BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.85.105 pertaining to fee schedule revisions for the durable medical equipment program, home and community based services, and personal assistance and self-directed personal assistance services
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On August 13, 2014, at 10:00 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 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 August 6, 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 firstname.lastname@example.org.
3. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) and (2) remain the same.
(3) The department adopts and incorporates by reference, the fee schedule for the following programs within the Health Resources Division, on the date stated.
(a) through (k) remain the same.
(l) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual which outlines the Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs) as provided in ARM 37.86.1802, effective
January October 1, 2014. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective January October 1, 2014.
(m) through (6) remain the same.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-402, MCA
4. STATEMENT OF REASONABLE NECESSITY
STATEMENT OF REASONABLE NECESSITY - HEALTH RESOURCES DIVISION
The Health Resources Division of the Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.85.105. The proposed amendments are necessary to reflect the updated fee schedule date due to changes on the fee schedule and to reflect any Medicare coverage criteria changes. They are also necessary to remove noncovered codes from the fee schedule and to adopt Medicare coverage criteria changes since January 1, 2014.
The department is proposing to change the fee schedule effective date and the Medicare coverage criteria effective date as outlined in the Region D Supplier Manual from January 1, 2014 to October 1, 2014 to reflect the change in the fee schedule due to the deletion of noncovered codes and to reflect any changes in coverage criteria. Noncovered codes are being deleted from the existing fee schedule and therefore the fee schedule effective date needs to be changed to reflect the October 1, 2014 effective date of these changes. Also, the effective date of Medicare coverage criteria as outlined in the Region D Supplier Manual is being updated to reflect any changes.
This proposed change is budget neutral and will have no fiscal impact. The proposed rule amendments are estimated to effect 391 durable medical equipment (DME) providers and 124,056 Medicaid recipients.
STATEMENT OF REASONABLE NECESSITY- SENIOR AND LONG-TERM CARE DIVISION
The department is proposing to amend the provider fee schedules under ARM 37.85.105(4)(a), (c) and (d). The purpose of the proposed fee schedule amendments is to update and set provider rates to take into consideration the Community First Choice state plan programmatic requirements, which were implemented July 1, 2014. These amendments will impact Home and Community Based Services case management provider agencies, and the Personal Assistance Services and Self-directed Personal Assistance Services provider agencies.
The effective date will be retroactive to July 1, 2014 for the Home and Community Based Services for elderly and physically disabled, the Personal Assistance Services, and Self-directed Personal assistance fee schedules changes. The department will provide fee schedules to all case management, personal assistance, and self-directed personal assistance providers in advance of the rule for verification purposes and in order to facilitate comments when rate information becomes available. These sheets will incorporate the proposed reimbursement adjustment for person-centered planning and coordinated visits that will be implemented as part of the Community First Choice program.
The fee schedule for Home and Community Based Services for elderly and physically disabled will include a reimbursement adjustment to case management provider rates, which has been projected at $920,000 in total funds. This funding will impact all Medicaid home and community based waiver physically disabled and elderly recipients and case management providers. The anticipated number of recipients who will receive waiver services in state fiscal year (SFY) 15 is approximately 1,500. The number of case management provider agencies that will be affected is seven.
The fee schedule for Personal Care Services and Self-directed Personal Care Services will include a reimbursement adjustment to provider rates, which has been projected at $134,000 in total funds. This funding will impact all Medicaid personal assistance service and self-directed personal assistance service recipients and providers. The anticipated number of recipients who will receive personal assistance and self-directed personal assistance services in SFY15 is approximately 175.
5. The department intends to adopt the rule amendments found in ARM 37.85.105(3)(l), for the DME program, effective October 1, 2014.
6. The department intends to apply the rule amendments found in ARM 37.85.105(4)(a), (c) and (d), for the Senior and Long Term Care (SLTC) program, retroactively to July 1, 2014. A retroactive application of the proposed rule amendments does not result in a negative impact to any affected party.
7. 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 email@example.com, and must be received no later than 5:00 p.m., August 21, 2014.
8. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
9. 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 7 above or may be made by completing a request form at any rules hearing held by the department.
10. 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.
11. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
12. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.
/s/ John C. Koch /s/ Richard H. Opper
John C. Koch Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State July 14, 2014.