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| Montana Administrative Register Notice 37-748 | No. 8 04/22/2016 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On May 12, 2016, 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 the Department of Public Health and Human Services no later than 5:00 p.m. on May 5, 2016, 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:
37.40.301 SCOPE, APPLICABILITY, AND PURPOSE (1) This subchapter specifies requirements applicable to provision of and reimbursement for Medicaid nursing facility services, including intermediate care facility services for (2) and (3) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.40.304 NURSING FACILITY SERVICES (1) Nursing facility services are provided in accordance with 42 CFR, part 483, subpart B, or intermediate care facility services for (2) through (4) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.40.307 NURSING FACILITY REIMBURSEMENT (1) For nursing facility services, other than (2) Effective July 1, 2001, and in subsequent rate years, nursing facilities will be reimbursed using a price-based reimbursement methodology. The rate for each facility will be determined using the operating component defined in (2)(a) and the direct resident care component defined in (2)(b): (a) through (c) remain the same. (d) The total payment rate available for the period (3) Providers who, as of July 1 of the rate year, have not filed with the department a cost report covering a period of at least six months participation in the Medicaid program in a newly constructed facility will have a rate set at the statewide median price as computed on (4) For (5) In addition to the per diem rate provided under (2) or the reimbursement allowed to an (6) For nursing facility services, including (7) through (12) remain the same.
IMP: 53-6-101, 53-6-111, 53-6-113, MCA
37.40.315 STAFFING AND REPORTING REQUIREMENTS (1) Providers must provide staffing at levels which are adequate to meet federal law, regulations, and requirements. (a) Each provider must submit to the department within ten days following the end of each calendar month a complete and accurate (b) If a complete and accurate
AUTH: 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-108, 53-6-111, 53-6-113, MCA
37.40.326 INTERIM PER DIEM RATES FOR NEWLY CONSTRUCTED FACILITIES AND NEW PROVIDERS (1) This rule specifies the methodology the department will use to determine the interim per diem rate for in-state providers, other than (a) and (b) remain the same.
AUTH: 53-6-113, MCA
37.40.330 SEPARATELY BILLABLE ITEMS (1) through (8) remain the same. (9) The provisions of (3) through (7) apply to all nursing facilities, including intermediate care facilities for (10) remains the same.
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.40.336 REIMBURSEMENT FOR INTERMEDIATE CARE FACILITIES FOR (2) remains the same. (3) All (4) and (5) remain the same. (6) Following the sale of an intermediate care facility for
AUTH: 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.40.345 ALLOWABLE COSTS (1) and (2) remain the same. (3) For purposes of reporting costs as required in ARM 37.40.346, allowable costs will be determined in accordance with the PRM-15, subject to the exceptions and limitations provided in these rules, including but not limited to the following: (a) Return on net invested equity is an allowable cost only for providers of intermediate care facility services for (b) through (4) remain the same.
37.40.352 UTILIZATION REVIEW AND QUALITY OF CARE (1) Upon admission and as frequently thereafter as the department may deem necessary, the department or its agents, in accordance with 42 CFR 456 subpart F (1997), may evaluate the necessity of nursing facility care for each Medicaid resident in an intermediate care facility for
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-142, MCA
37.40.361 DIRECT CARE AND ANCILLARY SERVICES WORKERS' WAGE REPORTING/ADDITIONAL PAYMENTS INCLUDING LUMP SUM PAYMENTS FOR DIRECT CARE AND ANCILLARY SERVICES WORKERS' WAGE AND BENEFIT INCREASES (1) Effective for the period (2) The department will pay Medicaid certified nursing care facilities located in Montana that submit an approved request to the department a lump sum payment in addition to the amount paid as provided in ARM 37.40.307 and 37.40.311 to their computed Medicaid payment rate to be used only for wage and benefit increases or lump sum payments for direct care or ancillary services workers in nursing facilities. (a) The department will determine the lump sum payments, twice a year commencing (b) through (3) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
4. STATEMENT OF REASONABLE NECESSITY
The 64th Legislature in House Bill 2 (HB2) has provided funding to implement an approximate 2% increase in Medicaid provider rates using state and federal funds for state fiscal year (SFY) 2017. The increase is necessary to maintain Medicaid provider rates at a level consistent with efficiency, economy, quality of care, and to ensure the continued participation of providers.
