BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.86.2901, 37.86.2905, and 37.86.2918 pertaining to changes to Medicaid inpatient hospital services
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On December 1, 2014, at 1:30 p.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 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 the Department of Public Health and Human Services no later than 5:00 p.m. on November 24, 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 rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.86.2901 INPATIENT HOSPITAL SERVICES, DEFINITIONS (1) through (28) remain the same.
(29) "Long-acting reversible contraceptives (LARCs)" means intrauterine devices and contraceptive implants that provide long-acting reversible contraception.
(29) through (47) remain the same, but are renumbered (30) through (48).
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, 53-6-149, MCA
37.86.2905 INPATIENT HOSPITAL SERVICES, GENERAL REIMBURSEMENT (1) through (4) remain the same.
(5) The Medicaid statewide average PPS inpatient cost to charge ratio including capital expenses is 52%.
(6) The Medicaid statewide average cost based inpatient cost to charge ratio including capital expenses is 53%.
(5) All PPS inpatient and outpatient hospital services that occur during an inpatient stay are included in the APR-DRG grouper except:
(a) dialysis services; and
(b) long-acting reversible contraceptives (LARCs) inserted at the time of delivery.
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
37.86.2918 INPATIENT HOSPITAL
, READMISSIONS, PARTIAL ELIGIBILITY, OUTPATIENT BUNDLING, AND TRANSFERS FOR PROSPECTIVE PAYMENT SYSTEM (PPS) FACILITIES (1) All readmissions occurring within 30 days will be subject to review to determine whether additional payment as a new APR-DRG or as an outlier is warranted. As a result of the readmission review, the following payment changes will be made:
(a) through (d) remain the same.
All hospital inpatient and outpatient services except dialysis services are included in the APR-DRG payment. Services that are performed at a second hospital because the services are not available at the first hospital (e.g., a CT scan) are included in the first hospital's payment. This includes transportation to the second hospital and back to the first hospital. Arrangement for payment to the transportation provider and the second hospital where the services were actually performed must be between the first and second hospital and the transportation provider.
(2) through (4) 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
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.86.2901, 37.86.2905, and 37.86.2918 regarding inpatient hospital services. These rules are regarding the unbundling of the insertion of long-acting reversible contraceptives (LARCs) at the time of delivery from the APR-DRG payment, and to remove the information regarding Medicaid statewide inpatient cost- to-charge ratios for prospective payment systems (PPS) and cost-based facilities, as they no longer are used.
The Center for Medicaid & CHIP Services (CMCS), the U.S. Department of Health and Human Services Secretary's Advisory Committee on Infant Mortality (SACIM), the Health Resources and Services Administration, and the American Congress of Obstetricians and Gynecologists all recommend the use of LARCs at the time of delivery. According to the National Survey of Family Growth, 51 percent of pregnancies in the United States are unintended. Mistimed, unplanned, or unwanted pregnancies are associated with an increased risk of poor health outcomes for mothers and babies, including delayed access to prenatal care, preterm birth, and negative physical and mental health effects. LARCs require no user intervention, they work over long periods, they are highly effective, and they are reversible.
The current inpatient payment methodology for PPS hospitals does not increase payment for a delivery when a LARC is inserted at the time of delivery, hindering the availability to members.
Montana Medicaid no longer uses statewide inpatient cost-to-charge ratios for PPS facilities or cost-based facilities. Hospital-specific cost-to-charge ratios are now used.
The department is proposing to add a new definition of long-acting reversible contraceptive (LARCs) and adjust the numbering throughout the rule.
The department is proposing to remove information regarding Medicaid statewide average PPS inpatient cost-to-charge ratio. The department is proposing to add information regarding services that are not included in the APR-DRG payment during an inpatient stay. These services include dialysis and long-acting reversible contraceptives inserted at the time of delivery. The department is also removing information regarding Medicaid statewide cost-based inpatient cost to charge ratio.
The department is proposing to remove the first sentence of (1)(e) regarding all hospital services except dialysis; this is being moved to ARM 37.86.2905.
We expect the cost of paying for long-acting reversible contraception to be fully offset by the anticipated decrease in the number of unplanned pregnancies that Medicaid will pay for in the future. No fiscal impact is expected from other changes to these rules.
5. The department intends to apply these proposed rule amendments on January 1, 2015.
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 email@example.com, and must be received no later than 5:00 p.m., December 4, 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 amendment of the above-referenced rules will not significantly and directly impact small businesses.
/s/ Geralyn Driscoll /s/ Richard H. Opper
Geralyn Driscoll, Attorney Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State October 27, 2014.