Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the adoption of New Rules I, II, and III and the amendment of ARM 37.86.4412 pertaining to the promising pregnancy care program

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION AND AMENDMENT

TO: All Concerned Persons

1. On June 1, 2017, at 1:30 p.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed adoption and 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 24, 2017, 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 adopted provide as follows:

NEW RULE I PROMISING PREGNANCY CARE - DEFINITIONS

(1) "Group prenatal care" means a combination of individual prenatal care with facilitated group education and support. The groups consist of four to twelve pregnant women with similar due dates.

(2) "Promising Pregnancy Care (PPC)" means the Montana Healthcare Programs reimbursable group prenatal care program. The Montana Healthcare Programs include:

(a) Montana Medicaid;

(b) Healthy Montana Kids (HMK);

(d) the Health and Economic Livelihood Plan (HELP).

(3) "Self-care activities" means activities that members complete on their own and includes activities such as measuring weight and blood pressure.

(4) "State approved program" means a program that meets the education requirement of the department or is Centering Certified through the Centering Healthcare Institute and has been approved for reimbursement by the department.

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

IMP: 53-2-201, 53-6-101, 53-6-113, MCA

NEW RULE II PROMISING PREGNANCY CARE - GENERAL PROVISIONS

(1) These requirements are in addition to those requirements contained in rule and statutory provisions generally applicable to Medicaid providers.

(2) For purposes of Medicaid reimbursement, providers must be a state-approved program.

(3) Pregnant members of Montana Healthcare Programs are eligible for Promising Pregnancy Care.

(4) The department must approve educational materials.

(5) A pregnancy notebook that includes personal health tracking and education materials must be provided to class participants.

(6) Data on all pregnant Medicaid members under the provider's care must be collected and reported to the department. The required data elements are available at the department's website at http://medicaidprovider.mt.gov.

(7) Classes must be provided in a group setting.

(8) Individual assessment will occur in a private area of the group space.

(9) Each class must include time for the participants to interact with other participants.

(10) The classes must be facilitated and have a planned learning objective.

(11) Participants must engage in self-care activities.

(12) The program must include the following information:

(a) nutrition information;

(b) healthy lifestyle choices;

(d) body changes in pregnancy;

(e) stress management;

(f) family planning;

(g) labor education, including types of delivery;

(h) newborn care;

(i) preventing shaken baby syndrome;

(j) preventing sudden infant death syndrome (SIDS); and

(k) postpartum care and adjustments.

(13) The program must include a participant satisfaction survey. The results of this survey must be reported to the department semi-annually. A sample survey is posted at the department's web site at http://medicaidprovider.mt.gov.

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

IMP: 53-2-201, 53-6-101, 53-6-113, MCA

NEW RULE III PROMISING PREGNANCY CARE - REIMBURSEMENT

(1) Promising Pregnancy Care is reimbursed at the lower of the following:

(a) the provider's usual and customary charge to the general public for the service; or

(b) the department's current fee schedule under ARM 37.85.105 for the appropriate provider type.

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

IMP: 53-2-201, 53-6-101, 53-6-113, MCA

4. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:

37.86.4412 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, REIMBURSEMENT (1) and (2) remain the same.

(3) All RHCs and FQHCs will be reimbursed on a prospective payment system (PPS) beginning January 1, 2001 and each succeeding calendar year. The ~~prospective payment system~~ PPS will apply equally to provider based and independent RHCs and FQHCs.

(4) through (6) remain the same.

(7) ~~Approved RHC and FQHC education health service(s) payments will be reimbursed separately from their prospective payment at a rate determined by the department.~~ ~~The fee schedule is adopted and effective as provided at ARM 37.85.105.~~ Effective July 1, 2017, approved RHCs and FQHCs participating in Promising Pregnancy Care (PPC) will be reimbursed an enhanced PPS rate. Therefore, RHCs and FQHCs will be reimbursed their existing PPS rate plus an additional amount, in accordance with the fee schedule adopted and effective as provided in ARM 37.85.105, whenever a member attends the educational aspect of the PPC session.

