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Montana Administrative Register Notice 37-725 No. 24   12/24/2015    
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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 37.86.2803, 37.86.3001, 37.86.3002, and 37.86.3003 pertaining to the addition of lactation services to Medicaid outpatient hospital services

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NOTICE OF AMENDMENT

 

TO: All Concerned Persons

 

1. On October 15, 2015, the Department of Public Health and Human Services published MAR Notice No. 37-725 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1661 of the 2015 Montana Administrative Register, Issue Number 19. On October 29, 2015, the Department of Public Health and Human Services published an Amended Notice of Public Hearing on Proposed Amendment at page 1823 of the 2015 Montana Administrative Register, Issue Number 20.

 

2. The department has amended the following rules as proposed: ARM 37.86.2803 and 37.86.3003.

 

3. The department has amended the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

          37.86.3001 OUTPATIENT HOSPITAL SERVICES, DEFINITIONS

          (1) through (23) remain as proposed.

         

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA

 

          37.86.3002 OUTPATIENT HOSPITAL SERVICES, SCOPE AND REQUIREMENTS (1) remains as proposed.

          (2) Outpatient hospital services are services that would also be covered by Medicaid if provided in a nonhospital setting and are limited to the following diagnostic and therapeutic services furnished by hospitals to outpatients:

          (a) through (e) remain as proposed.

          (f) lactation services provided in a certified baby-friendly hospital approved by the department and performed by nonphysician providers, i.e., certified lactation providers. These services will only be allowed to be billed by the facility effective on or after January 1, 2016.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA

 

4. 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 expressed concern about the requirements of the "Baby Friendly Initiative." Commenters stated the hardline requirement, that infant formula not be offered, leads to mothers feeling shame or inadequate. Overall, commenters felt the initiative was unfriendly. Commenters are advocating that the "Baby Friendly" designation not be a prerequisite to obtain Medicaid funding for their lactation program.

 

RESPONSE #1: The department thanks the commenters for expressing their concerns. The department is removing the "Baby Friendly" designation requirement from the rule.

 

COMMENT #2: One commenter stated that another requirement of the "Baby Friendly" program is to only allow healthy newborns in the nursery for less than one hour per day. The commenter said this requirement caused the hospital's satisfaction scores to drop because mothers would like to check their baby into the nursery to shower or take a nap. The commenter is requesting that the "Baby Friendly" designation requirement be removed.

 

RESPONSE #2: The department thanks the commenter for expressing their concern. The department is removing the "Baby Friendly" designation requirement from the rule.

 

COMMENT #3: One commenter states that typically, private insurance will cover three outpatient follow-up lactation visits. The commenter asks why Medicaid patients should have substandard care.

 

RESPONSE #3: The department thanks the commenter for expressing their concern. The department is removing the "Baby Friendly" designation requirement from the rule. All outpatient hospitals will be able to bill Montana Medicaid for the allowed lactation services.

 

COMMENT #4: One commenter stated that the burden of documentation that nursing staff must do, under the "Baby Friendly" designation, takes away from face-to-face patient care. This burden leads to greater expenses and could potentially lead the institution to increase the cost of healthcare they deliver. The commenter advocates for the "Baby Friendly" designation to be removed.

 

RESPONSE #4: The department thanks the commenter for expressing their concern. The department is removing the "Baby Friendly" designation requirement from the rule.

 

COMMENT #5: One commenter stated that parents had to hide things, like pacifiers, from staff because they felt judged for using these items. This commenter cites review articles from 2007 and 2012 where there was not any significant difference in long-term breast-feeding outcomes in two of the mainstays of the "Baby Friendly" initiative, i.e., not allowing pacifier use and cup feeding. The commenter summarized by stating that the restrictive regulations ended up being "family unfriendly" and several regulations have not shown to improve long-term breast-feeding outcomes.   The commenter is also asking that the "Baby Friendly" designation not be a determining factor in the funding of outpatient lactation services and be removed as a requirement.

 

RESPONSE #5: The department thanks the commenters for expressing their concerns. The department is removing the "Baby Friendly" designation requirement from the rule.

 

COMMENT #6: One commenter stated support of the Medicaid proposal regarding lactation support and favors the changes outlined in the proposal.

 

RESPONSE #6: The department would like to thank the commenter for their support of the rule.

 

COMMENT #7: Several commenters said they liked that Medicaid was looking at how it can expand and support lactation services.

 

RESPONSE #7: The department would like to thank the commenters for their support of the rule.

 

COMMENT #8: Alexis Sandru, attorney from the Legislative Services Division, sent a comment to the department indicating that 53-6-141, MCA, in ARM 37.86.3001 and 37.86.3002, has been repealed.

 

RESPONSE #8: The department has removed this statute from the implementing citations in these two rules.

 

 

 

/s/ Francis X. Clinch                              /s/ Robert Runkel for Richard H. Opper 

Francis X. Clinch, Attorney                     Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

         

Certified to the Secretary of State December 14, 2015

 

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