Montana Administrative Register Notice 37-882 No. 10   05/24/2019    
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In the matter of the amendment of ARM 37.40.307 pertaining to nursing facility reimbursement






TO: All Concerned Persons


            1. On June 13, 2019, at 11:30 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 June 4, 2019, 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) and (b) remain the same.

            (c) The statewide price for nursing facility services will be determined each year through a public process. Factors that could be considered in the establishment of this price include the cost of providing nursing facility services, Medicaid recipients access to nursing facility services, and the quality of nursing facility care. The statewide price (average daily rate) for State Fiscal Year (SFY) 2020 is $204.30.

            (d) The total payment rate available for the period July 1, 2018 July 1, 2019, through June 30, 2019 June 30, 2020, will be the rate as computed in (2) increased by 3.08%, plus any additional amount computed in ARM 37.40.311 and 37.40.361Copies of the department's current nursing facility Medicaid reimbursement rates per facility are posted at https://dphhs.mt.gov/sltc/csb/provider#28702384-nursing-facilities-and-swing-bed-services and may be obtained from the Department of Public Health and Human Services, Senior & Long-Term Care Division, P.O. Box 4210, Helena, MT 59604-4210.

            (3) Providers who, as of July 1 of the rate year, have not filed with the department a cost report covering a period of at least six months participation in the Medicaid program in a newly constructed facility will have a rate set at the statewide median price as computed on July 1, 2018 July 1, 2019. Following a change in provider as defined in ARM 37.40.325, the per diem rate for the new provider will be set at the previous provider's rate, as if no change in provider had occurred.

            (4) 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 amendments to ARM 37.40.307 pertaining to revising nursing facility reimbursement rates for the upcoming SFY 2020.


ARM 37.40.307


The proposed amendment to ARM 37.40.307(2) updates the SFY 2019 reference (July 1, 2018 through June 30, 2019), to SFY 2020 (July 1, 2019 through June 30, 2020). The proposed amendment also updates the average statewide price to $204.30. The proposed changes are necessary for the department to provide notice of the change to Medicaid nursing facility provider rates.


In SFY 2019, the average statewide price was $202.46. The proposed change to the average statewide price for SFY 2020 equates to a 0.91% average increase over SFY 2019. The rate calculation includes consideration of sufficient funding and access to services. 


Copies of the department's proposed nursing facility Medicaid reimbursement rates per facility are posted at: https://dphhs.mt.gov/sltc/csb/privider#28702384-nursing-facilities-and-swing-bed-services.


The proposed amendment to ARM 37.40.307(3) updates the SFY 2019 reference to SFY 2020. This change is necessary for the department to provide notice of the current period Medicaid nursing facility statewide average price. 


Fiscal Impact


Nursing facility reimbursement will include an average increase of 0.91% over the SFY 2019 statewide average price. The total cost for the SFY 2020 nursing facility reimbursement increase is estimated at approximately $1.85 million of combined state funds, federal funds, and patient contributions.


Anticipated days for SFY 2020 are 1,006,337 using estimates from SFY 2019 Medicaid paid days.


Seventy nursing facility providers participated in the Medicaid nursing facility payment program and approximately 4,100 recipients received services in nursing facilities under Medicaid.


Medicaid nursing facility rates will be applied retroactively to July 1, 2019.


            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., June 21, 2019.


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


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


8. 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.


9. 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/ Robert Lishman                                      /s/ Sheila Hogan                             

Robert Lishman                                           Sheila Hogan, Director

Rule Reviewer                                              Public Health and Human Services



Certified to the Secretary of State May 14, 2019.


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