Montana Administrative Register Notice 37-701 No. 22   11/20/2014    
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In the matter of the amendment of ARM 37.40.830 pertaining to updating hospice reimbursement fee schedules to reflect new federal rates







TO: All Concerned Persons


            1. On December 10, 2014, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, at Helena, Montana, to consider the proposed amendment of 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 the Department of Public Health and Human Services no later than 5:00 p.m. on December 3, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:


37.40.830 HOSPICE, REIMBURSEMENT (1) remains the same.

(2) The department adopts and incorporates by reference 42 CFR 418.302, effective August 6, 2009, and 42 CFR 418.306, effective August 8, 2008 August 22, 2014, which sets forth the Medicare payment procedures. Copies of 42 CFR 418.302 and 42 CFR 418.306 are available at the federal web site: http://cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html.

(3) through (10) remain the same.

          (11)  The hospice fee schedules are effective October 1, 2013 October 1, 2014. Copies of the department's current fee schedules are posted at http://medicaidprovider.hhs.mt.gov and may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59602-2951.


AUTH: 53-6-113, MCA

IMP:     53-6-101, MCA




The department proposes to amend ARM 37.40.830 to update its Medicaid hospice reimbursement fee schedule to reflect increases in federal hospice reimbursement rates set by the Centers for Medicare and Medicaid Services (CMS), effective October 1, 2014; and incorporate by reference the most recently amended 42 CFR 418.306, which was amended to authorize a reduction in the hospice reimbursement rate index for any hospice provider that does not comply with reporting requirements.


In (2) the department proposes to adopt and incorporate by reference 42 CFR 418.306, which was amended effective August 22, 2014, to provide that beginning October 1, 2014 and for each subsequent fiscal year, any Medicare-certified hospice provider that does not submit hospice quality data as specified by the Secretary of Health and Human Services will receive payment rates equal to the rates for the previous fiscal year, increased by the applicable market basket index reimbursement increase, minus two percentage points.


In (11) the department proposes to amend the fee schedule referenced in the rule, effective October 1, 2014, which will incorporate an approximate 3.6 percent market basket index reimbursement increase, as computed and published by CMS. The market basket index is CMS's projection of the annual percentage increase in hospital inpatient operating costs. The funds impacted are federal Medicaid-funded (03585) and general fund (01100) sources.


The proposed rule amendments are necessary to pay Medicaid providers according to the current Medicare fee schedule, effective October 1, 2014, and to adopt by reference the current applicable federal regulations related to determination of payment rates. Failure to amend the rule as proposed will result in a deficient state hospice reimbursement rate from the current federal rate, which would result in underpayment to hospice providers, and introduces an inability for the state to comply with federal requirements pertaining to reductions in reimbursement rates for noncompliant hospice data quality submissions.


A majority of the department's hospice program's $4 million Medicaid budget funds reimbursement for hospice services delivered in nursing facilities in the form of room and board for inpatient nursing facility hospice. In fiscal year (FY) 2014, approximately 360 Medicaid members received hospice benefits under Medicaid. Hospice rates are affected by the market basket index which is applied by county. The result of adoption of the proposed amendments is that all counties in Montana will see an increase from the 2014 funding levels of approximately 3.6 percent. One hospice provider will receive a reduced reimbursement rate from failure to comply with quality data reporting requirements.


Fee schedules will be posted on the medicaidprovider.hhs.mt.gov site and will be mailed to each participating hospice provider prior to the rule hearing.


            5. The department intends to apply this rule adoption retroactively to October 1, 2014.  The implementation date is consistent with the federal approval of the hospice reimbursement rate fee increases and the effective dates of the stated promulgated regulations.  If any provider would experience a decrease in hospice rates, the decrease will not be applied retroactively. It will begin on the final adoption of this proposed rule. Therefore, there will be no retroactive negative impact to any hospice program.


            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., December 18, 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 rule will not significantly and directly impact small businesses.


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

Cary B. Lund, Attorney                                 Richard H. Opper, Director

Rule Reviewer                                             Public Health and Human Services


Certified to the Secretary of State November 10, 2014.


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