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| Montana Administrative Register Notice 37-710 | No. 9 05/14/2015 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On June 4, 2015, 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 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 May 27, 2015, 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:
37.34.3005 REIMBURSEMENT FOR SERVICES OF MEDICAID FUNDED DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY-BASED SERVICES (HCBS) WAIVER PROGRAMS (1) remains the same. (2) The department adopts and incorporates by this reference the rates of reimbursement for the delivery of services and items available through each Home and Community-Based Services Waiver Program as specified in the Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c 0208, 1037, and 0667 Waiver Programs, effective
37.86.3607 CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, REIMBURSEMENT (1) Reimbursement for the delivery by provider entities of Medicaid funded targeted case management services to persons with developmental disabilities is provided as specified in the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are 16 Years of Age or Older or Who Reside in a Children's Community Home, dated (2) The department adopts and incorporates by this reference the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are 16 Years of Age or Older or Who Reside in a Children's Community Home, dated
AUTH: 53-6-113, MCA IMP: 53-6-101, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.34.3005 and 37.86.3607. These two rules pertain to the reimbursement of services provided to persons who are recipients of developmental disabilities services funded by the state of Montana with Medicaid monies. These proposed amendments are necessary for two reasons: to increase the reimbursement rates to incorporate state fiscal year (SFY) 2016 additional funding appropriated through House Bill 2 (HB2) of the 64th Montana State Legislature; and to implement needed changes in the texts of the two manuals that are incorporated by reference in these rules.
Specifically, the department proposes the following amendments:
ARM 37.34.3005
The purpose of this proposed amendment is to incorporate by reference a new edition of the Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c 0208, 1037, and 0667 Waiver Programs dated July 1, 2015. This new edition of the manual includes changes in the rates of reimbursement that are necessitated by additional legislative appropriations for the reimbursement of the Medicaid funded home and community services. The new edition also integrates changes to be in compliance with the plan for the delivery of the Medicaid funded home and community services approved by the federal Centers for Medicare and Medicaid Services (CMS).
ARM 37.86.3607
The purpose of this proposed amendment is to incorporate into the rule a new edition of the Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are 16 Years of Age or Older or Who Reside in a Children's Community Home, to be dated July 1, 2015. The proposed amendments include a change in the rate of reimbursement that is necessitated by additional legislative appropriations for the reimbursement of the Medicaid funded case management services. This proposed change in reimbursement is only applicable to the provision of case management services that are contracted for by the department and is not applicable to the reimbursement of case management services delivered by state employees. The department proposes to incorporate into the rule the web site location for viewing the manual.
Amendments to Manuals
"Montana Developmental Disabilities Program Manual of Service Rates and Procedures of Reimbursement for Home and Community-Based Services (HCBS) 1915c 0208, 1037, and 0667 Waiver Programs, April 2015 Edition"
1. The proposed effective date of the revised manual is July 1, 2015.
2. The proposed maximum payment rates per unit of services for all the categories and subcategories of Table #1 of the manual, Service Reference Information & Clarification, Billable Units, and Reimbursement Rates have been modified to account for the availability of the increased funding appropriated by the 64th Montana State Legislature.
3. Adjustments in payment rates are being made for categories of home and community services that are available as extensions beyond the coverage available for those categories of services as state plan services. These adjustments are necessary to make certain that the extended services are reimbursed at the state plan rates anticipated for July 1, 2015.
4. The hourly units for the Supported Employment – Follow Along services are to be modified to allow hourly units to be used when monthly units are cost prohibitive.
5. Additional details are added to the Homemaker service to clarify that fees can be charged by third parties.
6. Language was added to the Waiver Children's Case Management (WCCM) service to provide clarification that the service is not required to be delivered every month. But, if the service is provided in a month, then a visual contact must be made for that month within the billed units.
7. Language was added to the Caregiver Training and Support service to provide clarification that the service is not required to be delivered every month. But, if the service is provided in a month, then a visual contact must be made for that month within the billed units.
8. In the past the department allowed providers to impose an administrative fee above the purchase price for the services a home and community participant member receives from the provider. The department has been informed that CMS does not allow for this practice since the participant is charged more than other consumers as a result. Consequently, language referencing administrative fees are to be removed for Adult Foster, Remote Monitoring, Remote Monitoring Equipment, Community Transition Services, Individual Goods and Services, Assisted Living, Transportation, Environmental Modifications, Adaptive Equipment, PERS, Respite, and Live-In Caregiver services categories in both Table #1 of the manual, Service Reference Information and Clarification, Billable Units, and Reimbursement Rates, and Table #2 of the manual, Documentation Expectations By Service and Administrative Rule Reference/Authority.
"Montana Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures for Developmental Disabilities Case Management Services for Persons with Developmental Disabilities Who Are 16 Years of Age or Older or Who Reside in a Children's Community Home"
1. The proposed effective date of the revised manual is July 1, 2015.
2. The proposed reimbursement fee includes the amount appropriated by the 64th Montana State Legislature for provider rate increases.
3. An additional change was necessary to reflect the most current web links where the manual can be accessed.
5. The department intends to adopt these rule amendments effective July 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 dphhslegal@mt.gov, and must be received no later than 5:00 p.m., June 11, 2015.
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/ Cary B. Lund /s/ Richard H. Opper Cary B. Lund, Esq. Richard H. Opper, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 4, 2015.
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A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact sosarm@mt.gov.
