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| Montana Administrative Register Notice 37-949 | No. 12 06/25/2021 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On July 15, 2021, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider the proposed amendment of the above-stated rules. Because there currently exists a state of emergency in Montana due to the public health crisis caused by the coronavirus, there will be no in-person hearing. Interested parties may access the remote conferencing platform in the following ways: (a) Join Zoom Meeting at: https://mt-gov.zoom.us/j/86879372576, meeting ID: 868 7937 2576; or (b) Dial by telephone +1 646 558 8656, meeting ID: 868 7937 2576. Find your local number: https://mt-gov.zoom.us/u/kbv8oyWBJj.
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 9, 2021, to advise us of the nature of the accommodation that you need. Please contact Heidi Clark, 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:
37.34.3005 REIMBURSEMENT FOR SERVICES OF MEDICAID FUNDED DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY-BASED SERVICES (HCBS) WAIVER PROGRAMS (1) remains the same. (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 Services Manual, effective
37.86.3607 CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, REIMBURSEMENT (1) Reimbursement for the delivery by provider entities of Medicaid funded targeted case management services to persons with developmental disabilities is provided as specified in the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915(c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, dated (2) The department adopts and incorporates by this reference the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915(c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, dated
AUTH: 53-6-113, MCA IMP: 53-6-101, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) proposes to amend ARM 37.34.3005 and 37.86.3607 pertaining to reimbursement rates in the Montana Developmental Disabilities Program Services Manual and the Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915 (c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over.
The proposed rule amendments would adopt and incorporate the updated versions of the manuals, dated July 1, 2021, to include grammar and punctuation clean-up and changes in billing and reimbursement of services provided to persons who are recipients of developmental disabilities services through the Medicaid programs.
Based on legislative appropriations in the 2021 legislative session, the Developmental Disabilities Program proposes to implement a 1% average provider rate increase to provider rates, and a retention adjustment for workers who provide direct care to people with developmental disabilities. The proposed manuals, dated July 1, 2021, reflect these rate adjustments.
ARM 37.34.3005 The proposed amendment would give an approximate 1% increase to Medicaid Waiver services, and a $0.24/hour payment for recruitment and retention of direct care workers to specified services, with an effective date of July 1, 2021.
The proposed amendment would give an approximate 1% provider rate increase to the following waiver services:
Homemaker Supported Employment Follow Along - BASE Supported Employment Follow Along - TIER #1 Supported Employment Follow Along - TIER #2 Supported Employment Follow Along hourly Supported Employment Follow Along - both Self Direct options Supported Employment - Individual Employment Support Supported Employment - Individual Employment Support - both Self Direct options Supported Employment - Co Worker Support Supported Employment - Co Worker Support - both Self Direct options Caregiver Training & Support Caregiver Training & Support - AwC Self Direct Remote Monitoring Supports Broker (both Self Direct options) Behavioral Support Services Meal Services Meal Services - Empl Auth Self Direct Transportation - Mileage Reimbursement Transportation - Mileage Reimbursement - both Self Direct options Transportation - Commute Individual Transportation - Commute Individual Wheelchair Van Transportation - Commute Shared Transportation - Commute Shared Wheelchair Van Transportation - Commute Individual AwC Self Direct Transportation - Work/Day Integration Transportation - Work/Day Integration Wheelchair Van Transportation - Residential Integration Wheelchair Van Transportation - Residential Integration Transportation - Res Integration AwC Self Direct
The proposed amendment would give an approximate 1% provider rate increase plus a $0.24/hour recruitment and retention for direct care workers who serve the Medicaid home and community-based services population in the developmental disabilities waiver.
The following waiver services will receive both rate adjustments:
Congregate Living Hourly (more than 10.95 ave hrs/day, over 4000 annual hrs) Congregate Living Tier 1 (1-4.8 ave hrs/day. 0-1735.99 annual hrs) Congregate Living Tier 2 (4.9-5.47 ave hrs/day. 1754-2005.99 annual hours) Congregate Living Tier 3 (5.48-6.14 ave hrs/day. 2006-2235.99 annual hours) Congregate Living Tier 4 (6.15-7.14 ave hrs/day. 2236-2605.99 annual hours) Congregate Living Tier 5 (7.15-7.7 ave hrs/day. 2606-2845.99 annual hours) Congregate Living Tier 6 (7.8-8.43 ave hrs/day. 2846-3075.99 annual hours) Congregate Living Tier 7 (8.44-8.75 ave hrs/day. 3076-3194.99 annual hours) Congregate Living Tier 8 (8.76-9.9 ave hrs/day. 3195-3613.99 annual hours) Congregate Living Tier 9 (10-10.95 ave hrs/day. 3614-3999.99 annual hours) Congregate Living Medical Congregate Living Children's Residential Habilitation Supported Living no geographic factor Residential Habilitation Supported Living medium geographic factor Residential Habilitation Supported Living high geographic factor Residential Habilitation Supported Living (small agency) no geo factor Residential Habilitation Supported Living (small agency) Medium geo factor Residential Habilitation Supported Living (small agency) High geo factor Residential Habilitation Supported Living - base Residential Habilitation Supported Living - flex Residential Habilitation Supported Living rural remote Residential Habilitation Supported Living medium geographic factor