Montana Administrative Register Notice 37-676 No. 8   04/24/2014    
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In the matter of the amendment of ARM 37.86.4202 and 37.86.4205 pertaining to dialysis clinic method of reimbursement







TO: All Concerned Persons


            1. On May 16, 2014, 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 9, 2014, 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:


            37.86.4202 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REQUIREMENTS (1) These requirements are in addition to those contained in ARM 37.85.401, 37.85.402, 37.85.406, 37.85.407, 37.85.410, 37.85.414, and 37.85.415 and 46.12.314.

            (2) and (3) remain the same.


AUTH: 53-6-113, MCA

IMP:     53-6-101, MCA


            37.86.4205 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REIMBURSEMENT (1) Reimbursement for outpatient maintenance dialysis and other related services provided in a dialysis clinic to include the bundled Medicare composite rate is effective as provided in ARM 37.85.105(3). The department will not allow add-on adjustments to the composite rate.


AUTH: 53-6-113, MCA

IMP:     53-6-101, MCA




The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.86.4202 and 37.86.4205 regarding Medicaid Dialysis clinic services.


The purpose of the proposed rule amendments is to update the current administrative rules governing dialysis clinics and incorporate the reimbursement methodology changes mandated by the Centers for Medicare and Medicaid Services (CMS).


The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires CMS to implement a bundled prospective payment system (PPS) for providers of renal dialysis facility services.  Medicaid proposes to use the Medicare composite payment rate methodology instead of the composite rate payment currently in use.  This change will meet the Upper Payment Limit (UPL) requirements proposed by CMS.


The proposed amendments are necessary to maintain continued compliance with CMS requirements for Medicaid participation.  It will maintain Medicaid rates at a level consistent with efficiency, economy and quality of care, and will ensure the continued participation of providers.


ARM 37.86.4202


The department is proposing to remove the citation to ARM 46.12.314 because it does not pertain to this rule. The inclusion of ARM 46.12.314 appears to be a clerical mistake.


ARM 37.86.4205


The department is proposing to pay dialysis claims at the Medicare composite rate as instructed by CMS.  This will meet the upper payment limit requirements.  Current composite rate payments are identified in the Medicaid Management Information System (MMIS) on the provider charge file.


            5. The department intends to adopt these rule amendments effective July 1, 2014.


            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 28, 2014.


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.


11. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.



/s/ John C. Koch                                          /s/ Richard H. Opper                                   

John C. Koch                                               Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services


Certified to the Secretary of State April 14, 2014.



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