BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.81.1002, 37.81.1018, 37.86.805, 37.86.1105, 37.86.1506, 37.86.2105, 37.86.2207, 37.86.2405, 37.86.2505, 37.86.2605, and 37.86.2907 pertaining to Montana PharmAssist Program and Medicaid reimbursement rates for some services with rates not set under resource based relative value scale (RBRVS)

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On October 2, 2009, at 1:30 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 rules.

 

            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 September 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, 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:

 

            37.81.1002  RULE DEFINITIONS  In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter:

            (1) through (4) remain the same.

            (5)  "Continuing education (CE)" means an initial six-hour and annual two-hour CE program meeting the requirements of ARM 37.81.1018, created and instructed by the University of Montana, Skaggs School of Pharmacy, Department of Pharmacy and accredited by the American Council on Pharmaceutical Education (ACPE).

            (6) (5)  "Credentialed pharmacist" means a Montana licensed pharmacist in good standing who has completed the required continuing education initial training for the PharmAssist Program and has a current personal service contract with the department.

            (7) through (13) remain the same but are renumbered (6) through (12).

 

AUTH:  53-2-201, 53-6-1006, MCA

IMP:  53-2-201, 53-6-1006, MCA

 

            37.81.1018  MONTANA PHARMASSIST, CONTINUING EDUCATION

      (1)  The CE program will consist of an overview of the Montana PharmAssist Program and completion of program paperwork, instruction on documentation and communication of the patient care plan, and review of treatment guidelines and drug interactions for four therapeutic topics (cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, and geriatric issues).  In addition, the CE program will provide hands-on experience in reviewing patient medication profiles.  To participate in the PharmAssist Program a pharmacist must be licensed by the state of Montana and complete initial training, which consists of a self-guided educational packet prepared by the department.

 

AUTH:  53-2-201, 53-6-1006, MCA

IMP:  53-2-201, 53-6-1006, MCA

 

            37.86.805  HEARING AID SERVICES, REIMBURSEMENT  (1)  The department will pay the lower of the following for covered hearing aid services and items:

            (a) remains the same.

            (b)  the amount specified for the particular service or item in the department's fee schedule.  The department adopts and incorporates by reference the department's fee schedule dated July 2008 2009.  A copy of the department's fee schedule is posted at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (2) remains the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.1105  OUTPATIENT DRUGS, REIMBURSEMENT  (1) remains the same.

            (2)  The dispensing fee for filling prescriptions shall be determined for each pharmacy provider annually.

            (a) remains the same.

            (b)  The dispensing fees assigned shall range between a minimum of $2.00 and a maximum of $4.94 $5.04.

            (c) and (d) remain the same.

            (3)  In-state pharmacy providers that are new to the Montana Medicaid program will be assigned an interim $3.50 $5.04 dispensing fee until a dispensing fee questionnaire, as provided in (2), can be completed for six months of operation.  At that time, a new dispensing fee will be assigned which will be the lower of the dispensing fee calculated in accordance with (2) for the pharmacy or the $4.70 $5.04 dispensing fee.  Failure to comply with the six months dispensing fee questionnaire requirement will result in assignment of a dispensing fee of $2.00.

            (4) through (7) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-2-201, 53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.1506  HOME INFUSION THERAPY SERVICES, REIMBURSEMENT

            (1)  Subject to the requirements of these rules, the Montana Medicaid program will pay for home infusion therapy services on a fee basis, as specified in the department's home infusion therapy services fee schedule.  The department adopts and incorporates by reference the Home Infusion Therapy Services Fee Schedule dated July 2008 2009.  A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the Home Infusion Therapy Services Fee Schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.  The specified fees are on a per day or a per dose basis as specified in the fee schedule.  The fees are bundled fees which cover all home infusion therapy services as defined in ARM 37.86.1501.

            (2) through (4)(c) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, MCA

 

            37.86.2105  EYEGLASSES, REIMBURSEMENT  (1) through (2)(a)(ii) remain the same.

            (3)  The department adopts and incorporates by reference the department's Eyeglasses Fee Schedule effective July 2007 2009.  A copy of the department's fee schedule is posted at the the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

 

AUTH:  53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.2207  EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT SERVICES (EPSDT) SERVICES, REIMBURSEMENT  (1) through (1)(d) remain the same.

