BEFORE THE DEPARTMENT OF LABOR AND INDUSTRY

OF THE STATE OF MONTANA

 

In the matter of the amendment of ARM 24.29.1433, 24.29.1534, and 24.29.1538 pertaining to workers' compensation facility service rules and rates and conversion factors

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NOTICE OF AMENDMENT

 

TO: All Concerned Persons

 

            1. On April 14, 2017, the Department of Labor and Industry (department) published MAR Notice No. 24-29-322 regarding the public hearing on the proposed amendment of the above-stated rules, at page 399 of the 2017 Montana Administrative Register, Issue No. 7.

 

            2. On May 5, 2017, a public hearing was held on the proposed amendment of the above-stated rules in Helena. No members of the public commented on the proposed amendments at the public hearing, but members of the public commented during the rule comment period.

 

            3. The department has thoroughly considered the comments received. A summary of the comments received and the department's responses are as follows:

 

COMMENT 1: A commenter asked the department to allow an ambulatory surgery center to perform certain inpatient surgical procedures in an outpatient setting. The commenter noted that some commercial insurance carriers are authorizing and paying for some of the procedures to be performed in an outpatient setting. The commenter provided a list of 20 procedure codes that it contends can be safely performed in an outpatient setting, and asked for those procedures to be allowed by department rule to be performed by an ambulatory surgical center.

 

RESPONSE 1: The department is constrained by the provisions of 39-71-704(2)(c), MCA, to follow various standards adopted by the Centers for Medicare and Medicaid Services (CMS), regardless of where those services are provided. CMS makes the determination in those standards, based on its data, as to which surgical procedures must be performed only in an inpatient setting, and which procedures may be performed in either an inpatient setting or an outpatient setting. CMS, in its procedure coding and relative value units, does not provide for any of the 20 procedures identified by the commenter to be performed in an outpatient setting. The department therefore concludes that it does not have the discretion to modify the rule as requested by the commenter.

 

COMMENT 2:  A commenter expressed support for the proposed changes.

 

RESPONSE 2:  The department appreciates all comments received during the rulemaking process.

 

            4. The department has amended the above-stated rules exactly as proposed.

 

/s/ MARK CADWALLADER Mark Cadwallader Alternate Rule Reviewer

/s/ PAM BUCY Pam Bucy, Commissioner DEPARTMENT OF LABOR AND INDUSTRY

 

            Certified to the Secretary of State May 30, 2017.