This regulation governs Medicaid reimbursement, service standards, provider qualifications, and operational requirements for Home Support Services (HSS) and Therapeutic Foster Care (TFC), including TFC Permanency (TFOC-P), in Montana. Providers must be licensed mental health centers (and, for TFC, also child-placing agencies) and must deliver intensive in-home therapeutic services to youth with serious emotional disturbance, following individualized treatment plans, minimum contact requirements, crisis response protocols, and safety planning standards. Reimbursement is set at the lesser of the department fee schedule or the provider's usual and customary charges, with specific unit-of-service and daily-rate structures.
View official source37.87.1401 HOME SUPPORT SERVICES AND THERAPEUTIC FOSTER CARE, SERVICES REIMBURSEMENT (1) Reimbursement for the therapeutic portion of home support services (HSS) and therapeutic foster care (TFC) services is the lesser of: (a) the amount specified in the department's fee schedule adopted in ARM 37.85.105 ; or (b) the provider's usual and customary charges. (2) HSS and TFC providers must use the procedure codes designated by the department, in the fee schedule referred to in (1)(a) to be reimbursed for HSS and TFC. (3) The TFC provider is reimbursed a daily rate. For TFC services, the department will reimburse the provider the daily rate for every day of a four-week period if the provider meets the minimum number of contacts as described in ARM 37.87.1410 (6) during the four-week period. (4) The HSS provider is reimbursed on a fee per unit of service basis. The two-hour weekly service requirement for HSS services must be met to be eligible for reimbursement. For purposes of this rule, a unit of service is based on a 15-minute unit increment. A unit of service is a period of 15 minutes as follows: (a) one unit of service is equal to 8 minutes but fewer than 23 minutes; (b) two units of service are greater than or equal to 23 minutes but fewer than 38 minutes; (c) three units of service are greater than or equal to 38 minutes but fewer than 53 minutes; (d) four units of service are greater than or equal to 53 minutes but fewer than 68 minutes; (e) five units of service are greater than or equal to 68 minutes but fewer than 83 minutes; (f) six units of service are greater than or equal to 83 minutes but fewer than 98 minutes; (g) seven units of service are greater than or equal to 98 minutes but fewer than 113 minutes; and (h) eight units of service are greater than or equal to 113 minutes but fewer than 128 minutes. (5) HSS rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.105 . (6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of HSS or TFC treatment, including when this service is delivered in a foster home. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2020 MAR p. 2435, Eff. 1/1/21. 37.87.1402 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), DEFINITIONS (1) "Behavioral Aide" means for therapeutic foster care permanency, an unlicensed employee of the mental health center who works under the supervision of the licensed mental health professional. All behavioral aides must have, at a minimum, a high school diploma and at least two years of experience working with emotionally disturbed youth or providing direct services in a human services field. Aides may only provide services for which they have demonstrated competency and which are not limited to the scope and practice of the licensed mental health professional. (2) "Caregiver" means a person responsible for the well-being of the youth on a day-to-day basis with written permission from the legal representative of the youth, when applicable. (3) "Clinical lead" means a person who is an employee of the provider agency who is responsible for the supervision and overall provision of treatment services to youth in HSS and TFC. The clinical lead must be a licensed mental health professional as defined in ARM 37.87.102 or an individual providing in-training mental health services as defined in ARM 37.87.702 . (4) "Concurrent" means any time during the 90-day period of the individualized treatment plan for HSS and TFC, unless the youth is discharged from service. (5) "Family support specialist" (FSS) means a person who is an employee of the provider agency who provides therapeutic interventions to youth who are receiving HSS and TFC. The FSS must have a bachelor's degree in a human services field or a combination of experience and education equivalent to a bachelor's degree. For an FSS, six years of human services experience equates to a bachelor's degree, and each year of post-secondary education in human services equates to one year of experience. (6) "Home support services (HSS)" is defined in the Manual adopted and incorporated by reference in ARM 37.87.903 . (7) "Natural supports" means relationships and supports that occur within the community in everyday life including but not limited to relationships with family members, friends, neighbors, and community acquaintances. (8) "Therapeutic foster care (TFC)" means medically necessary, intensive in-home services delivered by a provider with specialized training and experience working with caregivers and youth in their homes, with temporary services available when a youth is homeless for fewer than 90 days. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2020 MAR p. 2435, Eff. 1/1/21. 37.87.1404 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), INDIVIDUALIZED TREATMENT PLAN (1) The individualized treatment plan (ITP) must be developed in accordance with ARM 37.106.1916 . (2) The caregiver may select the members of the ITP team. (3) Providers must inform the youth and their caregiver that Medicaid requires coordination of HSS and TFC with comprehensive school and community treatment (CSCT) planning, when applicable. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13. 