            (2)  Reimbursement for outpatient chemical dependency treatment, nutrition, and private duty nursing services is specified in the department's fee schedule.  This cross reference does not outline reimbursement.  The department adopts and incorporates by reference the department's private duty nursing services EPSDT Fee Schedule dated July 2008 2009 and the nutrition EPSDT Fee Schedule dated July 2008 2009.  The fee schedules are posted at http://medicaidprovider.hhs.mt.gov.  Reimbursement for outpatient chemical dependency treatment is outlined in ARM 37.27.912.  A copy of the nutrition and private duty nursing services fee schedules may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (3)  Except as provided in (4), the reimbursement rate Reimbursement for the therapeutic portion of therapeutic youth group home treatment services provided on or after October 1, 2007 is the lesser of:

            (a)  the amount specified in the department's Medicaid Mental Health Fee Schedule.  The department adopts and incorporates by reference the department's Medicaid Mental Health and Mental Health Services Plan, Individuals Under 18 Years of Age Fee Schedule dated July 1, 2008 2009.  A copy of the fee schedule may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951; or

            (b) remains the same.

            (4)  If a provider does not comply with the cost reporting requirements in (5), the final reimbursement rate for the therapeutic portion of therapeutic youth group home treatment services provided during state fiscal year (SFY) 2008, July 1, 2007 through June 30, 2008 will be determined by adjusting the interim rate adopted in (3)(a) for the provider so that the total amount received for SFY 2008 equals the lesser of:

            (a)  the amounts specified in the department's Medicaid Mental Health and Mental Health Services Plan, Individual Under 18 Years of Age Fee Schedule dated July 15, 2005 which is adopted and incorporated by reference, if a provider does not comply with the cost reporting requirements set forth in (5).  A copy of the fee schedule may be obtained from the Department of Public Health and Human Services, Health Resources Division, Children's Mental Health Bureau, 1400 Broadway, P.O. Box 202951, Helena MT 59620-2951; or

            (b)  the provider's usual and customary charges (billed charges).

            (5)  Each provider of therapeutic youth group home services will report allowable costs for SFY 2008 that starts July 1, 2007 using auditable data, standardized forms, instructions, definitions, and timelines supplied by the department.

            (a)  The cost study will be performed on an individually licensed therapeutic youth group home basis; and

            (b)  Reports of allowable costs for SFY 2008 must be received by the department before October 20, 2008.

            (6) through (10) remain the same but are renumbered (4) through (8).

            (11) (9)  Reimbursements for school-based health related services are specified in the School-Based Health Service Fee Schedule dated October 2008 2009, which is adopted and incorporated by reference.  A copy of the School-Based Health Service Fee Schedule is posted at http://medicaidprovider.hhs.mt.gov.  Rates are adjusted to reimburse these services at the federal matching assistance percentage (FMAP) rate.

            (12) and (13) remain the same but are renumbered (10) and (11).

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.86.2405  TRANSPORTATION AND PER DIEM, REIMBURSEMENT 

            (1) through (1)(b) remain the same.

            (2)  The department adopts and incorporates by reference the department's Montana Medicaid Fee Schedule, Personal and Commercial Transportation dated October 2008 July 2009 that sets forth the reimbursement rates for transportation, per diem, and other Medicaid services.  A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the fee schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (3) through (5) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.2505  SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, REIMBURSEMENT  (1) through (1)(b) remain the same.

            (2)  The department adopts and incorporates by reference the department's fee schedule dated October 2008 July 2009 which sets forth the reimbursement rates for specialized nonemergency medical transportation services and other Medicaid services.  A copy of the fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.2605  AMBULANCE SERVICES, REIMBURSEMENT  (1) through (1)(b) remain the same.

            (2)  The department adopts and incorporates by reference the Montana Medicaid Fee Schedule, Ambulance dated October 2008 July 2009.  A copy of the fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (3) through (4) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.2907  INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION  (1)  The department's APR-DRG prospective payment rate for inpatient hospital services is based on the classification of inpatient hospital discharges to APR-DRGs.  The procedure for determining the APR-DRG prospective payment rate is as follows:

            (a) through (b) remain the same.

