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 and 37.85.105 pertaining to updating Medicaid and non-Medicaid provider rates, fee schedules, and effective dates
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On August 25, 2022, at 9:00 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/84555355149?pwd=bGxQVTVoVWlpNmlRRDdSRCtvR3V6Zz09, Meeting ID: 845 5535 5149, and Password: 364347; or
(b) Dial by telephone +1 646 558 8656, Meeting ID: 845 5535 5149, and Password: 364347. Find your local number: https://mt-gov.zoom.us/u/kbBCRNKkuu.
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 August 11, 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 email@example.com.
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 Behavioral Health and Developmental Disabilities Division on the dates stated:
Mental health services plan provider reimbursement, as provided in ARM 37.89.125, is effective July 1, 2022. Mental health crisis services, as provided in ARM 37.88.101, is effective October 1, 2022.
72-hour presumptive eligibility for adult-crisis stabilization services reimbursement for services, as provided in ARM 37.89.523, is effective July 1, 2022. Goal 189, as provided in [NEW RULE V in MAR Notice No. 37-1010], is effective October 1, 2022.
(c) remains the same.
(d) Substance use disorder services provider reimbursement, as provided in ARM 37.27.905, is effective
July 1, 2022 October 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) and (2) 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) The inpatient hospital services fee schedule and inpatient hospital base fee schedule rates including:
(i) the APR-DRG fee schedule for inpatient hospitals, as provided in ARM 37.86.2907, effective
October 1, 2021 October 1, 2022; and
(ii) the Montana Medicaid APR-DRG relative weight values, average national length of stay (ALOS), outlier thresholds, and APR grouper version
38 39.1, contained in the APR-DRG Table of Weights and Thresholds, effective October 1, 2021 October 1, 2022. The department adopts and incorporates by reference the APR-DRG Table of Weights and Thresholds effective October 1, 2021 October 1, 2022.
(b) and (b)(i) remain the same.
(ii) the conversion factor for outpatient services on or after
October 1, 2021 October 1, 2022 is $55.89 $56.14;
(iii) through (4) remain the same.
(5) The department adopts and incorporates by reference, the fee schedule for the following programs within the 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, 2022 October 1, 2022.
(b) remains the same.
(c) The substance use disorder services fee schedule, as provided in ARM 37.27.905, is effective
July 1, 2022 October 1, 2022.
(6) remains the same.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing to amend ARM 37.85.104 pertaining to updating non-Medicaid provider rates, fee schedules, and effective dates. The department is also proposing to amend ARM 37.85.105 pertaining to updating 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 amendments are explained below.
ARM 37.85.104(1)(a)(b) Mental Health Services Plan and 72-hour presumptive eligibility
As part of the department's Healing and Ending Addiction through Recovery and Treatment (HEART) Initiative, the Behavioral Health and Developmental Disabilities Division (BHDD) proposes to remove references to the Mental Health Services Plan and the 72-Hour Presumptive Eligibility program, which has provided mental health services for individuals who do not qualify for Medicaid services but whose income qualifies them for non-Medicaid mental health services paid for with state funds. The department has proposed replacing those non-Medicaid mental health services with the same services provided to Medicaid members. The alignment of Medicaid and non-Medicaid mental health services will establish a comprehensive continuum of care to address Montana's behavioral health needs, which include services for mental health. By aligning the services, the state will have a unified and efficient system of mental health and crisis stabilization services for eligible Montanans. Additionally, BHDD proposes to add a fee schedule for the Goal 189 program, which pays for support items and services to assist individuals in avoiding admission to Montana State Hospital (MSH) or in successfully transitioning to a community setting upon discharge from MSH. By adding the fee schedule, Goal 189 services can be reimbursed through the same mechanism as other Medicaid and non-Medicaid services. This will increase efficiencies and reduce burden on providers. The HEART Initiative represents the state's commitment to expanding coverage and promoting access to prevention, crisis intervention, treatment, and recovery services for eligible Montanans with mental health issues.
