, including training in procedures performed at the facility.

(5) The medical director can also serve as the abortion clinic administrator.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3106 Minimum Standards for Abortion Clinics: Staff Files

(1) The facility is responsible for maintaining a file on each employee. Employee files may be inspected by the department at any time. If the file is not maintained at the facility, it must be made available to the department within 24 hours of request.

(2) At a minimum, the employee file must contain:

(a) the employee's name;

(b) a job description signed by the employee;

(d) a copy of current credentials, certification, or professional licenses required to perform the duties described in the job description;

(e) a name-based or FBI fingerprint background check; and

(f) documentation of annual training required in accordance with the policies adopted pursuant to ARM 37.106.3104(4)(f).

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3107 Minimum Standards for Abortion Clinics: Patient Files

(1) An individual clinical record must be established for each person receiving care. Each record must be accurate, legible, and promptly completed. The record must include at least the following:

(a) patient identification including the patient's full name, sex, address, date of birth, and next of kin (for minor patients) or emergency contact (for adult patients);

(b) admitting diagnosis;

(d) anesthesia reports;

(e) procedure reports;

(f) pertinent laboratory and pathology reports as indicated and tests for RH Negative factor. A pregnancy test or pathological exam of tissue shall be recorded to verify pregnancy;

(g) nurses' notes including admission, preoperative, and recovery;

(h) preoperative and postoperative orders;

(i) any allergies and abnormal drug reactions;

(j) discharge note, discharge diagnosis, and instructions given to the patient;

(k) documentation of properly executed informed patient consent which includes notice of transfer when deemed appropriate; and

(l) documentation:

(i) that the patient was provided a hotline telephone number for women who are coerced into an abortion or who are victims of rape, incest, or sex trafficking;

(ii) of the assistance provided to the patient if abortion clinic staff suspect the patient may be coerced into an abortion or may be the victim of rape, incest, or sex trafficking; and

(iii) of compliance with any applicable mandatory reporting requirements with respect to the patient.

(2) To ensure confidentiality, security, and physical safety of a patient's medical record, the abortion clinic must designate a person to oversee and manage the clinical records.

(3) The abortion clinic must have policies concerning clinical records. The policies must include:

(a) the retention of active records;

(b) the retirement of inactive records;

(d) the release of information contained in records.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3108 Minimum Standards for Abortion Clinics: Sanitation

(1) Each abortion clinic must ensure the premises and equipment be kept clean and free of vermin capable of transmitting disease, including without limitation, rats, mice, mosquitos, and flies.

(2) An abortion clinic must provide housekeeping services on a daily basis.

(3) Garbage and waste receptacles must be collected, stored, and disposed of in a manner designed to prevent the transmission of disease. Containers must be washed and sanitized before being returned to work areas.

(4) Suitable equipment for rapid and routine sterilization must be available to ensure the operating room materials are sterile. Sterilized materials must be packaged, labeled, and stored in a manner to maintain sterility and identify sterility dates. Sterility requirements also include:

(a) processes for cleaning and sterilization of supplies and equipment complying with manufacturer's instructions and recommendations; and

(b) internal and external indicators demonstrating a high level of disinfection and sterilization.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3109 Minimum Standards for Abortion Clinics: Emergency Procedures

(1) Staff trained in the use of emergency equipment and in cardiopulmonary resuscitation must be available whenever there is a patient in the abortion clinic.

(2) The following equipment shall be available to the operating room: emergency call system; oxygen; assistance equipment, including airways and manual breathing bag; sonography; and emergency drugs and supplies specified by the medical staff.

(3) The abortion clinic must have a written transfer agreement with a hospital, critical access hospital, or rural emergency hospital, for transfer of patients experiencing a medical emergency.

(4) The abortion clinic must have policies and procedures in the event of emergency with documented staff training in:

(a) hemorrhage;

(b) perforation;

(d) anaphylaxis; and

(e) emergency transfer to the facility with which the abortion clinic has a written transfer agreement.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3110 Minimum Standards for Abortion Clinics: Anesthesia

(1) The abortion clinic must:

(a) prohibit the use of flammable anesthesia;

(b) have a policy which defines the types of anesthesia that will be used within the abortion clinic;

(c) conduct an assessment prior to the patient's admission as well as prior to surgical abortion to evaluate the risk of anesthesia and of the procedure to be performed; and

(d) have policies that address the pre-operative assessment, the post-anesthesia assessment, and the basis or criteria used in conducting such assessments; and

(e) prevent recirculation of smoke originating within the surgical suite.

(2) Anesthesia must be administered only by a physician qualified to administer anesthetic agents or a certified registered nurse anesthetist (CRNA).

(3) A pre-operative evaluation of the patient within 24 hours of surgical abortion shall be done by a physician to determine the risk of and anesthesia needed for the procedure.

(4) Before discharge, each patient who received anesthesia must be evaluated by a physician or by a CRNA in accordance with applicable state health and safety laws, standards of practice, and abortion clinic policy. This post-anesthesia assessment must include evaluation of:

(a) respiratory function, including respiratory rate, airway patency, and oxygen saturation;

(b) cardiovascular function, including pulse rate and blood pressure;

(d) temperature;

(e) pain;

(f) nausea and vomiting; and

(g) postoperative hydration.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3111 Minimum Standards for Abortion Clinics: Quality Assurance

(1) Abortion clinics must have a quality assurance program that:

(a) is ongoing;

(b) is data-driven;

(d) addresses clinical and administrative issues as well as actual patient outcomes;

(e) has a defined set of quality improvement goals and objectives;

(f) actively seeks patient feedback, evaluates complaints and suggestions, and works to improve patient satisfaction;

(g) includes the active participation of the medical staff; and

(h) respects the health care rights of all patients, including the right to privacy.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3112 Minimum Standards for Abortion Clinics: Infection Prevention and Control

(1) The abortion clinic must maintain an infection prevention and control program that seeks to minimize infections and communicable diseases. The abortion clinic is responsible for providing a plan of action for preventing, identifying, and managing infections and communicable diseases, and for immediately implementing corrective and preventive measures that result in improvement.

(a) The infection prevention and control program must include documentation that the abortion clinic has considered, selected, and implemented nationally recognized infection control guidelines.

(2) The abortion clinic must have written policies that also address cleaning of patient treatment and care areas, including:

(a) cleaning before use; and

(b) cleaning between patients.

(3) The abortion clinic must have policies and processes in place for:

(a) the monitoring and documentation of the cleaning, high level disinfection, and sterilization of medical equipment, accessories, instruments, and implants; and

(b) minimizing the sources and transmission of infections, including adequate surveillance techniques.

(4) A system must exist for the proper identification, management, handling, transport, storage, and disposal of biohazardous materials, and medical wastes, and human fetal remains, whether solid, liquid, or gas.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3113 Minimum Standards for Abortion Clinics: Safety

(1) The abortion clinic must designate a safety officer who is responsible for the facility's safety plan.

(2) The abortion clinic must have a safety program which addresses the organization's environment of care and safety for all patients, staff, and others. The elements of the safety program must include:

(a) a process for identifying hazards, potential threats, near misses, and other safety concerns;

(b) a process for reporting known adverse incidents to proper authorities;

(d) prevention of falls or physical injuries involving patients, staff, and others.

(3) Products that carry an expiration date, including medications, reagents, and solutions, are monitored and disposed of accordingly.

(4) Prior to use, appropriate education is provided to intended operators of newly acquired devices or products to be used in the care of patients.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Mont. Admin. R. 37.106.3114 Minimum Standards for Abortion Clinics: Emergency Preparedness

(1) Abortion clinics must develop a written disaster plan in conjunction with emergency services in the community.

(2) Abortion clinics must conduct a review or physical exercise of such procedures at least once a year, and prepare and retain on file, for a minimum of three years, a written report that includes:

(a) date and time of the review or exercise;

(b) the names of staff involved in the review or exercise;

(d) the names of other persons involved in the review or exercise;

(e) a description of all phases of the procedure and suggestions for improvement; and

(f) the signature of the person conducting the review or exercise.

(3) Fire drills must be conducted twice annually no closer than four months apart.

History

Authorizing statute(s): 50-20-903, MCA
Implementing statute(s): 50-20-903, MCA
History: NEW, 2024 MAR p. 2242, Eff. 9/21/24.

Subchapter 37.106.32 Residential Treatment Centers

Mont. Admin. R. 37.106.3201 Purpose

(1) These rules establish licensing procedures and requirements for residential treatment centers.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3202 Definitions

(1) "Adolescent" means any person between the ages of 10 and 19 years old who is placed in a facility by a parent or legal guardian.

(a) Upon admission to the facility, the adolescent is considered a resident.

(b) The adolescent may remain as a resident up to the age of 20 if they are enrolled in an accredited secondary school.

(2) "Case plan" means a specific plan for providing care, treatment, and services of any kind to a specific resident.

(3) "Chemical restraint" means the use of a drug or medication that is used to control behavior or restrict the resident’s freedom of movement, and which is not a standard treatment for the resident’s medical or psychiatric condition.

(4) "Correspondence search" means reading a resident’s mail or inspecting the contents of a package.

(5) "Department" means the Department of Public Health and Human Services.

(6) "Direct care staff" or "staff" means facility personnel who directly participate in the care, supervision, and guidance of the resident.

(7) "Discharge plan" means a realistic plan developed to transition the resident home or to a less restrictive and appropriate placement with specific services identified and available.

(8) "Licensed addiction counselor" means a person licensed under Title 37, chapter 39, MCA.

(10) "Licensure bureau" means the Office of Inspector General Licensure Bureau.

(11) "Mechanical restraint" means the use of devices as a means of restricting a person's freedom of movement.

(12) "Mental health professional" means a person licensed pursuant to 37-39 102(18), MCA.

(13) "Near miss" means an unplanned, unforeseen, or potentially dangerous situation where safety was compromised but that did not result in injury.

(14) "Pat-down search" means a body search done outside of a person's clothing with the intention of locating suspected contraband.

(15) "Personal property search" means a search which includes going through a resident’s personal property and/or room including closet, bed, desk, dresser drawers, backpacks, etc., with the intention of looking for contraband.

(16) "Physical escort" means the temporary touching or holding of the hand, wrist, arm, shoulder, or back for the purpose of inducing a resident to walk to a specific location.

(17) "Physical restraint" means a personal restriction that immobilizes or reduces the ability of the free movement of an individual's arms, legs, or head. The term does not include physical escort.

(18) "Resident-to-staff ratio" means the number of residents in care per each on-duty awake direct care staff member.

(19) "Seclusion" means a behavior control technique involving locked isolation in which the resident is physically prevented from leaving. The term does not include time-out.

(20) "Self-administration assistance" means providing necessary assistance to any resident in taking their medication, including:

(a) removing medication containers from secured storage;

(b) providing verbal suggestions, promoting, reminding, gesturing, or providing a written guide for self-administering medications;

(c) handling a prefilled, labeled medication holder, labeled unit dose container, syringe, or original marked, labeled container from the pharmacy;

(d) opening the lid of the container described in (c) for the resident;

(e) guiding the hand of the resident to self-administer the medication;

(f) holding and assisting the resident in drinking fluids to assist in the swallowing of oral medications; and

(g) assisting with removal of a medication from a container for a resident with a physical disability which prevents independence in the act.

(21) "Serious incident" means suicide attempt, use of excessive physical force by staff, use of a restraint or seclusion, physical or sexual assault of a resident by staff, or another resident, injury to a resident which requires emergency medical care, known or suspected abuse or neglect of a resident by staff or another resident, a near miss or the death of a resident, elopement, or an incident that involves law enforcement.

(a) “Abuse” means actual or psychological harm, or substantial risk of psychological harm to a resident.

(b) “Neglect” means abandonment of a resident.

(22) "Time-out" means the restriction of a resident for a period of time to a designated unlocked area from which the resident is not physically prevented from leaving for the purpose of providing the resident the opportunity to regain self-control.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3203 Application of Other Rules

(1) Any facility that includes in its marketing, advertising, information packet, or other similar document reference to providing residential mental health services, assessment, counseling, co-occurring substance use disorder treatment, and behavioral health treatment 24 hours a day to youth under 19 years of age must be licensed by the department under Title 50, chapter 5, MCA.

(2) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of ARM Title 37, chapter 106, subchapter 32, the terms of subchapter 32 will apply to residential treatment facilities.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3204 Licensing Fees

(1) Facilities must submit payment for licensure annually.

(2) Licensing fees are based on the number of residents the facility is licensed to serve as shown in the table below:

Number of residents | Licensing Fees 1-10 | $1,688 11-25 | $4,345 26-50 | $8,138 51 and more | $13,313

(3) All fees provided for by this rule are nonrefundable and are not prorated for portions of the licensing period.

(4) All fees must be paid in full by June 1 of each year.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3205 Issuance and Renewal of a License

(1) Applications for a facility license must be submitted on an application provided by the department.

(2) Renewal applications must be received within 30 days prior to the expiration date of the current license.

(3) The facility must submit all written facility management policies and procedures to the department for approval with the initial application. Policies and procedures must comply with requirements outlined in this subchapter.

(5) If the department determines during the survey that the applicant is out of compliance with the applicable licensing requirements, the department will notify the applicant of the specific deficiencies. The applicant must submit a written plan of correction within ten working days of the department's notification of noncompliance specifying how compliance will be made and maintained in the future.

(6) The department must receive all required information and approve the plan of correction prior to issuing a license.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3206 License Denial, Suspension, Restriction, and Revocation

(1) The department, after written notice to the applicant or facility, may deny, suspend, cancel, reduce, modify, or revoke a license upon a finding of any of the following:

(a) the facility is not in compliance with fire safety standards;

(b) the facility is not in substantial compliance with other licensing requirements established by this subchapter;

(c) the facility has made any misrepresentations to the department, either negligent or intentional, regarding any aspect of its operations or facility;

(d) the facility has failed to use payments for the support of the residents;

(e) the facility, persons associated with the facility, any staff member, or persons living at the facility have been named as the perpetrator in a substantiated report of abuse or neglect;

(f) the facility, persons associated with the facility, any staff member, or persons living at the facility have violated provisions of this subchapter that resulted in abuse or neglect;

(g) the facility, persons associated with the facility, or any staff member do not meet the requirements in ARM 37.106.3224;

(h) the facility failed to report an incident of abuse or neglect to the department or its local affiliate as required in 41-3-201, MCA;

(i) it is determined on the basis of a department or law enforcement investigation that the facility, persons associated with the facility, any staff member, or anyone living in a facility may pose any risk or threat to the safety or welfare of residents;

(j) the facility has failed to provide an acceptable written plan of correction as specified in ARM 37.106.3205(5);

(k) the facility did not pay the licensure fee as required in ARM 37.106.3204; or

(l) the facility employs or has persons living at the facility that do not have an approved background check as required in ARM 37.106.3213.

(2) At the discretion of the department and for their protection, residents may be removed immediately upon receipt of a report of sexual or physical abuse or neglect by the facility.

(a) upon referral of suspected child abuse or neglect regarding a facility, the initial investigation reveals that there are reasonable grounds to believe that a resident may be in danger of harm;

(b) the department requests and is denied access to the facility, residents, or staff; or

(c) through a licensing investigation, it is determined that the facility, persons associated with the facility, any staff member, or persons living at the facility have violated a licensing regulation that results in harm to a resident which falls within the definitions of abuse and neglect as defined in ARM 37.106.3202(21)(a) and (b), whether or not a criminal prosecution is initiated.

(4) Until the issuance of a contrary decision by the department, the denial, suspension, cancellation, reduction, modification, or revocation of a license will remain effective and enforceable.

(6) Nothing in these rules precludes the department from utilizing provisions of the Montana Administrative Procedure Act, including but not limited to summary suspension under 2-4-631(3), MCA.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3207 Written Policy and Procedures

(1) A current written policy and procedure manual that includes all policies required in this subchapter and describes all services provided in the facility, must be developed, implemented, and maintained at the facility. The manual must be available to staff, residents, parents or legal guardians of residents, and the department and must be complied with by all personnel and its agents.

(2) The policy and procedure manual must be submitted with the initial application for department approval.

(3) Any updates to the policy and procedure manual must be submitted to the department for approval 30 days prior to implementing the policy.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3208 Admissions

(1) The facility will admit only those residents who meet its admissions policies.

(2) The facility must have written policies and procedures for screening all referrals.

(3) The facility must have a written admissions policy and procedures which include:

(a) the age, sex, and behavioral and/or emotional needs of adolescents served;

(b) verification of legal authority to place or remove a resident from the facility;

(d) a description of the orientation provided to residents; and

(e) an initial assessment of the resident’s emotional, medical, developmental, social, and behavioral status that must be conducted at the time of admission.

(5) The facility’s policies and procedures must provide for and encourage a preplacement process with the resident and family.

(6) Placements may only be accepted from the parent or legal guardian of the resident.

(7) The admissions policy may not limit contact with the resident’s family for no more than seven days after admission.

(8) A facility must have written orientation policies and procedures for admission to the facility that include:

(a) a procedure for ensuring that each resident receives a personal orientation to the facility as soon as appropriate, but no later than 24 hours after admission;

(b) an inventory of each resident’s belongings;

(d) information on privilege systems;

(e) a discipline policy;

(f) health and safety procedures;

(g) facility rules;

(h) information on the facility’s search policies, resident rights, and grievance procedure; and

(i) emergency evacuation procedures, including designated escape routes.

(9) Documentation that is signed by both the resident and the staff person(s) conducting the orientation must be placed in the resident’s file.

(10) A facility must maintain a list of current residents to ensure all residents are accounted for and that staffing requirements are met in all circumstances.

(11) A facility must ensure compliance of each resident’s placement with the Interstate Compact on the Placement of Children (ICPC), as provided in 41-4-101, MCA, and ARM 37.50.901.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3209 Written Agreement

(1) The facility must enter into a written agreement with the resident’s parent or legal guardian at the time of admission. The written agreement must include:

(a) the terms of the placement, the responsibilities of the facility, and the responsibility of the parent or legal guardian;

(b) a statement describing specific services the facility will provide;

(d) a statement explaining the resident’s responsibilities, including house rules;

(e) a statement describing the communication policy, which must include a minimum of one confidential video telephonic communication contact per week between the resident and the resident's parents or legal guardians or foster parent(s), in addition to any therapeutic contact (family therapy), which:

(i) is confidential, i.e., in a private setting with no other individuals in the vicinity of being able to see or hear what is being discussed; and

(ii) is allocated a minimum of 15 minutes for confidential video communication between the resident and the resident's parents or legal guardian;

(f) transportation of the resident to and from medical appointments and activities;

(g) a statement explaining specific charges for care and an itemized statement of what expenses in addition to the cost of care will be charged, including fines, penalties, or late fees that will be assessed;

(h) a statement that the agreed-upon rate will not be changed unless 30 days' advance written notice is given to the resident’s parent or legal guardian;

(i) criteria for requiring transfer or discharge of the resident;

(j) the refund policy; and

(k) date and signature of the administrator and the resident’s parent or legal guardian.

(2) A copy of the agreement must be filed in the resident’s file and a copy must be provided to the resident’s parent or legal guardian.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3210 Discharge

(1) The facility must assist the resident and family in preparing for the resident’s discharge from the facility.

(2) At the time of discharge of a resident from the facility, a written discharge report must be completed, and include:

(a) the resident’s name, date of birth, admission and discharge dates, reason for placement and discharge, and name of parent or legal guardian;

(b) a written summary of services provided, including the resident’s participation and progress in the facility, contact information of people who conducted evaluations, and condition of the resident at time of discharge;

(d) medical, dental, and psychiatric care received during placement;

(e) follow-up health care required;

(f) current medications, dosage taken, number of times per day, and name of prescribing licensed health care professional;

(g) the resident’s reaction to discharge and whether or not the discharge was planned or unplanned;

(h) recommendations for follow-up services;

(i) an up-to-date inventory of the resident’s clothing and personal belongings; and

(j) the signature of the staff member who prepared the report and the date of preparation.

(3) The discharge report must be maintained by the facility in the resident’s file and a copy must be provided to the parent or legal guardian at the time of discharge. Written documentation that the discharge report was provided to the parent or legal guardian must be maintained in the resident’s file.

(4) A resident may only be discharged to the parent or legal guardian of the resident. The resident may be discharged to individuals other than the parent or legal guardian with written consent from the parent or legal guardian prior to discharge.

(5) Unless otherwise prohibited by law or court order, a facility must allow a parent or legal guardian to remove a youth from the facility at any time.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3211 Case Plan

(1) Each facility must develop and implement a case plan for each resident in care.

(2) The case plan must include:

(a) the resident’s physical and medical needs;

(b) behavior management issues;

(d) measurable goals and objectives and corresponding time frames;

(e) the responsibilities of the resident, staff, and parent or legal guardian for meeting the goals and objectives;

(f) education plans; and

(g) discharge plans and estimated discharge date.

(3) The initial case plan must:

(a) be developed within seven business days after admission; and

(b) be updated at least every 90 days from the day of development.

(4) The resident and the parent or guardian must be involved in developing and updating the case plan.

(5) The resident, parent or legal guardian, and facility staff developing the case plan must sign and date the plan and plan updates.

(6) A copy of the signed case plan must be provided to the parent or legal guardian and maintained in the resident’s file.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3212 Rights and Grievances

(1) The facility must have a written resident rights policy that supports and protects the constitutional and statutory rights of all residents. These rights must include the right to:

(a) be treated with dignity and respect;

(b) be free from abuse, neglect, exploitation, harassment, and unnecessary physical restraint;

(c) be free from corporal, cruel, harsh, unnecessary punishment, name calling, infliction of pain, or excessive physical exercise;

(d) have adequate food, water, clothing, school supplies, and personal hygiene supplies;

(e) receive care and services according to individual need;

(f) receive educational services in accordance with Montana state law, if the facility operates during the school year;

(g) be free from discrimination;

(h) a safe environment with respect for human dignity;

(i) protection of the privacy of information and records regarding each resident and the resident’s family;

(j) communication and visitation privileges with family in person, by mail, or by phone;

(k) be allowed to contact the Montana abuse reporting hotline to report allegations of abuse and neglect;

(l) submit complaints and alleged violations of these rules, including a prohibition on retaliation against a resident for submitting such a complaint;

(m) personal privacy, when it is not contrary to the treatment and safety needs of the resident; and

(n) have consideration of the resident’s opinions and recommendations when developing the case plan.

(2) A facility is prohibited from:

(a) using physical discipline or the threat of physical discipline as a punishment, deterrent, or incentive;

(b) unlawfully depriving a resident of a basic necessity or a constitutional or a statutory right, including education;

(c) admitting a resident who is under the age approved on the license or has a condition that the facility is not authorized to treat pursuant to the facility’s admission policy;

(d) using medical, chemical, or mechanical restraints;

(e) using physical restraints, except in emergency circumstances to ensure the immediate physical safety of the resident, a staff member, or others, when less restrictive interventions have been determined to be ineffective;

(f) using a licensure candidate to provide mental health professional services if the parent or legal guardian of a resident has not provided written consent;

(g) using seclusion; and

(h) sexually abusing, exploiting, or harassing a resident.

(3) The facility must review the resident rights policy with the resident and parent or legal guardian at the time of admission.

(a) The facility staff reviewing the policy, the resident, and the parent or legal guardian of the resident must sign a statement acknowledging the review.

(b) The signed statement must be maintained in the resident’s file.

(4) The facility must have a written grievance policy which outlines the procedures to be followed by a resident or parent or legal guardian in presenting a grievance to the facility.

(5) The facility must review the grievance policy with the resident and the parent or legal guardian at the time of admission.

(a) The facility staff reviewing the policy, the resident, and the parent or legal guardian of the resident must sign a statement acknowledging the review.

(b) The signed statement must be maintained in the resident’s file.

(6) Any written grievance report must be maintained in the resident’s file. The report must include the nature of the complaint, the date of the complaint, and a statement indicating how the issue was resolved.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3213 Background Checks

(1) All administrators, staff, volunteers, persons associated with the facility, and any adult living at the facility must complete a National Crime Information Center (NCIC) fingerprint-based background check from the Federal Bureau of Investigation. Results of the fingerprint-based background check must be documented prior to working or living at the facility.

(2) All administrators, staff, volunteers, persons associated with the facility, and any adult living at the facility must complete a Department of Public Health and Human Services child protective services background check, and, if applicable, a tribal child protective services background check, and a tribal criminal background check prior to working or living at the facility.

(4) All administrators, staff, volunteers, persons associated with the facility, and any adult working or living at the facility must complete a Montana Sexual or Violent Offender Registry Check at https://app.doj.mt.gov/apps/svow/search.aspx and a National Sexual and Violent Registry Check at https://www.nsopw.gov/.

(5) Results of all required criminal and child protective background checks and registry checks must be documented prior to working or living at a facility.

(6) The department will deny or revoke a license upon finding that:

(a) any administrator, staff, volunteer, person associated with the facility, or any adult living at the facility has been convicted by a court of competent jurisdiction of a felony or misdemeanor involving but not limited to homicide, sexual intercourse without consent, sexual assault, aggravated assault, assault on a minor, assault on an officer, assault with a weapon, kidnapping, aggravated kidnapping, prostitution, robbery, or burglary;

(b) any administrator, staff, volunteer, person associated with the facility, or any adult living at the facility has a conviction of a crime pertaining to children and families, including, but not limited to child abuse or neglect, incest, child sexual abuse, ritual abuse of a minor, felony partner and family member assault, child pornography, child prostitution, internet crimes involving children, felony endangering the welfare of a minor, felony unlawful transactions with children, or aggravated interference with parent-child contact;

(c) any administrator, staff, volunteer, person associated with the facility, or any adult living at the facility has within the previous five years a felony conviction of a drug-related offense, including but not limited to use, distribution, or possession or manufacture of dangerous drugs, criminal possession of imitation dangerous drugs with the purpose to distribute, criminal possession, manufacture of, or delivery of drug paraphernalia, or driving under the influence of alcohol or other drugs; or

(d) any administrator, staff, volunteer, person associated with the facility, or any adult living at the facility has within the previous five years a conviction for misdemeanor partner and family member assault, misdemeanor endangering the welfare of a child, misdemeanor unlawful transaction with a child, or for a crime involving an abuse of the public trust; or

(e) any administrator, staff, volunteer, person associated with the facility, or any adult living at the facility has been convicted of abuse, sexual abuse, neglect, or exploitation of an elderly person or a person with a developmental disability.

(7) Any administrator, staff member, volunteer, person associated with the facility, or adult living at the facility, who is charged with a crime involving children, physical or sexual violence against any person, or any felony drug-related offense and awaiting trial may not provide care or be present at the facility pending the outcome of the criminal proceeding.

(8) No administrator, staff, volunteer, person associated with the facility, or any adult living at the facility shall have been named as a perpetrator in a substantiated report of child abuse or neglect or listed on the Montana Sexual or Violent Offender Registry or the National Sex Offender Public Website.

(9) The facility is responsible for ensuring that the persons covered by this subchapter have met these requirements prior to providing care.

(10) No administrator, staff, volunteer, person associated with the facility, or adult living at the facility may pose any potential threat to the health, safety, and well-being of the residents.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3214 Child Abuse or Neglect and Serious Incidents

(1) A facility must require each resident, person associated with the facility, and staff member to read and sign a statement that clearly defines abuse and neglect and outlines the individual's responsibility to report all known or suspected incidents of abuse or neglect of any resident to the department within 24 hours.

(2) Any facility staff or person associated with the facility who knows or has reasonable cause to suspect that an incident of abuse or neglect has occurred must report within 24 hours of the incident to the administrator, or a person designated by the administrator, and to the state child abuse hotline, (866) 820-5437, as required in 41-3-201, MCA. The facility must fully cooperate with any investigation conducted as a result of the report.

(3) A facility must have written policies and procedures for handling any suspected incident of abuse or neglect, including:

(a) a procedure for ensuring that the staff member suspected does not continue to provide direct care until an investigation is completed;

(b) a procedure for developing a safety plan approved by the department which protects the residents and staff until the investigation is complete;

(d) a procedure for reporting, investigating, and taking appropriate disciplinary measures against any staff member accused of sexually abusing, exploiting, or harassing a resident.

(4) Any serious incident involving a resident must be reported in writing within one business day to the department's licensure bureau. The report must include:

(a) the date and time of the incident;

(b) the names of all residents and staff member(s) involved;

(d) a statement written by the staff member that was involved in the incident or witnessed the incident; and

(e) documentation of the date and time the incident was reported to the parent or legal guardian.

(5) A copy of the report must be maintained in the resident’s file.

(6) The facility must cooperate with all licensing surveys and investigations, which may include private one-on-one interviews with staff and residents.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3215 Physical Environment

(1) Each facility must comply with all applicable federal, state, and local regulations, laws, and building codes.

(2) Adequate space must be provided for all phases of daily living, including recreation, privacy, group activities, and visits from family, friends, and community acquaintances.

(3) Residents must have indoor areas of at least 40 square feet of floor space per resident for quiet, reading, study, relaxing, and recreation. The minimum space requirement may not include halls, kitchens, and any rooms not used by residents.

(4) A bedroom must contain at least 50 square feet of floor space per person. Bedrooms for single occupancy must have at least 80 square feet.

(5) The maximum number of residents per bedroom must not exceed four. The bedrooms must have floor-to-ceiling walls.

(6) Residents sharing a bedroom must be no more than three years in age apart.

(7) The facility must provide:

(a) at least one toilet for every eight residents; and

(b) one bathing facility for every eight residents.

(8) All rooms with toilets or shower and bathing facilities must have an operable window to the outside or must be exhausted to the outside by a mechanical ventilation system.

(9) Each resident must have access to a bathroom without entering another bedroom, the kitchen, or dining areas.

(10) Hot and cold water must be available in all kitchens, bathrooms, and laundry. The temperature of hot water supplied to hand washing and bathing facilities must not exceed 120°F.

(11) For adequate housekeeping the facility must ensure that:

(a) the building and grounds are free, to the extent possible, of harborage for insects, rodents, and other vermin;

(b) all electrical, mechanical, plumbing, fire protection, heating, and sewage disposal systems must be kept in operational condition;

(c) the floors, walls, ceilings, furnishings, and other equipment are clean and in good repair, free of hazards and offensive odors;

(d) cleaning equipment and supplies are provided in sufficient quantity to meet the housekeeping needs of the facility; and

(e) a maintenance policy and schedule, which describes the regular maintenance of the facility, is adhered to.

(12) All rooms and hallways must have adequate lighting.

(13) Facilities must post a sign within the facility that is accessible to all residents and to the public. The sign must provide information on what agency should be contacted to report a violation of law or policy and must include contact information for the Office of Inspector General Licensure Bureau, the Montana Child Abuse and Neglect Hotline (866-820-5437), and local law enforcement.

(14) With respect to any conditions in existence in licensed facilities prior to July 1, 2025, the specific requirements in this rule may be modified by the department to allow alternative arrangements that will provide the same level of safety to residents and staff. In no case will the modification afford less safety than that which, on the discretion of the department, would be provided by compliance with the corresponding requirement in this rule.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3216 Water Supply

(1) An adequate and potable supply of water must be provided.

(2) Before a license may be issued, a facility using an individual, shared, or multiple user water supply must submit the following to the department or its designee:

(a) satisfactory coliform bacteria and nitrate test results as specified in ARM Title 17, chapter 38, subchapter 2; and

(b) the results of an onsite sanitary survey of the water supply system to detect sanitary deficiencies.

(3) A supplier of an individual, shared, or multiple user water supply shall conduct a coliform bacteria test of the system at least twice a year with one sample collected between April 1 through June 30 and the second sample collected between August 1 through October 31 and conduct a nitrate test of the system at least once every three years. Water tests must be analyzed at a certified laboratory. A supplier must keep sampling result records for at least three years.

(4) A public water supply system must be constructed and operated in accordance with current applicable laws as regulated by the Montana Department of Environmental Quality.

(5) Nonpotable water sources must be marked "not for human consumption."

(6) Plumbing must be installed and maintained in a manner to prevent cross connections between the potable water supply and any nonpotable or questionable water supply or any source of pollution through which the potable water supply might be contaminated. The potable water system must be installed to preclude the possibility of backflow. A hose may not be attached to a faucet unless a backflow prevention device is installed.

(8) Extension, alteration, repair, or replacement of a water supply system or development of a new water supply system must be in accordance with all applicable state and local laws.

(9) Bottled and packaged potable water must be obtained from a licensed and approved source and be handled and stored in a way that protects it from contamination.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3217 Sewage System and Solid Waste

(2) All sewage, including liquid waste, must be disposed of by a public sewage treatment and disposal system constructed and operated in accordance with applicable state and local laws.

(3) A wastewater system has failed and requires replacement or repair if any of the following conditions occur:

(a) the system fails to accept, treat, or dispose of wastewater as designed;

(b) effluent from the wastewater system contaminates a potable water supply or state waters; or

(c) the wastewater system is subjected to mechanical failure, including electrical outage, or collapse or breakage of a septic tank, lead line, or drain field line.

(4) Extension, alteration, replacement, or repair of any wastewater system must be done in accordance with all applicable state and local laws.

(5) Mop water or soiled cleaning water may not be disposed of in any sink other than a mop or utility sink or a toilet.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3218 Fire Safety

(1) The department adopts and incorporates by reference the 2012 edition of the National Fire Protection Association (NFPA) 101: Life Safety Code Handbook, which sets forth the fire safety regulations that apply to all facilities.

(2) The local or state fire authority having jurisdiction must annually certify a facility for fire and life safety.

(3) Smoke detectors and smoke alarms must be installed and operated in accordance with the FC set forth in the locally adopted NFPA.

(4) Carbon monoxide detectors must be installed and operated in accordance with the NFPA.

(5) A workable portable fire extinguisher, with a minimum rating of 2A10BC, must be located on each floor of the facility. Fire extinguishers must be:

(a) mounted on the wall not to exceed five feet from handle to floor and no closer than four inches from the floor;

(b) no more than 75 feet travel distance apart;

(c) inspected, recharged, and tagged at least once a year by a person certified by the state to perform such services; and

(d) not obstructed or obscured from view.

(6) Staff must check battery operated smoke detectors at least once each month and the batteries must be replaced at least once each year. Documentation, including the date and the signature of the person checking or replacing the batteries, must be maintained at the facility.

(7) Integrated dial-out-smoke detection systems that are monitored from an outside source must have the date showing the most recent maintenance. Maintenance must occur once per year.

(8) Orientation for staff and residents must include instruction of the facility’s fire evacuation procedure. The fire evacuation procedure must be posted in a conspicuous place in the facility.

(9) All exits must be clear and unobstructed at all times.

(10) Paint, flammable liquids, and other combustible material must be kept in locked storage away from heat sources or in outbuildings not used by the residents.

(11) The facility must conduct at least one fire drill per quarter per each work shift. Drill observations must be documented and maintained in the facility files for at least three years. The documentation must include:

(a) time and location of the drill;

(b) identification of participating staff;

(d) steps taken to correct such problems.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3219 Emergency and Evacuation Plans

(1) A facility must have and follow a written emergency plan developed in conjunction with emergency services in the community, and it must include specific procedures for evacuations, disasters, medical emergencies, hostage situations, casualties, missing residents, and other serious incidents identified by the facility.

(2) The emergency plan must include:

(a) designation of authority and staff assignment;

(b) a specific evacuation plan;

(d) provisions for supervision of residents after an evacuation or relocation;

(e) provisions for the instruction of all residents on how to respond in the case of an emergency;

(f) provisions for arranging medical care and notifying the resident’s licensed health care professional, and parent or legal guardian; and

(g) maintenance and repair of essential equipment including a two-way radio.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3220 Safety

(1) A facility must have written policies and procedures on safety and equipment.

(2) There must always be a first aid kit with sufficient supplies available. A first aid kit must:

(a) be readily available on site as well as in all vehicles used by the facility;

(b) meet the standards of an appropriate national organization for the activity being conducted and the location and environment being used;

(d) be inventoried on a quarterly basis.

(3) Policies and procedures must be in place for the safe use and storage of fuels and all heat sources, including inaccessibility to residents when not being used under the direct supervision of staff.

(4) Cleaning materials, flammable liquids, detergents, aerosol cans, and other poisonous and toxic materials must be kept in their original containers and in a place inaccessible to residents. They must be used in such a way that will not contaminate play surfaces, food, food preparation areas, or constitute a hazard to the residents. Bio-contaminants including blood, bodily fluids, and other infectious materials must be properly disposed of.

(5) No extension cord will be used as permanent wiring. All appliances, lamp cords, and exposed light sockets must be suitably protected to prevent electrocution.

(6) Any pet or animal present at the facility indoors or outdoors must be in good health, show no evidence of carrying disease, and be a friendly companion for the residents. The administrator is responsible for maintaining the animal's vaccinations and vaccination records. These records must be made available to the department upon request. The facility must make reasonable efforts to keep stray animals off the premises.

(7) Emergency information for residents must be easily accessible at the facility. Emergency information for each resident must include:

(a) the name, address, telephone number, and relationship of a designated person to be contacted in case of an emergency;

(b) the name, address, and telephone number of the resident’s licensed health care professionals or source of health care;

(c) the name, address, telephone number, and relationship of the person able to give consent for emergency medical treatment;

(d) documentation of any medical conditions that may affect care including but not limited to known allergies;

(e) a signed release for emergency medical treatment from the parent or legal guardian; and

(f) a copy of the resident’s current medical insurance card or insurance information when a card is not available to providers.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3221 Case Records

(1) A facility must maintain a written case record for each resident which contains administrative, treatment, and educational data from the time of admission until the time the resident is discharged from the facility.

(2) The case record must include:

(a) the name, sex, and birth date of the resident;

(b) the name, address, and telephone number of the parent or legal guardian of the resident;

(d) current immunization records and documentation of exemptions per facility policy;

(e) date of discharge, person, and signature whom the resident was released to, and signed discharge summary;

(f) all documents related to the referral of the resident to the facility;

(g) current custody and parent or legal guardianship documents or other documents verifying legal custody of the parent or legal guardian placing the resident per facility policy;

(h) the resident’s court status, if applicable;

(i) a copy of the resident’s birth certificate;

(j) consent forms signed by the parent or legal guardian prior to placement allowing the facility to authorize all necessary medical care, routine tests, immunization, and emergency medical or surgical treatment;

(k) cumulative health records including medical history provided by the parent or legal guardian;

(l) education records and reports, including but not limited to report cards and individual education plan reports;

(m) treatment or clinical records and reports;

(n) records of physical restraints and special or serious incidents;

(o) case plans, treatment plans, all updates and related material;

(p) social assessment that is current to date of placement; and

(q) an immediate needs assessment and assigned responsibilities.

(3) Resident records must be maintained at the facility for a minimum of six years.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3222 Confidentiality of Records and Information

(1) All records maintained by a facility and all personal information made available to a facility pertaining to a resident must be kept confidential and are not available to any person, agency, or organization except as specified in (2) and (3).

(2) All records pertaining to a resident are available upon request to:

(a) the resident’s parent or legal guardian or attorney absent specific and compelling reasons for refusing such records;

(b) a court with continuing jurisdiction over the placement of the resident or any court of competent jurisdiction issuing an order for such records;

(d) an adult who was formerly the resident in care to whom the records pertain.

(3) Records pertaining to residents must be available to the department for the purposes of licensing, relicensing, or investigating a complaint of the facility.

(4) Necessary information pertaining to the resident must be disclosed when staff are following mandatory reporting requirements as outlined in this rule and within the scope of an individual's license.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3223 Reports

(1) The facility must submit to the department, upon its request, any reports required by federal law, state law, or regulations.

(2) The facility must report any of the following changes in writing to the department's licensure bureau, prior to the effective date of the change:

(a) a change of administrator;

(b) a change in location of which the department must approve prior to the move;

(d) any significant change in the facility policies or procedures or services.

(3) Runaways shall be reported immediately to the police and parent or legal guardian and within the next working day to the licensure bureau.

(4) Disasters or emergencies which require relocation of residents or closure of the facility must be reported to the licensure bureau within the next working day.

(5) Any serious incident as defined in this subchapter must be reported in writing to the licensure bureau within 24 hours of the incident.

(6) Any fire or other incident that caused significant damage to the property must be reported to the licensure bureau within 24 hours of the incident.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3224 Requirements for All Administrators, Staff Members, and Volunteers

(1) A facility must have written personnel and facility policies and procedures covering the following items:

(a) screening procedure for all applicants;

(b) job qualifications for all positions;

(d) supervisory structure; and

(e) performance evaluations.

(2) In addition to the specific requirements set out in this subchapter, all staff working in a facility must:

(a) be at least 19 years of age;

(b) have a high school diploma or GED; and

(3) Any administrator, staff member, volunteer, or other person whose behavior or health status endangers the residents may not be allowed at the facility.

(4) Facility volunteers must:

(a) not be included in the resident-to-staff ratios;

(b) be under the supervision of staff;

(c) follow written policies and procedures developed by the facility defining the responsibilities, limitations, and supervision of volunteers;

(d) complete all required background checks; and

(e) be provided orientation and initial training. The training must include orientation on all facility policies and procedures.

(5) All facility staff who transport residents must have a valid driver's license and, while transporting residents, follow all laws applicable to driving in Montana.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3225 Personnel Records

(1) The facility is responsible for maintaining a file on each administrator, person associated with the facility, staff member, or volunteer. Files may be inspected by the department at any time. If the file is not maintained at the facility, it must be available to the department within 24 hours of the request.

(2) The file must contain:

(a) application for employment;

(b) written results of at least two references;

(d) periodic performance evaluations;

(e) a copy of current credentials, certification, or professional licenses required to perform the duties described in the job description;

(f) documentation of criminal background check as specified in ARM 37.106.3213;

(g) documentation of child protective services background checks as specified in ARM 37.106.3213;

(h) documentation of Montana and national registry checks as specified in ARM 37.106.3213;

(i) a copy of current driver's license for employees transporting residents; and

(j) any other employee records required by this subchapter.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3226 Quality Assessment

(1) The facility must implement and maintain an active quality assessment program for improving policies, procedures, and services. At a minimum, the quality assessment program must include procedures for:

(a) conducting resident satisfaction surveys at least annually which are maintained and filed at the facility;

(b) maintaining records on the occurrence, duration, and frequency of physical restraints used; and

(2) The facility must prepare and maintain, on file, an annual report including improvements made as a result of the quality assessment activities specified in this rule.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3227 Administrator

(1) Each facility must employ an administrator that is responsible for the day-to-day operation of the facility.

(2) The administrator must have formal training and/or experience in residential programs and demonstrates the ability to perform the functions and duties required in these rules.

(3) In the absence of the administrator, a staff member must be designated to oversee the operation of the facility during the administrator's absence. The administrator or designee must be in charge, on call, and physically available daily as needed, and must ensure there are sufficient, qualified staff so that the care, well-being, health, and safety needs of the residents are always met.

(a) If the administrator will be absent from the facility for more than 30 continuous days, the department must be given written notice of the individual who has been appointed the designee. The appointed designee must meet the requirements for an administrator.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3228 Staffing

(1) Each facility must maintain the minimum resident to awake-staff ratios:

(a) from 7:00 a.m. to 11:00 p.m., eight residents to one staff;

(b) from 11:00 p.m. to 7:00 a.m., or any other reasonable eight-hour period of time when residents are generally sleeping, 16 residents to one staff; and

(c) facilities must have at least one awake night staff in each building housing residents regardless of the number of residents.

(2) During regular school hours when residents are not normally present, at least one on-call staff must be available for duty within 30 minutes of notification that they are needed.

(3) The facility must have a policy that specifies a nighttime safety protocol that outlines staff responsibility for monitoring the residents.

(4) Sufficient staff must be employed to meet the supervision needs of the residents and implement each resident’s individualized case plan.

(5) Mental health professionals must be licensed as defined in 53-21-102(12), MCA, and be employed in sufficient number to meet the mental health needs of residents as outlined in the facility description.

(6) A registered nurse or licensed practical nurse must be employed to meet the needs of the residents as outlined in the facility description.

(7) Any facility that includes in its facility description, marketing, advertising, information packet, or other similar document reference to providing chemical dependency services must employ licensed addiction counselors in sufficient number to meet the needs of the residents.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3229 Staff Training

(1) A facility must have written policies, procedures, and initial and ongoing training curriculum that meets the minimum requirements in this rule.

(2) Facilities must provide adequate and timely training to ensure the safety of residents.

(3) All staff must complete a minimum of 24 hours of orientation training consisting of the following minimum requirements:

(a) an overview of the facility’s policies, procedures, organization, and services;

(b) mandatory child abuse reporting laws;

(d) fire safety, including emergency evacuation routes;

(e) confidentiality;

(f) suicide prevention;

(g) emergency medical procedures;

(h) report writing including the development and maintenance of logs and journals;

(i) resident rights as outlined in ARM 37.106.3212; and

(j) hours required for on-the-job training.

(4) Orientation training must be completed and documented before the staff person may count in the staff ratio as specified in ARM 37.106.3228.

(5) All staff must complete the following certification training within six months of hire:

(a) the use of de-escalation training and methods of managing residents as described in the facility’s policies;

(b) first aid and hands-on CPR certification; and

(6) Staff may not work alone without completing the requirements of (5).

(7) The facility must provide ongoing training for staff to maintain and improve proficiency in their knowledge and skills. Training must be a minimum of 20 hours annually and appropriate for the level of care provided.

(8) All training must be documented and kept on file for each staff member, administrator, and volunteer.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3230 Physical Care

(1) Every resident must have access to the services of at least one licensed health care professional as defined in 50-5-101, MCA.

(2) Medical, dental, psychiatric, psychological care, and counseling services will be arranged for the resident as needed.

(3) If a resident has not received a complete physical examination within a year prior to placement, within 30 days after admission the facility must arrange for a complete physical examination and annually thereafter.

(4) If a resident has not had a dental examination within a year prior to placement, the facility must arrange for the resident to have a dental examination within 90 days after admission. All necessary dental work must be completed, and checkups must be arranged for the resident at least annually.

(5) If a resident has not had an eye examination within a year prior to placement, the facility must arrange for the resident to have an eye examination within 90 days after admission. All necessary checkups must be arranged for the resident at least annually.

(6) Provisions for medical, dental, or vision care must be made by the facility staff immediately upon the licensed health care professional's recommendation with notification to the parent or legal guardian.

(7) Documentation of all required services must be in the resident’s file.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3231 Medication Storage and Administration

(1) A facility must have written policies and procedures regarding the storage, administration, and disposal of prescription, non-prescription, and over-the-counter medication.

(2) All medication must be kept in a locked non-portable container, stored in its original container with the original prescription label. For medications taken on outings, all medication must be in the possession of a staff member trained to assist with the self-administration of medications.

(3) Staff who assist with self-administration must be trained to assist in proper medication procedures. Training must be documented in each staff member's personnel file.

(4) All prescription medications must be ordered by licensed health care professionals working within the scope of their practice. All prescription orders must contain the dosage to be given.

(5) Psychotropic medication is prohibited unless a licensed health care professional working within the scope of that professional's practice determines that the medications are clinically indicated.

(7) A written record of all medications administered to a resident must be maintained and include:

(a) the resident’s name;

(b) the name and dosage of the medication;

(d) the name of the staff member who assisted in the self-administration of the medication; and

(e) documentation of any medication errors, results of errors, and any effects observed.

(9) Parent or legal guardian must be notified of all medications prescribed to the resident including medication changes. Documentation of notification must be maintained in the medication record.

(10) All unused and expired medication must be properly disposed of and documented in the medication record.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3232 Care and Guidance

(1) A facility must provide to each resident sufficient staff to ensure:

(a) appropriate medical care, supervision, safety, treatment, and guidance;

(b) opportunities for educational, social, and cultural growth through suitable reading materials, toys, activities, and equipment; and

(2) A facility must arrange for contact with each resident’s parent or legal guardian and approved family members.

(3) The facility must assist the parent or legal guardian with referral for support services.

(4) The provider must assist the resident and, when appropriate, the family, in preparing for the resident’s discharge.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3233 Nutrition

(1) A facility must provide for or serve three regular, well-balanced meals per day, and snacks. Foods must be served in amounts and a variety sufficient to meet the nutritional needs of each resident.

(2) Special diets must be provided for residents as ordered in writing by a licensed health care professional. Such orders must be kept on file by the facility.

(3) Food may not be altered, modified, restricted, or prohibited as a means of punishment, discipline, or as a behavioral modification technique.

(4) Records of menus as served must be filed at the facility for three months after the date of service for review by the department.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3234 Food Preparation and Handling

(1) Safe food handling and preparation practices must be followed in all facilities. All food must be from an approved source and must be transported, labeled, stored, covered, prepared, and served in a sanitary manner to prevent contamination.

(2) The facility must have conveniently located hand washing facilities, supplied with liquid hand soap, disposable towels kept clean in a dispenser, and cleanable trash can.

(3) Any staff person or resident handling or preparing food must thoroughly wash hands, wrists, and exposed arms with soap and warm running water for at least 20 seconds:

(a) before and after handling food;

(b) after using the bathroom; and

(4) General food safety requirements must include:

(a) all canned foods and dry ingredients must be stored in a designated area;

(b) food cannot be stored on the floor;

(d) food that is not stored in original containers must be dated, labeled, and covered;

(e) all food must be cooked and reheated to the recommended temperature;

(f) milk and other dairy products must be pasteurized;

(g) use of home canned foods other than jams, jellies, and fruits is prohibited;

(h) use of thermometers is required to check food temperatures;

(i) cold storage of potentially hazardous food must be at 41°F or below;

(j) frozen food must be kept frozen;

(k) hot storage of potentially hazardous food must be 135°F or above;

(l) each type of food must be stored and arranged so that cross-contamination of one type with another is prevented; and

(5) General health and safety requirements include the following:

(a) use clean cutting boards, knives, can openers, and other equipment and utensils for each type of food preparation to prevent cross-contamination;

(b) a person with symptoms of a communicable disease that can be transmitted to foods or who is a carrier of such a disease may not work with food, clean equipment, or clean utensils;

(c) when the regulatory authority has reasonable cause to suspect possible disease transmission within a facility, the facility must take appropriate action in accordance with ARM Title 37, chapter 114, regarding communicable disease control.

(6) Equipment and utensil sanitation requirements include the following:

(a) kitchenware, tableware, and food contact surfaces must be washed, rinsed, and completely dried after each use;

(b) moist cloths used for wiping kitchen and dining area surfaces, equipment, and utensils must be placed in chemical sanitizer solution frequently enough and be of sufficient strength to maintain 200 to 400 parts per million available chlorine or equivalent; and

(7) A domestic style dishwasher may be used only if it is equipped with a heating element and the following conditions are met:

(a) the dishwasher must be capable of washing and sanitizing all dishware, utensils, and food service equipment normally used for the preparation and service of a meal in one cycle;

(b) the dishwasher must have water at a temperature of at least 165°F when it enters the machine, if it uses hot water for sanitization; and

(c) if it uses a heat cycle with a heating element for sanitization, the dishwasher must be allowed to run through the entire cycle before it is opened.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3235 Personal Needs

(1) The facility must ensure that each resident has clothing suitable to the resident’s age and size and comparable to the clothing of other adolescents in the community.

(2) Residents must have some choice in the selection of their clothing.

(3) A facility must provide necessary supplies and train residents in personal care, hygiene, and grooming.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3236 Behavior Management Policies

(1) A facility must have written behavior management policies and procedures which include a description of the model, program, or techniques to be used with residents. The facility must have policies addressing discipline, therapeutic de-escalation in crisis situations, crisis intervention and physical restraint, and time-out. Behavior management must be based on an individual assessment of each resident’s needs, stage of development, and behavior. It must be designed with the goal of teaching the residents to manage their own behavior and be based on the concept of providing effective treatment by the least restrictive means.

(2) The behavior management policies and procedures must prohibit:

(a) the use of physical force, mechanical, chemical, or physical restraint as discipline;

(b) pain compliance, aversive conditioning, and use of pressure point techniques;

(d) cruel or excessive physical exercise, prolonged positions, or work assignments that produce unreasonable discomfort;

(e) verbal abuse, ridicule, humiliation, profanity, and other forms of degradation directed at a resident’s family;

(f) physical discipline of any means including but not limited to hitting, shaking, biting, or pinching;

(g) locked confinement or seclusion;

(h) withholding of necessary food, water, clothing, shelter, bedding, rest, medications as prescribed, medical care, or toilet use;

(i) denial of visits or communication with the resident’s family;

(j) isolation as punishment; and

(k) any other form of punishment or discipline which subjects a resident to pain, humiliation, or unnecessary isolation or restraint.

(3) If facility policies and procedures allow for disciplining a group of residents for actions of one resident, the policies and procedures must clearly prescribe the circumstances and safeguards under which disciplining the group is allowed.

(5) A copy of the incident report must be placed in the resident’s file and the incident must be reported to the licensure bureau and parent or legal guardian within 24 hours of its occurrence.

(6) An authorized staff person must be notified of the incident immediately and:

(a) begin an investigation within 24 hours of the incident; and

(b) complete a written report and submit it to the licensure bureau within two days of completion of the investigation.

(7) An investigation of the incident may be conducted by the department.

(8) A complete report of any investigation conducted by the facility must be placed in the facility’s records and must be available for inspection by the department.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3237 Time-Out

(1) A facility must develop a written time-out policy and procedures which clearly provide:

(a) length of time the resident may remain in time-out which must be age appropriate;

(b) guidelines for staff observation of the resident when in time-out;

(d) purpose of time-out; and

(e) staff training pertaining to the use of time-out.

(2) Staff may direct a resident to time-out when the behavior is disruptive to the resident’s ability to learn, to participate appropriately, or to function appropriately with other residents and the activity, and when the other de-escalation techniques have failed. Restraint, seclusion, or confinement may not be used as part of time-out procedures.

(3) Time-out may not be used as punishment.

(4) Residents placed in time-out must be reintroduced to the group in a sensitive and nonpunitive manner as soon as control is regained.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3238 Use of Crisis Intervention and Physical Restraint Strategies

(1) The facility must have written policies and procedures governing the appropriate use of crisis intervention and physical restraint methods if used by the facility.