            (c)  The department computes a Montana average base price per case.  Effective October 1, 2008 July 1, 2009 the average base price, including capital expenses, is $4,129 $4,209.  Disproportionate share payments are not included in this price.

            (i)  The average base price for Center of Excellence hospitals, including capital expenses, is $6,890 $7,024.  Disproportionate share payments are not included in this price.

            (ii) through (2) remain the same.

 

AUTH:  2-4-201, 53-2-201, 53-6-113, MCA

IMP:  2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            4.  The Department of Public Health and Human Services (department) is proposing amendments to the following rules implementing the Montana Medicaid statutes:  ARM 37.81.1002, 37.81.1018, 37.86.805, 37.86.1105, 37.86.1506, 37.86.2105, 37.86.2207, 37.86.2405, 37.86.2505, 37.86.2605, and 37.86.2907.  Montana Medicaid is a program administered by the department that is jointly funded by the state and federal government.  Montana Medicaid pays providers for covered health care service delivered to eligible low income and disabled Montana residents enrolled in Medicaid.

 

The changes to ARM 37.81.1002 and 37.81.1018 are necessary to eliminate an annual two-hour training requirement for licensed pharmacists who participate in the PharmAssist Program.  The changes to the remaining rules are necessary to change the reimbursement rates for some providers whose rates are not set based on the Resource Based Relative Value Scale (RBRVS) rate system. 

 

ARM 37.81.1002 and 37.81.1018

 

The proposed amendments to ARM 37.81.1002 and 37.81.1018 remove the requirement that pharmacists annually complete two hours of continuing education to participate in the PharmAssist Program.  The requirement is not needed because a pharmacist must complete 15 hours of continuing education to maintain his or her state license through the State Board of Pharmacy.  The additional two-hour requirement was not productive and removing it may encourage more pharmacists to participate in the program.  The requirement that a pharmacist must complete initial training about the PharmAssist Program to participate remains but that training will be a self-guided education packet.  Reference to training by the University of Montana is being removed from the rules.

 

ARM 37.86.805

 

The proposed amendment to ARM 37.86.805 changes the reference date of the current fee schedule for hearing aid services to July 2009.  The fee schedule was amended to increase provider rates by 2% based on the appropriation in House Bill 2 (HB 2) of the 2009 Montana Legislative Session.  The estimated fiscal impact of the amendments to this rule is an increase of $2,551 federal expenditures and $793 state expenditures.

 

ARM 37.86.1105

 

The proposed amendment to ARM 37.86.1105 increases the maximum dispensing fee for filling prescriptions from $4.94 to $5.04 to increase provider rates by 2% based on the appropriation in HB 2 of the 2009 Montana Legislative Session.  The amendment to this rule also increases the interim dispensing fee for in-state providers new to the Montana Medicaid program from $3.50 to $5.04 for the first six months of operation.  This change is necessary to fairly reflect the cost of dispensing during the initial startup phase.  The estimated fiscal impact of the amendments to this rule is an increase of $104,212 federal expenditures and $32,388 state expenditures for state fiscal year (SFY) 2010.

 

ARM 37.86.1506

 

The proposed amendment to ARM 37.86.1506 changes the reference date of the current fee schedule for home infusion therapy services from July 2008 to July 2009.  The fee schedule is being amended to increase provider rates by 2% based on the appropriation in HB 2 of the 2009 Montana Legislative Session.  The estimated fiscal impact of this change is an increase of $9,896 federal expenditures and $3,075 of state expenditures for SFY 2010.

 

ARM 37.86.2105

 

The proposed amendment to ARM 37.86.2105 changes the reference date of the current fee schedule for eyeglasses from July 2007 to July 2009.  The fee schedule was amended to reflect the current year of reimbursement, there are no rate changes in this fee schedule.  No fiscal impact is expected from this change because eyeglasses are reimbursed through a bulk purchasing contract.

 

ARM 37.86.2207

 

ARM 37.86.2207 Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Reimbursement refers to services provided through Medicaid to individuals under the age of 21.  The proposed amendments to ARM 37.86.2207(2) and (3) of this rule change the reference date of the current fee schedule for EPSDT nutrition and private duty nursing services from July 2008 to July 2009.  The fee schedules are being amended to increase provider rates by 2% based on the appropriation in HB 2 of the 2009 Montana Legislative Session.  The estimated fiscal impact of the change to the private duty nursing fee schedule is an increase of $49,105 federal expenditures and $15,261 of state expenditures.  The estimated fiscal impact of the change for the nutrition fee schedule is an increase of $134 federal expenditures and $41 state expenditures.