ARM 37.85.104(1)(d) Substance Use Disorder services
The department proposes to amend the rule to update the effective date of the fee schedule to October 1, 2022. The reasonable necessity for this change is to align non-Medicaid substance use disorder services with such Medicaid services. The updated fee schedule will reflect the removal of the psycho-social rehabilitation service and replacing it with community-based psychiatric rehabilitation and support service. Additionally, the intensive outpatient program is shifting from tiered reimbursement to a weekly bundled rate. And, the fee schedule will reflect the addition of two levels of care for clinically managed residential withdrawal management (ASAM 3.2-WM) and clinically managed population-specific high-intensity residential services (ASAM 3.3). It will also change room and board reimbursement for clinically managed low intensity residential (ASAM 3.1) to a bundled rate consistent with Medicaid reimbursement. All of these changes are consistent with the American Society of Addiction Medicine (ASAM) guidelines and are necessary to align payment and billing procedures for non-Medicaid substance use disorder services with the Montana Medicaid fee schedule and billing procedures for such services.
ARM 37.85.105(3)(a) Inpatient Hospital Services Rates
The House Bill (HB) 2 Narrative for the 2023 biennium provides for a reduced appropriation from the 2021 biennium for Medicaid services provided by non-critical access hospitals in an amount equivalent to a 1.0 percent provider rate reduction. (https://leg.mt.gov/content/Publications/fiscal/Session-2021/HB-2-Narrative/B-Senate-Floor.pdf, page 2).
With a proposed effective date of October 1, 2022, the department targeted a 0.45 percent increase in inpatient non-critical access hospital reimbursement for the remaining nine months of SFY 2023. The combination of the SFY 2022 decrease (implemented through MAR Notice No. 37-957) and the proposed SFY 2023 increase will net to an overall targeted 2023 biennium decrease of 1.0 percent.
The department proposes to adopt Version 39.1 of the 3M APR-DRG grouper effective October 1, 2022. This grouper update includes changes to DRG relative weights, average length of stays, and adds and/or deletes some DRGs. The department proposes to increase the base rate for "General Hospitals" to $5,390 and the base rate for "Centers of Excellence" to $8,030.
ARM 37.85.105(3)(b) Outpatient Hospital Services Fee Schedules
The department proposes to increase the conversion factor utilized when pricing services under the Outpatient Prospective Payment System reimbursement methodology. The conversion factor is proposed to be $56.14.
With a proposed effective date of October 1, 2022, the department targeted a 0.45 percent increase in outpatient non-critical access hospital reimbursement for the remaining nine months of SFY 2023. The combination of the SFY 2022 decrease (implemented through MAR Notice No. 37-957) and the proposed SFY 2023 increase will net to an overall targeted 2023 biennium decrease of 1.0 percent. This is necessary to meet the intent of the legislature provided in the HB 2 Narrative document. The HB 2 Narrative document reduced the appropriation for Medicaid services provided by non-critical access hospitals in an amount equivalent to a 1.0 percent provider rate reduction over the 2023 biennium.
Free Standing Birthing Centers are reimbursed under the Outpatient Hospital Service reimbursement methodology pursuant to ARM 37.86.3005. While the HB 2 reduction did not specify Free Standing Birthing Centers, the reimbursement rates for this provider are impacted by changes to the conversion factor. Therefore, the combination of the SFY 2022 decrease (implemented through MAR Notice No.37-957) and the proposed SFY 2023 increase will result in overall 2023 biennium decrease of approximately 1.0 percent for Free Standing Birthing Center provider reimbursement.
ARM 37.85.105(5)(a)(c) Mental Health Center services and Substance Use Disorder services
As part of the department's HEART Initiative, the department proposes to amend the rule to update the effective date of both fee schedules to October 1, 2022. As indicated above, this is necessary to ensure that BHDD is allowed to expand the behavioral health continuum of care and ensure consistency in the delivery of those services.
The proposed October 1, 2022, fee schedules can be found at: https://medicaidprovider.mt.gov/proposedfs.
The following table displays the anticipated financial impact during SFY 2023, and the number of providers affected by the proposed amendments.
SFY 2023 Budget Impact (Federal Funds)
SFY 2023 Budget Impact (State Funds)
SFY 2023 Budget Impact (Total Funds)
Active Provider Count
Free Standing Birthing Center
Hospitals – Inpatient
Hospitals – Outpatient
Chemical Dependency Clinics
Mental Health Centers
5. The department intends these amendments to be effective October 1, 2022.
6. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: 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 firstname.lastname@example.org, and must be received no later than 5:00 p.m., September 2, 2022.
7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
8. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 6 above or may be made by completing a request form at any rules hearing held by the department.
9. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
10. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.
11. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make 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/ CHARLES T. BRERETON
Brenda K. Elias Charles T. Brereton, Director
Rule Reviewer Department of Public Health and Human Services
Certified to the Secretary of State July 26, 2022.