Montana Administrative Register Notice 37-793 No. 19   10/13/2017    
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In the matter of the adoption of New Rules I, II, and III and the amendment of ARM 37.86.4412 pertaining to the promising pregnancy care program






TO: All Concerned Persons


1. On May 12, 2017 the Department of Public Health and Human Services published MAR Notice No. 37-793 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 595 of the 2017 Montana Administrative Register, Issue Number 9.


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 20, 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 MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.


3.  Subsequent to filing the proposal notice, the department determined the statement of reasonable necessity did not adequately explain the reasonable necessity of promulgating new rules establishing the Promising Pregnancy Care program. 


4. The statement of reasonable necessity is being amended as follows, new matter underlined, deleted matter interlined:


The Department of Public Health and Human Services (department) is proposing new rules regarding the Promising Pregnancy Care program. The new rules outline the definitions, general provisions, and reimbursement requirements for the department’s group prenatal program, Promising Pregnancy Care. The department is also proposing amendments to ARM 37.86.4412 regarding Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) and long-acting reversible contraceptives (LARCs).


The new rules are necessary to establish the Promising Pregnancy Care program, an evidence-based health care delivery system that combines prenatal visits with group education sessions. The department is establishing the program to improve health outcomes for Montana Medicaid members. The goal of the program is to reduce the incidence of preterm birth in Montana and improve health outcomes for mothers and babies. Studies have shown that pregnant women who participate in group education during their pregnancy are 33 percent less likely to deliver a preterm infant. The program is also intended to result in cost savings for the Montana Medicaid Program, which pays for 45 percent of all births in Montana.


New Rule I


Proposed New Rule I provides a set of definitions for principal terms appearing in the proposed rule. Definitions are an essential feature of understanding the meaning of written text. The department determined that a comprehensive presentation of the definitions in one rule is the most appropriate practice and is essential to the implementation of the new rules.


New Rule II


Proposed New Rule II provides the department's requirements for a Promising Pregnancy Care (PPC) program. This rule specifies the topics that must be presented to members and it requires that providers commit to sharing data related to their pregnant Medicaid members, even if they are not enrolled in the providers PPC program. All providers who seek reimbursement for the PPC program must be state approved.


New Rule III


Proposed New Rule III outlines the reimbursement policy for the new Promising Pregnancy Care program. Providers will be reimbursed for the group sessions in addition to the individual prenatal visit.


Fiscal Impact


The proposed rule adoption is projected to have a total fiscal impact of $42,000 in SFY2018. $14,499 of this impact is from the state general fund. This rule will impact 45 FQHCs, 28 RHCs, 330 physicians, and 69,947 Medicaid members.


ARM 37.86.4412


The department is proposing to make two amendments to this subsection of rule. In (7), the proposed amendment will allow an enhanced prospective payment system (PPS) rate for approved FQHCs and RHCs that participate in Promising Pregnancy Care. The proposed amendment provides an avenue for FQHCs and RHCs to receive payment for the educational portion of the new Promising Pregnancy Care program.


The department is proposing to add a new (8) which allows a separate reimbursement for LARCs in addition to the PPS rate. This proposed change is necessary to increase access to LARCs for the Medicaid population.


Fiscal Impact


The proposed amendment is budget neutral.


5. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on October 27, 2017. Comments may also be faxed to (406) 444-9744 or e-mailed to dphhslegal@mt.gov



/s/ Brenda K. Elias                                       /s/ Marie Matthews for                                

Brenda K. Elias                                            Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services


Certified to the Secretary of State October 2, 2017.

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