Montana Administrative Register Notice 37-772 No. 19   10/14/2016    
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In the matter of the amendment of ARM 37.86.2928 pertaining to inpatient hospital reimbursement






TO: All Concerned Persons


          1. On November 3, 2016, at 1:30 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 rule.


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 October 26, 2016, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:



          (3) Part 2 of the HRA payment will be based upon total hospital Medicaid charges, and will be computed as follows: HRA2 = (I ÷ D) x P.

          (a) remains the same.

          (b) The numbers used in (2) through (3)(a)(iv) must be from the department's paid claims data from for the most recent calendar year that ended at least 12 months prior to the calculation of the HRA payments.

          (c) remains 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, 53-6-149, MCA




The Department of Public Health and Human Services (department) is proposing amendments to ARM 37.86.2928.


In 2015, the Montana Legislature passed Senate Bill 405 enacting the Montana Health and Economic Livelihood Partnership (HELP) Program.  The HELP Program, which began on January 1, 2016, expanded Medicaid health insurance coverage in Montana to adults with incomes up to 138 percent of the federal poverty level. 


The proposed rule amendment provides that Medicaid paid claims data from the most recent calendar year must be used to calculate HRA payments. The amendment is necessary so that paid claims data from the first year of the HELP Program will be included in the next HRA methodology calculation. Under the terms of the existing rule, the 2016 paid claims data from the HELP plan could not be used to calculate HRA payments.


ARM 37.86.2928


The proposed amendment will revise the period in which paid claims data will be retrieved from to calculate hospital reimbursement adjustor (HRA) payments.


Fiscal Impact


The proposed amendment will not have a state fiscal impact.


          5. The department intends to adopt these rule amendments effective January 1, 2017.


          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., November 11, 2016.


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 rule will not significantly and directly impact small businesses.


12. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.


The department has determined that the proposed program changes presented in this notice are appropriate for performance-based measurement and therefore are subject to the performance-based measures requirement of 53-6-196, MCA.


The department will monitor and compare hospital utilization prior to and after the implementation of the HELP Act to determine if the HELP Act had a direct relation to hospital utilization.




/s/ Brenda K. Elias                                 /s/ Richard H. Opper                            

Brenda K. Elias, Attorney                       Richard H. Opper, Director

Rule Reviewer                                        Public Health and Human Services



Certified to the Secretary of State October 3, 2016.


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