| HOME | SEARCH | ABOUT US | CONTACT US | HELP | ||
 |
 |
|
|
| Montana Administrative Register Notice 37-705 | No. 9 05/14/2015 | |
|
||
| Prev | Next | ||
|
BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On June 3, 2015, 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 the Department of Public Health and Human Services no later than 5:00 p.m. on May 27, 2015, 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:
37.40.1026 AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: REIMBURSEMENT (1) through (5) remain the same. (6)
AUTH: 53-2-201, MCA
37.40.1135 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: REIMBURSEMENT (1) through (5) remain the same. (6)
37.85.104 EFFECTIVE DATES OF PROVIDER FEE SCHEDULES FOR MONTANA NON-MEDICAID SERVICES (1) The department adopts and incorporates by reference the fee schedule for the following programs within the Addictive and Mental Disorders Division and Developmental Services Division on the dates stated: (a) Mental health services plan provider reimbursement, as provided in ARM 37.89.125, is effective (b) 72-hour presumptive eligibility for adult-crisis stabilization services reimbursement for services, as provided in ARM 37.89.523, is effective (c) Youth respite services reimbursement for services as provided in ARM 37.87.2233, is effective (2) Copies of the department's current fee schedules are posted at
AUTH: 53-2-201, 53-6-101, 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) The Montana Medicaid Program establishes provider reimbursement rates for medically necessary, covered services based on the estimated demand for services and the legislative appropriation and federal matching funds. Provider reimbursement rates are stated in fee schedules for covered services applicable to the identified Medicaid program. New rates are established by revising the identified program's fee schedule and adopting the new fees as of the stated effective date of the schedule. Copies of the department's current fee schedules are posted at (2) The department adopts and incorporates by reference, the resource-based relative value scale (RBRVS) reimbursement methodology for specific providers as described in ARM 37.85.212 on the date stated. (a) Resource-based relative value scale (RBRVS) means the version of the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services and published at (b) Fee schedules are effective (c) Policy adjustors are effective (d) The payment-to-charge ratio is effective (e) The specific (f) Psychiatrists receive a 112% provider rate of reimbursement adjustment to the reimbursement of physicians effective (g) Midlevel practitioners receive a 90% provider rate of reimbursement adjustment to the reimbursement of physicians for those services described in ARM 37.86.205(5)(b) effective (h) Optometric services receive a 112% provider rate of reimbursement adjustment to the reimbursement for allied services as provided in ARM 37.85.105(2) effective (i) remains the same. (3) The department adopts and incorporates by reference, the fee schedule for the following programs within the Health Resources Division, on the date stated. (a) The inpatient hospital services fee schedule and inpatient hospital base fee schedule rates including: (i) the APR-DRG fee schedule for inpatient hospitals as provided in ARM 37.86.2907, effective (ii) the Montana Medicaid APR-DRG relative weight values, average national length of stay (ALOS), outlier thresholds, and APR grouper version (b) The outpatient hospital services fee schedules including: (i) the Outpatient Prospective Payment System (OPPS) fee schedule as published by the Centers for Medicare and Medicaid Services (CMS) in (ii) the conversion factor for outpatient services on or after (iii) the Medicaid statewide average outpatient cost-to-charge ratio is 46.3%; and (iv) remains the same. (c) The hearing aid services fee schedule, as provided in ARM 37.86.805, is effective (d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in (e) The dental services covered procedures, the Dental and Denturist Program Provider Manual, as provided in ARM 37.86.1006, is effective (f) The outpatient drugs reimbursement, dispensing fees range as provided in ARM 37.86.1105(2)(b) is effective (i) remains the same. (ii) a minimum of $2.00 and a maximum of (g) remains the same. (h) The outpatient drugs reimbursement, vaccine administration fee as provided in ARM 37.86.1105(5), will be $21.32 for the first vaccine and (i) and (j) remain the same. (k) The home infusion therapy services fee schedule, as provided in ARM 37.86.1506, is effective (l) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, December 2014, which outlines the Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs) as provided in ARM 37.86.1802, effective (m) The early and periodic screening, diagnostic and treatment (EPSDT) services fee schedules for private duty nursing, nutrition, and orientation and mobility specialists as provided in ARM 37.86.2207(2), is effective (n) The transportation and per diem fee schedule, as provided in ARM 37.86.2405, is effective (o) The specialized nonemergency medical transportation fee schedule, as provided in ARM 37.86.2505, is effective (p) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective (q) The audiology fee schedule, as provided in ARM 37.86.705, is effective (r) The therapy fee schedules for occupational therapists, physical therapists, and speech