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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AMENDED NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

1. On April 25, 2013, the Department of Public Health and Human Services published MAR Notice No. 37-635 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 616 of the 2013 Montana Administrative Register, Issue Number 8.

 

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 28, 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 MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

3.  The Department of Public Health and Human Services (the department) is proposing to amend this rulemaking. At the time of the original notice, House Bill 2 (HB2) of the 63rd Montana Legislature was not finalized; therefore, the department was unable to determine the actual rates affecting Medicaid reimbursement.  For this reason, an amended proposed notice is being filed to advise the public of the correct rates affecting Medicaid reimbursement and to extend the comment period for public comment.

 

Governor Bullock originally proposed and supported a 2% provider rate increase for the department. The Legislature included an additional 2% provider rate increase. The Governor vetoed this additional 2% increase and stated that the original 2% increase was a fair and reasonable increase. The "Statement of Reasonable Necessity" in the proposed notice is being amended in this notice to reflect this decision.

 

A typographical error was made in ARM 37.40.307 when numbering the rule in the proposed notice. This is being corrected and is included in this amended notice.

 

            4. The rule as proposed to be amended provides as follows:

 

            37.40.307 NURSING FACILITY REIMBURSEMENT (1) and (2) remain as proposed.

            (3) Providers who, as of July 1 of the rate year, have not filed with the department a cost report covering a period of at least six months participation in the Medicaid program in a newly constructed facility shall have a rate set at the statewide median price as computed on September 1, 2012. Following a change in provider as defined in ARM 37.40.325, the per diem rate for the new provider shall be set at the previous provider's rate, as if no change in provider had occurred.

            (4) through (12) remain as proposed.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

            5. The statement of reasonable necessity from the proposed notice dated April 25, 2013 is being amended as follows, new matter underlined, deleted matter interlined:

 

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 $142,582,963 which is comprised of $16,694,858 in state special revenue, $32,395,857 $31,398,375 in state general funds, and $96,449,503 $94,489,730 in federal funds when the 2% provider rate increases are is included. The estimated total funding available for fiscal year 2014 for nursing facility reimbursement is estimated at approximately $179,065,639 $176,108,384 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 $1,342,827 of general funds and $2,636,288 $2,638,279 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.

 

6. The public comment period has been extended. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, 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 30, 2013. Comments may also be faxed to (406) 444-9744 or e-mailed to dphhslegal@mt.gov.

 

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

Rule Reviewer                                             Richard H. Opper, Director

                                                                        Public Health and Human Services

 

Certified to the Secretary of State May 13, 2013.