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Montana Administrative Register Notice 37-505 No. 8   04/29/2010    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.805, 37.86.1506, 37.86.2105, 37.86.2207, 37.86.2224, 37.86.2405, 37.86.2505, and 37.86.2605 pertaining to Medicaid reimbursement for hearing aid services, outpatient drugs, home infusion therapy services, eyeglasses, early and periodic screening, diagnostic and treatment services, comprehensive school and community treatment, transportation and per diem, specialized nonemergency medical transportation, and ambulance services

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On May 20, 2010, at 1:30 p.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 Department of Public Health and Human Services no later than 5:00 p.m. on May 11, 2010, to advise us of the nature of the accommodation that you need.  Please contact Rhonda Lesofski, 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:

 

            37.86.805  HEARING AID SERVICES, REIMBURSEMENT  (1)  The department will pay the lowest of the following for covered hearing aid services and items:

            (a) remains the same.

            (b)  the amount specified for the particular service or item in the department's fee schedule.  The department adopts and incorporates by reference the department's Hearing Aid Fee Schedule dated July 2009 2010.  A copy of the department's fee schedule is posted at http://medicaidprovider.hhs.mt.gov and may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951; or

            (c) and (2) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA

 

            37.86.1506  HOME INFUSION THERAPY SERVICES, REIMBURSEMENT

            (1)  Subject to the requirements of these rules, the Montana Medicaid program will pay for home infusion therapy services on a fee basis, as specified in the department's home infusion therapy services fee schedule.  The department adopts and incorporates by reference the Home Infusion Therapy Services Fee Schedule dated July 2009 2010.  A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the Home Infusion Therapy Services Fee Schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.  The specified fees are on a per day or a per dose basis as specified in the fee schedule.  The fees are bundled fees which cover all home infusion therapy services as defined in ARM 37.86.1501.

            (2) through (4)(c) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, MCA

 

            37.86.2105  EYEGLASSES, REIMBURSEMENT  (1) through (2)(a)(ii) remain the same.

            (3)  The department adopts and incorporates by reference the department's Eyeglasses Fee Schedule effective July 2009 2010.  A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may also be obtained from Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

 

AUTH:  53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.2207  EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT (EPSDT) SERVICES, REIMBURSEMENT  (1) through (1)(d) remain the same.

            (2)  Reimbursement for nutrition and private duty nursing services is specified in the department's fee schedule.  The department adopts and incorporates by reference the department's private duty nursing services EPSDT Fee Schedule dated July 2009 2010 and the nutrition EPSDT Fee Schedule dated July 2009 2010.  The fee schedules are posted at http://medicaidprovider.hhs.mt.gov.  Reimbursement for outpatient chemical dependency treatment is outlined in ARM 37.27.912.  A copy of the Nutrition and Private Duty Nursing Services Fee Schedules may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (3) through (8) remain the same.

            (9)  Reimbursements for school-based health related services are specified in the School-Based Health Service Fee Schedule dated October 2009 2010, which is adopted and incorporated by reference.  A copy of the School-Based Health Service Fee Schedule is posted at http://medicaidprovider.hhs.mt.gov.  Rates are adjusted to reimburse these services at the federal matching assistance percentage (FMAP) rate.

            (10) and (11) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.86.2224  EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT SERVICE (EPSDT), COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT  (1)  Comprehensive school and community treatment (CSCT) means a comprehensive, planned course of outpatient treatment provided in the school and community to a child or adolescent with a serious emotional disturbance (SED), as defined in ARM 37.86.3702(2) 37.87.303.  A CSCT program may be operated by a licensed mental health center with a CSCT endorsement.  The criteria for a mental health center's CSCT endorsement are found in ARM 37.106.1955.

            (2) and (3) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.86.2405  TRANSPORTATION AND PER DIEM, REIMBURSEMENT

            (1) through (1)(b) remain the same.

