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Montana Administrative Register Notice 37-529 No. 23   12/09/2010    
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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 37.86.3515 pertaining to case management services for adults with severe disabling mental illness, reimbursement

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On December 29, 2010, at 10:30 a.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 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 Department of Public Health and Human Services no later than 5:00 p.m. on December 17, 2010, to advise us of the nature of the accommodation that you need.  Please contact Gwen Knight, 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 amended provides as follows, new matter underlined, deleted matter interlined:

 

            37.86.3515  CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, REIMBURSEMENT  (1)  Case management services for adults with severe disabling mental illness will be reimbursed on a fee per unit of service basis as follows.  For purposes of this rule, a unit of service is a period of 15 minutes.

            (a)  The department will pay the lower of the following for case management services:

            (i)  the provider's actual submitted charge for services; or

            (ii)  the amount specified in the department's Medicaid fee schedule

            (2)  The department adopts the method of establishing rates for mental health case manager providers approved by the Centers for Medicare and Medicaid Services (CMS) on February 1, 2011.  That method is:

            (a)  The department determined the total costs of providing case management services by using case management provider reports of the most recent wage costs, benefit costs, and other case management costs.

            (b)  The department used actual time units billed from the providers of the most complete fiscal year.

            (c)  The department determined yearly wage cost per case manager full-time employee (FTE) added to the yearly benefit costs per case manager FTE, and yearly other costs per FTE.  The total costs are divided by the average units billed per FTE.  This final calculation will be the rate per 15-minute unit.

            (d)  The department will update the rate setting methodology every three years or whenever significant changes in services occur.

            (3)  The department adopts and incorporates by reference the department's fee schedule dated February 1, 2011 which sets forth the reimbursement rates for case management.  A copy of the fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, PO Box 202905, Helena, MT 59620-2905.

            (2) remains the same but is renumbered (4).

 

AUTH:  53-2-201, 53-6-113, MCA

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

 

            4.  The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.86.3515 pertaining to the method for setting the rates for case management services for adults with severe disabling mental illness.   Case management services is defined as "services furnished to assist Medicaid and mental health services plan eligible individuals who reside in a community setting, or are transitioning to a community setting, in gaining access to needed medical, social, educational, and other services". 

 

The proposed rule amendment to ARM 37.86.3515 states the new method for setting Montana Medicaid provider rate and adds the effective date of the most recent Medicaid Fee Schedule for reimbursement.  The reference to the Medicaid Fee Schedule for reimbursement is clarified by the addition of the effective date of that fee schedule.  The fee schedule's effective date will be updated in administrative rule prior to future case management provider rate changes.

 

The proposed amendment to ARM 37.86.3515 is necessary to state a specific reimbursement rate for mental health case management services.

 

Fiscal Impact

 

The providers for case management services for adults with severe disabling mental illness participated in the Cost Study and provided the data needed to complete the rate determination. The method of establishing rates for mental health case management, as approved by the Centers for Medicare and Medicaid Services (CMS), determined a reimbursement rate of $16.83 per unit which is lower than the current reimbursement rate.  The current rate of reimbursement rate for case manager services is $18.91 per unit.  It is necessary to lower the rate to reflect the actual cost of providing case management services.

 

 

            5.  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: Gwen Knight, 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., January 6, 2011.

 

6.  The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

7.  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 5 above or may be made by completing a request form at any rules hearing held by the department.

 

8.  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.

 

9.  The bill sponsor contact requirements of 2-4-302, MCA, do not apply.

 

 

 

/s/ John Koch                                     /s/ Anna Whiting Sorrell                               

Rule Reviewer                                    Anna Whiting Sorrell, Director

                                                             Public Health and Human Services

 

Certified to the Secretary of State November 29, 2010.

 

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