Montana Administrative Register Notice 6-205 No. 15   08/08/2013    
    Page No.: 1379 -- 1379
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In the matter of the adoption of NEW RULES I through V pertaining to Patient-Centered Medical Homes






TO: All Concerned Persons


1. On August 29, 2013, at 10:00 a.m., the Commissioner of Securities and Insurance, Montana State Auditor, will hold a public hearing in the 2nd floor conference room, at the Office of the Commissioner of Securities and Insurance, Montana State Auditor (CSI), 840 Helena Ave., Helena, Montana, to consider the proposed adoption of the above-stated rules.


2. The CSI will make reasonable accommodations for persons with disabilities who wish to participate in this public hearing, or need an alternative accessible format of this notice. If you require an accommodation, contact the CSI no later than 5:00 p.m., August 22, 2013, to advise us of the nature of the accommodation that you need. Please contact Darla Sautter, CSI, 840 Helena Avenue, Helena, Montana, 59601; telephone (406) 444-2726; TDD (406) 444-3246; fax (406) 444-3499; or e-mail dsautter@mt.gov.


3. The new rules as proposed to be adopted provide as follows:


            NEW RULE I  PURPOSE  (1) The purpose of these rules is to implement the provisions of the Patient-Centered Medical Homes Act specified in Title 33, Chapter 40.  These rules establish the process under which the commissioner may qualify patient-centered medical homes that meet the standards set forth in the Act and in these rules, acknowledge certain accrediting entities, and provide guidance concerning the activities of the patient-centered medical homes program.


            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA



            (1)  After January 1, 2014, health plans and primary care practices as defined in 33-40-103, MCA, self-funded government plans, Medicaid plans, and other health care providers offering medical services as defined in 33-22-140, MCA, may not offer or identify themselves as a patient-centered medical home or "medical home" unless the participating provider groups are qualified by the commissioner, and the health plan or other payer is utilizing healthcare providers who are qualified when offering "medical home" services to covered individuals under the plan.

            (2)  A primary care practice that is currently operating as a patient-centered medical home must submit an application for qualification by December 1, 2013, if the practice wishes to continue using that designation. Thereafter, any provider seeking to use the patient-centered medical home designation must apply for qualification and receive approval from the commissioner before holding itself out as a patient-centered medical home.

            (3)  The commissioner may provisionally qualify a patient-centered medical home for up to one year after the submission of an application, if the applicant needs additional time to obtain the necessary accreditation.

            (4)  A primary care practice must apply for qualified patient-centered medical home qualification in a form prescribed by the commissioner.

            (5)  The commissioner shall maintain a list of qualified patient-centered medical homes on the agency's web site.


            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA


            NEW RULE III  NATIONAL ACCREDITATION  (1)  A primary care practice that seeks recognition as a patient-centered medical home must obtain accreditation from a nationally recognized accrediting organization approved by the commissioner as meeting the standards of the Montana patient-centered medical home program, including any additional standards adopted in these rules.

            (2)  The commissioner shall approve and maintain a current list of national accrediting organizations that have demonstrated that their standards meet or exceed the required Montana standards for patient-centered medical homes.

            (3)  The commissioner may qualify primary care practices that have obtained the appropriate accreditation as a patient-centered medical home from an accrediting organization approved by the commissioner.

            (4)  Nothing in this rule prevents the commissioner from monitoring and reviewing primary care practices and health plan payers for compliance with these rules and the Patient-Centered Medical Homes Act.


            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA


            NEW RULE IV  ESTABLISHMENT AND DUTIES OF THE PATIENT-CENTERED MEDICAL HOMES STAKEHOLDER COUNCIL  (1)  The stakeholder council consists of 15 members who represent the interested parties identified in 33-40-104, MCA. The commissioner shall appoint members to serve a 12-month term beginning on October 15 of each year, beginning in 2013. Members may be reappointed.

            (2) The commissioner shall consult with the stakeholder council before proposing new administrative rules, setting patient-centered medical home standards that implement, or further define, the standards set forth in 33-40-105, MCA, and establishing the process for qualifying patient-centered medical homes.

            (3) The council shall advise the commissioner regarding activities relating to the promotion and coordination of the patient-centered medical home program in Montana and provide guidance concerning medical home activities.

            (4) The council shall meet at least twice a year. The commissioner, or the commissioner's designee, shall provide updates regarding patient-centered medical home activities at each meeting.

