Montana Administrative Register Notice 37-826 No. 7   04/13/2018    
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In the matter of the adoption of New Rule I pertaining to Medicaid Auditor Evaluation Hearings






TO: All Concerned Persons


            1. On May 16, 2018, at 1:00 p.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 adoption 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 May 4, 2018, to advise us of the nature of the accommodation that you need. Please contact Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.


3. The rule as proposed to be adopted provides as follows:


            NEW RULE I MEDICAID OVERPAYMENT AUDITS AUDITOR EVALUATION HEARINGS (1) Within one year after the establishment of the contract auditor, and each subsequent year, the department will announce auditor evaluation hearing meetings via the department's website at www.dphhs.mt.gov and the State of Montana's public calendaring system. The meetings will provide an opportunity for the Medicaid provider community and the department to discuss appropriate conduct and determinations by contract auditors. The evaluation meetings' information will be published no less than 30 calendar days in advance of any annual meeting.


AUTH: 53-6-1409, MCA

IMP: 53-6-111, 53-6-1409, MCA




Montana Medicaid, the HELP Program, and CHIP/Healthy Montana Kids (HMK) programs (Montana Healthcare Programs) are administered in Montana by the Department of Public Health and Human Services (department). The Montana Healthcare Programs are funded jointly by federal and state tax dollars.  These funds are used to compensate health care provider claims for services rendered. Federal law also requires the department to implement program integrity functions as safeguards against the misuse of Montana Healthcare Program benefits and overabundant billing. The department has implemented defined guidelines for services rendered and claim coding and providers enrolled with Montana Healthcare Programs agree to abide by these guidelines plus state and federal law. Audits are then conducted to identify potential claim underpayments and overpayments, which are addressed with a provider and, in some cases, corrected.


The department finds this rulemaking necessary as the 65th Montana Legislature passed Senate Bill 82, which became effective July 1, 2017, and requires the department provide greater clarity and transparency regarding its Montana Healthcare Program integrity reviews. This rule provides for the required auditor evaluation hearing meetings.




The department does not contemplate any fiscal impact associated with the proposed adoption of New Rule I.


            5. The department intends to apply this rule adoption retroactively to July 1, 2017. A retroactive application of the proposed rule adoption 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: Todd Olson, 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 24, 2018.


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. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The primary bill sponsor was notified by letter on March 16, 2018.


10. With regard to the requirements of 2-4-111, MCA, the department has determined that the adoption of the above-referenced rule will not significantly and directly impact small businesses.


11. 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/ Flint Murfitt                                               /s/ Sheila Hogan                                         

Flint Murfitt                                                   Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services



Certified to the Secretary of State April 3, 2018.


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