(2) The crisis intervention and physical restraint policies and procedures must include evidence-based training and include:

(a) suicide prevention training for all staff to include risk identification, screening and assessment, indicated interventions, safety planning, treatment, follow-up care, and documentation;

(b) crisis prevention and verbal and nonverbal de-escalation techniques are the preferred methods and must be used first to manage behavior;

(c) all staff must be trained in the facility’s crisis intervention, de-escalation techniques, and physical restraint methods;

(d) physical restraint may only be used to safely control a resident until the resident can regain control of their own behavior;

(e) physical restraint must only be used in the following circumstances:

(i) when the resident has failed to respond to de-escalation techniques and it is necessary to prevent harm to the resident or others; or

(ii) when a resident’s behavior puts themselves or others at substantial risk of harm and the resident must be forcibly moved;

(f) physical restraint must be used only until the resident has regained control and must not exceed 15 consecutive minutes. If the resident remains a danger to self or others after 15 minutes, the resident’s record must include written documentation of attempts made to release the resident from the restraint and the reasons that continuation of restraint is necessary; and

(g) physical restraint may be used only by staff who are documented to be specifically trained in crisis intervention and physical restraint techniques.

(3) The facility policies and procedures must require the documentation of:

(a) the specific behavior which required the physical restraint;

(b) the specific attempts to de-escalate the situation before using physical restraint;

(d) the identity of the specific staff member(s) involved in administering the physical restraint;

(e) the type of physical restraint used;

(f) any injuries to the resident resulting from the physical restraint;

(g) debriefing completed with the staff and resident involved in the physical restraint; and

(h) notification of the parent or legal guardian within 24 hours of restraint.

(4) The documentation required in (3) must be submitted in writing to the Office of Inspector General Licensure Bureau within one business day of the physical restraint.

(5) Facility policies and procedures must require that whenever a physical restraint has been used on a resident more than four times within a seven-day period, the administrator or designee will review the resident’s situation to determine the suitability of the resident to remain in the facility, whether modification of the case plan is warranted, or whether staff need additional training in alternative therapeutic behavior management techniques. The facility must take appropriate action as a result of the review.

(6) Facility policies and procedures must prohibit the application of a physical restraint if a resident has a documented physical condition that would contradict its use, unless a licensed health care professional has previously and specifically authorized its use in writing. Documentation must be maintained in the resident’s file.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3239 Searches

(1) The provisions of this rule apply to all searches by facility staff of the resident’s person and personal property, including searches of personal correspondence. The facts and circumstances supporting a determination of reasonable cause for the search must be documented in the resident’s file.

(2) Residents may not be subjected to any search except as follows:

(a) there is reasonable cause to believe that the search will result in discovery of contraband;

(b) there is reasonable cause to believe that the search is necessary to alleviate a threat of harm to the resident, other individuals, or staff; or

(3) The facility must have written policies and procedures relating to searches, including pat-down searches, personal property searches, correspondence searches, urinalysis testing, and breathalyzer testing. The policies must include the following:

(a) a procedure for documenting all searches, reasons for the search, who conducted the search, and the results of the search;

(b) notification of the search policy to the parent or legal guardian and resident at time of admission;

(c) a protocol for conducting personal property searches when the resident is not available to be present for the search;

(d) the consequences to a resident when contraband is located;

(e) description of what happens to contraband which has been located; and

(f) pat-down searches on residents, which must be conducted by staff persons of the same sex.

(4) Staff must be trained in the proper protocol for all searches. Training must be documented in staff's personnel record.

(5) Residents may not be subjected to any of the following intrusive acts:

(a) strip searches;

(b) body cavity searches; or

(6) The facility must have written policies and procedures prior to use of urinalysis testing for the purpose of determining drug and alcohol use which include:

(a) procedures for obtaining samples for urinalysis testing;

(b) procedures for processing urinalysis testing; and

(7) The facility must have written policies and procedures prior to use of breathalyzer testing for the purpose of determining drug and alcohol use which include:

(a) procedures for operating the breathalyzer; and

(b) consequences to the resident when a breathalyzer is positive.

(8) Residents may not be subjected to urinalysis or breathalyzer testing unless the testing:

(a) has been ordered by a court;

(b) is required pursuant to a case plan for monitoring alcohol use, as approved by the parent or legal guardian; or

(9) The facility must notify the resident’s parent or legal guardian within 24 hours of every search, urinalysis testing, or breathalyzer testing performed on the resident and the results.

(10) Staff shall document compliance with facility policies and procedures in connection with each search, urinalysis testing, or breathalyzer testing.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3240 Contraband and Weapons

(1) A facility must define prohibited contraband in a written policy.

(2) Law enforcement must be notified as appropriate when illegal contraband is discovered.

(3) All contraband that is not illegal must be returned to the resident’s parent or legal guardian or destroyed in accordance with the facility’s contraband policy. When contraband is disposed of, at least two staff members must be present, and the disposal must be documented in the resident’s case record.

(4) If contraband that is not illegal is stored by the facility, the facility must have written policies clearly outlining the storage procedure.

(5) A facility must have a written policy and procedure on management of weapons and potential weapons.

(7) A resident must have one-on-one supervision when handling a weapon or gun.

(8) Staff shall supervise a resident’s possession and use of knives, hatchets, other edged tools, or any item which may pose a danger to self or others.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3241 Money and Adolescent Training and Employment

(1) Money earned or received as a gift or allowance must be part of the resident’s personal property and accounted for separately from the facility funds.

(2) If the facility is partly supported by institutional production on a commercial basis, the facility must comply with state and federal child labor and minimum wage laws.

(3) For residents aged 16 and older, a facility may assist in:

(a) preparing the resident for economic independence;

(b) referring the resident to an appropriate independent living program if applicable; and

(c) obtaining skills necessary for employment as determined to be appropriate to meet the individual's needs. Such skills include:

(i) completing applications;

(ii) personal appearances for employment situations;

(iii) attitudes toward employment; and

(iv) interviewing for jobs.

(4) A facility must distinguish between tasks which residents are expected to perform as part of living together, jobs to earn spending money, and jobs performed for vocational training. Residents may not be compelled to work for the facility without prior approval of the parent or legal guardian.

(5) Residents may be given age-appropriate, non-vocational work assignments within the resident’s capabilities as a constructive experience. The work assignment must comply with all state and federal labor laws and regulations.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3242 Recreation

(1) The facility may have an on-grounds recreation program that is operated by the staff. However, when available, the facility must provide the resident access to community recreation and cultural events when appropriate to the resident’s needs, interests, and abilities.

(2) Residents must have the opportunity to participate in age-appropriate recreational activities on a regular basis.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3243 Infection Control

(1) A facility must develop and implement an infection prevention and control program. At a minimum the facility must develop, implement, and review, at least annually, written policy and procedures regarding infection prevention and control which must include procedures to identify high-risk individuals and what methods are used to protect, contain, or minimize the risk to residents and staff.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3244 Religious and Cultural Beliefs

(1) The facility must have written policies and procedures on how the resident’s individual religious and cultural beliefs will be addressed.

(2) The facility must provide residents with a reasonable opportunity to practice their respective religions. Residents must be permitted to have reasonable access to religious materials of their choice. If reasonable access is denied, the facility must have documentation of the specific reasons for the denial.

(3) The facility must document its efforts in providing opportunity and encouragement to each resident to identify with their cultural heritage.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Mont. Admin. R. 37.106.3245 Transportation

(1) All staff transporting residents must possess a valid driver's license for the type of vehicle used in transporting the residents.

(2) Any person transporting residents must comply with applicable traffic laws.

(3) All vehicles used in transporting residents must:

(a) have proper Montana registration;

(b) have, at minimum, liability insurance coverage;

(d) be equipped with a red triangle reflector device for use in an emergency; and

(e) be equipped with a first aid kit.

(4) The driver and all the passengers must ride in a vehicle manufactured seat. Each person must use a seat belt.

(5) Residents must not ride in the bed of or in the back of a truck.

(6) Residents utilizing off road or all terrain recreational vehicles must wear a helmet and be instructed on safety procedures.

History

Authorizing statute(s): 50-5-101, 50-5-248, MCA
Implementing statute(s): 50-5-101, 50-5-248, MCA
History: NEW, 2026 MAR, Notice No. 2026-322, Eff. 8/22/26.

Subchapter 37.106.33 Experimental Treatment Centers

Mont. Admin. R. 37.106.3301 Purpose

(1) The purpose of these rules is to establish the minimum licensing requirements for the licensure of experimental treatment centers, pursuant to Title 50, chapter 5, part 2, MCA.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3302 Scope

(1) For purposes of this subchapter, experimental treatment centers include the facilities described at 50-5-101(17), MCA.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3303 Application of Other Rules

(1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of ARM Title 37, chapter 106, subchapter 33, the terms of subchapter 33 will apply to experimental treatment centers.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3304 Definitions

(1) "Administrator" means the person designated on the center application or by written notice to the department as the person responsible for the daily operation of the center and for the daily patient care provided in the center.

(2) "Change of ownership" means the transfer of ownership of an experimental treatment center to any person or entity other than the person or entity to whom the experimental treatment center's license was issued, including the transfer of ownership to an entity that is wholly owned by the person or entity to whom the experimental treatment center's license was issued.

(3) "Department" means the Department of Public Health and Human Services.

(4) “Experimental treatment review board” means a board that examines and evaluates patient safety and treatment results pursuant to ARM 37.106.3316.

(5) An “inpatient experimental treatment center” offers experimental treatment services to patients who are admitted to or reside at the facility for 24 hours or more.

(6) “Investigational medical device” means any device, including devices with health-tracking or data monitoring functions, falling under the definition of “experimental treatment” as defined in 50-12-102(1), MCA.

(7) "License" means the document issued by the department that authorizes a person or entity to provide experimental treatments in the center in which the license is issued.

(8) "Licensed health care professional" means a licensed physician, physician assistant-certified, advanced practice registered nurse, or registered nurse who is practicing within the scope of the license issued by the appropriate licensing board at the Montana Department of Labor and Industry.

(9) "Medical director" means a physician licensed by the Montana Board of Medical Examiners who has the responsibilities outlined in ARM 37.106.3308 and who is the head of the experimental treatment center’s Quality Assurance and Performance Improvement (QAPI) and infection control programs.

(10) An “outpatient experimental treatment center” offers experimental treatment services to patients who reside there for 23 hours and 59 minutes or less per day.

(11) "Practitioner" means an individual licensed by the Montana Department of Labor and Industry who has assessment, admission, and prescription authority.

(12) “Qualified medical institution” means an institution that has generated documented clinical evidence supporting the safety of a medical intervention equivalent to that required for successful completion of a phase 1 clinical trial, and operates under one of the following frameworks:

(a) oversight by a regulatory authority recognized by international standards; or

(b) oversight by a regulatory authority that demonstrates substantially equivalent standards for data quality, monitoring, and patient protection.

(13) "Treatment" means a medication, modality, product, device, or dietary supplement used to maintain well-being or to diagnose, assess, alleviate, or prevent a disability, injury, illness, disease, or other similar condition.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3305 Application and Licensing

(1) In addition to the requirements set forth in 50-5-203, MCA, each application for an experimental treatment center must include:

(a) the name of the medical director of the experimental treatment center;

(b) the qualifications of the administrator, medical director, and all professional staff;

(i) whether the applicant, owner, or affiliate has operated a health care facility that was closed as a direct result of issues of patient health and safety;

(ii) whether the owner or any clinic staff has been convicted of a felony offense; and

(iii) whether the owner or any clinic staff was ever employed by a facility owned or operated by the applicant that was closed because of administrative or legal action;

(d) the general types of experimental treatments the center intends to perform or provide;

(e) an attestation that the applicant is of reputable and responsible character, including demonstrating accountability and reliably fulfilling commitments, and is able to comply with all rules applicable to experimental treatment centers; and

(f) an explanation of how the experimental treatment center will fulfill the health freedom and access requirement pursuant to 50-5-251, MCA.

(2) Pursuant to 50-5-201(2), MCA, upon a change of ownership, a new owner must apply for a new license.

History

Authorizing statute(s): 50-5-250, 50-5-251, MCA
Implementing statute(s): 50-5-250, 50-5-251, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3306 POLICIES AND PROCEDURES

NEW RULE 6 POLICIES AND PROCEDURES

(1) An experimental treatment center must maintain a policies and procedures manual that is available to all patients, visitors, and members of the public.

(2) The manual must contain policies and procedures for:

(a) preadmission screening and admitting patients;

(b) obtaining informed consent pursuant to 50-12-105, MCA;

(d) staff screening and hiring;

(e) maintaining and securing medical records, including:

(i) retention of active records;

(ii) retirement of inactive records;

(iii) timely entry of data in records; and

(iv) release of information contained in records;

(f) patient files;

(g) patient progress notes, including frequency and responsible party;

(h) observation and recovery;

(i) discharging patients;

(j) follow-up care;

(k) patient grievances;

(l) patient education;

(m) emergency procedures;

(n) medically necessary transfers;

(o) infection control;

(p) investigational medical device procedures, if applicable;

(q) the types of anesthesia to be used, the conduct of anesthesia assessments, and the criteria to be used in conducting anesthesia assessments, if applicable;

(r) disaster planning and training;

(s) staff training on emergency and disaster protocols; and

(t) fulfilling the health freedom and access requirement, pursuant to 50-5-251, MCA.

(3) The policies and procedures manual must include a current organizational chart.

(4) The policies and procedures manual must have a documented review at least biennially. The manual should be kept current and updated as needed, with documentation of amendments or updates.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3307 Administrator

(1) An experimental treatment center must have an administrator who:

(a) maintains daily overall responsibility for the center operations;

(b) develops and oversees the implementation of all policies and procedures pertaining to the operation of the experimental treatment center;

(d) establishes a process for patient complaints and grievances;

(e) establishes a patient incident report file on all patient incidents or allegations of abuse;

(g) is responsible for regulatory compliance for the licensure of the experimental treatment center;

(h) promotes and protects the health, safety and welfare of patients; and

(i) develops and implements written orientation and training procedures on all center policies and procedures for all employees or contractors, relief workers, temporary employees, students, interns, volunteers, and trainees to include, but not limited to:

(i) defining responsibilities, limitations, and supervision of students, interns, and volunteers working for the experimental treatment center; and

(ii) verifying each professional staff member's credentials, when hired, and annually thereafter, to ensure the continued credentialing of required licenses.

(2) The administrator must develop policies and procedures for screening, hiring, and assessing staff, which include practices that assist the employer in identifying employees that may pose a risk or threat to the health, safety, or welfare of any patient, and provide written documentation of findings and the outcome in the employee’s file.

(3) In the administrator's absence, a staff member must be designated to oversee the operation of the center. The administrator or their designee must be in charge, on call, and available (physically or remotely) daily as needed. They must also ensure that there are sufficient, qualified staff on site to meet the care, health, safety, and welfare needs of patients at all times.

(4) If the administrator is absent for more than 30 calendar days, the department must be given written notice of the individual who has been appointed as the designee.

(5) An administrator may serve multiple experimental treatment centers, provided that:

(a) each center is owned and operated by the same legal entity;

(b) each center maintains a written agreement with the administrator defining specific responsibilities;

(d) each center meets all applicable standards under these rules.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3308 Medical Director

(1) An experimental treatment center must have a medical director who has a current physician license in good standing with the Montana Board of Medical Examiners.

(2) The medical director is responsible for:

(a) overseeing treatment delivered in the center;

(b) developing and maintaining a comprehensive system that tracks all experimental treatments conducted at the center, including patient outcomes for each treatment and the current Food and Drug Administration (FDA) approval status of each; and

(3) The medical director must participate in establishing competency criteria for medical personnel, including training in procedures performed at the center.

(4) The medical director must ensure that treatments are compliant with 50-12-102(1), MCA.

(5) The medical director may also serve as the experimental treatment center administrator.

(6) The medical director may provide oversight to multiple experimental treatment centers, provided that:

(a) each center is owned and operated by the same legal entity;

(b) each center maintains a written agreement with the medical director defining specific responsibilities;

(d) each center meets all applicable standards under these rules.

(7) The medical director serves as the center’s safety officer and is responsible for overseeing the center’s safety program.

(8) The medical director has the responsibility of the infection control officer, ensuring that the infection control program meets all requirements of ARM 37.106.3318.

(a) The medical director may delegate this responsibility to another practitioner who, given the clinical risks and oversight demands, is qualified to serve as the infection control officer.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3309 Staff Requirements

(1) A physician, an advanced practice registered nurse authorized by the Montana Board of Nursing to have prescription authority, a physician assistant, or a nurse practitioner must be physically present on site whenever there are patients admitted to or present in the experimental treatment center.

(2) All licensed health care professional staff must have current licenses that are in good standing with the respective Montana licensing board.

(3) Licensed health care professionals licensed in states other than Montana may collaborate or consult with center licensed health care professional staff on treatments, treatment options, adverse side effects, and patient outcomes.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3310 Staff Files

(1) An experimental treatment center must keep a file for all staff employed and contracted by an experimental treatment center.

(2) Each staff file must contain:

(a) the most recent copy of the staff's license or certification;

(b) documented orientation, including orientation to policies and procedures and emergency and disaster protocols;

(d) evaluations as applicable; and

(e) ongoing training.

(3) A staff file meeting these requirements must be maintained onsite at the center for all out-of-state professionals providing collaboration and consultation for an experimental treatment center.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3311 Patient Agreement

(1) An experimental treatment center must enter into a written patient agreement with each prospective patient prior to admission.

(2) The patient agreement must include:

(a) documentation that the patient, or their legal representative, agrees to the treatment;

(b) the criteria for admitting and discharging from the center;

(d) the full text of the provisions contained in 50-12-110, MCA (Immunity From Suit);

(e) a detailed description of all the anticipated costs to the patients, if any, and how the center intends to bill or receive payments;

(f) the acknowledgment related to the patient’s health insurance as stated in 50-12-105(2)(e), MCA; and

(g) the center’s patient grievance policy.

(3) The patient agreement must be signed and dated by both the patient or the patient’s legal representative and a licensed health care professional of the center prior to the initiation of any treatment.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3312 Patient Files

(1) An experimental treatment center must keep a separate, secured file for each patient treated at the center.

(2) The patient file must include, at a minimum:

(a) patient identification, including the patient’s full name, sex, address, date of birth, and next of kin or emergency contact;

(b) a full history and physical (H&P) by a treating practitioner;

(i) documentation from the patient’s treating practitioner that the patient meets the criteria for experimental treatments;

(ii) the recommendation from the patient’s treating practitioner for an experimental treatment;

(iii) the H&P must have been completed within 30 days of the visit to the experimental treatment center;

(d) admitting diagnosis and desired health outcomes;

(i) desired health outcomes must be specific to the patient’s condition for which experimental treatment is being provided;

(e) allergies or known abnormal drug reactions;

(f) documentation to support that the patient evaluated other treatment options currently approved by the United States Food and Drug Administration;

(g) informed consent pursuant to and in alignment with 50-12-105, MCA;

(h) a copy of the patient agreement required by ARM 37.106.3311;

(i) documentation and results of all tests, reports, procedures, and labs obtained at the center;

(j) pre-treatment screening for contraindications, concomitant medications, and lifestyle risk factors;

(k) interdisciplinary progress notes;

(l) treatment plans and outcomes; and

(m) discharge note, discharge diagnosis, and discharge instructions.

(3) If the center performs procedures requiring anesthesia, each patient who receives anesthesia must also have in their chart:

(a) anesthesia reports;

(b) nurses’ notes on preoperative and recovery conditions; and

(4) Patient files must include the date and circumstances of discharge. Discharged patient files must be kept for a minimum of five years after the date of discharge.

History

Authorizing statute(s): 50-5-250, 50-12-105, MCA
Implementing statute(s): 50-5-250, 50-12-105, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3313 Treatment Documentation

(1) An experimental treatment center must keep documentation for all experimental treatments provided for each patient. The documentation must include:

(a) the treatment being provided;

(b) expected outcomes, including the source used to determine these outcomes;

(d) remedy for adverse side effects and outcome; and

(e) patient response to treatment, adverse side effects, and remedies.

(2) An experimental treatment center must obtain and retain a transfer agreement with a local hospital.

(3) Before transferring a patient from an experimental treatment center, the experimental treatment center must:

(a) notify the receiving hospital before the patient is transferred, and receive confirmation from the receiving hospital that the services necessary to treat the patient are available;

(b) use medically appropriate life support measures to stabilize the patient before the transfer and to sustain the patient during the transfer;

(d) in cases of non-emergency care services, ensure that the patient or legally responsible person acting on the patient's behalf is informed of the risks and benefits of transfer.

(4) The transfer agreement must be renewed annually.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3314 Emergency Procedures

(1) Staff trained in the use of emergency equipment and cardiopulmonary resuscitation must be available whenever a patient is in the experimental treatment center.

(2) If the experimental treatment center performs surgical or anesthetic procedures, the following equipment shall be available to the operating room:

(a) emergency call system;

(b) oxygen;

(d) sonography; and

(e) emergency drugs and supplies specified by the medical staff.

(3) The experimental treatment center must have policies and procedures in the event of an emergency with documented staff training in:

(a) hemorrhage;

(b) perforation;

(d) anaphylaxis; and

(e) emergency transfer to the facility with which the experimental treatment center has a written transfer agreement.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3315 Quality Assurance and Performance Improvement Program

(1) An experimental treatment center must have a quality assurance and performance improvement (QAPI) program that:

(a) is ongoing;

(b) is data-driven; and

(2) The QAPI program must be led by a medical director who meets the definition of ARM 37.106.3304(9).

(3) In addition to the medical director, the QAPI program must also include at least one member from each department within the experimental treatment center.

(4) The QAPI program will meet at least quarterly and maintain a written record of key information discussed, decisions made, and action items assigned during each meeting.

(5) The center will retain QAPI program meeting documentation onsite for a minimum of three years.

(6) At each QAPI program meeting, the following must be reviewed and discussed, with documentation of discussion:

(a) any patient or staff incidents that occurred since either the initial center licensing or the last QAPI meeting;

(b) all treatments provided since the later of the initial center licensing or the last QAPI meeting, that had adverse side effects;

(c) all patient grievances that have been received since the later of the initial center licensing or the last QAPI meeting;

(i) the QAPI program will ensure that the center’s policy is followed in response to the grievance;

(d) address clinical and administrative issues as well as patient outcomes;

(e) any unresolved matters that were discussed or reviewed at the previous QAPI meeting; and

(f) a review of adverse event data as reported under ARM 37.106.3317.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3316 Experimental Treatment Review Board

(1) An experimental treatment center must establish or contract with an experimental treatment review board.

(2) The review board may be:

(a) independently contracted through competitive selection; or

(b) shared among multiple experimental treatment centers.

(3) The review board must be comprised only of members who have no personal, financial, employment, or ownership interest, or any other conflict of interest in the experimental treatment center or centers for which it is contracted.

(a) Each experimental treatment center must maintain a list of all board members and documentation supporting that each member declares no interest in the experimental treatment center as described in (3).

(b) The declaration must align with the requirements set forth in 1-6-105, MCA.

(4) An experimental treatment review board may serve multiple experimental treatment centers, provided that:

(a) adequate capacity exists to review all assigned protocols within competitive time frames;

(b) each center designates the board through a written agreement;

(c) consolidated quarterly safety outcome reports are prepared by the review board and must clearly identify outcomes by center. These reports shall be maintained for internal quality assurance and made available to:

(i) the department during survey or upon request; and

(ii) the QAPI program;

(d) all board members meet the requirements of (3) for each center to which the board provides review services.

(5) The experimental treatment review board shall consist of at least five members. It shall include at least one Montana-licensed physician, at least one researcher with expertise in clinical outcome data, and at least one ethicist.

(a) The credentials of each board member shall be provided to the department.

(b) Members of the board shall adhere to professional standards regarding disclosure and management of financial conflicts of interest.

(6) The experimental treatment review board shall:

(a) review and approve treatment protocols to be offered at an experimental treatment center that meet the standards of 50-12-102(1), MCA, documenting that:

(i) safety standards equivalent to or higher than those of recognized regulatory authorities are met;

(ii) informed consent procedures are comprehensive and understandable;

(iii) risk-benefit analysis demonstrates a reasonable safety profile; and

(iv) alternative treatments have been appropriately evaluated;

(b) evaluate quality and safety outcomes using recognized metrics;

(c) prepare, at least annually, a public summary report to be published on the center’s website or otherwise made accessible for public review. The report must include:

(i) aggregate numbers and types of experimental treatments reviewed and approved;

(ii) aggregate safety outcome data (including number and general categories of serious adverse events, with a patient’s personal identifiable information removed);

(iii) aggregate treatment outcome data;

(iv) general approval or review time frames; and

(v) recommended system-wide quality improvements;

(d) preserve all records related to protocol review, approvals, safety evaluations, and reports for at least five years, and make such records available to the department upon request;

(e) review adverse event data as reported under ARM 37.106.3317; and

(f) evaluate each experimental treatment and medical device to determine the level of risk to patients, and whether the treatment or device is safe for administration outside of an experimental treatment center.

(i) An experimental treatment center is responsible for formulating an evaluation assessment and standard to determine the level of risk to patients and guidelines for determining whether the treatment or device is safe for delivery outside of the center.

(7) An experimental treatment center may be licensed provisionally without the establishment of an experimental treatment review board, but may not provide any treatments or devices until a review board is established and provides the evaluation requirements in (6)(f).

(8) The experimental treatment review board must meet at least monthly.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3317 Adverse Event Reporting

(1) Experimental treatment centers must report any serious adverse events to the department within five days.

(2) An adverse event or suspected adverse reaction is considered “serious” if, in the view of the medical director, it results in any of the following outcomes: death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital anomaly/birth defect. Important medical events that may not result in death, be life-threatening, or require hospitalization may be considered serious when, based upon appropriate medical judgment, they may jeopardize the patient and may require medical or surgical intervention to prevent one of the outcomes listed in this definition.

(3) Each report must include, at a minimum:

(a) the type of experimental treatment involved;

(b) the nature and severity of the adverse event;

(d) any corrective actions taken; and

(e) information about the patient’s medical condition.

(4) All adverse event data collected and reported must be reported to the experimental treatment review board and to the QAPI program pursuant to ARM 37.106.3315.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3318 Infection Prevention and Control

(1) An experimental treatment center must maintain an infection prevention and control program that seeks to minimize infections and communicable diseases. An experimental treatment center is responsible for developing a plan of action to prevent, identify, and manage infections and communicable diseases, and for promptly implementing corrective and preventive measures that lead to improvement.

(a) The infection prevention and control program must include documentation that the experimental treatment center has considered, selected, and implemented nationally recognized infection control guidelines.

(2) An experimental treatment center must have written policies that also address the cleaning of patient treatment areas and care areas, to include:

(a) cleaning before use; and

(b) cleaning between patients.

(3) An experimental treatment center must have policies and processes in place for:

(a) the monitoring and documentation of the cleaning, high-level disinfection, and sterilization of medical equipment, accessories, instruments, and implants; and

(b) minimizing the sources and transmission of infections, including the use of adequate surveillance techniques.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3319 Safety Program

(1) An experimental treatment center must have a safety program that addresses the organization's environment of care and safety for all patients, staff, and visitors. The elements of the safety program must include:

(a) a process for identifying hazards, potential threats, near misses, and other safety concerns;

(b) a process for reporting known adverse incidents to proper authorities;

(d) prevention of falls or physical injuries involving patients, staff, and visitors.

(2) Products that carry an expiration date, including medications, reagents, and solutions, must be monitored and disposed of accordingly.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3320 Anesthesia Risk and Evaluation

(1) An experimental treatment center that performs procedures requiring anesthesia must:

(a) prohibit the use of flammable anesthesia;

(b) have a policy that defines the types of anesthesia that will be used within the center. Similarly, the experimental treatment center must address in this policy the American Society of Anesthesiologists (ASA) Physical Status Classification System level appropriate to receive surgical services in these types of facilities;

(c) conduct an assessment prior to the patient's admission as well as prior to surgery to evaluate the risk of anesthesia and of the procedure to be performed; and

(d) have policies that address the basis or criteria used in conducting the assessments.

(2) Supplies and exhaust systems for windowless anesthetizing locations must be arranged to automatically vent smoke and products of combustion.

(a) Ventilating systems for anesthetizing locations using general anesthesia must be provided that automatically:

(i) prevent recirculation of smoke originating within the surgical suite; and

(ii) prevent the circulation of smoke entering the system intake, without, in either case, interfering with the exhaust function of the system.

(3) Anesthesia must be administered only by:

(a) a qualified anesthesiologist;

(b) a physician qualified to administer anesthesia; or

(4) Before discharge, each patient must be evaluated by a physician or by a person authorized to administer anesthesia in accordance with applicable state health and safety laws, standards of practice, and center policy. This post-anesthesia assessment must include evaluation of:

(a) respiratory function, including respiratory rate, airway patency, and oxygen saturation;

(b) cardiovascular function, including pulse rate and blood pressure;

(d) temperature;

(e) pain;

(f) nausea and vomiting; and

(g) postoperative hydration.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3321 Investigational Medical Devices

(1) An experimental treatment center that provides investigational medical devices must:

(a) maintain specialized equipment and facilities appropriate for device implantation, monitoring, or administration;

(b) establish device-specific informed consent procedures in addition to those required under 50-12-105, MCA. These procedures must address:

(i) risks associated with device implantation and removal;

(ii) long-term monitoring requirements;

(iii) compatibility with other medical devices or treatments; and

(iv) data collection, cybersecurity, and transmission capabilities of smart devices.

(2) Experimental treatment centers administering investigational devices must have procedures in place for the following:

(a) pre-procedure device inspection and calibration protocols;

(b) device implementation;

(d) device malfunction reporting and response procedures; and

(e) patient device registry and maintenance for long-term tracking.

(3) Health care providers who administer investigational medical devices to patients must have documented training and demonstrated competency for device-specific procedures. Records must be maintained by the center’s administrator pursuant to ARM 37.106.3307.

(4) The center must maintain a registry of all investigational medical devices administered to patients for a minimum of five years. The registry must include:

(a) purpose of the treatment;

(b) device identifiers;

(d) any adverse events.

(5) For smart or internet-connected devices, the center must have policies and procedures addressing:

(a) cybersecurity;

(b) patient data privacy; and

(6) The center must have policies and procedures to address device malfunction, emergency removal, reporting of adverse events, and device or device part recalls.

(7) Device performance and safety must be reviewed regularly as part of the center’s QAPI program in accordance with ARM 37.106.3315.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3322 Reports to the Department

(1) The Department of Public Health and Human Services, Office of Inspector General, will develop a reporting form that facilitates data collection and review of quality assurance systems, pursuant to 50-5-250(2)(f), MCA. The department will make the form available through the electronic licensing system.

(2) An experimental treatment center must complete the form with information from the full calendar year.

(a) The report is due to the department by February 1 of the next calendar year and submitted through the electronic licensing system.

(b) The department may reduce the license of an experimental treatment center to a provisional license if the report is not received by the date it is due.

(3) All identifying patient information must be redacted for standard reporting purposes.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3323 Physical Plant Requirements for an Outpatient Center

(1) An outpatient experimental treatment center must have the local building authority inspect and approve the center prior to initial licensing. The department must receive a copy of the signed approval.

(2) The local or state fire marshal must inspect the center prior to licensing and annually thereafter.

(3) Each center must be equipped with a fire alarm system that is tested and inspected annually.

(a) Inspection results must be maintained at the center for three years.

(4) All patient rooms must be a minimum of ten feet by ten feet in size.

(5) All corridors within a center must be at a minimum of six feet wide.

(6) There must be illuminated exit signs on all exit doors.

(7) The department may waive any provision of this rule if construction factors would make compliance extremely difficult or impossible and if the department determines that the level of safety to patients and staff is not diminished.

(8) A licensed outpatient experimental treatment center may apply to the department to transfer its primary location, provided that:

(a) there is no change in legal ownership, administrative structure, or core staff as relevant for compliance;

(b) the department receives at minimum 30 days’ prior notice, updated address, floor plans, and an attestation of ongoing compliance;

(d) a copy of the continuity of care plan covering patient notification, handling of ongoing treatments, and medical record access or transfer shall be provided to the department with the relocation notice and must be available for review.

(9) If an outpatient experimental treatment center operates within another health care facility, the center must:

(a) be operated in a distinct and separate unit of the facility;

(b) have two-hour fire barriers separating the experimental treatment center from the other health care facility;

(c) store all experimental treatment medications, treatments, or devices in such a manner that they are inaccessible to any staff other than those who work for the experimental treatment center;

(d) separately store and maintain all equipment pertinent to the care and treatment of patients within the experimental treatment center; and

(e) maintain a separate staff from that of the other health care facility.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3324 Physical Plant Requirements for an Inpatient Center

(1) An inpatient experimental treatment center must have the local building authority inspect and approve the center prior to initial licensing. The department must receive a copy of the signed approval.

(2) The local or state fire marshal must inspect the center prior to licensing and annually thereafter.

(3) Each center must be fully suppressed. The suppression system must be tested and inspected annually.

(a) Inspection results must be maintained at the center for three years.

(4) All patient rooms must have three feet of clearance to the foot and each side of the bed.

(5) All corridors within the center must be at a minimum of eight feet wide.

(6) There must be illuminated exit signs on all exit doors.

(7) There must be at least one toilet for every four patients.

(8) There must be at least one shower for every 12 patients.

(9) Each patient room must be equipped with a call system that meets the standard in the American Institute of Architects (AIA) Guidelines chapter 4.1-8.3.7.4 (2).

(10) There must be a nurses' station for each wing of the center. The nurses' station should provide a clear line of sight to each patient room and the room’s light for the call system.

(11) Every patient room must have generator-backup electrical for provisions of oxygen and medical gas to be rolled in and utilized whenever necessary.

(12) If an inpatient experimental treatment center operates within another health care facility, the center must:

(a) be operated in a distinct and separate unit of the facility;

(b) have two-hour fire barriers separating the experimental treatment center from the other health care facility;

(c) store all experimental treatment medications, treatments, or devices in such a manner that they are inaccessible to any staff other than those who work for the experimental treatment center;

(d) separately store and maintain all equipment pertinent to the care and treatment of patients within the experimental treatment center; and

(e) maintain a separate staff from that of the other health care facility.

(13) The department may waive any provision of this rule if construction factors would make compliance extremely difficult or impossible and if the department determines that the level of safety to patients and staff is not diminished.

(14) A licensed inpatient experimental treatment center may apply to the department to transfer its primary location, provided that:

(a) there is no change in legal ownership, administrative structure, or core staff as relevant for compliance;

(b) the department receives 30 days’ prior notice, updated address, floor plans, and an attestation of ongoing compliance;

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Mont. Admin. R. 37.106.3325 Agreement with Outside Entities

(1) When an experimental treatment or medical device has been evaluated by the experimental treatment review board and deemed to have minimal potential risk to a patient and determined to be safe to administer outside of the experimental treatment center, the center may make the treatment or device available for administration to private practicing physicians if there is a signed written agreement between the experimental treatment center and the physician that includes at a minimum:

(a) the name of the disease or health condition that the treatment is approved to treat;

(b) the requirement that the physician document the treatment outcomes;

(c) the requirement that the physician report any adverse side effects to the experimental treatment center within 24 hours;

(d) that the physician provides all patients with the name, number, and address of the experimental treatment center that the physician is contracting with for the treatment; and

(e) that the physician agrees to share all treatment documentation, laboratory, and other test results of a patient receiving experimental treatments or devices with the contracted experimental treatment center.

(2) There must be a written and signed agreement for each treatment or device that is approved for administration or delivery.

(3) The agreement must have a documented renewal annually by both parties.

(4) If a treatment or device is discontinued from use outside of the experimental treatment center or when a treatment or device clears Food and Drug Administration (FDA) approval and no longer meets experimental treatment criteria, there must be a documented termination of the agreement.

History

Authorizing statute(s): 50-5-250, MCA
Implementing statute(s): 50-5-250, MCA
History: NEW, 2026 MAR, Notice No. 2026-427, Eff. 7/25/26.

Chapter 37.107 Marijuana Registry

Authorizing statute(s): 50-46-344, MCA
Implementing statute(s): 50-46-303, 50-46-344, MCA
History: NEW, 2011 MAR p. 2047, Eff. 9/23/11; REP, 2018 MAR p. 321, Eff. 4/10/18.

Subchapter 37.107.3 Testing Laboratories

Mont. Admin. R. 37.107.305 Marijuana Testing Laboratory Licensee Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-46-344, MCA
Implementing statute(s): 50-46-303, 50-46-311, 50-46-312, 50-46-326, 50-46-328, 50-46-329, MCA
History: NEW, 2018 MAR p. 321, Eff. 4/10/18; AMD, 2018 MAR p. 1968, Eff. 10/6/18; REP, 2019 MAR p. 1868, Eff. 10/19/19.

Mont. Admin. R. 37.107.306 Marijuana Testing Laboratories Accreditation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-46-344, MCA
Implementing statute(s): 50-46-303, 50-46-311, 50-46-312, MCA
History: NEW, 2018 MAR p. 321, Eff. 4/10/18; REP, 2019 MAR p. 1868, Eff. 10/19/19.

Chapter 37.108 Managed Care Quality Assurance

Subchapter 37.108.3 Independent Review of Health Care Decisions

Mont. Admin. R. 37.108.301 Independent Review of Health Care Decisions: Definitions

The following definitions, in addition to those contained in 33-37-101 , MCA, apply to this chapter:

(1) "Expedited review" means an accelerated appeal of an adverse determination made by a health carrier or managed care entity involving an enrollee with urgent medical needs whose life or health would be seriously threatened by the delay of a standard appeals process.

(2) "Independent review organization" means a network of peers conducting an independent review of an adverse determination made by a health carrier or managed care entity.

(3) "Internal appeals process" means a process established by a health carrier or managed care entity by which a party affected by an adverse determination made by a health carrier or managed care entity may appeal the adverse decision within the deciding agency.

History

Authorizing statute(s): Sec. 33-37-105, MCA
Implementing statute(s): Sec. 33-37-101 and 33-37-105, MCA
History: NEW, 1999 MAR p. 2880, Eff. 12/17/99; AMD, 2003 MAR p. 1662, Eff. 8/1/03.

Mont. Admin. R. 37.108.305 Independent Review of Health Care Decisions: Peer Review Process

(1) A health carrier or managed care entity and an enrollee may agree on a peer to conduct an independent review, as specified in these rules, of any adverse determination made by the health carrier or managed care entity. If the health carrier or managed care entity and the enrollee are unable to agree on a peer to conduct the independent review, then the health carrier or managed care entity shall forward the case file to the independent review organization designated by the department.

(2) The peer or the independent review organization designated by the department shall ensure that the case file contains the information listed in 33-37-102 (2) (a) through (2) (d) , MCA, and that it otherwise is eligible for independent review.

(3) In the case of routine health care decisions, the peer or independent review organization shall notify the health carrier or managed care entity, the enrollee, and the health care provider of its decision within 30 calendar days after receiving the case file. The notification shall include a statement of the basis for the decision and shall list the evidence the peer or independent review organization considered in making the decision. If the peer or independent review organization requires additional time to complete its review, it shall request an extension in writing from the department. The request for extension shall include the reasons for the request and state the specific time the review is expected to be completed.

(4) In the case of expedited review, the enrollee's health care provider must certify in writing, facsimile, or by electronic mail the need for the expedited review. Within 72 hours from the date the request for expedited review is received, the peer or independent review organization shall notify the health carrier or managed care entity, the enrollee, and the health care provider of its decision. The notification shall include a statement of the basis for the decision and shall list the evidence the peer or independent review organization considered in making the decision.

(5) A peer or independent review organization may not review any adverse determination in which the peer or independent review organization has an interest in the outcome. The peer or independent review organization must notify the health carrier or managed care entity and enrollee if there is a potential conflict of interest. The peer or independent review organization may not review any adverse determination which involves a potential conflict of interest unless the health carrier or managed care entity and enrollee provide a written acknowledgment of the conflict and waiver.

(6) A health carrier or managed care entity or its agent that provides medicaid-funded or any other publicly funded health care-related services is exempt from this peer review process for adverse determinations concerning clients covered by those programs.

History

Authorizing statute(s): Sec. 33-37-105, MCA
Implementing statute(s): Sec. 33-37-102 and 33-37-103, MCA
History: NEW, 1999 MAR p. 2880, Eff. 12/17/99; AMD, 2003 MAR p. 1662, Eff. 8/1/03.

Mont. Admin. R. 37.108.306 Independent Review of Health Care Decisions: Confidentiality

(1) All health care information provided to a peer or independent review organization is confidential and is subject to the provisions of Title 50, chapter 16, MCA, and 33-19-306 , MCA.

History

Authorizing statute(s): Sec. 33-37-105, MCA
Implementing statute(s): Sec. 33-37-102 and 33-37-103, MCA
History: NEW, 1999 MAR p. 2880, Eff. 12/17/99.

Mont. Admin. R. 37.108.310 Independent Review of Health Care Decisions: Notice of Adverse Determination and Independent Review Rights

(1) A health carrier or managed care entity shall notify an enrollee and the health care provider of any adverse determination:

(a) within 10 calendar days from the date the decision is made if the decision involves routine medical care; or

(b) within 48 hours from the date the decision is made, excluding Sundays and holidays, if the decision involves a medical care determination which qualifies for expedited review.

(2) The notice shall:

(a) be printed in clear legible type using a font of at least 12 point size;

(b) be written using a format and language which can be understood by a person who has no more than an eighth grade education;

(d) provide the enrollee with instructions on the process necessary to initiate an appeal or independent review; and

(e) inform the enrollee that an expedited review process is available and explain how an enrollee may initiate an expedited review.

(3) If an internal appeal process exists, the notice shall:

(a) inform the enrollee of the enrollee's right to appeal any adverse determination by requesting an internal review within 180 days after the date the adverse decision is made; and

(b) notify the enrollee, once the internal appeals process has been exhausted, of the enrollee's right to seek an independent review of any adverse determination within 60 days after the date the internal review decision is made.

(4) If an internal appeal process does not exist, the notice shall inform the enrollee of the enrollee's right to seek an independent review of any adverse determination within 180 days after the date the adverse decision is made.

History

Authorizing statute(s): Sec. 33-37-105, MCA
Implementing statute(s): Sec. 33-37-102, MCA
History: NEW, 1999 MAR p. 2880, Eff. 12/17/99; AMD, 2003 MAR p. 1662, Eff. 8/1/03.

Mont. Admin. R. 37.108.315 Independent Review of Health Care Decisions: Internal Appeals Process

(1) If a health carrier or managed care entity has an internal appeals process in place, the internal appeals process provided by the health carrier or managed care entity must be exhausted before the enrollee or the enrollee's authorized representative can submit a decision for independent review, unless:

(a) the internal appeals process is not completed within 60 calendar days from the date the request for appeal is received, in which case the internal appeals process will be interrupted and the case forwarded for independent review; or

(b) the health care treatment decision results in a serious threat to the health or threatens the life of the enrollee, in which case upon certification by the health care provider as defined in (1) (b) (i) , the internal appeals process will be bypassed and the matter shall immediately be submitted for expedited review.

(i) If the enrollee's health care provider determines that the adverse determination involves a condition which seriously threatens the life or health of the enrollee, the enrollee's health care provider shall certify in writing, facsimile or by electronic mail that the life or health of the enrollee would be seriously threatened by the delay of an internal appeals process.

(2) The health carrier or managed care entity shall maintain written records of all requests for appeal and shall retain all related data for a period of three years unless a claim, audit, or litigation involving the records and data is pending, in which case the records and data must be retained until the claim, audit, or litigation is finally resolved, or for three years, whichever is longer.

(3) The peer or independent review organization shall retain all records and data generated by the peer or independent review organization for the purposes of completing the review for no less than three years, unless a claim, audit or litigation is pending, in which case the records or data shall be retained until the claim, audit or litigation is finally resolved or for three years, whichever is longer.

(4) The department shall have reasonable access to the records and data for quality assurance purposes, to perform an evaluation of the independent review process, or for any other lawful purpose of the department.

History

Authorizing statute(s): Sec. 33-37-105, MCA
Implementing statute(s): Sec. 33-37-102, MCA
History: NEW, 1999 MAR p. 2880, Eff. 12/17/99; AMD, 2003 MAR p. 1662, Eff. 8/1/03.

Chapter 37.109 Montana Community Health Center Support Act

Subchapter 37.109.1 Montana Community Health Centers

Mont. Admin. R. 37.109.101 Purpose

(1) These rules establish a procedure for awarding grants to carry out the purposes of the Montana Community Health Center Support Act.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-804, 50-4-805, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.103 Definitions

(1) "Advisory group" means the nine member group appointed as provided in 50-4-810, MCA.

(2) "Applicant" means the entity applying for the grant. An entity applying for a grant will be expected to apply for federal grants supporting Public Health Service Act (PHSA) (2007) Section 330 grantees when available.

(3) "Bureau of Primary Health Care (BPHC)" means the bureau within the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services that oversees the determination of Community Health Center (CHC ) status and makes a recommendation regarding federally qualified health center (FQHC) and FQHC look-alike status. A health care center that wants Section 330 grant money from the PHA must apply to the BPHC as provided in 42 CFR 51c (2007).

(4) "Capital Expenditure Application" means an application for a one-time capital expenditure to an existing federally qualified health center to expand services by increasing medical, dental, or mental health capacity by purchasing equipment or renovating clinic facilities.

(5) "Centers for Medicare and Medicaid Services (CMS)" is the division of the United States Department of Health and Human Services that confers FQHC and FQHC look-alike status and implements FQHC reimbursement policy.

(6) "Community health center (CHC)" means a health care center that meets the requirements of 42 USC 254b (2007) and 42 CFR 51c (2007), and is receiving federal Section 330 grant money under the PHSA.

(7) "Comprehensive primary health care services" means:

(a) basic health services which, for the purposes of this subchapter, shall consist of:

(i) health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;

(ii) diagnostic laboratory and radiologic services;

(iii) preventive health services, including:

(A) prenatal and perinatal services;

(B) appropriate cancer screening;

(D) immunizations against vaccine-preventable diseases;

(E) screenings for elevated blood lead levels, communicable diseases, and cholesterol;

(F) pediatric eye, ear, and dental screenings to determine the need for vision and hearing correction and dental care;

(G) voluntary family planning services;

(H) preventive dental services;

(iv) emergency medical services; and

(v) pharmaceutical services as may be appropriate for particular centers;

(b) referrals to providers of medical services (including specialty referral when medically indicated) and other health-related services (including substance abuse and mental health services);

(c) patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to federal, state, and local programs that provide or financially support the provision of medical, social, housing, educational, or other related services;

(d) services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals); and

(e) education of patients and the general population served by the health center regarding the availability and proper use of health services.

(8) "Department" means the Montana Department of Public Health and Human Services.

(9) "Department committee" means employees of the department and other persons appointed by the department director to participate in the screening and grant awards determination in this rule.

(10) "Expanded Medical Capacity Application" means an application to expand the medical services offered by existing federally qualified health centers or other facilities that have received federally qualified health center look-alike status.

(11) "Federally qualified health center" means a facility that meets the definition of 42 USC 1396d(I)(2)(B) (2007). A FQHC is entitled to receive enhanced Medicaid and Medicare reimbursement. Federally qualified community health centers, federally qualified health center look-alikes, and certain tribal and urban Indian entities are FQHCs.

(12) "FQHC look-alike" means a FQHC that has been determined by the United States Department of Health and Human Services to meet the requirements to be a Section 330 grantee but has not received Section 330 grants. A FQHC look-alike is entitled to receive enhanced Medicaid and Medicare reimbursement.

(13) "Medically underserved area or population (MUA/MUP)" means an area or population designated by the Secretary of the United States Department of Health and Human Services as having a shortage of primary health services. Designation information may be obtained from the primary care office within the United States Department of Health and Human Services.

(14) "New Access Points Application" means an application to create and support a health center which will serve a significant portion of a population located in a medically underserved area (MUA), or designated as a medically underserved population (MUP). Successful applicants will be expected to apply for federally qualified health center look-alike status and federal community health center grants at the first available opportunity.

(15) "New Satellite Access Application" means an application by an existing 330 grant funded federally qualified health center to establish a new access point to serve a new patient population that is outside the approved scope of project .

(16) "Public Health Service Act (PHSA)" means the federal Public Health Service Act codified at 42 USC 201, et seq. (2007).

(17) "Section 330 grantee" means a CHC that meets the requirements of 42 USC 254b and 254c (2007) and has been awarded federal grant money under the PHSA.

(18) "Service Expansion Application" means an application to expand the medical, mental health, or dental services offered by existing federally qualified health centers or other facilities that have received federally qualified health center look-alike status.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-801, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.105 Priorities Among Goals

(1) The advisory group appointed pursuant to 50-4-810, MCA, shall advise the department committee, in writing, of its recommendations for the priorities related to awarding state grant(s) from among the following goals:

(a) create and support new access points for comprehensive primary health care services by applicants that will be working toward FQHC status;

(b) create and support new access satellites in new locations for comprehensive primary health care services by existing CHCs;

(d) expand the medical, mental health, or dental services offered by existing FQHCs that are Section 330 grantees; or

(e) award one time grants for FQHCs to purchase equipment or renovate clinic facilities.

(2) Final decision will be made by the department committee. If the department committee does not follow the recommendations of the advisory group it will provide its reasons for not doing so in writing to the advisory group.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-805, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.107 Eligibility for Grant

(1) To be eligible for consideration for a state grant an applicant must submit a proposal and meet the requirements listed in (1)(a) through (f) and (2). The applicant for:

(a) "capital expenditure" must be an existing FQHC. Capital expenditure grants are for the purchase of equipment or renovation of clinic facilities. Capital expenditure applications must demonstrate that additional services will be made available and/or increase patient capacity per department guidelines for capital expenditure applications;

(b) "expanded medical capacity" must be able to meet the qualifications contained in the United States Department of Health and Human Services, Policy Information Notice (PIN) 2006-09 dated February 8, 2006;

(c) "new access points" must be able to meet the qualifications for new access points described in the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007;

(d) "new satellite access sites" must be able to meet the qualifications for new access points described in the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007;

(e) "service expansion" must be able to meet the qualifications for service expansion grants contained in the United States Department of Health and Human Services, Policy Information Notice (PIN) 2003-03 dated February 12, 2003; and

(f) "state grants" must also apply for FQHC look-alike status and/or 330 grants, where applicable.

(2) The applicant for new access points must be able to meet all the requirements of 42 CFR 51c (2007) and provide evidence that the following requirements of 42 CFR 51c (2007) will be met:

(a) The successful applicant must have a governing board with at least nine but not more than 25 members, a majority of whom are individuals served or who will be served by the health center and are representative of the health center's patient demographics. No more than one-half of the remaining members of the governing board may be individuals who derive more than ten percent of their annual income from the health care industry. The remaining members of the governing board shall be representative of the area which the center serves.

(b) The successful applicant must have a sliding schedule of fees that is linked to the patient's ability to pay for patients with incomes up to 200% of the federal poverty level.

(c) The successful applicant must serve a significant portion of a population located in a medically underserved area (MUA) or designated as a medically underserved population (MUP). If the area is not currently federally designated, in whole or in part, as a MUA or MUP, the applicant must provide documentation that the request has been submitted.

(d) The successful applicant must provide access to services in the targeted service area or population without discrimination.

(3) The applicant for new satellite access sites, service expansion, expanded medical capacity, or capital expenditure must meet the requirements of 42 CFR 51c (2007) and provide evidence that the following requirements of 42 CFR 51c (2007) have been met:

(a) The successful applicant must have, or intend to have, a governing board with at least nine but not more than 25 members, a majority of whom are individuals served, or will be served, by the health center and are representative of the health center's patient demographics. No more than one-half of the remaining members of the governing board may be individuals who derive more than ten percent of their annual income from the health care industry. The remaining members of the governing board shall be representative of the area which the center serves.

(b) The successful applicant must have a sliding schedule of fees that is linked to the patient's ability to pay for patients with incomes up to 200% of the federal poverty level.

(c) The successful applicant must serve a significant portion of a population located in a medically underserved area (MUA) or designated as a medically underserved population (MUP).

(d) The successful applicant must provide access to services in the targeted services area or population without discrimination.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-802, 50-4-805, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.109 Requests for Proposals for Montana Community Health Center Support Act Grants

(1) The department will solicit proposals and award grants whenever funding is appropriated by the Legislature. The Department of Administration's request for proposals (RFP) process will be utilized to solicit applications based on the priority among projects determined pursuant to ARM 37.109.105. The opportunity to make a proposal for a grant will also be posted on the department's web site. The RFP will include the application selection criteria established pursuant to ARM 37.109.111.

(2) The applicant's proposal will consist of a brief statement of the amount of the funds requested and how the applicant proposes to use such funds. The proposal must disclose if it is for capital expenditure, expanded medical capacity, new access points, new satellite access, or service expansion. The applicant should also include a description of need, impact on access, projected number of additional patients served and encounters, timelines for providing services and applying for federal grant and/or look-alike status.

(3) In addition the RFP may require that the application include:

(a) its most recent application to the Secretary of HHS for a grant under Section 330 of the Public Health Service Act, if such grant application has been or will be submitted;

(b) its most recent application to the Secretary of HHS requesting designation as a federally qualified health center "look-alike" if such application has been or will be submitted;

(d) its expanded medical capacity application which it has submitted or will submit to the Secretary of HHS; or

(e) its capital expenditure application which it will submit to the department.

(4) The applicant may refer to the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2003-03 dated February 12, 2003; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2006-09 dated February 8, 2006; or department guidelines for capital expenditure applications; whichever is most appropriate for additional information.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-802, 50-4-805, 50-4-806, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.111 Criteria for Awarding Grants

(1) Proposals will be evaluated by the department committee using the priorities developed by the advisory group pursuant to ARM 37.109.105 and the criteria by category of application as located at the United States Department of Health and Human Services, HRSA-08-077 dated September 28, 2007; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2003-03 dated February 12, 2003; or the United States Department of Health and Human Services, Policy Information Notice (PIN) 2006-09 dated February 8, 2006, or department guidelines for capital expenditure applications.

