| HOME | SEARCH | ABOUT US | CONTACT US | HELP | ||
 |
 |
|
|
| Montana Administrative Register Notice 37-609 | No. 24 12/20/2012 | |
|
||
| Prev | Next | ||
|
BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons 1. On October 25, 2012, the Department of Public Health and Human Services published MAR Notice No. 37-609 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 2131 of the 2012 Montana Administrative Register, Issue Number 20. 2. The department has amended ARM 37.85.207, 37.85.220, 37.85.905, 37.86.105, 37.86.501, 37.86.1401, 37.86.1701, and 37.86.3201 as proposed. 3. As a result of comments, the department has adopted the following rule: NEW RULE I (37.86.1201) BIRTH ATTENDANT SERVICE (1) "Birth Attendant" means a person that is licensed as a direct entry midwife as defined in Title 37, chapter 27, MCA and ARM Title 24, chapter 111, subchapter 6. (2) Birth attendants may only provide prenatal labor and delivery or postpartum care in a birthing center as defined at ARM 37.86.3001. (3) Reimbursement for birth attendants will be determined in accordance with ARM 37.85.212 for allied service providers. IMP: 53-6-101, MCA 4. The department has amended the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined: 37.86.101 PHYSICIAN SERVICES, DEFINITIONS (1) through (5) remain as proposed. (6) A "primary care physician" for purposes of this rule means a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine and all subspecialties of these three specialties recognized by the American Board of Medical Specialties, American Board of Physician Specialties, and American Osteopathic Association. IMP: 53-6-101, 53-6-113, 53-6-141, MCA 37.86.104 PHYSICIAN SERVICES, REQUIREMENTS (1) through (12) remain as proposed. (13) The department will confirm the self-attestation of the physician. Providers that are found to be eligible for this program are eligible to receive additional reimbursement commencing from the date of confirmation. Confirmation consists of: (a) verification of board certification by the American Board of Medical Specialties, American Board of Physician Specialties, and American Osteopathic Association as a primary care physician as defined in ARM 37.86.101(6); or (b) remains as proposed. IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA 37.86.202 MID-LEVEL PRACTITIONER SERVICES, DEFINITIONS For the purpose of these rules, the following definitions will apply: (1) remains as proposed. (3) through (5) remain as proposed, but are renumbered (2) through (4). (a) advanced practice registered nurse; and (b) physician assistant (8) through (16) remain as proposed, but are renumbered (7) through (15). IMP: 53-6-101, MCA 37.86.205 MID-LEVEL PRACTITIONER SERVICES, REQUIREMENTS AND REIMBURSEMENT (1) through (6) remain as proposed. (7) Mid-level practitioners under the supervision of a primary care physician and performing primary care services as defined in ARM 37.86.101 and 37.86.104 qualify for enhanced reimbursement as defined at ARM 37.86.105 except that reimbursement must be reduced in accordance with provisions in this rule. (7) through (9) remain as proposed, but are renumbered (8) through (10). IMP: 53-6-101, MCA 5. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows: COMMENT #1: Several commenters noted that proposed rule amendments concerning primary care physicians are appreciated by the provider community and will permit them to better serve the primary care needs of Montanans. RESPONSE #1: The department agrees and appreciates the comments. COMMENT #2: A commenter suggests that the department should amend the proposed rule amendment at ARM 37.86.101(6) which states "A "primary care physician" for purposes of this rule means a physician with a specialty designation of family medicine, general medicine, or pediatric medicine and all subspecialties of these three specialties recognized by the American Board of Medical Specialties." The commenter suggests striking "family medicine, general medicine, or pediatric medicine" and inserting "family medicine, internal medicine or pediatrics." RESPONSE #2: The language in the proposed rule amendment mirrors the federal rule. Although the comment has merit, the department will not stray from the federal terminology for purposes of adopting this rule amendment. COMMENT #3: Two comments stated that the proposed rule amendment at ARM 37.86.101(6) uses the term "general medicine" as one of the physician specialties recognized in the rule. The final federal rule uses the term "general internal medicine". The department should amend their rule to reflect this. RESPONSE #3: The purpose of this rule amendment is to implement federal rules concerning the Affordable Care Act. ARM 37.86.101(6) will be amended to