            (2)  The department adopts and incorporates by reference the department's Montana Medicaid Fee Schedule, Personal and Commercial Transportation dated July 2009 2010 that sets forth the reimbursement rates for transportation, per diem, and other Medicaid services.  A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the fee schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (3) through (5) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.2505  SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, REIMBURSEMENT  (1) through (1)(b) remain the same.

            (2)  The department adopts and incorporates by reference the department's fee schedule dated July 2009 2010 which that sets forth the reimbursement rates for specialized nonemergency medical transportation services and other Medicaid services.  A copy of the fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            37.86.2605  AMBULANCE SERVICES, REIMBURSEMENT  (1) through (1)(b) remain the same.

            (2)  The department adopts and incorporates by reference the Montana Medicaid Fee Schedule, Ambulance dated July 2009 2010.  A copy of the fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov.  A copy of the department's fee schedule may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (3) through (4) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:  53-6-101, 53-6-113, 53-6-141, MCA

 

            4.  The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.86.805, 37.86.1506, 37.86.2105, 37.86.2207, 37.86.2224, 37.86.2405, 37.86.2505, and 37.86.2605 pertaining to Medicaid reimbursement for hearing aid services, outpatient drugs, home infusion therapy services, eyeglasses, early and periodic screening, diagnostic and treatment services, comprehensive school and community treatment, transportation and per diem, specialized nonemergency medical transportation, and ambulance services.  The proposed rule amendments are necessary to update the department's Medicaid nonresource-based fee schedules, update the appropriate dispensing fees for pharmacy providers and to appropriately associate ARM 37.87.303 definition of a serious emotional disturbance.

 

ARM 37.86.805, 37.86.1506, 37.86.2105, 37.86.2207, 37.86.2405, 37.86.2505, and 37.86.2605

 

The proposed amendment to these rules adopts the fee schedule dated July 2010.  The proposed amendment to ARM 37.86.2207(9) changes the fee schedule date from October 2009 to October 2010 for school-based services.  The proposed amendment to the fee schedules would only change the reference date to reflect the current year.  There are no rate changes and no changes, other than dates, are proposed at this time.

 

As of April 19, 2010, the date this proposed rule amendment is filed with the Secretary of State, there is a projected Montana general fund budget deficit as that term is defined in 17-7-140(3), MCA for state fiscal year 2011.  The Governor has instructed the department and other agencies of state government to implement a general fund spending reduction plan.  As part of the department's spending reduction plan appropriated provider rate increases for state fiscal year 2011 will not be implemented.

 

ARM 37.86.2224

 

The amendment to ARM 37.86.2224 updates the reference serious emotional disturbance (SED) definition reference from ARM 37.86.3702(2) to 37.87.303(1).

 

Fiscal Impact

 

The amendments to the proposed rules are expected to have no fiscal impact to the department and no material effects on Medicaid recipients or Medicaid providers.  Fee schedule dates are being changed in rule to properly refer to the most recent fee schedule available.

 

Number of persons effected:

 

The proposed rule changes could affect an estimated 81,920 Medicaid recipients and the following number of providers listed by program: 48 hearing aid providers; 265 pharmacy providers; 11 home infusion therapy providers; 169 optometric providers; 12 private duty nursing providers; 7 nutrition providers; 19 EPSDT mental health providers; 229 school-based services providers; 17 transportation providers; 107 ambulance providers; and 262 inpatient hospital providers.

 

            5.  The department intends the proposed rule amendments to ARM 37.86.805, 37.86.1506, 37.86.2105, 37.86.2207(2), 37.86.2224, 37.86.2405, 37.86.2505, and 37.86.2605 be applied effective July 1, 2010.  The proposed change to ARM 37.86.2207(9) will be applied effective October 1, 2010.

 

            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: Rhonda Lesofski, 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., May 28, 2010.

 

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.

 

 

 

 

/s/  John Koch                                                /s/  Anna Whiting Sorrell                              

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

           

Certified to the Secretary of State April 19, 2010.

 

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