(2) The advisory group may develop additional criteria related specifically to Montana and its unique circumstances. Criteria to be considered may include, but are not limited to: high need areas, impact, federal funding opportunities, readiness, collaborations, and cost per client served.

(3) All criteria shall be listed in the request for proposal. If the department committee does not follow the recommendations of the advisory group, it must comply with the requirements of 50-4-811, MCA.

(4) In the event that funding is available after the initial award process has been completed, the department shall have the option of making awards to the next highest rated applicant(s) without requiring a new RFP process.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-802, 50-4-805, 50-4-806, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.113 Initial Screening of Proposals

(1) The department committee will conduct an initial screening of the proposals to determine if the applicants have complied with the requirements set forth in the request for proposal. The department committee may allow an applicant to correct omissions or errors in its proposal that are not material. When exercising this option, the department committee shall notify all other applicants of the corrections made.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-805, 50-4-806, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.115 Review of Proposals

(1) An objective grant review process will be performed by the department committee consistent with the criteria stated in ARM 37.109.111.

(2) The advisory group will have an opportunity to define its role in the evaluation process in accordance with Montana Department of Administration requirements regarding requests for proposals.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-805, 50-4-806, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Mont. Admin. R. 37.109.117 Award and Administration of Grant

(1) Final grant awards determination, along with a prioritized listing arranged by highest score of applicants will be made by the department committee. The department committee shall advise the advisory group, in writing, of its determination of grant award(s) along with the prioritized listing of additional eligible applicants. If the department committee does not follow the recommendation(s) of the advisory group, the department committee will provide its reasons for not doing so in writing to the advisory committee.

(2) Successful applicants, also referred to as "grantees", that are to be awarded grants by the department will negotiate a contract with the department. Grant amounts will be awarded prior to the end of the state fiscal year.

(3) The contract will be administered by the Hospital and Clinic Services Bureau, Health Resources Division of the department.

(4) The contract may be terminated for nonperformance or underperformance on the part of the grantee. The department committee may make a determination of nonperformance or underperformance based on the grantee's demonstrated work toward accomplishing the objectives of their request for proposal. The grantee will be notified by the department committee of its determination of nonperformance or underperformance. The grantee will be afforded an opportunity to remedy the nonperformance or underperformance. The department committee may make a determination of continuing nonperformance or underperformance based on the grantee's demonstrated work toward accomplishing the objectives of their request for proposal. The grantee will have the right to seek all contractual and judicial remedies available if aggrieved by the determination of continuing nonperformance or underperformance of the department committee.

(5) Grant awards will not supplant already available funds and in-kind resources.

(6) Grant award monies will cease once federal monies are received by the successful applicant for the same purpose as this grant award.

(7) In the event of (4) or facility closure, the department reserves the right to recoup unused capital grants and/or assets purchased with the monies derived from this grant award.

(8) Benchmarks and other reporting tools may be used by the department to determine a grantee's performance.

(9) Grant awards amounts may be expended over a time period not to exceed one year beyond the end of the biennium the grant was awarded if the project requires it and if legislative funding permits it. After that time period has elapsed, an application must be submitted for continuation of state funding based upon compliance with grant requirements and meeting performance measures.

History

Authorizing statute(s): 50-4-804, MCA
Implementing statute(s): 50-4-802, 50-4-805, 50-4-806, MCA
History: NEW, 2008 MAR p. 959, Eff. 5/9/08.

Chapter 37.110 Food and Drug Standards

Subchapter 37.110.1 Food, Drugs and Cosmetics

Mont. Admin. R. 37.110.101 Food Standards

(1) The department adopts by reference the following federal regulations establishing food definitions and standards promulgated by the United States Food and Drug Administration that are found in the corresponding parts of Title 21 of the Code of Federal Regulations (CFR) as of April 1, 2017 and 2018. These standards apply to all food as the term is defined in 50-31-103(15), MCA.

(2) Copies of the federal regulations which were adopted and incorporated by reference under (1) may be obtained from the Department of Public Health and Human Services, Food and Consumer Safety Section, 1400 Broadway, P.O. Box 202951, Helena, Montana 59620-2951, phone: (406) 444-2408.

History

Authorizing statute(s): 50-31-104, 50-31-108, 50-31-201, MCA
Implementing statute(s): 50-31-101, 50-31-104, 50-31-203, MCA
History: Eff. 12/31/72; AMD, 1979 MAR p. 321, Eff. 3/30/79; AMD, 1982 MAR p. 2123, Eff. 1/15/83; AMD, 1994 MAR p. 2743, Eff. 10/14/94; TRANS, from DHES, 2001 MAR p. 2423; AMD, 2003 MAR p. 20, Eff. 1/17/03; AMD, 2019 MAR p. 2126, Eff. 1/1/20.

Subchapter 37.110.2 Retail Food Establishments

Mont. Admin. R. 37.110.201 Introduction

(1) This is a subchapter regulating retail food establishments that serve food to the public, as provided in Title 50, chapter 50, MCA.

(2) All retail food establishments must comply with all appropriate building construction standards as set forth by 50-60-101, MCA and all applicable administrative rules as adopted by the Department of Labor and Industry in ARM Title 24.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; AMD, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.202 Purpose

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.203 Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.204 Food Supplies

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.206 Food Storage and Protection

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.207 Food Preparation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.208 Food Display and Service

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.209 Food Transportation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.210 Food Employees

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.212 Materials for Equipment and Utensils

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.213 Equipment and Utensil Design and Fabrication

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.214 Equipment Installation and Location

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.215 Equipment and Utensil Cleaning and Sanitation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.216 Equipment and Utensil Storage

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.217 Water Supply

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.218 Sewage

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.219 Plumbing

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.220 Toilet Facilities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.221 Hand Washing Facilities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.222 Garbage and Refuse

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.223 Insect and Rodent Control

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.225 Floors

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.226 Walls and Ceilings

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.227 Cleaning Physical Facilities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.228 Lighting

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.229 Ventilation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.230 Dressing Rooms and Locker Areas

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.231 Toxic Materials

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1986 MAR p. 1076, Eff. 6/27/86; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.232 Premises

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.236 Temporary Food Service Establishments

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.238 Licenses

(1) No person may operate a food establishment who does not have a valid license issued by the department. Only a person who complies with the requirements of this subchapter will be entitled to receive or retain such a license. A valid license must be posted in every retail food establishment.

(2) Any person desiring to operate a retail food establishment must make written application for a license on forms provided by the department.

(3) Except for temporary food establishment permit fees set by the local health authority in accordance with 50-50-205(6), MCA, license fees are:

(a) $85 for each license issued to an establishment that does not have more than two employees working at any one time; and

(b) $115 for establishments with more than two employees.

(4) Prior to approval of an application for a license, the regulatory authority must inspect the proposed retail food establishment to determine compliance with the requirements of this subchapter.

(5) The department will issue a license to the applicant if an inspection by the regulatory authority reveals that the proposed retail food establishment complies with all applicable requirements of this subchapter.

(6) The department may, after providing opportunity for hearing, cancel a license for serious or repeated violations of any of the requirements of this subchapter or for interference with the department or other authorized persons in the performance of duty.

(7) Prior to cancellation, the department will notify, in writing, the licensee of the specific reason(s) for which the license is to be cancelled. The notice will further provide for the licensee the opportunity to request an administrative hearing in front of the department within ten business days after the receipt of the notice. If no request for hearing is filed within the ten-day period, the cancellation of the license becomes final.

(8) The licensee may submit to the department an acceptable plan of correction within ten business days after receiving the department's notice of cancellation. Such an acceptable plan of correction will be a bar to canceling the license.

(9) A notice provided for in this rule is properly served when it is delivered to the holder of the license, or the person in charge, or when it is sent by registered or certified mail, return receipt requested, to the last known address of the holder of the license. A copy of the notice will be filed in the records of the department.

(10) The hearing provided for in this rule will be conducted by the department pursuant to Title 2, chapter 4, subchapter 6, MCA of the Montana Administrative Procedure Act regarding contested cases and ARM 37.5.117. The department will make a final finding based upon the complete hearing record and will sustain, modify, or rescind any notice or order considered in the hearing. The department will furnish a written report of the hearing decision to the licensee.

(11) Whenever a cancellation of a license has become final, the holder of the cancelled license may make written application for a new license.

(12) Obtaining the license referred to in (1) does not relieve the applicant from satisfying applicable requirements from other federal, state, or local agencies. These may include:

(a) building code permits and inspections;

(b) fire and life safety inspections;

(d) occupational health and safety requirements.

(13) The regulatory authority will assign a food establishment to a license type and subtype by assessing food processing procedures, food service, and utilizing the definitions in these rules.

(14) At the time of initial licensing and updated as needed, but no less than each licensing year, the regulatory authority will correctly assign a food establishment to one of four categories by evaluating the food processing and service procedures of the food establishment based on the criteria specified in Table 1:

Table 1

Food Establishment Complexity Categories

Category | Establishment Complexity (1) | (i) only heat commercially processed time/temperature control for safety foods (TCS/potentially hazardous foods) for hot holding; (ii) process only non-TCS foods; (iii) no cooling TCS foods; (iv) establishments otherwise grouped in Category 2, but have shown through documentation to have achieved managerial control of foodborne illness risk factors; and (v) examples include: convenience stores, hot dog carts, coffee shops, and establishments that serve or sell only prepackaged, non-TCS foods. (2) | (i) establishment has a limited menu; (ii) processed foods are immediately served or made-to-order; (iii) food operations may involve hot and cold holding of TCS foods, after processing or cooking; (iv) limited processing of TCS foods that require cooking, cooling, reheating, and the limited service of a few TCS foods; (v) establishments that would otherwise be grouped in Category 3, but have shown through historical documentation to have achieved managerial control of foodborne illness risk factors; (vi) newly licensed establishments that would otherwise be grouped in Category 1 are categorized here, until a history of managerial control of foodborne illness risk factors is documented; (vii) examples include: retail food stores, schools not serving a highly susceptible population, and quick-service operations. (3) | (i) establishment has extensive menu and handling of raw ingredients; (ii) complex preparation including cooking, cooling, and reheating for hot holding involving many TCS foods; (iii) variety of processes require hot and cold holding of TCS food; (iv) establishments that would otherwise be grouped in Category 4, but have shown through historical documentation to have achieved managerial control of foodborne illness risk factors; (v) newly licensed establishments that would otherwise be grouped in Category 2 are categorized here, until a history of managerial control of foodborne illness risk factors is documented; (vi) examples include: full-service restaurant. (4) | (i) establishments serving a highly susceptible population; (ii) engage in specialized processes, such as smoking, curing, reduced oxygen packaging, etc.; (iii) examples include: preschools, hospitals, nursing homes, and special processing requiring a variance.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-201, 50-50-204, 50-50-205, 50-50-206, 50-50-207, 50-50-208, 50-50-209, 50-50-210, 50-50-211, 50-50-212, 50-50-213, 50-50-214, 50-50-215, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; AMD, 2014 MAR p. 2957, Eff. 1/1/15; AMD, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.239 Inspections

(1) The local health officer, registered sanitarian, or sanitarian-in-training employed by or contracted with the local board of health shall perform an inspection of each retail food establishment within the jurisdiction of the local board of health at least once every 12 months. Additional inspections of the food service establishment must be performed as often as necessary for the enforcement of this subchapter.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-104, 50-50-203, 50-50-205, 50-50-206, 50-50-301, 50-50-302, 50-50-305, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1994 MAR p. 2941, Eff. 11/11/94; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; AMD, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.240 Examination and Condemnation of Food

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, 50-50-303, MCA
Implementing statute(s): 50-31-509, 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.241 Review of Plans

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; AMD, 1985 MAR p. 928, Eff. 7/12/85; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.242 Suspected Disease Transmission: Procedure

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-105, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.243 Minimum Performance Requirements for Local Health Authorities

(1) To qualify for reimbursement under 50-50-305, MCA, a local board of health will perform inspections as specified in this subchapter or enter into a written, signed cooperative agreement with the department that establishes the duties and responsibilities of the local board of health and the department consistent with this subchapter.

(a) At least one sanitarian working with or for the local board of health must receive training from the department in standardized food inspections. The department is responsible for making training and standardization available on a periodic basis.

(b) Reporting of inspection dates must be documented in a manner and frequency approved by the department.

(c) All documentation of enforcement of this subchapter including inspection reports, consumer complaints, illness investigations, plans of correction, and enforcement actions is retained for five years and copies of the documentation are submitted or otherwise made available to the department upon request.

(3) All local boards of health must meet the following criteria:

(4) A failure by the local board of health to meet all of its responsibilities under (3)(a), (b), and (c) may result in the withholding of funds from the local board reimbursement fund in an amount to be determined by the department.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-104, 50-50-208, 50-50-214, 50-50-215, 50-50-301, 50-50-305, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00; AMD, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.251 Separability

(1) If any provision of this subchapter is held invalid, all other valid provisions remain in effect.

History

Authorizing statute(s): Sec. 50-50-103, MCA
Implementing statute(s): Sec. 50-50-103, MCA
History: NEW, 1979 MAR p. 677, Eff. 7/13/79; TRANS & AMD, 2000 MAR p. 3201, Eff. 11/23/00.

Mont. Admin. R. 37.110.252 Highly Susceptible Population

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.253 Variances

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.254 Submission of a Hazard Analysis and Critical Control Point (haccp) Plan

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.255 Contents of a Haccp Plan

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.256 Mobile Food Service

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.257 Pushcarts

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.258 Semipermanent Food Service Establishment

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.259 Perishable Food Vending Machines

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2000 MAR p. 3201, Eff. 11/23/00; REP, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.260 Incorporation by Reference

(1) The Department of Public Health and Human Services (department), except as otherwise provided in this chapter, adopts and incorporates by reference the following publication: "Food Code, 2013, Recommendations of the United States Public Health Service, Food and Drug Administration" published by National Technical Information Service, Publication PB2013-110462, ISBN 978-1-935239-02-4, November 3, 2013. This publication may be reviewed online at: http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm374275.htm ; or by contacting DPHHS-FCSS, 1400 Broadway Street, Helena, MT 59620. This publication is being adopted with modifications and additions as described in ARM 37.110.260 through 37.110.272.

(a) Chapter 1: Purpose and Definitions. Additions and modifications have been made to this chapter as described in ARM 37.110.261.

(b) Chapter 2: Management and Personnel. Additions have been made to this chapter as described in ARM 37.110.262.

(d) Chapter 4: Chapter 4: Equipment, Utensils, and Linens. An addition has been made to this chapter as described in ARM 37.110.266.

(e) Chapter 5: Water, Plumbing, and Waste. Additions have been made to this chapter as described in ARM 37.110.267.

(f) Chapter 6: Physical Facilities. An addition has been made to this chapter as described in ARM 37.110.268.

(g) Chapter 7: Poisonous or Toxic Materials. This chapter has been adopted with no modifications.

(h) Chapter 8: Compliance and Enforcement. Additions and modifications have been made to this chapter as described in ARM 37.110.272.

(i) Annexes 1 through 7 of the "Food Code, 2013, Recommendations of the United States Public Health Service, Food and Drug Administration" are excluded. These sections have not been adopted, but may be used as reference information for public health purposes.

(2) The department, except as otherwise provided in this chapter, adopts and incorporates by reference the following publication: "Food and Consumer Safety (FCS) Circular 1-2012" for nonpublic water systems serving food establishments, including temporary food establishments. A copy of FCS Circular 1-2012 may be obtained from the Department of Public Health and Human Services, Food & Consumer Safety Section, P.O. Box 202951, Helena, MT 59620-2951. The FCS Circular 1-2012 is also available on the department's web site at www.fcss.mt.gov .

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-102, 50-50-103, 50-50-105, 50-50-107, 50-50-201, 50-50-301, 50-50-302, 50-50-304, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.261 Chapter 1: Purpose and Definitions

The terms defined in this section are modifications or additions to the definitions described in this chapter of the 2013 Food Code:

(1) "Adulterated" means the same as determined in 50-31-202, MCA instead of the "Adulterated" definition in section 1-201.10 of the November 3, 2013 model document of food regulations promulgated by the United States Food and Drug Administration (Food Code).

(2) "Bakery" means processing or packaging of baked goods described in 50-50-102(1), MCA for sales or service directly to consumers.

(3) "Catering kitchen" means the activity of providing food wholly or in part owned by the caterer for a specific event at a location other than the food establishment, as defined in 50-50-102 (4)(a), MCA, on a contractual, prearranged basis to a specific subset of the public, such as invited guests to a wedding or similar celebration, or to participants in an organized group or activity. A catering kitchen is not the same activity as a contract cook.

(4) "Certified Food Protection Manager" (CFPM) means an individual who operates a food establishment or manages a food establishment who has successfully completed a test through an accredited program required under section 2-102.12 (A) of the Food Code.

(5) "Department" means the Montana Department of Public Health and Human Services.

(6) "Food Code" means the November 3, 2013 model document of food regulations promulgated by the United States Food and Drug Administration.

(7) "Food establishment" means the following:

(a) includes in section 1-201.10(B) of the Food Code, any and all licensable establishments stated in Title 50, chapter 50, MCA;

(b) does not include in section 1-201.10(B) of the Food Code, any and all food provider exclusions stated in Title 50, chapter 50, MCA;

(c) in section 1-201.10(B) of the Food Code, the term "small family day-care provider" actually means a day-care provider not required to be licensed by the department as a day-care center, under 52-2-721(1)(a), MCA; and

(d) in section 1-201.10(B) of the Food Code; a bed-and-breakfast operation actually means a bed-and-breakfast establishment that meets the definition in 50-51-102(1), MCA. Bed-and-breakfast establishments must meet food safety rules required in ARM 37.111.312 through 37.111.334.

(8) "Food manufacturing" means the same as 50-50-102(19), MCA, but for the purposes of license subtypes, should be on-site food processing for sales or service to the public, which includes drinking water vending machines and beverage ice production, packaging, or both.

(9) "Food service" means the same as 50-50-102(7), MCA, but for the purposes of license subtypes, should only be the sales or service of food to the public that is not processed on-site.

(10) "Legal licensee" means the same as "permit holder."

(11) "License" means the same as "permit."

(12) "License subtype" means one or more of the following food establishments: bakery, catering kitchen, food service, food manufacturing, meat shop, mobile food establishment, perishable food dealer, produce, school, tavern, or water hauler.

(13) "License type" means a food establishment at a fixed (nonmobile or permanent) location, mobile food establishment, or temporary food establishment.

(14) "Meat market" means the same as 50-50-102(10), MCA, but is the processing or packaging of meat or poultry for sales or service to the public.

(15) "Mobile food establishment" means:

(a) A food establishment where food is served or sold from a motor vehicle, nonmotorized cart, movable vehicle such as a push cart, trailer, or boat that periodically or continuously changes location and requires a servicing area to accommodate the unit for cleaning, inspection, and maintenance, as specified in sections 5-402.14, 6-101.11, and 6-202.18.

(b) Mobile food establishment does not include a motor vehicle used solely to transport or deliver food by a motorized carrier regulated by the state or federal government or a concession stand designed to operate as a temporary food establishment.

(16) "Perishable food" means foods that require time/temperature control for safety (formerly known as potentially hazardous foods).

(17) "Perishable food dealer" means the same as 50-50-102(12), MCA, which is an operation that is in the business of purchasing and selling foods that require time/temperature control for safety (formerly known as potentially hazardous foods).

(18) "Potentially hazardous food" means time/temperature control for safety food.

(19) "Processing" means the same as "preparation" of food through one or more methods including: assembling, baking, bottling, brewing, canning, coating, cooking, cutting, dicing, distilling, drying, extracting, fermenting, freezing, grinding, heating, infusing, mixing, packaging, reheating, repackaging, pickling, slicing, smoking, stuffing, or other food treatment or food preservation method.

(20) "Produce" means fruits, vegetables, or grains sold directly to consumers in their natural or unprocessed states.

(21) "Regulatory authority" means the department, the local board of health, the local health officer, or the local sanitarian, instead of the "regulatory authority" definition in section 1-201.10 of the Food Code.

(22) "School" means a building or structure or portion thereof occupied or used at least 180 days per year for the teaching of individuals, the curriculum of which satisfies the basic instructional program approved by the board of public education for pupils in any combination of kindergarten through grade 12. This term does not include home schools. For purposes of this licensing subtype, in general, a school is also a learning institution that participates in the federal National School Lunch Program, under 7 CFR 210 of the Code of Federal Regulations.

(23) "Tavern, bar, brewery, winery, distillery, or saloon" means the sale or service of alcoholic beverages with or without beverage ice. This licensing subtype does not include on-site food manufacturing or food service, as defined in this section of the rules.

(24) "Temporary food establishment" means a food establishment that operates at a fixed location for a period of no more than 21 days in a licensing year in conjunction with a single event or celebration, instead of the "Temporary food establishment" definition in section 1-201.10 of the Food Code.

(25) "Water hauler" means the same as 50-50-102(20), MCA.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 20-5-102, 50-50-102, 50-50-103, 50-50-104, 50-50-201, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.262 Chapter 2: Management and Personnel

(1) The following additions have been made to section 2-102.12 of Chapter 2.

(a) A one-year, phase-in period will apply to affected establishments to have a Certified Food Protection Manager, and the one-year period will begin from the date new rules are adopted.

(b) After the one-year, phase-in period, new legal licensees required to have a Certified Food Protection Manager must have a Certified Food Protection Manager within 90 days of issuance of a new license.

(c) After the one-year, phase-in period, existing legal licensees required to have a Certified Food Protection Manager must have a Certified Food Protection Manager within 45 days of losing their Certified Food Protection Manager.

(2) The following additions have been made to 2-102.12(B) of Chapter 2.

(a) Temporary food establishments engaged in the following activities are exempt from having a certified food protection manager:

(i) serving non-TCS (time/temperature controlled for safety) foods;

(ii) serving nonalcoholic or alcoholic beverages with or without beverage ice;

(iii) serving commercially pre-cooked, pre-packaged ready-to-eat, TCS foods, such as hot dogs, sausages, FDA and United States Department of Agriculture (USDA) registered canned food products, frozen pizzas;

(3) The regulatory authority may require or exempt additional food safety training for temporary food establishments under the authority granted in 8-102.10 of Chapter 8.

(4) The following additions have been made to subpart 2-201 Responsibilities of Permit Holder, Person in Charge, Food Employees, and Conditional Employees of Chapter 2.

(5) Specific communicable disease control measures, outlined in the Food Code, should be followed unless more stringent rules are provided in ARM 37.114.501.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.265 Chapter 3: Food

(1) This chapter has been adopted with the following modifications:

(a) section 3-201.17(A2) will not be adopted;

(b) section 3-201.17(A3) will not be adopted;

(d) section 3-201.17(A1cii) will be replaced with the requirements of 81-9-230, 87-4-702, and 87-6-106(1), MCA.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-102, 50-50-103, 50-50-301, 50-50-302, 50-50-303, 50-50-304, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.266 Chapter 4: Equipment, Utensils, and Linens

(1) This chapter has been adopted with the addition of the following paragraph: 4-301.12(F) A food preparation sink must be provided if food is placed into a sink or sink compartment for the purposes of thawing or cleaning. A food preparation sink must meet the requirements specified in Sections 4-205.10, 5-202.13, and 5-402.11 of the Food Code.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-102, 50-50-103, 50-50-301, 50-50-302, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.267 Chapter 5: Water, Plumbing, and Waste

(1) Additions have been made to paragraph 5-101.11(B) through section 5-103.12 of this chapter for public and nonpublic water systems.

(2) A nonpublic water supply system must meet the requirements of Food and Consumer Safety (FCS) Circular 1-2012 when:

(a) the water supply is constructed after the effective date of this rule;

(b) significant modifications are made to the water system; or

(c) the local regulatory authority determines compliance with FCS Circular 1-2012 is necessary to meet the requirements of this subchapter.

(3) An establishment using a nonpublic water supply system must have drinking water samples analyzed for coliform bacteria as follows:

(a) Sampling for coliform bacteria must be done before initial licensing, and at least in two separate months of each calendar year that the establishment operates.

(b) The sampling schedule must include collection when the water source is most likely to be contaminated, such as during April through June, September through October, during high, ground-water season, or as directed by the local regulatory authority.

(i) monthly;

(ii) in months the establishment operates; or

(iii) if an inspection, sampling results, or an event indicates the water source is at high risk of contamination.

(d) The local regulatory authority may return the establishment to the sampling frequency stated in (3)(a), if an examination of the drinking water system by the local regulatory authority indicates the system is no longer at high risk of contamination.

(4) An establishment using a nonpublic water supply system must have a water sample analyzed for total nitrates before initial licensing and at least every three years the establishment is operating.

(5) After shock disinfection of the system, a sample for coliform bacteria must be collected for analysis three to five days after the disinfectant is no longer detected in the system.

(6) Water samples must be analyzed by a laboratory licensed and certified for drinking water analysis by the state of Montana.

(7) The establishment must report water sampling test results to the local regulatory authority in a format acceptable to the local regulatory authority within five days of receiving the results, except as required in (9)(c) and (11)(d).

(8) The establishment must keep test results readily available for inspection purposes on the premises of the licensed establishment for at least five years.

(9) If coliform bacteria are detected in a nonpublic water system routine sample, the establishment must:

(a) collect at least four additional or repeat samples within 24 hours of notification of the contamination at the following system locations:

(i) site of the original contaminated routine sample;

(ii) upstream from the contaminated routine sample;

(iii) downstream from the contaminated routine sample; and

(iv) at the source of the drinking water supply system, before the distribution plumbing; or

(v) as directed by the local regulatory authority.

(b) collect at least five samples during the month following a detection of coliform bacteria in any routine sample; and

(10) If coliform bacteria are detected in a repeat sample, the establishment must:

(a) take appropriate corrective action to eliminate the condition causing the positive test results; and

(b) post an advisory sign or placard regarding the test results in a conspicuous place for public viewing at each point of entry, or as directed by the local regulatory authority.

(11) If fecal coliform bacteria, Escherichia coli, or both are detected in a routine sample or repeat sample, the establishment must:

(a) immediately stop using the water source;

(b) provide a temporary source of safe water in accordance with (17);

(d) notify the local regulatory authority of the test results within 24 hours of receiving them.

(12) If an establishment with a public or nonpublic water supply fails to take the required samples following the detection of coliform bacteria, or the laboratory fails to test for fecal coliform bacteria or Escherichia coli in coliform positive samples, the establishment must follow corrective actions as specified in (13).

(13) For nonpublic water systems, appropriate corrective actions must be implemented in a timely manner to eliminate the condition or conditions that resulted in the positive test result(s), which may include shock disinfection of the entire water system and replacement or repair of the water system by a date set by the local regulatory authority when:

(a) a water sample exceeds a maximum contaminant level as specified in ARM Title 17, chapter 38, subchapter 2;

(b) the water system does not have the capacity to provide the quantity needed for drinking, food processing, personal hygiene, or cleaning;

(c) after examination of the water system, the local regulatory authority provides a written report to the operator or person-in-charge that the water system is at high risk of contamination;

(d) a pathogenic microorganism is detected in a sample; or

(e) a confirmed disease outbreak is linked with the water system.

(14) When a water system is replaced or repaired, the water system must be shock disinfected before the system is placed into service.

(15) The local regulatory authority will issue a restricted-use order to an establishment using a nonpublic water supply when:

(a) fecal coliform or Escherichia coli is detected in a nonpublic water system sample;

(b) total nitrate level is greater than 10 milligrams per liter in a nonpublic water system sample;

(d) a pathogenic microorganism is detected; or

(e) a confirmed disease outbreak is linked with the water system.

(16) An establishment with a public or nonpublic water supply subject to a restricted-use order must provide and use a temporary source of potable water as described in (17) for consumers and staff for drinking, food processing, personal hygiene and cleaning, or immediately discontinue operations.

(17) With approval from the local regulatory authority, an establishment with a public or nonpublic water supply may provide potable water on a temporary basis using one or more of the following:

(a) bottled or packaged potable water from a department-licensed wholesale or retail food establishment, if the water is dispensed directly from the original container;

(b) water from a Department of Environmental Quality (DEQ)-approved public water supply that meets the requirements of ARM Title 17, chapter 38, subchapters 1, 2, 3, and 5, stored in a clean, sanitized, and covered potable water container or holding tank;

(d) if the water is contaminated with fecal coliform bacteria or Escherichia coli, water that has been boiled for at least one minute, and stored and served from a clean, sanitized, and covered container; or

(e) other source approved by the local regulatory authority.

(18) If the local regulatory authority determines that boiling water will not provide adequate potable water, it may require an establishment with a public or nonpublic water supply to use another approved method for supplying water.

(19) An establishment with a public or nonpublic water supply that is subject to a restricted-use order must post an advisory sign or placard regarding the restricted-use order in a conspicuous place for public viewing at each point of entry, or as directed by the local regulatory authority.

(20) A public or nonpublic water supply under a restricted-use order may not be used to make ice for food or beverages.

(21) An establishment with a public or nonpublic water supply that is subject to a restricted-use order may wash, rinse, and sanitize dishes, utensils, and equipment using the affected water system, if using an approved chemical disinfectant or dish machine that reaches 180 degrees Fahrenheit (82 degrees Celsius) during the final rinse cycle, or as directed by the local regulatory authority.

(22) A restricted-use order on a public or nonpublic water supply may be cancelled by the local regulatory authority after:

(a) Laboratory sampling demonstrates that the water supply is safe;

(b) Water system plumbing is completely flushed with cold water for at least five minutes; and

(c) Food-contact surfaces and equipment directly and indirectly connected to the water system must be cleaned and sanitized prior to use including, but not limited to: post-mix carbonated beverage machines, spray misters, coffee makers, tea urns, ice machines, glass washers, and dish machines.

(23) Additions have been made to section 5-303 of this chapter that may apply to public or nonpublic water supplies.

(24) Every mobile food establishment must be equipped with a gravity or pressurized water storage tank.

(25) The water storage tank, or tanks, in a mobile food establishment must be of adequate capacity, as required in section 5-103.11 (A), but no smaller than the following:

(a) a mobile food establishment that serves beverages or food or reheats processed foods must have a water storage tank, or tanks, with a capacity of at least 38 liters (10 gallons) for food employee handwashing;

(b) a food pushcart must have a water storage tank, or tanks, with a minimum capacity of 19 liters (5 gallons) for handwashing; and

(c) a mobile food establishment that processes food or beverages must have a water storage tank, or tanks, with a capacity of at least 151 liters (40 gallons) for handwashing, utensil washing, and sanitizing purposes.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.268 Chapter 6: Physical Facilities

(1) The following addition has been made to section 6-301.14 of this chapter.

(a) Food establishment operators may create and post their own signs or posters for the posting requirement.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.269 Chapter 7: Poisonous or Toxic Materials

(1) This chapter has been adopted with no modifications.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Mont. Admin. R. 37.110.272 Chapter 8: Compliance and Enforcement

(1) Additions and modifications have been made to this chapter.

(2) In section 8-201.11, the regulatory authority may require properly prepared plans and specifications for review and approval before issuance of a new license to a new legal licensee at the change in ownership of an existing food establishment.

(3) Section 8-301.11 has not been adopted.

(4) Section 8-302.11 has not been adopted.

(5) Section 8-302.12 has not been adopted.

(6) Section 8-302.13 has not been adopted.

(7) Section 8-302.14 has not been adopted.

(8) Section 8-303.30 has not been adopted.

(9) Section 8-304.10 has not been adopted.

(10) Section 8-304.20 has not been adopted.

(11) Section 8-401.10 has not been adopted.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-102, 50-50-103, 50-50-104, 50-50-106, 50-50-107, 50-50-108, 50-50-109, 50-50-110, 50-50-201, 50-50-203, 50-50-205, 50-50-206, 50-50-207, 50-50-209, 50-50-210, 50-50-211, 50-50-212, 50-50-213, 50-50-301, 50-50-302, 50-50-304, 50-50-305, MCA
History: NEW, 2014 MAR p. 2957, Eff. 1/1/15.

Authorizing statute(s): 50-50-103, 50-50-301, 50-50-302, MCA
Implementing statute(s): 50-50-103, 50-50-301, 50-50-302, MCA
History: NEW, Eff. 11/4/73; AMD, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.304 Introduction

(1) This subchapter regulates wholesale food establishments, as stated in Title 50, chapter 57, MCA. These rules reflect the most recent scientific information, align the regulations with other states, and correspond to the extent feasible with the retail food rules.

History

Authorizing statute(s): 50-57-103, MCA
Implementing statute(s): 50-57-103, MCA
History: NEW, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.305 Incorporation by Reference

(1) The Department of Public Health and Human Services (department) adopts and incorporates by reference the Food and Consumer Safety (FCS) Circular 2-2019 for wholesale food establishments. This publication may be reviewed online at: https://dphhs.mt.gov/publichealth/FCSS/WholesaleFoodEstablishments , or by contacting DPHHS-FCSS, 1400 Broadway Street, Helena, MT 59620. The circular is modeled after the 2015 Montana retail food rule, 2013 U.S. Food and Drug Administration "Food Code," and Montana food standards contained in ARM Title 37, chapter 110, subchapter 1.

History

Authorizing statute(s): 50-57-103, MCA
Implementing statute(s): 50-57-103, MCA
History: NEW, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.306 Licenses

(1) Any person applying to operate a wholesale food establishment must complete and submit a written application for a license on a form provided by the department. License application forms are available through the local health authority in the county where the activity is being proposed.

(2) A license applicant or legal licensee must submit to the regulatory authority properly prepared plans and specifications for review and approval before:

(a) construction of a new food establishment;

(b) conversion of an existing structure for use as a food establishment;

(d) significant change in licensing subtype from low-risk food processing to high-risk food processing, as determined by the regulatory authority; or

(e) a proposed change in legal ownership of an existing food establishment, as determined by the regulatory authority.

(3) Establishment plans and specifications must include, as required by the regulatory authority, the following information to demonstrate conformance with this subchapter:

(a) intended ingredients, recipes, or products;

(b) anticipated volume of food to be stored, processed, and sold or served;

(d) proposed equipment types, manufacturers, model numbers, locations, dimensions, performance capacities, and installation specifications;

(e) evidence that standard procedures ensuring compliance with the requirements of this rule are developed or are being developed; and

(f) other information that may be required by the regulatory authority for the proper review of the proposed construction, conversion, or modification, and procedures for operating a food establishment.

(4) Proposed mobile food establishments, engaged in food processing, especially high-risk processing, must adequately demonstrate to both the department and the local regulatory authority that the business plan can control at least the following factors, prior to issuance of a license for each and every anticipated food-processing site:

(a) access to sufficient quantity and quality of potable water;

(b) provision for numbers and location of handwashing stations;

(d) access to sufficient quantity and quality of wastewater disposal systems;

(e) control over possible airborne contaminants;

(f) control over possible ground-based contaminants;

(g) control over possible vermin access;

(h) control over proper plumbing for water and wastewater;

(i) control over operations to prevent water and wastewater freezing; and

(j) other relevant control items deemed appropriate by the department or local regulatory authority.

(5) A proposed food manufacturing establishment bottling drinking water in Montana must submit the following to the department and/or local health authority for review and approval:

(a) written test results of the most recent inorganic, volatile organic, organic chemical, and radiological analyses of the water serving the establishment;

(b) written test results for pesticides and synthetic organic chemicals, if the department or local health authority determines such tests are necessary, or if random testing has shown there is or may be contaminants present at levels which may adversely affect public health;

(c) a written description of the water source, water treatment systems, all substances added to the water, and any other documentation required by the department or local health authority to verify that labels and terminology used on product labels conform with applicable law; and

(d) for products labeled ″mineral water″ or for a label containing the term "mineral water" copies of laboratory testing results of mineral content and total dissolved solids (TDS) of the product, obtained during the last 12 months preceding the license year from an agency approved by the department or another public health agency, to test drinking water.

(6) License applicants and license holders must ensure uniform application of food safety standards and compliant product labels.

(a) Prior to approval of an application for a license, or change in certain license subtypes, the local regulatory authority will require the license applicant to submit to the department, and/or the local regulatory authority, food processing plans and food package labeling examples on a form provided by the department for assessment of compliance with this subchapter, and food standards in applicable subsections of ARM 37.110.101. The assessment will be conducted by either the local regulatory authority or the department, or both.

(b) Pursuant to the requirement in (6), this section addresses who is qualified to conduct food safety evaluations and scientific food studies:

(i) Food processes or packaging methods and scientific challenge studies that need a written safety evaluation must be conducted by a process authority currently listed with the Association of Food and Drug Officials at the time of the compliance assessment stated in (6)(a).

(ii) When a challenge study is proposed, in addition to the requirement in (b)(i), the study must be designed and evaluated by an expert food microbiologist, and the laboratory in which the study is conducted must be able to demonstrate prior experience in conducting valid scientific challenge studies.

(c) At the conclusion of the pre-licensing assessment done by the department, the department will submit in a timely manner to the local regulatory authority, and license applicant, a written report regarding findings of the pre-licensing assessment, which may be used by the local regulatory authority as a basis for approval or denial of an application for a license. The written report will also suggest to the local regulatory authority to which license subtype the business should be assigned.

(7) All wholesale food establishments must comply with all appropriate building construction standards in 50-60-101, MCA, and all applicable administrative rules as adopted by the Department of Labor and Industry in ARM Title 24, chapter 301 before issuance of a department wholesale food license.

(8) The regulatory authority must conduct one or more pre-licensing inspections to verify that the food establishment is constructed and equipped in accordance with the approved plans and approved modifications of those plans, and is in compliance with law and this subchapter. No license will be issued or permission granted to operate a proposed establishment if any violations of this rule are observed by the regulatory authority during the final onsite pre-licensing inspection. The department will issue a license to the applicant if the final pre-licensing inspection by the regulatory authority reveals that the proposed wholesale food establishment complies with requirements in this subchapter.

(9) No person may operate a wholesale food establishment who does not have a valid license issued by the department. Only a person who complies with the requirements of this subchapter will be entitled to receive or retain such a license. A valid license must be posted in a conspicuous place for viewing at every wholesale food establishment. Food establishments, under this subchapter that also sell or serve to consumers must procure a separate retail food establishment license, unless specifically exempted from licensure under law in Title 50, chapter 50, MCA.

(10) A license issued by the department must be validated by the local health officer of the local board of health with jurisdiction where the establishment is located in accordance with 50-57-208, MCA. Upon refusal to validate a license, the applicant may appeal the decision in accordance with 50-57-209, MCA.

(11) The department may deny or cancel a license, in accordance with 50-57-210, MCA. Prior to license cancellation, the applicant or licensee may submit a correction plan, in accordance with 50-57-211, MCA. A written notice to the applicant or licensee and hearing are required in cases involving license denials or cancellations, in accordance with 50-57-212, MCA.

(12) Whenever a cancellation of a license has become final, the holder of the cancelled license may make written application for a new license.

(13) Obtaining the license referred to in (9) does not relieve the applicant from satisfying applicable requirements from other federal, state, or local agencies. These may include:

(a) building rule permits and inspections;

(b) fire and life safety inspections;

(d) occupational health and safety requirements.

(14) The local regulatory authority will assign a food establishment to a license type and subtype by assessing food processing procedures, food service, and utilizing the definitions in this subchapter.

(15) At the time of initial licensing and updated as needed, but no less than each licensing year, the regulatory authority will correctly assign a food establishment to one of four categories by evaluating the food processing and service procedures of the food establishment based on the criteria specified in Table 1.

Table 1: Food Establishment Categories

Category A: a food establishment whose point value is less than two must be included in this category.

Category B: a food establishment whose point value is at least two, but not greater than four, must be included in this category.

Category C: a food establishment whose point value equals or exceeds five must be included in this category.

Category D: a food establishment that has been ordered closed by the regulatory authority, or caused a documented foodborne illness outbreak within the previous licensing year must be included in this category.

Food Establishment Point Assignments

Assignment Factors | Points Food is not processed at the facility | 0 Establishment has annual gross sales in excess of $1 million | 1 Establishment distributes food to other states or nations | 1 Establishment provides delivery of ready-to-eat food to consumers | 1 Potentially hazardous food (condition control food) are held at the facility for any period of time | 1 Establishment provides wild mushrooms or wild plants | 1 Establishment distributes food directly to schools, hospitals, elderly care facilities, or to other facilities that serve highly susceptible populations to foodborne illness | 4 Food is processed before being distributed, involving activities such as baking, blanching, boiling, chopping, cooking, cutting, dicing, heating, reheating, or slicing, back-sweetening, and the finished food product is considered ready-to-eat | 5 Food processed at the facility is classified as an acidified food, fish, or fishery product, low-acid canned food, or juice product | 5 Establishment is engaged in sprouting seeds or making ice for human consumption | 5 Establishment infuses vegetables or herbs in oil | 5 Establishment packages potentially hazardous foods in reduced oxygen packaging or modified atmospheric packaging | 5

(16) Botanical substances are those substances not classified in law as food, dietary supplements, drugs, or cosmetics but its use is commonly or usually known by reasonable persons to be an edible product available in commerce.

(a) Botanical substances as determined by the department that are in commerce, such as kratum (Mitragnya speciosa), will not be classified as foods, dietary supplements, drugs, or cosmetics if the following conditions apply to product labeling, promotional materials, and advertising:

(i) the information makes no reference to the product being edible; and

(ii) the information makes no health or health-related claims that would render the products unapproved drugs, dietary supplements, or food.

(b) This rule does not waive detainment and condemnation powers given in 50-31-509 and 50-31-510, MCA, for public health and safety purposes regarding adulteration and misbranding.

History

Authorizing statute(s): 50-57-103, MCA
Implementing statute(s): 50-57-103, 50-57-201, 50-57-203, 50-57-208, 50-57-209, 50-57-210, 50-57-211, 50-57-212, 50-57-213, MCA
History: NEW, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.307 Inspections

(1) The local health officer, registered sanitarian, or sanitarian-in-training employed by or contracted with the local board of health must perform an inspection of each wholesale food establishment within the jurisdiction of the local board of health at least once every 12 months. Additional inspections of the food service establishment must be performed as often as necessary for the enforcement of this subchapter.

History

Authorizing statute(s): 50-57-103, MCA
Implementing statute(s): 50-57-103, 50-57-301, MCA
History: NEW, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.310 Food Supplies

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.311 Milk and Milk Products

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; AMD, 1984 MAR p. 26, Eff. 1/13/84); TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.312 Frozen Desserts

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.313 Minimum Performance Requirements for Local Health Authorities

(1) To qualify for reimbursement under 50-57-305, MCA, a local board of health will perform inspections as specified in this subchapter or enter into a written, signed cooperative agreement with the department that establishes the duties and responsibilities of the local board of health and the department consistent with this subchapter.

(2) All local boards of health must meet the following criteria:

(b) Reporting of inspection dates must be documented in a manner and frequency approved by the department.

(c) All documentation of enforcement of this subchapter including inspection reports, consumer complaints, illness investigations, plans of correction, issuances of variances, and enforcement actions must be retained for five years and be submitted or otherwise made available to the department upon request.

(3) A failure by the local board of health to meet any or all of its responsibilities under this rule may result in the withholding of funds from the local board reimbursement fund in an amount to be determined by the department.

History

Authorizing statute(s): 50-57-103, MCA
Implementing statute(s): 50-57-103, 50-57-104, 50-57-301, 50-57-305, MCA
History: NEW, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.315 Certificate of Free Sale

(1) Requirements for issuance of a Certificate of Free Sale (CFS) by the department or local regulatory authority are:

(a) all certificate applicants must possess a valid wholesale food license;

(b) a CFS will be issued only for license subtypes listed on the issued license;

(c) a CFS will only be issued for compliance with general good food manufacturing practices regulated in this subchapter, and not for the specific food manufacturing regulations stated in ARM 37.110.101;

(d) products for certification must not be under or pending any known embargo, detainment, or litigation by the regulatory authority, U.S. Food and Drug Administration (USFDA), or other enforcement action by health or safety authorities recognized by the department, including local, state, or federal judicial orders;

(e) prior to issuing a CFS, the certificate applicant will provide to the department or local regulatory authority a signed statement that certifies to the best of their knowledge the products are not pending any known embargo, detainment, or litigation by a local regulatory authority, the department, or USFDA, or local, state, or federal judicial orders;

(f) certificate applicants that request a CFS must have been inspected by the regulatory authority within the inspection frequency stated in ARM 37.110.307;

(g) certificate applicants must be in substantial compliance, and not have any uncorrected critical or priority violations of applicable food safety laws and rules;

(h) a CFS will be issued in a format approved by the department that specifies:

(i) plant location where the products were processed;

(ii) date the plant was inspected, and found in substantial compliance, without any uncorrected critical or priority violations of applicable food safety laws and rules;

(iii) only known facts about the products, and conditions found during the inspection;

(iv) the inspection was not conducted to assess compliance with federal good manufacturing practices, only for compliance with Montana wholesale food rules;

(v) the issued document is clearly titled ″Certificate of Free Sale″; and

(vi) the certificate does not imply or express any testimonials regarding product warranty;

(i) the applicant must provide the department or local regulatory authority with information for a CFS on a form provided and approved by the department;

(j) certificate applicant must currently be registered with USFDA, if products are shipped out of state, or outside the United States;

(k) the CFS will be issued in the order the requests are received, and provided in accordance with department or local regulatory authority resources in the timeliest manner possible; and

(l) the department or local regulatory authority will deliver CFSs by the U.S. Postal Service.

(2) The department or local regulatory authority will not charge a fee for the CFS, unless allowed by law.

(3) The decision by the department or local regulatory authority to deny a CFS may be appealed by the applicant by filing a written notice of appeal to the department or local regulatory authority within 30 days of the date on the written denial. Upon the filing of the notice of appeal, the applicant is entitled to a hearing before the department or local regulatory authority held pursuant to the contested case procedure detailed in the Montana Administrative Procedure Act. If the department or local regulatory authority finds the applicant is entitled to a CFS, the presiding officer of the department will issue written directions about how and when the certificate will be issued.

History

Authorizing statute(s): 50-57-103, MCA
Implementing statute(s): 50-57-103, MCA
History: NEW, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.318 Shellfish

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.319 Meat and Meat Products

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.320 Poultry and Poultry Products

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.321 Bakery Products

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.323 Eggs and Egg Products

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.330 Food Protection

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.331 Temperature Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.332 Food Preparation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.333 Food Storage

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.340 Display and Service

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.341 Transportation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.342 Toxic Materials

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.347 Employee Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.348 Equipment and Utensils: Composition, Placement, Cleaning, Sanitizing and Storage

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.350 Water Supply

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.351 Sewage Disposal

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.352 Plumbing

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.353 Toilet and Lavatory Facilities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.354 Waste Disposal

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.355 Vermin Control

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.360 Floors, Walls and Ceilings

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.361 Lighting and Ventilation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.362 Dressing Rooms and Lockers

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.363 Cleaning of Premises

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.364 Live Animals and Birds: Prohibited on Premises

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, MCA
History: NEW, Eff. 11/4/73; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.370 Inspections

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-103, 50-50-305, MCA
Implementing statute(s): 50-50-301, 50-50-302, 50-50-305, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Mont. Admin. R. 37.110.371 Minimum Performance Requirements for Local Health Authorities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-50-305, MCA
Implementing statute(s): 50-50-305, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Authorizing statute(s): 50-50-305, MCA
Implementing statute(s): 50-50-305, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2423; REP, 2022 MAR p. 1880, Eff. 9/24/22.

Subchapter 37.110.5 Cottage Food Operations

Mont. Admin. R. 37.110.501 Purpose

(1) The purpose of this subchapter is to provide rules in addition to the provisions stated in 50-50-102, 50-50-116, 50-50-117, and 50-50-121, MCA, so that cottage food products may be safely produced for the public in approved home kitchens.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-102, 50-50-103, 50-50-116, 50-50-117, 50-50-121, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.502 Definitions

In addition to the definitions contained in 50-50-102, MCA, the following definitions apply to this subchapter:

(1) "Baked goods" means breads, candies, cookies, pastries, and pies that are non-potentially hazardous because they are non-time temperature controlled for safety.

(2) "Cottage food operator" means a person registered with the regulatory authority to operate a cottage food operation.

(3) "Approved" means acceptable to the regulatory authority based on their determination of conformity with principles, practices, and generally recognized standards that protect public health.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-102, 50-50-103, 50-50-116, 50-50-117, 50-50-215, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.503 Approved Cottage Food Products

(1) Only those products approved by the department and listed in the registration may be produced by a cottage food operation. A cottage food operation is allowed to produce the following food items as long as they are a non-potentially hazardous food:

(a) products that may be cooked in an oven including:

(i) loaf breads, rolls, biscuits, quick breads, and muffins;

(ii) cakes including celebration cakes such as birthday, anniversary, and wedding cakes;

(iii) pastries and scones;

(iv) cookies and bars;

(v) crackers;

(vi) cereals, trail mixes, and granola;

(vii) pies, except that custard style pies, pies with fresh fruit that is unbaked, or pies that require refrigeration after baking are not approved;

(viii) nuts and nut mixes; and

(ix) snack mixes;

(b) standardized jams, jellies, preserves, and fruit butters as identified under 21 CFR, Part 150, subject to the following:

(i) fresh picked or harvested fruits from noncommercial sources are allowed for use;

(ii) fresh fruits may be frozen in a household freezer and used at a later time;

(iii) all recipes must have a cook step included such as a hot fill or hot water bath, and freezer or refrigerator-style products are not approved;

(iv) all jams, jellies, preserves and fruit butters must be sealed in containers that are sterilized prior to filling; and

(v) paraffin wax is not allowed for sealing;

(c) repackaged, commercially dried fruit or vegetables from an approved source as described in ARM 37.110.510(2), or fresh fruits that:

(i) have a natural pH below 4.6, specifically: apples, apricots, grapefruit, lemons, limes, mangos, nectarines, oranges, peaches, plums, pomegranates, tangerines, blackberries, blueberries, cherries, cranberries, currants, gooseberries, grapes, raspberries, strawberries, and huckleberries; and

(ii) are dried by cottage food operators with the following methods:

(A) during the fruit drying process the fruit must reach 160 o Fahrenheit within an hour of processing the fruit;

(B) the fruit must then maintain 140 o Fahrenheit for the remainder of the drying process;

(d) dry herb combining and packaging, and seasoning and mixture combining; examples of which are dry bean soup mixes, dry teas and coffees, and spice seasonings;

(e) popcorn, popcorn balls, cotton candy;

(f) fudge, candies, and confections that require a cook step;

(g) molded chocolate using commercial chocolate melts; and

(h) honey.

(2) The following provisions apply to the production of cottage food products:

(a) fresh picked or harvested fruits from noncommercial sources are allowed in baked good products;

(b) fresh fruits can be frozen and used at a later time as long as there is a cook step in the recipe; and

(c) all frostings or glazes must have a cook step or be made with ingredients (such as a large amount of sugar) that when combined are stable at room temperature.

(3) Other products may be approved on a case-by-case basis by the department in consultation with the local health department of the county in which the cottage food operator is registered.

History

Authorizing statute(s): 50-50-102, 50-50-103, MCA
Implementing statute(s): 50-50-102, 50-50-116, 50-50-117, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.504 Labeling

(1) Cottage food operations must adhere to the labeling requirements outlined in 50-50-116, MCA.

(2) The following is representative of a label meeting the requirements of (1):

MADE IN A HOME KITCHEN THAT IS NOT SUBJECT TO RETAIL FOOD ESTABLISHMENT REGULATIONS OR INSPECTIONS Chocolate Chip Cookies Net Wt. 8oz (227g) Ingredients: Enriched flour (Wheat flour, niacin, reduced iron, thiamine, mononitrate, riboflavin and folic acid), butter (milk, salt), chocolate chips (sugar, chocolate liquor, cocoa butter, butterfat (milk), soy lecithin as an emulsifier), walnuts, sugar, eggs, salt, artificial vanilla extract, baking soda. Contains: Wheat, eggs, milk, soy, walnuts. Ashley Bryant 2550 Helena Lane Helena, MT 59620

(3) The department may allow large cakes or a container of bulk products to be handled and labeled in the following manner:

(a) be protected from contamination during transportation to the consumer; and

(b) have a product label sheet with all the required information as listed in (1) that is provided to the consumer.

History

Authorizing statute(s): 50-50-103, 50-50-116, MCA
Implementing statute(s): 50-31-103, 50-50-116, 50-50-117, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.506 Cottage Food Operator Health

(1) Cottage food operators must not manufacture cottage food products (for example, working with exposed food; working with cleaning equipment, utensils, and linens; or working with unwrapped single-service or single-use articles) while experiencing the following symptoms:

(a) vomiting;

(b) diarrhea;

(d) sore throat with fever;

(e) a lesion containing pus such as a boil or infected wound that is open or draining and is:

(i) on the hands or wrists, unless an impermeable cover such as a finger cot or stall protects the lesion and a single-use glove is worn over the impermeable cover;

(ii) on exposed portions of the arms, unless the lesion is protected by an impermeable cover; or

(iii) on other parts of the body, unless the lesion is covered by a dry, durable, tight-fitting bandage;

(f) symptoms of any of the following illnesses as diagnosed by a health practitioner:

(i) norovirus;

(ii) hepatitis A virus;

(iii) shigella spp.;

(iv) shiga toxin-producing escherichia coli;

(v) salmonella typhi; or

(vi) nontyphoidal salmonella.

(2) A cottage food operator experiencing persistent sneezing, coughing, or a runny nose that causes discharges from the eyes, nose, or mouth must not work with exposed food; clean equipment, utensils, and linens; or unwrapped single-service or single-use articles.

History

Authorizing statute(s): 50-50-103, 50-50-116, MCA
Implementing statute(s): 50-50-103, 50-50-105, 50-50-116, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.507 Personal Cleanliness

(1) Cottage food operators must keep their hands and exposed portions of their arms clean.

(2) Cottage food operators must use the following procedure in order to keep their hands and exposed portions of their arms clean:

(a) rinse under clean, running warm water;

(b) apply an amount of soap;

(i) paying particular attention to removing soil from underneath the fingernails during the cleaning procedure; and

(ii) creating friction on the surfaces of the hands and arms or surrogate prosthetic devices for hands and arms, finger tips, and areas between the fingers;

(d) thoroughly rinse under clean, running warm water; and

(e) immediately follow the cleaning procedure with thorough drying using a single use towel.

