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Montana Administrative Register Notice 37-674 No. 9   05/08/2014    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.34.3005 and 37.86.3607 pertaining to the update of developmental disabilities program home and community-based waiver and case management reimbursement

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On May 28, 2014, at 2:30 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 May 21, 2014, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, 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) Reimbursement through the Developmental Disabilities Program's (DDP) Medicaid Home and Community-Based Services (HCBS) Waiver Programs is only available to a provider for services or items:

            (a) through (c) remain 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 Section Two: Rates of Reimbursement for the HCBS 1915(c) 0208, 1037, 0667 Waiver Programs, of the Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures the Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c 0208, 1037, and 0667 Waiver Programs, effective July 1, 2013 July 1, 2014. A copy of Section Two of the manual may be obtained through the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and at http://www.dphhs.mt.gov/dsd/ddp/ddprateinformation.shtml.

 

AUTH: 53-2-201, 53-6-402, MCA

IMP:     53-2-201, 53-6-402, MCA

 

            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 Section One, Rates of Reimbursement for the Provision of Developmental Disabilities Case Management Services for Persons with Developmental Disabilities 16 Years of Age or Older and for Children with Developmental Disabilities Residing in a Children's Community Home the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are 16 Years of Age or Older or Who Reside in a Children's Community Home, dated July 1, 2013 July 1, 2014, of the Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures.

            (2) The department adopts and incorporates by this reference Section One, Rates of Reimbursement for the Provision of Developmental Disabilities Case Management Services for Persons with Developmental Disabilities 16 Years of Age or Older and for Children with Developmental Disabilities Residing in a Children's Community Home the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are 16 Years of Age or Older or Who Reside in a Children's Community Home, dated July 1, 2013 July 1, 2014, of the Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures, and published by the department as the Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures, Section One, Rates of Reimbursement for the Provision of Developmental Disabilities Case Management Services for Persons with Developmental Disabilities 16 Years of Age or Older or Who Reside in a DD Children's Group Home. A copy of Section One of the manual may be obtained through the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

 

AUTH: 53-6-113, MCA

IMP:     53-6-101, MCA

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing to amend ARM 37.34.3005 and 37.86.3607. These two rules pertain to the reimbursement of services provided to persons who are recipients of developmental disabilities services funded by the State of Montana with Medicaid monies. These proposed amendments are necessary to increase the reimbursement rates to incorporate for state fiscal year (SFY) 2015 additional funding appropriated through House Bill 2 (HB2) of the 63rd Montana Legislature. This proposed amendment also is necessary to implement needed changes in the texts of the two manuals that are incorporated by reference in these rules.

 

ARM 37.34.3005

 

The proposed rule amendment is for the purposes of:

 

1. changing the title of the manual referenced within the rule to the Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c 0208, 1037, and 0667 Waiver Programs; and

 

2. incorporating into the rule this new edition of the manual, to be dated July 1, 2014, which includes changes in the rates of reimbursement and in certain textual provisions that are necessitated by additional legislative appropriations for the reimbursement of the Medicaid funded home and community services and by changes in the plan for the delivery of the Medicaid funded home and community services entered into between the federal Centers for Medicare and Medicaid Services (CMS).

 

ARM 37.86.3607

 

The proposed rule amendment is for the purposes of:

 

1. changing the title of the manual referenced within the rule to the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are16 Years of Age or Older or Who Reside in a Children's Community Home; and

 

2. incorporating into the rule this new edition of the manual, to be dated July 1, 2014, which includes a change in the rate of reimbursement that is necessitated by additional legislative appropriations for the reimbursement of the Medicaid funded case management services.  This proposed change in reimbursement is only applicable to the provision of case management services that are contracted for by the department and is not applicable to the reimbursement of case management services delivered by state employees.

 

Textual changes in the proposed Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c 0208, 1037, and 0667 Waiver Programs, July 2014 edition include the following:

 

1. Existing language referencing pending approval of the Medicaid funded home and community waiver program, 1037, titled Supports for Community Working and Living, is to be modified to reference the waiver as approved since CMS has now approved the state's plan for that waiver.

2. The maximum payment rates per unit of service are to be modified in all the categories and subcategories of Table #1 of the manual, Service Reference Information & Clarification, Billable Units, and Reimbursement Rates, to account for the availability of the increased funding appropriated by the Legislature.

3. For categories of home and community services that are available as extensions beyond the coverage available for those categories of services as state plan services, adjustments in payment rates are to be made to provide that the extended services are reimbursed at the state plan rates anticipated for July 1, 2014.

4. The hourly units for the subcategories in "Supported Living Services" are to be modified to provide more flexibility. In addition, there are to be changes made that will further clarify the number of hours constituting monthly units for each subcategory.

5. An incorrect reference to transportation is to be removed from the Residential Training Supports Service subcategory for "Small agency/high geographic factor."

6. The billable monthly units for the "Follow Along Support" service category are to be further specified.

7. For the service "Small Group Employment Support," the only rate available for the service when delivered through an "Agency with Choice Self Directed Option" is to be the higher rate stated for the high geographic factor subcategory.

8. Based on advice given to the department by consultants, noting the unacceptability to CMS of percentage-based administrative fees, reference to percentage-based administrative fees are to be removed and actual fee rates are to be derived by the provider based on a methodology established by the provider for Individual Goods & Services, Assisted Living, Transportation, Environmental Modifications, Adaptive Equipment, PERS, Respite, and Live-In Caregiver services categories in both Table #1 of the manual, Service Reference Information & Clarification, Billable Units, and Reimbursement Rates, and Table #2 of the manual, Documentation Expectations By Service & Administrative Rule Reference/Authority. In addition, due to the use of actual fee rates for these services certain documentation requirements have been added to Table #2.

9. The administrative rule citations in Table #2 of the manual, Documentation Expectations by Service & Administrative Rule Reference/Authority, are to be modified to encompass the entire current set of rules adopted by the Developmental Disabilities Program.

 

Fiscal Impact of Proposed Rule Changes

 

The fiscal impact of the proposed changes to ARM 37.86.3005, implementing provider rate increases for DD providers will increase total expenditures to providers for state fiscal year 2015 by the sum of $4,050,116. These increased rates affect approximately 70 corporate providers of services.

 

The fiscal impact of the proposed change to ARM 37.86.3607, implementing provider rate increases for contracted providers of developmental disabilities case management services will increase total expenditures to those providers for state fiscal year 2015 by the sum of $166,043 in expenditures. These increased rates affect approximately four corporate providers of services.

 

Availability of the Texts for the Proposed Revised Manuals

 

The texts of the two proposed manuals' versions referenced in this notice, the Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c 0208, 1037, and 0667 Waiver Programs, dated July 1, 2014 and

the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are16 Years of Age or Older or Who Reside in a Children's Community Home, dated July 1, 2014, may be viewed via the following link:  http://www.dphhs.mt.gov/dsd/ddp/ddprateinformation.shtml.

 

            5. The department intends to adopt these rule amendments effective July 1, 2014.

 

            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: Kenneth Mordan, 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 5, 2014.

 

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.

 

11. 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.

 

 

/s/ Cary B. Lund                                           /s/ Richard H. Opper                                   

Cary B. Lund                                               Richard H. Opper, Director

Rule Reviewer                                              Public Health and Human Services

           

Certified to the Secretary of State April 28, 2014.

 

 

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