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| Montana Administrative Register Notice 37-899 | No. 21 11/08/2019 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On December 2, 2019, at 10:00 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 rule.
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 26, 2019, to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, 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 rule as proposed to be amended provides as follows, 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) remains the same. (2) The department adopts and incorporates by reference, the resource-based relative value scale (RBRVS) reimbursement methodology for specific providers as described in ARM 37.85.212 on the date stated. (a) Resource-based relative value scale (RBRVS) means the version of the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services and published at 83 Federal Register 226, page 59452 (November 23, 2018) effective January 1, 2019 which is adopted and incorporated by reference. Procedure codes created after (b) Fee schedules are effective (c) through (j) remain the same. (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) and (b) remain the same. (c) The hearing aid services fee schedule, as provided in ARM 37.86.805, is effective (d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in 2019 resulting in a dental conversion factor of $34.09 and fee schedule is effective (e) through (j) remain the same. (k) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective (l) through (p) remain the same. (q) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective (r) and (s) remain the same. (t) The optometric services fee schedule, as provided in ARM 37.86.2005, is effective (u) remains the same. (v) The lab and imaging services fee schedule, as provided in ARM 37.85.212(2) and 37.86.3007, is effective (w) through (y) remain the same. (z) The licensed direct-entry midwife fee schedule, as provided in ARM 37.85.212, is effective (aa) through (6) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing to amend ARM 37.85.105, pertaining to updating the effective dates of Medicaid fee schedules to January 1, 2020.
The following introductory explanation represents the reasonable necessity for the proposed amendments. The department administers the Montana Medicaid and non-Medicaid program to provide health care to Montana's qualified low income, elderly, and disabled residents. Medicaid is a public assistance program paid for with state and federal funds appropriated to pay health care providers for the covered medical services they deliver to Medicaid members.
The proposed rule amendments are necessary so that the Montana Medicaid Program can adopt updates to procedure codes that the federal Medicare program will enact in January 2020. The federal Medicare program's updates include new code additions, code deletions, and changes to existing code descriptions and rates. Medicare enacts routine updates every January, and Montana Medicaid, which uses Medicare procedure codes for billing, must adopt the changes for the state program.
Specific changes are explained below.
The department proposes to revise the effective date for the following fee schedules to January 1, 2020, which are being revised to reflect the updated procedure codes adopted by CMS: (1) RBRVS fee schedule, ARM 37.85.105(2)(b) (2) Hearing aid services, ARM 37.85.105(3)(c) (3) Dentist fee schedule, ARM 37.85.105(3)(d) (4) Ambulance services, ARM 37.85.105(3)(q) (5) Optometric fee schedule, ARM 37.85.105(3)(t) (6) Lab and imaging fee schedule, ARM 37.85.105(3)(v) (7) Licensed direct entry midwives fee schedule, ARM 37.85.105(3)(z)
The department is proposing to amend the effective date of the reference in ARM 37.85.105(3)(k) to the Region D Supplier Manual to January 1, 2020. The department is amending the effective date of local coverage determinations (LCDs), and national coverage determinations (NCDs) as provided in ARM 37.86.1802 to January 1, 2020. The department is proposing to revise the effective date regarding the durable medical equipment fee schedule to January 1, 2020 by proposing to adopt the Calendar Year 2020 Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule and criteria.
Fiscal Impact
The following table displays the fiscal impact to State general funds for State Fiscal Year (SFY) 2020 and SFY 2021 and the number of providers affected for the proposed amendments.
The rule amendments are proposed to take effect January 1, 2020.
5. 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: Gwen Knight, 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., December 6, 2019.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. 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 5 above or may be made by completing a request form at any rules hearing held by the department.
8. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.
10. 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 not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.
/s/ Brenda K. Elias /s/ Sheila Hogan Brenda K. Elias Sheila Hogan, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State October 29, 2019.
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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.
