Montana Administrative Register Notice 37-727 No. 19   10/15/2015    
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In the matter of the amendment of ARM 37.86.101 pertaining to updating the physician-related services provider manual







TO: All Concerned Persons


          1. On November 4, 2015, at 9:00 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, 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 October 28, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:


          37.86.101 PHYSICIAN SERVICES, DEFINITIONS (1) through (4) remain the same.

          (5) The department adopts and incorporates by reference the Physician-Related Services Manual governing the administration of the Physician program dated July 2014 August 1, 2015. The Physician-Related Services Manual is available for public viewing at the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951 and at the department's web site at http://medicaidprovider.mt.gov.

(6) through (8) remain the same.


AUTH: 53-6-113, MCA

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




The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.86.101.


ARM 37.86.101


The department is proposing to change the date in (5) to August 1, 2015. This is necessary due to the changes made in the Physician-Related Services Provider Manual which will be effective on August 1, 2015.


Revisions to the Physician-Related Services Manual


Each type of Medicaid provider has its own provider manual. The department has undertaken the following changes to the latest and current version of the "Physician-Related Services" manual (the manual), dated August 1, 2015.


1. The department is proposing moving the chapter for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) from each Montana Medicaid provider manual, including former versions of this manual, and placing it in the "General Information for Providers" manual, where it will be easier to maintain EPSDT information in a consistent manner for all Medicaid providers. The "General Information for Providers" manual is found at http://medicaidprovider.mt.gov/Portals/68/docs/manuals/general082015.pdf.


2. The department is proposing moving the Well Child Screen Chart which was formerly Appendix B to the July, 2014 version of the manual to the "General Information for Providers" manual. That chart is also part of EPSDT which was removed and placed in the "General Information for Providers" manual.


3. The department is proposing removing for the sake of clarity all definitions and acronyms which are not specific to this manual, and putting them in the "General Information for Providers" manual. Only definitions and acronyms that are specific to physician-related service providers are retained in this manual.


4. The department is proposing moving key contacts and web sites information from this manual to the "Contact Us" link in the Montana Healthcare Programs Provider Information web site in order to make those contacts and that information more broadly available, and to simplify the updating and maintenance process. The "Contact Us" link may be found at the following web site: http://medicaidprovider.mt.gov/contactus.


5. The department is proposing adding language to current Section 3.1 regarding Prior Authorization for Retroactively Eligible Members, clarifying that for persons who become retroactively eligible for Medicaid, providers may accept them as Medicaid members from the current date or from the date when retroactive eligibility was effective.


6. The department is proposing adding language to current Section 5.1 clarifying that Native Americans who have been treated at an Indian Health Service, tribal or urban facility are exempt from Member Cost Sharing.


7. The department is proposing adding language to current Section 5.9 specifying that except for "moderate conscious sedation," Montana Medicaid does not allow separate reporting of anesthesia for medical or surgical procedures when the practitioner performing the surgery provides anesthesia, and clarifying how to bill properly for anesthesia services.


8. The department is proposing adding language to current Section 5.11 clarifying the proper manner for including the date of, or date associated with service, when billing for obstetrical services.


9. The department is proposing removing a reference formerly included in Section 1.1 of the previous version of the manual to "nutrition services" because it was not referenced anywhere else.


10. The department is proposing making general improvements in the spelling and grammar of the manual.


11. The department is proposing changing the date of this manual from July 2014 to the date of the proposed current version, August 1, 2015.


Fiscal Impact


There is no fiscal impact associated with this rule amendment.


          5. The department intends to apply this rule retroactively to October 1, 2015. A retroactive application of the proposed rule 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: 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., November 12, 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 rule will not significantly and directly impact small businesses.


12. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement.  The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.


The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.



/s/ Francis X. Clinch                              /s/ Richard H. Opper                            

Francis X. Clinch                                   Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services



Certified to the Secretary of State October 5, 2015.



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