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Montana Administrative Register Notice 37-983 No. 8   04/29/2022    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.85.104, 37.85.105, 37.85.106, and 37.86.3607 pertaining to updating Medicaid and non-Medicaid provider rates, fee schedules, and effective dates

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

           1.  On May 19, 2022, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider the proposed amendment of the above-stated rules. Interested parties may access the remote conferencing platform in the following ways: 

            (a) Join Zoom Meeting at: https://mt-gov.zoom.us/j/83514476310?pwd=ZnlzZTJTRkRCR0lNL0ZlSUxpS0pvQT09 meeting ID:  835 1447 6310 and password 015673 or

            (b) Dial by telephone +1 646 558 8656, meeting ID: 835 1447 6310.  Find your local number: https://mt-gov.zoom.us/u/kcycXThM52.

 

2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact the Department of Public Health and Human Services no later than 5:00 p.m. on May 5, 2022, to advise us of the nature of the accommodation that you need. Please contact Valerie St. Clair, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-6863; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

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

           

37.85.104 EFFECTIVE DATES OF PROVIDER FEE SCHEDULES FOR MONTANA NON-MEDICAID SERVICES (1) The department adopts and incorporates by reference the fee schedule for the following programs within the Addictive and Mental Disorders Division and Developmental Services Behavioral Health and Developmental Disabilities Division on the dates stated:

            (a) Mental health services plan provider reimbursement, as provided in ARM 37.89.125, is effective July 1, 2021 July 1, 2022.

            (b) 72-hour presumptive eligibility for adult-crisis stabilization services reimbursement for services, as provided in ARM 37.89.523, is effective July 1, 2021 July 1, 2022.

            (c) Youth respite care services, as provided in ARM 37.87.2203, is effective July 1, 2021 July 1, 2022.

            (d) Substance use disorder services provider reimbursement, as provided in ARM 37.27.905, is effective July 1, 2021 July 1, 2022.

            (2) remains the same.

 

AUTH: 53-2-201, 53-6-101, 53-6-113, MCA

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

 

37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) remains the same.

            (2) The department adopts and incorporates by reference, the resource-based relative value scale (RBRVS) reimbursement methodology for specific providers as described in ARM 37.85.212 on the date stated.

            (a) Resource-based relative value scale (RBRVS) means the version of the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services and published at Federal Register Volume 85 86, Issue 248 221, page 84472 64996 (December 28, 2020 November 19, 2021) effective January 1, 2021January 1, 2022, which is adopted and incorporated by reference. Procedure codes created after January 1, 2022, will be reimbursed using the relative value units from the Medicare Physician Fee Schedule in place at the time the procedure code is created.

            (b) Fee schedules are effective January 1, 2022 July 1, 2022. The conversion factor for physician services is $41.88 $42.29. The conversion factor for allied services is $24.75 $25.34. The conversion factor for mental health services is $21.44 $21.69. The conversion factor for anesthesia services is $30.57.

            (c) Policy adjustors are effective July 1, 2021 July 1, 2022. The maternity policy adjustor is 100%. The family planning policy adjustor is 105%. The psychological testing for youth policy adjustor is 145%. The psychological testing policy adjustor applies only to psychologists.

            (d) remains the same.

            (e) The payment-to-charge ratio is effective July 1, 2021 July 1, 2022, and is 44.4% 43.8% of the provider's usual and customary charges.

            (f) through (h) remain the same.

            (i) Optometric services receive a 114.79% 115.33% provider rate of reimbursement adjustment to the reimbursement for allied services, as provided in ARM 37.85.105(2), effective July 1, 2021 July 1, 2022.

            (j) and (k) remain the same.

            (3) The department adopts, and incorporates by reference, the fee schedule for the following programs within the Health Resources Division, on the date stated.

            (a) remains the same.

            (b) The outpatient hospital services fee schedules including:

            (i) the Outpatient Prospective Payment System (OPPS) fee schedule as published by the CMS in Federal Register Volume 85 86, Issue 249 218, page 85866 63458 (December 29, 2020 November 16, 2021), effective January 1, 2021 January 1, 2022, and reviewed annually by CMS, as required in 42 CFR 419.5 (2016) and as updated by the department;

            (ii) and (iii) remain the same.

            (iv) the bundled composite rate of $258.02 $260.60 for services provided in an outpatient maintenance dialysis clinic effective on or after July 1, 2021 July 1, 2022.

