BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the adoption of New Rule I and the amendment of ARM 37.86.2907 and 37.86.3001 pertaining to ICD CM and PCS Services:  adoption of ICD-10

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION AND AMENDMENT

 

TO: All Concerned Persons

 

            1. On February 5, 2014, at 11:00 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 adoption and 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 January 29, 2014, 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 rule as proposed to be adopted provides as follows:

 

NEW RULE I ICD CLINICAL MODIFICATION (CM) AND PROCEDURAL CODING SYSTEM (PCS) SERVICES (1) The department adopts and incorporates by reference the Diagnosis coding practice of International Classification of Diseases (ICD) published by the World Health Organization. The ICD is used as a health care classification system for diseases and health conditions.

(a) For dates of service on or before September 30, 2014, the ICD edition being utilized will be the ninth revision (ICD-9) to code the diagnosis of services.

(b) For dates of service October 1, 2014 and thereafter the ICD edition being utilized will be the tenth revision (ICD-10) to code the diagnosis of services. ICD-10 consists of the following codes sets:

(i) ICD-Clinical Modification (CM); and

(ii) ICD-Procedure Coding System (PCS).

(c) For inpatient claims with a discharge date on or after October 1, 2014, the tenth revision (ICD-10) must be utilized.

(d) Outpatient claims with dates of service that span the utilization dates must be split based on date of service in order to utilize the appropriate edition as noted in (a) and (b).

(e) Per 45 CFR 162.1002, ICD-10 will replace ICD-9 for dates of service October 1, 2014 and after. A copy of the ICD codes may be obtained at http://www.medicalcodingbooks.com/.

 

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

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

 

4. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.86.2907 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION (1) The department's APR-DRG prospective payment rate for inpatient hospital services is based on the classification of inpatient hospital discharges to APR-DRGs. The provider reimbursement rates for inpatient hospital services, except as otherwise provided in ARM 37.85.206, is stated in the department's APR-DRG fee schedule adopted and effective at ARM 37.85.105. The procedure for determining the APR-DRG prospective payment rate is as follows:

            (a) The department will assign an APR-DRG to each Medicaid client discharge in accordance with the current APR-grouper program version, as developed by 3M Health Information Systems. The assignment and reimbursement of each APR-DRG is based on:

            (i) the ICD-9-CM principal diagnoses for dates of discharge prior to and including September 30, 2014, and the ICD-10-CM principal diagnoses for dates of discharge October 1, 2014 and thereafter;

            (ii) all ICD-9-CM secondary diagnoses for dates of discharge prior to and including September 30, 2014, and the ICD-10-CM secondary diagnoses for dates of discharge October 1, 2014 and thereafter;

            (iii) all ICD-9-CM medical procedures performed during the client's hospital stay for dates of discharge prior to and including September 30, 2014, and the ICD-10-PCS medical procedures performed during the client's hospital stay for dates of discharge October 1, 2014 and thereafter;

            (iv) through (2) remain the same.

 

AUTH: 2-4-201, 53-2-201, 53-6-113, MCA

IMP:    2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.86.3001 OUTPATIENT HOSPITAL SERVICES, DEFINITIONS

            (1) through (10) remain the same.

            (11) "ICD-9-CM" means the International Classification of Diseases, Ninth Revision based on the official version of the United Nations World Health Organization's Ninth Revision, effective for dates of service or discharge date prior to and including September 30, 2014.

            (12) "ICD-10-CM" means the International Classification of Diseases, Tenth Revision based on the official version of the World Health Organization's Tenth Revision for diagnosis coding, effective for dates of service or discharge date October 1, 2014 and thereafter.

            (12) through (20) remain the same, but are renumbered (13) through (21).

 

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

 

            5. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing New Rule I and is proposing to amend ARM 37.86.2907 and 37.86.3001 pertaining to the International Classification of Diseases, Clinical Modification (ICD CM) and Procedure Coding System (PCS) Services:  adoption of ICD-10.

 

The ICD is a set of diagnostic codes published by the World Health Organization (WHO). In 1990 the WHO updated the ICD code set creating the tenth edition (ICD-10). Other countries began adopting this code set as early as 1994. The transition from ICD-9 to ICD-10 for the United States is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). All covered entities under HIPAA are required to adopt the new ICD-10 codes for services provided on or after October 1, 2014.

 

New Rule I

 

Proposed New Rule I will specify the dates for which ICD edition should be utilized based on the date of service or date of discharge. In addition New Rule I will mandate the replacement of the ICD-9 code set with ICD-10 (45 CFR 162.1002) and will specify where providers can obtain code information. It is necessary in order for the department to comply with federal law and regulations.

 

ARM 37.86.2907 and 37.86.3001

 

Within the current Administrative Rules of Montana, the description of ICD is listed as the ninth revision (ICD-9). With the proposed amendments to ARM 37.86.2907 and 37.86.3001, the ICD references will be updated to include ICD-10 definitions and effective date as well as clarification of the ICD-9 effective dates. It is necessary in order for the department to comply with federal law and regulations.

 

Fiscal Impact

 

The implementation of ICD-10 is required for all covered entities under HIPAA. The fiscal impact on a provider practice can vary based on the size of the practice and the amount of changes to the business operations that are necessary. The estimated costs for Medicaid providers in Montana can be anywhere from $83,290 up to $2,728,780 per provider. However, this cost will be amortized over the provider's practice, because all insurers who must be HIPAA-compliant will be using the ICD-10 codes.

 

            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., February 13, 2014.

 

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 adoption and amendment of the above-referenced rules will significantly and directly impact small businesses.

 

 

/s/ John C. Koch                                          /s/ Marie Matthews for                                

John C. Koch                                               Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services

           

Certified to the Secretary of State January 6, 2014.