Residential Habilitation Supported Living high geographic factor Residential Habilitation Supported Living (small agency) no geo factor Residential Habilitation Supported Living (small agency) medium geo factor Residential Habilitation Supported Living (small agency) high geo factor Residential Habilitation Supported Living - base Residential Habilitation Supported Living - flex Residential Habilitation Supported Living rural remote Residential Training Support (no geographical factor) Residential Training Support (medium geographical factor) Residential Training Support (high geographical factor) Residential Training Support (small agency / no geographical factor) Residential Training Support (small agency / medium geographical factor) Residential Training Support (small agency / high geographical factor) Adult Foster Support (low supervision) Adult Foster Support (moderate supervision) Adult Foster Support (enhanced supervision) Adult Foster Support (intensive supervision) Assisted Living moderate Assisted Living enhanced Personal Care Companion Respite Supported Employment Small Group Hourly (over 8 ave hours per day) Supported Employment Small Group Hourly - AwC Self Direct Supported Employment Small Group Tier 1 (0-.5 ave hrs/day) Supported Employment Small Group Tier 2 (.5-1 ave hrs/day) Supported Employment Small Group Tier 3 (1.01-1.25 ave hrs/day) Supported Employment Small Group Tier 4 (1.26-1.75 ave hrs/day) Supported Employment Small Group Tier 5 (1.76-2.25 ave hrs/day) Supported Employment Small Group Tier 6 (2.26-2.75 ave hrs/day) Supported Employment Small Group Tier 7 (2.76-3.25 ave hrs/day) Supported Employment Small Group Tier 8 (3.26-4.0 ave hrs/day) Supported Employment Small Group Tier 9 (4.01-4.75 ave hrs/day) Supported Employment Small Group Tier 10 (4.76-5.5 ave hrs/day) Supported Employment Small Group Tier 11 (5.51-6.25 ave hrs/day) Supported Employment Small Group Tier 12 (6.26-6.99 ave hrs/day) Supported Employment Small Group Tier 13 (7.0-7.99 ave hrs/day) Retirement Services Hourly (over 8 ave hours per day) Retirement Services Tier 1 (.1-.5 ave hrs/day) Retirement Services Tier 2 (.5-1.0 ave hrs/day) Retirement Services Tier 3 (1.01-1.25 ave hrs/day) Retirement Services Tier 4 (1.26-1.75 ave hrs/day) Retirement Services Tier 5 (1.76-2.25 ave hrs/day) Retirement Services Tier 6 (2.26-2.75 ave hrs/day) Retirement Services Tier 7 (2.76-3.25 ave hrs/day) Retirement Services Tier 8 (3.26-4.0 ave hrs/day) Retirement Services Tier 9 (4.01-4.75 ave hrs/day) Retirement Services Tier 10 (4.76-5.5 ave hrs/day) Retirement Services Tier 11 (5.51-6.25 ave hrs/day) Retirement Services Tier 12 (6.26-6.99 ave hrs/day) Retirement Services Tier 13 (7.0-7.99 ave hrs/day) Day Supports and Activities Hourly (over 8 ave hours per day) Day Supports and Activities Tier 1 (.1-.5 ave hrs/day) Day Supports and Activities Tier 2 (.5-1.0 ave hrs/day) Day Supports and Activities Tier 3 (1.01-1.25 ave hrs/day) Day Supports and Activities Tier 4 (1.26-1.75 ave hrs/day) Day Supports and Activities Tier 5 (1.76-2.25 ave hrs/day) Day Supports and Activities Tier 6 (2.26-2.75 ave hrs/day) Day Supports and Activities Tier 7 (2.76-3.25 ave hrs/day) Day Supports and Activities Tier 8 (3.26-4.0 ave hrs/day) Day Supports and Activities Tier 9 (4.01-4.75 ave hrs/day) Day Supports and Activities Tier 10 (4.76-5.5 ave hrs/day) Day Supports and Activities Tier 11 (5.51-6.25 ave hrs/day) Day Supports and Activities Tier 12 (6.26-6.99 ave hrs/day) Day Supports and Activities Tier 13 (7.0-7.99 ave hrs/day) Personal Supports (both Self Direct options)
The following Extended State Plan services will receive updates per their established Medicaid State Plan rate methodologies:
Private Duty Nursing (Medicaid State Plan) LPN Private Duty Nursing (Medicaid State Plan) RN Psychological Services Physical Therapy (Medicaid State Plan) Occupational Therapy (Medicaid State Plan) Speech Therapy (Medicaid State Plan) Nutritionist Services (Medicaid State Plan)
The proposed Montana Developmental Disabilities Program Services Manual, dated July 1, 2021, can be found at https://dphhs.mt.gov/dsd/developmentaldisabilities/ddpratesinf.
The department also proposes to use this opportunity to clean up punctuation and grammar in the manual.
ARM 37.86.3607 The proposed amendment would give an approximate 1% rate increase to the following service: Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915 (c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, with an effective date of July 1, 2021.
The proposed Targeted Case Management Services for Individuals with Developmental Disabilities Enrolled in the 1915 (c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16 and Over, with an effective date of July 1, 2021 can be found at https://dphhs.mt.gov/dsd/developmentaldisabilities/ddpratesinf.
The department also proposes to use this opportunity to clean up punctuation and grammar in the manual.
Fiscal Impact
Waiver rate increases The provider rate increases are projected to have the following fiscal impact:
1% provider rate increase $473,818 General Fund increase $880,336 Federal Fund increase $1,354,154 Total Funds increase
Direct care retention increase $387,158 General Fund increase $719,324 Federal Fund increase $1,106,482 Total Funds increase
Targeted Case Management increase The provider rate increase for targeted case management is projected to have the following fiscal impact:
$14,890.58 General Fund increase $24,054.22 Federal Fund increase $38,944.80 Total Funds increase
The department intends to apply these proposed rule amendments retroactively to July 1, 2021. The proposed rule amendments do not result in a negative impact on any party.
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: Heidi Clark, 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 23, 2021.
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 rules 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/ Aleea Sharp /s/ Adam Meier Aleea Sharp Adam Meier, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State June 15, 2021.
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A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact sosarm@mt.gov.
