Montana Administrative Register Notice 37-866 No. 18   09/21/2018    
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In the matter of the amendment of ARM 37.40.307 pertaining to nursing facilities reimbursement






TO: All Concerned Persons


            1. On October 12, 2018, at 11:00 a.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 October 5, 2018, to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, 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:


            37.40.307 NURSING FACILITY REIMBURSEMENT (1) remains the same.

            (2) Effective July 1, 2001, and in subsequent rate years, nursing facilities will be reimbursed using a price-based reimbursement methodology. The rate for each facility will be determined using the operating component defined in (2)(a) and the direct resident care component defined in (2)(b):

            (a) through (c) remain the same.

            (d) The total payment rate available for the period July 1, 2018, through June 30, 2019, will be the rate as computed in (2) increased by 3.08%, plus any additional amount computed in ARM 37.40.311 and 37.40.361.

            (3) through (12) remain the same.


AUTH: 53-2-201, 53-6-113, MCA

IMP: 53-6-101, 53-6-111, 53-6-113, MCA




The Department of Public Health and Human services (department) is proposing a provider rate increase effective July 1, 2018. The rate increase reverses across-the-board provider rate reductions implemented in State Fiscal Year (SFY) 2018. The department proposes to raise Medicaid nursing facility rates, effective July 1, 2018, by 3.08%. If adopted as proposed, the existing nursing facility reimbursement rates, as recently adopted in MAR Notice No. 37-845, will increase by 3.08%.


Fiscal Impact


The estimated total funding available by SFY 2019 for nursing facility reimbursement is estimated at approximately $202,870,630 of combined state funds, federal funds, and patient contributions. These numbers do not include at-risk provider funds or direct care wage funding.


This proposed rule amendment increases estimated expenditures in the nursing home program by $2,086,595 in state funds and $3,977,326 in federal funds in SFY 2019.


Anticipated days for SFY 2019 are 1,002,018, using estimates from SFY 2018 Medicaid paid days. 


Seventy nursing facility providers participated in the Medicaid nursing facility payment program and approximately 4,200 recipients received services in nursing facilities under Medicaid.  If this notice is adopted as proposed, the rate adjustment would raise the statewide daily average to $202.46 per day.


            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: Gwen Knight, 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., October 19, 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 will not 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.




/s/ Brenda K. Elias                                       /s/ Laura Smith                                            

Brenda K. Elias                                            Laura Smith for Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services



Certified to the Secretary of State September 11, 2018.

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