(3) Cottage food operators must clean their hands and exposed portions of their arms immediately before engaging in food preparation, which includes working with exposed food, clean equipment and utensils, and unwrapped single-service and single-use articles, and:

(a) after touching bare human body parts other than clean hands and clean, exposed portions of arms;

(b) after using the toilet room;

(d) after coughing, sneezing, using a handkerchief or disposable tissue, using tobacco, eating, or drinking;

(e) after handling soiled equipment or utensils;

(f) during food preparation, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks;

(g) when switching between working with raw food and working with ready-to-eat food;

(h) before donning gloves to initiate a task that involves working with food; or

(i) after engaging in other activities that contaminate the hands.

(4) Cottage food operators must keep their fingernails trimmed, filed, and maintained so the edges and surfaces are cleanable and not rough. Unless wearing intact gloves in good repair, a cottage food operator may not wear fingernail polish or artificial fingernails when working with unpackaged food.

(5) Except for a plain ring such as a wedding band, cottage food operators may not wear jewelry on their arms and hands while preparing food, including medical information jewelry.

(6) Cottage food operators must wear clean outer clothing to prevent contamination of food, equipment, utensils, linens, and single-service and single-use articles.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-116, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.508 Hygienic Practices

(1) A cottage food operator must not eat, drink, or use any form of tobacco in the registered area of the domestic residence while preparing a cottage food, or where the contamination of exposed food, clean equipment, utensils, and linens, unwrapped single-service and single-use articles, or other items needing protection can result.

(2) Cottage food operators must provide a barrier between the registered area of their domestic residence and all pets while preparing and packaging cottage food items.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-116, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.510 Manufacture of Cottage Food Products

(1) Cottage food products must be safe, unadulterated, honestly presented, and:

(a) must be offered for human consumption in a way that does not mislead or misinform the consumer;

(b) food or color additives and colored overwraps may not be used to misrepresent the true quality of a cottage food product, although dying cookies or other similar products and/or wrapping them for a theme such as a green cookie for St. Patrick's Day or a popcorn ball wrapped in red plastic for Christmas is allowed.

(2) Food must be obtained from approved sources, including:

(a) retail and wholesale establishments licensed by the state of Montana;

(b) fluid and dry milk products must:

(i) be obtained pasteurized; and

(ii) comply with grade A standards.

(c) In many cases local farm products are considered approved sources; consult with your local health authority to make determinations on a case-by-case basis.

(3) Eggs and dairy ingredients must be stored under refrigeration.

(4) Upon receiving food packages from an approved source, food packages must be maintained in good condition and protect the integrity of the contents so the food is not exposed to adulteration or potential contaminants.

(5) Cottage food operators must minimize bare hand and arm contact with exposed food that is not in a ready-to-eat form.

(6) Cottage food operators may not contact exposed, ready-to-eat food with their bare hands, and must use suitable utensils such as deli tissue, spatulas, tongs, single-use gloves, or dispensing equipment.

(7) A cottage food operator may not use a utensil more than once to taste cottage food products or ingredients that are to be sold or served.

(8) Food contact surfaces must be easily cleanable.

(9) Food must only contact surfaces of equipment and utensils that are cleaned and sanitized as specified:

(a) equipment food-contact surfaces and utensils must be clean to sight and touch;

(b) food-contact surfaces of cooking equipment and pans must be kept free of encrusted grease deposits and other soil accumulations.

(c) To the extent practicable, cottage food manufacturers should either dip utensils, dishes, and equipment in a 100 ppm chlorine bleach solution (or other approved sanitizer) and allow to air dry, or use the sanitizing cycle of a dishwasher.

(10) Toxic chemicals such as household cleaners, concentrated bleach, and pesticides must be stored in a way that will not contaminate food, food-preparation areas, and food-contact surfaces.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-116, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.511 Registration Requirements

(1) Registration must follow the requirements provided in 50-50-117, MCA.

(2) The registrant must provide their name, mailing address, phone number, and e-mail address.

(3) The registrant must provide a detailed description of cottage food product manufacturing process including equipment and utensils to be used.

(4) The registrant must dispose of sewage through an approved facility that is:

(a) a public sewage treatment plant; or

(b) an individual sewage disposal system that is operated according to law.

(5) The recipe for each product must be submitted with the application for review and kept on file at the cottage food operation location. Ingredient lists are subject to public disclosure, but recipes are proprietary and are not subject to public disclosure.

(6) At the time of registration, the registrant must demonstrate that the water for the cottage food operation is either:

(a) from an approved public water system; or

(b) meets minimum drinking water standards from a certified laboratory by providing results for total coliform and nitrates from the private well serving the domestic residence that is being registered for the cottage food operation;

(i) nitrates must be below 10 mg/L from a sample within the last 12 months;

(ii) total coliforms must be absent from a sample within the last 6 months;

(iii) failure to meet minimum drinking water standards will result in registration being withheld until samples are provided that meet the minimum nitrate and total coliform standards in this rule.

(c) Water sampling may also be required by the state or local health authority when cottage food is suspected of being associated with an illness or outbreak.

(7) A registration fee of $40.00 must be paid to the county in which the cottage food operation is registered. Once registered, a cottage food operator may sell their registered products anywhere in the state of Montana. The cottage food operation must register again with the local health authority and pay the registration fee if it wishes to change the location of its cottage food operation or produce new products. Recipe changes to an existing approved product that necessitate redetermination as to whether that product constitutes a non-potentially hazardous food or contains a major allergen are new products for the purposes of this rule. While not exhaustive, the following are examples of when a new fee must be paid:

(a) when a cottage food operator moves to a new house;

(b) when a cottage food operator changes a recipe in a way that may make the recipe potentially hazardous or adds an allergen, such as switching from a traditional frosting to one that contains cream cheese or adding walnuts to chocolate chip cookies; and

(c) when a cottage food operator wishes to make a completely new product, such as dried fruit when they had previously registered chocolate chip cookies.

(8) A department-approved certificate of registration will be provided to each new registrant. A certificate of registration must be made available to a local health authority upon request when a cottage food operator is vending to the public.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-116, 50-50-117, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.513 Enforcement and Inspections

(1) Cottage food operations will be inspected according to the requirements of 50-50-301(3), MCA.

(2) Cottage food operators in violation of this subchapter are subject to enforcement action in accordance with Title 50, chapter 50, part 1, MCA.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-103, 50-50-301, 50-50-302, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Mont. Admin. R. 37.110.514 Samples

(1) A cottage food operator must furnish cottage food product or ingredient samples for analysis upon request of the regulatory authority when the food is suspected of being associated with an illness or outbreak.

History

Authorizing statute(s): 50-50-103, MCA
Implementing statute(s): 50-50-302, 50-50-303, MCA
History: NEW, 2015 MAR p. 1494, Eff. 9/25/15.

Authorizing statute(s): 50-50-305, MCA
Implementing statute(s): 50-50-053, MCA
History: NEW, 1994 MAR p. 2832, Eff. 10/28/94; AMD, 1995 MAR p. 26, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2423; REP, 2019 MAR p. 2126, Eff. 1/1/20.

Chapter 37.111 Public Accommodations

Subchapter 37.111.1 Public Sleeping Accommodations

Mont. Admin. R. 37.111.101 Definitions

In addition to those definitions contained in 50-51-102, MCA, the following definitions apply to this subchapter:

(1) "Bedding" means a mattress, box springs, mattress cover, mattress pad, sheets, pillow slip, pillow, pillow cover, blanket, comforter, quilt, duvet, and bedspread.

(2) "Building authority" means the Department of Labor and Industry Building Codes Program, or its local authorized agent.

(3) "Establishment" has the meaning provided for under 50-51-102, MCA. For the purpose of this subchapter, establishment does not include a "bed and breakfast," "guest ranch," or "outfitting and guide facility."

(4) "Fire authority" means the state fire marshal or the state fire marshal's authorized agent.

(5) "Fixture" means a shower, bathtub, toilet, toilet seat, urinal, handwashing sink, kitchen sink, janitor sink, dishwashing sink, and all exposed plumbing integral to them.

(6) "Guest" means each person using any provided services such as a bed or bathing facility within any unit of an establishment.

(7) "License" means a written document issued by the department authorizing the operation of an establishment.

(8) "Local regulatory authority" means the local board of health, local health officer, local sanitarian, or other authorized representative of the local government having jurisdiction.

(9) "Sanitarian" means the person who is qualified under Title 37, chapter 40, part 3, MCA, and represents the health officer.

(10) "Sanitize" means the application of a 100 to 200 parts per million (ppm) solution of household bleach, approximately 5% by weight, for at least ten seconds.

(11) "Shock disinfection" means an application of a chemical disinfectant to a water supply in order to kill all microorganisms. The chemical disinfectant is usually chlorine at a concentration much stronger than allowed in potable water, or another method approved by the local regulatory authority.

(12) "Sleeping accommodation" means the provision of sleeping quarters where the linen service or housekeeping service are provided by management or by the guests under the direct supervision of management. Sleeping accommodation does not include a place of residency subject to the Residential Landlord and Tenant Act of 1977, Title 70, chapter 24, MCA.

(13) "Wastewater treatment system" means a system that receives wastewater for purposes of treatment, storage, or disposal. The term includes public wastewater conveyance systems, wastewater systems, and all wastewater disposal methods described in Department of Environment Quality Circulars DEQ-2 and DEQ-4.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.102 Review of Plans and Specifications

(1) Plans and specifications must be submitted to the local regulatory authority for review and approval before any new license is issued.

(2) Local regulatory authority approval is required before any construction, remodeling, or conversion for a new or existing establishment begins.

(3) The local regulatory authority must review the plans and specifications and respond to the applicant within 30 days with a written approval, disapproval, or request for additional information.

(4) If the establishment was previously licensed by the department and no structural modification will be involved, the local regulatory authority may waive the requirement for the submission of plans and specifications.

(5) If the local regulatory authority is unable to perform the review, plans and specifications must be submitted to the department for review and approval.

(6) Plans and specifications must include the following:

(a) location and detail of storage rooms used for bedding and furnishings;

(b) location and detail of janitorial facilities;

(d) a flow chart indicating the route of laundry through sorting, washing, drying, ironing, folding, and storage;

(e) location and description of all food preparation, storage, and service areas, unless already required to license as a retail food service establishment under 50-50-102, MCA;

(f) description of dishes, cookware, utensils, and cooking equipment available in guest rooms, including details of cleaning and storage;

(g) location and detail of ice production, storage, and dispensing equipment;

(h) location of swimming pools, spas, and other recreational water features;

(i) name of sanitary landfill licensed by the Department of Environmental Quality (DEQ) which will receive solid waste from the establishment;

(j) documentation of approval from DEQ and any applicable local regulatory authority permit and inspection report, if the establishment will be served by a public wastewater treatment system;

(k) documentation of approval from the local regulatory authority, if the establishment will be served by a nonpublic wastewater treatment system;

(l) documentation of approval from DEQ, if the establishment will be served by a public water supply;

(m) demonstration of compliance with this subchapter, if the establishment will be served by a nonpublic water supply; and

(n) any other pertinent information requested by the department or local regulatory authority.

(7) Construction must be in accordance with the plans and specifications as approved. Any changes from the approved plans must be reviewed and approved, in writing, by the department or local regulatory authority.

(8) Approval is valid for two years. If construction, remodeling, or conversion is not completed within two years, the department or local regulatory authority may require plans and specifications to be resubmitted for review.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.103 Variance

(1) The local regulatory authority may grant a variance to a requirement of this subchapter if, in the opinion of the local regulatory authority, a health hazard or nuisance will not result from the variance.

(2) To apply for a variance, the applicant must submit the following information:

(a) a statement as to why the applicant is unable to comply with the rule from which the variance is requested;

(b) the nature and duration of the variance requested;

(c) a statement of how the intent of the rule will be met and the reasons why the public health or safety would not be jeopardized if the variance is granted; and

(d) other information deemed necessary by the local regulatory authority to establish that a health hazard or nuisance will not result from granting the variance.

(3) The local regulatory authority must retain the variance application and decision in the establishment file as long as the variance is applicable.

(4) Prior to issuing a variance, the local regulatory authority will contact, notify, and consult with the department about any similar variances to help ensure uniform application of the law.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.104 Preconstruction Review

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2010 MAR p. 1197, Eff. 1/15/10; REP, 2012 MAR p. 1042, Eff. 5/25/12.

Mont. Admin. R. 37.111.105 Existing Building: Change of Use

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; TRANS, from DHES, 2001 MAR p. 2425; REP, 2012 MAR p. 1042, Eff. 5/25/12.

Mont. Admin. R. 37.111.106 Licensure, Renewal, and Inspection

(1) The local regulatory authority must make a pre-licensing inspection to determine compliance with the requirements of this subchapter before a license is issued by the department or validated by the local health officer.

(2) The local regulatory authority must inspect each licensed establishment within the jurisdiction of the local board of health to determine compliance with this subchapter at least once each calendar year, unless that schedule is modified by signed agreement with the department.

(3) The local regulatory authority, after proper identification, must be provided access to the establishment at all reasonable hours for the purpose of conducting inspections and investigations as required under this subchapter.

(4) Inspection findings must be written to reference any rule violated, state the correction to be made, and specify a reasonable period of time for the correction.

(5) The written inspection report must be made on a form authorized by the department.

(6) Inspection findings must be given to the person in charge of the establishment at the conclusion of the inspection.

(7) A copy of the completed inspection form must be given to the establishment owner or designee within three business days.

(8) The local regulatory authority must retain all documentation of enforcement of this subchapter including inspection reports, consumer complaints, illness investigations, plans of correction, and enforcement actions for at least five years.

(9) The completed inspection report is a public document that must be made available for public review upon request, distribution to any person upon payment of copying costs, or provided to the department upon request.

(10) Obtaining a license under this subchapter does not relieve the applicant from satisfying other applicable plan review, licensing, and inspection requirements. Other requirements may include, but are not limited to the following:

(a) building code permit and inspection;

(b) fire and life safety inspection;

(d) public swimming pool, spa, and other water feature licensing; and

(e) business licensing.

(11) Notification of noncompliance from the building or fire authority may prevent a license from being issued by the department or validated by the local health officer.

History

Authorizing statute(s): 50-51-103, 50-51-303, MCA
Implementing statute(s): 50-51-103, 50-51-301, 50-51-303, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; AMD, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.107 Physical Requirements

(1) Sufficient storage space must be provided for extra bedding and furnishings.

(2) Adequate and convenient janitorial facilities must be provided, including a janitor sink and storage area for equipment and chemicals. A janitor sink is not required for:

(a) tourist homes;

(b) a private home or condominium that is occupied by an owner or manager and that is rented, leased, or furnished in its entirety or in part to transient guests on a daily or weekly basis; and

(3) All rooms, hallways, stairways, and public access areas must be provided with at least ten foot-candles of light.

(4) Floors and walls in toilet and bathing rooms, laundries, janitorial closets, and similar rooms subject to large amounts of moisture must be smooth, durable, nonabsorbent, and easily cleanable.

(5) Floor and wall-mounted furnishings must be easily moved to allow for cleaning or mounted in such a manner as to allow for cleaning around and under such furnishings.

(6) Bathing facilities must be provided with anti-slip surfaces or mats.

(7) Handwashing sinks and bathing facilities must be provided with water at a temperature of at least 100 ° F (38 ° C) and not more than 120 ° F (49 ° C).

(8) Establishment property must be maintained to minimize the presence of insects, rodents, and other vermin which may affect public health.

(9) The local regulatory authority may require licensed pesticide services for persistent pest infestations.

(10) Adequate ventilation must be provided to prevent excess moisture and odors.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; AMD, 1985 MAR p. 779, Eff. 6/28/85; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.110 Water Supply System General Requirements

(1) An establishment must provide an adequate and potable supply of water.

(2) A public water supply system must be approved by the Montana Department of Environmental Quality (DEQ) and meet the requirements of ARM Title 17, chapter 38, subchapters 1, 2, 3, and 5.

(3) A nonpublic water supply system must meet the requirements of Nonpublic Water Supply Circular FCS 1-2016 when:

(a) the water supply is constructed after the effective date of this rule;

(b) modifications are made to the water system; or

(c) the local regulatory authority determines compliance with Nonpublic Water Supply Circular FCS 1-2016 is necessary to meet the requirements of this subchapter.

(4) A non-potable water source may be used only if:

(a) access points are marked "not for human consumption";

(b) installation and maintenance prevent any connection to a potable water supply system; and

(5) The department adopts and incorporates by reference Nonpublic Water Supply Circular FCS 1-2016 in effect November 5, 2019, which contains potable water construction and maintenance standards for nonpublic water supplies serving licensed establishments. A copy of Nonpublic Water Supply Circular FCS 1-2016 may be obtained from the Department of Public Health & Human Services, Food & Consumer Safety Section, P.O. Box 202951, Helena, Montana 59620-2951. The Nonpublic Water Supply Circular FCS 1-2016 is also available on the department's web site at www.fcss.mt.gov .

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.111 Nonpublic Water Supply Sampling and Test Reports

(1) An establishment using a nonpublic water supply system must have water samples analyzed for coliform bacteria as follows:

(a) Coliform sampling must be done before licensing and in at least two different months of each calendar year that the establishment operates.

(b) The sampling schedule must include collection when the water source is most likely to be contaminated, such as during April through June and September through October, in the high ground water season, or as directed by the local regulatory authority.

(c) The local regulatory authority may require the establishment to sample monthly, in the months the establishment operates, or if an inspection, sampling results, or an event indicates the water source is vulnerable to contamination.

(d) The local regulatory authority may return the sampling frequency to two in a calendar year if an on-site sanitary inspection of the water source and other pertinent information shows the water source is no longer vulnerable to contamination.

(2) Following shock disinfection, a coliform sample must be collected at least three to five days after disinfectant is no longer detected in the system.

(3) An establishment using a nonpublic water supply system must have a water sample analyzed for total nitrate before initial licensing and at least every three years that the establishment is licensed.

(4) Water samples must be analyzed by a laboratory licensed and certified by the state of Montana for drinking water analysis.

(5) The establishment must ensure water test results are transmitted to the local regulatory authority from the laboratory in a format acceptable to the local regulatory authority within five working days, except as required in ARM 37.111.112(1)(c) and (3)(d).

(6) The establishment must keep test results available for inspection by the local regulatory authority for at least five years.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.112 Nonpublic Water Supply Contaminated Samples

(1) If coliform bacteria is detected in a nonpublic water supply routine sample, the establishment must:

(a) collect at least four more repeat samples within 24 hours of notice at the following system points:

(i) the location of the original contaminated routine sample;

(ii) up-gradient to the contaminated routine sample;

(iii) down-gradient to the contaminated routine sample; and

(iv) at the source; or

(v) as directed by the local regulatory authority.

(b) collect at least five routine samples in the month following a detection of coliform in any routine sample; and

(2) If coliform is detected in a repeat sample, the establishment must:

(a) take appropriate corrective action; and

(b) notify customers and staff by placing an advisory sign approved by the local regulatory authority at each point of use, or as directed by the local regulatory authority.

(3) If fecal coliform or E. coli is detected in a routine sample or repeat sample, the establishment must:

(a) stop using the water source immediately;

(b) provide a temporary source of safe water in accordance with ARM 37.111.114;

(d) notify the local regulatory authority within 24 hours of receiving test results.

(4) If an establishment fails to take the four repeat samples or the five routine samples, following the detection of coliform, or the laboratory fails to test for fecal coliform or E. coli in coliform positive samples, the establishment must follow corrective actions as specified in (3).

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.113 Water Supply Corrective Actions

(1) An establishment must take appropriate corrective action, which may include shock disinfection, replacement, or repair of the water supply system, within a period specified by the local regulatory authority when:

(a) a water sample exceeds a maximum contaminant level as specified in ARM Title 17, chapter 38, subchapter 2;

(b) the supply does not have the capacity to provide enough water for drinking, cooking, personal hygiene, laundry, cleaning, and wastewater disposal;

(c) the local regulatory authority reports to an establishment that the establishment's water supply system is vulnerable to contamination based on a site visit;

(d) a pathogenic microorganism is detected; or

(e) a confirmed disease outbreak is associated with the water supply through investigation.

(2) When a water supply is replaced or repaired, the water supply system must be shock disinfected before the system is placed into service.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.114 Water Supply Restricted-Use Order

(1) The local regulatory authority shall issue a restricted-use order to an establishment when:

(a) the Montana Department of Environmental Quality (DEQ) has issued a boil water order;

(b) fecal coliform or E. coli is detected in a nonpublic water supply sample;

(d) a nonpublic water supply sample exceeds a maximum contaminant level as specified in ARM Title 17, chapter 38, subchapter 2;

(e) a pathogenic microorganism is detected; or

(f) a confirmed disease outbreak is associated with the water source by investigation.

(2) An establishment that is subject to a restricted-use order must provide and use a temporary source of potable water as described in (3) for guest and staff drinking, food and drink preparation and service, ice, dishwashing, food contact surface cleaning, and hand washing, or discontinue operations.

(3) With approval from the local regulatory authority, an establishment may provide potable water on a temporary basis using one or more of the following:

(a) bottled or packaged potable water from a department-licensed water bottler, or other approved water bottler, if the water is dispensed directly from the original container;

(b) water from a DEQ-approved public water supply that meets the requirements of ARM Title 17, chapter 38, subchapters 1, 2, 3, and 5, stored in a clean, sanitized, and covered potable water container or holding tank;

(d) if the water is fecal or E. coli contaminated, water that has been boiled for at least one minute and stored and served from a clean, sanitized, and covered container; or

(e) other source approved by the local regulatory authority.

(4) If the local regulatory authority determines that boiling water will not provide adequate potable water, it may require an establishment to use another approved method for supplying water.

(5) An establishment subject to a restricted-use order must notify guests and staff of the restricted-use order by placing a sign at each point of use, or as otherwise directed by the local regulatory authority.

(6) A water supply under a restricted-use order may not be used to make ice.

(7) An establishment subject to a restricted-use order may wash, rinse, and sanitize dishes, utensils, and equipment using the affected water system if using an approved chemical disinfectant or a commercial dish machine that reaches 180°F (82°C) in the final rinse, or as directed by the local regulatory authority.

(8) A restricted-use order may be removed by the local regulatory authority after:

(a) laboratory sampling demonstrates that the water supply is safe;

(b) the establishment flushes all pipes, faucets, and drinking fountains by running cold water for at least five minutes; and

(c) the establishment flushes, cleans, and sanitizes food and beverage equipment connected to the water supply, such as post-mix beverage machines, spray misters, coffee makers, tea urns, ice machines, glass washers, and dishwashers in accordance with manufacturer's instructions.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.115 Water Supply System

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; AMD, 1985 MAR p. 779, Eff. 6/28/85; TRANS, from DHES, 2001 MAR p. 2425; REP, 2012 MAR p. 1042, Eff. 5/25/12.

Mont. Admin. R. 37.111.116 Wastewater Treatment System

(1) An adequate and safe wastewater system must be provided for conveying, treating, and disposing of all sewage from an establishment.

(2) Immediate measures must be taken to alleviate health and sanitation hazards caused by wastewater at the establishment when they occur.

(3) All wastewater must be disposed of by a public wastewater system approved by the Montana Department of Environmental Quality or by a private wastewater system constructed and operated in accordance to applicable state and local regulations.

(4) A wastewater system has failed and requires replacement or repair if any of the following conditions occur:

(a) the system fails to accept, treat, or dispose of wastewater as designed;

(b) the system displays surfacing effluent;

(d) the wastewater system experiences mechanical failure, including electrical outage, or collapse or breakage of a septic tank, lead line, or drainfield line.

(5) Extension, alteration, replacement, or repair of any wastewater system must be done in accordance with all applicable state and local regulations.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; AMD, 1985 MAR p. 779, Eff. 6/28/85; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.117 Solid Waste

(1) Solid waste must be collected, stored, and disposed of in a manner that does not create a sanitary nuisance.

(2) Solid waste must be removed from the premises at least weekly to a licensed solid waste disposal facility or at another frequency approved by the local regulatory authority.

(3) Solid waste may not be burned on the premises.

(4) Solid waste containers must be rodent-proof, stable, and protected from deterioration.

(5) Solid waste containers must be sufficiently covered when not in use to prevent the entry of water or flies.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.118 Ice

(1) Ice must be made from the establishment's approved water supply meeting the requirements of this subchapter or obtained from a licensed or approved supplier.

(2) Ice must be manufactured, stored, handled, transported, and served in a manner that prevents contamination.

(3) When ice is not stored in an automatic dispenser and is available to multiple guests or groups of guests, then the ice must be served directly by the establishment staff.

(4) An ice scoop must be readily available for use by the staff and protected from contamination.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2012 MAR p. 1042, Eff. 5/25/12.

Mont. Admin. R. 37.111.121 Laundry Facilities

(1) All bedding, towels, and other laundered items must be mechanically washed and hot air dried in laundry facilities which meet the following requirements:

(a) The wash cycle must run with sufficient detergent and for a time demonstrated to thoroughly remove all visible soil.

(b) Laundered items must be thoroughly hot air tumble dried to at least 130 º F (54 º C) for ten minutes.

(2) Clean laundry must be kept protected from contamination from soiled laundry and other sources by the following:

(a) using separate labeled carts or containers for transportation;

(b) providing sufficient space for sorting, folding, and storage; and

(3) Laundry facilities must have a convenient handwashing sink, hand soap, disposable towels, and trash can.

(4) If the hand sink is used for soaking laundry, it must be accessible for handwashing when needed.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; AMD, 1985 MAR p. 779, Eff. 6/28/85; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.122 Guest Room Cleaning and Maintenance

(1) Guest rooms must be cleaned and supplied with freshly laundered sheets, pillow covers, towels, and washcloths before each new guest or group of guests arrive.

(2) Clean bed sheets, pillow covers, towels, and washcloths must be provided to each guest at least weekly. They may be provided more frequently as requested by a guest or according to establishment policy.

(3) Shared bathrooms must be cleaned daily.

(4) All bedding, towels, and washcloths provided by management must be clean and in good repair.

(5) Each mattress must be covered with a machine-washable pad.

(6) Sheets must adequately cover the bed and fold over the blanket at least six inches.

(7) All bedding including quilts and comforters must be machine-washable or covered with machine-washable linen such as a duvet.

(8) Mops must be air dried between uses.

(9) A designated janitor sink must be used for washing and rinsing of mops, brooms, brushes, and other cleaning devices. Tourist homes and vacation rentals may use an alternative as approved by the local regulatory authority.

(10) Toilet and urinal cleaning devices must be kept separate from other cleaning supplies and may not be used for any other purpose. Bathtub and shower cleaning devices must be kept separate from other cleaning supplies and may not be used for any other purpose.

(11) All furnishings, fixtures, floors, walls, and ceilings must be clean and in good repair.

(12) Management must provide for maintenance as needed.

(13) Cleaning compounds and pesticides must be stored, used, and disposed of in accordance with the manufacturer's label instructions.

(14) Ozone air purifiers may not be used within the establishment.

(15) Glasses, pitchers, ice buckets, coffee pots, and other utensils used for food or drink provided for guests must be washed, rinsed, and sanitized or single-service items must be used.

(16) All utensils used for food or drink provided for guests must be stored, handled, and dispensed in a manner which prevents contamination.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; AMD, 1985 MAR p. 779, Eff. 6/28/85; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22.

Mont. Admin. R. 37.111.123 Pools, Spas, and Other Features

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2010 MAR p. 1197, Eff. 1/15/10; REP, 2012 MAR p. 1042, Eff. 5/25/12.

Mont. Admin. R. 37.111.124 Food Service Requirements

(1) An establishment preparing or serving food that meets the definition of a "retail food establishment" under 50-50-102, MCA, must obtain a separate retail food license.

History

Authorizing statute(s): 50-51-103, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 1981 MAR p. 1898, Eff. 1/1/82; TRANS, from 16.10.626, 1982 MAR p. 1049, Eff. 5/14/82; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12; AMD, 2022 MAR p. 1750, Eff. 9/10/22; AMD, 2024 MAR p. 333, Eff. 2/24/24; AMD, 2026 MAR, Notice No. 2026-433, Eff. 8/8/26.

Mont. Admin. R. 37.111.130 Guest Registration

(1) Each establishment must maintain a register of all overnight guests, including name and contact information of the guest and unit to which the guest was assigned.

(2) Guest registration must be kept available for at least one year for communicable disease investigations or other public health reasons.

History

Authorizing statute(s): 50-1-202, 50-51-103, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-51-103, MCA
History: NEW, 1982 MAR p. 1049, Eff. 5/14/82; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2012 MAR p. 1042, Eff. 5/25/12.

Mont. Admin. R. 37.111.135 Minimum Performance Requirements for Local Health Authorities

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-51-303, MCA
Implementing statute(s): 50-51-303, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2425; REP, 2012 MAR p. 1042, Eff. 5/25/12.

Authorizing statute(s): 50-52-102, 50-52-301, MCA
Implementing statute(s): 50-52-302, MCA
History: NEW, 1995 MAR p. 634, Eff. 4/28/95; TRANS, from DHES, 2001 MAR p. 2425; REP, 2022 MAR p. 1748, Eff. 9/10/22.

Subchapter 37.111.3 Bed and Breakfast Establishments

Mont. Admin. R. 37.111.301 Purpose

(1) The purpose of these rules is to establish public health requirements governing the operation of bed and breakfast establishments in order to protect the health and safety of guests staying at such establishments.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.302 Definitions

In addition to those definitions contained in 50-51-102 , MCA, the following definitions apply to this subchapter:

(1) "Bed and breakfast establishment" as defined in 50-51-102 (1) , MCA, means a private, owner or manager occupied residence that is used as a private residence but in which:

(a) breakfast is served and is included in the charge for a guest room; and

(b) the number of daily guests served does not exceed 18.

(2) "Bedding" means mattress covers, mattress pads, sheets, pillow protectors and cases, blankets, comforters, quilts and bedspreads.

(3) "Building authority" means the building codes bureau of the Montana department of labor and industry or a local government building inspector enforcing a local building code enforcement program certified by the Montana department of labor and industry.

(4) "Department" means the Montana department of public health and human services.

(5) "Dishwashing" means the cleaning and sanitizing of food contact surfaces of equipment, kitchenware, tableware and utensils.

(6) "Fire authority" means the state fire marshal or his or her authorized agent.

(7) "Fixtures" means a shower, bathtub, toilet, urinal, lavatory, all types of sinks and all exposed plumbing integral to them.

(8) "Food equipment" means items, other than utensils, that are used in the food service operation of the bed and breakfast establishment such as freezers, grinders, ventilation hoods, ice makers, meat blocks, mixers, ovens, refrigerators, sinks, slicers , stoves, tables, dishwashing machines, counters or water heaters.

(9) "Furnishings" means those items contained in guest rooms and guest bathrooms such as draperies, curtains, blinds, lamps and lamp shades, chairs, tables, desks, shelves, books, magazines, bookcases, dressers, bedsteads, mattresses, box springs, towels, washcloths, soap, toilet tissue, radios, television sets, coffee makers, pictures, waste containers and mirrors.

(10) "Guest" means each registered occupant of any unit of a bed and breakfast establishment.

(11) "Individual wastewater system", in accordance with ARM 17.36.101, means a wastewater system that serves one living unit or commercial structure. The total number of people served may not exceed 24.

(12) "Individual water system", in accordance with ARM 17.36.101, means any water system that serves one living unit or commercial structure. The total number of people served may not exceed 24.

(13) "Living unit", in accordance with ARM 17.36.101 and for the purpose of interpreting the size of wastewater and water systems, means the area under one roof occupied by a family. For example, a duplex is considered two living units.

(14) "Local health authority" means a local health officer, local sanitarian or any other person authorized by the department.

(15) "Multiple user wastewater system", in accordance with ARM 17.36.101, means a non-public wastewater system that serves or is intended to serve three through 14 living units or three through 14 commercial structures. The total number of people served may not exceed 24.

(16) "Multiple user water system", in accordance with ARM 17.36.101, means a non-public water supply system designed to provide water for human consumption to serve three through 14 living units or three through 14 commercial structures. The total number of people served may not exceed 24.

(17) "Poisonous or toxic materials" may include, but are not limited to:

(a) insecticides and rodenticides ;

(b) detergents , sanitizers and related cleaning or drying agents;

(d) substances necessary for kitchen equipment operation and maintenance such as nonfood-grade lubricants;

(e) substances not necessary for the kitchen operation such as petroleum products and paints; and

(f) personal care items or medications.

(18) "Potentially hazardous food" means a food that is natural or synthetic and is in a form capable of supporting the rapid and progressive growth of infectious or toxigenic microorganisms, the growth and toxin production of Clostridium botulinum or in raw shell eggs the growth of Salmonella enteritidis .

(a) the term "potentially hazardous food" includes cut melons, garlic and oil mixtures, a food of animal origin that is raw or heat treated and a food of plant origin that is heat treated or consists of raw seed sprouts; and

(b) the term "potentially hazardous food" does not include:

(i) an air cooled, hard boiled egg with intact shell;

(ii) a food with a hydrogen ion concentration (pH) level of 4.6 or below when measured at 75°F;

(iii) a food with a water activity (Aw) value of 0.85 or less;

(iv) a food in an unopened hermetically sealed container that is commercially processed to achieve and maintain commercial sterility under conditions of nonrefrigerated storage and distribution; or

(v) a food for which laboratory evidence is accepted by the department as demonstrating that rapid and progressive growth of infectious and toxigenic microorganisms or the slower growth of Clostridium botulinum cannot occur.

(19) "Public wastewater system", in accordance with ARM 17.36.101, means a system for collection, transportation, treatment, or disposal of wastewater that serves 15 or more families or 25 or more persons daily for a period of at least 60 days in a calendar year.

(20) "Public water supply system", in accordance with ARM 17.36.101, means a system for the provision of water for human consumption that has at least 15 service connections or that regularly serves at least 25 persons daily for any 60 days or more in a calendar year.

(21) "Regulatory authority" means the department of public health and human services or the local health authority.

(22) "Shared wastewater system", in accordance with ARM 17.36.101, means a wastewater system that serves or is intended to serve two living units or commercial structures. The total number of people served may not exceed 24.

(23) "Shared water system", in accordance with ARM 17.36.101, means a water system that serves or is intended to serve two living units or commercial structures. The total number of people served may not exceed 24.

(24) "Single service articles" means cups, containers, lids, closures, plates, knives, forks, spoons, stirrers, paddles, straws, napkins, wrapping materials and other similar articles intended for one-time, one-person use and then discarded.

(25) "Tableware" means eating, drinking and serving utensils for table use, such as flatware which includes forks, knives and spoons, hollowware including bowls, cups, serving dishes and tumblers and plates.

(26) "Utensil" means a food contact implement or container used in the storage, preparation, transportation, dispensing, or service of food, such as:

(a) kitchenware or tableware that is multi-use or single-use;

(b) gloves used in contact with food; and

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-102 and 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.305 Prelicensure Review and Approval

(1) Bed and breakfast establishments shall submit facility and operating plans to the regulatory authority for review and approval when the following conditions apply:

(a) Before construction commences for a new establishment or for an addition to or an alteration of an existing establishment.

(i) Construction may not commence until all plans required by (1) have been approved by the regulatory authority. Construction must be in accordance with the plans as approved unless permission is granted by the regulatory authority to make changes.

(ii) Approval will be granted for a period not to exceed three years, after which, if construction has not been completed, plans must again be submitted to the regulatory authority for reevaluation.

(b) During the license application process for a bed and breakfast establishment planning to operate in an existing building.

(i) An existing building must receive prior approval from the regulatory authority to be used as a bed and breakfast establishment.

(ii) When a proposal to use an existing building as an establishment involves structural modification, plans meeting the requirements of (2) must be submitted to the regulatory authority for review and approval. If no structural modification is involved, the regulatory authority may waive the requirement for submission of plans if:

(A) an inspection by the regulatory authority indicates that the proposed establishment meets the requirements of this subchapter;

(B) the fire authority approves the building;

(D) the establishment is in compliance with other state and local requirements.

(2) Facility and operating plans must include the following:

(a) location and detail of storage rooms used for extra bedding and furnishings;

(b) specifications for the water supply to serve the establishment;

(c) evidence of the review and approval of the sewage treatment and disposal system by the local health authority or the Montana Department of Environmental Quality;

(d) location and detail of laundry facilities including description of equipment, floor and wall finish material and a flow chart indicating the route of laundry through sorting, washing, drying, ironing, folding and storage;

(e) specifications for a swimming pool, spa, or other water feature to serve the establishment unless the swimming pool, spa, or other water feature has been previously approved by the department;

(f) identification of the process that will be used to dispose of solid waste;

(g) location of utility sink or a plan for mop water disposal;

(h) specifications for the proposed food service, including menu, equipment, facility design, location, materials and other information necessary to assure the implementation of this rule;

(i) location of hand washing sink(s);

(j) evidence of approval by the building authority;

(k) evidence of approval by the fire authority; and

(l) any other applicable information as requested by the regulatory authority.

History

Authorizing statute(s): 50-51-103, 50-51-108, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03; AMD, 2010 MAR p. 80, Eff. 1/15/10.

Mont. Admin. R. 37.111.306 Licensure , Renewal, and Inspection

(1) It is unlawful for a bed and breakfast establishment to operate without a license, as specified in 50-51-201 , MCA. Failure to procure a license may subject the operator to criminal penalties as provided in 50-51-106 , MCA, and/or civil penalties, injunctive relief, and costs as provided in 50-51-401 through 50-51-402 , MCA.

(2) Upon notification by the department that an application and fee have been received for a license for a previously unlicensed establishment or by request from the bed and breakfast establishment, the regulatory authority shall make a prelicensing inspection to determine compliance with the requirements of this subchapter.

(3) The regulatory authority shall inspect each licensed establishment within the jurisdiction of the local board of health to determine compliance with this subchapter at least once every 12 months.

(4) If the establishment is in compliance with this subchapter and the department does not receive notification of noncompliance from the building authority or fire authority, a license will be issued or renewed.

(5) A bed and breakfast establishment that serves food only to its registered guests must meet the food service requirements of this rule but does not need a separate food establishment license as required by 50-50-201 , MCA.

(6) An applicant or licensee who is denied a license or whose license is cancelled has the rights specified in 50-51-210 and 50-51-211 , MCA.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, 50-51-201, 50-51-202 and 50-51-204, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.307 Variances

(1) An operator of a bed and breakfast establishment may request from the regulatory authority a variance to waive or modify construction or food equipment requirements contained in this subchapter. The request must be in writing, and must:

(a) demonstrate that the variance requested does not have the potential to cause adverse public health or safety effects and no other reasonable alternative exists; and

(b) describe any measure that will be taken to assure that public health and safety are maintained.

(2) The regulatory authority will maintain a record of the variance requests submitted along with the regulatory authority's responses.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.308 Personnel

(1) No person, while infected with a disease in a communicable form that can be transmitted by foods or who is a carrier of organisms that cause such a disease or while afflicted with a boil, an infected wound, diarrheal illness or acute gastrointestinal illness or an acute respiratory infection, shall work in a food service portion of the bed and breakfast in any capacity in which there is a likelihood of such person contaminating food or food contact surfaces with pathogenic organisms or transmitting disease to other persons. Food employees experiencing persistent sneezing, coughing or runny nose that causes discharges from the eyes, nose or mouth may not work with exposed food, clean food equipment, utensils, linens or unwrapped single-service or single-use articles.

(2) All personnel shall thoroughly wash their hands and the exposed portions of their arms with soap and warm water before starting work, during work, as often as is necessary to keep them clean and especially after smoking, eating, drinking or using the toilet. Employees shall keep their fingernails clean and trimmed.

(3) The outer clothing of all personnel must be clean.

(4) All personnel shall consume food only in areas that will not result in contamination of other food, equipment, utensils or items needing protection.

(5) All personnel shall maintain a high degree of personal cleanliness and shall conform to good hygienic practices during all working periods in the bed and breakfast establishment.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.310 Guest Registration

(1) The operator of each bed and breakfast establishment shall keep a register, entry book or card filing system containing the names and mailing addresses of every guest renting a guest room and the dates when occupied. This register, entry book or card filing system may be different than a guest sign-in book and may be inaccessible to other guests.

(2) The register, entry book or card filing system must be available for inspection by the regulatory authority in accordance with 50-16-603 , MCA, which provides for the confidentiality of health care information obtained by the government. The register, entry book or card filing system must be maintained for every calendar year and may not be discarded or destroyed until one year after the calendar year for which it was maintained.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-16-603 and 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.312 Food Supplies

(1) Food must be in sound condition, free from spoilage, filth or other contamination and shall be safe for human consumption. Food must be obtained from sources that comply with the applicable requirements of the Montana Food, Drug and Cosmetic Act, Title 50, chapter 31, MCA. The use of food in hermetically sealed containers that was not prepared in a licensed food processing establishment is prohibited except those foods which are included within the definition of preserves as defined in 50-50-102 (16) (a) , MCA, which are not potentially hazardous foods.

(2) Fluid milk and fluid milk products used or served must be pasteurized and shall meet grade A quality standards. Dry milk and dry milk products must be made from pasteurized milk and milk products.

(3) Only clean whole eggs, with shell intact and without cracks or checks, or pasteurized liquid, frozen, or dry eggs or pasteurized dry egg products must be used, except that hard boiled, peeled eggs commercially prepared and packaged may be used. Guests must be advised if uninspected farm eggs are to be used.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.313 Food Protection

(1) At all times, including while being stored, prepared, displayed, served or transported, food must be protected from potential contamination, including dust, insects, rodents, unclean equipment and utensils, unnecessary handling, coughs and sneezes, flooding, drainage and overhead leakage or overhead drippage from condensation. The temperature of potentially hazardous food must be 45 ˚ F (5 ˚ C) or below or 135 ˚ F (60 ˚ C) or above except as provided in (2) .

(2) Potentially hazardous foods prepared and held refrigerated for more than 24 hours in a bed and breakfast establishment shall be clearly marked at the time of preparation to indicate the date by which the food will be consumed which is, including the day of preparation:

(a) seven calendar days or less from the day that the food is prepared, if the food is maintained at 41 ˚ F (5 ˚ C) or less; or

(b) four calendar days or less from the day the food is prepared, if the food is maintained at 45 ˚ F (7 ˚ C) or less.

(3) Laundry facilities may be present in the residential kitchen, but may not be used during food preparation and service.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.314 Food Storage

(1) Food, whether raw or prepared, if removed from the container or package in which it was obtained, must be stored in a clean, covered container except during necessary periods of preparation or service. Container covers must be impervious and nonabsorbent, except that clean linens or napkins may be used for lining or covering bread or roll containers.

(2) Containers of food must be stored above the floor in a manner that protects the food from splash and other contamination, and that permits easy cleaning of the storage area.

(3) Food and containers of food may not be stored under exposed or unprotected sewer lines or water lines, except for automatic fire protection sprinkler heads that may be required by the fire authority. The storage of food in toilet rooms or entryways is prohibited.

(4) Food not subject to further washing or cooking before service must be stored in a way that protects it against cross contamination from food requiring washing or cooking.

(5) Packaged foods, including wrapped sandwiches, may not be stored in direct contact with water or undrained ice.

(6) Unless its identity is unmistakable, bulk food such as cooking oil, syrup, salt, sugar or flour not stored in the product container or package in which it was obtained must be stored in a container identifying the food by common name.

(7) Enough conveniently located refrigeration facilities or effectively insulated facilities must be provided to assure the maintenance of potentially hazardous food at required temperatures during storage. Each mechanically refrigerated facility storing potentially hazardous food must be provided with a numerically scaled temperature measuring device, accurate to ±3 ˚ F (±1.5 ˚ C) and must be located to measure the air temperature in the warmest part of the facility and must be located to be easily readable. Recording temperature measuring devices accurate to ±3 ˚ F (± 1.5 ˚ C) , may be used in lieu of indicating temperature measuring devices.

(8) Potentially hazardous food requiring refrigeration after preparation shall be rapidly cooled utilizing such methods as shallow pans, agitation, quick chilling or water circulation external to the food container so that the cooling period and internal food temperature total no more than two hours with food cooled from 135°F (57.2°C) to below 70°F (21°C) or below and four hours with food cooled from 70°F (21°C) to 45°F (7°C) or less.

(9) Ice used as a medium for cooling stored food, food containers or food utensils must not be used for human consumption.

(10) The internal temperature throughout potentially hazardous foods requiring hot holding must be 135 ˚ F (57.2 ˚ C) unless maintained in accordance with (8) .

(11) Guest food may be kept in the bed and breakfast establishment's refrigeration equipment, but must be segregated and labeled as not for sale or for use by the establishment.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.315 Food Preparation

(1) Food must be prepared with the least possible manual contact, with suitable utensils, and on surfaces that prior to use have been cleaned, rinsed and sanitized to prevent cross contamination. Sinks used for the preparation of foods must be cleaned and sanitized immediately before beginning the preparation of the food.

(2) Raw fruits and raw vegetables must be thoroughly washed with potable water before being cooked or served.

(3) Potentially hazardous foods must be cooked to heat all parts of the food to a temperature of at least 135 o F (57.2 o C) , except as follows:

Food Item | Temperature Poultry, poultry stuffing, stuffed meats, stuffings containing meat | heat all parts of the food to at least 165 o F (74 o C) with no interruption in the cooking process Pork and pork products | heat all parts of the food to at least 145 o F(63 o C) Rare roast beef, rare beef steak | cook to an internal temperature of at least 130 o F(55 o C) unless otherwise ordered by customer for immediate service Ground meat | cook to an internal temperature of 155 o F (68 o C) , and the food must hold this temperature for at least 15 seconds

(4) Uncooked, unpasteurized shell eggs may not be used for the preparation of ready-to-eat foods or foods that are not further cooked or baked.

(5) The reheating of food for hot holding must be done as follows:

Food Item | Temperature Potentially hazardous food that has been cooked, cooled and reheated for hot holding | reheat to reach at least 165 o F (74 o C) in all parts of the food and maintain temperature for 15 seconds Reheating all food for hot holding | reheat rapidly so that temperature of 165 o F (74 o C) is attained within two hours Ready-to-eat food taken from commercially processed hermetically sealed container or intact package from a licensed or approved food processing plant | reheat to reach at least 140 o F (60 o C) prior to hot holding Cooked and refrigerated food that is for immediate service in response to a consumer's order, such as a roast beef sandwich au jus | serve at any prepared temperature

(6) Potentially hazardous food reheated for hot holding in a microwave oven must:

(a) be covered;

(b) rotated or stirred throughout or midway during cooking or according to label instructions during heating;

(d) allowed to stand covered for two minutes after reheating.

(7) Digital or dial type metal stem temperature measuring devices accurate to + 2 o F ( + 1 o C) , must be used to assure the attainment and maintenance of proper internal cooking or holding temperatures of all potentially hazardous foods.

(8) Potentially hazardous foods must be thawed:

(a) in refrigerated units at a temperature not to exceed 45 o F (7 o C) ;

(b) under potable running water of a temperature of 70 o F (22 o C) or below, with sufficient water velocity to agitate and float off loose food particles into the overflow for a period of time that does not allow thawed portions of a raw animal food requiring cooking to be above 45 o F (7 o C) for more than four hours;

(c) in a microwave oven only when the food will be immediately transferred to conventional cooking facilities as part of a continuous cooking process or when the entire, uninterrupted cooking process takes place in the microwave oven; or

(d) as part of the conventional cooking process.

(9) Except for cooking and baking uses, potentially hazardous foods, once served, may not be returned to the preparation area and reserved for later meals.

(10) Serving utensils must be used for the display and service of foods during family style meals.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.320 Food Equipment and Utensils

(1) Multi-use food equipment and utensils must be:

(a) constructed and repaired with safe materials, including finishing materials;

(b) corrosion resistant and nonabsorbent; and

(2) Single-service articles must be made from clean, sanitary and safe materials.

(3) Food equipment, utensils and single-service articles may not impart odors, color or taste, nor contribute to the contamination of food.

(4) Food equipment must be installed according to manufacturer's instructions.

(5) Hard maple or other nonabsorbent material that meets the general requirements set forth in (1) may be used for kitchen utensils, cutting blocks, cutting boards, salad bowls and baker's tables. Wood may be used for single-service articles, such as chop sticks, stirrers or ice cream spoons.

(6) Safe plastic, safe rubber or safe rubber-like materials are permitted for repeated use if they:

(a) are resistant under normal conditions of use to scratching, scoring and decomposition;

(b) are of sufficient weight and thickness to permit cleaning and sanitizing by normal dishwashing methods; and

(7) Re-use of single-service articles is prohibited.

(8) Food-contact surfaces must be easily cleanable, smooth and free of breaks, open seams, cracks, chips, pits and similar imperfections. Cast iron may be used as a food-contact surface only if the surface is heated, such as in grills, griddle tops and skillets.

(9) Surfaces not intended for contact with food debris or which otherwise require frequent cleaning must be washable, nonabsorbent, accessible for cleaning and must be of such materials and in such repair as to be easily maintained in a clean and sanitary condition.

(10) Ventilation hoods and devices must be designed and installed to prevent grease or condensation from collecting on walls and ceilings and dripping into food or onto food-contact surfaces. Filters or other grease extracting equipment must be readily removable for cleaning and replacement if not designed to be cleaned in place.

(11) Food equipment that was installed in a bed and breakfast establishment prior to July 1, 2003 that does not fully meet all the design and fabrication requirements of this rule may be used if they are in good repair, capable of being maintained in a sanitary condition and the food-contact surfaces are nontoxic, except that:

(a) refrigeration equipment must be capable of holding potentially hazardous foods at or below 45°F (7°C) ;

(b) bed and breakfast establishments serving up to 10 meals per day that have only a two compartment dishwashing sink must install a heat-boosted domestic dishwashing machine or an adequate three compartment dishwashing sink;

(c) bed and breakfast establishments serving more than 10 meals per day must have a three compartment dishwashing sink; and

(d) bed and breakfast establishments licensed on or before July 1, 2003 must meet the provisions of (11) (c) within five years from July 1, 2003, when applicable.

(12) All replacement food equipment and new food equipment acquired after July 1, 2003 must meet the requirements of this rule.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.321 Food Equipment and Utensils: Cleaning and Sanitization

(1) Food contact equipment, surfaces and utensils must be cleaned and sanitized prior to food preparation for the public and after each use.

(2) Sinks, basins or other receptacles used for cleaning equipment and utensils must be cleaned and sanitized before use.

(3) Food equipment and utensils must be preflushed or prescraped and when necessary, presoaked to remove food particles and soil.

(4) Manual cleaning and sanitizing must be conducted in five steps as follows:

(a) prerinsing or scraping;

(b) thoroughly washing in a warm detergent solution that is kept clean;

(d) sanitization ; and

(e) air drying and draining.

(5) The food contact surfaces of all equipment and utensils must be sanitized by:

(a) immersion for at least 1/2 minute in clean, hot water at a temperature of at least 170°F (77°C) or above;

(b) immersion for at least one minute in a clean solution containing at least 50 parts per million ( ppm ) of available chlorine as a hypochlorite and at a temperature of at least 75°F (24°C) ;

(c) immersion for at least one minute in a clean solution containing at least 12.5 ppm of available iodine and having a pH of 5.0 or less and at a temperature of at least 75°F (24°C) ;

(d) immersion for at least one minute in a clean solution containing no more than 200 ppm of a quaternary ammonium compound solution by following manufacturer instructions;

(e) immersion in a clean solution containing any other chemical sanitizing agent approved by the U.S. environmental protection agency that will provide the equivalent bactericidal effect of a solution containing at least 50 ppm of available chlorine as a hypochlorite at a temperature of at least 75°F (24°C) for one minute; or

(f) rinsing , spraying or swabbing with a chemical sanitizing solution of at least twice the strength required for that particular sanitizing solution under (5) (a) through (e) in the case of food equipment being too large to sanitize by immersion.

(6) Chemicals used for sanitization may not have concentrations higher than the maximum permitted by (5) . A test kit or other device that measures the ppm concentration of the solution must be used at least once each business day.

(7) Mechanical cleaning and sanitizing must be conducted using:

(a) commercial dishwashers, which must comply with ARM 37.110.215(17) through (27) ; or

(b) a domestic or home style dishwasher may be used provided the following performance criteria are met:

(i) the dishwasher must effectively remove physical soil from all surfaces of dishes;

(ii) the dishwasher must sanitize dishes by the application of sufficient accumulative heat;

(iii) the operator shall provide and use daily a maximum registering temperature measuring device or a heat thermal label to determine that the dishwasher's internal temperature is a minimum of 150°F (66°C) after the final rinse and drying cycle; and

(iv) the dishwasher must be installed and operated according to manufacturer's instructions for the highest level of sanitization possible when sanitizing utensils and tableware. A copy of the instructions must be available on the premises at all times.

(8) Drainboards , portable dish tubs, or similar devices must be provided for proper handling of soiled utensils prior to washing and for cleaned utensils following sanitizing and must be located so as to not interfere with the proper use of the dishwashing facilities.

(9) Food contact surfaces must be sanitized by one of the following methods:

(a) using moist cloths, which are kept clean and are rinsed frequently in a sanitizing solution mixed at twice the strength required for that sanitizing solution as provided in (5) (a) through (e) . However, using the same cloths and sanitizing solution for both food contact and nonfood contact surfaces is prohibited;

(b) spraying with a sanitizing solution mixed at twice the strength required for that sanitizing solution as provided in (5) (a) through (e) ; or

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.322 Food Equipment and Utensils: Storage and Handling

(1) Cleaned and sanitized food equipment and utensils must be handled in a way that protects them from contamination. Spoons, knives and forks must be touched only by their handles. Cups, glasses, bowls, plates and similar items must be handled without contact with inside surfaces or surfaces that contact the user's mouth.

