Montana Administrative Register Notice 37-852 No. 12   06/22/2018    
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In the matter of the amendment of ARM 37.34.3005 pertaining to home and community-based services (HCBS) waiver programs







TO: All Concerned Persons


            1. On July 12, 2018, at 3:30 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 July 2, 2018, to advise us of the nature of the accommodation that you need. Please contact Todd Olson, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:



            (2)  The department adopts and incorporates by this reference the rates of reimbursement for the delivery of services and items available through each Home and Community-Based Services Waiver Program as specified in the Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c, 0208, and 0667 Waiver Programs, effective January 1, 2018 July 1, 2018. A copy of the manual may be obtained through the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and at http://dphhs.mt.gov/dsd/developmentaldisabililities/DDPratesinf.


AUTH: 53-2-201, 53-6-402, MCA

IMP: 53-2-201, 53-6-402, MCA




The Department of Public Health and Human Services (department) is proposing to amend ARM 37.34.3005 by changing the effective date of the Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c, 0208, and 0667 Waiver Programs (the manual) to July 1, 2018. The department has made substantive changes to the manual and the July 1, 2018 date reflects the new version of the manual, which the department has adopted by reference in ARM 37.34.3005. One of the changes proposed in this rule notice relating to private duty nursing rate reimbursement will take effect July 15, 2018.


The new manual reflects changes to the 0208 home and community-based 1915(c) waiver for individuals with developmental disabilities. Although final approval for the changes has not been granted by the Centers for Medicare and Medicaid (CMS), the department anticipates approval will be finalized by the July 1, 2018, effective date.


The July 1, 2018, manual reflects the following changes and the reasons for those changes:

  • Discontinuation of the following services:

    • Children's case management because the department is providing that service to children age 16 and under through the targeted case management service in the Medicaid State Plan;

    • Live-in caregiver service because this service is not being used in any capacity and the department wants to remove it from the waiver to accurately reflect the services that are being used;

    • Job discovery and job preparation because those services are now included in the day supports and activities service; and

    • Adaptive equipment because this service will be provided through the newly added specialized medical equipment and supplies service.

  • Add specialized medical equipment and supplies service, which expands the equipment and supplies that are provided through this service;

  • Changes the name of adult companion to companion because the service has been expanded to provide services to younger individuals who are not yet adults;

  • Changes the name of psychological and counseling services to psychological evaluation, counseling, and consultation services to expand the service to include evaluation and consultation;

  • Adjusts the reimbursement for private duty nursing (PDN), which will take effect July 15, 2018. The rate will increase from $29.52 per hour for LPN services to $35.00 and from $34.76 per hour for RN services to $45.12 per hour. This change is consistent with rate increases proposed by the department for PDN services in other department programs and is intended to ensure that high-needs Montana Medicaid members have access to services in the least costly setting.

  • Clarification of the following services:

    • Supported living hourly services are no longer tied to members receiving waiver children's case management or for adults. This is because the department is discontinuing waiver children's case management services.

    • Supported living, small agency rates require a provider to meet all three criteria:  1)  support less than 10 individuals; 2)  employ 12 or fewer direct care staff; and 3)  director routinely provides some direct support every week. This change reflects the department's current practice and provides clarity to providers.

    • Clarifying that the day supports and activities rate is not available for self-direct service delivery and that the high geographic factor should be used as the maximum rate for all day supports and activities

      self-direct options.

    • Change the maximum rate for remote monitoring equipment to ensure that it matches the maximum monthly amount that is listed in the waiver.

    • Change the units defined for day integration and residential integration transportation and clarify that transportation OTHER is for miscellaneous costs such as bus passes, taxi fees, licensure, insurance, and other costs.


Fiscal Impact


The fiscal impact of the proposed amendments to ARM 37.34.3005, implementing private duty nursing rate adjustments for DD providers will increase total expenditures to providers for state fiscal year 2019 by the sum of $247,807.96. These rates affect approximately 15 corporate providers of services.


            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: Todd Olson, 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., July 20, 2018.


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. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.


9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule may significantly and directly impact small businesses.


10. 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.


11. The PDN rate increase will take effect retroactive to July 15, 2018, as described above, and as set forth in the manual. The department will apply all other rule amendments retroactively to July 1, 2018, which is the effective date of the revised manual. Neither retroactive application of the proposed rule amendments results in a negative impact to any affected party.



/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 June 12, 2018.



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