These rules continue the methodology for implementing legislative funding for nursing facility reimbursement, including updated estimated patient days, patient contribution amounts, and case mix indices (acuity) into the rate calculation for SFY 2017. Funding will continue to be available to provide for a direct care worker wage increase for nursing facility providers for workers who provide direct care and ancillary services in SFY 2017.
The Legislature continued approval for the use of local county matching funds as a source of additional revenue for nursing facility providers. The intergovernmental fund transfer (IGT) program maintains access to, and the quality of, nursing facility services, and will be available for SFY 2017.
The department will provide rate sheets to all providers in advance of the rule hearing for verification purposes and in order to facilitate comments. These sheets will distribute the funding available in order to meet the department goals for a price-based system of reimbursement and will incorporate legislative appropriated funding levels.
The department is proposing to amend the fiscal year to the current fiscal year.
The department is proposing to amend the wording in the rule relative to the staffing report requirements.
The department is proposing to amend the fiscal year to the current fiscal year.
37.40.301, 37.40.304, 37.40.307, 37.40.326, 37.40.330, 37.40.336, 37.40.345, and 37.40.352
The department is proposing to amend the wording from "individual with Mental Retardation (ICF/MR) to "individuals with Intellectual Disabilities (ICF/IID)." These proposed amendments reflect the current language reference from the Centers for Medicare and Medicaid (CMD) for this category of service.
Fiscal Impact
The total state and federal funding available for state fiscal year (SFY) 2017 for rate calculation purposes utilizing the funding in HB2 is currently projected at $145,987,024 which is comprised of $15,704,708 in state special revenue, $35,445,757 in state general funds, and $94,836,559 in federal funds when the provider rate increases are included.
The ongoing funding of lump sum payments to providers for direct care workers and ancillary staff consists of $2,445,820 of state general funds and $4,540,242 in federal funds for a total appropriation of $6,986,062 for the nursing facility direct care worker wage program. This total funding for direct care wages includes an additional $0.25 per hour increase of $1,502,478 in new funding for SFY 2017.
The estimated total funding available for SFY 2017 for nursing facility reimbursement is estimated at approximately $178,738,473 of combined state funds and federal funds, including $32,751,449 in patient contributions. These numbers do not include at risk provider funds or direct care wage funding.
Anticipated days for SFY 2016 are 1,015,234 using estimates of caseload adopted by the Legislature.
The estimated total funding impact of the onetime payments to "at risk" nonstate governmental providers and other nursing facilities not determined to be "at risk," has been appropriated at $20,150,700 in total funds of which $7,054,760 comes from state special revenue funds and approximately $13,095,940 comes from federal funding sources.
Seventy-seven nursing facility providers participated in the Medicaid nursing facility payment program and approximately 4,669 recipients received services in nursing facilities under Medicaid.
The analysis of Medicaid nursing facility rates that is annually conducted by Myers and Stauffer, LC shows that in SFY 2015 Montana Medicaid on average is reimbursing approximately 94% of the cost of providing nursing facility services. The department considered the impact of the rate changes on efficiency, economy, quality of care, and access to Medicaid services and concluded that the rates are still sufficient to meet the requirements of 42 USC 1396a (a) (30(A).
5. The department intends to amend these rules effective July 1, 2016.
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., May 20, 2016.
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.
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/ Valerie Bashor /s/ Richard H. Opper Valerie Bashor, Attorney Richard H. Opper, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State April 11, 2016.
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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.