            (c) The hearing aid services fee schedule, as provided in ARM 37.86.805, is effective January 1, 2022 July 1, 2022.

            (d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in 2021 2022 resulting in a dental conversion factor of $35.06 $35.48 and fee schedule is effective January 1, 2022 July 1, 2022.

            (e) The Dental and Denturist Program Provider Manual, as provided in ARM 37.86.1006, is effective October 1, 2019 July 1, 2022.

            (f) The outpatient drugs reimbursement dispensing fees range as provided in ARM 37.86.1105(3)(b) is effective July 1, 2021 July 1, 2022:

            (i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $6.06 $4.32 and the maximum is $15.57 $15.73;

            (ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $6.06 $4.32 and the maximum is $13.49 $13.62; or

            (iii) for pharmacies with prescription volume greater than or equal to 70,000, the minimum is $6.06 $4.32 and the maximum is $11.41 $11.52.

            (g) remains the same.

            (h) The outpatient drugs reimbursement vaccine administration fee, as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $15.50 $15.65 for each additional administered vaccine, effective July 1, 2021 July 1, 2022.

            (i) remains the same.

            (j) The home infusion therapy services fee schedule, as provided in ARM 37.86.1506, is effective July 1, 2021 July 1, 2022.

            (k) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective January 1, 2022 July 1, 2022, which outlines the Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs), as provided in ARM 37.86.1802, effective January 1, 2022 July 1, 2022. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective January 1, 2022 July 1, 2022.

            (l) The nutrition services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2021 July 1, 2022.

            (m) remains the same.

            (n) The orientation and mobility specialist services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2021 July 1, 2022.

            (o) The transportation and per diem fee schedule, as provided in ARM 37.86.2405, is effective July 1, 2021 July 1, 2022.

            (p) The specialized nonemergency medical transportation fee schedule, as provided in ARM 37.86.2505, is effective July 1, 2021 July 1, 2022.

            (q) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective January 1, 2022 July 1, 2022.

            (r) The audiology fee schedule, as provided in ARM 37.86.705, is effective January 1, 2022 July 1, 2022.

            (s) The therapy fee schedules for occupational therapists, physical therapists, and speech therapists, as provided in ARM 37.86.610, are effective January 1, 2022 July 1, 2022.

            (t) The optometric services fee schedule, as provided in ARM 37.86.2005, is effective January 1, 2022 July 1, 2022.

            (u) The chiropractic fee schedule, as provided in ARM 37.85.212(2), is effective July 1, 2021 July 1, 2022.

            (v) The lab and imaging services fee schedule, as provided in ARM 37.85.212(2) and 37.86.3007, is effective January 1, 2022 July 1, 2022.

            (w) The Targeted Case Management for Children and Youth with Special Health Care Needs fee schedule, as provided in ARM 37.86.3910, is effective July 1, 2021 July 1, 2022.

            (x) The Targeted Case Management for High-Risk Pregnant Women fee schedule, as provided in ARM 37.86.3415, is effective July 1, 2021 July 1, 2022.

            (y) The mobile imaging services fee schedule, as provided in ARM 37.85.212, is effective January 1, 2022 July 1, 2022.

            (z) The licensed direct-entry midwife fee schedule, as provided in ARM 37.85.212, is effective January 1, 2022 July 1, 2022.

            (aa) The private duty nursing services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2021 July 1, 2022.

            (4) The department adopts and incorporates by reference, the fee schedule for the following programs within the Senior and Long Term Care Division on the date stated:

            (a) The Big Sky Waiver home and community-based services for elderly and physically disabled persons fee schedule, as provided in ARM 37.40.1421, is effective July 1, 2021 July 1, 2022.

            (b) The home health services fee schedule, as provided in ARM 37.40.705, is effective July 1, 2021 July 1, 2022.

            (c) The personal assistance services fee schedule, as provided in ARM 37.40.1135, is effective July 1, 2021 July 1, 2022.

            (d) The self-directed personal assistance services fee schedule, as provided in ARM 37.40.1135, is effective July 1, 2021 July 1, 2022.

            (e) The community first choice services fee schedule, as provided in ARM 37.40.1026, is effective July 1, 2021 July 1, 2022.

            (5) The department adopts and incorporates by reference, the fee schedule for the following programs within the Addictive and Mental Disorders Behavioral Health and Developmental Disabilities Division on the date stated:

            (a) The mental health center services for adults fee schedule, as provided in ARM 37.88.907, is effective July 1, 2021 July 1, 2022.