(8) Effective July 1, 2017, RHCs and FQHCs will be reimbursed separately for long-acting reversible contraceptives (LARCs) in addition to their PPS rate. LARCs include intrauterine devices (IUDs) and birth control implants.

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

IMP: 53-6-101, 53-6-111, 53-6-113, MCA

5. STATEMENT OF REASONABLE NECESSITY

The Department of Public Health and Human Services (department) is proposing new rules regarding the Promising Pregnancy Care program. The new rules outline the definitions, general provisions, and reimbursement requirements for the department’s group prenatal program, Promising Pregnancy Care. The department is also proposing amendments to ARM 37.86.4412 regarding Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) and long-acting reversible contraceptives (LARCs).

New Rule I

Proposed New Rule I provides a set of definitions for principal terms appearing in the proposed rule. Definitions are an essential feature of understanding the meaning of written text. The department determined that a comprehensive presentation of the definitions in one rule is the most appropriate practice and is essential to the implementation of the new rules.

New Rule II

Proposed New Rule II provides the department's requirements for a Promising Pregnancy Care (PPC) program. This rule specifies the topics that must be presented to members and it requires that providers commit to sharing data related to their pregnant Medicaid members, even if they are not enrolled in the providers PPC program. All providers who seek reimbursement for the PPC program must be state approved.

New Rule III

Proposed New Rule III outlines the reimbursement policy for the new Promising Pregnancy Care program. Providers will be reimbursed for the group sessions in addition to the individual prenatal visit.

Fiscal Impact

The proposed rule adoption is projected to have a total fiscal impact of $42,000 in SFY2018. $14,499 of this impact is from the state general fund. This rule will impact 45 FQHCs, 28 RHCs, 330 physicians, and 69,947 Medicaid members.

ARM 37.86.4412

The department is proposing to make two amendments to this subsection of rule. In (7), the proposed amendment will allow an enhanced prospective payment system (PPS) rate for approved FQHCs and RHCs that participate in Promising Pregnancy Care. The proposed amendment provides an avenue for FQHCs and RHCs to receive payment for the educational portion of the new Promising Pregnancy Care program.

The department is proposing to add a new (8) which allows a separate reimbursement for LARCs in addition to the PPS rate. This proposed change is necessary to increase access to LARCs for the Medicaid population.

Fiscal Impact

The proposed amendment is budget neutral.

6. The department intends to apply these rule adoptions and amendments retroactively to July 1, 2017. A retroactive application of the proposed rule adoptions and 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 dphhslegal@mt.gov, and must be received no later than 5:00 p.m., June 9, 2017.

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 adoption and amendment of the above-referenced rules will not significantly and directly impact small businesses.

13. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.

The department has determined that the proposed program changes presented in this notice are appropriate for performance-based measurement and therefore are subject to the performance-based measures requirement of 53-6-196, MCA.

The proposed amendment to allow FQHCs and RHCs to reimburse an enhanced prospective payment system (PPS) rate for the prenatal educational aspect of the Promising Pregnancy Care (PPC) can be assessed by performance-based measures. This will be completed by analyzing the first 9 months of the program and the number of:

1. state approved providers;

2. Medicaid members utilizing the program; and

3. classes that the utilizing members attend.

The proposed amendment to allow FQHCs and RHCs to be reimbursed separately for long-acting reversible contraceptives (LARCs) in addition to their PPS rate can be assessed by performance-based measures. This will be completed by analyzing the first 9 months of the program and the number of reimbursed LARCs by FQHC and RHC.

/s/ Brenda Elias /s/ Sheila Hogan

Brenda Elias, Attorney Sheila Hogan, Director

Rule Reviewer Public Health and Human Services

Certified to the Secretary of State May 1, 2017.