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 and 37.86.1807 pertaining to Effective Dates of Montana Medicaid Provider Fee Schedules

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AMENDED NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

1. On October 29, 2015 the Department of Public Health and Human Services published MAR Notice No. 37-728 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1826 of the 2015 Montana Administrative Register, Issue Number 20.

 

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 December 30, 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 MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

3.  The Department of Public Health and Human Services (department) is updating the fiscal impact to the notice of proposed amendment based on the Centers for Medicare and Medicaid Services' publication of the Medicare DMEPOS calendar year 2016 fee schedule on November 23, 2015. With regard to the requirements of 2-4-111, MCA, the department has determined that the proposed amendment may directly impact small businesses. Due to the late release of the Medicare fee schedule and the small business impact determination the department is extending the comment period for the proposed rule amendments to ensure provider and public comment are taken into consideration.

 

4. ARM 37.86.1807 remains as proposed.

 

5. ARM 37.85.105 remains as proposed, but with the following changes to the original proposal, 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 as proposed.

          (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 (d) remain as proposed.

          (e) The dental services covered procedures, the Dental and Denturist Program Provider Manual, as provided in ARM 37.86.1006, is effective July 1, 2015 January 1, 2016.

          (f) through (k) remain as proposed.

          (l) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, January 2016, 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 1, 2016. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective January 1, 2016 February 1, 2016.

          (m) through (o) remain as proposed.

          (p) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective January 1, 2016 July 1, 2015.

          (q) through (6) remain as proposed.

 

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

IMP: 53-2-201, 53-6-101, 53-6-402, MCA

 

          6. The statement of reasonable necessity is being amended as follows, new matter underlined, deleted matter interlined:

 

ARM 37.85.105

 

The department is proposing to change the fee schedule effective date in (3)(c), (3)(d), (3)(e) (3)(l), (3)(p), and (3)(s) from July 1, 2015 to January 1, 2016, and the effective date for (3)(l), pertaining to items provided for in ARM 37.86.1807, from January 1, 2016 to February 1, 2016 to reflect the current procedure codes and reimbursement amount for codes that are reimbursed with a resource-based relative value scale (RBRVS) Medicare methodology. Section (3)(p) will remain with the July 1, 2015 fee schedule date, because the department determined there were no substantive changes to the ambulance fee schedule. These amendments will permit the department to update fee schedules to reflect the most current Medicare fees, additions, deletions, or changes to procedure codes. The department is proposing to change the fee schedule effective date in (3)(d) and (3)(e) from July 1, 2015 to January 1, 2016 to reflect the addition of two new dental preventive procedure codes for adults and changes to the Dental and Denturist Program Provider Manual. The department decided to add the dental procedure codes to the fee schedule based on recommendations from the Montana Dental Association that these procedure codes are evidence-based in the prevention of dental caries. The updated Dental and Denturist Program Provider Manual, found at  https://medicaidprovider.mt.gov/18, incorporates the changes from MAR Notice No. 37-732.

 

          The effective date for the fee schedule referenced in (3)(l) is being changed from January 1, 2016 to February 1, 2016 because the changes to the fee schedule include a reduction in fees for some items and fee reductions cannot be applied retroactively.

 

7. The fiscal and small business impact statement is new text being added to the proposal notice as follows:

 

Fiscal and Small Business Impact

 

The department estimates the adoption of the calendar year 2016 Medicare durable medical equipment fee schedule and the department established incontinent supply fee schedule will affect 301 durable medical equipment providers and 134,318 eligible members.

 

Adoption of the fee schedules will result in an estimated general fund savings of $571,181 for the 2016 Medicare fee schedule and $294,065 for incontinence supply fee schedule change.

 

Adoption of the Calendar Year 2016 Medicare DMEPOS Fee Schedules will have a direct impact on businesses that dispense prescribed durable medical equipment; the department expects the reimbursement to these facilities to be reduced by an estimated $1,648,907 in total funds.

 

For businesses that dispense prescribed incontinence supplies, the department expects the reimbursement to these facilities to be reduced by an estimated $848,917 in total funds.

 

8. The department intends to adopt these rules as effective on January 1, 2016.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will significantly and directly impact small businesses.

 

10. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on January 4, 2016. Comments may also be faxed to (406) 444-9744 or e-mailed to dphhslegal@mt.gov.

 

 

 

/s/ Shannon McDonald for                     /s/ Robert Runkel for Richard H. Opper 

Susan Callaghan, Attorney                     Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

 

Certified to the Secretary of State December 14, 2015.