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 37.86.1105 pertaining to Montana Medicaid pharmacy reimbursement
NOTICE OF AMENDMENT
TO: All Concerned Persons
1. On June 17, 2016, the Department of Public Health and Human Services published MAR Notice No. 37-757 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1043 of the 2016 Montana Administrative Register, Issue Number 12.
2. The department has amended the following rule as proposed: ARM 37.86.1105.
3. The department has amended the following rule as proposed, but with the following changes from 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 (e) remain as proposed.
(f) The outpatient drugs reimbursement, dispensing fees range as provided in ARM 37.86.1105(3)(b) is effective July 1, 2016:
(i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $2.00 and the maximum is
(ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $2.00 and the maximum is
$11.51 $13.00; or
(iii) for pharmacies with prescription volume greater than 70,000, the minimum is $2.00 and the maximum is
(g) through (6) remain as proposed.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-402, MCA
4. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:
COMMENT #1: Several commenters expressed concern about the cost savings associated with the reimbursement changes.
RESPONSE #1: Federal law requires the average acquisition cost (AAC) drug reimbursement change. The savings to the Medicaid program from the federal change in AAC reimbursement is greater than the increase in pharmacy professional dispensing fee rates.
COMMENT #2: The department received several comments proposing modifications to the dispensing fee structure outlined in this rulemaking. Some commenters expressed support, others proposed different volume bands and dispensing fee, some commenters asked for a rural rate, and others requested a flat dispensing fee for all pharmacy providers.
RESPONSE #2: The department has increased the proposed maximum dispensing fees based on the comments received, but the prescription volume will remain unchanged for each tier. The survey data did not support the commenters' recommended prescription volume levels. The changes to the proposed maximum dispensing fees were made in ARM 37.85.105(3)(f).
COMMENT #3: A commenter requested that the department assign everyone the maximum dispensing fee for the appropriate dispensing fee bands until 2017.
RESPONSE #3: The department will assign pharmacy providers the lower of their calculated cost to dispense, based on the annual Montana Dispensing Fee Questionnaire, or the maximum allowed for their store's prescription volume.
COMMENT #4: A commenter stated they are losing money every day and will begin looking at their staffing and patients they can serve. They see patients from long term care and mental health group homes, and state that there is "no way" pharmacies will continue to provide patients with proper medications. Another commented on the high cost of doing business in a small town.
RESPONSE #4: The department will implement the amended tiered professional dispensing fee with a retroactive effective date of July 1, 2016. The department will adjust claims to account for the increase in the professional dispensing fee. The department has determined reimbursement rates are competitive and adequately compensate providers for their product and services.
COMMENT #5: Comments were received that some providers strongly oppose any proposals to provide tiered dispensing fees.
RESPONSE #5: The tiered dispensing fee structure was selected based on comments and the statistical analysis completed using the results of the department's annual dispensing fee survey. The tiered dispensing fee structure should adequately compensate providers for their professional services.
COMMENT #6: The department received comments requesting an increase in the maximum dispensing fee for rural pharmacy providers.
RESPONSE #6: The department has determined that a professional dispensing fee formula based on a pharmacy's expenses and prescription volume better represents the cost to dispense as opposed to a pharmacy's location.
5. The effective date for ARM 37.85.105 is October 1, 2016. The department intends to apply the rule amendment in ARM 37.85.105(3)(f) retroactively to July 1, 2016. The department intends to apply the rule amendment in ARM 37.85.105(3)(a) to October 1, 2016.
The effective date for ARM 37.86.1105 is August 20, 2016, which is the day after publication in the Register. The department intends to apply the rule amendments in ARM 37.86.1105 retroactively to July 1, 2016.
A retroactive application of the proposed rule amendments does not result in a negative impact to any affected party.
/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 August 8, 2016