(2) Cleaned and sanitized food equipment and utensils must be stored above the floor in a clean, dry location in a way that protects them from being contaminated by splash, dust and contaminants. The food contact surfaces of fixed equipment must be protected from contamination. Food equipment and utensils may not be placed under exposed sewer or water lines except for automatic fire protection sprinkler heads.

(3) Utensils must be air dried before being stored or must be stored in a self draining position.

(4) Single-service articles must be stored above the floor in closed cartons or containers which protect them from contamination and must not be placed under exposed sewer or water lines except for automatic fire protection sprinkler heads.

(5) Single-service articles must be handled and dispensed in a manner that prevents contamination of surfaces which may come in contact with food or with the mouth of the user.

(6) Food equipment, utensils or single-service articles may not be stored in toilet rooms or entryways.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.326 Water Supply and Plumbing

(1) An adequate and potable supply of water must be provided.

(2) Before a license may be issued, an establishment using an individual, shared or multiple user water supply must submit the following to the regulatory authority:

(a) satisfactory coliform bacteria and nitrate test results. Nitrate results in excess of 10 mg/L are considered unsatisfactory; and

(b) the results of an on site sanitary survey of the water supply system to detect sanitary deficiencies.

(3) A supplier of an individual, shared or multiple user water supply shall conduct a coliform bacteria test of the system at least twice a year with one sample collected between April 1 through June 30 and the second sample collected between August 1 through October 31 and shall conduct a nitrate test of the system at least once every three years. A supplier shall keep sampling result records for three years at the premises of the bed and breakfast establishment for review by the regulatory authority.

(4) A supplier of a public water supply shall undertake sample analyses for its system according to ARM Title 17, chapter 38, subchapter 2.

(5) Nonpotable water sources must be marked "not for human consumption".

(7) Handsinks and bathing facilities must be provided with water at a temperature of at least 100°F (37.8°C) and not more than 120°F (49°C) .

(8) A water supply system is determined to have failed and requires treatment, replacement, repair or disinfection, when the water supply becomes unsafe (when it exceeds the maximum contaminant levels specified in ARM Title 17, chapter 38, subchapter 2) or inadequate (when it is found to be less than 20 psi measured at the extremity of the distribution line during instantaneous peak usage) .

(9) Extension, alteration, repair or replacement of a water supply system or development of a new water supply system must be in accordance with all applicable state and local laws.

(10) Bottled and packaged potable water must be obtained from a licensed and approved source and shall be handled and stored in a way that protects it from contamination. Bottled and packaged potable water for consumer self-service must be dispensed from the original container.

(11) The department hereby adopts and incorporates by reference the provisions of ARM Title 17, chapter 38, subchapter 2, stating maximum allowable contaminant levels, sampling and other requirements for public water supplies. Copies of the above mentioned rules may be obtained from the Department of Public Health and Human Services, Food and Consumer Safety Section, P.O. Box 202951, Helena, MT 59620-2951 or the Department of Environmental Quality, Permitting and Compliance Division, P.O. Box 200901, Helena, MT 59620-0901.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.327 Wastewater System

(1) An adequate and safe wastewater system must be provided for conveying, treating and disposing of all sewage. Immediate measures must be taken to alleviate health and sanitation hazards caused by wastewater at the bed and breakfast establishment when they occur.

(2) A wastewater system has failed and requires replacement or repair if any of the following conditions occur:

(a) the system fails to accept, treat or dispose of wastewater as designed;

(b) effluent from the wastewater system contaminates a potable water supply or state waters; or

(c) the wastewater system is subjected to mechanical failure, including electrical outage, or collapse or breakage of a septic tank, lead line or drainfield line.

(3) Extension, alteration, replacement or new development of any wastewater system must be done in accordance with all applicable local laws and ARM Title 17, chapter 36, subchapters 1, 3 and 6, which cover the minimum standards for individual, shared or multiple user wastewater systems, as regulated by the Montana department of environmental quality.

(4) Disposing of discharged liquid wastes from sinks, showers, toilets or baths on the ground surface is prohibited. Such waste must be discharged into the wastewater system serving the bed and breakfast establishment or into an alternate system approved by the regulatory authority.

(5) Mop water or heavily soiled cleaning water may not be disposed of in any sink other than a mop or utility sink or a toilet.

(6) The department hereby adopts and incorporates by reference ARM Title 17, chapter 36, subchapters 1, 3 and 6 which set rules for subdivisions and on site subsurface wastewater treatment. Copies of the above rules may be obtained from the Department of Public Health and Human Services, Food and Consumer Safety Section, P.O. Box 202951, Helena, MT 59620-2951, or the Department of Environmental Quality, Permitting and Compliance Division, P.O. Box 200901, Helena, MT 59620-0901.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.328 Toilet Facilities

(1) Toilet facilities must be installed in accordance with the state plumbing code and must be conveniently located and accessible to employees at all times.

(2) Toilet rooms must be completely enclosed and the doors must be kept closed when they open into the kitchen. Additionally, if toilet facilities open onto or are located adjacent to the food preparation area, the toilet facilities must contain mechanical ventilation or a window.

(3) Toilet fixtures must be kept clean and in good repair. A supply of toilet tissue must be provided at each toilet at all times. Easily cleanable receptacles must be provided for waste materials.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.329 Hand Washing Facilities

(1) Bed and breakfast establishments serving up to 10 meals per day may use a compartment of a dishwashing sink for hand washing purposes in the kitchen. Bed and breakfast establishments serving more than 10 meals per day must have a dedicated hand washing sink.

(2) Hand washing facilities must be conveniently located to the kitchen food preparation area and laundry handling area and must provide hot and cold potable water tempered by means of a mixing valve or combination faucet.

(3) A supply of hand cleansing soap or detergent must be available from a dispensing unit at each hand washing facility. A supply of sanitary, single-use towels must be conveniently located near each hand washing facility. The use of common towels is prohibited. If disposable towels are used, easily cleanable waste receptacles must be conveniently located near the hand washing facilities.

(4) A soap dispenser and disposable towels for use in hand washing must be provided at the kitchen sink. This sink must not be used for hand washing after toilet use. After toilet use, personnel shall wash hands first in an approved hand washing facility before they are washed in the kitchen sink.

(5) Hand washing facilities, soap or detergent dispensers, hand drying devices and all related equipment must be kept clean and in good repair.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.330 Solid Waste and Pest Control

(1) Garbage and refuse must be kept in durable, easily cleanable, insect proof and rodent proof containers that do not leak and do not absorb liquids. Plastic bags and wet strength paper bags may be used to line these containers and they may be used for storage inside the establishment. The containers must be kept clean and in good repair and be of sufficient number to hold the solid waste that accumulates.

(2) Outside storage of unprotected plastic bags or wet strength paper bags or baled units containing garbage or refuse is prohibited. Cardboard or other packaging material not containing garbage or food wastes need not be stored in covered containers.

(3) Garbage and refuse must be disposed of often enough to prevent the development of odor and the attraction of insects and rodents.

(4) Effective measures intended to minimize the presence of rodents, flies, cockroaches and other insects on the premises must be utilized.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.334 Floors, Walls, Ceilings and Lighting

(1) The floors, walls and ceilings and attached equipment in food preparation and service areas and in employee bath rooms of bed and breakfast establishments must be fabricated from easily cleanable material and must be maintained in good repair and kept clean. Artificial lighting must be provided sufficient to facilitate sanitary food handling and cleaning of facilities. Light sources in food preparation areas must be adequately shielded or be made of a shatter resistant design or material.

(2) Carpeting, if used as a floor covering in food preparation areas or in toilet facilities, must be of closely woven construction. All carpeting located in guest rooms, hallways and other portions of the bed and breakfast used by guests must be properly installed, easily cleanable and maintained in good repair.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.335 Laundry

(1) Laundries operated or used by a bed and breakfast establishment must be provided with:

(a) a mechanical washer and hot air tumble dryer;

(b) a hot water supply system capable of supplying water at a temperature of 120°F (49°C) to the washer during all periods of use;

(d) sanitizers approved by the U.S. environmental protection agency.

(2) Bedding, towels and washcloths must be machine washed at a minimum temperature of 120°F (49°C) for a minimum time of eight minutes and dried in a hot air tumble dryer or ironed at a minimum temperature of 150°F (65.5°C) .

(3) Laundry other than bedding, towels and washcloths may be washed at a minimum temperature of 110°F (43.3°C) for at least eight minutes using a detergent and a sanitizer. Bleach, as a hypochlorite, may be used according to manufacturer's specifications during the final rinse.

(4) Manual washing and line drying of bed linen, towels and washcloths is prohibited.

(5) All bed and breakfast establishments must have a sink that can be used for hand washing within a reasonable distance of the laundry. Hands must be washed between the handling of soiled and clean laundry.

(6) To prevent cross contamination, a separate handling process must be used for the sorting and storage of soiled laundry and the folding and storage of clean laundry. Clean cloths and linens must be laundered, stored and protected from contamination between uses.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.336 Housekeeping and Maintenance

(1) Housekeeping and maintenance services must be provided a minimum of every three days and must be available on a daily basis when requested by a guest. Housekeeping and maintenance services must be provided between guest occupancies. Shared bathrooms must be cleaned daily.

(2) Maintenance and properly labeled cleaning supplies and cleaning tools such as brooms, mops, vacuum cleaners and similar equipment must be maintained and stored in a way that does not contaminate food, utensils, food equipment or linens or endanger the safety of guests. The storage area for cleaning supplies and cleaning tools must be kept clean.

(3) Toilets, bathtubs, hand washing sinks and showers may not be used for washing and rinsing of mops, brooms, brushes or any other cleaning devices.

(4) Cleaners used in cleaning bathtubs, showers, sinks, urinals, toilet bowls, toilet seats and floors in bathrooms must contain an approved disinfectant or sanitizing agent.

(5) Cleaning devices used for cleaning toilet bowls, urinals, sinks, showers and bathtubs may not be used for any other purpose and must be kept segregated when stored. Cleaning devices used for cleaning toilet bowls and urinals may not be used to clean sinks, showers and bathtubs.

(6) Deodorizers and odor masking agents may not be used unless the room in which it is used is clean to sight and touch.

(7) All bedding, towels and washcloths provided by management must be clean and in good repair. Clean bed sheets and pillowcases must be provided on each bed and shall be replaced by clean, freshly laundered sheets and pillowcases after the departure of each guest and prior to occupancy by the next guest. Clean bedding must be available to each guest on a weekly basis or more often if requested by a guest. Clean towels and washcloths must be available to each guest every three days, at minimum, or more often if requested by a guest.

(8) All furnishings, fixtures, floors, walls and ceilings must be clean and in good repair.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.339 Pools, Spas, and Other Water Features

(1) Any swimming pool, spa, or other water feature that exists in a bed and breakfast establishment for guest use must be constructed and operated in compliance with Title 50, chapter 53, MCA, and ARM 37.115.102, 37.115.103, and 37.115.106.

(2) Sauna services that exist in a bed and breakfast establishment for guest use must be operated in a clean and sanitary manner and must be maintained in good repair.

(3) Guest towels provided by the bed and breakfast establishment for use in the swimming and bathing area or in a sauna must be laundered between each guest use.

(4) Copies of ARM 37.115.102, 37.115.103, and 37.115.106 may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Food and Consumer Safety Section, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-51-103, 50-51-108, MCA
Implementing statute(s): 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03; AMD, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2019 MAR p. 62, Eff. 1/12/19.

Mont. Admin. R. 37.111.342 Blood -Borne Pathogen Protection

(1) To minimize exposure to potential blood-borne pathogens during housekeeping, maintenance, laundry or other provided services, employees shall:

(a) wear protective gloves and use an appropriate cleaning solution when cleaning up hazardous materials;

(b) use disposable towels to clean up spills and dispose of the towels in a special biohazard labeled bag;

(d) wear waterproof gloves when handling dirty laundry.

(2) All actions that involve contact with blood and other potentially contaminated products should be done in such a way as to minimize splashing, spraying, splattering and the creation of droplets. If workers come into contact with blood or body fluids, they must:

(a) wash their hands or any other contaminated parts of their body with soap and warm water;

(b) wash their hands and potentially exposed skin when they remove protective gloves or other personal protective equipment; and

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.343 Safety

(1) Containers of poisonous or toxic materials must be prominently and distinctly labeled according to law for easy content identification and must be used according to manufacturer's directions. These materials must not be stored or used in any manner which may contaminate food or food contact surfaces. This provision does not prohibit the convenient availability of detergents or sanitizers for use at hand washing or dishwashing stations.

(2) First aid materials must be available on the premises.

(3) Guests must be provided with emergency exit information upon registration.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.344 Pets

(1) Pets may be present on the premises with the following restrictions:

(a) pets shall be kept out of the kitchen food preparation and dining areas during food preparation and service to the public;

(b) pets shall be kept out of the laundry area during its use; and

(c) birds shall be kept out of the kitchen, dining and laundry areas at all times and be kept away from forced air ducts and heating system areas.

History

Authorizing statute(s): Sec. 50-51-103 and 50-51-108, MCA
Implementing statute(s): Sec. 50-51-103, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Mont. Admin. R. 37.111.350 Minimum Performance Requirements for Local Health Authorities

(1) To qualify for reimbursement under 50-51-303 , MCA, the local health authority must either enter into a written, signed cooperative agreement with the department that establishes the duties and responsibilities of the local health authority and the department consistent with this subchapter or meet each of the following requirements:

(a) At least one sanitarian working with or for the local health authority must receive training from the department in bed and breakfast inspection techniques. The department is responsible for making training available on a periodic basis.

(b) The local health authority must ensure that the following are done by the local health officer, sanitarian or sanitarian-in-training:

(i) Upon notification by the department or the establishment, a prelicensing inspection is made to determine compliance with the requirements of this subchapter.

(ii) Each establishment within the jurisdiction of the local health authority is inspected at least once every 12 months or on the schedule specified in a signed agreement with the department.

(iii) Quarterly inspection reports are submitted to the department within 10 days following the closing of each quarter of the fiscal year (1st quarter, September 30; 2nd quarter, December 31; 3rd quarter, March 31; 4th quarter, June 30) on forms approved by the department.

(iv) All documentation of enforcement of this subchapter, including but not limited to inspection reports, consumer complaints, illness investigations, plans of correction and enforcement actions, must be retained for five years and copies of the documentation are submitted or otherwise made available to the department upon request.

(2) A failure by the local health authority to meet all of its responsibilities under the cooperative agreement or under (1 ) ( a) and (b) shall result in the withholding of funds from the local board reimbursement fund in an amount to be determined by the department.

History

Authorizing statute(s): Sec. 50-51-303, MCA
Implementing statute(s): Sec. 50-51-204 and 50-51-303, MCA
History: NEW, 2003 MAR p. 1338, Eff. 7/1/03.

Authorizing statute(s): 50-52-302, MCA
Implementing statute(s): 50-52-302, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2425; REP, 2022 MAR p. 1748, Eff. 9/10/22.

Authorizing statute(s): 50-52-302, MCA
Implementing statute(s): 50-52-302, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2425; REP, 2022 MAR p. 1748, Eff. 9/10/22.

Subchapter 37.111.8 Schools

Mont. Admin. R. 37.111.801 Definitions

(1) "Approved" means acceptable to the department, based on its determination of conformance with this subchapter and good public health practices.

(2) "Bin placement" means placing sample results into the correct cell within Table 1 in ARM 37.111.832, to determine the required response to those results.

(3) "Bin placement sample" means those samples that will be used to determine bin placement in ARM 37.111.832.

(4) "Chemical" means any substance which has been assigned an EPA Hazardous Waste Number.

(5) "Contamination" means impairment or other alteration of the physical, chemical, or biological properties of water, including causing violation of the maximum contaminant levels for public water supplies contained in ARM Title 17, chapter 38, subchapter 2 or otherwise creating a hazard to human health.

(6) "Department" means the Department of Public Health and Human Services.

(7) "First-draw sample" means a 250 milliliter sample of tap water that has stood motionless in the plumbing pipes for at least six hours and is collected without flushing the tap.

(8) "Fixtures" means any shower, toilet, toilet seat, urinal, lavatory, drinking fountain, kitchen sink, janitor and custodial sink, utensil sink, handwashing sink, eye washing station, emergency shower, and all exposed plumbing integral to them.

(9) "Floors" means floor covering of all rooms including stairways, hallways, and lobbies.

(10) "Foot Candles" is the unit as defined as the amount of illumination the inside surface of a one-foot-radius sphere would be receiving if there were a uniform point source of one candela in the exact center of the sphere.

(11) "Furnishings" means draperies, curtains, blinds, light fixtures, chairs, tables, desks, shelves, and bookcases.

(12) "Green products" means products and services that have a lesser or reduced negative effect on human health and the environment when compared with competing products or services that serve the same purpose. This comparison applies to raw materials, manufacturing, packaging, distribution, use, reuse, operation, maintenance, and disposal. These products have a "Green Approval Stamp" certified by at least one of the following organizations: Green Seal, UL ECOLOGO®, the EPA Safer Choice, and the USDA Bio-Preferred.

(13) "Human consumption fixture (HCF)" means any endpoint device that provides or may reasonably provide water for human consumption or for food preparation.

(14) "Inactive" means the student population is not accessing the school for a period of more than 3 days. This includes, but is not limited to: holidays, summer vacation, or emergency situations.

(15) "Laboratory" or "Lab" is any space where hazardous chemicals are used for educational purposes.

(16) "Local education agency (LEA)" means the local school district board of trustees recognized as the administrative agency for a public elementary or secondary school.

(17) "Local health authority" means a local health officer, local sanitarian, or their authorized agents.

(18) "Pest" means any animal, plant, or other organism which has a harmful effect on humans, their food, or the conditions of their school, workplace, home, or recreation sites.

(19) "Radon" is a colorless, odorless, tasteless gas and comes from the natural breakdown of uranium in the ground.

(20) "Sanitarian" means a person, by reason of the person's special knowledge of the physical, biological, and chemical sciences and the principles and methods of public health acquired by professional education and practical experience through inspectional, educational, or enforcement duties, who is qualified to practice the profession of sanitarian.

(21) "School" means a building or structure, or portion thereof occupied for the teaching of individuals, the curriculum of which satisfies the basic instructional program approved by the Board of Public Education for pupils in any combination of kindergarten through grade 12, but excludes home schools as that term is defined in 20-5-102(2)(e), MCA.

(22) "School administrator" has the meaning provided for under ARM 10.55.602.

(23) "School site" means the ground immediately adjacent to a school used on a regular basis for school-related activity.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.802 Incorporation by Reference

(1) For purposes of this subchapter, the department adopts and incorporates by reference the following:

(a) Department of Public Health and Human Services and Department of Environmental Quality "Recommendations for Outdoor Activities Based on Air Quality for School and Child Care Facilities" (2018 edition).

(b) 29 CFR 1910.1450 "Occupational exposure to hazardous chemicals in laboratories" (effective January 22, 2013).

(d) United States Consumer Product Safety Commission "Public Playground Safety Handbook" (2010 edition).

(e) United States Department of Justice "2010 ADA Standards for Accessible Design."

(f) Department of Environmental Quality Circular 4, "Montana Standards for Subsurface Wastewater Treatment Systems (2013 edition), setting forth construction and operation standards for sewage systems.

(g) The definition of "school administrator" provided for under ARM 10.55.602.

(2) Copies of these publications may be obtained from the Department of Public Health and Human Services, Chronic Disease Prevention and Health Promotion Bureau, chronicdiseaseprevention@mt.gov; 1(844)684-5848, CDPHP Bureau, P.O. Box 202951, 1400 Broadway, Suite C317, Helena MT 59601.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.804 Preconstruction Review

(1) Before construction commences, plans for construction of a new school or an addition to or an alteration of an existing school must be submitted to the department or local health authority for review and approval. Plans must include the following where applicable:

(a) location and detail of classrooms used for science or science laboratories, consumer science, art classrooms, art supply rooms, mechanic/carpentry, and industrial arts, including location and ventilation detail of lockable storage area of chemicals and other hazardous products;

(b) location and detail of janitorial facilities;

(d) specifications for the water supply to serve the school, except as provided in (2);

(e) locations for all emergency eyewash and shower stations, which must meet the American National Standard for Emergency Eyewash and Shower Equipment (ANSI/ISEA Z358.1);

(f) location and detail of laundry facilities including description of equipment and a flow chart indicating the route of laundry through sorting, washing, drying, ironing, folding, and storage;

(g) specifications for the final finishes of floors, walls and ceilings in toilet, locker and shower rooms, laundries, and janitorial closets;

(h) a statement from the designer of the facilities that lighting capable of meeting the minimum requirements of ARM 37.111.830 will be provided;

(i) location and detail of the solid waste storage facilities;

(j) name of DEQ-approved sanitary landfill which will receive solid waste from the school;

(k) specifications for a food service to serve the school unless the food service has been previously approved by the department and/or local health department;

(l) any other information requested by the department or local health authority relating to the health, sanitation, safety, and physical well-being of the teachers, staff, and students;

(m) specifications for any new or modified playground equipment, which must comply with the standards of the United States Consumer Product Safety Commission's Handbook for Public Playground Safety (2010 edition) and the requirements of the 2010 ADA Standards for Accessible Design;

(n) specifications for any new or modified air intakes; and

(o) specifications for any radon-resistant technique used in the building process.

(2) If the sewage treatment or disposal system or water supply has been previously approved by the department and/or DEQ and is designed to handle any increased load necessitated by the school's use, the applicant need not submit system specifications, but must submit written certification that the owner of the system has agreed to provide service.

(3) Schools must be constructed in locations which present the least risk of exposure to pollutants or other health hazards originating onsite or offsite. If potential environmental concerns are identified during the preconstruction process, and the Local Education Agency (LEA) still desires to consider the site, a more comprehensive environmental review must be performed with the help of the department, the local health authority, or DEQ.

(4) The topography of the site must permit good drainage of surface water away from the school building to eliminate significant areas of standing water and infiltration of surface water into the school building.

(5) All chemical storage areas in new construction must be constructed to maintain negative air pressure to eliminate contamination of the school's indoor air quality by being vented to the outside of the building.

(6) Gas supply lines serving science laboratories, consumer science, industrial arts, and other rooms utilizing multiple outlets must have a master shut-off valve that is readily accessible to the instructor or instructors-in-charge without leaving the classroom or storage area.

(7) Industrial arts classrooms or buildings and other rooms using electrically operated instruction equipment which presents a significant safety hazard to the student utilizing such equipment must be supplied with a master electric switch readily accessible to the instructor or instructors-in-charge without leaving the classroom or storage area.

(8) Janitorial storage spaces must be constructed to meet the following requirements:

(a) must be lockable;

(b) must include a storage area for equipment and chemicals; and

(9) Hot and cold water must be provided to handwashing sinks and shower facilities. Hot water must not be below 100° F nor exceed a temperature of 120° F.

(10) The department recommends the use of radon prevention strategies in new construction.

(11) Construction may not commence until all plans required by (1) through (9) have been approved by the department or local health authority. The department or local health authority must complete this review within 60 days after submission to them of complete plans and specifications. Construction must be in accordance with the plans as approved unless permission is granted in writing by the department or local health authority to make changes.

(12) Approval will be granted for a period not to exceed 3 years, after which, if construction has not been completed, plans must again be submitted to the department or local health authority for re-evaluation.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.805 Existing Building: Change of Use

(1) An existing building not currently used as a school may not be used as a school without the prior approval of the department or local health authority.

(a) When a proposal to use an existing building as a school involves physical modification, plans meeting the requirements of ARM 37.111.804(1) through (9) must be submitted to the department or local health authority for review and approval. If no physical modification is involved, the department or local health authority may waive the requirement for submission of plans if an inspection by the department or local health authority indicates that the proposed school meets the requirements of this subchapter.

(b) The use of modular or mobile buildings in response to temporary or permanent closure of the existing school facility, segments thereof, or classroom overflow may be granted a one-year written exemption from the requirements of ARM 37.111.804 by the department or local health authority. Plans to continue use of modular or mobile buildings past one year must be shared with the local health authority or department.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.806 State-Local Coordination

(1) If plans for a new or existing building are submitted for review to the local health authority pursuant to ARM 37.111.804 or 37.111.805 and the local health authority determines that it will be unable to conduct the review within a reasonable period of time, the local authority shall transmit the plans to the department within ten days after receipt, and shall notify the applicant that the review will be conducted by the department.

(2) If a local health authority conducts a plan review pursuant to ARM 37.111.804 or 37.111.805 and approves the plans, the local health authority shall submit written certification of such approval to the department no later than 30 days following such approval.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425.

Mont. Admin. R. 37.111.810 Inspection

(1) Representatives of the department or local health authority must be permitted to enter any school at any reasonable time for the purpose of making inspections to determine compliance with this subchapter. Annual inspections must be conducted by a school administrator, facility manager, or other staff member approved by the school administration, as well as having a department or local health authority inspection once a year, or as necessary. The department or local health authority may determine that special circumstances or local conditions warrant inspections with greater or less frequency. Upon receiving a complaint, the local health authority may determine if more inspections are necessary.

(2) Inspections of school facilities must be done using forms approved by the department.

(3) Inspection records must be kept on file at the school for at least three years from the time of inspection.

(4) Following each inspection, representatives of the department or local health authority must give the school administration a copy of an inspection report which notes any deficiencies and sets a time schedule for compliance. The report must document deficiencies.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.811 Physical Requirements

(1) A school must comply with the following physical requirements:

(a) Floors, walls, and ceilings in toilet, locker, and shower rooms, laundries, janitorial closets, and similar rooms subject to large amounts of moisture must be maintained in a smooth and non-absorbent condition. Non-absorbent, non-skid floor matting may be used where appropriate to prevent injury.

(b) Adequate coat/jacket and book storage for each student must be provided.

(c) Beginning September 1, 2021, the school shall have and follow written policies and procedures regarding the storage, administration, and lawful disposal of prescription, nonprescription, and over-the-counter medication.

(d) All non-emergency medication must be kept in a locked, nonportable container, stored in its original container with the original prescription label. Epinephrine, naloxone, and student emergency medication may be kept in portable containers and transported by the school nurse or other authorized school personnel.

(e) Food is not allowed to be stored in refrigeration units with medications.

(f) Schools must comply with the applicable requirements of Section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C 207) and 39-2-215, MCA, requiring employers to provide a nursing mother reasonable break time and a place to express breast milk after the birth of her child.

(g) The school must provide reasonable accommodations for students and staff on the school campus to express breast milk, breastfeed an infant child, or address other needs related to breastfeeding. Reasonable accommodations include, but are not limited to:

(i) access to a place, that is shielded from view and free from intrusion from the public, students, and other staff, to express breast milk or breastfeed an infant child;

(ii) permission to bring onto a school campus a breast pump and any other equipment used to express breast milk;

(iii) access to a power source for a breast pump or any other equipment used to express breast milk; and

(iv) access to a place to store expressed breast milk safely.

(h) The school must take measures consistent with the programmatic and developmental needs of its students to ensure the safe use and secure storage of any equipment including but not limited to: kitchen appliances, industrial arts equipment, maintenance tools, and hazardous art supplies.

(i) To reduce the spread of animal-borne diseases, livestock and poultry must be located more than 50 feet from food service areas, offices, or classrooms except those offices and classrooms associated with animal husbandry activities or other demonstrations as approved by the school administration. In classrooms, offices, or food service areas where livestock and poultry are approved by the administrator, animals must not have contact with eating or serving surfaces.

(2) In addition to compliance with this subchapter, school officials must comply with the Building and Fire Safety Codes administered by the State Building Codes Division and the State Fire Marshal or by local building officials (see Title 50, chapters 60 and 61, MCA, and rules adopted thereunder).

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.812 Safety Requirements

(1) Janitorial and other storage areas that contain toxic or hazardous materials must be kept locked between periods of use. Custodial closets, boiler rooms, and other areas where hazardous or poisonous compounds are stored must be inaccessible to students.

(2) All cleaning compounds and other toxic chemicals not stored in the product container or package in which it was obtained must be stored in a labeled container that clearly identifies the product by name.

(3) Chemicals must be stored as specified by the chemical's Safety Data Sheet (SDS).

(4) The school and school site must be free of objects or conditions which create unreasonable or unnecessary dangers to health or safety.

(5) First aid kits and AEDs must be provided and stored in accessible locations that are easily identifiable to staff and trained personnel.

(6) Playground and school yards must be inspected every month by the facility manager or other school personnel and the inspection must be recorded and records kept on the school site. Inspections must be conducted using a playground safety checklist approved by the department.

(7) Playground inspection results must be made available for review by the local health authority or the department upon request.

(8) Periodic maintenance and repair must be performed on playground equipment according to the manufacturer's specifications. Repairs, not including the leveling of fall protection material, must be documented.

(9) Playground equipment must be maintained in a safe condition.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.813 Science, Industrial Arts, and Art Laboratory Safety

(1) Schools must comply with the Montana Employee and Community Hazardous Chemical Information Act (ECHCIA), 50-78-101, MCA, et seq.

(2) Schools containing science labs, industrial arts classrooms or buildings, and art labs that use and store hazardous chemicals must maintain a Chemical Hygiene Plan (CHP) and designate a Chemical Hygiene Officer (dCHO) in accordance with the requirements of the Occupational Safety and Health Administration (OSHA) Occupational Exposure to Hazardous Chemicals in Laboratories standard 29 CFR 1910.1450.

(3) CHPs must include plans for appropriate selection, storage, inventory, use, and disposal of hazardous chemicals, and biological materials.

(a) The dCHO has primary responsibility for ensuring the implementation of all components of the CHP.

(b) The school Chemical Hygiene Officer (sCHO) must oversee the implementation and enforcement of the schools' CHP at their school(s). A science chairperson, equivalently qualified faculty member, or staff member with knowledge of the chemicals used in the school may be designated as the sCHO.

(4) Safety Data Sheets (SDS) for all materials in science labs, industrial arts classrooms or buildings, art labs, and lab storage rooms will be stored in those rooms and be accessible at all times.

(a) The SDS must also be kept in a secure, remote site outside of the science labs, industrial arts classroom or buildings, art labs, and lab storage rooms.

(5) All storage areas must be kept clean and organized according to OSHA Standard 29 CFR 1910.1450.

(6) Unused hazardous materials must be disposed of in a timely manner as stated by the manufacturer and approved by the DEQ). Schools must consult with the DEQ and the department for additional information about how they can properly discard hazardous material.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 2020 MAR p. 47, Eff. 9/1/21.

Mont. Admin. R. 37.111.825 Health Supervision and Maintenance

(1) Soap and disposable towels or other hand-drying devices must be available at all handwashing sinks. Common-use towels are prohibited.

(2) Sanitary napkin disposal must be provided for girls of age ten or older and in teachers' toilet rooms and nurses' toilet rooms. The school must provide either sanitary napkin dispensers in the girls', nurses', and teachers' toilet rooms or some other readily available on-site access to sanitary napkins.

(3) If a student or a staff member develops symptoms of any reportable communicable or infectious illness as defined by ARM 37.114.203 while at school, the responsible school officials shall do the following:

(a) isolate the student or staff member immediately from other children;

(b) if the individual is a student, inform the parent or guardian as soon as possible about the illness and request him or her to pick up the student; and

(c) consult with a physician, other qualified medical professional, or the local county health department to determine if the case should be reported to the local health officer pursuant to 37-2-301, MCA.

(4) Schools shall develop and enforce policies on first aid which include, at a minimum, the following:

(a) obtaining emergency phone numbers for parents or guardians;

(b) procedures to be followed in the event of accidents, injuries, or chronic disease exacerbations; and

(c) emergency coverage, including the presence of a person with a valid American Red Cross, American Heart Association, or American Health and Safety Institute CPR and first aid certification from an equivalent first aid course, during school-sponsored activities, including field trips, athletic, and other off-campus events. Recommendations for first aid supplies, health history tracking, emergency contact forms, chronic disease management training, and policies may be secured from the Department of Public Health and Human Services, Public Health and Safety Division, Food and Consumer Safety Section and the Chronic Disease Prevention and Health Promotion Bureau, 1400 Broadway, P.O. Box 202951, Helena, Montana 59620-2951.

(5) In addition to the requirements of 50-40-104 and 20-1-220, MCA, "no tobacco use/electronic cigarette" signs must be posted at school building entrances and should be clearly visible. Tobacco/electronic cigarette use must be prohibited in school vehicles at all times.

(6) In addition to the requirements of this rule, school officials should also be aware of the need to comply with the laws and rules relating to the immunization of children in ARM Title 37, chapter 114 and communicable disease reporting in 37-2-301, MCA. Copies of these requirements may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Communicable Disease and Epidemiology Section, 1400 Broadway, P.O. Box 202951, Helena, Montana 59620-2951, or by visiting the website at https://dphhs.mt.gov/publichealth/epidemiology .

(7) Pursuant to the advisory authority of 50-1-202, MCA, the department recommends that students be evaluated by registered professional nurses or other appropriately qualified health professionals on a periodic basis in order to identify those health problems which have the potential for interfering with learning, including:

(a) assessment of student's health and developmental status;

(b) vision screening;

(d) chemical and alcohol abuse;

(e) mental health screening;

(f) nutritional screening; and

(g) dental screening.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2006 MAR p. 1296, Eff. 5/19/06; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.826 Indoor Air Quality

(1) Ventilation systems must undergo annual checks by the school facility manager, school administrator, or administrator-approved staff to ensure they are operating within manufacturer parameters.

(2) Air filters must have a minimum efficiency reporting value of between 8 and 13 as recommended by the National Air Filtration Association and the Environmental Protection Agency (EPA) unless other types of non-MERV rated filters are used.

(a) The department recommends that schools with ventilation systems using MERV rated air filters change their filters to MERV 13 or greater during times of poor outdoor air quality.

(b) Schools using electrostatic air filters must clean the filters according to manufacturer specifications.

(3) The school facility manager, school administrator, lead teacher, or other administrator-approved staff must complete annual indoor air quality inspections using the Walk Through Inspection Checklist from EPA's Indoor Air Quality Tools for Schools or other department-approved inspection form.

(a) Schools must maintain records of indoor air quality inspection on site for no less than three years and the records must be made available to the local health authority and the department upon request.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-206, MCA
History: NEW, 2020 MAR p. 47, Eff. 9/1/20.

Mont. Admin. R. 37.111.827 Outdoor Air Quality

(1) Schools must reference the Recommendations for Outdoor Activities Based on Air Quality for School and Child Care Facilities developed by the Montana Department of Public Health and Human Services and the Montana Department of Environmental Quality to determine local air quality conditions and choose to cancel outdoor recess and delay or not delay outdoor school-sponsored events.

(2) Schools must have a protocol in place on how to limit the infiltration of outside air into the school during poor air quality conditions.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-206, MCA
History: NEW, 2020 MAR p. 47, Eff. 9/1/20.

Mont. Admin. R. 37.111.830 Lighting

The following standards are advisory, rather than mandatory:

(1) Sources of illumination, both natural and artificial, should be provided with light diffusion means, or should be of a type and design which limits excessive glare.

(2) The following minimum lighting, measured in foot-candles, should be maintained during all periods of use:

(a) hallways, corridors, storerooms, locker rooms, shower rooms, auditoriums (not for study) -- 10;

(b) cafeterias, reception rooms, swimming rooms, gymnasiums, toilet rooms, laundry rooms -- 20;

(3) In shops, laboratories, drafting rooms, typing rooms, home economics rooms, or other areas where pupils use specific machines or equipment, a minimum of 100 footcandles should be maintained on such machinery or equipment while in use.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425.

Mont. Admin. R. 37.111.831 Heating

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; REP, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.832 Water Supply System

(1) The department adopts and incorporates by reference ARM Title 17, chapter 38, subchapters 1 and 2, which set forth standards for design, operation, and maintenance of public water supplies; DEQ Circulars 1, 3, and PWS 5, published by the Department of Environmental Quality, which sets construction, operation, and maintenance standards for small water systems, and the Department Nonpublic Water Supply Circular Food and Consumer Safety 1-2016 (FCS 1-2016). Copies of these publications may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Food and Consumer Safety Section, 1400 Broadway, P.O. Box 202951, Helena, Montana 59620-2951.

(2) In order to ensure an adequate and potable supply of water, a school must either:

(a) connect to a water supply system meeting the requirements of ARM Title 17, chapter 38, subchapters 1 and 2; or

(b) if the school is not utilized by more than 25 persons daily at least 60 days out of the calendar year, including staff and students, and an adequate public water supply system satisfying the requirements of ARM Title 17, chapter 38, subchapters 1 and 2, is not accessible, utilize a non-public system whose construction and use meet the standards set in Nonpublic Water Supply Circular Food and Consumer Safety 1-2016 published by the department.

(3) A water supply system of a type other than described in this rule may be utilized only if it is designed by a professional engineer and offers equivalent sanitary protection as determined by the department or local health authority.

(4) If a water supply system is used other than described in (2)(a) above, a school must submit a water sample at least quarterly to a laboratory licensed by the department to perform microbiological analysis of the water supplied in order to determine that the water does not exceed the maximum microbiological contaminant levels stated in ARM 17.38.207 and following all testing requirements in Circular FCS 1-2016.

(5) A school must replace or repair the water supply system serving it whenever the water supply:

(a) contains microbiological contaminants in excess of the maximum levels contained in ARM 17.38.207;

(b) exceeds the Maximum Contaminant Level (MCL) for all other contaminants in Circular FCS 1-2016; or

(c) does not have the capacity to provide adequate water for drinking, cooking, personal hygiene, laundry, and water-carried waste disposal.

(6) Common drinking cups or containers are prohibited.

(7) Where water under pressure cannot be made available, the drinking water from an approved source must be stored in a clean and sanitized container having a tight-fitting lid and a suitable faucet apparatus for filling individual cups. Single service drinking cups must be provided.

(8) Schools must sample all water fountains and sinks used for food preparation. All other potential human consumption fixtures (HCF) must be sampled, unless the school or school district submits a testing plan to the DEQ to test a representative sample of potential HCFs in the school. Proposed testing plans will be approved or denied by the DEQ. Initial samples must be taken by December 31, 2021. All samples must be analyzed by a Montana certified lab using EPA-approved standard drinking water methods for the detection and quantification of lead.

(a) Schools must submit to the department a basic schematic and inventory identifying plumbing materials, all fixture locations, and those fixtures meeting the definition of a HCF. Templates for creating the schematic and inventory are available from the department or the Montana Department of Environmental Quality (DEQ) and can be used to complete this requirement. Lead service lines must be clearly identified in the inventory and should be considered for replacement.

(b) The schematic and inventory must be maintained by the school and shall record any repair, modification, or change in water source that may result in a change in lead exposure from water. Sample results for each HCF must also be maintained in conjunction with the plan and inventory.

(c) All samples collected must be first-draw samples unless otherwise requested or approved by the department or DEQ and samples must be reported to DEQ.

(d) Each first-draw sample for lead must be 250 milliliters in volume and must have stood motionless in the plumbing system of each sampling site for at least six hours. For fixtures with hot and cold water, first-draw samples must only be collected from the cold water. First-draw samples may be collected by a school representative instructed in the proper sampling procedures specified in this rule.

(e) All sample results must be submitted electronically to DEQ in a format approved by the department. All sample results must be submitted to DEQ no later than 72 hours after the school has received the results. Sample results may be submitted to DEQ by certified labs on behalf of the school.

(f) All samples will be considered bin placement samples and must be placed into the appropriate bin in Table 1 unless otherwise designated by the department or DEQ. Follow-up actions are required for each HCF based on the bin placement.

(g) All schools must conduct follow-up sampling of each HCF according to the requirements of Table 2.

(h) Schools must make test results publicly available.

(9) By September 1, 2021, all schools must create and implement a flushing program unless the school meets the waiver requirements indicated under (9)(c).

(a) Schools must use the template provided by the department to produce their flushing program.

(b) Flushing will be required following any period of time during which the school is inactive.

(c) Schools may apply to DEQ for a flushing program waiver based on materials inventory and certification by the school that the school meets the lead-free definition as defined in Section 1417 of the Safe Drinking Water Act.

Table 1.

Bin Placement | Lead Detection | Follow-up Actions 1 | Above 15.0 ug/L | Immediately discontinue use of the affected HCF by physical removal or plumbing disconnection. Remediation is required before the school can resume use of the HCF, subject to the follow-up sampling requirements of Table 2. 2 | 5.0 ug/L up to 15.0 ug/L | Evaluate the conditions at the affected HCF. Determine appropriate remedial action(s) to reduce lead concentration(s) to below 5.0 ug/L. Remediation is required before the school can resume use of the HCF, subject to the follow-up sampling requirements of Table 2. Schools may continue to use the HCF until remediation has occurred only if a daily flushing program for the HCF is implemented. 3 | Below 5.0 ug/L | HCF below 5.0 ug/L does not require remedial action but routine monitoring must be conducted as stated in Bin 3 of Table 2.

Table 2.

Bin Placement | Follow-up Sampling Requirement 1 | Each Bin 1 HCF will be required to be resampled after remediation to show effectiveness of the remediation effort before it is returned to service. The HCF must be resampled within one year of the sample taken after the remediation that returned the fixture to service to confirm that the HCF continues to deliver water below 5.0 ug/L. 2 | Each Bin 2 HCF must be resampled after remediation. The HCF must be resampled within one year of the HCF's last sample. 3 | Routine Monitoring - Each Bin 3 HCF must be sampled once every 3 calendar years to confirm that the HCFs continue to deliver water below 5.0 ug/L. Schools may submit a waiver to sample HCFs on an alternative frequency. Waivers must be submitted to the DEQ in writing using a form approved by the department. Sampling frequency may be adjusted by the DEQ based on test results and inventory.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.833 Waste Water System

(1) In order to ensure waste water is completely and safely disposed of, a school must:

(a) connect to a public waste water system meeting the requirements of ARM Title 17, chapter 38, subchapter 1; or

(b) if the school is not utilized by more than 25 persons daily at least 60 days out of the calendar year, including staff and students, and an adequate public waste water system satisfying the requirements of ARM Title 17, chapter 38, subchapter 1 is not available, utilize a non-public system whose construction and use meet the construction and operation standards contained in DEQ Circular 4.

(2) Where pit privies are currently in use, the privies must be operated and maintained in compliance with the standards specified in DEQ Circular 4.

(3) A waste water system design of a type other than described in this rule may be utilized only if it is designed by a professional engineer and offers equivalent sanitary protection as determined by the department, DEQ, or local health authority.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.834 Solid Waste

(1) In order to ensure that solid waste is safely stored and disposed of, a school must:

(a) store all solid waste between collections in containers which have lids, are corrosion-resistant, and are constructed to minimize pest attraction and harborage;

(b) clean all solid waste containers with sufficient frequency to maintain them in a condition which minimizes pest attraction;

(c) for exterior containers other than dumpsters or compactors, utilize stands which prevent the containers from being tipped, protect them from deterioration, and allow easy cleaning below and around them;

(i) dumpsters or compactors must be located on or above a smooth surface of non-absorbent material, such as concrete or asphalt, that is maintained in clean and good condition;

(d) transport, or utilize a private or municipal hauler to transport, the solid waste at least weekly to a landfill site approved by the Department of Environmental Quality in a covered vehicle or covered containers.

(2) Solid waste includes recycling material.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.840 Laundry Facilities

(1) Laundries operated in conjunction with or utilized by a school must be provided with:

(a) a mechanical washer and hot air tumble dryer. Manual washing and line drying of towels and other laundry items is prohibited. Dryers must be properly vented to prevent maintenance problems and buildup of moisture.

(b) a hot water supply system capable of supplying water at a temperature of 120°F to the washer during all periods of use.

(c) sufficient separation between the area used for sorting and storing soiled laundry and the area used for folding and storing clean laundry to prevent the possibility of cross-contamination.

(d) separate carts for transporting soiled and clean laundry.

(e) handwashing facilities including sink, soap, and disposable towels. A soak sink may double as a handwashing sink.

(2) Towels and other laundry items must be machine washed at a minimum temperature of 120°F for a minimum time of ten minutes and dried to greater or equal to 130°F for ten minutes in a hot air tumble dryer.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.841 Cleaning and Maintenance

(1) A school must comply with the following cleaning and maintenance requirements:

(a) Daily cleaning and maintenance services must be provided whenever the school is in use.

(b) Each janitor room must be kept clean, ventilated, lockable, and free from odors.

(d) Toilets, lavatories, and showers must not be used for washing and rinsing of mops, brooms, brushes, or any other cleaning device.

(e) Cleaners used in cleaning showers, lavatories, urinals, toilet bowls, toilet seats, and floors must contain fungicides or germicides.

(f) Deodorizers and odor-masking agents must not be used.

(g) Toilet bowl brushes, mops and sponges must be used only for cleaning toilet bowls and urinals and must be stored separately from other cleaning devices. Cleaning devices used for lavatories and showers may not be used for any other purposes.

(h) Dry dust mops and dry dust cloths for cleaning purposes are prohibited, except for use on gymnasium floors. Only treated mops, wet mops, treated cloths, moist cloths or other means approved by the department or health authority which will not spread soil from one place to another may be used for dusting and cleaning, with the exception of gymnasium floors.

(i) All furnishings, fixtures, floors, walls, and ceilings must be clean and in good repair.

(j) Cleaning compounds and pesticides must be stored, used, and disposed of in accordance with the manufacturer's instructions.

(k) Safety data sheets must be kept with all cleaning supplies in the area where the cleaning supplies are located.

(l) As current non-green cleaning supplies are depleted it is recommended that they are replaced with cleaning products that are "Green Products."

(m) All cleaning supplies need to have an EPA registration number, a "use by" reading letter, be stored with approved ventilation, and out of the reach of students.

(n) There must be an approved district policy on how to safely clean up vomit, blood, and fecal matter including diarrhea. Cleaning supplies used for vomit, blood, and fecal matter must be disposed of per approved district policy.

(o) Whenever therapeutic whirlpools are used, they must be constructed and maintained for easy cleaning. Whirlpools must be drained and sanitized after each use. Individuals with open sores or infections are prohibited from using therapeutic whirlpools.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.842 Food Service Requirements

(1) Whenever a food service is operated as an integral part of a school, compliance with ARM Title 37, chapter 110, subchapter 2, rules for food service establishments, is required.

(a) If the food service is available only to staff and students of the school and their guests, licensure as a food service establishment is not required, but compliance with ARM Title 37, chapter 110, subchapter 2, rules for food service establishments, is required.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Mont. Admin. R. 37.111.846 Noxious Plant and Animal Control

(1) The school and school site must be maintained free of harborage for insects, rodents, and other pests. Extermination methods and other measures to control pests must conform with the requirements of the department or the local health authority.

(2) All areas must be maintained free of accumulation of debris or standing water which may provide harborage for pests.

(3) Storage areas must be maintained so as to prevent pest harborage. Lumber, pipe, and other building materials must be stored neatly.

(4) The growth of brush, weeds, and grass must be controlled to prevent harborage of pests. School grounds must be maintained to prevent the growth of noxious weeds considered detrimental to health.

(5) Schools must develop and implement an approved Integrated Pest Management (IPM) program beginning September 1, 2021. Students, parents, and staff must be notified when chemicals for IPM are going to be used.

(6) The school IPM must include strategies to prevent the spread of pests.

(7) The school administrator must, whenever practical, ensure the use of nonchemical methods to control pests, including proper sanitation practices, structural repair, and window screens.

(8) Except as provided in (9)(c), at least 24 hours before the application of a pesticide to an area of the school that is used by or is accessible to students, the school administrator must notify parents or guardians of students of the application. A notice of application must include:

(a) a description of the area where the pesticide will be applied;

(b) the date and approximate time of application;

(d) the targeted pests to be controlled by the pesticide;

(e) each active ingredient in the pesticide;

(f) the EPA registration number;

(g) the telephone contact number, if any, on the label of the pesticide for additional information about each pesticide; and

(h) a contact name and telephone number at the school.

(i) If the application will be outdoors, the notification must also include three dates in chronological order in case the preceding date is canceled due to weather.

(9) During the school term the required notification must be made by individual notice delivered by phone, face-to-face oral communication, electronic mail, postal mail, or facsimile. A school or school district may also develop a registration system to provide this notification only to those parents who wish to receive the notification. If the school or school district develops a registration system, the school administrator must provide written notice to the parents or guardians of the students at the beginning of the school year, or upon a student's enrollment, that pesticides may be used in or around the school, and must explain to each parent or guardian how to register to be notified at least 24 hours before a pesticide treatment.

(a) If pesticides are used outside the school term and the school is open or to be accessible by the public, the notification required must be prominently posted in a conspicuous location on the school premises at least 24 hours before the pesticide treatment is scheduled to begin.

(b) Immediately before starting the application of a pesticide, the certified applicator must post in the area of the school where the pesticide is to be applied, a sign 8.5x11-inch in size, or greater. Fonts must be no smaller than 26 point (one-fourth inch). The school administrator must ensure the sign remains posted and students are kept out of the treated area until the reentry interval on the label, if any, has expired, or, if the label does not specify a reentry interval, for at least 24 hours.

(c) A school administrator may authorize an immediate pesticide treatment without prior notification if the school administrator determines an emergency exists. An emergency includes an immediate and unanticipated threat to the health and safety of the individuals at the school. An emergency does not exempt the school from the requirements of (10).

(d) The following pesticide applications are not subject to the notification or posting requirements of this rule:

(i) applications of antimicrobial pesticides;

(ii) an application where the school remains unoccupied for a continuous 72-hour period following the application of the pesticide;

(iii) applications of rodenticides in tamper-resistant bait stations or in areas inaccessible to students; and

(iv) applications of silica gels and other ready-to-use pastes, foams, or gels that will be used in areas inaccessible to students.

(10) A school administrator must keep records of pesticide applications subject to the notification and posting requirements of this rule.

(a) Records must include:

(i) a copy of each notice issued;

(ii) the date of application;

(iii) the name and employer of the individual who applied the pesticide, including the individual's certification number;

(iv) the rate of application;

(v) the concentration of the pesticide applied; and

(vi) the total amount of pesticide used.

(b) If a school administrator authorizes a pesticide application under (9)(c), all the information that is required in a notice under (8) must be included in the record.

(c) Records must be kept for at least five years and must be made available to the local health authority, the department, or the public for review upon request.

History

Authorizing statute(s): 50-1-206, MCA
Implementing statute(s): 50-1-203, 50-1-206, MCA
History: NEW, 1986 MAR p. 546, Eff. 4/11/86; TRANS, from DHES, 2001 MAR p. 2425; AMD, 2020 MAR p. 47, Eff. 1/18/20.

Authorizing statute(s): 50-53-103, 50-53-218, MCA
Implementing statute(s): 50-53-103, 50-53-218, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2425; REP, 2010 MAR p. 80, Eff. 1/15/10.

Authorizing statute(s): 50-53-103, 50-53-218, MCA
Implementing statute(s): 50-53-103, 50-53-218, MCA
History: NEW, 1994 MAR p. 2941, Eff. 11/11/94; TRANS, from DHES, 2001 MAR p. 2425; REP, 2010 MAR p. 80, Eff. 1/15/10.

Subchapter 37.111.12 Trailer Courts, Campgrounds, Youth Camps, and Work Camps

Mont. Admin. R. 37.111.1201 Definitions

In addition to the definitions contained in 50-52-101, MCA, the following definitions apply to this subchapter:

(1) "Alteration" means an expansion, change in purpose, or change in use of any portion of an existing trailer court, campground, work camp, or youth camp. The term includes changing from a trailer court to a campground, adding additional spaces, or changing from a work camp to a campground. The term does not include landscaping alterations that do not affect the number of spaces.

(2) "Applicant" means the owner or person responsible for the license application or plan submittal.

(3) "Approved" means acceptable to the regulatory authority, based on its determination of conformance with Montana statutes, this subchapter, and good public health practices.

(4) "Bedding" means a mattress, box springs, mattress cover, mattress pad, sheets, pillow slip, pillow, pillow cover, blanket, comforter, quilt, duvet, and/or bedspread.

(5) "Building authority" means the Department of Labor and Industry Building Codes Program or its local authorized agent.

(6) "Camp" means a parcel of land on which facilities are provided including designated sites, barracks or structures, any appurtenant water supply and distribution system, wastewater collection and treatment system, solid waste collection and disposal system, or food service and dining facilities.

(7) "Camping unit" means a portable, temporary dwelling supplied by the occupant, including a camping trailer, recreational vehicle, motor home, bus, van, pickup truck, yurt, tipi, or tent.

(8) "Connection" means a line that provides water or sewer service to a designated site, a mobile home site, or a single building or main building with accessory buildings and that is designed to service line specifications.

(9) "Contamination" means impairment or other alteration of the physical, chemical, or biological properties of water, including causing violation of the surface water quality standards contained in ARM Title 17, chapter 30, subchapter 6 or of the maximum contaminant levels for public water supplies contained in ARM Title 17, chapter 38, subchapter 2, or otherwise creating a hazard to human health.

(10) "Dependent unit" means a camping unit or a shelter unit without a water storage tank and a wastewater holding tank as an integral part of the unit and plumbing for potable water and a toilet.

(11) "Designated site" means the permanent area that is designated or used for a camping unit or a shelter unit.

(12) "Independent unit" means a camping unit or shelter unit containing a water storage tank and a wastewater holding tank as an integral part of the unit and plumbing for potable water and a toilet.

(13) "Local regulatory authority" means the local health officer, local sanitarian, or other authorized representative of the local government having jurisdiction.

(14) "Mobile home" means a trailer equipped with necessary service connections that is designed for use as a long-term residence and not on a permanent foundation. The term may include mobile homes, trailers, manufactured homes, modular homes, park model homes, and tiny houses.

(15) "Mobile home space" means a space used for the accommodation of a single mobile home located within a trailer court.

(16) "Permanent foundation" means concrete, concrete block, or wood pier, resting on embedded concrete or concrete block footings. The term does not include mud sill, pier and post, wood blocks, concrete block, or other types of temporary support, resting on the ground.

(17) "Permanent structure" means a structure attached to a permanent foundation.

(18) "Pest" means insects, rodents, and other animals of public health concern.

(19) "Plumbing fixture" means a receptacle or device that:

(a) is permanently or temporarily connected to the water distribution system of the premises and demands a supply of water from the system; or

(b) discharges wastewater.

