Montana Administrative Register Notice 37-469 No. 8   04/30/2009    
Prev Next






In the matter of the amendment of ARM 37.108.507 pertaining to components of quality assessment activities










TO:  All Concerned Persons


1.  On May 30, 2009, 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 need an alternative accessible format of this notice.  If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on May 22, 2009, to advise us of the nature of the accommodation that you need.  Please contact Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.


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



            (1)  Annually, the health carrier shall evaluate its quality assessment activities by using the following HEDIS year 2008 2009 measures:

            (a) through (3) remain the same.

            (4)  The department adopts and incorporates by reference the HEDIS year 2008 2009 measures for the categories listed in (1)(a) through (e).  The HEDIS year 2008 2009 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 2008 2009 measures are available from the National Committee for Quality Assurance, 2000 L Street NW, Suite 500, Washington, DC 20036 1100 13th St. NW, Suite 1000, Washington, D.C. 20005 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 37.108.501, 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 healthcare effectiveness 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 2008 measures to the proposed 2009 measures are quoted below:


"Changes to HEDIS 2009


Childhood Immunization Status


a)  Revised the required number of doses for the Hib vaccine, per ACIP recommendations to defer the third Hib booster during vaccine shortage.


b)  Deleted ICD-9-CM Procedure code 99.37 from Table CIS-A. Vaccine for acellular pertussis antigen only is no longer produced.


c)  Clarified medical record review requirements for immunizations documented using a generic header of "DTaP/DTP/DT."


Breast Cancer Screening


a)  Removed age stratifications.


b)  Added HCPCS codes G0204, G0206 to Table BCS-A.


c)  Added UB-04 Revenue code 0401 to Table BCS-A.


d)  Deleted CPT code 76083 from Table BCS-A.


Cervical Cancer Screening


a)  Added LOINC code 47528-5 to Table CCS-A.


b)  Added CPT codes 5857058573 to Table CCS-B.


Comprehensive Diabetes Care


a)  Added amylin analogs category to Table CDC-A.


b)  Deleted CPT code 99499 from Table CDC-C.


c)  Removed the requirement that HCPCS S0625 (Table CDC-G) be billed by an optometrist or ophthalmologist for the eye exam indicator.


d)  Added CPT codes 67041-67043, 67113 to Table CDC-G.


e)  Clarified the use of CPT Category II code 3072F in Table CDC-G.


f)  Deleted CPT codes 83715, 83716 from Table CDC-H.


g)  Deleted DRGs from Tables CDC-B, CDC-K.


h)  Added UB Type of Bill code 72x to Table CDC-K.


i)  Added POS code 65 to Table CDC-K.


Note:  Because of the anticipated publication of several new, relevant studies, NCQA will review the HbA1c good control (<7.0%) indicator during summer 2008.  Modifications to the indicator will be announced in the Volume 2 Technical Update.


HEDIS/Consumer Assessment of Health Plan Survey (CAHPS) for Adults


a)  This measure is collected using survey methodology.  Detailed specifications and summary of changes are contained in HEDIS 2009, Volume 3:  Specifications for Survey Measures.


Corrections, policy changes and clarifications to HEDIS 2009


Updated Random Number Table for Measures Using the Hybrid Method


Childhood Immunization Status


                    Table CIS-A


                        Delete CPT codes 90702, 90703, 90719.


                        Delete ICD-9-CM Procedure codes 99.36, 99.38.


Rationale:  Because the member needs 4 DTaP for numerator compliance and because the vaccine for acellular pertussis antigen only is no longer produced, these codes cannot be used to demonstrate numerator compliance.


Cervical Cancer Screening


                    Table CCS-A


                        Delete HCPCS code G0101.


Comprehensive Diabetes Care


Throughout the measure specification


See specifications regarding the Comprehensive Diabetes Care-HbA1c specification.  All changes are underlined.


                    Table CDC-J


                        Add LOINC codes 47558-2, 49023-5, 50561-0, 50949-7, 53121-0,     53525-2, 53530-2, 53531-0, 53532-8.


                    Table CDC-K


                        Add LOINC codes 50556-0, 50561-0, 50564-4 to the Urine      macroalbumin test row."


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.  The department intends the proposed rule amendments to be applied retroactively to January 1, 2009.  There is no negative impact to the affected health insurance companies by applying the rule amendment retroactively.


            6.  Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Rhonda Lesofski, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on May 28, 2009.  Comments may also be faxed to (406) 444-1970 or e-mailed to dphhslegal@mt.gov.


            7.  If persons who are directly affected by the proposed action wish to express their data, views, or arguments orally or in writing at a public hearing, they must make written request for a hearing and submit this request along with any written comments to Rhonda Lesofski at the above address no later than 5:00 p.m., May 28, 2009.


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 directly affected by the proposed action; from the appropriate administrative rule review committee of the Legislature; from a governmental subdivision or agency; or from an association having not 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.  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.


10.  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. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.


11.  The bill sponsor contact requirements of 2-4-302, MCA, do not apply.





/s/  Lisa Swanson                                          /s/  Anna Whiting Sorrell                              

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services


Certified to the Secretary of State April 20, 2009.


Home  |   Search  |   About Us  |   Contact Us  |   Help  |   Disclaimer  |   Privacy & Security