            (b) The home and community-based services for adults with severe disabling mental illness fee schedule, as provided in ARM 37.90.408, is effective July 1, 2021 July 1, 2022.

            (c) The substance use disorder services fee schedule, as provided in ARM 37.27.905, is effective July 1, 2021 July 1, 2022.

            (6) For the Developmental Services Division Behavioral Health and Developmental Disabilities Division, the department adopts and incorporates by reference the Medicaid youth mental health services fee schedule, as provided in ARM 37.87.901, effective October 1, 2021 July 1, 2022.

 

AUTH: 53-2-201, 53-6-113, MCA

IMP: 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA

 

37.85.106 MEDICAID BEHAVIORAL HEALTH TARGETED CASE MANAGEMENT FEE SCHEDULE (1) remains the same.

(2) The Department of Public Health and Human Services (department) adopts and incorporates by reference the Medicaid Behavioral Health Targeted Case Management Fee Schedule effective July 1, 2021 July 1, 2022, for the following programs within the Developmental Services Division (DSD) and the Addictive and Mental Disorders Division (AMDD)Behavioral Health and Developmental Disabilities Division:

(a) through (3) remain the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

37.86.3607 CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, REIMBURSEMENT (1) Reimbursement for the delivery by provider entities of Medicaid funded targeted case management services to persons with developmental disabilities is provided as specified in the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915(c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, dated July 1, 2021 July 1, 2022.

            (2) The department adopts and incorporates by this reference the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915(c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, dated July 1, 2021 July 1, 2022. A copy of the manual may be obtained through the Department of Public Health and Human Services, Developmental Services Behavioral Health and Developmental Disabilities Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and at http://dphhs.mt.gov/dsd/developmentaldisabililities/DDPratesinf https://dphhs.mt.gov/dsd/developmentaldisabilities/ddpratesinf.

 

AUTH: 53-6-113, MCA

IMP: 53-6-101, MCA

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) is proposing to amend ARM 37.85.104, 37.85.105, 37.85.106, and 37.86.3607 pertaining to updating Medicaid and non-Medicaid provider rates, fee schedules, and effective dates.

 

The following explanation represents the reasonable necessity for the proposed amendments. The department administers the Montana Medicaid and non-Medicaid program to provide health care to Montana's qualified low income, elderly, and disabled residents. Medicaid is a public assistance program paid for with state and federal funds appropriated to pay health care providers for the covered medical services they deliver to Medicaid members.

 

The proposed July 1, 2022 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.

 

The proposed amendments are explained below, with reference to the specific subsections of ARM 37.85.104, 37.85.105, 37.85.106, and 37.86.3607.

 

ARM 37.85.104  Effective Dates of Provider Fee Schedules for Montana Non-Medicaid Services

 

(1) Behavioral Health and Developmental Disabilities Division Non-Medicaid Fee Schedules

The Developmental Services Division and Addictive and Mental Disorders Division names will be updated to reflect the new combined division name, Behavioral Health and Developmental Disabilities Division.

 

(1)(c)

Although the department proposes no changes to youth respite care services, the effective date for this fee schedule must be amended to July 1, 2022, because the department is proposing changes in other parts of that fee schedule and the date will be changed.  See below at ARM 37.85.105(6). 

 

(1)(a), (b), (d)

The department is proposing to amend the effective date of the fee schedules for Mental Health Services Plan, 72-hour Presumptive Eligibility for Adult Crisis Stabilization Services, and Substance Use Disorder Services from July 1, 2021, to July 1, 2022.  This is necessary to reflect the 1% provider rate increase approved by the Montana Legislature during the 2021 regular session.

 

ARM 37.85.105 Effective Dates, Conversion Factors, Policy Adjusters, And Cost-To-Charge Ratios of Montana Medicaid Provider Fee Schedules

 

(2)(a) and (b) Resource-Based Relative Value Scale (RBRVS) Federal Register

Effective July 1, 2022, the department is proposing to adopt the version of the RBRVS contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare & Medicaid Services (CMS) in the November 19, 2021, federal register (effective January 1, 2022) for the RBRVS reimbursement methodology.  This adoption is necessary to incorporate the most up-to-date changes made by CMS.

