Montana Administrative Register Notice 6-220 No. 20   10/29/2015    
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In the matter of the amendment of ARM 6.6.4907 pertaining to Patient-Centered Medical Homes







TO: All Concerned Persons


1. On November 24, 2015, 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 amendment of the above-stated rule.


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., November 17, 2015, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:


6.6.4907 PATIENT-CENTERED MEDICAL HOME REPORTING--SPECIFIC QUALITY MEASURES REQUIRED (1) A qualified or provisionally qualified patient-centered medical home (PCMH) shall report annually to the commissioner on its performance related to certain standards and health care quality measures, as prescribed by the commissioner. A PCMH health care provider that provides care to adults only, or both children and adults, shall choose at least three of the four five quality measures listed in (2)(3)(a) through (d)(e) to report to the commissioner. A PCMH health care provider that provides care only to children shall choose only the child immunization performance measure in (2)(c). A PCMH shall choose four out of five measures for the 2016 reporting year, for the report due in March 2017.

(2) A PCMH health care provider that provides care only to children, referred to as a pediatric practice, shall choose at least the child immunization performance measure in (3)(c). Reporting on depression screening in (3)(e) is optional for pediatric practices until the 2017 reporting year, for the report due in March 2018. At that time, all pediatric clinics shall report on both the depression and immunization measures.

(2) and (2)(a) remain the same but are renumbered (3) and (3)(a).

(b) screening for tobacco use and tobacco cessation intervention counseling for adults;

(c) age appropriate immunization for children who turned age three during the reporting year; and

(d) poor control of A1C levels in adults with diagnosed diabetes; and

(e) screening for clinical depression and follow-up plan for individuals age 12 and older.

(3) remains the same but is renumbered (4).

(4)(5) A PCMH health care provider may not change the reporting measures the provider chooses chose for the 2014 reporting year until after the end of the 2016 reporting year for the report due in March of 2017, or until otherwise instructed by the commissioner. However, a provider may report on additional measures at any time.

(5) remains the same but is renumbered (6).

(6)(7) The commissioner shall provide detailed instructions on the agency web site for reporting by qualified and provisionally qualified PCMHs on the quality measures described in (2)(3). Date reporting requirements must be aligned with the federal Physician Quality Reporting System (PQRS), except for childhood immunizations, and the instructions provided on the commissioner's web site.

(7)(8) The report referenced in ARM 6.6.4906 is separate from the report required for the quality measures in (2)(3).

(8) remains the same, but is renumbered (9).

(9)(10) Payers who choose to participate in the Montana PCMH program, and who use require reporting on quality measures in their contract with PCMH health care providers reporting in their payment model shall include, but are not limited to, the four measures specified in (2). Those payers must also use the same data reporting requirements prescribed by the commissioner, if the payer collects data on the measures described in (3).


AUTH: 33-40-104, MCA

IMP: 33-40-104, 33-40-105, MCA


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


          Amendments to ARM 6.6.4907 are proposed for the purpose of adding clarity to the existing rule language and to add one new quality measure: depression screening. The PCMH stakeholder council and other interested parties discussed the importance of adding the depression screening measure to the rule for several months. The stakeholders and the commissioner believe that need for increased mental health services is very significant in Montana and that depression screening during primary care visits is a significant step towards improving outcomes. As the PCMH program evolves, it is necessary to add new measures from time to time in order to expand and improve the outcome reporting necessary to evaluate the success of this program with regard to improving health outcomes for the citizens of this state. These rules must include specific guidance for patient-centered medical homes regarding the "uniform set of health care quality and performance measures that include prevention services," as required by 33-40-105(2)(c), MCA. This new measure is specifically aligned with the PQRS reporting measure for depression screening because most health care providers already report on PQRS measures. Aligning the PCMH data reporting with PQRS measures will reduce data reporting burdens and complications. Furthermore, reporting on this measure is not required until March of 2017 in order to give the PCMHs additional time to prepare for reporting on this measure.


          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 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) 444-5223; or e-mail cgoe@mt.gov, and must be received no later than 5:00 p.m., December 2, 2015.


          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. 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 Darla Sautter using the contact information in 2 above, 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 May 9, 2014, with a previous filing, and contacted again on October 14, 2015, by e-mail.


          10. ECONOMIC IMPACT STATEMENT: The CSI has complied with the requirements of 2-4-111, MCA, and determined that the amendments to ARM 6.6.4907 will not have a significant adverse impact on small businesses. The reporting requirement discussed in ARM 6.6.4907 already exists under 33-40-105, MCA. The amendments and additions to ARM 6.6.4907 further clarify the health care quality and performance measures that are subject to that requirement, and the timeline for reporting the data. Additionally, the affected parties already report the quality measures in ARM 6.6.4907 to other entities. Thus, the amendments to ARM 6.6.4907 do not require the parties to collect and collate substantial amounts of additional information.



          /s/ Nick Mazanec                         /s/ Christina L. Goe                   

          Nick Mazanec                             Christina L. Goe

          Rule Reviewer                            General Counsel


          Certified to the Secretary of State October 19, 2015.


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