BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES
OF THE STATE OF MONTANA
In the matter of the amendment of ARM 37.87.1223 pertaining to Psychiatric Residential Treatment Facility (PRTF) services, reimbursement
NOTICE OF PROPOSED AMENDMENT
NO PUBLIC HEARING CONTEMPLATED
TO: All Concerned Persons
1. On March 30, 2009, the Department of Public Health and Human Services proposes to amend 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 Department of Public Health and Human Services no later than 5:00 p.m. on March 23, 2009, to advise us of the nature of the accommodation that you need. Please contact Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena MT 59604-4210; telephone (406) 444-4094; fax (406) 444-1970; or e-mail firstname.lastname@example.org.
3. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
37.87.1223 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, REIMBURSEMENT (1) For PRTF services provided on or after
January 1, March 1, 2009, the Montana Medicaid program will pay a provider for each patient day as provided in these rules.
(a) through (3)(b) remain the same.
(4) Out-of-state PRTF providers who are not hospital-based will be reimbursed 50% of their usual and customary charges. Reimbursement will include all Medicaid covered psychiatric, medical, and ancillary services. Medical services are included as ancillary services. Ancillary services are defined in ARM 37.87.1222. The PRTFs usual and customary charge for medical and ancillary services must be defined by the facility and may not be more than two times the cost of procuring these services.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
4. The Department of Public Health and Human Services (the department) is proposing an amendment to ARM 37.87.1223, pertaining to Medicaid reimbursement for out-of-state psychiatric residential treatment facility (PRTF) services. The proposed change is necessary to change the effective date of the reimbursement change to March 1, 2009 instead of January 1, 2009. The department, ACS and First Health (the department's utilization contractor) were not ready to change the reimbursement method for psychiatric residential treatment facilities (PRTFs) as proposed January 1, 2009. The in-state PRTFs requested the department wait to implement the change until after ACS and First Health had made the changes to reimbursement and authorization, respectively. The department believes the changes will be ready by March 1, 2009.
The department is also proposing an amendment necessary to clarify how PRTFs establish their usual and customary rate for medical and ancillary services procured for youth in their facility. Without making this change, PRTFs may not be reimbursed their cost for procuring needed medical and ancillary services to youth in their facility or they could charge Montana Medicaid more than their cost without setting a limit. Without reimbursing out-of-state PRTFs their cost for medical and ancillary services, Montana youth would likely not receive these services. Youth could also lose access to out-of-state PRTFs.
The department is following directives from the Centers for Medicare and Medicaid Services (CMS) and their Department of Appeals Board, New York, decision dated February 8, 2007, in changing how we reimburse PRTFs. The Social Security Act prevents federal financial participation in services to youth residing in residential treatment facilities that are institution for mental disease (IMDs). This means that PRTFs enrolled in Montana Medicaid are responsible to provide (directly or indirectly) all services youth need while in their facility. All needed services, psychiatric, medical, or ancillary, are included in their reimbursement rate.
5. The department intends the proposed rule amendments to be effective March 1, 2009. This is likely to result in retroactive application upon adoption of the final amendments. Such retroactive application will have no detrimental effects for Medicaid recipients and providers.
6. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Rhonda Lesofski, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on March 30, 2009. Comments may also be faxed to (406) 444-1970 or e-mailed to email@example.com.
7. If persons who are directly affected by the proposed action wish to express their data, views, or arguments orally or in writing at a public hearing, they must make written request for a hearing and submit this request along with any written comments to Rhonda Lesofski at the above address no later than 5:00 p.m., March 30, 2009.
8. If the agency receives requests for a public hearing on the proposed action from either 10% or 25, whichever is less, of the persons directly affected by the proposed action; from the appropriate administrative rule review committee of the Legislature; from a governmental subdivision or agency; or from an association having not less than 25 members who will be directly affected, a hearing will be held at a later date. Notice of the hearing will be published in the Montana Administrative Register. Ten percent of those directly affected has been determined to be four persons based on 41 PRTF providers enrolled in Montana Medicaid.
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 6 above or may be made by completing a request form at any rules hearing held by the department.
10. An electronic copy of this Proposal Notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of this Notice conform to the official version of the Notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the Notice and the electronic version of the Notice, only the official printed text will be considered. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.
11. The bill sponsor notice requirements of 2-4-302, MCA, do not apply.
/s/ John Koch /s/ Anna Whiting Sorrell
Rule Reviewer Anna Whiting Sorrell, Director
Public Health and Human Services
Certified to the Secretary of State February 17, 2009.