BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.4201, 37.86.4202, and 37.86.4205 pertaining to dialysis clinics

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On September 28, 2011, 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, at 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 September 19, 2011, 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 amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.86.4201  FREESTANDING DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, DEFINITIONS  (1)  "Freestanding dialysis clinics (FDC)" "Dialysis clinics (DC)" are facilities licensed by the officially designated authority in the state where the institution is located and certified by the health care financing administration (HCFA) Centers for Medicare and Medicaid Services (CMS) to:

            (a) and (b) remain the same.

 

AUTH:  53-6-113, MCA

IMP:     53-6-101, MCA

 

            37.86.4202  FREESTANDING DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REQUIREMENTS  (1) remains the same.

            (2)  The provision of outpatient maintenance dialysis and related services by the mMedicaid program shall will be coordinated with the mMedicare renal disease program as provided in Title XVIII of the Social Security Act and any other program providing the same or similar service CFR Title 42 section 413.171 and 413.172.

            (3)  Outpatient maintenance dialysis and related services in a FDC shall will be provided only to a person who has been diagnosed as suffering from chronic ESRD by a physician.

 

AUTH:  53-6-113, MCA

IMP:     53-6-101, MCA

 

            37.86.4205  FREESTANDING DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REIMBURSEMENT  (1)  Reimbursement for outpatient maintenance dialysis and other related services provided in a FDC shall will be as follows: a bundled composite rate of $262 effective October 1, 2011.  The department will not allow add-on adjustments to the composite rate.

            (a)  FDCs will be reimbursed under the composite rate reimbursement system for independent facilities in accordance with 42 CFR 413 172 (b) subpart H and as detailed in the HIM-15, chapter 27.  The department hereby adopts and incorporates by reference 42 CFR 413. subpart H (1989 edition) and the HIM-15, chapter 27 (1983 edition).  Copies may be obtained from the Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

            (b)  The reimbursement period will be the FDC's fiscal year.

            (c)  These reimbursement rules are in addition to those contained in ARM 46.12.509(2) through (6).

 

AUTH:  53-6-113, MCA

IMP:     53-6-101, MCA

 

            4.  STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.86.4201, 37.86.4202, and 37.86.4205 regarding Medicaid freestanding dialysis services.  The purpose of the proposed rule amendments is to revise the current administrative rules governing dialysis.

 

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), requires the Centers for Medicare and Medicaid Services (CMS) to implement a bundled prospective payment system (PPS) to renal dialysis facility providers.  This new requirement replaces the current basic case-mix adjusted composite payment system and will cover all the resources used in providing outpatient dialysis treatment.  This single-bundled composite payment rate requirement is a change from the composite rate and fee-for-service payment methodology currently in use.

 

Currently the department is following Medicare's methodology which has become very complex.  The department would need to make major changes to the Medicaid Management Information System (MMIS) in order to incorporate all of the Medicare suggested adjustments.  The department thinks this would add unneeded complexity.  Instead, the department is proposing a per diem fee of $262 per day for someone who is only covered by Medicaid.  For the vast majority of patients on dialysis, who are receiving both Medicare and Medicaid, the department will continue to pay their Medicare co-pay and deductible.

 

ARM 37.86.4201

 

Since both independent and hospital-based dialysis clinics are reimbursed under the same methodology, the change in the definition will place all dialysis clinics under one definition.  The term "Health Care Financing Administration (HCFA)" was replaced with CMS.

 

ARM 37.86.4202

 

The federal code cites were changed in order to provide the reader information of where to find the revised definitions to be used within the ESRD program and the principles of the new rate payment system.

 

ARM 37.86.4205

 

The department has constructed an all-inclusive rate that has the benefit of encompassing all Medicare-allowable services into a single PPS that can be updated on an annual basis.

 

Fiscal Impact

 

The new proposed method of reimbursement is estimated to be budget neutral with no fiscal impact.

 

Person and Entities Affected

 

The proposed changes will affect approximately 20 dialysis clinic providers, both in and out of state.  The proposed changes will not affect services provided to Medicaid clients.

 

            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: 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., October 6, 2011.

 

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.  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.

 

9.  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 August 29, 2011.