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Montana Administrative Register Notice 37-635 No. 8   04/25/2013    
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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 37.40.307, 37.40.325, and 37.40.361 pertaining to nursing facility reimbursement

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

 

TO:  All Concerned Persons

 

            1.  On May 15, 2013, at 3:30 p.m., the Department of Public Health and Human Services will hold a public hearing in the Auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rules.

 

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 8, 2013, to advise us of the nature of the accommodation that you need.  Please contact Kenneth Mordan, 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 rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.40.307  NURSING FACILITY REIMBURSEMENT  (1) remains the same.

          (2)  Effective July 1, 2001, and in subsequent rate years, nursing facilities will be reimbursed using a price-based reimbursement methodology.  The rate for each facility will be determined using the operating component defined in (2)(a) and the direct resident care component defined in (2)(b):

            (a) through (c) remain the same.

            (d)  The total payment rate available for the period September 1, 2012 through June 30, 2013 rate year will be the rate as computed in (2), plus any additional amount computed in ARM 37.40.311 and 37.40.361.

            (3) through (12) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-6-101, 53-6-111, 53-6-113, MCA

 

            37.40.325  CHANGE IN PROVIDER DEFINED  (1) through (5) remain the same.

            (6)  Any change in provider, corporate or other business ownership structure, or operation of the facility that results in a change in the National Provider Identifier (NPI) will require a provider to seek a new Medicaid provider enrollment.  If the NPI is transferred with the facility, then only a provider file update is required to change the federal tax identification number and ownership information and this results in a change in the federal tax identification number, the provider will be required to seek a new Medicaid provider enrollment.  A written request must be made to the department if the NPI is transferred with the facility.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.40.361  DIRECT CARE AND ANCILLARY SERVICES WORKERS' WAGE REPORTING/ADDITIONAL PAYMENTS INCLUDING LUMP SUM PAYMENTS FOR DIRECT CARE AND ANCILLARY SERVICES WORKERS' WAGE AND BENEFIT INCREASES  (1)  Effective for at the period September 1, 2012 beginning of the rate year and for the six months thereafter, nursing facilities must report to the department actual hourly wage and benefit rates paid for all direct care and ancillary services workers or the lump sum payment amounts for all direct care and ancillary services workers that will receive the benefit of the increased funds.  The reported data shall be used by the department for the purpose of comparing types and rates of payment for comparable services and tracking distribution of direct care wage funds to designated workers.

            (2)  The department will pay Medicaid certified nursing care facilities located in Montana that submit an approved request to the department a lump sum payment in addition to the amount paid as provided in ARM 37.40.307 and 37.40.311 to their computed Medicaid payment rate to be used only for wage and benefit increases or lump sum payments for direct care or ancillary services workers in nursing facilities.

            (a)  The department will determine the lump sum payments, twice a year commencing September 1, 2012, with the first payment at the beginning of the rate year, and again in six months from that date as a pro rata share of appropriated funds allocated for increases in direct care and ancillary services workers' wages and benefits or lump sum payments to direct care and ancillary services workers.

            (b) through (3) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            4.  STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.40.307, 37.40.325, and 37.40.361, nursing facility services, regarding a 2% increase in Medicaid fees to providers.  This increase is mandated by House Bill 2 (HB2) of the 63rd Montana Legislature.

 

These rules continue the methodology of implementing legislative funding for nursing facility reimbursement; including, updated estimated patient days, patient contribution amounts, and case mix indices (acuity) into the rate calculation for State Fiscal Year (SFY) 2014.

The Montana Legislature is still in session as of this date and the department does not have available, at this time, all of the information that will be necessary in order to establish final payment rates for nursing facility providers effective July 1, 2013.  The final rates that will be set will be dependent on the funding levels authorized by the 63rd Legislature.

The Legislature has provided funding to implement a 2% provider rate increase effective July 1, 2013.  In addition to the 2% provider rate increase, the Legislature has provided additional funding for nursing facility providers to be used only to raise nursing facility rates for Medicaid services above the level paid in "fiscal year 2012" and may be used only to augment any other rate increase for nursing facility Medicaid services.

Funding will continue to be available to provide for a direct care worker wage increase for nursing facility providers for workers who provide direct care and ancillary services in SFY 2014.