use the term "general internal medicine" to mirror the final federal rule. COMMENT #4: A commenter noted that physicians with specialties of obstetrics and gynecology should be allowed to participate in this program. RESPONSE #4: The department will mirror the federal rule which provides enhanced federal participation to state Medicaid programs when enhancing reimbursement to primary care physicians as defined by federal rule. This permits physicians with specialties of family medicine, general internal medicine or pediatric medicine, or any subspecialty thereof to participate. Physicians who do not qualify for enhanced reimbursement under the federal rule will not receive enhanced reimbursement as a result of these rule amendments. COMMENT #5: A commenter stated that the rule amendment should require qualifying providers to become Passport providers. RESPONSE #5: The purpose of the rule amendment is to implement requirements of the Affordable Care Act. Although the suggestion has merit, the department will not require qualifying providers to become Passport providers at this time. COMMENT #6: A commenter noted that under the final federal rule state Medicaid programs may enhance the reimbursement to mid-level practitioners that are supervised by physicians who qualify for this program. They expressed concern about how the department will interpret this requirement. The commenter requests the department provide guidance. RESPONSE #6: The department shares this concern. State Medicaid programs have asked the Centers for Medicare and Medicaid Services for guidance concerning supervision requirements. We are waiting for a response from them and will share it once guidance is received. Because the final federal rule requires mid-level practitioners under the supervision of a qualifying physician to receive enhanced reimbursement, the department will amend ARM 37.86.202 as described below: "Mid-level practitioners under the supervision of a primary care physician and performing primary care services as defined in ARM 37.86.101 and 37.86.104 qualify for enhanced reimbursement as defined at ARM 37.86.105 except that reimbursement must be reduced in accordance with provisions in this rule." COMMENT #7: A commenter stated that the department should add additional accreditation bodies to the administrative rule so they mirror those listed in the final federal rule. RESPONSE #7: The proposed rule amendments at ARM 37.86.101(6) and 37.86.104(13)(a) permit certification exclusively by the American Board of Medical Specialties. This was the only board allowed for certification purposes in the proposed federal rule which the department's proposed rule amendments are based on. The final federal rule requires state Medicaid programs to allow accreditation from the American Osteopathic Association and American Board of Physician Specialties in addition to the American Board of Medical Specialties. The department agrees with this comment and will add the additional accreditation bodies to the final rule at ARM 37.86.101(6) and 37.86.104(13)(a). COMMENT #8: Two commenters stated that because this program will have an effective date of January 1, 2013 and an implementation date some time thereafter, they are concerned that a mass adjustment of claims will create an administrative burden. They prefer a lump sum payment. RESPONSE #8: The department will attempt to keep the administrative burden as low as possible. The department will consult with its fiscal intermediary to determine the least administratively burdensome solution. Providers will be apprised of how the department will make these payments. COMMENT #9: Several commenters opposed proposed amendments to define and reimburse birth attendants as mid-level practitioners at ARM 37.86.202. They contend the rules in place presently governing mid-level practitioners are appropriate and should not be amended. They urge the department to only allow advanced practice registered nurses and physician assistants to be considered mid-level practitioners. RESPONSE #9: Due to the concern voiced by the provider community in opposition to adding birth attendants to the mid-level rules, the department removes the proposed amendments at ARM 37.86.202. The department will instead create a New Rule I (37.86.1201) for birth attendants defining and reimbursing them as allied service providers. The text in New Rule I (37.86.1201) was originally proposed in ARM 37.86.202. 6. These rule amendments are effective January 1, 2013. /s/ John Koch /s/ Mary E. Dalton acting for Rule Reviewer Anna Whiting Sorrell, Director Public Health and Human Services Certified to the Secretary of State December 12, 2012
|
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.
