BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.85.403 and 37.86.2907 pertaining to date changes to ICD CM and PCS Services-ICD-10
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On August 27, 2014, at 1:30 p.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 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 August 20, 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 email@example.com.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.85.403 ICD CLINICAL MODIFICATION (CM) AND PROCEDURAL CODING SYSTEM (PCS) SERVICES (1) The department adopts and incorporates by reference the Diagnosis coding practice of International Classification of Diseases (ICD) published by the World Health Organization. The ICD is used as a health care classification system for diseases and health conditions.
(a) For dates of service on or before
September 30, 2014 September 30, 2015 , the ICD edition being utilized will be the ninth revision (ICD-9) to code the diagnosis of services.
(b) For dates of service
October 1, 2014 October 1, 2015 and thereafter the ICD edition being utilized will be the tenth revision (ICD-10) to code the diagnosis of services. ICD-10 consists of the following codes sets:
(i) and (ii) remain the same.
(c) For inpatient claims with a discharge date on or after
October 1, 2014 October 1, 2015 , the tenth revision (ICD-10) must be utilized.
(d) remains the same.
(e) Per 45 CFR 162.1002, ICD-10 will replace ICD-9 for dates of service
October 1, 2014 October 1, 2015 and after. A copy of the ICD codes may be obtained at http://www.medicalcodingbooks.com/.
AUTH: 53-2-201, 53-6-101, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-113, MCA
37.86.2907 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION (1) The department's APR-DRG prospective payment rate for inpatient hospital services is based on the classification of inpatient hospital discharges to APR-DRGs. The provider reimbursement rates for inpatient hospital services, except as otherwise provided in ARM 37.85.206, is stated in the department's APR-DRG fee schedule adopted and effective at ARM 37.85.105. The procedure for determining the APR-DRG prospective payment rate is as follows:
(a) The department will assign an APR-DRG to each Medicaid client discharge in accordance with the current APR-grouper program version, as developed by 3M Health Information Systems. The assignment and reimbursement of each APR-DRG is based on:
(i) the ICD-9-CM principal diagnoses for dates of discharge prior to and including
September 30, 2014 September 30, 2015 , and the ICD-10-CM principal diagnoses for dates of discharge October 1, 2014 October 1, 2015 and thereafter;
(ii) all ICD-9-CM secondary diagnoses for dates of discharge prior to and including
September 30, 2014 September 30, 2015 , and the ICD-10-CM secondary diagnoses for dates of discharge October 1, 2014 October 1, 2015 and thereafter;
(iii) all ICD-9-CM medical procedures performed during the client's hospital stay for dates of discharge prior to and including
September 30, 2014 September 30, 2015 , and the ICD-10-PCS medical procedures performed during the client's hospital stay for dates of discharge October 1, 2014 October 1, 2015 and thereafter;
(iv) through (2) remain the same.
AUTH: 2-4-201, 53-2-201, 53-6-113, MCA
IMP: 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
4. STATEMENT OF REASONABLE NECESSITY
The International Classification of Disease (ICD) is a set of codes published by the World Health Organization (WHO). In 1990 the WHO updated the ICD code set creating the tenth edition (ICD-10); other countries began adopting this code set in 1994. The transition from ICD-9 to ICD-10 for the U.S. is covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under previous enactments the department was required to implement ICD-10 October 1, 2014. The department adopted the current rule under this law; however, implementation has been postponed by Congress. All covered entities under HIPAA are now required to adopt the new ICD-10 codes for services provided on or after the compliance date of October 1, 2015.
The Department of Public Health and Human Services (the department) is proposing amendments to delay the implementation of ICD-10 in ARM 37.85.403 and 37.86.2907.
ARM 37.85.403 and 37.86.2907
Within the current rules the description of ICD is listed as the ninth revision (ICD-9). With the proposed amendments to ARM 37.86.2907 and ARM 37.85.403 the ICD language will be updated to include the effective date as well as clarification of the ICD-9 effective dates.
The implementation of ICD-10 is required for all covered entities under HIPAA. The fiscal impact on a provider practice can vary based on the size of the practice and the amount of changes to the business operations that are necessary. The estimated costs can be anywhere from $83,290 up to $2,728,780. However, this cost will be amortized over the provider's practice, because all insurers who must be HIPAA-compliant will be using the ICD-10 codes.
5. 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 firstname.lastname@example.org, and must be received no later than 5:00 p.m., September 4, 2014.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. 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 5 above or may be made by completing a request form at any rules hearing held by the department.
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. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
10. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will 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 July 28, 2014.