therapists, as provided in ARM 37.85.610, are effective (s) The optometric fee schedule provided in ARM 37.86.2005, is effective (4) The department adopts and incorporates by reference, the fee schedule for the following programs within the Senior and Long Term Care Division on the date stated: (a) Home and community-based services for elderly and physically disabled persons fee schedule, as provided in ARM 37.40.1421, is effective (b) Home health services fee schedule, as provided in ARM 37.40.705, is effective (c) Personal assistance services fee schedule, as provided in ARM (d) Self-directed personal assistance services fee schedule, as provided in ARM (e) Community first choice services fee schedule, as provided in ARM 37.40.1026, is effective July 1, 2015. (5) The department adopts and incorporates by reference, the fee schedule for the following programs within the Addictive and Mental Disorders Division on the date stated: (a) Case management services for adults with severe disabling mental illness reimbursement, as provided in ARM 37.86.3515, is effective (b) Mental health center services for adults reimbursement, as provided in ARM 37.88.907, is effective (c) Home and community-based services for adults with severe disabling mental illness, reimbursement, as provided in ARM 37.90.408, is effective (d) Targeted case management services for substance use disorders, reimbursement, as provided in ARM 37.86.4010, is effective (6) The department adopts and incorporates by reference, the fee schedules for the following programs within the Developmental Services Division, on the date stated (a) Mental health services for youth, as provided in ARM 37.87.901 in the Medicaid Youth Mental Health Services Fee Schedule, is effective (b) Mental health services for youth, as provided in ARM 37.87.1313 in the 1915(i) HCBS State Plan Program for Youth with Serious Emotional Disturbance Fee Schedule, is effective (c) Mental health services for youth, as provided in ARM
IMP: 53-2-201, 53-6-101, 53-6-402, MCA
4. STATEMENTS OF REASONABLE NECESSITY
Section 53-6-111, MCA, requires the Department of Public Health and Human Services (the department) to establish the Montana Medicaid provider reimbursement rates. The department establishes rates based on the estimated demand for services and the legislative appropriation and federal matching funds. Rates are stated in program fee schedules and rates are changed by revising the fee schedule as of the stated effective date of the schedule. The department adopts fee schedules and fee schedule changes by amending ARM 37.85.104 and 37.85.105.
SUMMARY OF PROPOSED AMENDMENTS TO ARM 37.85.104 AND 37.85.105
These summaries are categorized according to the following divisions: Health Resources Division (HRD), Addictive and Mental Disorders Division (AMDD), Senior and Long Term Care Division (SLTC), and Developmental Services Division (DSD).
Summary of HRD'S Proposed Amendments
Some Montana Medicaid providers' rates are established through the resource-based relative value scale (RBRVS) model. RBRVS is used nationwide by most health plans, including Medicare and Medicaid. The relative value unit component of RBRVS is revised annually by the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association. The department amends ARM 37.85.105 annually to adopt current relative value units (RVUs). An RVU is a numerical value assigned to each medical procedure. RVUs are based on physician work, practice expense, and malpractice insurance expenses and express the relative effort and expense expended to provide one procedure compared with another. RVUs are added for new procedures and the RVUs of particular procedures may increase or decrease from year to year.
"Conversion factor" (CF) means a dollar amount by which RVUs are multiplied to establish the RBRVS fee for a service. The department annually calculates conversion factors for physician services, allied services, mental health services, and anesthesia services. These conversion factors are calculated by dividing the Montana Legislature's appropriation for Medicaid member's health care during the upcoming state fiscal year (SFY) by the estimated total units of health care, expressed as total RVUs, to be provided during the upcoming SFY. The resulting quotient is the conversion factor. The RVU for a procedure multiplied by the conversion factor is the fee paid for the procedure. The conversion factor for licensed physicians is set by 53-6-124 through 53-6-127, MCA.
During SFY 2015, the physician services CF was increased by the consumer price index for medical care for the previous year and in SFY 2016, the CF will increase by 3.0%. This is required by 53-6-125, MCA. Other providers receive, in aggregate, the amount appropriated by the 64th Montana State Legislature for provider rate increases.
Summary of Proposed Amendments
HRD has no amendments to ARM 37.85.104. The following describes the proposed amendments that the HRD will make to ARM 37.85.105.
(1) – Amend the provider web site to http://medicaidprovider.mt.gov.
(2)(a) – Amend the citations to the Federal Register to adopt the current RBRVS and RVUs.
(2)(b) – Amend the effective date of the RBRVS fee schedules to July 1, 2015 and the physician services CF from $35.86 to $36.93, the allied services CF from $24.33 to $24.93, the mental health services CF from $23.87 to $24.55, and the anesthesia services CF from $28.66 to $29.23.