(20) "Potable Water" means water that meets the standards for drinking purposes of the regulatory authority having jurisdiction, or water that meets the quality standards prescribed by the U.S. Environmental Protection Agency's National Primary Drinking Water Regulations (40 CFR Part 141).

(21) "Public sewage system" means a public sewage system as defined in 75-6-102, MCA.

(22) "Public water supply system" means a public water supply system as defined in 75-6-102, MCA.

(23) "Regulatory authority" means the department, the local board of health, the local health officer, or the local sanitarian.

(24) "Sanitary dump station" means a facility connected to an approved wastewater treatment system and designed for receiving liquid and water-carried waste from camping unit holding tanks.

(25) "Service building" means a structure that provides bathing, toilet, hand washing, or other facilities required by this subchapter.

(26) "Sewer riser" means that portion of the sewer connection which extends vertically above the ground elevation and terminates at each camping unit, shelter unit, or mobile home space.

(27) "Shelter unit" means a structure supplied by the licensee, which may have plumbing, including potable water or a toilet. The term includes barracks, dorms, tents, cabins, yurts, and tipis.

(28) "Side by side separation" means a measure of distance between the two closest points of adjacent structures.

(29) "Solid waste" means solid waste as defined in 75-10-203, MCA, and includes abandoned, damaged, or dismantled mobile homes and recreational vehicles.

(30) "Special event campground" means a temporary or occasional use campground, work camp, or youth camp operated by a single operator at one location for individual events such as a fair, rally, or project involving the gathering of camping units for a maximum period of 14 consecutive days.

(31) "State waters" means state waters as defined in 75-5-103, MCA.

(32) "Stop and waste valve" means any unit that permits the outlet valve to be drained through a port or drain hole provided in the valve.

(33) "Trailer" means a dwelling intended to be portable and mounted on wheels.

(34) "Wastewater" means water-carried waste including household, commercial, or industrial wastes, chemicals, human excreta, or animal and vegetable matter in suspension or solution.

(35) "Wastewater treatment system" means a system that receives wastewater for purposes of treatment, storage, or disposal. The term includes public wastewater treatment systems and all disposal methods described in Department of Environmental Quality Circulars DEQ-2 and DEQ-4.

(36) "Water riser" means the portion of the water connection which extends vertically above the ground elevation and terminates at a designated point at each designated site, mobile home space, or water station.

(37) "Water station" means a facility for supplying potable water to the water storage tanks of camping units or other potable water containers.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1202 Incorporation by Reference

(1) For purposes of this subchapter, the Department of Public Health and Human Services adopts and incorporates by reference the following:

(a) Department of Environmental Quality Circular DEQ-4, "Montana Standards for Subsurface Wastewater Treatment Systems" (2013 edition), and Circular, DEQ-2 "Design Standards for Public Sewage Systems" (2018 edition), setting forth minimum requirements for the design and preparation of plans and specifications for subsurface wastewater treatment systems.

(b) ARM Title 17, chapter 30, subchapter 6, containing surface water quality standards (last amended December 24, 2020).

(c) ARM Title 17, chapter 38, subchapters 1 and 2, containing public water supply maximum contaminant levels and requirements (last amended February 14, 2020).

(d) ARM Title 17, chapter 36, subchapters 1, 3, 6, and 8 setting forth subdivision review requirements (last amended February 14, 2020).

(e) Food and Consumer Safety (FCS) Circular 1, (2016 edition), setting forth standards for non-public water supplies serving licensed establishments.

(f) ARM Title 37, chapter 115, subchapter 1 containing swimming pool and spa requirements (last amended May 15, 2020).

(g) ARM 24.301.301, setting forth state plumbing code requirements (last amended June 10, 2022).

(h) "Manual of Cross-Connection Control" (10th edition), published by the Foundation for Cross-Connection Control and Hydraulic Research, University of Southern California. This publication sets forth standards for backflow and back siphonage prevention devices.

(i) American Society of Sanitary Engineering (ASSE) Standard 1001-2021, "Performance Requirements for Atmospheric Type Vacuum Breakers" (ANSI Approved: November 2021). This standard sets forth regulations and requirements for the use of atmospheric type vacuum breakers. These devices provide protection of the potable water supply against pollutants or contaminants that enter the system due to back siphonage through the outlet.

(j) ASSE Standard 1003-2020e2, "Performance Requirements for Water Pressure Reducing Valves for Potable Water Distribution Systems" (ANSI Approved: December 2020). This standard sets forth regulations and requirements for water pressure reducing valves for domestic water distribution systems. These devices reduce static and flowing pressures in water distribution systems. Devices covered by this standard are self-contained, direct acting, single diaphragm types.

(k) ASSE Standard 1004-2017, "Performance Requirements for Backflow Prevention Requirements for Commercial Dishwashing Machines" (ANSI Approved: January 2017). This standard sets forth regulations and requirements for backflow prevention devices used on potable water supplies connected to commercial dishwashing machines.

(l) ASSE Standard 1011-2017, "Performance Requirements for Hose Connection Vacuum Breakers" (ANSI Approved: November 2017). This standard sets forth regulations and requirements for the use of devices designed to be installed on the discharge side of the hose bibb, hydrant, or faucet which is fitted with hose threads.

(m) ASSE Standard 1012-2021, "Performance Requirements for Backflow Preventers with an Intermediate Atmospheric Vent" (ANSI Approved: November 2021). This standard sets forth regulations and requirements for devices that have functional capabilities for preventing both back-siphonage and back pressure and which can operate under continuous or intermittent pressure conditions.

(n) ASSE Standard 1013-2021, "Performance Requirements for Reduced Pressure Principle Backflow Prevention Assemblies" (ANSI Approved: June 2021). This standard sets forth regulations and requirements for reduced pressure principle backflow prevention assemblies. These devices are designed to operate under continuous pressure conditions.

(o) ASSE Standard 1015-2021, "Performance Requirements for Double Check Backflow Prevention Assemblies" (ANSI Approved: June 2021). This standard sets forth regulations and requirements for double check backflow prevention assemblies. These assemblies are designed and constructed to operate under intermittent or continuous pressure conditions.

(p) ASSE Standard 1020-2020, "Performance Requirements for Pressure Vacuum Breaker Assemblies" (ANSI Approved: February 2020). This standard sets forth regulations and requirements for vacuum breaker assemblies. These devices are intended for use in both high and low hazard applications.

(q) ASSE Standard 1024-2017(R2021), "Performance Requirements for Dual Check Backflow Preventers" (ANSI Approved: June 2021). This standard sets forth regulations and requirements for dual check backflow preventers. The devices covered by this standard are intended to protect the potable water supply from low hazard pollution at residential service lines and individual outlets.

(r) ASSE Standard 1047-2021, "Performance Requirements for Reduced Pressure Detector Backflow Prevention Assemblies" (ANSI Approved: June 2021). This standard sets forth regulations and requirements for reduced pressure detector backflow prevention assemblies. These devices are designed to detect low rates of flow up to 2.0 gpm (0.13 L/s) caused by leakage or unauthorized use.

(s) ASSE Standard 1048-2021, "Performance Requirements for Double Check Detector Backflow Prevention Assemblies" (ANSI Approved: June 2021). This standard sets forth regulations and requirements for d ouble check detector backflow prevention assemblies. These assemblies are also designed to detect low rates of flow up to 2 gpm (0.13 L/s) caused by leakage or unauthorized use.

(t) ASSE Standard 1052-2016 "Performance Requirements for Hose Connection Backflow Preventers" (ANSI Approved: June 2016). This standard sets forth regulations and requirements for hose connection backflow preventers. These devices are designed to be installed on the discharge side of a hose threaded outlet on a potable water system. These two-check devices protect against backflow, due to back siphonage or low-head backpressure, and are field testable to certify protection under the high-hazard conditions present at a hose threaded outlet.

(u) ASSE Standard 1053-2019, "Performance Requirements for Dual Check Backflow Preventer Wall Hydrants – Freeze Resistant Type" (ANSI Approved: April 2019). This standard sets forth regulations and requirements for freeze resistant dual check backflow preventer wall hydrants. These devices protect the potable water supply against back siphonage and backpressure without damage to the device due to freezing.

(v) ASSE Standard 1056-2013, "Performance Requirements for Spill Resistant Vacuum Breaker Assemblies" (ANSI approved: February 2021). This standard sets forth regulations and requirements for assemblies classified as spill-resistant vacuum breaker assemblies. These assemblies are designed for installation in water systems that are normally under continuous pressure conditions.

(w) ASSE Standard 1057-2012, "Performance Requirements for Freeze Resistant Sanitary Yard Hydrant with Backflow Protection" (ANSI Approved: August 2012). This standard sets forth regulations and requirements for assemblies classified as spill-resistant vacuum breaker assemblies. These assemblies are designed for installation in water systems that are normally under continuous pressure conditions.

(2) To obtain, or for information on how to obtain, any document or publication incorporated by reference, contact the Department of Public Health and Human Services, Public Health and Safety Division, Communicable Disease Control and Prevention Bureau, 1400 E. Broadway, P.O. Box 202951, Helena, MT 59620-2951, phone: (406) 444-2837. Copies of the ASSE standards referenced under (1)(i) through (1)(w) are available at https://www.asse-plumbing.org/asse/standards/product/current-standards .

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1203 General Operating Requirements

(1) The environmental conditions of the establishment, including soil, groundwater level and quality, drainage, and topography, shall not create hazards to the property or health or safety of the occupants.

(2) The licensee and manager of an establishment are responsible for ensuring that the requirements of this subchapter are met.

(3) The licensee must have a manager on duty or on call to maintain the establishment and its facilities in accordance with this subchapter and Title 50, chapter 52, MCA.

(a) The manager shall have authority to take immediate action, including actions requiring the expenditure of funds, to correct public health problems.

(b) The licensee must provide occupants and the local regulatory authority the manager's name and contact information.

(4) Each designated site or mobile home space must be clearly marked and numbered on a sign at each site or on the mobile home, except at special event campgrounds, and on a map available to all campground occupants.

(5) Each mobile home shall be fully skirted. Skirting shall be attached to the mobile home. An access opening in the skirting must be provided near the water and sewer connections.

(6) Designated sites may be located only in an area not subject to the accumulation of storm water or surface water.

(7) Pets must not be permitted to run at large or create a nuisance within the establishment. Pets must be limited to the area of the designated site or mobile home space unless leashed. The establishment is responsible for addressing any nuisance caused by a pet.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1204 Plan Approval

(1) The department is the regulatory authority for plan review, unless the local regulatory authority has been approved by the department, in writing, to review plans. Plans may be reviewed jointly by the county and the department.

(2) The owner, or their designee, must submit plans and specifications for any new or altered establishment to the regulatory authority for examination and approval before beginning construction or alteration. Facilities proposed in the plans and specifications must meet the requirements of this subchapter.

(3) Plans and specifications must include a scaled site plan showing the location of all improvements and must show how all applicable rules will be met, including those regarding water supply, wastewater disposal, and solid waste disposal. If the proposal requires Department of Environmental Quality Sanitation in Subdivision review, public water review or public wastewater review, documentation from the Department of Environmental Quality approving the subdivision or public facilities must be submitted as part of a complete plan review application. Specifications and floor plans for any permanent structures, such as service buildings, must be submitted.

(4) No change in plans or specifications involving any provision of this subchapter may be made unless the change is approved in writing by the regulatory authority.

(5) The plans and specifications must be submitted in a manner approved by the department.

(6) Plans and specifications submitted under this rule are reviewed under authority provided by Title 50, chapter 52, MCA, and this subchapter. Regulatory authority approval of plans and specifications under this subchapter does not constitute approval for compliance with planning, building codes, fire codes, or other state, federal, or local requirements (including compliance with the Americans with Disabilities Act, Public Law 101-336).

(7) Within 60 days after the receipt of a complete plan submittal, the regulatory authority will make any deficiencies known to the applicant.

(8) Access, density of sites, and site spacing must conform to local planning and/or subdivision requirements. Mobile homes must be located with at least 20 feet of side-to-side separation.

(9) Approval to construct will be limited to two years, after which, if a license has not been issued, plans and specifications must again be submitted for re-evaluation under rules in effect at the time of resubmittal.

(10) Non-licensure for two or more years requires a new submittal of plans and specifications for review and approval by the local regulatory authority and the department before the establishment is relicensed. The establishment must comply with the requirements of current rule at the time of submission.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1207 Water Supply Requirements

(1) The establishment shall always provide an adequate and potable supply of water, as approved by the local regulatory authority.

(2) If an existing public water supply of satisfactory quantity and pressure is available, and the owner of the public water system agrees to provide service, connection must be made to the public water system and its supply used exclusively except for non-potable water uses approved by the department in writing.

(3) Public water supply systems must be approved by the Department of Environmental Quality and meet the requirements of ARM 17.38.101 et seq., or, if applicable, must be approved by the U.S. Environmental Protection Agency.

(4) Non-public water supply systems must meet the requirements of Food and Consumer Safety (FCS) Circular 1, 2016 edition.

(5) For campgrounds, the local regulatory authority, upon consultation with the department, may allow a variance from the requirements of (1) for a potable water supply upon demonstration by the applicant that the deviation does not have the potential to cause adverse public health effects. The applicant must submit a plan that demonstrates that the public is informed of the absence of a potable water supply, and that the public is warned that the existing water in the area is not suitable for drinking or other uses that may adversely affect public health. This deviation will be noted on the establishment license.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1208 Individual Water Connections

(1) Plans for a new or modified water distribution system must be approved by the regulatory authority before construction. The system must be designed to protect the water from contamination. This includes providing protection from backflow and precluding the creation of cross connections.

(2) If individual water connections for camping units, shelter units, or mobile home spaces are provided, the following standards apply:

(a) Water riser pipes must extend at least 24 inches above ground elevation with the outlet directed downward for campgrounds, and water risers for a mobile home must extend at least four inches above ground elevation. Surface water must be directed away from the riser.

(b) Adequate provision must be made to prevent freezing of service lines, valves, and riser pipes.

(c) Water risers must be located and constructed to minimize potential for damage from trailers. Protection may consist of posts, fences, or other permanent barriers.

(d) Stop and waste type control valves may not be installed underground.

(e) Where health hazards exist that could lead to the contamination of the water supply, the water supply must be protected against backflow or back siphonage. A backflow or back siphonage prevention device installed on a water supply system shall meet American Society of Sanitary Engineering (ASSE) or the Foundation for Cross Connection Control and Hydraulic Research (FCCCHR) standards for construction, installation, maintenance, inspection, and testing for that specific application and type of device.

(f) There must be at least ten feet of horizontal distance between a sewer line connection and a stop and waste valve.

(g) A water connection must be laid at least ten feet horizontally from any existing or proposed sewer line or in a manner allowed under the state plumbing requirements described in ARM 24.301.301.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1209 Wastewater Treatment Requirements

(1) Wastewater treatment systems must be located, designed, constructed, and operated in accordance with local and state regulations.

(a) A failed wastewater treatment system must not be used until repaired or replaced. An alternative system approved by the local regulatory authority must be provided during the interim.

(b) All plumbing fixtures must discharge to an approved wastewater treatment system.

(2) An establishment that limits occupancy of individuals to 14 days or less may use an alternative system with applicable approval by the local regulatory authority, Department of Environmental Quality, or department for sewage disposal, provided the system does not place sewage in a location likely to cause pollution of state waters, in violation of Title 75, chapter 5, MCA, or pose potential adverse public health effects.

(3) If the establishment provides individual connections for wastewater disposal:

(a) the sewer riser must be four inches in diameter;

(b) surface drainage must be diverted away from the riser;

(c) if serving a mobile home space, the sewer riser must be located so that connection to the mobile home will approximate a vertical position;

(d) the sewer riser must be separated from the water riser by at least six feet;

(e) the sewer riser must be securely plugged or capped when not in use; and

(f) flex hose may be used to connect an independent or dependent unit if the unit will be connected for less than 30 days. Connections for mobile homes and units that will be connected for more than 30 days must meet state plumbing codes and local wastewater treatment and disposal regulations.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1210 Toilet Facilities

(1) Toilet facilities are required for establishments with dependent unit sites. Toilets must be located within 300 feet of sites for dependent units and must be accessible whenever the establishment is operating.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1211 Pools and Spas

(1) A public swimming pool, as defined under 50-53-102, MCA, provided by a campground, trailer court, work camp, or youth camp must be licensed, constructed, and operated in accordance with ARM Title 37, chapter 115, subchapter 1.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1212 Water Station

(1) Establishments that do not have individual water connections for all designated sites shall provide a water station.

(2) A water station must consist of at least a water hydrant and the necessary appurtenances, and must be protected against backflow, back siphonage, and hose contamination. The backflow or back siphonage prevention device installed on a water supply system shall meet American Society of Sanitary Engineering (ASSE) or the Foundation for Cross Connection Control and Hydraulic Research (FCCCHR) standards for construction, installation, maintenance, inspection, and testing for that specific application and type of device.

(3) A water station must be separately located from the sanitary dump station to ensure that the water station hose is not used to flush sewage from the sewage holding tank.

(4) A water station must be provided within 300 feet of each site for dependent units that lack individual water connections.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1213 Sanitary Dump Station

(1) A sanitary dump station is required in each establishment that has designated sites for independent units, unless the following circumstances exist:

(a) each independent unit designated site is provided with an individual sewer riser;

(b) a sanitary dump station accepted by the regulatory authority is available for public use on a full-time basis within 15 miles from the campground, and the campground owner or operator has posted a sign at the campground stating the location of the nearest available sanitary dump station; or

(c) the regulatory authority determines that installation of a sanitary dump station is not feasible because of lack of electricity, water under pressure, or other sanitary reasons.

(2) If a sanitary dump station is required, as determined under (1), there must be at least one station for every 100 independent unit designated sites lacking individual sewer risers.

(3) The sanitary dump station shall consist of at least a trapped four inch sewer riser pipe connected to an approved wastewater treatment system, surrounded at the inlet end by a concrete apron sloped to the drain, and with a suitable hinged cover provided for the riser. A water outlet shall be included to permit sanitary maintenance of the station. The water outlet shall be marked: "THIS WATER FOR FLUSHING AND CLEANING — UNSAFE FOR DRINKING." The water outlet hose shall be mounted on a reel or tower to ensure that the nozzle does not touch the ground when not in use. The water outlet shall be provided with an approved device to prevent backflow.

(4) A sanitary dump station may not be located within 100 feet of a permanent body of surface water or well nor within 75 feet of a designated site.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1216 Service Building Requirements

(1) A service building must be provided at each establishment that provides dependent unit designated sites unless the campground limits occupancy of individuals to 14 days or less. The service building is subject to the following requirements:

(a) the service building must be of permanent construction and equipped with lighting, handwashing sinks, toilets, and a janitorial sink;

(b) interior service building surfaces in plumbed areas must be smooth, nonabsorbent, and easily cleanable;

(c) showers, if provided, must have non-slip surfaces sloped to drain, provide warm water, not to exceed 120°F, and provide adequate ventilation;

(d) all windows, doors, and other openings must be screened or closed;

(e) the service building must be conveniently located within a radius of 300 feet from all sites designated for use by dependent units;

(f) the service building must be connected to approved water and wastewater treatment systems;

(g) the number and type of plumbing fixtures must be provided in accordance with Table I below. If a campground has more than 100 dependent unit designated sites, two additional toilets shall be provided for every additional 75 designated sites. The numbers may be either unisex toilet facilities or divided equally between separate men's and women's facilities.

TABLE I

# Dependent Unit Designated Sites | # Toilets | # Handwashing Sinks 1 - 15 | 2 | 2 16 - 30 | 4 | 4 31 - 45 | 6 | 6 46 - 60 | 8 | 8 61 - 80 | 10 | 10 81 - 100 | 12 | 12

(h) all equipment must be kept clean and in good repair. All showers, toilets, and handwashing sinks must be cleaned with disinfectant products regularly; and

(i) the service building must have hand cleaner, disposable towels or hot air dryers, and toilet tissue at all times of operation.

(2) All cooking shelters or other buildings must be cleaned after each day's use during the operating season.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1217 Shelter Units

(1) Each shelter unit will be maintained as follows:

(a) the shelter unit must be thoroughly cleaned after being occupied;

(b) the shelter unit must be maintained in good repair and in a safe and sanitary condition;

(d) all bedding, towels, and other laundered items must be washed and dried as specified in ARM 37.111.121;

(e) each mattress, when provided, must be covered with a machine washable cover and must be kept in clean and sanitary condition;

(f) utensils used for food or drink must be washed, rinsed, and sanitized by camp employees or single-service items must be used. All utensils used for food or drink must be stored, handled, and dispensed in a manner which prevents contamination;

(g) floors and walls of rooms subject to large amounts of moisture must be smooth, non-absorbent, and easily cleanable;

(h) bathing facilities, if present, must be provided with anti-slip surfaces; and

(i) the temperature of water for handwashing and bathing must not exceed 120°F.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1218 Solid Waste Requirements

(1) The establishment must ensure that the storage, collection, and disposal of solid waste does not cause health hazards, rodent harborage, insect breeding areas, accident or fire hazards, or air pollution. The licensee or manager must take immediate measures to alleviate public health or sanitation hazards presented by solid waste in the establishment.

(2) The establishment shall provide adequate solid waste containers and service to the establishment.

(3) Solid waste shall be kept in durable, easily cleanable, pest resistant, wildlife resistant, leak proof, and nonabsorbent containers. Containers for solid waste must be located within 300 feet of each designated site and mobile home space, except that the regulatory authority may approve a centrally located solid waste handling system.

(4) Containers must be provided in sufficient number and capacity to store all solid waste between collections. The regulatory authority may require additional capacity if waste is documented outside or overflowing from containers.

(5) Containers for solid waste used in food preparation and in areas used for washing utensils shall be kept covered or closed when not in use and emptied at a frequency that minimizes the development of objectionable odors and other conditions that attract or harbor pests and wildlife.

(6) Recyclable materials shall be stored in a clean and sanitary manner to prevent pest attraction and nuisance odors.

(7) Solid waste shall be disposed of at least weekly at an approved landfill facility.

(8) Other solid waste removal arrangements may be approved by the regulatory authority if they provide for timely and adequate solid waste removal and waste does not accumulate outside of containers.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1219 Pest and Weed Control

(1) Buildings and other structures must be maintained to be kept free of harborage for, and infestations of, pests and wildlife.

(2) Any extermination or control measures involving insecticides, rodenticides, or herbicides must strictly conform to the manufacturer's application instructions, and not be used within 100 feet of a drinking water well.

(3) The growth of brush, weeds, grass, and other plants must be controlled within the establishment to eliminate harborage of pests.

(4) The growth of ragweed, poison ivy, poison oak, poison sumac, and other similarly noxious plants must be controlled within the area of the establishment frequented by occupants.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1220 Fire Protection and Hazardous Substances

(1) Facilities shall be kept free of litter, rubbish, and other flammable materials.

(2) Chemicals, flammables, and other hazardous substances shall be used for their intended purpose and according to the manufacturer's directions stated on the container label.

(3) Chemicals and other hazardous substances shall be stored according to the manufacturer's directions in their original, covered, and labeled containers in a separate, secure area accessible only by appropriate employees.

(4) Flammable materials shall be stored in a well-ventilated structure, separate from areas occupied by campers and employees.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1223 Registration

(1) All campgrounds, youth camps, and work camps shall maintain a camp register that contains the names, home addresses, and phone numbers of the occupants.

(2) A youth camp shall maintain a camp register that also contains names and phone numbers of persons to notify in case of an emergency for employees and campers.

(3) Outside groups that rent a campground or youth camp must maintain a list of attendees to be made available upon request to the regulatory authority for purposes of investigation of communicable disease or other conditions of public health importance.

(4) Registers shall be retained for a minimum of two years.

(5) Registers shall be made available to the regulatory authority upon request.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1224 Special Event Campgrounds

(1) A special event campground may be licensed by the local regulatory authority for a single event that takes place at a single venue for 14 days or less.

(2) The operator of a special event campground must submit a complete plan review application to the regulatory authority at least 30 days prior to opening and must receive approval from the regulatory authority before opening.

(3) The application must include a site plan showing:

(a) the area that will be used for camping;

(b) the location of the event;

(d) the maximum number of people that can be accommodated;

(e) the number of toilets, handwashing, and bathing facilities to be provided and plans for servicing and maintenance;

(f) the water supply source and distribution method; and

(g) the method of handling solid and liquid waste.

(4) Water must be supplied by a public water supply, licensed water hauler, bottled water, or alternative system approved by the local regulatory authority in compliance with state and local regulations.

(5) Wastewater treatment systems must meet the requirements of ARM 37.111.1209.

(6) The licensee must ensure solid waste requirements under ARM 37.111.1218 are met.

(7) The operator must comply with all components of the approved plan. No modifications to the plan are allowed without regulatory authority approval.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1225 Food Service

(1) An establishment preparing or serving food that meets the definition of a "retail food establishment" under 50-50-102, MCA, must obtain a separate retail food license. An establishment as defined in 50-51-102, MCA, that is licensed as a public accommodation may serve food to registered guests and day visitors without obtaining a retail food license pursuant to 50-50-102(21)(c)(xii), MCA.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1226 Licensure

(1) The local regulatory authority shall perform a pre-licensing inspection prior to submitting a complete license application with the appropriate fee found in 50-52-202, MCA.

(2) A licensee shall give notice in writing to the local regulatory authority at least 30 days prior to selling, transferring, giving away, or otherwise disposing of interest in or control of the establishment. The notice must include the name and address of the person assuming ownership or control of the establishment. The new owner must contact the local regulatory authority to obtain a new license. At the regulatory authority's discretion, a plan review may be required as part of the change of ownership.

(3) Licenses are not transferrable.

(4) The license must be posted on the premises at a location approved by the local regulatory authority.

(5) The licensee or manager of an establishment may not accept or offer camping units, shelter units, or mobile homes in excess of the number and types approved under the license.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, 50-52-202, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1227 Youth Camps

(1) In addition to the other requirements of this subchapter, the operator of a youth camp must:

(a) ensure that the site is as free as reasonably possible of objects or conditions which are hazardous to humans;

(b) post a warning of potential natural hazards and otherwise inform each camper of the danger; and

(c) ensure that each facility and item of equipment used in camp programs are of sufficient quality and properly maintained.

(3) Adequate and convenient janitorial facilities including a sink and storage area for equipment and chemicals must be provided.

(4) Poisonous compounds shall not be stored in food preparation areas or food storage areas or in any areas where campers may initiate unsupervised contact.

(5) In cases in which a youth develops symptoms of illness while at camp, the operator of the youth camp must:

(a) isolate the child immediately in a room or area segregated for that purpose;

(b) as soon as possible, contact, inform, and consult with a parent or guardian of the child about the illness and take one of the following actions:

(i) request that the child be picked up and taken home immediately;

(ii) if the parent or guardian agrees, observe the child for a reasonable time and, if the symptoms do not pass, request that the child be taken home; or

(iii) if the parent or guardian agrees, call a physician, and follow the physician's instructions.

(6) Cases of suspected communicable diseases and conditions listed under ARM 37.114.203 must be reported by telephone to the local health officer upon discovery or as soon as possible thereafter if no contact can be made the same day.

(7) A youth camp operator shall develop and enforce policies on first aid which include, at a minimum:

(a) keeping a record of an emergency phone number for the parent or guardian of each child attending the camp;

(b) measures to be taken in case of injury; and

(c) having a physician on call and a person on-site who is trained in Red Cross basic first aid during camp-sponsored activities. Recommendations for first aid supplies and policies may be secured from the Department of Public Health and Human Services, Emergency Medical Services and Injury Prevention Section, 1400 Broadway, P.O. Box 202951, Helena, Montana 59620-2951.

(8) The youth camp operator must prepare and maintain a record of each instance of fatality stemming from an injury occurring at camp and for each illness or injury occurring at camp which results in a camper either being admitted to the hospital or being diagnosed with a reportable disease listed under ARM 37.114.203. The record must contain:

(a) description of the injury or illness;

(b) description of how the injury or illness occurred;

(d) measures taken to prevent similar injuries from happening in the future.

(9) A youth camp that prepares or serves food to employees or registered guests must follow the "Food Code, 2013, Recommendations of the United States Public Health Service, Food and Drug Administration," adopted and incorporated by reference under ARM 37.110.260.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1228 Work Camps

(1) Whenever operation of a work camp is permanently discontinued, all septic tanks, privy vaults, and cisterns must be removed or emptied and subsequently filled with solid materials.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1231 Variances

(1) The regulatory authority may grant a variance to a requirement of this subchapter if, in the opinion of the regulatory authority, a health hazard or nuisance will not result from the variance.

(2) To apply for a variance, the applicant must submit the following information:

(a) a statement as to why the applicant is unable to comply with the rule to which the variance is requested;

(b) the nature and duration of the variance requested;

(c) a statement of how the intent of the rule will be met and the reasons why the public health or safety would not be jeopardized if the variance is granted; and

(d) other information deemed necessary by the regulatory authority to establish that a health hazard or nuisance will not result from granting the variance.

(3) The regulatory authority must retain the variance application and decision in the establishment file as long as the variance is applicable.

(4) Prior to issuing a variance, the local regulatory authority will contact, notify, and consult with the department about any similar variances to help ensure uniform and equitable application of the law.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1232 Inspections and Compliance Requirements

(1) In accordance with 50-52-303, MCA, a licensee shall allow the local regulatory authority to perform inspections at reasonable hours for determining compliance with this subchapter.

(2) Whenever an inspection is made to determine compliance with this subchapter, the findings must be recorded on an inspection form approved by the department. Within 15 days after each inspection, the local regulatory authority shall give the owner or operator a copy of the inspection report.

(3) If the regulatory authority determines that one or more violations exist, the inspection form must designate the administrative rule(s) that have been violated, the observed basis of the violations(s), any required corrective action, and the date by which the correction must be implemented.

(4) If plans for correction are required, the licensee shall submit necessary plans to the local regulatory authority that include a proposed time schedule for corrective measures. The time schedule and plans, if approved, shall become conditions of licensure.

History

Authorizing statute(s): 50-52-102, 50-52-301, MCA
Implementing statute(s): 50-52-102, 50-52-103, 50-52-301, 50-52-303, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Mont. Admin. R. 37.111.1233 Performance Requirements for Local Regulatory Authorities

In addition to the requirements of 50-52-301, MCA, the following performance requirements apply to the local board of health:

(1) for a local board of health to qualify for reimbursement under 50-52-302, MCA, the local regulatory authority shall:

(a) use inspection forms approved by the department;

(b) update the department's inspection database quarterly;

(c) inspect each establishment within its jurisdiction at least once per license year, or as otherwise agreed upon in a cooperative agreement;

(d) provide copies of program documentation, including inspection reports, plans of correction, and enforcement actions when requested by the department; and

(e) keep all documentation related to an establishment for five years from the date of its creation, unless required to be kept longer by another part of this rule. Plan reviews must be retained for five years after establishment closure.

History

Authorizing statute(s): 50-52-102, MCA
Implementing statute(s): 50-52-102, 50-52-302, MCA
History: NEW, 2022 MAR p. 1748, Eff. 9/10/22.

Chapter 37.112 Body Art

Subchapter 37.112.1 Body Art Facilities

Mont. Admin. R. 37.112.101 Tattooing: Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.102 Purpose

(1) The rules in this chapter pertain to body art establishments under Title 50, chapter 48, MCA, that are licensed by the Department of Public Health and Human Services. Unless otherwise specified by the rules of the local health authority, the rules in this chapter do not apply to body art establishments that are licensed solely by local boards of health pursuant to 50-48-203, MCA.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, 50-48-203, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.103 Definitions

In addition to the definitions contained in 50-48-102, MCA, the following definitions apply to this subchapter:

(1) "Aftercare instructions" means verbal and written instructions that the client should follow to prevent infection and promote healing of the skin after receiving a body art procedure.

(2) "Antiseptic" means a product that is labeled as useful in preventing diseases caused by microorganisms present on the skin and/or on mucosal surfaces of humans. This includes products meant to kill germs and/or labeled as “antiseptic,” “antimicrobial,” “antibacterial,” “microbicide,” “germicide,” or other similar terms.

(3) "Aseptic technique" means a procedure that prevents contamination of any object or person.

(4) “Autoclave” means a device that is intended for use by a user to sterilize products by means of pressurized steam. This device must comply with one of three types of steam programs defined as B, N, and S by standard EN13060, ISO 17665.

(5) “Automated instrument washer” means a mechanical washer designed specifically for the decontamination of instruments prior to sterilization. These devices must comply with ISO 158831/2.

(6) “Blood-borne pathogens” means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).

(7) “Body art” means body piercing and tattooing. The term includes ear lobe piercing, branding and scarification.

(8) “Body artist” means a person performing body art services.

(9) "Body modification" is the intentional altering of the human body for any nonmedical reason.

(10) “Branding” means the process in which a mark or marks are burned into human skin tissue with the intention of leaving a permanent mark.

(11) "Cleaning room" means the room used to sterilize instruments and jewelry with an autoclave.

(12) "Client" means an individual on whom a body artist performs a body art procedure.

(13) "Contaminated" means the probable presence of blood or other potentially infectious materials on an item or surface.

(14) "Disinfectant" means a substance or solution, registered with the United States Environmental Protection Agency (EPA), which kills or inactivates viruses and pathogenic microorganisms, but not necessarily their spores.

(15) "Ear lobe piercing" means the puncturing of the ear lobe, but not the ear cartilage, to create a permanent hole for cosmetic purposes.

(16) "Easily cleanable" means a characteristic of a surface that allows effective removal of soil by normal cleaning methods.

(17) "Equipment" means all machinery, including fixtures, containers, vessels, instruments, tools, devices, implements, furniture, display and storage areas, sinks, and all other apparatus and appurtenances used in connection with the operation of an establishment.

(18) "Implant" means any transdermal or subdermal object that is embedded into a person's body. Implants do not include microdermal anchors or two-point piercings.

(19) "Infectious waste" has the meaning provided for in 75-10-1003, MCA.

(20) "Ink cup" means a small container for an individual portion of pigment which may be installed in a holder or palette, and in which a small amount of pigment is placed.

(21) "Instrument" means a hand piece, needle, and any other tool that may come in contact with a client's body or be exposed to blood or body fluids during a body art procedure.

(22) "Jewelry" means any biocompatible object that is worn through a body piercing.

(23) "Material certificate" means all documents intended to state the specifics of a material used for body jewelry. Names for these documents include but are not limited to mill certificates, material certificates, metal composition sheets, MSD, and material certification sheets.

(24) "Microdermal anchor" means a piece of jewelry used for single-point piercings that has a foot no larger than 8mm in length.

(25) "Mobile establishment" means a licensed facility where body art is conducted, utilizing a wheeled vehicle for movement from place to place.

(26) "Operator" means any owner of an establishment or any person who is responsible for the establishment as well as the other body artists working at the establishment, for the purpose of meeting the requirements of this chapter.

(27) "Permanent cosmetics" means a tattoo, whether permanent or semipermanent, which is applied to a body part, including eyebrows, eyelids, lips, and other parts of the body for beauty marks, hair imitation, lash enhancement, or areola repigmentation. This term also includes procedures commonly referred to as permanent makeup, micropigmentation, micropigment implantation, microblading, dermagraphics, cosmetic tattooing, and other similar types of procedures.

(28) "Physician" means a person licensed to practice medicine in Montana by the Montana Board of Medical Examiners under the Department of Labor and Industry.

(29) “Piercing gun” means a device approved by the department that pierces an individual’s ear lobe using a single-use stud and clasp ear piercing system.

(30) "Sanitization" means the effective treatment of surfaces of inanimate objects by a product registered by the EPA that provides a sufficient concentration of chemicals and enough time to reduce the bacterial count, including pathogens, to a safe level.

(31) “Scarification” means the process in which a mark or marks are cut into human skin tissue with the intention of leaving a permanent mark.

(32) "Sharps" means any discarded instrument or article that may be contaminated with blood or other bodily fluid and may cause punctures or cuts, including needles, scalpel blades, uncovered razors, and broken glass. A disposable shaving razor with protective cap in place is not considered a sharp.

(33) "Single-point piercing" means a piercing that creates a hole in the skin that acts as both the entry and exit for a microdermal or transdermal anchor.

(34) "Single-use" means products or items that are intended for one-time, one-person use and that are disposed of after use on a client, including cotton swabs or cotton balls, tissues or paper products, paper or plastic cups, gauze and sanitary coverings, razors, needles, scalpel blades, stencils, ink cups, and protective gloves.

(35) "Sterilize" means to treat an object or surface with a procedure that kills or irreversibly inactivates all microorganisms, including bacteria, viruses, and pathogenic fungi, including their spores.

(36) “Strike branding” means the process by which a mark is burned with heated metal into the tissue of a person.

(37) "Subdermal object" means an item that is implanted under the skin.

(38) "Tattooist" means a person who engages in the practice of tattooing.

(39) "Temporary establishment" means a facility where body art is conducted for not more than 14 days at one location in a calendar year.

(40) "Transdermal anchor" means a piece of jewelry used for single-point piercings that has a foot larger than 8mm in length.

(41) "Transdermal object" means an item that is passed, entered, or made by penetration through the skin. Transdermal objects do not include microdermal anchors.

(42) "Two-point piercing" means a piercing that punctures the skin creating a distinct entry and exit point.

(43) “Ultrasonic unit” means a device that removes debris by a process called cavitation, in which waves of acoustic energy are propagated in aqueous solutions to disrupt the bonds that hold particulate matter to surfaces.

(44) "Universal precautions" means the current set of guidelines and controls published by the U.S. Centers for Disease Control and Prevention that includes specific recommendations for the use of protective equipment such as gloves, masks, or protective eye wear whenever contact with blood or body fluids containing blood is anticipated.

(45) "Work room" means a designated room or area in which body art takes place. The work room includes the client chair or table, counter, mayo stand, instrument tray, storage drawer, and body artist’s chair.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-102, 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.105 Tattooing: Tattoo Shop Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.106 Tattooing: Work Room Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.107 Tattooing: Utensils and Supplies

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.108 General Facility Requirements

(1) Work rooms, cleaning rooms, restrooms, handwashing facilities, waiting areas, and all establishment areas to which clients have access must be kept clean and free of garbage, litter, unnecessary articles, dust, dirt, and sources of airborne dust or fumes.

(2) Utility rooms, storage rooms, and all other auxiliary rooms separated from other areas of the establishment by closed doors must be in good repair and cleaned as often as necessary to prevent insect or rodent harborage, airborne dust, airborne hazardous chemicals, or other contaminants.

(3) All rooms in the establishment must be provided with an artificial light source equivalent to 20 foot-candles of light three feet off the floor, except as required for work rooms in ARM 37.112.117(5).

(4) An establishment may not be operated in any room or area used as living or sleeping quarters, including bathroom or handwashing sink areas. An establishment must be separated from any living or sleeping quarters by solid self-closing doors. Access to the establishment must be separate from access to living areas.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.109 Water Supply

(1) An adequate and potable supply of water must be provided.

(2) A nonpublic water supply system must meet the requirements of Food and Consumer Safety (FCS) Circular 1-2012 when:

(a) the water supply is constructed after the effective date of this rule;

(b) modifications are made to the water system; or

(c) the local health authority determines compliance with FCS circular 1-2012 is necessary to meet the requirements of this subchapter.

(3) Before a license may be issued, an establishment using an individual, shared, or multiple user water supply must submit the following to the department or its designee:

(a) satisfactory coliform bacteria and nitrate test results as specified in ARM Title 17, chapter 38, subchapter 2; and

(b) the results of an onsite sanitary survey of the water supply system to detect sanitary deficiencies.

(4) A supplier of an individual, shared, or multiple user water supply must conduct a coliform bacteria test of the system at least twice a year with one sample collected between April 1 through June 30 and the second sample collected between August 1 through October 31, and must conduct a nitrate test of the system at least once every three years. Water tests must be analyzed at a certified laboratory. A supplier must keep sampling result records for at least three years.

(5) A public water supply system must be constructed and operated in accordance to current applicable laws as regulated by the Montana Department of Environmental Quality.

(6) Nonpotable water sources must be marked "not for human consumption".

(7) Plumbing must be installed and maintained in a manner to prevent cross connections between the potable water supply and any nonpotable or questionable water supply or any source of pollution through which the potable water supply might become contaminated. The potable water system must be installed to preclude the possibility of backflow. A hose may not be attached to a faucet unless a backflow prevention device is installed.

(8) A water supply system is determined to have failed and requires treatment, replacement, repair, or disinfection, when the water supply becomes unsafe, when it exceeds the maximum contaminant levels specified in ARM Title 17, chapter 38, subchapter 2, or inadequate when it is found to be less than 20 psi measured at the extremity of the distribution line during the instantaneous peak usage.

(9) Extension, alteration, repair, or replacement of a water supply system or development of a new water supply system must be in accordance with all applicable state and local laws.

(10) Bottled and packaged potable water must be obtained from a licensed and approved source and must be handled and stored in a way that protects it from contamination.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13.

Mont. Admin. R. 37.112.112 Tattooing: Hepatitis B Vaccination

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.113 Tattooing: Sterilization Requirements

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.114 Tattooing: Ultrasonic Cleaning Unit

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.115 Sewage System and Solid Waste

(2) All sewage, including liquid waste, must be disposed of by a public sewage system approved by the Montana Department of Environmental Quality or by a sewage treatment and disposal system constructed and operated in accordance to applicable state and local laws. Nonwater-carried sewage disposal facilities are prohibited, except as permitted by ARM 37.112.121 for temporary or mobile establishments.

(3) A wastewater system has failed and requires replacement or repair if any of the following conditions occur:

(a) the system fails to accept, treat, or dispose of wastewater as designed;

(b) effluent from the wastewater system contaminates a potable water supply or state waters; or

(c) the wastewater system is subjected to mechanical failure, including electrical outage, or collapse or breakage of a septic tank, lead line, or drainfield line.

(4) Extension, alteration, replacement, or repair of any wastewater system must be done in accordance with all applicable state and local laws.

(5) Mop water or soiled cleaning water may not be disposed of in any sink other than a mop or utility sink or a toilet.

(6) Solid waste must be collected, stored, and disposed of in a manner that does not create a sanitary nuisance and meets the requirements of ARM 37.112.137 for disposal of infectious waste. Solid waste must be removed from the premises at least weekly to a licensed solid waste disposal facility.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.116 Toilets and Handwashing Sinks

(1) Each establishment must have a toilet and handwashing sink conveniently available to clients and body artists during all hours of operation.

(2) The toilet room must be located within 200 feet by a normal pedestrian route of the work room and not more than one floor-to-floor flight of stairs.

(3) The toilet room must be ventilated, well lit, equipped with a door, toilet tissue, and waste receptacle.

(4) Floors, walls, and ceilings of the toilet room must be in good repair and in clean condition.

(5) Equipment and supplies used for body art procedures must not be stored or used within the toilet room.

(6) The handwashing sink must be located either within the toilet room or within ten feet of the toilet room door.

(7) The handwashing sink must be provided with hot and cold running water by means of a mixing valve or combination faucet, except as provided in ARM 37.112.121(2) for temporary or mobile establishments.

(8) Any self-dispensing, slow-closing, or metering faucet used must be designed to provide a flow of water for at least 20 seconds without the need to reactivate the faucet.

(9) Steam mixing valves are prohibited.

(10) Soap must be conveniently located to the handwashing sink.

(11) Each handwashing sink must be provided with single-use towels that are kept clean for drying hands and a waste receptacle. Non-disposable single-use towels may be used, subject to the following requirements:

(a) the towels must be mechanically washed and hot air dried;

(b) the wash cycle must run with sufficient detergent and for a time demonstrated to thoroughly remove all visible soil;

(d) laundered towels must be kept protected from contamination from soiled laundry and other sources by using separate labeled carts or containers for transportation, by providing sufficient space for sorting, folding, and storage, and by washing hands between touching soiled and clean laundry.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.117 Work Room Requirements

(1) All body art procedures must take place in the work room only.

(2) The work room must be separated by a barrier from the waiting area. The room does not need to have complete physical separation, but it must be segregated by counters, self-closing doors, or other barriers so that clients or other employees may not enter the work room unless they open the barrier to gain access.

(3) The work room may not be used as a corridor for access to other rooms.

(4) Animals are not allowed in the establishment except for:

(a) patrol dogs accompanying security or law enforcement;

(b) service animals such as guide dogs; and

(c) aquatic species within fish aquariums located in waiting rooms and areas outside of the work room provided that the aquatic species can survive underwater for a minimum of 48 hours.

(5) The work room must have a minimum of 50 foot-candles of light measured at the level where the procedure is implemented. Spot lighting may be used to achieve this degree of illumination.

(6) The work room must have adequate ventilation.

(7) Openings to the outside must be protected by such means as self-closing doors, screened or closed windows, or air currents to protect against the entrance of insects, rodents, or other animals. Screening material must not be less than 16 mesh to the inch.

(8) Work rooms must have at least one handwashing sink unless there is a handwashing sink outside the work room within ten feet of the work room door.

(a) If any client chair is more than fifteen feet from a handwashing sink, additional sinks may be required within the work room.

(b) If the handwashing sink is outside the work room, the work room door must have a two-way self-closing door. The two-way self-closing door may be a solid door, swinging café door, or curtain.

(d) If controls for wrist or foot activation are not available, single service towels must be used for turning controls off after washing hands.

(e) The handwashing sink must be sanitized with an EPA-certified disinfectant at least once at the beginning of each day while the establishment is in operation.

(f) The handwashing sink must be provided with hot and cold running water by means of a mixing valve or combination faucet, except as provided in ARM 37.112.121(2) regarding temporary or mobile establishments.

(g) Any self-dispensing, slow-closing, or metering faucet used must be designed to provide a flow of water for at least 20 seconds without the need to reactivate the faucet.

(h) Steam mixing valves are prohibited.

(i) Soap must be conveniently located near the handwashing sink.

(j) Individual, disposable towels must be conveniently located for drying hands.

(9) The work room must have a sufficient number of waste receptacles for the disposal of waste materials.

(a) Waste receptacles must be lined and covered. The receptacles must be cleanable, kept clean, and have self-closing lids with hands-free controls.

(b) Waste receptacles in the work room must be emptied daily or more often, as needed.

(c) A dedicated container for the disposal of sharps and a dedicated container for other contaminated waste must be located in the work room in accordance with ARM 37.112.137 for disposal of infectious material.

(10) The work room must be maintained in a clean condition.

(11) The floor of the work room must be constructed of smooth and impervious materials that are easily cleanable and in good condition. The floor must be wet-mopped daily.

(12) Except as provided in (12)(a), tobacco use, vaping, eating, and drinking are prohibited in the work room where body art preparations and procedures are performed and any location where instruments or supplies are stored or cleaned.

(a) Eating and drinking is allowed when needed for first aid purposes. The use of bottled water and covered drinks is allowed. Hands must be washed and body artists must use a new pair of gloves before returning to the procedure area.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.120 Tattooing: Skin Preparation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.121 Temporary or Mobile Establishment

(1) A temporary or mobile establishment may be operated if:

(a) the operator submits to the department or its designee a written plan that demonstrates how the temporary or mobile establishment will meet the provisions of these rules, or will use alternatives that provide equivalent protection as provided by these rules; and

(b) the department or its designee issues written approval of the plan.

(2) A temporary or mobile establishment that cannot provide mechanically heated water may provide temperate water for hand washing as long as the water is provided in a system that is constructed and operated in accordance with applicable state and local laws for potable water.

(3) A temporary or mobile establishment that cannot meet ARM 37.112.115(1) regarding sewage systems may use an acceptable portable toilet unit with final waste disposal that complies with applicable state and local laws.

(4) Mobile establishments, such as a trailer, mobile home, or mobile vehicle, must have four solid walls. Outdoor tents are prohibited.

(5) Mobile establishments must be equipped with a gravity or pressurized water storage tank. The water storage tank, or tanks, shall be sufficient capacity to meet the peak water demands of the body art establishment.

(a) Mobile establishments using disposable equipment only must have a water storage tank, or tanks, with a capacity of at least 38 liters (10 gallons) for handwashing.

(b) Mobile establishments that reuse equipment must have a water storage tank, or tanks, with a capacity of at least 151 liters (40 gallons) for handwashing, equipment washing, and sanitizing purposes.

(6) The venue for a temporary event must be approved by the department or local health authority prior to the event. The venue must be indoors and meet all requirements of ARM 37.112.117.

(7) Temporary or mobile establishments must be used solely for the purpose of body art procedures. Food prep and habitation are prohibited.

(8) Mobile and temporary establishments must properly sterilize instruments and provide evidence of a spore test performed on sterilization equipment no later than 30 days prior to the date of the event. Otherwise only single-use, prepackaged, sterilized instruments marked with a expiration date, lot number, and method of sterilization can be used. A clean room is required if equipment is reusable, cleaned and sanitized.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.122 Tattooing: Pattern Transfer

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

Rule 37.112.123 reserved

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.124 Tattooing: Tattoo Application

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.125 Equipment and Supplies

(1) Equipment, tools, and jewelry must be clean, in sound condition, and free of rust. Sharp instruments and tools must not be dull. Defective needles may not be used.

(2) Single-use or disposal items must be used only once.

(3) Gloves that come into contact with a client must be single-use nonlatex examination gloves designed for medical or clinical use.

(4) A durable tray must be maintained in the work room for the placement of used articles which require cleaning and autoclaving.

(5) Single-use needles must be disposed of in a sharps disposal container that meets the requirements in ARM 37.112.137.

(6) Work tables, counter tops, and client contact surfaces must be:

(a) constructed of material that is easily cleanable, smooth, nonabsorbent, and corrosion-resistant; and

(b) cleaned and sanitized with a disinfectant between clients.

(7) The operator must maintain at all times enough sterile supplies, disinfectant, antiseptic, and gloves for three working days.

(8) Disinfectants, cleaning compounds, pesticides, and other chemicals must be stored in such a manner that prevents contamination of equipment, supplies, and work surfaces.

(9) Chemical containers must be clearly labeled with the common name of the material. Chemicals must be used in a manner consistent with the manufacturer's labeling.

(10) Instruments, supplies, and other materials that come into contact with the client must be stored in closed clean containers or clean cabinets.

(11) Tables, trays, machinery, tools, containers, and all other equipment used by each individual body artist may not be shared among body artists serving different clients at the same time.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.126 Tattooing: Aftercare

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

Rule 37.112.127 reserved

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.128 Tattooing: Colors, Dyes and Pigments

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.129 Blood-Borne Pathogen Exposure Control

(1) An establishment operator employing at least one body artist shall meet the applicable requirements of 29 CFR 1910.1030, which provides standards for blood-borne pathogen exposure control as promulgated by the U.S. Department of Labor, Occupational Safety and Health Administration. The department adopts and incorporates by reference 29 CFR 1910.1030, as amended May 14, 2019. Copies of this federal regulation may be obtained by contacting the Department of Public Health and Human Services, Public Health and Safety Division, Environmental Health and Food Safety Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951 or by visiting https://www.ecfr.gov/.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.130 Tattooing: Handling and Disposal of Infectious Material

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.131 Sterilization of Equipment and Jewelry

(1) All nondisposable instruments used for body art that can come into contact with blood or body fluids must be individually wrapped and sterilized by an autoclave. All disposable instruments that come into contact with blood or body fluids must come from the supplier individually wrapped and sterile or be sterilized at the time of use.

(2) All jewelry must be sterilized by one of the following methods:

(a) individually wrapped and autoclaved; or

(b) come from the supplier individually wrapped and sterile.

(3) Whenever an autoclave is used, the following requirements apply:

(a) Autoclave packaging and a testing indicator for verifying temperatures must be used each time the autoclave is used.

(b) The autoclave must be allowed to run a complete cycle for 20 minutes at 15 pounds of pressure at a temperature of 250°F (121°C), or in accordance with the autoclave manufacturer's instructions.

(c) After autoclaving, the package must be dated and initialed by the body artist. If the autoclaved instrument or jewelry is not used within six months of the sterilization date, or if the packaging is no longer intact, the article must be rewrapped and resterilized before use.

(d) Monthly biological monitoring must be conducted on the autoclave using standard spore units that are analyzed by a certified laboratory. The results of the monthly spore test must be posted in a conspicuous place.

(e) The department or its designee may require that an operator submit the results of a monthly spore test directly to its office if the establishment fails to perform a monthly spore test or has one or more failed spore tests.

(f) In the event of a failed spore test, the operator must immediately cease use of the autoclave and contact the health authority within one business day.

(g) Following sterilization, equipment and jewelry must remain in the autoclave packaging.

(4) Sterile packages must be opened in full view of the client.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.132 Cleaning and Ultrasonic Use

(1) All reusable instruments used for body art procedures must be cleaned thoroughly with an appropriate soap or detergent and rinsed completely with potable water.

(2) Establishments that reuse instruments must have at least a one-compartment sink with hot and cold running water for the cleaning of instruments or an automated instrument washer. The sink must be used only for cleaning contaminated instruments and shall not be used for hand washing. The sink must be of an adequate size to submerge the instruments being cleaned, except as provided in (3).

(3) Establishments that use ultrasonic units with heating elements to clean their instruments are not required to have hot water at the cleaning sink, provided the heating elements can heat the cleaning solution and maintain the temperature according to the manufacturer's specifications.

(4) An ultrasonic unit must be used in accordance with the manufacturer's instructions. An ultrasonic unit does not satisfy the sterilization requirements in ARM 37.112.131, with or without the addition of chemical sanitizers.

(5) Ultrasonic unit use, cleaning, dusting, or vacuuming is prohibited during times when clients are being tattooed or pierced.

(6) The covered ultrasonic unit and the sink used for rinsing and scrubbing contaminated tools must be separated from the autoclave to prevent contamination. If space is an issue, the establishment may install a Plexiglas, stainless steel, or other nonporous barrier to prevent cross contamination.

(7) Except as provided in (8), all reusable instruments must be cleaned in a separate cleaning room.

(a) The cleaning room must be enclosed by four solid walls except for windows and doors and not open to the public.

(b) The cleaning room must only be used for cleaning, disinfecting, sterilizing, storage, and related tasks. No other services, including tattooing, piercing, or retail sales, may occur within this sterilization room/area.

