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Montana Administrative Register Notice 37-833 No. 3   02/09/2018    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.5102 and 37.86.5112 and the repeal of ARM 37.86.5201, 37.86.5202, 37.86.5204, 37.86.5205, and 37.86.5206 pertaining to passport to health program updates and the repeal of health improvement program rules

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT AND
REPEAL

 

TO: All Concerned Persons

 

            1. On March 2, 2018, at 1:00 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 and repeal of the above-stated rules.

 

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 February 21, 2018, 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 rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.86.5102 PASSPORT TO HEALTH PROGRAM: DEFINITIONS

            (1) through (7) remain the same.

            (8) "Ineligible" means a Medicaid member who is not eligible to participate in a managed care program, such as the Passport Program, but is eligible for regular Medicaid. The following categories of members are ineligible for the Passport Program:

            (a) through (e) remain the same.

            (f) eligible for pregnancy Medicaid foster care;

            (g) and (h) remain the same.

            (i) eligible for Plan First; and

            (j) receiving Medicaid under a presumptive eligibility program. ; and

            (k) eligible for the Breast and Cervical Cancer program.

            (9) through (16) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-113, 53-6-116, MCA

 

            37.86.5112 PASSPORT TO HEALTH PROGRAM: REIMBURSEMENT

            (1) Reimbursement for primary care case management services is $3.00 a month for each enrollee as follows:

(a)  $3.00 per enrollee per month for individuals categorically eligible for Aged, Blind, Disabled and Medically Frail Medicaid; or

            (b)  $1.00 per enrollee per month for all others who are members of Passport eligible populations.

            (2) through (4) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-116, MCA

 

4. The department proposes to repeal the following rules:

 

37.86.5201 HEALTH IMPROVEMENT PROGRAM: DEFINITIONS is found on page 37-21255 of the Administrative Rules of Montana.

 

AUTH:  53-6-101, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, MCA

 

37.86.5202 HEALTH IMPROVEMENT PROGRAM: GENERAL is found on page 37-21256 of the Administrative Rules of Montana.

 

AUTH:  53-6-101, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, MCA

 

37.86.5204 CRITERIA FOR DETERMINING MEDICAID AND HEALTHY MONTANA KIDS PLUS (HMK PLUS) ELIGIBLE INDIVIDUALS MANAGED UNDER THE HEALTH IMPROVEMENT PROGRAM is found on page 37-21259 of the Administrative Rules of Montana.

 

AUTH:  53-6-101, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, MCA

 

37.86.5205 HEALTH IMPROVEMENT PROGRAM: CLIENT ELIGIBILITY AND ASSIGNMENT is found on page 37-21261 of the Administrative Rules of Montana.

 

AUTH:  53-6-101, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, MCA

 

37.86.5206 HEALTH IMPROVEMENT PROGRAM: SCOPE OF SERVICES AND REIMBURSEMENT is found on page 37-21262 of the Administrative Rules of Montana.

 

AUTH:  53-6-101, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, MCA

 

            5. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) is proposing to amend ARM 37.86.5102 and 37.86.5112 and the repeal of ARM 37.86.5201, 37.86.5202, 37.86.5204, 37.86.5205, and 37.86.5206.

 

In November of 2017, the governor called a special session to address the state budget, which had experienced revenue shortfalls combined with high fire season expenditures. The governor and the legislature worked together to reach a compromise to bring the budget into balance. That compromise included a number of proposed spending reductions for all state agencies and included a $49 million reduction in general fund dollars to the department's budget for the 2018-2019 biennium.

 

The rule amendments in this notice are proposed as part of spending reductions under 17-7-140, MCA, which ensures the expenditure of appropriations does not exceed available revenue. The proposed rule amendments include program eliminations and reductions in rates and services. In proposing the rates of reimbursement in this rule notice, the department primarily considered the availability of appropriated funds, as provided in 53-6-113(3), MCA. In considering service reductions proposed in this rule notice, the department considered the factors set forth in 53-6-101, MCA as follows:

 

a. protecting those persons who are most vulnerable and most in need, as defined by a combination of economic, social, and medical circumstances;

 

b. giving preference to the elimination or restoration of an entire Medicaid program or service, rather than sacrifice or augment the quality of care for several programs or services through dilution of funding; and

 

c. giving priority to services that employ the science of prevention to reduce disability and illness, services that treat life-threatening conditions, and services that support independent or assisted living, including pain management, to reduce the need for acute inpatient or residential care.

 

In this notice, the Health Resources Division (HRD) proposes to update the list of ineligible populations for the Passport to Health Program, revise the monthly primary care management rates for Passport, and repeal rules for the Health Improvement Program (HIP). In place of HIP, the department will be implementing a new Complex Care Management Program with Patient Centered Medical Home (PCMH) providers that will provide specialized care management for members with complex needs. This new program will be implemented within the PCMH provider contracts and is not reflected in this rule notice.

 

The following summaries describe in detail the changes that will be made:

 

ARM 37.86.5102

 

In ARM 37.86.5102(8), the department will revise the list of ineligible populations for Passport. Foster care will be removed from the list, which will allow children in foster care to receive Passport services. Pregnancy Medicaid and Breast and Cervical Cancer populations will be added to the list of ineligible populations because enrollees in those populations receive specialized services from medical specialists, and they should not have to get referrals through the Passport program to see those specialists. Enrollees in those populations may later become eligible for the Passport program after their eligibility category changes – when the pregnancy ends or cancer treatment is completed.

 

ARM 37.86.5112

 

In ARM 37.86.5112(1), the department will reduce provider reimbursement from $3.00 to $1.00 per enrollee per month for primary care case management services for most Passport eligible populations. However, reimbursement for members who are categorically eligible for Aged, Blind, Disabled and Medically Frail Medicaid will remain $3.00 per member per month. Members determined categorically eligible for Aged, Blind, Disabled and Medically Frail Medicaid typically have more healthcare needs and could benefit the most from care coordination through the Passport program. All other Passport eligible populations are typically healthy and need access to a health home but require less care coordination.

 

ARM 37.86.5201, 37.86.5202, 37.86.5204, 37.86.5205, and 37.86.5206

 

The department proposes to repeal rules relating to the Health Improvement Program and eliminate HIP. The department is expanding the Patient Centered Medical Home (PCMH) model and will transition HIP to the new Complex Care Management program, which will be part of the PCMH contracts. Providers who currently participate in HIP may be eligible to enter into PCMH contracts with the department, if the providers choose to do so.

 

Fiscal Impact

 

The proposed changes will result in a total projected cost savings in state and federal funds of $3,336,437 in state fiscal year (SFY) 2018 and $6,672,873 in SFY 2019.

 

The proposed rulemaking is estimated to affect:  7,103 Medicaid members, 113,345 Health Improvement program members, 283 Passport providers, and 13 Health Improvement program providers.

 

            6. The department intends the proposed rule amendments to be applied effective April 1, 2018.

 

            7. 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., March 9, 2018.

 

8. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

9. 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 7 above or may be made by completing a request form at any rules hearing held by the department.

 

10. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The primary bill sponsor was notified by electronic mail on January 26, 2018.

 

11. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment and repeal of the above-referenced rules may 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 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, Attorney                            Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services

 

 

Certified to the Secretary of State January 30, 2018.

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