37.87.1405 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), ASSESSMENTS (1) A clinical assessment consistent with ARM 37.106.1915 must be completed for each youth documenting the youth has a serious emotional disturbance as defined in ARM 37.87.102 . Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2020 MAR p. 691, Eff. 11/1/20. 37.87.1407 THERAPEUTIC FOSTER CARE (TFC), PROVISIONS OF SERVICE (1) The main focus of the service is to address the mental health needs and strengthen the structure and support for youth and the caregivers. TFC serves the youth and the caregivers in their home and community environment through understanding the needs of the youth and the dynamics of the caregivers. TFC requires a structured, consistent, strength based therapeutic relationship between the provider and the youth and the caregiver for the purpose of treating the behavioral health needs of the youth, including improving the caregiver's ability to provide effective support for the youth and to promote healthy functioning. (2) The following must be available and provided as clinically indicated by a mental health professional: (a) conduct a treatment team meeting with the caregiver to develop an individualized treatment plan in accordance with ARM 37.106.1916 (5); (b) write treatment summaries at a minimum of every month describing progress and changes in the strengths and needs of the youth and the caregiver to inform service provisions; and (c) develop a crisis plan with the caregiver that identifies a range of potential crisis situations with a range of corresponding responses including direct (face-to-face) and telephonic responses 24/7. (3) The following services, identified in the individualized treatment plan, must be available and provided as clinically indicated: (a) individualized therapeutic support to the youth and the caregiver based on strengths and needs; (b) identification, coordination, and strengthening of formal and informal supports; and (c) post-crisis consultation and crisis plan revision with the team and the caregiver, as needed. (4) The following services must be available and provided as clinically indicated. The services must be identified in the ITP and include two of the following: (a) skill building; (b) assistance for the youth and the caregiver to identify resources to meet their needs; (c) instruction for the caregiver on behavior management strategies; and (d) psycho-educational programs. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2020 MAR p. 2435, Eff. 1/1/21. 37.87.1408 THERAPEUTIC FOSTER CARE (TFC), DISCHARGE PLANNING AND DOCUMENTATION (1) The youth may be discharged from this level of care based upon at least one the following criteria: (a) the caregiver no longer needs this level of support or is actively using other formal and informal support networks; (b) the treatment plan for the youth indicates the goals and objectives for the services have been substantially met; (c) the caregiver is not engaged in the services. The lack of engagement is of such a degree that this type of support becomes ineffective or unsafe, despite documented attempts to address the engagement issues; (d) the caregiver withdraws consent for the treatment; (e) the youth is placed in a residential treatment setting with no plan for return to the home setting; or (f) the youth has moved to an independent living situation and is no longer in or returning to the family setting. (2) A discharge summary must be documented and indicate the reason for the discharge. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2020 MAR p. 2435, Eff. 1/1/21. 37.87.1410 THERAPEUTIC FOSTER CARE (TFC), PROVIDER REQUIREMENTS (1) The TFC provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19. (2) The provider must also be a child-placing agency. (3) A full-time clinical lead is responsible for not more than five full-time family support specialists (FSS). (4) The clinical lead must: (a) provide direction and consultation to the FSS to address the clinical needs of the youth and the needs of the caregiver as identified in the youth's individualized treatment plan (ITP); (b) respond to the youth's and the caregiver's needs when the FSS is not available; (c) orient, train, and coach the FSS; and (d) provide one-on-one supervision at least monthly to the FSS. (5) A full-time FSS is responsible for not more than ten youths at a time. (6) The following requirements must be met by either the clinical lead, the FSS, or both: (a) provide contacts at the frequency, location, and duration that are sufficient to meet the identified needs of the youth and the caregiver, with the duration of the contacts not limited; (b) conduct a minimum of four scheduled contacts or sessions with the caregiver in each four-week period, two of which must be face-to-face within the home and community environment, excluding the provider's office or facility, based on the needs of the caregiver that are documented in the ITP; (c) conduct a minimum of two scheduled treatment sessions with the youth, one of which must be face to face, within the home and community environment, excluding the provider's office or facility, in each four-week period, based on the needs of the youth that are documented in the ITP; (i) For both requirements in (b) and (c), face-to-face delivery of the treatment services is preferred. Telehealth may be substituted if clinically indicated or if the youth does not have access to face-to-face services. Case notes must include the reason(s) for telehealth delivery of service, including documentation of attempts to identify local supports, if the need for telehealth delivery of services is related to access issues; and (d) services provided above the minimum face-to-face contact requirements in (b) and (c) may be provided in the provider's office or facility to further meet the identified needs of the youth and the caregiver documented in the ITP. The duration of the contacts are not limited. (7) 24/7 face-to-face and telephonic crisis response is expected. (8) The provider of TFC must use a research-based practice curriculum to provide family-based services. Staff training in the research-based practice must be documented in the provider's personnel records. