BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.1501, 37.86.1502, and 37.86.1506 pertaining to home infusion therapy program revisions

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On May 16, 2012, at 9:30 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 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 Department of Public Health and Human Services no later than 5:00 p.m. on May 9, 2012, 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:

 

            37.86.1501  HOME INFUSION THERAPY SERVICES, DEFINITIONS  In ARM 37.86.1501, 37.86.1502, 37.86.1505, and 37.86.1506, the following definitions apply:

            (1)  "Agency staff services" means all services provided by the home infusion therapy agency's staff, as provided in ARM 37.106.2405, including all professional and nonprofessional employed and contracted individuals.

            (a) through (h) remain the same.

            (2)  "Home infusion therapy services" means a comprehensive treatment program for the preparation and administration of parenteral medications or parenteral or enteral nutritional services to a recipient who is not receiving infusion therapy as a hospital inpatient or outpatient.  Home infusion therapy services include all pharmacist professional services, all agency staff services and all associated medical equipment and supplies.  Home infusion therapy services do not include professional nursing services, professional physician services, or drugs.  Drugs are covered under the pharmacy outpatient program.

            (3)  "Home Nursing Services for Infusion/Specialty Drug Administration" means high-tech registered nurse (RN) services provided by an RN with special education, training and expertise in home administration of drugs via infusion, home administration of specialty drugs, or home nursing management of disease state and care management programs.  Typical services include:

            (a)  evaluation and assessment;

            (b)  education and training for the patient or caregiver;

            (c)  inspection and consultation of aseptic home environment;

            (d)  catheter insertion; and

            (e)  patient assessment.

            (3)(4)  "Pharmacist professional services" include:

            (a) through (d) remain the same.

            (e)  delivery, pick up, and disposal of equipment, supplies and/or, drugs; and

            (f)  24-hour on call status;. and

            (g) (5) any other services of the pharmacist related to the recipient's home infusion therapy services. Pharmacist professional services do not include costs, fees or charges for the drugs that are compounded or administered.  Other home infusion therapy services include services as provided in ARM 37.106.2411 and the procedure codes included in the department's Home Infusion Therapy Fee Schedule.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-6-101, 53-6-113, MCA

 

            37.86.1502  HOME INFUSION THERAPY SERVICES, PROVIDER REQUIREMENTS  (1) remains the same.

            (2)  Home infusion therapy service providers, as a condition of participation in the Montana Medicaid program, must:

            (a)  maintain a current home infusion therapy agency license issued by the department's quality assurance division, and meet the standards set forth in ARM 37.106.2422, or, if the provider is serving recipients outside the state of Montana, maintain a current license in the equivalent category under the laws of the state in which the services are provided; and

            (b) remains the same.

 

AUTH:  53-2-201, 53-6-113, MCA

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

 

            37.86.1506  HOME INFUSION THERAPY SERVICES, REIMBURSEMENT

            (1)  Subject to the requirements of these rules, the Montana Medicaid program will pay for home infusion therapy services on a fee basis, as specified in the department's home infusion therapy services fee schedule.  The department adopts and incorporates by reference the Home Infusion Therapy Services Fee Schedule dated August 2011 July 1, 2012.  A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the Home Infusion Therapy Services Fee Schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.  The specified fees are on a per day or a per dose basis as specified in the fee schedule.  The fees are bundled fees which cover all home infusion therapy services as defined in ARM 37.86.1501.

            (2) and (3) remain the same.

 

            (4)  Subject to (4)(c), professional nursing services provided as part of a recipient's home infusion therapy program are separately billable and will be reimbursed in the following manner:

            (a)  nursing services provided by a home health agency will be reimbursed under the Home Health Services program as provided in ARM 37.40.701, 37.40.702, and 37.40.705;

            (b)  nursing services provided by licensed nurses employed by the home infusion therapy agency will be reimbursed to the agency under the methodology specified in ARM 37.86.2207; and

            (c)  professional nursing services are not separately billable when the home infusion therapy program is provided in a nursing facility.

            (4)  Nursing services provided by licensed nurses employed by the home infusion therapy agency will be reimbursed to the agency as specified in the Home Infusion Therapy Fee Schedule.  Home nursing services for infusion / specialty drug administration are not billable when the home infusion therapy program is provided in a nursing facility.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-6-101, 53-6-113, MCA

 

            4.  STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.86.1501, 37.86.1502, and 37.86.11506.  The proposed amendments are necessary because home infusion therapy providers are required to follow two different sets of nursing rules and fee schedules causing administrative confusion.  Consolidating home nursing services for infusion/specialty drug administration into the Home Infusion Therapy Program provides an efficient mode to manage the infusion therapy and associated nursing services.  This consolidation will reduce duplicative efforts and will focus on providing a continuum of care for the department's clients.

 

The proposed rule amendments will better manage nursing services provided to Medicaid clients receiving home infusion therapy.  The proposed amendments define nursing services, reimbursement policy, and align the program with the Quality Assurance Division's (QAD) Administrative Rules for Home Infusion Therapy.

 

ARM 37.86.1501

 

This rule directs the reader to the appropriate Quality Assurance Division rules to clarify the agency's personnel duties, descriptions and allowed services.  Additionally, the rule change will allow for professional nursing services to be managed under the program and directs the reader to the outpatient pharmacy program for coverage of drugs.  Because professional nursing services will be allowed under the program, it is necessary to include the nurse's responsibilities.  Due to the technical complexity of home infusion therapy the reader is directed to the department's home infusion fee schedule for clarity of covered services.

 

ARM 37.86.1502

 

The department is amending this rule by referencing QAD's ARM 37.106.2422 in order to provide a more comprehensive description of expectations for providers.

 

ARM 37.86.1506

 

The department is amending this rule by removing references that professional nursing services are separately billable.  Home infusion nursing services will be reimbursed according to the department's home infusion therapy fee schedule.  The amendment also clarifies that home nursing services for infusion/specialty drug administration are not billable in a nursing facility.

 

FISCAL IMPACT

 

There should not be a fiscal impact to any programs caused by the proposed rule revisions.

 

            5.  The department intends the proposed rule changes to be applied effective July 1, 2012.

 

            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 24, 2012.

 

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.

 

 

/s/ John Koch                                               /s/ Anna Whiting Sorrell                            

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                      Public Health and Human Services

           

Certified to the Secretary of State April 16, 2012.