BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.86.2925 and 37.86.2928 pertaining to Medicaid inpatient hospital services
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On November 6, 2013, at 11:00 a.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, 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 October 30, 2013, 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 email@example.com.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.86.2925 INPATIENT HOSPITAL REIMBURSEMENT,
DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS (1) Routine disproportionate share hospitals (RDSH)
shall will receive an additional payment amount equal to the product of the hospital's prospective base rate times the adjustment percentage of:
(a) and (b) remain the same.
(2) Subject to federal approval and the availability of sufficient state special revenue, all supplemental disproportionate share hospitals (SDSH)
shall will receive a supplemental disproportionate share hospital SDSH payment. In order to maintain access and quality in the most rural areas in Montana, critical access hospitals shall will receive an increased portion of the available funding. The supplemental disproportionate share hospital SDSH payment shall will be calculated using the formula: SDSH = (M ÷ D) x P.
(a) For the purposes of
the determining supplemental disproportionate share hospital SDSH payment amounts, the following definitions apply:
(i) and (ii) remain the same.
(A) For critical access hospitals, weighted Medicaid inpatient days
shall equals the number of Medicaid inpatient days provided multiplied by 3.8.
(B) remains the same.
(iii) "D" equals the total number of weighted Medicaid paid inpatient days provided by all
supplemental disproportionate share hospitals SDSHs in Montana.
(iv) "P" equals the unexpended, unencumbered disproportionate share hospital (DSH) allotment for Montana, as determined by the federal Centers for Medicare and Medicaid Services (CMS) according to section 1923 of the Social Security Act, remaining after routine
disproportionate share hospital DSH payments have been calculated according to (1), plus the state financial participation.
(v) remains the same.
Disproportionate share hospital DSH payments, including routine disproportionate share hospital RDSH payments and supplemental disproportionate share hospital SDSH payments, will be limited to the cap established by the federal Centers for Medicare and Medicaid Services (CMS ) for the state of Montana. The adjustment percentages specified in this rule shall (1) will be ratably reduced as determined necessary by the department to avoid exceeding the cap.
(a) through (c)(i) remain the same.
(ii) redistribute the amount in overpayment to providers that had not exceeded the hospital-specific limit during the period in which the DSH payments were determined utilizing the methodology used in the payment of the original allocation; and
(iii) remains the same.
(d) Should the DSH overpayment exceed the aggregate hospital-specific limit, the federal amount of overpayment will be returned to
the Center for Medicare and Medicaid Services (CMS ).
(e) and (f) remain the same.
(4) Eligibility for
routine disproportionate share hospital RDSH and supplemental disproportionate share hospital SDSH payments will be determined based on a provider's year-end reimbursement status.
AUTH: 2-4-201, 53-2-201, 53-6-113, MCA
IMP: 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.86.2928 INPATIENT HOSPITAL REIMBURSEMENT, HOSPITAL REIMBURSEMENT ADJUSTOR (1) All hospitals meeting the eligibility requirements in ARM 37.86.2940
shall will receive a hospital reimbursement adjustor (HRA) payment. The payment consists of two separately calculated amounts. In order to maintain access and quality in the most rural areas of Montana, critical access hospitals shall will receive both components of the HRA. All other hospitals shall will receive only Part 1, as defined in (2)(a). Eligibility for an HRA payment will be determined based on a hospital's year-end reimbursement status.
(2) Part 1 of the HRA payment will be based upon Medicaid inpatient utilization, and will be computed as follows: HRA1 = (M ÷ D) x P.
(a) For the purposes of calculating Part 1 of the HRA, the following apply:
(i) through (iii) remain the same.
(iv) "P" equals the total amount to be paid via Part 1 of the HRA. "P" consists of a state-paid amount plus the applicable federal financial participation (FFP). The portion of "P" that is paid by the state will equal the amount of revenue generated by Montana's hospital utilization fee, less all of the following:
(A) remains the same.
(B) 4% of the total revenue generated by the hospital utilization fee, which will be expended as match for continuity of care adjustor payments, as provided in ARM
37.88.1106 37.87.1224; and
(C) through (3) remain the same.
AUTH: 2-4-201, 53-2-201, 53-6-113, MCA
IMP: 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.86.2925 and 37.86.2928 regarding Medicaid Inpatient Hospital Services. The amendments are necessary to reflect the department's methodology for distributing disproportionate share hospital (DSH) overpayments and to update the rules using current terminology and rule formats.
The department is proposing to amend this rule by specifying for providers how the department will redistribute DSH overpayments to providers within a specified period of time. This overpayment amount will be redistributed to providers that have not exceeded the hospital-specific limit. Overpayment redistribution will be determined utilizing the methodology used in the original DSH allocation for that time period in which the original DSH payment was made. The department is also amending grammatical errors in this rule. The proposed change of the term "shall" to "will" reflects current rule format standards and is not intended to change provider rights or privileges.
In the current rule, a reference to ARM 37.88.1106 is made which provides for continuity of care adjustor payments. However, ARM 37.88.1106 has been repealed and replaced with ARM 37.87.1224. Therefore, to maintain accuracy within the rule, ARM 37.88.1106 will be replaced with ARM 37.87.1224. The proposed change of the term "shall" to "will" reflects current rule format standards and is not intended to change provider rights or privileges.
Because the monies allocated to fund the hospital utilization fee are not generated through the Medicaid budget, the proposed amendments to the above-mentioned rules will not have any fiscal impact on the Medicaid budget for state fiscal year (SFY) 2014. Current hospital base rates will remain the same, having a budget-neutral effect.
5. The department intends to adopt these rule amendments effective January 1, 2014.
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: 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 firstname.lastname@example.org, and must be received no later than 5:00 p.m., November 14, 2013.
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.
11. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.
/s/ John C. Koch /s/ Mary E. Dalton acting for
John C. Koch Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State October 7, 2013.