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2017 MAR p. 607, Eff. 5/13/17; AMD, 2020 MAR p. 2435, Eff. 1/1/21; AMD, 2024 MAR p. 611, Eff. 3/23/24. 37.87.1413 THERAPEUTIC FOSTER CARE PERMANENCY SERVICES, PROVIDER PARTICIPATION (1) Therapeutic foster care permanency (TFOC-P) services must be provided in accordance with ARM 37.87.1401 through 37.87.1408 (HSS/TFC). (2) TFOC-P must be provided by a child placement agency in accordance with ARM Title 37, chapter 93. (3) TFOC-P is an intensive level of treatment for youth in a therapeutic foster family placement which is permanent and includes: (a) individual, family, and group therapies; (b) clinical supervision provided by a licensed psychologist on a 1:20 ratio; (c) a treatment manager who is a masters or bachelors level social worker with three years' experience, on a 1:6 ratio; (d) behavioral aide services averaging at least ten hours per week; (e) respite care at least one weekend per month; and (f) additional specialized training for families. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13. 37.87.1414 HOME SUPPORT SERVICES (HSS), PROVISIONS OF SERVICE (1) Home support services (HSS) providers must support the strengths of youth and caregivers by: (a) identifying behavioral health abilities and needs across key areas such as school, family, social, community, and vocational environments; (b) identifying strengths that can form the basis of the treatment plan in the areas of school, family, social, community, and vocational functioning; and (c) prioritizing the most critical behavioral health needs and concerns as the focus of the treatment planning and delivery. (2) HSS providers must engage in treatment planning that: (a) clearly states the treatment goals identified in the clinical eligibility recommendation; (b) is based on the functional assessment conducted pursuant to the manual adopted and incorporated by reference in ARM 37.87.903 ; (c) is a collaborative process that involves youth and caregivers in developing a treatment plan with a manageable number of prioritized needs along with goals and strategies for addressing each need and goal; (d) includes goals with measurable and observable outcomes; (e) includes monthly summaries and updates every 90 days, which include outcome measurements of treatment goals; and (f) unifies treatment plans with a targeted case manager, if applicable, and identifies all services and supports to caregivers. (3) The provider must conduct a treatment team meeting with the caregiver to develop an individualized treatment plan in accordance with ARM 37.106.1916 . (4) The provider must measure progress on individualized treatment goals, using both the department-approved standardized assessment and treatment goal indicators to measure progress from baseline. Progress towards individualized treatment goals must be considered as part of discharge planning. (5) The provider must collaborate and coordinate with the TCM provider, if youth and caregivers are engaged in TCM services. (6) The provider must collaborate with youth and caregivers to identify and address suicidality, risk, and safety concerns at home, in school, and in the community to develop an individualized safety plan for each youth. Individual safety plans must be completed within 21 days of admission to HSS and must be reviewed monthly and after crisis with updates as necessary. Individual safety plans must contain the following components: (a) delineate required safety planning and processes, youth and caregiver involvement, and plan dissemination; (b) identification of what is considered a crisis for youth and caregivers; (c) natural supports currently accessible to the youth and caregivers; (d) current resources and skills accessible to the youth and caregivers; (e) crisis escalation patterns and triggers; (f) de-escalation strategies that are easily understood and can be implemented by the youth and caregivers; (g) if indicated by suicidality screening, a specific plan to address suicidal thoughts or ideations; (h) when to call the HSS team; and (i) when to call 911. (7) The provider must maintain requirements for crisis response as defined in ARM 37.106.1945 . Individual treatment and safety plans must be immediately available to mental health center employees engaged in crisis response. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2020 MAR p. 2435, Eff. 1/1/21. 37.87.1415 HOME SUPPORT SERVICES (HSS), PROVIDER REQUIREMENTS (1) The HSS provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19. (2) HSS teams should consist of a family support specialist (FSS) and a clinical lead. (3) HSS providers must ensure caseload sizes are sufficiently small to permit home support teams to respond flexibly to differing service needs of youth and families, including frequency of contact. FSS caseloads may vary between 4 to 14 families. (4) HSS providers must provide coaching to an FSS on in-home behavioral health skills. The clinical lead shall provide feedback based on observation of practice, review of plans of care and other documentation, and progress for each youth and caregiver. The FSS must meet with their clinical lead regularly. Frequency must be at least once a week, or more frequently based on documented skills and competencies. (5) Coaching and mentoring must be skills-based and include coaching to promote competencies in key skill sets such as safety planning, behavior management, cognitive behavioral interventions, caregivers and systemic interventions, and psychoeducation. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , MCA History: NEW, 2020 MAR p. 2435, Eff. 1/1/21.