(c) If any items are stored in the cleaning room, cabinets or drawers must be made of smooth, nonporous wipeable materials.

(8) Reusable tattoo machines and ear piercing guns must be cleaned in accordance with manufacturer instructions and guidelines.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.133 Skin Preparation, Aseptic Technique, and Aftercare

(1) Aftercare instructions appropriate for the body art procedure that describe effective means of infection prevention must be provided to the client both verbally and in writing before every procedure.

(2) At all times during the body art procedure, body artists must use sterile instruments as specified in ARM 37.112.131 and aseptic techniques.

(3) Before performing the body art procedure, body artists must remove all rings, watches, and bracelets, and before and after performing the body art procedure, a body artist must thoroughly wash their hands, wrists, and lower arms in warm running water with soap for at least 20 seconds, scrubbing around and under their fingernails, rinsing completely, drying with clean, individual, disposable towels, and use a new clean disposable towel to turn off the faucet.

(4) Body artists must wear a clean outer garment. A hair restraint must be worn if necessary to prevent the body artist's hair from contact with the client. All necklaces, bracelets, or other personal items of the body artist that could come in contact with the client must be removed.

(5) If it is necessary to shave the client's skin, the body artist must use single-use razors. Straight razors, electric razors, and replaceable blade units may not be used. After shaving the client's skin, the body artist must:

(a) wash and scrub their hands as described in (3); and

(b) wash and rinse the client's area of skin that was shaved.

(6) A body artist must wear gloves when washing or shaving the client's skin. Following washing or shaving of the client’s skin, the body artist must remove the gloves, wash hands, and put on a new pair of gloves before continuing the body art procedure.

(7) Before performing the body art procedure, the skin and surrounding area where the procedure is to be done must be thoroughly dampened with an antiseptic using a clean single-use cotton ball, gauze, or tissue.

(8) If it is necessary to use a marking device, the marking device will be used only once and disposed of.

(9) New gloves must be put on before each body art procedure.

(10) If the body artist's gloved hands become contaminated during the body art procedure, then the body artist must remove the gloves, wash hands, and put on a new pair of gloves before resuming the procedure.

(a) Inadvertent contamination of gloved hands may include touching eyes, nose or mouth, answering the phone, opening a door, or retrieving an item from the floor.

(b) If the body artist sustains a needle stick, the body artist must resume the body art procedure with clean and sterile equipment after rewashing hands and regloving. If a needle stick occurs, the department recommends consulting a health care provider.

(11) Upon completion of the body art procedure, body artists must apply an antiseptic solution to the procedure area in accordance with the manufacturer's instructions with a clean single-use cotton ball, gauze, or tissue. In the event of bleeding, all products used to stop the flow of blood or to absorb blood must be sterile, single-use items that are disposed of immediately after use in appropriate covered containers. All products used to cover the procedure site must be used in accordance with the manufacturer's instructions.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.135 Tattooing: Client Record

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.136 Tattooing: Consent Form

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.137 Handling and Disposal of Infectious Material

(1) Waste that may have been contaminated with blood or body fluids must be separated from other waste and stored in a container with a biohazard warning label.

(2) An adequate supply of sharps containers must be maintained on the premises. A sharps container must:

(a) be leakproof, rigid, and strong enough to protect the handler and others from accidental cuts or puncture wounds;

(b) be closed or capped securely to prevent the loss of contents for disposal; and

(3) Waste that may have been contaminated with blood or body fluids, other than sharps, must be placed in moisture-proof single-use containers or bags of a strength sufficient to prevent ripping, tearing, or bursting under normal conditions of use. Also, the bags must be:

(a) securely tied to prevent leakage or the expulsion of solid or liquid wastes during storage, handling, and transportation; and

(b) placed in a durable, leakproof container for storage and transportation.

(4) A body artist must use adequate protections, such as a brush, dust pan, or tongs to pick up any broken glassware in the work room. After engaging in such cleaning, the body artist must wash hands and reglove as described in ARM 37.112.133 before working with a client.

(5) Laundry that may have been contaminated with blood or body fluids must be stored separately in a leakproof and closed container or bag prior to cleaning.

(6) All infectious waste must be treated and disposed of in accordance with Title 75, chapter 10, part 10, MCA.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.140 Tattooing: Restrictions and Prohibitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.141 Record Keeping and Review

(1) Client records, consent forms, autoclave sterilization test results, and any other records required by this chapter must be maintained on the establishment premises for a minimum of three years. The records must be:

(a) available for review and verification by the department or its designee; and

(b) typed, printed in ink, or electronic.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.142 Client Record

(1) The operator must maintain a client record for each client. At a minimum, the client record must include:

(a) a copy of the signed consent form required by ARM 37.112.144;

(b) the name of the body artist who performed the body art procedure;

(d) special instructions or information regarding the client's medical or skin conditions which are relevant to the body art procedure; and

(e) a written physician referral if one is required by ARM 37.112.158.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.143 Tattooing: Operation

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.144 Consent Form

(1) The client must sign a consent form before each body art procedure. If the client is under the age of 18, then the client's parent or legal guardian must sign the consent form, in person, before the procedure.

(2) The consent form must contain:

(a) the client's name and address, the date of the procedure, the design of the tattoo, if applicable, the location of the procedure on the client's body, and any other information that the body artist may consider appropriate;

(b) a description of potential complications and side-effects, including abscesses, allergies, excessive bleeding (from body piercing), heavy metal poisoning, infection, keloid formation, muscle paralysis, nerve paralysis, scarring, swelling, blood-borne pathogens, tongue swelling, throat closure, and tooth fracture (from oral piercing).

(d) instructions to consult a licensed medical provider if symptoms of infection or other complications occur;

(e) the permanent nature of the body art procedures; and

(f) a statement by the client that the client:

(i) has been provided with the aftercare instructions, both in writing and verbally by the body artist; and

(ii) consents to the body art procedure.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.146 Tattooing: Inspection and Enforcement

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1998 MAR p. 967, Eff. 4/17/98; TRANS, from DHES, 2001 MAR p. 2429; REP, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.147 Training

(1) Operators and body artists must complete formal training in at least general sanitation, first aid, and universal precautions for preventing the transmission of blood-borne pathogens before licensure. Training may be provided by the department, its designee, or an organization approved by the department or its designee as having adequate content in each subject.

(2) Operators and body artists must maintain current training certification with approved providers for first aid, and universal precautions for preventing the transmission of blood-borne pathogens and follow certifying organizations guidelines for expiration and renewal.

(3) Guest body artists and new body artists must complete formal training and provide the inspecting authority with documentation of this training prior to working in a licensed facility.

(4) Equivalent formal training that is not provided by the department or its designee may be permitted if the training contains the same subject matter requirements as specified in (1), and the department or its designee has approved the training.

(5) Each formal training course must provide written documentation to trainees indicating successful completion the course.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.150 License Requirement and Display

(1) No person shall operate an establishment without a license issued by the department. Only a person who complies with the requirements of this chapter shall be entitled to receive or retain such a license. Licenses are not transferable.

(2) A valid license must be posted in every establishment in a conspicuous location.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, 50-48-201, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.151 License Application

(1) Any person desiring to operate an establishment shall submit an application for a license on forms provided by the department. The application must include the name and address of the applicant, and the location and type of the proposed establishment.

(2) The applicant for licensure and all body artists working in the proposed establishment shall be at least 18 years of age at the time of application.

(3) Prior to approval of an application for a license, the department or its designee will inspect the proposed establishment to determine compliance with the requirements of this chapter.

(4) The department will issue a license to the applicant if the applicant demonstrates that the proposed establishment complies with all applicable requirements of this chapter by plan review, inspection, and upon receipt of the license fee.

(5) Obtaining a license from the department does not relieve the applicant from satisfying applicable requirements from other federal, state, or local agencies. These requirements may include:

(a) building code permits and inspections;

(b) fire and life safety inspections; and

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, 50-48-201, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.152 License Fee and Expiration

(1) Except as provided in (2), the license fee is $185 each for a tattoo license and body piercing license.

(2) The license fee for establishments that only pierce ear lobes is $125.

(3) The license will expire annually on December 31 following the date of its issuance.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, 50-48-201, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.153 License Denial and Cancellation

(1) A notice of license denial or cancellation, as provided for in 50-48-205, MCA, is properly served when it is hand-delivered to the operator of the license or the person in charge, or when it is sent by registered or certified mail to the last known address of the operator.

(2) The hearing process provided in 50-48-205, MCA, concerning license denial or cancellation, must be conducted by the department pursuant to Title 2, chapter 4, part 6, MCA, of the Montana Administrative Procedure Act regarding contested cases, and ARM 37.5.117.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 2-4-201, 2-4-631, 50-48-205, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.156 Review of Plans

(1) Whenever an initial license is applied for, the license applicant must submit properly prepared plans and specifications to the department or its designee for review and approval before construction, remodeling, or conversion begins.

(2) For initial plan reviews submitted to the department, the initial plan review fee is $200 and must be submitted by the applicant before the plan review will begin. A local board of health may establish its own fee for plans that are submitted to the local heath authority for review.

(3) The plans and specifications must demonstrate how the establishment will meet the requirements of this rule, including the following:

(a) a layout of work rooms, waiting areas, auxiliary rooms, toilet rooms, handwashing facilities, doorways, stairways, fixed equipment, and facilities;

(b) specifications for any autoclave that may be used, including manufacturer and model number;

(d) copies of formal training documentation as described in ARM 37.112.147.

(4) If the department or its designee disapproves of the plans, the department or its designee will make the deficiencies known to the applicant.

(5) If the facility was previously licensed or certified by the department as a body art establishment and no structural modification is involved, the department may waive the requirement for the submission of plans.

(6) Changes in the client consent form and client record form must be submitted to the department or its designee before implementation.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.157 Inspection

(1) The department or its designee, after proper identification, must be permitted to enter any establishment at any reasonable time for the purpose of making inspections to determine compliance with this chapter and must be permitted to examine the records of the establishment pertaining to compliance with this chapter.

(2) The department or its designee shall conduct inspection of establishments at least once per year. Additional inspections of the establishment may be performed as often as necessary for the enforcement of this chapter. The department will charge a follow-up fee for a third or subsequent inspection if a violation of this chapter is not corrected by the end of the second visit to the establishment. The follow-up fee is $150.

(3) Whenever an inspection of an establishment is made, the department or its designee will document its findings on an inspection form. At the conclusion of the inspection, the department or its designee shall provide a copy of the completed inspection report and the notice to correct violations to the person in charge of the establishment and request a signed acknowledgment of receipt.

(a) Correction of the violations that the department or its designee finds must be accomplished within the period specified on the inspection form.

(b) Failure to comply with any time limits for corrections of critical item violations may result in cessation of establishment operations.

(c) The completed inspection report form is a public document that must be made available for public review or distribution upon payment of reasonable copying costs.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, 50-48-206, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.158 Restrictions and Prohibitions

(1) A body art procedure may not occur if:

(a) either the body artist or the client is under the apparent influence of alcohol or other mind-altering drugs;

(b) the client has not signed the consent form required by ARM 37.112.144; or

(c) the client is under the age of 18, without the explicit in-person consent of the client's parent or legal guardian as provided in 45-5-623, MCA.

(2) If the client is under the age of 18, the parent or legal guardian must accompany the client throughout the procedure.

(3) A written physician referral is required before a body art procedure if the client:

(a) is taking any drug or dietary supplements that may induce bleeding tendencies or reduce clotting;

(b) has a medical condition that is known to cause bleeding tendencies or reduce clotting;

(d) has a sunburn, a skin disease such a psoriasis or eczema, a skin infection, or lesions such as a mole in the proposed procedure site; or

(e) discloses or evidences allergies or contact sensitivity to pigments, soaps, or other substances that may be used in the procedure.

(4) The body artist may delay or require a medical referral before conducting any body art procedure for any person whose physical health, understanding, or judgment may be in question.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.159 Variance

(1) A licensee may request a variance to waive or modify compliance with the health requirements of this subchapter by petitioning the department. An application for a variance must contain:

(a) a statement of the proposed variance from the chapter's requirements, citing the relevant rule numbers; and

(b) a rationale explaining how the potential public health hazards addressed by the relevant rules will be alternatively addressed by the proposal.

(2) The department may grant a variance by modifying or waiving the requirements of this chapter if, in the opinion of the department, a health hazard will not result from the variance.

(3) The failure to continuously demonstrate compliance with a variance or modification may result in license revocation or nonvalidation.

(4) The department reserves the right to deny or revoke a variance if, in its judgment, a health risk may occur.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, 50-48-204, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13.

Mont. Admin. R. 37.112.160 Branding Safety and Sanitation Requirements

(1) The work room must have walls that extend to the ceiling and a closeable door.

(2) A branding work room must be equipped with an ultraviolet air purifier appropriately sized to the room based on the square footage and the manufacturer’s recommendations.

(3) Any person present during the branding procedure, including all personnel and the client, must wear a mask rated as N-95 or higher.

(4) Body artists must use the process of “strike branding” or use a thermal cautery unit (TCU).

(5) Only nongalvanized metal may be used for “strike branding.”

(6) Body artists must use only propylene gas to heat the metal for “strike branding.”

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2025 MAR, 37-1072, Eff. 4/26/25

Mont. Admin. R. 37.112.161 Scarification Safety and Sanitation Requirements

(1) The body artist must wear personal protective equipment (PPE) consisting of disposable sleeves.

(2) The scarification work room must have walls that extend to the ceiling and a closeable door.

(3) The scarification work room must be equipped with an ultraviolet air purifier appropriately sized to the room based on the square footage and the manufacturer’s recommendations.

(4) The body artist must wear sterile gloves when coming into contact with sterile equipment during the procedure.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2025 MAR, 37-1072, Eff. 4/26/25

Mont. Admin. R. 37.112.162 Tattooing: Pattern Transfer

(1) If the method of pattern transfer involves a reusable plastic or acetate stencil, the stencil must be cleaned and sanitized immediately prior to the application.

(2) An adherent or emollient applied to facilitate a pattern transfer, or to cover a pattern after transfer, must be from a single-use container or must be extracted from a supply container in a manner to prevent contamination of the adherent or emollient supply.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07.

Mont. Admin. R. 37.112.163 Tattooing: Colors, Dyes, and Pigments

(1) Each tattooist shall use colors, dyes, and pigments from reputable suppliers, designed for tattooing, stored in appropriate clean and sterile containers, and labeled with the manufacturer name and lot number.

(2) Pigments mixed or prepared in the tattoo establishment must be prepared and stored in accordance with the manufacturer's instructions. When using water to mix colors, dyes, and pigments, distilled or sterilized water must be used.

(3) A tattooist who becomes aware of a client who has experienced an apparent reaction, allergy, or sensitivity to a pigment used in tattooing must report the condition and pigment information to the Department of Public Health and Human Services, Public Health and Safety Division, Environmental Health and Food Safety Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951 or the local health officer.

(4) Adulterated pigments or those containing deleterious substances may be subject to voluntary hold, manufacturer recall, or other action under the Montana Food, Drug and Cosmetic Act, Title 50, chapter 31, MCA; the Federal Food, Drug and Cosmetic Act; or other federal, state, or local law.

(5) Pigments or dyes may not be used if they are disapproved of or under recall by the United States Food and Drug Administration or the department under the Montana Food, Drug and Cosmetic Act, Title 50, chapter 31, MCA.

(6) Individual pigment portions and ink cups must be used for one client, then disposed in accordance with ARM 37.112.137 pertaining to infectious waste.

(7) If additional pigment must be added to an ink cup during the tattooing, the tattooist shall wash hands and reglove, or use a single-use liner to handle the ink storage container.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.164 Jewelry Standards for Initial Body Piercings

(1) All materials used for an initial body piercing must meet ASTM and/or ISO standards for implantation. Examples of allowable materials include:

(a) steel that is ASTM F138 compliant or ISO 5832-1 compliant;

(b) steel that is ISO 10993-6, 10993-10, and/or 10993-11 compliant;

(d) alloyed titanium (Ti6Al4V ELI) that is ASTM F136 compliant or ISO 5832-3 compliant;

(e) alloyed titanium (Ti6Al7Nb ELI) that is ASTM F1295 compliant or ISO 5832-11 compliant; and

(f) any polymer or plastic material that is ISO 10993-6, 10993-10, and/or 10993-11 compliant and/or meets the U.S. Pharmacopeia (USP) Class VI classification, including polytetrafluoroethylene (PTFE) that is ASTM F754 compliant.

(2) Gold jewelry must be comprised of solid 14 karat or higher yellow, white, or rose gold that is nickel free and cadmium free. Gold jewelry may not be:

(a) plated, unless using materials approved by the department or local health authority that is solid 14 karat or higher yellow, white, or rose gold that is nickel free and cadmium free;

(b) gold filled; or

(3) Platinum jewelry must be comprised of solid unalloyed or alloyed platinum that is nickel free and cadmium free.

(4) Niobium jewelry must be comprised of unalloyed niobium (Nb) that is ASTM B392 compliant. This includes commercial grade 2 niobium and commercial grade 4 niobium that contains 1% zirconium.

(5) Glass jewelry must be lead free. Examples of permissible glass jewelry materials include:

(a) fused quartz;

(b) borosilicate; and

(6) All threaded or press-fit jewelry must have internal tapping. Threads on exterior of posts and barbells are not permitted.

(7) Jewelry surfaces and ends must be smooth and free of nicks, scratches, burrs, stamps, hallmarks, and polishing compounds.

(8) Jewelry metals must have a consistent mirror finish on surfaces that frequently come in contact with tissue.

(9) All jewelry used for initial piercing on persons older than 12 years of age must be ASTM F2999 compliant.

(10) All jewelry used for initial piercing on persons 12 years of age or younger must be ASTM F2923 compliant.

(11) Receipts for jewelry purchased for initial piercings must include the specifications for items sold in accordance with the standards set forth in (1). Receipts must be retained by the establishment for at least three years, kept on premises for at least one year, and made available to the department or the local health authority upon request.

(12) Material certificates from jewelry suppliers for jewelry used for initial piercings must include the name of the purchaser of material, the name of the seller of the material, the date of material sales, the type of material purchased, the composition of material purchased, the quantity of material purchased, and the country of origin. Records must:

(a) be updated from the supplier for each new lot of material; and

(b) be retained by the establishment for a minimum of three years, kept on the premises for a minimum of one year, and made available to the department or the local health authority upon request.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2025 MAR, 37-1072, Eff. 4/26/25

Mont. Admin. R. 37.112.165 Body Piercing: Additional Requirements and Restrictions

(1) If the client is under the age of three, the client's parent or legal guardian must be given verbal and written warning of the inherent choking hazard of the jewelry before the body piercing. This warning may be included on the consent form.

(2) Piercing guns may be used on the ear lobe only and shall not be used on body parts such as cartilage, nostrils, navels, eyebrows, and tongues.

(3) For the purposes of this chapter, body piercing does not include the following:

(a) the practice of electrology as defined in 37-31-101, MCA;

(b) the practice of a physician or licensed medical professional as long as the person does not hold himself or herself out as a body artist;

(d) other types of body modifications, including cutting muscle to make a permanent split such as tongue-splitting, cutting into bone, trepanation (drilling into the skull), dental modification, amputation, implants, saline injection, vacuum pumping, circumcision, castration, penectomy, and subincision or superincision of genitals.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Mont. Admin. R. 37.112.167 Body Piercing: Ear Lobe Piercing Exemptions

(1) Establishments that perform ear lobe piercing only by using a mechanized presterilized piercing gun approved by the department or its designee may be exempted from ARM 37.112.116(2) and 37.112.117(8) if:

(a) the body artist and client have convenient access to handwashing sinks. If the handwashing sink is not within the work room or within ten feet of the work room door, then a 70% alcohol-based hand sanitizer must be used in accordance with the U.S. Centers for Disease Control "Guideline for Hand Hygiene in Health-Care Settings" (Morbidity and Mortality Weekly Reports, 2002, Vol. 51, No. RR-16) immediately before putting on gloves and immediately after removal of the gloves. The department adopts and incorporates by reference the U.S. Centers for Disease Control "Guideline for Hand Hygiene in Health-Care Settings" (Morbidity and Mortality Weekly Reports, 2002, Vol. 51, No. RR-16). Copies of this guideline may be obtained by contacting the Department of Public Health and Human Services, Public Health and Safety Division, Environmental Health and Food Safety Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): 50-48-103, MCA
Implementing statute(s): 50-48-103, MCA
History: NEW, 2007 MAR p. 351, Eff. 3/23/07; AMD, 2013 MAR p. 156, Eff. 2/1/13; AMD, 2025 MAR, 37-1072, Eff. 4/26/25.

Chapter 37.113 Montana Clean Indoor Air Act

Subchapter 37.113.1 Montana Clean Indoor Air Act

Mont. Admin. R. 37.113.101 Definitions

In addition to those terms defined in 50-40-103 , MCA, the following terms, as used in Title 50, chapter 40, part 1, MCA, have the meaning set forth below:

(1) "Designee" means, for purposes of determining who is designated by the department to act on its behalf in enforcement of the Montana Clean Indoor Air Act of 1979, is any entity with which the department has entered into an agreement outlining mutual responsibilities.

(2) "Enclosed room", for purposes of the definition of "place of work" in 50-40-103 , MCA, means an area with a wall on all sides reaching from floor to ceiling, exclusive of windows and doors, and does not include an area completely or partially open to the outside air such as a roofed shelter.

(3) "Private residence" means the personal living quarters of an individual, regardless of the legal status of the property, such as incorporation of a ranch, unless the residence is part of a structure, such as a health care facility, where smoking is specifically prohibited by Title 50, chapter 40, part 1, MCA.

History

Authorizing statute(s): 50-40-110, MCA
Implementing statute(s): 50-40-103, 50-40-104, MCA
History: NEW, 2005 MAR p. 2079, Eff. 10/28/05.

Mont. Admin. R. 37.113.104 Bars, Certification of Qualification for Exception

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-40-110, MCA
Implementing statute(s): 50-40-104, 50-40-108, MCA
History: NEW, 2005 MAR p. 2079, Eff. 10/28/05; REP, 2009 MAR p. 1414, Eff. 10/1/09.

Mont. Admin. R. 37.113.108 Inspections and Enforcement

(1) The department, a local health board and their respective designees may conduct inspections of:

(a) enclosed public places to determine if any violation of the Montana Clean Indoor Air Act, Title 50, chapter 40, parts 1 and 2, MCA has occurred; and

(b) public school property to determine compliance with 20-1-220, MCA, relating to tobacco use on public school property.

(2) For every inspection conducted, a written inspection report must be made and retained by the agency conducting the inspection.

(3) Any violation of the Montana Clean Indoor Air Act or of 20-1-220, MCA must be reported to the local health board or its designee and the county attorney of the county in which the violation occurred.

History

Authorizing statute(s): 50-40-110, MCA
Implementing statute(s): 20-1-220, 50-40-104, 50-40-108, MCA
History: NEW, 2005 MAR p. 2079, Eff. 10/28/05; AMD, 2009 MAR p. 1414, Eff. 10/1/09.

Mont. Admin. R. 37.113.112 Complaint Procedure Regarding Smoking Violations

(1) An individual who believes that a violation of the Montana Clean Indoor Air Act or of 20-1-220, MCA has occurred may file a written or electronic complaint with the department or the local health board or its designee that describes the violation, and provides the date of the violation and is signed by the complaining party.

(2) If a complaint is filed with the local health board, a written or electronic copy of the complaint must be forwarded within 30 days to the Department of Public Health and Human Services, Montana Tobacco Use Prevention Section, P.O. Box 202951, Helena, MT 59620-2951.

(3) If a complaint is filed initially with the department or a designee of the department, a written or electronic copy will be forwarded within five working days to the local health board of the county in which the violation allegedly occurred.

(4) Once a complaint is filed, the department or a designee of the department, which may include the local health department, may conduct an investigation to determine if a violation occurred.

(5) If the department or its designee, after an investigation, determines that a violation did occur, it will document the violation and file the documentation and the determination of the department or its designee with the office of the county attorney in the county where the violation occurred.

History

Authorizing statute(s): 50-40-110, MCA
Implementing statute(s): 20-1-220, 50-40-104, 50-40-108, MCA
History: NEW, 2005 MAR p. 2079, Eff. 10/28/05; AMD, 2009 MAR p. 1414, Eff. 10/1/09.

Chapter 37.114 Communicable Disease Control

Subchapter 37.114.1 General Provisions

Mont. Admin. R. 37.114.101 Definitions

In addition to the definitions contained in 50-1-101, MCA, unless otherwise indicated, the following definitions apply throughout this chapter:

(1) "Case" means a person who is confirmed or suspected to have a reportable disease or condition as listed in ARM 37.114.203.

(2) "Contact" means a person or animal that may have had an opportunity to acquire an infection due to the contact's association with a suspected or confirmed infected person or animal or a contaminated environment.

(3) "Contaminated" means the presence of a disease-causing agent upon a living body surface or within or upon any inanimate article or substance.

(4) "Control of Communicable Diseases Manual" means the publication adopted and incorporated by reference in ARM 37.114.105(1)(a).

(5) "Day care facility" has the meaning provided for under 52-2-703, MCA.

(6) "Directly observed therapy (DOT)" means the method whereby a trained health care worker or another trained designated person watches a patient swallow each dose of antituberculosis medication and documents it. DOT can include electronic directly observed therapy (eDOT) utilizing a video conferencing application only with express permission from the state TB program.

(7) "Form" means a paper form or electronically submitted information consisting of data elements necessary to implement effective surveillance, investigation, or mitigation of reportable diseases and outbreaks.

(8) "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings" means the publication adopted and incorporated by reference in ARM 37.114.105(1)(b).

(9) "Health care" means health care as defined in 50-16-504, MCA.

(10) "Health care facility" is a facility as defined in 50-5-101, MCA.

(11) "Health care provider" means a health care provider as defined in 50-16-504, MCA.

(12) "HIV infection" means infection with the human immunodeficiency virus.

(13) "Household contact" is a person or animal living within the household of an infected person.

(14) "Infected person" means a person who harbors an infectious agent whether or not illness is currently discernible.

(15) "Infection" means the entry and development or multiplication of an infectious agent in the body of man or animals.

(16) "Infection control precautions" means those measures necessary to prevent the transmission of disease from an infected person to another person, taking into consideration the specific suspected or confirmed communicable disease and the specific circumstances of the case. The infection control precautions required for a case admitted to a hospital or other health care facility are those measures identified as isolation precautions applicable to the specific disease in the "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings" adopted and incorporated by reference in ARM 37.114.105(1)(b). The infection control precautions required for a case not admitted to a hospital or other health care facility are those measures identified as methods of control applicable to the specific disease in the "Control of Communicable Diseases Manual", adopted and incorporated by reference in ARM 37.114.105(1)(a). Infection control precautions are required, as stated in this rule, whether or not the person is subject to isolation.

(17) "Infectious agent" means an organism including virus, rickettsia, bacteria, fungus, protozoan, prion, or helminth that is capable of producing an infection or infectious disease.

(18) "Infectious disease" means a clinically manifest disease of man or animals resulting from an infection.

(19) "Infectious person" means a person from whom another person may acquire an infectious agent by touch or proximity.

(20) "Institutional and congregate setting" means a setting in which a group of unrelated persons reside, meet, or gather either for a limited or extended period of time in close physical proximity. The term includes correctional facilities, day care facilities, detention centers, group homes, health care facilities as defined in 50-5-101, MCA, schools, and youth camps.

(21) "Laboratory" means any facility or other area used by microbiological, serological, chemical, hematological, immunohematological, molecular, biophysical, cytological, pathological or other examinations of human body fluids, secretions, excretions, or excised or exfoliated tissues, for the purpose of providing information for the diagnosis, prevention or treatment of any human disease or impairment, for the assessment of human health.

(22) "Laboratory Professional" means any person who supervises or works in a laboratory.

(23) "Multidrug-Resistant Organisms (MDRO)" means microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents.

(24) "Outbreak" means the occurrence of more cases of a disease than would normally be expected in a specific place or group of people over a given period of time.

(25) "Potential outbreak" means the presence or suspected presence of a communicable disease in a population where the number of susceptible persons and the mode of transmission of the disease may cause further transmission of that disease.

(26) "Reportable disease" means any disease, the occurrence or suspected occurrence of which is required to be reported by ARM 37.114.203.

(27) "Sensitive occupation" means an occupation described in ARM 37.114.301.

(28) "Sexually transmitted infection" means human immunodeficiency virus (HIV) infection, syphilis, gonorrhea, chancroid, lymphogranuloma venereum, granuloma inguinale, or all chlamydia trachomatis infections including chlamydial genital infections.

(29) "Sexually Transmitted Infections Treatment Guidelines" means the guidelines adopted and incorporated by reference in ARM 37.114.105(1)(c).

(30) "Surveillance" means scrutiny of all aspects of occurrence and transmission of a disease that are pertinent to effective control.

(31) "Susceptible" means having insufficient resistance against a disease and likely to contract the disease if exposed.

(32) "Toxic Metals" means individual metals and metal compounds that may negatively affect an individual's health and, for the purpose of these rules, includes arsenic, cadmium, lead, and mercury.

(33) "Youth camp" has the meaning provided for under 50-52-101, MCA.

History

Authorizing statute(s): 50-1-202, 50-2-116, 50-17-103, MCA
Implementing statute(s): 50-1-202, 50-17-103, 50-18-101, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 1998 MAR p. 2493, Eff. 9/11/98; AMD, 2000 MAR p. 2986, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20; AMD, 2022 MAR p. 1855, Eff. 9/24/22; AMD, 2024 MAR p. 1885, Eff. 7/27/24.

Mont. Admin. R. 37.114.102 Local Board Rules

(1) A local board of health may adopt rules for the control of communicable diseases, if such rules are as stringent as and do not conflict with the requirements of this chapter.

History

Authorizing statute(s): 50-1-202, 50-2-116, MCA
Implementing statute(s): 50-1-202, 50-2-116, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; TRANS, from DHES, 2002 MAR p. 913.

Mont. Admin. R. 37.114.105 Incorporation by Reference

(1) The department adopts and incorporates by reference the following publications:

(a) The "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", 21st edition, 2022, which lists and specifies control measures for communicable diseases.

(b) The "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings," published by the U.S. Centers for Disease Control and Prevention, which specifies precautions that should be taken to prevent transmission of communicable diseases for cases admitted to a hospital or other health care facility.

(c) The "Sexually Transmitted Infections Treatment Guidelines, 2021," published by the U.S. Centers for Disease Control and Prevention in the July 23, 2021, Morbidity and Mortality Weekly Report, volume 70, hereafter referred to as "Sexually Transmitted Infections Treatment Guidelines, 2021," and specify the most currently accepted effective treatments for sexually transmitted infections.

(d) The "Food Code, 2013, Recommendations of the United States Public Health Service, Food and Drug Administration," published by the National Technical Information Service.

(e) The Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, published in Clinical Infectious Diseases, October 1, 2016.

(f) The "Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis," which provide recommendations from the National Tuberculosis Controllers Association and the U.S. Centers for Disease Control and Prevention, published December 16, 2005.

(g) The "Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs)", updated January 2019, published by the U.S. Centers for Disease Control and Prevention, which serves as general guidance to state and local health departments and healthcare facilities in relation to the initial response for the containment of novel or targeted MDROs or resistance mechanisms.

(2) To obtain, or for information on how to obtain, any document or publication incorporated by reference, contact the Department of Public Health and Human Services, Public Health and Safety Division, Epidemiology and Scientific Support, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951, phone: (406) 444-0273, or by visiting its website at: https://dphhs.mt.gov/publichealth/cdepi/reporting .

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Subchapter 37.114.2 Reporting Requirements

Mont. Admin. R. 37.114.201 Reporters

(1) With the exceptions noted in (3), (4), and (5), any person, including a physician, dentist, nurse, medical examiner, other health care practitioner, administrator of a health care facility or laboratory, public or private school administrator, day care facility or youth camp personnel, or laboratory professional, who knows or has reason to believe that a case exists of a reportable disease or condition defined in ARM 37.114.203 must immediately report to the local health officer the information specified in ARM 37.114.205(1) and (2).

(2) A local health officer must submit to the department, on the schedule noted in ARM 37.114.204, the information specified in ARM 37.114.205 concerning each confirmed or suspected case of which the officer is informed.

(3) A state-funded anonymous testing site for HIV infection is not subject to the reporting requirement in (1) with regard to HIV testing.

(4) With the exception of a licensed healthcare provider, reporters under (1) may report directly to the department at the department's request with approval of the local health authority.

(5) With the exception of diseases listed in ARM 37.114.204(1) and (2)(a), laboratories, with the consent of the local health officer, may utilize electronic laboratory reporting (ELR) to satisfy (1).

History

Authorizing statute(s): 50-1-202, 50-17-103, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-17-103, 50-18-102, 50-18-106, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1986 MAR p. 254, Eff. 2/28/86; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.203 Reportable Diseases and Other Conditions of Public Health Importance

(1) The following communicable diseases and conditions and other conditions of public health importance are reportable:

(a) Acute flaccid myelitis (AFM);

(b) AIDS, as defined by the Centers for Disease Control and Prevention, and HIV infection, as determined by a positive result from a test approved by the Federal Food and Drug Administration for the detection of HIV, including antibody, antigen, and all HIV nucleic acid tests;

(d) Arboviral diseases, neuroinvasive and nonneuroinvasive (California serogroup, Chikungunya, Eastern equine encephalitis, Oropouche, Powassan, Saint Louis encephalitis, West Nile virus, Western equine encephalitis, Zika virus infection);

(e) Arsenic poisoning (≥ 70 micrograms per liter (µg/L) total arsenic in urine; or ≥ 35 µg/L methylated plus inorganic arsenic in urine);

(f) Babesiosis;

(g) Botulism (including infant, foodborne, other, and wound botulism);

(h) Brucellosis;

(i) Cadmium poisoning (≥ five µg/L total blood cadmium levels; or ≥ three µg/L total cadmium in urine);

(j) Campylobacteriosis;

(k) Candida auris (C. auris);

(l) Carbapenemase-producing organisms (CPO);

(m) Chancroid;

(n) Chlamydia trachomatis infection;

(o) Cholera;

(p) Coccidioidomycosis;

(q) Colorado tick fever;

(r) Coronavirus Disease 2019 (COVID-19)-associated hospitalizations and deaths;

(s) Cronobacter in infants;

(t) Cryptosporidiosis;

(u) Cyclosporiasis;

(v) Dengue virus infections;

(w) Diphtheria;

(x) Escherichia coli, Shiga toxin-producing (STEC);

(y) Gastroenteritis outbreak;

(z) Giardiasis;

(aa) Gonorrhea;

(bb) Granuloma inguinale;

(cc) Group A Streptococcus, invasive disease;

(dd) Haemophilus influenzae invasive disease;

(ee) Hantavirus pulmonary syndrome or infection;

(ff) Hemolytic uremic syndrome, post diarrheal;

(gg) Hepatitis A, acute;

(hh) Hepatitis B, acute, chronic, perinatal;

(ii) Hepatitis C, acute, chronic;

(jj) Influenza-associated hospitalizations and deaths;

(kk) Lead levels in a capillary blood specimen of ≥ 3.5 micrograms per deciliter(µg/dL) in a person less than 16 years of age;

(ll) Lead levels in a venous blood specimen at any level;

(mm) Legionellosis;

(nn) Leprosy (Hansen’s disease);

(oo) Leptospirosis;

(pp) Listeriosis;

(qq) Lyme disease;

(rr) Lymphogranuloma venereum;

(ss) Malaria;

(tt) Measles (rubeola);

(uu) Melioidosis;

(vv) Meningococcal disease (Neisseria meningitidis);

(ww) Mercury poisoning (≥ ten µg/L total mercury in urine; or ≥ ten µg elemental mercury/g creatinine in urine; or ≥ ten µg/L elemental, organic, and inorganic blood mercury levels);

(xx) Multisystem inflammatory syndrome in children (MIS-C);

(yy) Mpox;

(zz) Mumps;

(aaa) Novel influenza A virus infections;

(bbb) Pertussis;

(ccc) Plague;

(ddd) Poliomyelitis, paralytic or nonparalytic;

(eee) Psittacosis;

(fff) Q-fever (acute and chronic);

(ggg) Rabies in a human or animal; exposure to a human by a species susceptible to rabies infection;

(hhh) Respiratory syncytial virus (RSV)-associated deaths in a person less than 18 years of age;

(iii) Rickettsial diseases (including spotted fevers, flea-borne typhus, scrub typhus, anaplasmosis, and ehrlichiosis);

(jjj) Rubella (including congenital);

(kkk) Salmonella Paratyphi infection;

(lll) Salmonella Typhi infection;

(mmm) Salmonellosis;

(nnn) Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease;

(ooo) Shigellosis;

(ppp) Smallpox;

(qqq) Streptococcus pneumoniae, invasive disease;

(rrr) Streptococcal toxic shock syndrome (STSS);

(sss) Syphilis;

(ttt) Tetanus;

(uuu) Tickborne relapsing fever;

(vvv) Toxic shock syndrome (TSS) (nonstreptococcal);

(www) Transmissible spongiform encephalopathies (including Creutzfeldt Jakob Disease);

(xxx) Trichinellosis (trichinosis);

(yyy) Tuberculosis (TB) including latent tuberculosis infection;

(zzz) Tularemia;

(aaaa) Varicella (chickenpox);

(bbbb) Vibriosis;

(cccc) Viral hemorrhagic fevers; and

(dddd) Yellow fever.

(2) Also reportable is:

(a) an outbreak or cluster of any communicable disease listed in the "Control of Communicable Diseases Manual" in any setting, including an institutional or congregate setting; or

(b) any unusual incident of illness or death in a human or animal with potential human health implications.

History

Authorizing statute(s): 50-1-202, 50-17-103, 50-18-105, 50-18-106, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-17-103, 50-18-102, 50-18-106, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1980 MAR p. 2870, Eff. 10/31/80; AMD, 1981 MAR p. 1289, Eff. 10/30/81; AMD, 1986 MAR p. 254, Eff. 2/28/86; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1994 MAR p. 1295, Eff. 5/13/94; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 2000 MAR p. 2986, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20; AMD, 2022 MAR p. 1855, Eff. 9/24/22; AMD, 2024 MAR p. 1885, Eff. 7/27/24; AMD, 2026 MAR, Notice No. 2026-442, Eff. 9/26/26.

Mont. Admin. R. 37.114.204 Reports and Report Deadlines

(1) A local health officer must immediately report (within four hours) to the department by telephone the information cited in ARM 37.114.205(1) and (2) whenever a case of one of the following diseases or other condition of public health importance is suspected or confirmed:

(a) Anthrax;

(b) Botulism;

(d) Poliomyelitis, paralytic or nonparalytic;

(e) Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease;

(f) Smallpox;

(g) Tularemia; or

(h) Viral hemorrhagic fevers.

(2) A local health officer must transmit by telephone or secure electronic means to the department the information required by ARM 37.114.205(1) and (2) for each suspected or confirmed case of one of the following diseases, within the time limit noted for each:

(a) Information about a case of one of the following diseases should be submitted within 24 hours after it is received by the local health officer:

(i) an outbreak of a disease or condition specified in ARM 37.114.203;

(ii) any unusual incident of illness or death in a human or animal with potential human health implications;

(iii) Acute flaccid myelitis (AFM);

(iv) Brucellosis;

(v) Cronobacter in infants;

(vi) Diphtheria;

(vii) Gastroenteritis outbreak;

(viii) Measles;

(ix) Melioidosis;

(x) Mpox;

(xi) Novel influenza A virus infections;

(xii) Rabies in a human;

(xiii) Rabies in an animal;

(xiv) Rubella; and

(xv) Syphilis.

(b) Information about a case of one of the following diseases must be submitted within seven calendar days after it is received by the local health officer:

(i) AIDS or HIV infection;

(ii) Arboviral diseases, neuroinvasive and non-neuroinvasive (California serogroup, Chikungunya, Eastern equine encephalitis, Powassan, Saint Louis encephalitis, West Nile virus, Western equine encephalitis, Zika virus infection);

(iii) Arsenic poisoning (≥ 70 µg/L total arsenic in urine; or ≥ 35 µg/L methylated plus inorganic arsenic in urine);

(iv) Babesiosis;

(v) Cadmium poisoning (≥ five µg/L total blood cadmium levels; or ≥ three µg/L total cadmium in urine);

(vi) Campylobacteriosis;

(vii) Candida auris (C. auris);

(viii) Carbapenemase-producing organisms (CPO);

(ix) Chancroid;

(x) Chlamydia trachomatis infection;

(xi) Cholera;

(xii) Coccidioidomycosis;

(xiii) Colorado tick fever;

(xiv) Coronavirus Disease 2019 (COVID-19)-associated hospitalizations and deaths;

(xv) Cryptosporidiosis;

(xvi) Cyclosporiasis;

(xvii) Dengue virus infections;

(xviii) Escherichia coli, Shiga toxin-producing (STEC);

(xix) Giardiasis;

(xx) Gonorrhea;

(xxi) Granuloma inguinale;

(xxii) Group A Streptococcus, invasive disease;

(xxiii) Haemophilus influenzae, invasive disease;

(xxiv) Hantavirus pulmonary syndrome or infection;

(xxv) Hemolytic uremic syndrome, post diarrheal;

(xxvi) Hepatitis A, acute;

(xxvii) Hepatitis B, acute, chronic, perinatal;

(xxviii)Hepatitis C, acute, chronic;

(xxix) Influenza-associated hospitalizations and deaths;

(xxx) Lead levels in a capillary blood specimen of ≥ 3.5 micrograms per deciliter(µg/dL) in a person less than 16 years of age;

(xxxi) Lead levels in a venous blood specimen at any level;

(xxxii) Legionellosis;

(xxxiii)Leprosy (Hansen’s disease);

(xxxiv)Leptospirosis;

(xxxv) Listeriosis;

(xxxvi)Lyme disease;

(xxxvii)Malaria;

(xxxviii)Meningococcal disease (Neisseria meningitidis);

(xxxix)Mercury poisoning (≥ ten µg/L total mercury in urine; or ≥ ten µg elemental mercury/g in creatinine in urine; or ≥ ten µg/L elemental, organic, and inorganic blood mercury levels);

(xl) Multisystem inflammatory syndrome in children (MIS-C);

(xli) Mumps;

(xlii) Oropouche;

(xliii) Pertussis;

(xliv) Psittacosis;

(xlv) Q-fever (acute and chronic);

(xlvi) Respiratory syncytial virus (RSV)-associated deaths in a person less than 18 years of age;

(xlvii)Rickettsial diseases (including spotted fevers, flea-borne typhus, scrub typhus, anaplasmosis, and ehrlichiosis);

(xlviii)Salmonella Paratyphi infection;

(xlix) Salmonella Typhi infection;

(l) Salmonellosis;

(li) Shigellosis;

(lii) Streptococcus pneumoniae, invasive disease;

(liii) Streptococcal toxic shock syndrome (STSS);

(liv) Tetanus;

(lv) Tickborne relapsing fever;

(lvi) Toxic shock syndrome (nonstreptococcal) (TSS);

(lvii) Transmissible spongiform encephalopathies;

(lviii) Trichinellosis (trichinosis);

(lix) Tuberculosis (TB) including latent tuberculosis infection;

(lx) Varicella (chickenpox);

(lxi) Vibriosis; and

(lxii) Yellow fever.

(3) For any animal exposure that may result in a risk of rabies transmission to a human by a species susceptible to rabies infection, the local health officer must report by secure electronic means to the department documentation of a rabies post-exposure prophylaxis recommendation or administration within seven calendar days of the recommendation or administration.

(4) A laboratory that performs testing for influenza or RSV must report results as follows:

(a) The laboratory utilizes electronic laboratory reporting (ELR), they must report positive and negative influenza and RSV results to the department electronically.

(b) The laboratory does not utilize ELR, the local health officer may request that the information listed in ARM 37.114.205 be reported for positive influenza test results by secure electronic means or by another secure method approved by the local health officer.

(5) A laboratory that performs testing associated with HIV infection must report to the department:

(a) any test result or combination of test results that indicate HIV infection;

(b) all CD4 T-lymphocyte test results unless it is known that the test was performed in association with a disease other than HIV infection or HIV-related illness;

(d) all test results for assays designed to assess HIV infection subtype and resistance to antiretroviral drugs, including nucleotide sequences, in a format designated by the department; and

(e) submit a specimen utilized for surveillance purposes only, to the department's public health laboratory upon request.

(6) A laboratory that performs testing for hepatitis B must report to the department:

(a) the following positive test results:

(i) hepatitis B surface antigen;

(ii) hepatitis B core antibody, total;

(iii) hepatitis B core antibody, IgM; and

(iv) hepatitis B envelope antigen.

(b) The following tests, regardless of the result:

(i) hepatitis B DNA.

(7) A laboratory that performs testing for hepatitis C must report to the department:

(a) the following positive test results:

(i) hepatitis C antigen;

(ii) hepatitis C antibody; and

(iii) hepatitis C genotype.

(b) the following tests, regardless of the result:

(i) hepatitis C nucleic acid test (NAT) for RNA.

(8) A laboratory that performs testing for group A Streptococcus must report to the department:

(a) positive Streptococcus pyogenes culture results collected from a normally sterile specimen source (e.g., blood, CSF, and pleural fluid).

History

Authorizing statute(s): 50-1-202, 50-17-103, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-17-103, 50-18-102, 50-18-106, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1994 MAR p. 1295, Eff. 5/13/94; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 2000 MAR p. 2986, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20; AMD, 2022 MAR p. 1855, Eff. 9/24/22; AMD, 2024 MAR p. 1885, Eff. 7/27/24; AMD, 2026 MAR, Notice No. 2026-442, Eff. 9/26/26.

Mont. Admin. R. 37.114.205 Report Contents

(1) A report of a case of reportable disease or a condition which is required by ARM 37.114.204(1) or (2) must include, if available:

(a) first and last name and middle initial, physical address including city, state and zip code, date of birth, gender, race, and ethnicity of the case;

(b) dates of onset of the disease or condition and the date the disease or condition was reported to the health officer;

(d) name and address of the case's physician; and

(e) name of the reporter or other person the department can contact for further information regarding the case.

(2) The information required by (1) must be supplemented by any other information in the possession of the reporter which the department or local health officer requests and which is related to case management and/or investigation of the case.

(3) The name or other identifying information of any case with a reportable disease or condition and the name and address of the reporter of any such case are confidential and not open to public inspection.

History

Authorizing statute(s): 50-1-202, 50-17-103, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-17-103, 50-18-102, 50-18-106, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13.

Subchapter 37.114.3 General Control Measures

Mont. Admin. R. 37.114.301 Sensitive Occupations and Settings

(1) A local health officer or the department may restrict a person employed or engaged in direct care of children, the elderly, or individuals who are otherwise at a high risk for disease from practicing an occupation or activity while infected by a reportable disease if, given the means of transmission of the disease in question, the nature of the person's work would tend to transmit the disease.

(2) No infectious person may engage in any occupation or activity involving the preparation, serving, or handling of food, including milk, to be consumed by others than their immediate family, until a local health officer determines them to be free of the infectious agent or unlikely to transmit the infectious agent due to the nature of their particular work.

(3) Persons involved in food preparation, serving, or handling of food may be subject to additional restrictions as specified in: "Food Code, 2013, Recommendations of the United States Public Health Service, Food and Drug Administration" published by National Technical Information Service, Publication PB2013-110462, ISBN 978-1-935239-02-4, November 3, 2013.

(4) Persons attending or residing in congregate settings may be subject to additional restrictions and exclusions to prevent further transmission as determined by the local health authority.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17.

Mont. Admin. R. 37.114.303 Funerals

(1) A funeral service for a person who died of a reportable disease must be conducted in accordance with instructions of a local health officer.

(2) If a person dies from a disease requiring quarantine of contacts, a funeral service for that person may be open to the public only if the casket remains closed and those contacts subject to the quarantine who attend the funeral are segregated from the rest of those attending, unless the contacts have been determined by a local health officer to be incapable of transmitting the infection or disease which caused the death.

(3) Transportation of dead human bodies must be in accord with ARM 37.116.103.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913.

Mont. Admin. R. 37.114.306 Transportation of Communicable Disease Cases

(1) Neither an infected person with a communicable disease for which subchapter 5 of this chapter prescribes isolation nor a contact made subject to quarantine by that subchapter may travel or be transported from one location to another without the permission of the local health officers with jurisdiction over the places of departure and arrival, except if, in the case of an infected person:

(a) the infected person is to be admitted directly to a hospital for the treatment of the communicable disease; and

(b) both local health officers are satisfied that adequate precautions are taken to prevent dissemination of the disease by the infected person en route to the hospital.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913.

Mont. Admin. R. 37.114.307 Quarantine of Contacts: Notice and Observation

(1) If a communicable disease requires quarantine of contacts, a local health officer or the department shall institute whatever quarantine measures are necessary to prevent transmission, specifying in writing the person or animal to be quarantined, the place of quarantine, the frequency with which possible or known contacts must be medically observed to determine if physiological signs of the disease are occurring, and the duration of the quarantine.

(2) A local health officer or the department must ensure such contacts are medically observed as frequently as necessary during the quarantine period.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913.

Mont. Admin. R. 37.114.308 Isolation of Patient: Notice

(1) When isolation of a patient is declared, the agency declaring the isolation must supply to the infected person in writing a description of the place of isolation, the length of the isolation period, and the name and title of the person declaring the isolation.

(2) A local health officer or the department may inspect the place of isolation during the period of isolation to determine compliance with the isolation.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913.

Mont. Admin. R. 37.114.312 Importation of Disease

(1) No person who has a reportable disease for which subchapter 5 of this chapter prescribes isolation may be brought within the boundaries of the state without prior notice to the department and approval of measures to be taken within Montana to prevent disease transmission.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.313 Confirmation of Disease

(1) Subject to the limitation in (2), if a local health officer receives information about a case of any of the following diseases, the officer must work with the department to ensure that a specimen from the case is submitted to the department, when possible, which will be analyzed to confirm the existence or absence of the disease in question, or for further examination associated with surveillance or investigation of disease transmission:

(a) Anthrax;

(b) Arboviral diseases, neuroinvasive and non-neuroinvasive (California serogroup, Chikungunya, Eastern equine encephalitis, Oropouche, Powassan, Saint Louis encephalitis, West Nile virus, Western equine encephalitis, Zika virus infection);

(d) Brucellosis;

(e) Candida auris (C. auris);

(f) Carbapenem-Resistant Organisms;

(g) Cholera;

(h) Diphtheria;

(i) Escherichia coli, Shiga toxin-producing (STEC);

(j) Haemophilus influenzae invasive disease;

(k) Hantavirus pulmonary syndrome or infection;

(l) Influenza;

(m) Listeriosis;

(n) Measles (rubeola);

(o) Meningococcal disease (Neisseria meningitidis);

(p) Plague;

(q) Poliomyelitis, paralytic or non-paralytic;

(r) Rabies (human);

(s) Rubella (including congenital);

(t) Salmonellosis (including Salmonella Typhi and Paratyphi);

(u) Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease;

(v) Shigellosis;

(w) Smallpox;

(x) Trichinellosis (Trichinosis);

(y) Tuberculosis disease;

(z) Tularemia;

(aa) Vancomycin-intermediate staphylococcus aureus (VISA);

(bb) Vancomycin-resistant staphylococcus aureus (VRSA); and

(cc) Vibriosis.

(2) In the event of an outbreak, emergence of a communicable disease or a disease of public health importance, specimens must be submitted at the request of the department until a representative sample has been reached as determined by the department.

(3) A laboratory professional or any other person in possession of a specimen from a case of a disease listed in (1) must submit the specimen to the department upon request.

(4) If no specimen from the case is otherwise available and the case refuses to allow a specimen to be taken for purposes of (1), the case will be assumed to be infected and must comply with whatever control measures are imposed by the department, or the local health officer.

History

Authorizing statute(s): 50-1-202, 50-1-204, MCA
Implementing statute(s): 50-1-202, 50-1-204, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1994 MAR p. 1295, Eff. 5/13/94; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20; AMD, 2026 MAR, Notice No. 2026-442, Eff. 9/26/26.

Mont. Admin. R. 37.114.314 Investigation of a Case

(1) Immediately after being notified of a case or an outbreak of a reportable disease, a local health officer must investigate and take whatever steps are necessary to prevent transmission of the disease.

(2) If the local health officer finds that the nature of the disease and the circumstances of the case or outbreak warrant such action, the local health officer must:

(a) examine or ensure that a health care provider examines any infected person in order to verify the diagnosis;

(b) make an epidemiologic investigation to determine the source and possible transmission of infection;

(c) take appropriate steps, as outlined in the "Control of Communicable Diseases Manual", to prevent or control the transmission of disease; and

(d) notify contacts as defined in ARM 37.114.101 of the case and give them the information needed to prevent contracting the disease.

(3) Whenever the identified source of a reportable disease or a person infected with or exposed to a reportable disease who should be isolated, quarantined, interviewed, or placed under surveillance is located outside of the jurisdiction of the local health officer, the local health officer must coordinate with the department to notify the health officer of the relevant jurisdiction.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-17-103, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-17-103, 50-17-105, 50-18-102, 50-18-107, 50-18-108, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1994 MAR p. 1295, Eff. 5/13/94; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.315 Potential Outbreaks

(1) Whenever a communicable disease listed in ARM 37.114.203, or the "Control of Communicable Diseases Manual", or other communicable disease that constitutes a threat to the health of the public, becomes so prevalent as to endanger an area outside of the jurisdiction where it first occurred, the local health officer of the jurisdictional area in which the disease occurs must notify and cooperate with the department to control the transmission of the disease in question.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1994 MAR p. 1295, Eff. 5/13/94; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.316 Outbreak in an Institutional or Congregate Setting

(1) Infection control precautions must be employed until laboratory tests indicate what organism is responsible for the outbreak, after which, control measures must be taken which are specific for the organism in question.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 2017 MAR p. 343, Eff. 3/25/17.

