BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES

OF THE STATE OF MONTANA

 

In the matter of the amendment of ARM 37.85.104 and 37.85.105 pertaining to the revision of fee schedules for Medicaid provider rates effective July 1, 2016

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AMENDED NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

1. On April 22, 2016, the Department of Public Health and Human Services published MAR Notice No. 37-745 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 669 of the 2016 Montana Administrative Register, Issue Number 8.

 

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 20, 2016, 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 MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

3.  The department will not be adopting a new conversion rate for outpatient hospitals or a new APR-DRG fee schedule for inpatient hospitals effective July 1, 2016. The 64th Montana Legislature did not appropriate a provider rate increase for the hospital program for state fiscal year (SFY) 2017. A provider rate increase for the hospital program was inadvertently added to the changes to ARM 37.85.105, published in MAR Notice No. 37-745.

 

4. ARM 37.85.105 remains as proposed, but with the following changes to the original proposal, 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) and (2) remain as proposed.

          (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) The inpatient hospital services fee schedule and inpatient hospital base fee schedule rates including:

          (i) the APR-DRG fee schedule for inpatient hospitals as provided in ARM 37.86.2907, effective July 1, 2016 July 1, 2015; and

          (ii) the Montana Medicaid APR-DRG relative weight values, average national length of stay (ALOS), outlier thresholds, and APR grouper version 33 32 are contained in the APR-DRG Table of Weights and Thresholds effective July 1, 2016 July 1, 2015. The department adopts and incorporates by reference the APR-DRG Table of Weights and Thresholds effective July 1, 2016 July 1, 2015.

          (b) The outpatient hospital services fee schedules including:

          (i) remains as proposed.

          (ii) the conversion factor for outpatient services on or after July 1, 2016 July 1, 2015 is $57.21 $56.64;

          (iii) through (6) remain as proposed.

 

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

IMP: 53-2-201, 53-6-101, 53-6-402, MCA

 

5. The statement of reasonable necessity is being amended as follows: deleted matter interlined:

 

At page 675 the following text is being removed:

 

(3)(a)(ii): Revise the effective date regarding the APR-DRG Table of Weights and Thresholds to July 1, 2016. Update the APR-DRG grouper version from version 32 to version 33.

 

(3)(b)(ii): Revise the effective date regarding the conversion factor for outpatient services to July 1, 2016. Update the conversion factor for outpatient services from $56.64 to $57.21.

 

At page 677 the following text is being removed:

 

Provider Type	SFY 2017 Budget Impact (All Funds)	SFY 2017 Budget Impact (GF and SSR Only)	SFY 2017 Budget Impact (Federal Funds)	Active Provider Count
Inpatient Hospital	$1,940,497	$671,764	$1,268,733	374
Outpatient Hospital	$1,057,063	$362,618	$694,445	374

 

6. ARM 37.85.104 remains as proposed.

 

7. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on May 27, 2016.  The department has extended the comment period seven days.  Comments may also be faxed to (406) 444-9744 or e-mailed to dphhslegal@mt.gov.

 

 

/s/ Geralyn Driscoll                                /s/ Richard H. Opper                            

Geralyn Driscoll, Attorney                      Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

 

Certified to the Secretary of State April 25, 2016.