            (5) All stakeholder council meetings are subject to open meeting laws.


            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA


            NEW RULE V  TIMELINES FOR REQUIRED REPORTING  (1)  Pursuant to 33-40-105, MCA, a patient-centered medical home shall report on its compliance with quality and performance measures to participating health plans and other payers and the commissioner, no later than March 31 of each year, beginning with 2015, or according to the timeline required by its contract with each payer, whichever is earlier.

            (2)  A health plan and other payers shall report to the patient-centered medical home and the commissioner regarding their compliance with the uniform set of cost and utilization measures set forth in the Act, these rules, or in the provider/payer contract, no later than March 31 of each year, beginning with 2015, or according to the timeline required by its contract with each patient-centered medical home, whichever is earlier.

            (3)  The commissioner shall share with the public, in the form of a summary report, de-identified, nonconfidential information contained in the reports listed in (1) and (2) at least once a year, beginning in June 2015.


AUTH: 33-40-104 MCA

IMP: 33-40-104, 33-40-105, MCA


            4. STATEMENT OF REASONABLE NECESSITY: The Commissioner of Securities and Insurance, Montana State Auditor, Monica J. Lindeen, (commissioner) is the statewide elected official responsible for administering the Montana Insurance Code and regulating the business of insurance.


Title 33, Chapter 40, The Patient-Centered Medical Homes Act, requires the commissioner to adopt rules. Patient-centered medical homes cannot be qualified until the qualification process is further refined. These rules set forth the specific process for determining patient-centered medical home qualification.


NEW RULE I is necessary to establish a purpose for this new set of administrative rules.


NEW RULE II is necessary to establish which entities may use or continue to use the "patient-centered medical home" or "medical home" designation. It describes the timeline and process for applying for qualification for newly established and preexisting patient-centered medical home practices. The rule allows for provisional qualification in order to give primary care practices time to complete the necessary accreditation process. It requires the commissioner to develop an application form and post a list of qualified medical homes on the agency's web site.


NEW RULE III is necessary to describe how the commissioner will determine which nationally recognized accrediting organizations will be approved by the commissioner as meeting the standards set forth in Chapter 40. In order to accept this type of accreditation process, the commissioner must first ensure that the accrediting organization is meeting all of the standards required by Montana law. The rule allows the commissioner to do independent reviews beyond those required by the accrediting entity, as a cross-check on quality and maintaining standards.


NEW RULE IV is necessary to establish the size, individual terms of service, and meeting times of the stakeholder council. The rules also define when the commissioner must consult with the stakeholder council. This is necessary because the consultation with the interested parties, including the payers and healthcare providers, is critical to the success of the patient-centered medical home program.


NEW RULE V is necessary to set a timeline for the reports that are required in 33-40-105, MCA. The statute does not set forth a timeline for reporting.


            5. Concerned persons may submit their data, views, or arguments concerning the proposed actions either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to Christina L. Goe, General Counsel, Office of the Commissioner of Securities and Insurance, Montana State Auditor, 840 Helena Ave., Helena, Montana, 59601; telephone (406) 444-2040; fax (406) 444-3499; or e-mail cgoe@mt.gov, and must be received no later than 5:00 p.m., September 5, 2013.


            6. Christina Goe, General Counsel, has been designated to preside over and conduct this hearing.


            7. The CSI maintains a list of concerned 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 and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Such written request may be mailed or delivered to Darla Sautter, Office of the Commissioner of Securities and Insurance, Montana State Auditor, 840 Helena Ave., Helena, Montana, 59601; telephone (406) 444-2726; fax (406) 444-3499; or e-mail dsautter@mt.gov, or may be made by completing a request form at any rules hearing held by the CSI.


            8. 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.


            9. Pursuant to 2-4-302, MCA, the bill sponsor contact requirements apply. Christine Kaufmann is the bill sponsor, and she was contacted by e-mail on July 23, 2013, by phone message on July 23, 2013, and by letter sent July 26, 2013.


            10. The proposed rule does not and cannot be applied directly to small businesses; therefore, the requirements of Chapter 318, Section 1, Laws of 2013 do not apply.


            /s/ Brett O'Neil                                   /s/ Jesse Laslovich            

            Brett O'Neil                                       Jesse Laslovich

            Rule Reviewer                                   Chief Legal Counsel


            Certified to the Secretary of State July 29, 2013.



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