Subchapter 37.114.5 Specific Control Measures

Mont. Admin. R. 37.114.501 Minimal Control Measures

(1) The control measures described in the "Control of Communicable Diseases Manual" must be employed, unless otherwise provided in this subchapter. Unless a particular control measure specifies who is responsible, the local health officer or the authorized representative of a local health officer must:

(a) employ the minimum control measures; or

(b) ensure that minimal control measures are employed by a health care provider or other person caring for a person with a reportable disease.

History

Authorizing statute(s): 50-1-202, 50-2-116, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-116, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1998 MAR p. 2493, Eff. 9/11/98; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.503 Acquired Immune Deficiency Syndrome (aids) and Hiv Infection

(1) Whenever human immunodeficiency virus (HIV) infection occurs, infection control fluid precautions must be used for the duration of the infection.

(2) The department or local health officer must ensure that the following actions are taken:

(a) instruct the case how to prevent transmitting the HIV infection to others;

(b) provide the case with information about any available services relevant to the case's health status and refer the case to appropriate services;

(d) locate each contact, counsel each contact, advise the contact to receive testing to determine the contact's HIV status, and refer the contact for appropriate services.

(3) The health care provider may perform the required actions under (2) at the discretion of the department or local health officer.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-16-1004, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-16-1004, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1998 MAR p. 2493, Eff. 9/11/98; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.504 Amebiasis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.506 Anthrax

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.507 Botulism: Infant Botulism

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.509 Brucellosis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.510 Campylobacter Enteritis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.512 Chancroid

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the ″Sexually Transmitted Infections Treatment Guidelines″ are followed.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.514 Chickenpox (varicella)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.515 Chlamydia Infection

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

(2) The local health officer must interview an individual who contracts the infection in order to determine the person's sexual contacts, and must ensure that those contacts are examined and receive the medical treatment indicated by clinical or laboratory findings.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 1998 MAR p. 2493, Eff. 9/11/98; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.516 Cholera

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.518 Colorado Tick Fever

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.519 Cryptosporidiosis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1995 MAR p. 1127, Eff. 6/30/95; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.521 Diarrheal Disease Outbreak

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): History: 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1994 MAR p. 1295, Eff. 5/13/94; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.522 Diphtheria

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.524 Encephalitis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.525 Escherichia Coli 0157:h7 Enteritis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1994 MAR p. 1295, Eff. 5/13/94; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.526 Escherichia Coli Enteritis (shiga-Toxin Producing)

(1) The local health officer or the department must ensure that a child attending day care or child care as defined in ARM 37.95.102 must be excluded from such care until diarrhea resolves and two stool specimens collected at least 24 hours apart, obtained at least 48 hours after antimicrobial therapy has been discontinued, are negative.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20.

Mont. Admin. R. 37.114.527 Gastroenteritis Outbreak

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2986, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2017 MAR p. 343, Eff. 3/25/17.

Mont. Admin. R. 37.114.528 Giardiasis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.530 Gonorrhea

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 1998 MAR p. 2493, Eff. 9/11/98; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.531 Granuloma Inguinale

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.533 Haemophilus Influenza B Invasive Disease

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.534 Hansen's Disease (leprosy)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.536 Hantavirus Pulmonary Syndrome

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1994 MAR p. 1295, Eff. 5/13/94; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.537 Hemolytic Uremic Syndrome

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1995 MAR p. 1127, Eff. 6/30/95; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.539 Hepatitis Type a

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.540 Hepatitis Type B (acute or Chronic)

(1) For a case of type B hepatitis not involving a pregnant woman, control measures outlined in Control of Communicable Diseases Manual must be applied.

(2) In the event a hepatitis B surface antigen (HbsAg) is positive in a pregnant woman, the local health officer must:

(a) ensure appropriate health care providers and the birthing facility are aware of the mother's status and the infant's need for prophylaxis;

(b) ensure that hepatitis B immunoglobulin (HBIG) and vaccine are readily available at the birthing facility at the expected time of delivery;

(c) confirm the administration of HBIG and vaccine after delivery and submit the report form provided by the department within seven days after delivery and counsel the mother and provider regarding the need for further vaccination and testing;

(d) at one to two months and again at six to seven months after delivery contact the health care provider or guardian of the infant to confirm the vaccine was given and provide an update to the department using a form provided by the department; and

(e) at nine to 15 months after delivery, confirm testing of the infant for the surface antigen and antibody to the hepatitis B virus (HBV), counsel as appropriate, and provide an update to the department using a form provided by the department.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-19-101, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-19-101, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.542 Hepatitis C (acute or Chronic)

(1) The local health officer must ensure that each case is counseled regarding prevention of transmission to others and provided with referrals to counseling and medical care as appropriate.

(2) In cases of acute Hepatitis C, the local health officer must identify, notify, and refer at-risk contacts for testing.

(3) In cases of chronic Hepatitis C, the local health officer may notify and refer at-risk contacts for testing, or encourage the case to do so.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.544 Influenza

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.546 Toxic Metals

(1) The health officer must gather information about the circumstances and nature of the exposure using forms developed by the department.

(2) The local health officer must ensure that the following actions are performed when a biological sample derived from the human body is reported that exceeds reportable toxic metal levels indicated in ARM 37.114.203(1)(e), (i), (ai), and (ar). The health officer or health-care provider must provide:

(a) counseling about the health consequences of their toxic metals exposure;

(b) information about ways to reduce or eliminate their exposure(s) to toxic metals; and

(c) referral of the case and household members potentially at risk of exposure to a health-care provider for additional follow-up and testing as appropriate.

(3) The department will provide consultation, assist with investigations, and coordinate responses in occupational and community settings at the request of the health officer.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20.

Mont. Admin. R. 37.114.548 Legionellosis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.549 Listeriosis Outbreak

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.551 Lyme Disease

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.552 Lymphogranuloma Venereum

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.554 Malaria

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.555 Measles: Rubeola

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.557 Meningitis: Bacterial or Viral

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.558 Mumps

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.559 MULTIDRUG-RESISTANT ORGANISMS (MDROs)

(1) For cases or outbreaks of Multidrug-Resistant Organisms (MDROs), control measurers outlined in the "Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs)," updated January 2019, must be applied and infection control precautions appropriate to the event must be implemented.

(2) The department will provide consultation, assist with investigations, and coordinate responses in healthcare facility and community settings at the request of the local health officer.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2019 MAR p. 1745, Eff. 1/1/20.

Mont. Admin. R. 37.114.560 Ophthalmia Neonatorum

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.561 Psittacosis

(1) For a case of Psittacosis, control measures outlined in Control of Communicable Diseases Manual must be applied.

(2) The local health officer must inquire whether a bird epidemiologically linked to a case of psittacosis was obtained from an aviary, and if so, determine the location of the aviary and report it to the Montana State Veterinarian, Department of Livestock.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.563 Pertussis

(1) Infection control precautions must be imposed upon a case of pertussis for five days after the start of antibiotic therapy, or 21 days after the date of onset of symptoms if no antibiotic therapy is given.

(2) An individual identified by the local health officer as a household contact or individual at high risk of severe illness or an individual who has close contact with a person at high risk of severe illness must be referred by the officer to a physician for chemoprophylaxis. Persons at high risk for severe illness include infants under 12 months, pregnant women, or individuals with preexisting health conditions that may be exacerbated by a pertussis infection. Other individuals identified as close contacts may be referred for chemoprophylaxis depending on the circumstances of the case or cases.

(3) An individual identified by the local health officer as a close contact must be monitored by the local health officer for respiratory symptoms for 21 days after the person's last contact with the case.

(4) If an individual identified as a close contact shows respiratory symptoms consistent with pertussis, the health officer must order the individual to avoid contact with anyone outside of the individual's immediate family until a medical evaluation indicates that the individual is not developing pertussis.

(5) Surveillance for susceptible close contacts must be initiated immediately by the local health officer and immediate immunizations recommended by the officer must be administered to identified susceptible close contacts.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.565 Plague

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.566 Poliomyelitis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.568 Q-Fever (query Fever)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.570 Rabies: Human

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.571 Rabies Exposure

(1) Control measures outlined in the Control of Communicable Diseases Manual must be applied for confirmed or suspected exposures to a human by a species susceptible to rabies infection.

(2) The local health officer must investigate each report of possible rabies exposure and gather, at a minimum, information about the circumstances of the possible rabies exposure; nature of the exposure; name, age, and address of the exposed individual; vaccination status of the animal in question; treatment of the exposed person; and eventual outcome for both animal and person involved.

(3) As soon as possible, after investigating a report of possible rabies exposure, the local health officer must inform the exposed person or the individual responsible for the exposed person if that person is a minor, whether or not treatment is recommended to prevent rabies and provide a referral to a health care provider.

(4) Whenever the circumstances involve a dog, cat, or ferret, the local health officer must:

(a) arrange for the animal to be observed for signs of illness during a ten-day observation period at an animal shelter, veterinary facility, or other adequate facility, and ensure that any illness in the animal during the confinement or before release is evaluated by a veterinarian for signs suggestive of rabies; and

(b) if the symptoms observed are consistent with rabies, order the animal euthanized and the head sent to the Department of Livestock's diagnostic laboratory in Bozeman for rabies analysis. The local health officer may also order an animal euthanized subsequent to isolation, and the brain analyzed.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20.

Mont. Admin. R. 37.114.573 Rocky Mountain Spotted Fever

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.574 Rubella

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.575 Rubella: Congenital

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.577 Salmonellosis (other Than Typhoid Fever)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.578 Severe Acute Respiratory Syndrome (sars)

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.579 Shigellosis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.581 Smallpox

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.582 Streptococcus Pneumoniae Invasive Disease, Drug Resistant

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1995 MAR p. 1127, Eff. 6/30/95; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.583 Syphilis

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

History

Authorizing statute(s): 50-1-202, 50-2-118, 50-18-105, MCA
Implementing statute(s): 50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2013 MAR p. 967, Eff. 6/7/13; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.585 Trichinosis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.586 Tuberculosis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS from DHES, 2002 MAR p. 913; REP, 2022 MAR p. 1855, Eff. 9/24/22.

Mont. Admin. R. 37.114.588 Tularemia

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.589 Typhoid Fever

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.590 Salmonella Typhi

(1) The local health officer or the department must ensure that a child attending child care in facilities defined in ARM 37.95.102 must be excluded from such care until diarrhea resolves and three stool cultures collected at least 24 hours apart, obtained at least 48 hours after antimicrobial therapy has been discontinued, are negative.

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20.

Mont. Admin. R. 37.114.591 Yellow Fever

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.592 Yersiniosis

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Mont. Admin. R. 37.114.595 Illness in Traveler from Foreign Country

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1994 MAR p. 1295, Eff. 5/13/94; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; REP, 2013 MAR p. 967, Eff. 6/7/13.

Subchapter 37.114.7 Immunization of School Children

Mont. Admin. R. 37.114.701 Definitions

The following definitions, together with the definitions contained in 20-5-402, MCA, apply throughout this subchapter:

(1) "ACIP" means the advisory committee on immunization practices of the U.S. Public Health Service.

(2) "Adequate documentation" means documentation which meets the specifications set forth in ARM 37.114.703.

(3) "CLIA" means the federal clinical laboratory improvement amendments of 1988.

(4) "Commencing attendance for the first time" means the first occasion a pupil attends any Montana school, and does not include transfers from one Montana school to another.

(5) "Department" means the Department of Public Health and Human Services.

(6) "DT vaccine" means a vaccine containing a combination of diphtheria and tetanus toxoids.

(7) "DTP vaccine" and "DTAP vaccine" mean vaccines containing diphtheria and tetanus toxoids and pertussis (whooping cough) vaccine combined.

(8) "Healthcare provider" is a person who is licensed, certified, or otherwise authorized by any U.S. state or Canada to provide health care and who meets the additional qualifying criteria specified in 20-5-405, MCA.

(9) "Hib vaccine" means a vaccine immunizing against infection by Haemophilus influenzae type B disease.

(11) "MMR vaccine" means a vaccine containing a combination of measles, mumps, and rubella vaccine.

(12) "Montana Certificate of Immunization Form (HES 101)" means the form provided by the department to consolidate immunization history. Copies of the form are electronically accessible at https://dphhs.mt.gov/publichealth/immunization/ .

(13) "MR vaccine" means a vaccine containing a combination of measles and rubella vaccine.

(14) "Official immunization record" means a standard electronic or paper record that is maintained by the department, by another state's principal health agency, or by a healthcare provider to record the immunization status of a child, and includes the following:

(a) child's legal name;

(b) birthdate;

(d) vaccination date (month, day, and year) by vaccine type, or, in the case of a postsecondary record, the month and year of vaccine administration.

(15) "Physician" is a person licensed to practice medicine in any jurisdiction in the United States or Canada and who holds a degree as a doctor of medicine or of osteopathy.

(16) "Polio vaccine" means a trivalent polio vaccine, known by the abbreviation OPV, or enhanced inactivated polio vaccine, known by the abbreviation of IPV.

(17) "Preschool" means any facility that is established chiefly for educational purposes, limits its services to children who are at least three years of age, and meets the definition of a preschool in 20-5-402, MCA.

(18) "Pupil" means a person who receives school instruction:

(a) in a preschool or kindergarten through grade 12 setting, including a foreign exchange student, regardless of the length of attendance or whether credit is received;

(b) in a home school, but only while participating in a group activity with pupils in a school otherwise subject to the requirements of Title 20, chapter 5, part 4, MCA, such as laboratories, libraries, gymnasiums, and team activities; or

(c) in a postsecondary school who is attending classes on the school's campus and who has either matriculated into a degree program or is registered for more than one-half of the full-time credit load that is normal for that school.

(19) "Td vaccine" means a vaccine containing tetanus and diphtheria toxoids.

(20) "Tdap vaccine" means a vaccine containing tetanus and diphtheria toxiods, and acellular pertussis.

(21) "Transfer" means to change school attendance, at any time, from one public school district to another, between private schools, or between public and private schools, and includes a change which occurs between the end of one school year and commencement of the next.

(22) "Vaccine" means:

(a) if administered in the United States, an immunizing agent recommended by the ACIP and approved by the Food and Drug Administration, U.S. Public Health Service; or

(b) if administered outside of the United States, an immunizing agent:

(i) administered by a person licensed to practice medicine in the country where it is administered or by an agent of the principal public health agency of that country; and

(ii) having adequate documentation.

(23) "Varicella vaccine" means a vaccine containing a live-attenuated varicella vaccine.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-402, 52-2-703, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1980 MAR p. 1699, Eff. 6/27/80; AMD, 1981 MAR p. 621, Eff. 7/1/81; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2015 MAR p. 1493, Eff. 10/1/15; AMD, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.702 General Immunization Requirements for All Schools

(1) This subchapter specifies the immunization requirements of 20-5-403, MCA.

(2) Administration of a vaccine is only acceptable if it is done in accordance with the standards and schedules for vaccine use adopted by ACIP of the U.S. Public Health Service.

(3) Half doses of vaccine are unacceptable for purposes of meeting the school immunization requirements of these rules.

(4) Vaccine doses given up to four days before the minimum interval or age are counted as valid. Live vaccines not administered at the same visit must be separated by at least four weeks.

(5) Documentation of immunity from varicella, measles, mumps, or rubella by laboratory evidence, or diagnosis/verification of disease by physician, nurse practitioner, or physician's assistant, may be used in lieu of the vaccine requirement.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-403, MCA
History: NEW, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2015 MAR p. 1493, Eff. 10/1/15.

Mont. Admin. R. 37.114.703 Requirements for Adequate Documentation of Immunization Status

(1) The following are considered adequate documentation of immunization for the purposes of this subchapter, subject to the restriction in (2):

(a) a record from any local health department in the United States, signed by a local health officer or nurse;

(b) a certificate signed by a local health officer or nurse;

(c) any official immunization record, if information has been recorded and signed or stamped by a physician, physician's designee, local health officer, or that officer's designee; or an official report from the statewide immunization information system, or a healthcare provider's medical record system;

(d) a form approved by the U.S. federal government;

(e) any state's official parent maintained immunization record;

(f) the international certificates of vaccination approved by the world health organization; or

(g) in the case of vaccine administered outside of the United States, a record of the vaccination signed by an official of the principal public health agency of the country where the vaccination occurred.

(2) Vaccine administration data may not be filled out by a parent, guardian or other person unless they are a physician, health department official or person otherwise authorized to do so by this subchapter.

(3) The following are considered adequate documentation in lieu of receiving required vaccines:

(a) the conditional enrollment form prescribed by the department;

(b) a medical exemption statement prepared in accordance with the requirements of 20-5-405, MCA;

(d) documentation of immunity from varicella, measles, mumps, or rubella by laboratory evidence or diagnosis/verification of disease by physician, nurse practitioner, or physician's assistant. The tests must indicate serological evidence of immunity and must be performed by a CLIA-approved lab. A copy of the test results must be attached to the pupil's official immunization record.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-402, MCA
History: NEW, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2015 MAR p. 1493, Eff. 10/1/15; AMD, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.704 Requirements for Attendance at a Preschool

(1) Before a prospective pupil may attend a Montana preschool, that school must be provided with adequate documentation that the prospective pupil has been immunized in accordance with the following standards:

(a) the prospective pupil must have received three doses of polio vaccine and four doses of DTP/DTaP vaccine or DT vaccine, subject to the requirement that DT vaccine administered to children is acceptable only if accompanied by a medical exemption for that prospective pupil from pertussis vaccination;

(b) the prospective pupil must receive one dose of MMR vaccine, administered no earlier than 12 months of age;

(c) one dose of Hib vaccine must be administered on or after the first birthday, unless the prospective pupil is older than 59 months of age; and

(d) the prospective pupil must have received one dose of varicella vaccine, administered no earlier than 12 months of age.

(2) If a prospective pupil is not vaccinated with all of the vaccines required in (1), the prospective pupil may be admitted conditionally in accordance with the requirements of ARM 37.114.710.

(3) A preschool must keep immunization data for each enrolled pupil, including the date, month, and year of administration of all required vaccines. The HES 101 may be used for this purpose, but is not mandatory.

(4) If a religious or medical exemption is claimed, the preschool must maintain the record of that exemption in accord with the requirements of ARM 37.114.715 or 37.114.716, whichever applies.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-403, 20-5-406, MCA
History: NEW, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2015 MAR p. 1493, Eff. 10/1/15; AMD, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.705 Requirements for Unconditional Attendance at a School Offering Any Portion of Grades Kindergarten Through 12

(1) Before a prospective pupil may unconditionally attend a Montana school offering any portion of kindergarten through grade 12, that school must be provided with adequate documentation that the prospective pupil has been immunized through administration of the vaccines and on the schedules specified in this rule.

(2) Vaccines immunizing against diphtheria, pertussis, and tetanus must be administered as follows:

(a) A pupil or prospective pupil less than seven years of age must be administered four or more doses of DTP or DTAP vaccine, at least one dose of which must be given after the fourth birthday;

(b) A pupil or prospective pupil seven years old or older who has not completed the requirement in (2)(a) must receive additional doses of Tdap vaccine or Td vaccine to become current in accordance with the ACIP schedule;

(i) the pupil is 11 years of age or older; or

(ii) a dose of Tdap vaccine was not given to the pupil at ten years of age or older;

(d) If a pupil enters the seventh grade before reaching 11 years of age, a booster shot of Tdap vaccine must be administered to the pupil as soon as possible after the pupil attains that age, unless the pupil already was administered a dose of Tdap vaccine at ten years of age or older.

(3) Polio vaccine must be administered to a prospective pupil in three or more doses of trivalent poliomyelitis vaccine, at least one dose of which must be given after the fourth birthday.

(4) A pupil or prospective pupil must have received two doses of live measles, mumps, and rubella vaccine no earlier than 12 months of age.

(5) A pupil or prospective pupil must have received two doses of live varicella vaccine no earlier than 12 months of age.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-403, 20-5-405, 20-5-406, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1980 MAR p. 1699, Eff. 6/27/80; AMD, 1981 MAR p. 621, Eff. 7/1/81; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2015 MAR p. 1493, Eff. 10/1/15; AMD, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.708 Documentation of Immunization Status of Persons Commencing Attendance in Preschool or Kindergarten Through Grade 12

(1) After receiving the documentation set forth in ARM 37.114.703, a school must obtain and keep the following immunization data for each pupil:

(a) legal name;

(b) birthdate;

(d) the vaccination date (month, day and year) of each vaccine administered.

(2) HES 101 may be accepted by the school without reference to other adequate documentation if:

(a) sections I and II are completed and signed by a physician, local health department official, the designee of either, or the form is directly obtained from the immunization information system; and

(b) the pupil claims no exemptions.

(3) If the information required by (1) has not been provided to the school on HES 101:

(a) immunization data may be transferred onto HES 101 from adequate documentation; and

(b) a copy of the adequate documentation must be attached to the official immunization record.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-406, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2015 MAR p. 1493, Eff. 10/1/15; AMD, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.709 Requirements for Unconditional Attendance at a Postsecondary School

(1) Before a prospective pupil may enter a Montana postsecondary school, the prospective pupil must provide the school with the proof of measles (rubeola) and rubella immunity as specified in (2) or (3), whichever is applicable.

(2) If a prospective pupil was born in 1957 or later, the school must receive either:

(a) adequate documentation that:

(i) the prospective pupil was administered two doses of live MMR or MR vaccine, or any equivalent combination of measles and rubella vaccines, subject to the restrictions in ARM 37.114.712(2); and

(ii) dose one was administered at or after 12 months of age, and dose two was administered at least 28 days after dose one; or

(b) a CLIA approved laboratory report that meets the requirements of ARM 37.114.712(2) and indicates the prospective pupil is immune to measles and rubella.

(3) If a prospective pupil was born prior to 1957, the school must receive either:

(a) one of the forms of proof of measles and rubella immunity cited in (2); or

(b) the evidence of date of birth before January 1, 1957, required by ARM 37.114.712(2).

(4) In the event of an outbreak of either measles or rubella, a pupil must provide the documentation required by either (2)(a) or (b) or be excluded from classes and other school sponsored activities until the local health officer indicates to the school that the outbreak is over. If the laboratory documentation required by (2)(b) is provided, the laboratory report need only show immunity to whichever of the two diseases is the cause of the outbreak.

(5) The school must maintain a list of pupils who were born prior to 1957 and who provide the school only with the documentation specified in (3)(b). In the event of an outbreak of measles or rubella, the school must exclude those pupils as required by (4).

(6) A pupil who enters a postsecondary school may be conditionally enrolled as allowed by ARM 37.114.711 if that pupil has received only one dose of MMR or MR, but must have received the second dose before being eligible to attend during the next school term.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-403, 20-5-406, MCA
History: NEW, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05.

Mont. Admin. R. 37.114.710 Requirements for Conditional Enrollment in a Preschool or a School Offering Any Portion of Kindergarten Through Grade 12

(1) A prospective pupil who does not meet school immunization entry requirements for a preschool or a school offering any portion of kindergarten through grade 12 may be admitted to school under the following conditions:

(a) A physician or local health department must indicate on the department's conditional attendance form that immunization of the prospective pupil has already been initiated by the prospective pupil receiving, at a minimum, one dose of each of the vaccines required in ARM 37.114.705. If a prospective pupil is exempt from any of the foregoing vaccinations, the requirements of this rule apply to the remaining immunizations for which no exemption exists.

(b) The conditional attendance form must include the date each dose of the required vaccines are to be administered, the signature of the physician, the physician's designee or the school or public health official who established the foregoing immunization schedule, and the signature of a parent or guardian acknowledging the immunization schedule; and

(2) The conditional attendance form prescribed by the department must be used to document conditional attendance status and must be retained in the pupil's school record.

(3) If the pupil who is attending school conditionally fails to receive vaccines on the date they are due, as stated on the conditional exemption form, the pupil must:

(a) be vaccinated;

(b) qualify for and claim an exemption from the immunizations not received and documented; or

(4) A pupil who is excluded from school due to failure to meet the requirements of the conditional exemption may return to school only after the school receives the required documentation that the pupil has been administered the vaccines that were due according to the immunization schedule on the conditional form. If additional immunizations are still required, a physician, physician's designee or the school or public health official must reestablish the schedule as stated in (1)(b).

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-402, 20-5-404, 20-5-405, 20-5-408, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1980 MAR p. 1699, Eff. 6/27/80; AMD, 1981 MAR p. 621, Eff. 7/1/81; AMD, 1981 MAR p. 1788, Eff. 12/18/81; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05.

Mont. Admin. R. 37.114.711 Requirements for Conditional Enrollment in a Postsecondary School

(1) A prospective pupil who has not received two doses of live measles (rubeola) and rubella vaccine or provided the school with the alternative documentation allowed by ARM 37.114.709(2) may be admitted to postsecondary school under the following conditions:

(a) the prospective pupil must receive a second dose of live measles and rubella vaccine before the beginning of the succeeding school term and no earlier than 28 days after administration of the first dose of measles and rubella vaccine; and

(b) the conditional enrollment form must be signed by the prospective pupil, acknowledging the measles and rubella immunization schedule and deadline date for compliance.

(2) If the pupil attending school conditionally fails to complete measles and rubella immunization within the time period indicated in (1)(a), the pupil must either qualify for and claim an exemption from measles and rubella immunization or be excluded immediately from school by the school administrator or that person's designee.

(3) A pupil excluded from school due to failure to receive the second dose of measles and rubella vaccine by the deadline specified in (1)(a) may continue school only after the pupil has received a second dose of measles and rubella vaccine or claims an exemption from immunization.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-402, 20-5-404, 20-5-405, 20-5-408, MCA
History: NEW, 2005 MAR p. 1074, Eff. 7/1/05.

Mont. Admin. R. 37.114.712 Documentation of Immunization Status of Persons Commencing Attendance in a Postsecondary School

(1) Postsecondary schools must keep immunization data for each pupil either on HES 101 or on another document that includes, at a minimum:

(a) the pupil's name and birth date;

(b) the vaccination dose type administered to the pupil; and

(c) the month, day, and year each dose was administered, unless only the month and year of administration are known, in which case the administration date will be considered to be the first day of that month.

(2) Documentation of the proof of measles and rubella immunity required by ARM 37.114.709 must meet the following standards:

(a) there must be adequate documentation of the doses required by ARM 37.114.709, subject to the following restrictions:

(i) no measles vaccination given before 1967 is valid; and

(ii) no rubella vaccination given before 1969 is valid;

(b) if the pupil was born prior to January 1, 1957, proof of age must be made through a driver's license, school transcript, birth certificate, or passport, as long as the date of birth is indicated on the document;

(i) indicate that the person is immune to either measles and rubella;

(ii) specify the type of test performed and the test date; and

(iii) include a determination from the clinician interpreting the laboratory results.

(3) The documentation of immunization status must be kept on file with the immunization records required by (1).

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-406, MCA
History: NEW, 2005 MAR p. 1074, Eff. 7/1/05.

Mont. Admin. R. 37.114.715 Medical Exemption

(1) A prospective pupil seeking to attend school is not required to have any immunizations which are medically contraindicated. A medical exemption statement prepared and signed in accordance with the requirements of 20-5-405, MCA, will exempt a prospective pupil from those immunization requirements specified in the exemption.

(2) It is preferred, but not mandatory, that the medical exemption be recorded on the HES 101A "Medical Exemption Statement" form provided by the department.

(3) The medical exemption statement must be maintained by the school as part of the immunization record of the pupil qualifying for the exemption. In preschool and kindergarten through grade 12 settings, the medical exemption statement must be attached to the official immunization record.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-405, 20-5-406, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.716 Religious Exemption

(1) A prospective pupil seeking to attend school is exempt from those immunization requirements specified in a religious exemption that is prepared and signed in accordance with the requirements of 20-5-405, MCA. The religious exemption must be prepared using form HES 113 "Affidavit of Exemption on Religious Grounds from Montana School Immunization Law and Rules" provided by the department.

(2) The form must be provided to the school prior to attendance by the pupil.

(3) The original copy of the claim of religious exemption must be kept by the school as part of the pupil's school record.

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-405, 20-5-406, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1980 MAR p. 1699, Eff. 6/27/80; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; AMD, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.720 Report of Immunization Status

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-408, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1981 MAR p. 621, Eff. 7/1/81; AMD, 1982 MAR p. 1936, Eff. 10/29/82; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; REP, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.721 Report of Noncompliance for Kindergarten Through Grade 12

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-408, MCA
History: NEW, 1981 MAR p. 620, Eff. 7/1/81; AMD, 1981 MAR p. 1788, Eff. 12/18/81; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; AMD, 2005 MAR p. 1074, Eff. 7/1/05; REP, 2021 MAR p. 1328, Eff. 10/9/21.

Mont. Admin. R. 37.114.799 Documentation of Immunization Status of Persons Commencing Attendance for the First Time Prior to August 1, 1980, at a School Offering Any Portion of Grades Kindergarten Through 12

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 20-5-407, MCA
Implementing statute(s): 20-5-406, MCA
History: NEW, 1980 MAR p. 1265, Eff. 8/2/80; AMD, 1980 MAR p. 1699, Eff. 6/27/80; AMD, 1983 MAR p. 852, Eff. 7/15/83; AMD, 1993 MAR p. 1214, Eff. 6/11/93; TRANS, from DHES, 2002 MAR p. 913; REP, 2002 MAR p. 1511, Eff. 5/17/02.

Subchapter 37.114.10 Tuberculosis Control

Mont. Admin. R. 37.114.1001 Tuberculosis Diagnosis

(1) A case of active tuberculosis disease exists if the case meets the laboratory or clinical criteria in (2) or (3).

(2) Laboratory criteria for active tuberculosis diagnosis:

(a) isolation of M. tuberculosis complex from a clinical specimen;

(b) demonstration of M. tuberculosis complex from a clinical specimen by nucleic acid amplification test; or

(c) demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be obtained or is falsely negative or contaminated.

(3) Clinical criteria for active tuberculosis diagnosis:

(a) usually a positive tuberculin skin test result or positive interferon gamma release assay for M. tuberculosis;

(b) other signs and symptoms compatible with tuberculosis are for example: abnormal chest radiograph, abnormal chest computerized tomography scan or other chest imaging study, or clinical evidence of current disease;

(d) a completed diagnostic evaluation.

(4) A case of latent tuberculosis infection exists if the case meets the laboratory and clinical criteria in (5) and (6).

(5) Laboratory criteria for latent tuberculosis infection:

(a) a positive tuberculin skin test (TST); or

(b) a positive interferon gamma release assay (IGRA).

(6) Clinical criteria for latent tuberculosis infection:

(a) no clinical evidence compatible with TB disease including no signs or symptoms consistent with TB disease; and

(b) chest imaging without abnormalities consistent with TB disease (chest radiograph or CT scan); or

(c) abnormal chest imaging that could be consistent with TB disease with microbiologic testing that is negative for abnormal chest imaging that could be consistent with TB disease with microbiologic testing that is negative for Mycobacterium Tuberculosis Complex and where TB disease has been clinically ruled out.

History

Authorizing statute(s): 50-1-202, 50-17-103, 50-17-105, MCA
Implementing statute(s): 50-1-202, 50-17-103, 50-17-105, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20.

Mont. Admin. R. 37.114.1002 Tuberculosis: Active Disease

(1) A person will be considered to have active tuberculosis until either the diagnosis of active tuberculosis is ruled out or adequate treatment is completed as determined by the local health officer or the department.

(2) When a person with active tuberculosis is an in-patient at a healthcare facility, either for diagnosis, acute care, or long-term care, the facility must notify the local health officer or department before the patient is discharged from their facility.

History

Authorizing statute(s): 50-1-202, 50-17-103, MCA
Implementing statute(s): 50-1-202, 50-17-103, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2017 MAR p. 343, Eff. 3/25/17.

Mont. Admin. R. 37.114.1005 Isolation of Case Testing and Quarantine of Contacts

(1) Isolation must be imposed upon a case of active tuberculosis until the patient is considered not able to transmit tuberculosis as determined by the local health officer and the department's tuberculosis program.

(2) The local health officer or department's tuberculosis program may require contacts of a case to be tested for tuberculosis infection and disease.

(3) No quarantine of contacts is required unless the contact is symptomatic for active tuberculosis disease and has not completed a diagnostic evaluation to rule out active tuberculosis disease.

History

Authorizing statute(s): 50-1-202, 50-1-204, 50-2-118, 50-17-103, MCA
Implementing statute(s): 50-1-202, 50-1-204, 50-2-118, 50-17-102, 50-17-103, 50-17-105, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 2000 MAR p. 2528, Eff. 9/22/00; TRANS, from DHES, 2002 MAR p. 913; AMD, 2006 MAR p. 2112, Eff. 9/8/06; AMD, 2017 MAR p. 343, Eff. 3/25/17.

Mont. Admin. R. 37.114.1006 Treatment Standards

(1) Treatment of drug-susceptible active tuberculosis must be consistent with the standards contained in the Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, published in Clinical Infectious Diseases, October 1, 2016.

(2) For patients with multi-drug resistant tuberculosis or other findings beyond the scope of the above guidelines in (1), the opinion of a tuberculosis expert physician with experience in treating drug-resistant or medically complicated tuberculosis will be sought and approved by the local health officer and the department's tuberculosis program.

(3) A person with active tuberculosis will be treated using directly observed therapy (DOT) until treatment is completed. The DOT plan will be approved by the local health officer and the department's tuberculosis program.

History

Authorizing statute(s): This rule is advisory only, but may be a correct interpretation of the law. 50-1-202, 50-17-103, MCA
Implementing statute(s): 50-17-102, 50-17-105, 50-17-107, 50-17-108, 50-17-112, 50-17-113, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2017 MAR p. 343, Eff. 3/25/17.

Mont. Admin. R. 37.114.1010 Employee of School: Day Care Facility Care Provider

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-1-202, 50-17-103, 52-2-735, MCA
Implementing statute(s): 50-1-202, 50-17-103, 52-2-735, MCA
History: NEW, 1980 MAR p. 1579, Eff. 6/13/80; AMD, 1981 MAR p. 1060, Eff. 9/18/81; AMD, 1987 MAR p. 2147, Eff. 11/28/87; AMD, 1992 MAR p. 2744, Eff. 12/25/92; AMD, 1994 MAR p. 2305, Eff. 8/12/94; TRANS, from DHES, 2002 MAR p. 913; REP, 2017 MAR p. 343, Eff. 3/25/17.

Mont. Admin. R. 37.114.1015 Case Follow-Up, Reporting, and Contact Investigation

(1) The local health officer must ensure that each case of active tuberculosis within their jurisdiction obtains the follow-up tests, treatment, and monitoring recommended in the Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, published in Clinical Infectious Diseases, October 1, 2016.

(2) The local health officer must submit a report to the department every month documenting the course of treatment and treatment completion date of each reported active tuberculosis case.

(3) The local health officer must ensure that a contact investigation is completed for each active case of tuberculosis considered able to transmit tuberculosis, following the "Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis," December 16, 2005, a publication from the National Tuberculosis Controllers Association and the U.S. Centers for Disease Control and Prevention.

(4) The local health officer must submit reports to the department documenting the progress of the contact investigation and a final summary on forms provided by the department.

(5) A case of latent tuberculosis must be referred to a health-care provider to rule out active TB disease. Once active TB disease has been ruled out, the individual should be:

(a) educated on risks of conversion to active TB disease; and

(b) referred for treatment for latent tuberculosis infection.

(6) Local health officers must ensure that a latent tuberculosis infection report form, provided by the department, is completed and submitted.

History

Authorizing statute(s): 50-1-202, 50-17-103, MCA
Implementing statute(s): 50-1-202, 50-17-102, 50-17-105, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2019 MAR p. 1745, Eff. 1/1/20.

Mont. Admin. R. 37.114.1016 Submission of a Specimen or Culture

(1) Whenever a physician diagnoses a case of tuberculosis, they must ensure that a specimen or culture from the tuberculosis case is sent to the department's public health laboratory, Montana Public Health Laboratory (MTPHL), for confirmation of the results, drug susceptibility testing, and genotyping.

(2) Whenever a laboratory finds a specimen or culture is positive for M. tuberculosis, the laboratory must submit the specimen or culture to the department's public health laboratory, MTPHL, for confirmation of the results, drug susceptibility testing, and genotyping.

(3) The department may utilize a standing order issued by the state medical officer to request that one or more nucleic acid amplification tests (NAAT) be performed at MTPHL for tuberculosis detection and public health disease control, if:

(a) one or more specimens are sent to MTPHL for smear testing without a NAAT being ordered;

(b) suspicion of tuberculosis exists; and

(4) Whenever the state medical officer standing order is used to order NAAT testing at MTPHL, the department must notify the original ordering provider as soon as practical and the department will cover the cost of this testing.

History

Authorizing statute(s): 50-1-202, 50-17-103, MCA
Implementing statute(s): 50-1-202, 50-17-102, 50-17-103, MCA
History: NEW, 1987 MAR p. 2147, Eff. 11/28/87; TRANS, from DHES, 2002 MAR p. 913; AMD, 2017 MAR p. 343, Eff. 3/25/17; AMD, 2026 MAR, Notice No. 2026-442, Eff. 9/26/26.

Chapter 37.115 Pools, Spas, and Other Water Features

Subchapter 37.115.1 Purpose, Applicability, and Incorporation by Reference

Mont. Admin. R. 37.115.101 Purpose and Applicability

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Mont. Admin. R. 37.115.102 Purpose

(1) The intent of this chapter is to help assure a safe and sanitary environment in and around public swimming pools.

(2) This chapter defines public swimming pools; establishes minimum standards for the construction, maintenance, and operation of public swimming pools; and provides for the enforcement of this chapter.

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-103, MCA
History: NEW, 2018 MAR p. 2216, Eff. 1/1/19.

Mont. Admin. R. 37.115.103 Applicability

(1) New and existing public swimming pools must conform to the provisions of this code, and any other standard and code referenced herein, except as specified in FCS 3-2018, Chapter 14, Grandfather Clause, or elsewhere in this chapter.

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 53-103, MCA
History: NEW, 2018 MAR p. 2216, Eff. 1/1/19.

Mont. Admin. R. 37.115.104 Required Upgrading to Existing Facilities and Operations

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Mont. Admin. R. 37.115.105 Definitions

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Mont. Admin. R. 37.115.106 Incorporation by Reference

(1) The department, except as otherwise provided, adopts and incorporates by reference the following chapters of the International Swimming Pool and Spa Code (ISPSC), 2021, which sets forth design, construction, alteration, repair, and maintenance standards for public swimming pools. This publication may be obtained by contacting the International Code Council, 3060 Saturn Street, Suite 100, Brea, California 92821. The following chapters of this publication are being adopted with modifications as described:

(a) Chapter 1: Scope and Administration. This chapter has been deleted in its entirety.

(b) Chapter 2: Definitions. This chapter is adopted with the following modifications:

(i) the following definitions are excluded from chapter 2:

(A) Code Official;

(B) Pool;

(D) Residential Swimming Pool.

(ii) The following definitions are modified in chapter 2:

(A) Public Swimming Pool – is modified to include 50-53-102(7)(a), MCA, for the purposes of department licensing and other administrative functions.

(B) Spa – is modified to include 50-53-102(8), MCA, for the purposes of department licensing and other administrative functions.

(i) Sub-Section 305.1 – is modified to read as follows, "The provisions of this section shall apply to the design of barriers for restricting entry into areas having pools and spas."

(d) Chapter 4: Public Swimming Pools. This chapter has been adopted with no changes.

(e) Chapter 5: Public Spas and Public Exercise Spas. This chapter has been modified with these changes:

(i) Section 509.2 is deleted in its entirety.

(f) Chapter 6: Aquatic Recreation Facilities. This chapter has been modified with the following changes:

(i) Section 611 is deleted in its entirety.

(g) Chapter 7: Onground Storable Residential Swimming Pools. This chapter has been deleted in its entirety.

(h) Chapter 8: Permanent Inground Residential Swimming Pools. This chapter has been deleted in its entirety.

(i) Chapter 9: Permanent Residential Spas and Permanent Residential Exercise Spas. This chapter has been deleted in its entirety.

(j) Chapter 10: Portable Residential Spas and Portable Residential Exercise Spas. This chapter has been deleted in its entirety.

(2) The department adopts and incorporates by reference the American National Standard for Suction Entrapment Avoidance in Swimming Pools, Wading Pools, Spas, Hot Tubs, and Catch Basins (ANSI/PHTA/ICC 7 – 2020), which sets forth design and performance criteria for circulation systems including components, devices, and related technology installed to protect against entrapment hazards in public swimming pools. This publication may be obtained by contacting The Association of Pool and Spa Professionals, 2111 Eisenhower Ave., Alexandria, VA 22314.

(3) The department adopts and incorporates by reference the provisions in Circular FCS 3-2022. Circular FCS 3-2022 may be obtained by calling 406-444-2837 to request a copy; or email hhsfcs@mt.gov, or request one by mail by writing to DPHHS – FCS, P.O. Box 202951, Helena, MT 59620-2951, or by visiting the department's web site at: https://dphhs.mt.gov/publichealth/FCSS/SwimmingPools .

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-103, MCA
History: NEW, 2018 MAR p. 2216, Eff. 1/1/19; AMD, 2020 MAR p. 913, Eff. 5/16/20; AMD, 2023 MAR p. 179, Eff. 2/25/23.

Subchapter 37.115.2 Engineering Standards

Mont. Admin. R. 37.115.201 Adoption of Ansi/Nspi Standards

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-103, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA IMP, 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
Implementing statute(s): 2010 MAR p. 80, Eff. 1/15/10
History: AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Subchapter 37.115.11 Operator Qualifications

Mont. Admin. R. 37.115.1101 Operator Qualifications

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Mont. Admin. R. 37.115.1103 Record Keeping

Publisher status: INEFFECTIVE (not currently effective).

(REPEALED)

History

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; AMD, 2011 MAR p. 2657, Eff. 12/9/11; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-101, 50-53-102, 50-53-103, 50-53-104, 50-53-106, 50-53-107, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 50-53-206, 50-53-207, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103,MCA
Implementing statute(s): 50-53-104, 50-53-109, 50-53-216, 50-53-217, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Authorizing statute(s): 50-53-103, MCA
Implementing statute(s): 2-4-614, 3-5-604, MCA
History: NEW, 2010 MAR p. 80, Eff. 1/15/10; REP, 2018 MAR p. 2216, Eff. 1/1/19.

Chapter 37.116 Dead Human Bodies

Subchapter 37.116.1 Embalming and Transportation

Mont. Admin. R. 37.116.101 Definitions

For the purpose of this chapter, the following definitions apply:

(1) "Alternative container" means any receptacle or enclosure which:

(a) is of sufficient strength to be used to hold and to transport a dead human body;

(b) is able to be closed to provide a complete covering for the human remains;

(d) minimizes the exchange of air between the inside and outside of the container; and

(e) is able to provide protection for the health and safety of persons handling the container.

(2) "Common carrier" means a person or organization that offers to the public, transportation of people and/or materials for compensation, including railroads, airlines, or other public transportation.

(3) "Coroner" means a county coroner elected or appointed pursuant to 7-4-2203 , MCA.

(4) "Department" means the department of public health and human services.

(5) "Destination" means a cemetery, crematorium, or other place of ultimate disposition of a dead human body.

(6) "Embalming" means the preservation and disinfection of the dead human body by application of chemicals, externally, internally, or both.

(7) "Health care facility" has the meaning provided in 50-16-1003 , MCA.

(8) "Health care provider" has the meaning provided in 50-16-1003 , MCA, including but not limited to a physician, nurse, or emergency medical technician.

(9) "Infectious disease" means any of the following:

(a) meningococcal meningitis;

(b) communicable pulmonary tuberculosis;

(d) hepatitis B, C, or D; and

(e) any disease attributed to a specific bacterial, parasitic, or other agent recognized by the Control of Communicable Diseases Manual as transmitted person to person by an aerosol or by contact with infectious blood or body fluids. The department hereby adopts and incorporates by reference the Control of Communicable Diseases Manual published by American Public Health Association, 16th edition, 1995, which specifies the modes of transmission for communicable diseases. The portions of the manual that will be used are those identifying the diseases transmittable by the foregoing means. A copy of the manual may be obtained from the American Public Health Association, 1015 15th Street, NW, Washington, DC 20005.

(10) "Local health officer" means a county, city, city-county, or district health officer appointed by a local board of health or the board of a multijurisdictional service district formed pursuant to Title 7, chapter 11, part 11, MCA, to provide health services.

(11) "Mortuary" means a facility licensed pursuant to Title 37, chapter 19, MCA.

(12) "Private conveyer" means any entity other than a common carrier that transports a dead human body, including but not limited to, a mortuary or an ambulance service.

(13) "Transport" means to carry a dead human body from one location to another.

History

Authorizing statute(s): Sec. 50-1-202, 50-16-701 and 50-16-705, MCA
Implementing statute(s): Sec. 50-1-202, 50-16-701 and 50-16-705, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS & AMD, from DHES, 1999 MAR p. 345, Eff. 2/26/99.

Mont. Admin. R. 37.116.102 Death of a Person with an Infectious Disease and Notification of Mortuary

(1) When a person dies, the person's health care provider, the local coroner who certifies the death, or, if the death occurs in a health care facility, a facility staff member designated by the facility must notify the mortuary receiving the person's body, at the time of transfer of the body to the mortuary or as soon after transfer as possible, whether or not the person had or was suspected of having an infectious disease at the time of death. If the person did have or was suspected of having an infectious disease, the notice must also include what infectious disease the deceased individual had at the time of death and the nature of the disease. A sample form is available from the department's communicable disease control and prevention bureau, which may be used to provide the notice in writing to a mortuary.

(2) If a person has or is suspected by the person's health care provider or the coroner of having an infectious disease at the time of death, the local health officer, immediately after receiving notification of the infectious disease, must inform the mortician or any other person handling the body (before or after death) of that fact and of the appropriate measures which should be taken to prevent transmission.

(3) As soon as reasonably possible following death or the conclusion of further examination required to determine the cause of death, the body of a person who had or is suspected by the person's health care provider, the coroner, or the local health officer of having a viral hemorrhagic fever (lassa, ebola, Marburg, Congo-Crimean) or any other undiagnosable febrile disease occurring shortly after returning from international travel must be placed in a hermetically sealed bag or alternative container, handled only to the extent necessary, and either cremated subject to the restriction in 37-19-705 (2) , MCA, or buried immediately, unless an exception is granted pursuant to ARM 37.116.105

(4) Whether or not the mortuary receives notice that a deceased person had an infectious disease, blood and body fluid precautions as defined in ARM 37.114.101 must be taken by the mortuary staff in order to prevent transmission of any potential infectious disease to mortuary personnel.

(5) The definitions in ARM 37.114.101 apply to this chapter. A copy of ARM 37.114.101 may be obtained from the Department of Public Health and Human Services, Health Policy and Services Division, Communicable Disease Control and Prevention Bureau, Cogswell Building, P.O. Box 202951, Helena, MT 59620-2951.

History

Authorizing statute(s): Sec. 50-1-202, 50-16-701 and 50-16-705, MCA
Implementing statute(s): Sec. 50-1-202, 50-16-705 and 50-16-712, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1987 MAR p. 2147, Eff. 11/28/87; TRANS & AMD, from DHES, 1999 MAR p. 345, Eff. 2/26/99.

Mont. Admin. R. 37.116.103 Transportation of Dead Human Bodies

(1) The body of a person who died or is suspected by the person's health care provider, the coroner, or the local health officer of dying with a disease listed in ARM 37.116.102(3) may not be transported unless enclosed in a hermetically sealed casket or alternative container and the plans for transporting the container are approved by the local health officer.

(2) The body of a person who, at the time of death, did not have a disease listed in ARM 37.116.102(3):

(a) when removed from the place of death to a mortuary, must be transported by removal cot, transport stretcher or alternative container;

(b) must be placed in a casket or alternative container in order to be transported by common carrier. If such body is en route more than eight hours, or if the termination of common carrier transport occurs more than 36 hours after the time of death, the body must be either embalmed or refrigerated at 35° F or colder, so as to prevent or substantially retard decomposition and the resultant effluents and odors;

(c) when being transported by a private conveyer and the body will not reach its destination within 48 hours after the time of death, must be either embalmed or refrigerated at 35° F or colder, so as to prevent or substantially retard decomposition and the resultant effluents and odors.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; AMD, 1995 MAR p. 850, Eff. 5/12/95; TRANS & AMD, from DHES, 1999 MAR p. 345, Eff. 2/26/99.

Mont. Admin. R. 37.116.104 Prohibitions

(1) A disinterred human body of a person who died with a disease listed in ARM 37.116.102(3) may not be accepted for transportation by a common carrier or private conveyer unless the remains are enclosed in an alternative container approved by the local health officer or the department's director or designee.

History

Authorizing statute(s): Sec. 50-1-202, MCA
Implementing statute(s): Sec. 50-1-202, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS & AMD, from DHES, 1999 MAR p. 345, Eff. 2/26/99.

Mont. Admin. R. 37.116.105 Exceptions

(1) The department or a local health officer may grant an exception to the provisions of:

(a) ARM 37.116.103(2) or 37.116.104(1) if such exception is requested prior to transportation of the dead human body and if such exception does not constitute a hazard to public health, create a public nuisance, or violate the provisions of Title 50, chapter 15, part 4, MCA;

(b) the requirement of ARM 37.116.102(3) for immediate cremation or burial if special circumstances exist that ensure protection against exposure to the disease in question.

History

Authorizing statute(s): 50-1-202, MCA
Implementing statute(s): 50-1-202, MCA
History: NEW, 1980 MAR p. 1587, Eff. 6/13/80; TRANS & AMD, from DHES, 1999 MAR p. 345, Eff. 2/26/99.

Chapter 37.117 Tobacco Settlement Accounts

Subchapter 37.117.1 Purposes and Uses

Mont. Admin. R. 37.117.101 Tobacco Settlement Accounts: Purposes and Uses

(1) The department will design and implement programs to prevent tobacco-related disease.

(2) The program will include, but will not be limited to, the following components: state and community interventions; health communication interventions; cessation interventions; surveillance and evaluation; and administration and management.

(3) The department will use national guidelines, including tobacco use prevention and control standards established by the Centers for Disease Control and Prevention in developing and implementing the statewide program.

(4) The department will use other evidence-based policies, interventions, and enforcement activities in the design and implementation of the program.

(5) The department will use the national guidelines and other evidence-based recommendations in the development of community interventions implemented by local and tribal health departments.

(6) The department will coordinate and work with other state agencies to implement tobacco disease prevention interventions, policies, and enforcement activities.

History

Authorizing statute(s): 17-6-606, MCA
Implementing statute(s): 17-6-606, MCA
History: NEW, 2012 MAR p. 1149, Eff. 6/8/12.

Chapter 37.118 Newborn Safety Devices

Subchapter 37.118.1 Grants

Mont. Admin. R. 37.118.101 General Requirements

(1) Newborn safety device grants, as provided for under 40-6-408, MCA, are available to eligible fire departments, hospitals, and law enforcement agencies for the installation and maintenance of newborn safety devices as defined under 40-6-402, MCA.

(2) The total amount of any grant awarded may not exceed $20,000 per eligible applicant.

(3) The total amount of grant funds awarded will not exceed the $160,000 total amount of available grant funding.

(4) The priority period to submit grant applications opens July 13, 2026, and closes September 11, 2026. Applications may continue to be submitted after the priority period and will be considered on a rolling basis until March 31, 2027, or when the grant funds become fully depleted, whichever occurs earlier.

(5) Requests for grant funding must be submitted by completing the department’s Newborn Safety Device Grant Application form (version 1.0) available at: https://dphhs.mt.gov/publichealth/EMSTS/index. The department adopts and incorporates this form by reference.

History

Authorizing statute(s): 40-6-408, MCA
Implementing statute(s): 40-6-408, MCA
History: NEW, 2026 MAR, Notice No. 2026-315, Eff. 7/11/26.

Mont. Admin. R. 37.118.102 Grant Review and Evaluation

(1) Upon receipt of a grant application, the department will review the application to determine whether it meets the requirements under 40-6-402, MCA. The department will score the application based on the following criteria:

(a) Demonstrated public need and community support (30 points). The extent to which the applicant demonstrates a need for the newborn safety device and support in their community for the proposed devices. This will be based on factors such as:

(i) Distance to the nearest existing newborn safety device or hospital.

(ii) Community backing such as a letter of support from a political subdivision, governing body, and/or a community-based organization.

(b) Applicant readiness and long-term project success (50 points). The applicant’s demonstrated ability to successfully install, maintain, and monitor the newborn safety device. This includes:

(i) Demonstrating that the location of the proposed device will be staffed 24 hours a day, 365 days a year, except when responding to an emergency call.

(ii) Documentation of a plan for device security, regular operational checks, and immediate response protocols.

(c) Cost-Effectiveness (20 points). The reasonableness of the proposed budget for the installation of the newborn safety device and plan for future maintenance costs beyond the grant period.

(2) Following review and scoring of an application, the department will, within 30 days, provide written notice to the applicant of its decision approving or denying the grant funding. For approved applications, written notice will include instructions on how to submit required documents and any special conditions that must be met or resolved by the grantee prior to payment.

(3) Incomplete or untimely applications will be returned to the applicant.

History

Authorizing statute(s): 40-6-408, MCA
Implementing statute(s): 40-6-408, MCA
History: NEW, 2026 MAR, Notice No. 2026-315, Eff. 7/11/26.

Mont. Admin. R. 37.118.103 Grant Recipient Awardee Requirements

(1) Fifty percent (50%) of the total award will be provided to successful grantees upon award of the grant. The other 50% will be awarded when the grantee provides the department with a copy of the signed agreement with the vendor supplying the newborn safety device. The signed agreement must be submitted no later than May 15, 2027.

(2) By June 1, 2027, each applicant awarded grant funds must submit a report to the department that includes:

(a) the number of newborns surrendered via the newborn safety device;

(b) the date and time that each newborn was placed in the newborn safety device;

(d) any other information specified by the department in the notice of grant award.

History

Authorizing statute(s): 40-6-408, MCA
Implementing statute(s): 40-6-408, MCA
History: NEW, 2026 MAR, Notice No. 2026-315, Eff. 7/11/26.