Montana Administrative Register Notice 37-497 No. 24   12/24/2009    
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In the matter of the amendment of ARM 37.108.507 pertaining to components of quality assessment activities










TO:  All Concerned Persons


1.  On January 23, 2010, 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 January 15, 2010, 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 2009 2010 measures:

            (a) through (3) remain the same.

            (4)  The department adopts and incorporates by reference the HEDIS year 2009 2010 measures for the categories listed in (1)(a) through (e).  The HEDIS year 2009 2010 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 2009 2010 measures are available from the National Committee for Quality Assurance, 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 2009 measures to the proposed 2010 measures are quoted below:


"Changes to HEDIS 2010


Childhood Immunization Status


a)  Added hepatitis A, rotavirus and influenza vaccines.


b)  Added Combinations 4–10.


c)  Clarified that pneumococcal conjugate vaccinations administered prior to 42 days after birth should not be counted as a numerator hit.


Breast Cancer Screening.  No changes to this measure.


Cervical Cancer Screening


a)  Removed the Hybrid Method of data collection for the commercial product line.


b)  Clarified documentation of "no endocervical cells".


Comprehensive Diabetes Care


a)  Clarified that HbA1c control (<7.0%) is only reported for the commercial and Medicaid product lines.


b)  Deleted CPT codes 99261–99263, 99301–99303, 99311–99313, 99321–99323, 99331–99333 from Table CDC-C.


c)  Deleted CPT Category II code 3047F from Tables CDC-D, CDC-E, CDC-F and CDC-Q.


d)  Clarified that a calculated or direct LDL may be used for LDL-C screening and control.


e)  Deleted LOINC code 24331-1 from Table CDC-H.


f)  Deleted LOINC code 34535-5, 53525-2 from Table CDC-J.


g)  Added CPT codes 90957–90962, 90965, 90966, 90969, 90970 to Table CDC-K "Evidence of treatment for nephropathy" description.


h)  Added LOINC code 53525-2 to Table CDC-K.


i)  Deleted LOINC codes 24356-8, 24357-6, 50556-0, 50564-4 from Table CDC-K.


j)  Deleted CPT code 90939 from Tables CDC-K, CDC-P.


k)  Deleted CPT Category II code 3076F from Table CDC-N.


l)  Clarified that member-reported BP readings are not acceptable.


m)  Added ICD-9-CM Diagnosis code 249 to Table CDC-O "Steroid induced" description.


n)  Added CPT codes 90957–90962, 90965, 90966, 90969, 90970 to Table CDC-P "ESRD" description.


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 2010, Volume 3:  Specifications for Survey Measures.


Corrections, policy changes and clarifications to HEDIS 2010, Volume 2, Technical Specifications


Updated Random Number Table for Measures Using the Hybrid Method

Childhood Immunization Status


                   Table CIS-A


                        Add CPT1 code 90670 to the "Pneumococcal conjugate" description.


Cervical Cancer Screening


                   Table CCS-B


Add ICD-9-CM Diagnosis codes V88.01, V88.03.


Comprehensive Diabetes Care


                  Throughout the measure specification


Replace "HbA1c Control <7.0%" with "HbA1c Control <7.0% for a Selected Population".


                    Required exclusions for the HbA1c Control <7.0% for a Selected Population indicator


Replace the first bullet with:


65 years of age and older as of December 31 of the measurement year.


                 Table CDC-H


            Add LOINC code 55440-2.


                    Hybrid Specification—Denominator


            Add the following text to the end of the first paragraph.


The HbA1c Control <7% for a selected population indicator is not collected or reported for the Medicare product line. Organizations should use a sample size of 411 for the Medicare product line.


·                    Required exclusions for the HbA1c Control <7.0% for a Selected Population—Medical Record


            Replace the first bullet with:


65 years of age and older as of December 31 of the measurement year.


·                    Hybrid Specification—Numerators: LDL-C screening


Replace the second sentence in the Medical record section with the following text.


The organization may use a calculated or direct LDL for LDL-C screening and control indicators."


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, 2010.  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 January 21, 2010.  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., January 21, 2010.


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/  Mary Dalton for                                       

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services


Certified to the Secretary of State December 14, 2009.



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