 

(2)(b) RBRVS Conversion Factors (CF)

RBRVS rates are calculated by multiplying code-specific relative value units (RVU) by the applicable conversion factor.  During the annual RBRVS reimbursement modeling process, the department considers all these factors in the aggregate using a weighted average based on utilization.  The 2021 legislature appropriated funds for a restricted provider rate increase of 1% for the state fiscal year 2023.  Considering the pricing factors and the appropriated provider rate increase, the department proposes increases to the allied services and mental health services conversion factors.  The proposed allied services conversion factor is $25.34, and the proposed mental health services conversion factor is $21.69. When the proposed conversion factor increases are applied against utilization and RVUs, the result is a weighted average rate increase of 1%.

 

For the physician services conversion factor, the department is directed by 53-6-125, MCA, to increase the conversion factor by the consumer price index for medical care for the previous year, which for this adjustment period is 1%.  Physician services are not included in the 2021 legislature appropriated provider rate increase.

 

(2)(c) Policy Adjustors

Although there will be no change to the policy adjustor for psychological testing, the department is proposing to update the language to remove "for youth" because the policy adjustor also applies to adult mental health services.

 

(2)(e) Payment to Charge Ratio

The payment to charge ratio, which is used to price some allowable procedures which do not have set reimbursement is proposed to be 43.8%, effective July 1, 2022.

 

(2)(i) Optometric Services Provider Rate of Reimbursement (PRR)

The department is proposing to increase the optometric services PRR, which is a pricing factor, to 115.33% of the reimbursement for allied services with an effective date of July 1, 2022.  When this pricing factor is applied against utilization, relative value units, and proposed allied services conversion factor, optometrists and opticians will receive a weighted average provider rate increase of 1%.

 

(3)(b)(i) Outpatient Prospective Payment System (OPPS) Federal Register

Effective July 1, 2022, the department is proposing to adopt the Outpatient Prospective Payment System fee schedule published by CMS in the November 16, 2021, federal register (effective January 1, 2022) for the OPPS reimbursement methodology.  This adoption is necessary to ensure outpatient hospital updates are aligned with CMS.

 

(3)(b)(iv) Outpatient Maintenance Dialysis Clinic

The bundled composite rate for outpatient maintenance dialysis clinics is proposed to increase by 1% to $260.60 to incorporate the provider rate increase approved by the Montana Legislature.

 

(3)(c), (j), (l), (n), (o), (p), (q), (r), (s), (t), (u), (v), (w), (x), (y), (z), and (aa) Fee Schedules

The department is proposing the adoption of fee schedules effective July 1, 2022. The fee schedules incorporate changes due to the proposed amendments within this rule notice (i.e., federal register changes, conversion factor updates, legislatively required provider rate increases).  The above-listed subsections are for the following fee schedules -- hearing aid services; home infusion therapy services; nutrition services; orientation and mobility specialist services; transportation and per diem fee schedule; specialized non-emergency medical transportation; ambulance services, audiology services; occupational, physical, and speech therapy services; optometric services; EPSDT chiropractic services; lab and imaging services; Targeted Case Management (TCM) for Children and Youth with Special Health Care Needs; TCM for High-Risk Pregnant Women; mobile imaging services; licensed direct-entry midwife; and private duty nursing.

 

(3)(d) Dental Reimbursement

The department proposes three changes to this subsection: 1) adoption of the Relative Values for Dentist reference published in 2022; 2) modification of the dental conversion factor to $35.48; and 3) adoption of the July 1, 2022, Dental Services fee schedules. These proposed changes are necessary to incorporate the legislatively approved provider rate increase and keep current with updated dental procedure codes.

 

(3)(e) Dental Provider Manual Update

The Dental Provider manual is proposed to be amended, effective July 1, 2022, to incorporate the updated terminology, acronyms, and contact information for the new provider enrollment portal and the Healthy Montana Kids section.  In addition, the dental provider manual is proposed to incorporate the addition and removal of orthodontic codes provided by the Current Dental Terminology (CDT) 2022 book.

 

(3)(f) Outpatient Drugs Dispensing Fee

Annually the department surveys enrolled pharmacies to establish the state fiscal year minimum dispensing fee. The results from the annual survey provide the data necessary to calculate the minimum dispensing fee, which is proposed to be $4.32. The maximum dispensing fee, for each volume range, is proposed to increase to incorporate the legislatively approved provider rate increase.

 

The department proposes to add "or equal to" to (3)(f)(iii).  This is necessary to ensure there is a dispensing fee for pharmacies with a prescription volume of exactly 70,000.