 

ARM 37.86.2207(3) through (6) of this rule implement the reimbursement rate for the therapeutic services delivered through therapeutic youth group homes.  The reimbursement rate is stated in the department's Medicaid Mental Health and Mental Health Services Plan, Individuals Under 18 Years of Age Fee Schedule which is updated to July 2009.  The fee schedule was amended to increase provider rates by 2% based on the appropriation in HB 2 of the 2009 Montana Legislative Session.  The estimated fiscal impact of the change to the fee schedule is an increase of $721,982 federal expenditures and $224,383 state expenditures.  ARM 37.86.2207(4) and (5) of the rule applied to 2008 only so are being deleted.

 

The proposed amendment to ARM 37.86.2207(11), which will be ARM 37.86.2207(9) change the reference date of the current fee schedule for EPSDT school based services from October 2008 to October 2009.  Rates are adjusted to reimburse these services at the federal matching assistance percentage (FMAP) rate.  The state participation in this program is certified match from schools.  There is no state general fund appropriation.

 

ARM 37.86.2405

 

The proposed amendment to ARM 37.86.2405 changes the reference date of the current fee schedule for transportation and per diem reimbursement from October 2008 to July 2009.  The fee schedule was amended to increase provider rates by 2% based on the appropriation in HB 2 of the 2009 Montana Legislative Session.  The estimated fiscal impact of this change is an increase of $6,669 federal expenditures and $2,072 of state expenditures.

 

ARM 37.86.2505

 

The proposed amendment to ARM 37.86.2505 changes the reference date of the current fee schedule for specialized nonemergency medical transportation, reimbursement from October 2008 to July 2009.  The fee schedule is updated to reflect the current year of reimbursement, there are no rate changes in this fee schedule because mileage rates were not included in the provider rate increase.  No fiscal impact is expected from this change.

 

ARM 37.86.2605

 

The proposed amendment to ARM 37.86.2605 changes the reference date of the current fee schedule for ambulance services from October 2008 to July 2009.  The fee schedule was amended to increase provider rates by 2% based on the appropriation in HB 2 of the 2009 Montana Legislative Session.  The estimated fiscal impact of this change is an increase of $45,850 federal expenditures and $14,249 of state expenditures.

 

ARM 37.86.2907

 

The proposed amendment to ARM 37.86.2907 changes the patient hospital prospective reimbursement rate.  The average base price, including capital expenses, is increased from $4,129 to $4,209.  The average base price for center of excellence hospitals, including capital expenses, is increased from $6,890 to $7,024.  These changes increase rates by 2% based on the appropriation in HB 2 of the 2009 Montana Legislative Session.  The estimated fiscal impact of this change is an increase of $1,127,812 and $350,510 of state expenditures.

 

The proposed rule changes effect approximately 81,920 Medicaid recipients and the following number of providers listed by program:  48 hearing aid providers; 265 pharmacy providers; 11 home infusion therapy providers; 169 optometric providers; 12 private duty nursing providers; 7 nutrition providers; 19 EPSDT mental health providers; 229 school-based services providers; 17 transportation providers; 107 ambulance providers; and 262 inpatient hospital providers.

 

            5.  The department intends to apply ARM 37.81.1002, 37.81.1018, 37.86.805, 37.86.1105, 37.86.1506, 37.86.2105, 37.86.2405, 37.86.2505, 37.86.2605, and 37.86.2907 retroactively to July 1, 2009.  The department intends to apply ARM 37.86.2207(9) retroactively to October 1, 2009.  A retroactive application of the proposed rules does not result in a negative impact to any affected party.

 

            6.  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: Rhonda Lesofski, 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 8, 2009.

 

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

 

            8.  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.

 

            9.  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 the 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.

 

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

 

 

 

 

/s/  Geralyn Driscsoll                         /s/  Mary E. Dalton for                                  

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

           

Certified to the Secretary of State August 31, 2009.