BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.86.1806 pertaining to updating durable medical equipment rules to reflect a sole-source provider for the purchase of breast pumps
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On June 29, 2017, 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 June 21, 2017, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
37.86.1806 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, REIMBURSEMENT REQUIREMENTS
(1) through (6) remain the same.
(7) Purchased breast pumps are paid by the department through a single-volume purchase contract.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113,
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing to amend ARM 37.86.1806 by updating the reimbursement requirements to reflect a single-volume purchase contract for purchased breast pumps.
After analysis and review of the current in-state durable medical equipment (DME) providers that supply either a rental or purchase of breast pumps, Montana Medicaid has decided to do a single-volume purchase contract, through the competitive bidding process, due to the limited number of providers. This would allow a greater access to Montana Medicaid members. The competitive bidding process has been started, but will not be completed until Centers for Medicare & Medicaid Services (CMS) approval.
Montana Medicaid has incorporated a single-volume purchase contract into ARM 37.86.1806, because it is necessary for the department to reflect compliance with the Affordable Care Act (ACA). The ACA requires all new health plans to follow the Health Resources and Services Administration (HRSA) guidelines regarding women's health. It is also necessary for these proposed amendments to ensure Montana Medicaid members have the proper access to breast pumps, which promotes and provides support for breastfeeding, and improves women's health.
The department estimates the adoption of a single-volume purchase provider under the durable medical equipment (DME) program for purchased breast pumps will affect three enrolled small business DME providers. These providers who currently provide rented breast pumps will have a direct impact unless they are awarded the single-volume purchase provider contract. The department expects the reimbursement to these providers to be reduced by an estimated average of $268.75 in total funds.
The department is amending this rule by adding a new (7) that states purchased breast pumps will be paid by the department through a single-volume purchase contract.
Based on the proposed amendments, the fiscal impact to state general funds for state fiscal year (SFY) is $173,671.
The proposed amendment is estimated to affect 69,947 members. The number of providers affected is nine.
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., July 7, 2017.
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 rule will significantly and directly impact small businesses.
11. 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 not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.
/s/ Brenda K. Elias /s/ Sheila Hogan
Brenda K. Elias Sheila Hogan, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 30, 2017.