Montana Administrative Register Notice 37-789 No. 18   09/22/2017    
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In the matter of the amendment of ARM 37.40.307, 37.40.311, 37.40.337, and 37.40.361 pertaining to revising nursing facility reimbursement rates for state fiscal year 2018






TO: All Concerned Persons


1. On July 21, 2017, the Department of Public Health and Human Services published MAR Notice No. 37-789 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1121 of the 2017 Montana Administrative Register, Issue Number 14.


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


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


Comment 1: Several comments were received expressing that the rule amendment fully implements House Bill (HB) 618 (2017) and are in support of the proposed rule amendment.


Response 1: The department thanks the respondents for their support of the proposed rule amendments.


Comment 2: Several comments were received that the intent of HB 618 is to cover the cost of implementing new federal regulations.


Response 2: The department thanks the commenters and notes that federal regulations are not within the state's control.


Comment 3: One comment stated the proposed rate does not cover nursing facilities' costs.


Response 3: The department thanks the commenter for expressing their concern and agrees that the nursing facility rate does not cover costs. Medicaid nursing facility rates are calculated utilizing a case-mix price-based system. Federal laws or regulations do not mandate that established Medicaid rates must cover all of the actual costs incurred by nursing facility providers.  This is not a standard by which the legal adequacy of rates has been measured in the past nor is it the standard that will be utilized in the future. Factors that are considered in the establishment of this price include the cost of providing nursing facility services, Medicaid recipient's access to nursing facility services, and the quality of nursing facility care as well as budgetary or funding levels.


Comment 4:  One commenter expressed concern that HB 618 was created without the knowledge of Senate Bill (SB) 261 (2017).


Response 4: The department thanks the commenter for expressing their concern and notes that the enactment of legislation is the responsibility of the Montana Legislature. The department was not asked to assist in the drafting of HB 618 or SB 261.


Comment 5: Several comments thanked the department for splitting the rate changes into two proposed rules.


Response 5: The department thanks the respondents for their support.


Comment 6: Several comments supported the direct care wage distributions appropriated by the Legislature.


Response 6: The department concurs with these comments and will continue to implement the direct care wage funding for nursing facility direct care workers.


            4. The department intends to apply these rule amendments retroactively to July 1, 2017. A retroactive application of the proposed rule amendments does not result in a negative impact to any affected party.



/s/ Caroline Warne                                       /s/ Sheila Hogan                                         

Caroline Warne                                           Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services


Certified to the Secretary of State September 11, 2017.


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