(2)(c) – Amend the effective date of the policy adjustors to July 1, 2015; and maintain the policy adjustor percentage for maternity at 112%, family planning at 105%, and psychological testing for youth at 145%.
(2)(d) – Amend the effective date of the payment-to-charge ratio to July 1, 2015; and the payment-to-charge ratio of the providers usual and customary charges from 44% to 47%.
(2)(e) – Amend the effective date for modifiers to July 1, 2015.
(2)(f) – Amend the effective date to July 1, 2015, and maintain the percentage at 112% for the psychiatrists' reimbursement rate.
(2)(g) – Amend the effective date to July 1, 2015, and maintain the percentage at 90% for the mid-level practitioners' reimbursement rate.
(2)(h) – Amend the effective date to July 1, 2015, and maintain the percentage at 112% for optometric services reimbursement rate.
(3)(a)(i) – Amend the effective date to July 1, 2015 for the inpatient hospital fee schedule.
(3)(a)(ii) – Amend the APR-DRG Table of Weights and Thresholds effective date to July 1, 2015, and the APR -DRG grouper version to version 32.
(3)(b)(i) – Adopt the current reference to the RBRVS in the Federal Register and update the effective date to January 1, 2015.
(3)(b)(ii) – Amend the conversion factor for outpatient services from $55.53 to $56.64, and the effective date to July 1, 2015.
(3)(c) – Amend the effective date of the hearing aid services fee schedule to July 1, 2015.
(3)(d) – Amend the Relative Value for Dentists schedule to 2015, the dental conversion factor from $32.53 to $33.18, and the effective date to July 1, 2015.
(3)(e) – Amend the effective date of the dental/denturist provider manual to July 1, 2015.
(3)(f) – Amend the effective date of the outpatient drug reimbursement dispensing fee range to July 1, 2015.
(3)(f)(ii) – Amend the maximum dispensing fee for preferred brand name and generic drugs and generic drugs not identified on the preferred list from $6.65 to $6.78.
(3)(h) - Amend the administration fee for each additional vaccine from $12.68 to $13.37 and the effective date to July 1, 2015.
(3)(k) – Amend the effective date of the home infusion therapy services fee schedule to July 1, 2015.
(3)(l) – Amend the effective date of the reference to the Region D Supplier Manual and the prosthetic devices, durable medical equipment, and medical supplies fee schedule to July 1, 2015. The date that the Region D Supplier Manual was last revised was also added.
(3)(m) – Amend the effective date of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) fee schedule for private duty nursing, nutrition, and orientation and mobility specialists to July 1, 2015.
(3)(n) – Amend the effective date regarding the transportation and per diem fee schedule to July 1, 2015.
(3)(o) – Amend the effective date of the nonemergency medical transportation fee schedule to July 1, 2015.
(3)(p) – Amend the effective date regarding the ambulance services fee schedule to July 1, 2015.
(3)(q) – Amend the effective date for the audiology services fee schedule to July 1, 2015.
(3)(r) – Amend the effective date of the occupational therapists, physical therapists, and speech therapists fee schedule to July 1, 2015.
(3)(s)- Amend the effective date of the optometric fee schedule to July 1, 2015.
Fiscal Impact for Health Resources Division
The proposed amendments will increase the Medicaid budget for SFY 2016 by the amount appropriated by the 64th Montana Legislature for provider rate increases. The number of providers affected by the increase and the fiscal impact for SFY 2016 are:
Physicians, mid-level practitioners, podiatrists, public health clinics, independent diagnostic testing facilities (IDTF), qualified Medicare beneficiary (QMB) and early and periodic screening, diagnostic and treatment (EPSDT) chiropractors, laboratory and x-ray services, family planning clinics, and dentists providing medical services comprise the provider types included in the physician services conversion factor. The physician services conversion factor will receive an increase. This increase is determined by the percentage increase to the consumer price index for medical care for the previous year. This is required by 53-6-125, MCA, and will be 3.0%. This amount was appropriated by the legislature.
The proposed rule is estimated to affect 154,734 Medicaid members. In addition, it will impact the provider populations outlined in the tables above.
Summary of Addictive and Mental Disorders Division (AMDD) Proposed Amendments
AMDD is proposing to amend provider fee schedules based on the amount appropriated by the 64th Montana State Legislature for provider rate increases. These increases to the Medicaid and Non-Medicaid budget are effective July 1, 2015. The increase will have a positive impact for providers with mental health centers, mental health waiver, mental health and substance abuse, Mental Health Services Plan, and the 72-Hour Presumptive Crisis Stabilization Program.