The Legislature continued approval for the use of local county matching funds as a source of additional revenue for nursing facility providers.  The Intergovernmental Fund Transfer (IGT) Program maintains access to, and the quality of, nursing facility services, and will be available for SFY 2014.

 

The department will provide rate sheets to all providers in advance of the rule hearing, for verification purposes and in order to facilitate comments, when final case mix information and Medicaid utilization data and other details necessary to compute accurate reimbursement rates become available.  These sheets will distribute the funding available in order to meet the department goals for a price-based system of reimbursement and will incorporate legislative appropriated funding levels.

The department has determined these rates are consistent with efficiency, economy, and quality of care and access to Medicaid services and concluded that the rates are sufficient to enlist enough providers so that care and services under the Montana Medicaid Program are available to the extent that such care and services are available to the general population in the geographic area.

The department administers the Montana Medicaid Program to provide health care to Montana's qualified low income and disabled residents.  It 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 clients.  The Legislature delegates authority to the department to set the reimbursement rates Montana pays Medicaid providers for Medicaid clients' covered services.  See 53-6-106(8) and 53-5-113, MCA.

 

ARM 37.40.307 and 37.40.361

 

The department is proposing amendments to ARM 37.40.307 and 37.40.361 pertaining to Medicaid nursing facility services to remove the rate effective date of September 1, 2012 in the reimbursement rule and in the direct care and ancillary services worker wage reimbursement rule and replace them with the term "rate year".  This will provide that the department will no longer have to amend these rules to change this effective date in these rule sections annually.  The term "rate year" is already defined in ARM 37.40.302(17) in the definitions section to mean, a 12-month period beginning July 1.  For example, rate year 2006 means a period corresponding to the SFY July 1, 2005 through June 30, 2006.

 

ARM 37.40.325

 

Additionally, the department is proposing to amend (6) to require new Medicaid provider enrollment for any provider change that results in a change in the federal tax identification number.

 

Fiscal Impact

 

The proposed amendments, as mandated in House Bill 2 (HB2), to the above-mentioned rules regarding services provided through the Senior and Long Term Care Division will increase provider rates, and are necessary to implement legislative funding for nursing facility reimbursement for SFY 2014.

The Legislature has provided funding to implement a 2% provider rate increase effective July 1, 2013.  Total funds for this 2% rate increase are $2,840,632.  In addition to the 2% provider rate increase, the Legislature has provided additional funding for nursing facility providers to be used only to raise nursing facility rates for Medicaid services above the level paid in "fiscal year 2012" and may be used only to augment any other rate increase for nursing facility Medicaid services.  This additional provider rate increase totals $2,957,255.

The total state and federal funding available for fiscal year 2014 for rate calculation purposes utilizing the funding in HB2 is currently projected at $145,540,218 which is comprised of $16,694,858 in state special revenue, $32,395,857 in state general funds, and $96,449,503 in federal funds when the provider rate increases are included.  The estimated total funding available for fiscal year 2014 for nursing facility reimbursement is estimated at approximately $179,065,639 of combined state funds, federal funds, including $33,525,421 in patient contributions.  These numbers do not include at-risk provider funds or direct care wage funding.

The additional funding for lump-sum payments to providers for direct-care workers and ancillary staff of $1,344,818 of general funds and $2,636,288 in federal funds for a total appropriation of $3,981,106 for the nursing facility direct care worker wage program is continued.

The estimated total funding impact of the onetime payments to 'at risk' nonstate governmental providers and other nursing facilities not determined to be 'at risk', has been appropriated at $22,651,002 in total funds of which $7,640,183 comes from state special revenue funds and approximately $15,010,819 comes from federal funding sources.

Anticipated days for state fiscal year 2014 are estimated at 1,060,260 using estimates of caseload adopted by the Legislature.  Eighty-one nursing facility providers participated in the Medicaid nursing facility payment program and approximately 4,792 recipients received services in fiscal year 2013 in nursing facilities under Medicaid.

 

            5.  The department intends to adopt these rule amendments effective July 1, 2013.

 

            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: Kenneth Mordan, 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 23, 2013.

 

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.  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 the 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.

 

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

 

 

 

/s/ Valerie A. Bashor                                    /s/ Richard H. Opper                                   

Valerie A. Bashor                                         Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services

           

Certified to the Secretary of State April 15, 2013.

 

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