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, 37.40.337, and 37.40.361 pertaining to nursing facility reimbursement
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On June 3, 2015, at 3:00 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 the Department of Public Health and Human Services no later than 5:00 p.m. on May 27, 2015, 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:
37.40.307 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
July 1, 2014 July 1, 2015 through June 30, 2015 June 30, 2016 will be the rate as computed in (2), plus any additional amount computed in ARM 37.40.311 and 37.40.361.
(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 will have a rate set at the statewide median price as computed on
July 1, 2014 July 1, 2015. Following a change in provider as defined in ARM 37.40.325, the per diem rate for the new provider will be set at the previous provider's rate, as if no change in provider had occurred.
(4) through (11) remain the same.
(12) Payments provided under this rule are subject to all limitations and cost settlement provisions specified in applicable laws, regulations, rules, and policies. All payments or rights to payments under this rule are subject to recovery or nonpayment, as specifically provided in these rules.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-6-101, 53-6-111, 53-6-113, MCA
37.40.337 REIMBURSEMENT TO OUT-OF-STATE FACILITIES
(1) and (2) remain the same.
(3) To receive payments, the out-of-state provider must enroll in the Montana Medicaid program. Enrollment information and instructions may be obtained from the department's fiscal intermediary,
ACS XEROX, at P.O. Box 4286 4936, Helena, MT 59604-4286 59604-4936.
(4) and (5) 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
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 the period
July 1, 2014 July 1, 2015 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 will 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
July 1, 2014 July 1, 2015, 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) To receive the direct care and/or ancillary services workers' lump sum payment, a nursing facility
shall must submit for approval a request form to the department stating how the direct care and ancillary services workers' lump sum payment will be spent in the facility to comply with all statutory requirements. The facility shall must submit all of the information required on a form to be developed by the department in order to continue to receive subsequent lump sum payment amounts for the entire rate year. The form for wage and benefit increases will request information including, but not limited to:
(i) through (c)(iv) remain the same.
(d) A facility that does not submit a qualifying request for use of the funds distributed under (2), that includes all of the information requested by the department, within the time established by the department, or a facility that does not wish to participate in this additional funding amount
shall will not be entitled to their share of the funds available for wage and benefit increases or lump sum payments for direct care and ancillary services workers.
(3) A facility that receives funds under this rule must maintain appropriate records documenting the expenditure of the funds. This documentation must be maintained and made available to authorized governmental entities and their agents to the same extent as other required records and documentation under applicable Medicaid record requirements, including, but not limited to, the provisions of ARM 37.40.345, 37.40.346, and 37.85.414.
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 the amendment of ARM 37.40.307, 37.40.337, and 37.40.361 pertaining to implementing Medicaid nursing facility reimbursement for state fiscal year (SFY) 2016.
The 64th Montana Legislature has provided funding to implement an increase in Medicaid provider rates using state and federal funds. $3,013,774 is the amount that equates to the provider rate increase in the Nursing Facility Program. This increase is funded by House Bill 2 (HB2) of the 64th Montana Legislature. The increase is necessary to maintain Medicaid provider rates at a level consistent with efficiency, economy, quality of care, and to assure the continued participation of providers.
These rules continue the methodology for 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 2016. 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 fiscal year 2016.
New funding has been appropriated to provide for an additional rate increase for wages and benefits to provide up to a 25-cent hourly increase in combined wages and benefits for direct-care workers in fiscal year 2016.
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 2016.
The department will provide rate sheets to all providers in advance of the rule hearing for verification purposes and in order to facilitate comments. 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 is proposing to amend (2)(d) and (3) by changing the fiscal year to the current fiscal year of 2016.
The department is proposing to amend the reference to ACS in (3) to XEROX and to update the post office box number.
The department is proposing to amend (1) and (2)(a) by changing the fiscal year to the current fiscal year of 2016.
The total state and federal funding available for SFY 2016 for rate calculation purposes utilizing the funding in HB2 is currently projected at $143,351,129 which is comprised of $15,704,708 in state special revenue, $34,050,761 in state general funds, and $93,595,660 in federal funds when the provider rate increases are included.
The ongoing funding for lump-sum payments to providers for direct care workers and ancillary staff consists of $1,342,827 of state general funds and $2,638,279 in federal funds for a total appropriation of $3,981,106 for the nursing facility direct care worker wage program.
New funding was provided for direct care worker wages for the purpose of providing a rate increase for wages and related benefits or to provide lump-sum payments to workers who provide direct care and ancillary services in the nursing facility program. The increase will provide up to a 25-cent hourly increase in combined wages and benefits in fiscal year 2016. The total funding provided for this purpose is $1,502,478 with $981,118 coming from federal funds and $521,360 from general fund dollars.
The estimated total funding available for SFY 2016 for nursing facility reimbursement is estimated at approximately $175,879,240 of combined state and federal funds, including $32,528,111 of patient contributions. These numbers do not include at-risk provider funds or direct care wage funding.
Anticipated days for SFY 2016 are 1,018,413 using estimates of caseload adopted by the Montana Legislature.
The estimated total funding impact of the one-time payments to "at-risk" nonstate governmental providers and other nursing facilities not determined to be "at risk," has been appropriated at $19,006,657 in total funds of which $6,737,566 comes from state special revenue funds and approximately $12,269,091 comes from federal funding sources.
Eighty-two nursing facility providers participated in the Medicaid nursing facility payment program and approximately 5,016 recipients received services in nursing facilities under Medicaid.
The analysis of Medicaid nursing facility rates that is annually conducted by Myers and Stauffer, LC shows that in SFY 2014 (report dated 2/3/2015) Montana Medicaid on average is reimbursing 95.65% of the cost of providing nursing facility services. The department considered the impact of the rate changes on efficiency, economy, quality of care, and access to Medicaid services and concluded that the rates are still sufficient to meet the requirements of 42 USC 1396a (a) (30)(A).
5. The department intends to adopt these rule amendments effective July 1, 2015.
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 firstname.lastname@example.org, and must be received no later than 5:00 p.m., June 11, 2015.
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/ Valerie A. Bashor /s/ Mary E. Dalton acting for
Valerie A. Bashor, Esq. Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 4, 2015.