ARM 37.85.104
ARM 37.85.104 is for Montana Non-Medicaid Services. The department is proposing to change the effective date in (1)(a) for mental health services plan provider reimbursement and (1)(b) 72-hour presumptive eligibility for adult crisis stabilization services reimbursement from July 1, 2014 to July 1, 2015.
ARM 37.85.105
The department is proposing to change the effective date in (5)(a), (b), and (c) from July 1, 2014 to July 1, 2015 for case management services for adults with severe disabling mental illness, mental health center services, home and community-based services for adults with severe disabling mental illness and targeted case management services for substance use disorders.
Fiscal Impact
The estimated provider rate increase fiscal impact is:
Summary of Senior and Long-Term Care Division's Amendments
The department is proposing to amend ARM 37.40.1026, 37.40.1135, and 37.85.105 to implement the legislatively appropriated provider rate increase effective July 1, 2015 for the Home Health Services Program, Home and Community-based Services (HCBS) Program, and the Community First Choice and Personal Assistance Services Program.
ARM 37.40.1026 and 37.40.1135
In this notice of proposed rulemaking, the fee schedules of two programs, the Community First Choice Program and the Personal Assistance Services Program, are being cross referenced for the first time in ARM 37.85.105. The proposed amendments remove the fee references in these rules and incorporate the fee schedules into the department's Medicaid provider fee rule found at ARM 37.85.105.
The proposed amendments to these rules also describe the method for setting the reimbursement rates for these programs. This is not a change in the method. It is a description of the existing method as required by ARM 37.85.105(1).
ARM 37.85.105
The proposed amendments to ARM 37.85.105 implement the July 1, 2015, provider rate increase appropriated by the 64th Montana Legislature for the Home Health Services Program, Home and Community-based Services (HCBS) Program, and the Community First Choice and Personal Assistance Services Program.
Fiscal Impact
Community First Choice (CFC) and Personal Assistance Program (PAS)
The fiscal impact of the rate changes is estimated to be $1,192,994 for CFC and $16,658 for PAS provider rate increases in total funds. This funding will impact all Medicaid Community First Choice and Personal Assistance Services members and providers who utilize this service.
The anticipated number of members who will receive Personal Assistance Services in FY15 is approximately 200 and the anticipated number of members who will receive Community First Choice services in FY15 is approximately 3,600.
Home Health Services Program
The fee schedule is amended to increase provider rates by $10,823 in total funds appropriated in HB2 (2015). This impacts all Medicaid home health members and home health providers who utilize this service. Approximately 400 members will receive home health services in SFY 2016.
Home and Community-based Services
The fee schedule is amended to increase provider rates by $787,093 in total funds appropriated in HB2 (2015). This impacts all HCBS Medicaid members and providers who utilize this service. Approximately 2,500 Medicaid members will receive HCBS in SFY 16.
Summary of Developmental Services Division's Proposed Amendments
The department is proposing to amend ARM 37.85.104 and 37.85.105 by incorporating by reference the new fee schedules that implement the amount appropriated by the 64th Montana State Legislature for provider rate increases.
Summary of Proposed Amendments - Children's Mental Health Bureau
ARM 37.85.104
The department proposes to amend the rates established in the Medicaid Youth Mental Health Fee Schedule to implement a rate increase in non-Medicaid fees to providers of respite services and update the effective date from July 1, 2014 to July 1, 2015.
ARM 37.85.105
The department proposes to amend the rates established in the Medicaid Youth Mental Health Fee Schedule to implement a rate increase in Medicaid fees to providers and update the effective date from July 1, 2014 to July 1, 2015.
The department proposes to amend rates established in the 1915(i) HCBS State Plan Program for Youth with Serious Emotional Disturbance Fee Schedule to implement a rate increase in Medicaid fees to providers and update the effective date from July 1, 2014 to July 1, 2015.
The department proposes to amend rates established in the Bridge Waiver Schedule to implement rate increases in Medicaid fees to providers and update the effective date from July 1, 2014 to July 1, 2015.
The department is also proposing to correct a typographical error found in (6)(c). The citation to ARM 37.87.1030 is being corrected to ARM 37.87.1303.
Fiscal Impact
The proposed amendments to rates for services provided through the Children's Mental Health Bureau will increase provider rates for Medicaid services by $1,933,594 for FY2016; Comprehensive School and Community Treatment $762,800 for FY2016; and Non-Medicaid Respite $5,800 for FY2016. These are total fund amounts. This funding will impact over 16,000 youth served by children's mental health Medicaid.
5. The department intends to adopt these rule amendments effective July 1, 2015.
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 11, 2015.
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/ Geralyn Driscoll /s/ Mary E. Dalton acting for Geralyn Driscoll, Esq. Richard H. Opper, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 4, 2015.
|
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.
