BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
|In the matter of the amendment of ARM 37.108.507 pertaining to components of quality assessment activities
NOTICE OF PROPOSED AMENDMENT
NO PUBLIC HEARING
TO: All Interested Persons
1. On March 28, 2008 the Department of Public Health and Human Services proposes to amend the above-stated rule.
2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or who need an alternative accessible format of this notice. If you need an accommodation, contact the department no later than 5:00 p.m. on March 3, 2008. Please contact Gwen Knight, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 202951, Helena MT 59620-2951; telephone (406)444-9503; fax (406)444-9744; e-mail firstname.lastname@example.org.
3. The rule as proposed to be amended provides as follows. New matter is underlined. Matter to be deleted is interlined.
37.108.507 COMPONENTS OF QUALITY ASSESSMENT ACTIVITIES
(1) Annually, the health carrier shall evaluate its quality assessment activities by using the following HEDIS year
2007 2008 measures:
(a) childhood immunization;
(b) breast cancer screening;
(c) cervical cancer screening;
(d) comprehensive diabetes care; and
(e) HEDIS/Consumer Assessment of Health Plan Survey (CAHPS) for adults.
(2) through (3) remain the same.
(4) The department adopts and incorporates by reference the HEDIS year
2007 2008 measures for the categories listed in (1)(a) through (e). The HEDIS year 2007 2008 measures are developed by the National Committee for Quality Assurance and provide a standardized mechanism for measuring and comparing the quality of services offered by managed care health plans. Copies of HEDIS 2007 2008 measures are available from the National Committee for Quality Assurance, 2000 L Street NW, Suite 500, Washington, DC 20036 or on the internet at www.ncqa.org.
AUTH: 33-36-105, MCA
IMP: 33-36-105, 33-36-302, MCA
4. The Managed Care Plan Network Adequacy and Quality Assurance Act (Title 33, chapter 36, MCA) established standards for health carriers offering managed care plans and for the implementation of quality assurance standards in administrative rules. ARM 37.105.501 et seq. were adopted in 2001 to establish mechanisms for the department to evaluate quality assurance activities of health carriers providing managed care plans in Montana. ARM 37.108.507 requires health carriers to report their quality assessment activities to the department using health plan employer data and information set (HEDIS) measures, nationally-utilized measures that are updated annually. Since the HEDIS standards change somewhat every year, the rule must also be updated annually to reflect the current year's measures and ensure that national comparisons are possible, since the other states will also be using the same updated measures. The changes from adopted 2007 measures to the proposed 2008 measures are quoted below:
"Changes to HEDIS 2008
Childhood Immunization Status
Deleted ICD-9-CM Diagnosis codes 032, 033, 037, 038.41, 041.5, 045, 138, 320.0, 482.2, V02.4, V12.02 from Table CIS-A.
Breast Cancer Screening
Cervical Cancer Screening
Comprehensive Diabetes Care
Added CPT codes 67030, 67031, 67036, 67121, 67220, 67221 to Table CDC-G.
HEDIS/Consumer Assessment of Health Plan Survey (CAHPS) for Adults
Corrections, policy changes and clarifications to HEDIS 2008
Updated Random Number Table for Measures Using the Hybrid Method
Childhood lmmunization Status
Add an asterisk after ICD-9-CM Diagnosis code 323.51 in the
DTaP row, and add the following below the table.
*Use ICD-9-CM Diagnosis code 323.5 (with no fifth digit) to
identify DTaP prior to October 1, 2006; the date of service
must be before October 1, 2006.
Cervical Cancer Screening
Add LOINC code 47527-7.
Comprehensive Diabetes Care
Replace the last sentence (in first paragraph) with the
following. The member is not numerator compliant if the
automated result for the most recent HbAlc test is ¡İ7% or is
missing a result, or if an HbAlc test was not done during the
Add LOINC code 49132-4.
Add LOINC codes 1757-4, 34535-5, 40486-3, 40662-9,
40663-7, 43605-5, 43606-3, 43607-1, 44292-1.
Replace the test with the following.
The organization should use the medical record from which it
abstracts data for the other CDC indicators. If the
organization does not abstract for other indicators, it should
use the medical record of the provider that manages the
member's diabetes. If that medical record does not contain a
BP, the organization may use the medical record of another
PCP or specialist from which the member receives care.
Addendum: MS-DRG Crosswalk
Table Name CDC-B: Codes to Identify Diabetes
CMS-DRG 294, 295
MS-DRG 637, 638, 639
Table Name CDC-K: Codes to Identify Evidence of
Description Evidence of treatment for nephropathy
CMS-DRG 316, 317
The option of not updating the HEDIS measure was considered and rejected because these are national quality measures which allow comparison among health plans. If the measures are not kept current, this function is lost.
5. This rule amendment will be applied retroactively to January 1, 2008. There is no negative impact to the affected health insurance companies by applying the rule amendment retroactively.
6. Interested persons may submit their data, views, or arguments concerning the proposed action in writing to Gwen Knight, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 202951, Helena MT 59620-2951, no later than 5:00 p.m. on March 13, 2008. Comments may also be faxed to (406)444-9744 or e-mailed to email@example.com. The department maintains lists of persons interested in receiving notice of administrative rule changes. These lists are compiled according to subjects or programs of interest. To be included on such a list, please notify this same person.
7. If a person who is directly affected by the proposed action wishes to comment orally or in writing at a public hearing, the person must make a written request for a public hearing and submit such request, with any written comments to Gwen Knight, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 202951, Helena MT 59620-2951; by fax (406)444-9744; or by e-mail to firstname.lastname@example.org no later than 5:00 p.m. on March 13, 2008.
8. If the agency receives requests for a public hearing on the proposed action from either 10% or 25, whichever is less, of the persons who are directly affected by the proposed action; from the appropriate administrative rule review committee; from a governmental subdivision or agency; or from an association having no less than 25 members who will be directly affected, a hearing will be held at a later date. Notice of the hearing will be published in the Montana Administrative Register. Ten percent of those directly affected has been determined to be one, based on the two health insurance providers affected by this rule change.
9. An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of this notice conform to the official version of the notice as printed in the Montana Administrative Register, but advises all concerned persons that, in the event of a discrepancy between the official printed text of the Notice and the electronic version of the notice, only the official printed text will be considered. The web site may be unavailable at times, due to system maintenance or technical problems.
10. The bill sponsor notice requirements of 2-4-302, MCA, do not apply.
/s/ Lisa A. Swanson /s/ John Chappuis for
Rule Reviewer Director, Public Health and Human Services
Certified to the Secretary of State February 4, 2008.