 

(3)(h) Outpatient Drugs Reimbursement Vaccine Administration Fee

The department proposes to increase the fee paid for each additional vaccine administered to $15.65. This change is necessary to maintain a vaccine administration fee aligned with the physician services rate.

 

(3)(k) Prosthetic Devices, Durable Medical Equipment, and Medical Supplies

The department proposes to adopt and incorporate by reference the Medicare Region D Supplier Manual effective July 1, 2022.  This proposal is necessary to ensure the department adopts newly added, revised, or deleted Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs).

The department also proposes to revise the effective dates for the durable medical equipment fee schedule to July 1, 2022, to reflect the Calendar Year 2022 Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule. This allows the department to update department set fees, Medicare fees, additions, deletions, or changes to procedure codes when Medicare releases and updates its fee schedule.

 

(4) Senior Long Term Care

The department proposes the adoption of updated fee schedules effective July 1, 2022. The updated fee schedules implement a legislatively appropriated Medicaid provider rate increase of 0.3% for the Community First Choice/Personal Assistance Services (CFC/PAS), Big Sky Waiver, and Home Health programs.

 

The proposed fee schedule for Big Sky Waiver also includes modifications to residential services to better define provider requirements and avoid duplication of overlapping services. The proposed changes include the addition of a new level of residential service known as Level 2 Assisted Living Facility – Behavior Management. The proposed changes also include the removal of the Residential Habilitation – Child Foster Care service due to federal requirements under which Home and Community Based Services cannot be used to supplant or duplicate services required to be provided by the state under Title IV-E of the Social Security Act. This service has not been used in approximately 10 years and therefore no individuals will be impacted by removal of the service.

 

The proposed fee schedules are available at: https://medicaidprovider.mt.gov/proposedfs.

 

(5)(a), (b), (c) Behavioral Health and Developmental Disabilities Division

The department is proposing to amend the effective date of the fee schedules for Mental Health Center Services for Adults, Home and Community-based Services for Adults with Severe Disabling Mental Illness, and Substance Use Disorder Services from July 1,2021 to July 1,2022.  This is necessary to reflect the 1% provider rate increase approved by the Montana Legislature during the 2021 regular session. The Addictive and Mental Disorders Division name will be updated to reflect the new division name, Behavior Health and Developmental Disabilities Division.

 

(6) Behavioral Health and Developmental Disabilities Division Medicaid youth mental health services fee schedule

The department proposes to revise the effective dates and reimbursements on the Medicaid youth mental health services fee schedule to July 1, 2022. This update incorporates the legislatively approved provider rate increase. In addition, we have updated the Acute Partial Hospitalization Full day to align with current reimbursement.  The Developmental Disabilities Division name will be updated to reflect the new division name, Behavioral Health and Developmental Disabilities Division.

 

ARM 37.85.106 Medicaid Behavioral Health Targeted Case Management Fee Schedule

 

(2) Fee schedule

The department is proposing to amend ARM 37.85.106 to update the fee schedule date for the Medicaid Behavioral Health Targeted Case Management Fee Schedule from July 1, 2021, to July 1, 2022. This is necessary to update provider rates in accordance with funding appropriated by the Montana Legislature during the 2021 regular session.  The Developmental Services Division and Addictive and Mental Disorders Division names will be updated to reflect the new combined division name, Behavioral Health and Developmental Disabilities Division.

 

ARM 37.86.3607 Case management services for persons with developmental disabilities, reimbursement 

 

(1) and (2) Reimbursement

The department is proposing to amend ARM 37.86.3607 pertaining to reimbursement rates in the Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915 (c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and over.

 

The rule amendment would adopt and incorporate an updated version of the manual dated July 1, 2022, and will reference the newly merged Behavioral Health and Developmental Disabilities Division.

 

Based on legislative appropriations in the 2021 legislative session, the Developmental Disabilities Program proposes to implement a 1.9% average provider rate increase to state fiscal year 2023 targeted case management rates.

 

The proposed amendment would give an approximate 1.9% rate increase to the following service: Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915 (c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and over, with an effective date of July 1, 2022.  The Developmental Services Division name will be updated to reflect the new division name, Behavioral Health and Developmental Disabilities Division. In addition, because the link to the manuals in regulation is now invalid, the department proposes to update it with a valid link.

 

Fiscal Impact

 

The following table displays the number of providers affected by the amended fee schedules, effective dates, conversion factors, and rates for services for SFY 2023 based on the proposed amendments.

 

Provider Type

SFY 2023 Budget Impact (Federal Funds)

SFY 2023 Budget Impact (State Funds)

SFY 2023 Budget Impact (Total Funds)

Active Provider Count

Ambulance

$104,215

$26,974

$131,189

               204

Audiologist

$1,325

$513

$1,838

                 83

BCBA/BCBA-D

$8,113

$4,335

$12,448

                 36

Case Management Services for Persons with Developmental Disabilities

$45,518

$28,318

$73,836

                   1

Chemical Dependency Clinic

$177,691

$31,609

$209,300

                 55

Community First Choice

$94,871

$35,882

$130,753

                 69

Dental

$522,798

$204,406

$727,204

               694

Denturist

$24,124

$6,474

$30,598

                 19

Dialysis Clinic

$28,356

$10,160

$38,516

                 25

Durable Medical Equipment

$261,829

$94,840

$356,669

               510

EPSDT - Chiropractic

$6,154

$3,046

$9,200

               157

Free Standing Birthing Center

$0

$0

$0

                   2

Hearing Aid Dispenser

$1,625

$626

$2,251

                 37

Home & Comm Based Services

$205,617

$110,486

$316,103

               562

Home Health Agency

$2,226

$611

$2,837

                 26

Home Infusion Therapy

$15,289

$5,025

$20,314

                 15

Hospital - Outpatient

$0

$0

$0

               439

Independent Diagnostic Testing Facility

$12,404

$2,934

$15,338

                 26

Laboratory

$218,242

$44,699

$262,941

               183

Licensed Clinical Social Worker

$127,394

$40,698

$168,092

               911

Licensed Professional Counselor

$200,682

$66,540

$267,222

             1,114

Licensed Marriage and Family Therapist

$509

$237

$746

                   5

Mental Health Center

$194,658

$78,578

$273,236

                 35

Mid-Level Practitioner

$662,580

$183,585

$846,165

             5,528

Mobile Imaging Service

$1,200

$281

$1,481

                   2

Nutritionist/Dietician

$991

$449

$1,440

               128

Occupational Therapist

$33,402

$16,356

$49,758

               326

Optician

$765

$263

$1,028

                 28

Optometrist

$52,485

$16,953

$69,438

               245

Orientation and Mobility

$941

$509

$1,450

                   4

Personal and Commercial Transportation

$1,368

$545

$1,913

                 12

Personal Care Agency

$1,677

$723

$2,400

                 69

Personal Care Agency - Adult MH

$85

$29

$114

                 69

Personal Care Agency - Child MH

$14

$7

$21

                 69

Pharmacy Dispensing Fee

$273,522

$63,682

$337,204

               440

Physical Therapist

$83,914

$20,795

$104,709

             1,057

Physician

$1,627,910

$456,822

$2,084,732

           12,787

Podiatrist

$31,560

$7,801

$39,361

                 78

Private Duty Nursing Agency

$27,718

$14,976

$42,694

                   4

Psychiatric Res. Treatment Facility

$120,581

$63,961

$184,542

                 26

Psychiatrist

$66,764

$20,443

$87,207

               344

Psychologist

$11,797

$3,618

$15,415

               280

Public Health Clinic

$3,212

$1,017

$4,229

                 43

CSCT Children's Mental Health

$141,875

$76,731

$218,606

               442

Speech Pathologist

$21,905

$11,373

$33,278

               307

Targeted Case Management - Children and Youth with Special Health Care Needs

$384

$191

$575

                   6

Targeted Case Management - High Risk Pregnant Women

$93

$46

$139

                  -  

Targeted Case Management - Mental Health

$68,524

$31,925

$100,449

                 21

Therapeutic Family Care

$17,616

$9,353

$26,969

                 14

Therapeutic Group Home

$117,795

$63,151

$180,946

                 26

Transportation Non-Emergency

$47

$25

$72

                   7

 

The department intends these amendments to be effective July 1, 2022.

 

            5. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Valerie St. Clair, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., May 27, 2022.

 

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

 

7. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.

 

8. The bill sponsor contact requirements of 2-4-302, MCA, does not apply.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will significantly and directly impact small businesses.

 

10. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement.  The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.

 

The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.

 

 

/s/ Brenda K. Elias                                       /s/ Adam Meier______________ 

Brenda K. Elias                                            Adam Meier, Director

Rule Reviewer                                              Public Health and Human Services

 

 

Certified to the Secretary of State April 19, 2022.

 

 

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