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| Montana Administrative Register Notice 37-842 | No. 9 05/11/2018 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On May 31, 2018, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 107 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 the Department of Public Health and Human Services no later than 5:00 p.m. on May 21, 2018, 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 rules to be amended provide as follows, new matter underlined, deleted matter interlined:
37.40.815 HOSPICE, ELECTION AND WAIVER OF OTHER BENEFITS (1) through (6) remain the same. (7) The hospice chosen by the eligible individual, or their representative, must file (8) remains the same.
AUTH: 53-6-113, MCA IMP: 53-6-101, MCA
37.40.830 HOSPICE, REIMBURSEMENT (1) through (11) remain the same. (12) The hospice fee schedules are effective
AUTH: 53-6-113, MCA IMP: 53-6-101, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) proposes to amend ARM 37.40.815 and 37.40.830 to specify when the Notice of Election must be filed for Medicaid hospice services for individuals, and to change the effective date for the new fee schedule for Medicaid hospice.
ARM 37.40.815
The department proposes amending ARM 37.40.815(7) to ensure the department complies with Medicaid requirements for submission of hospice Notice of Election requirements.
ARM 37.40.830
The department proposes amending ARM 37.40.830(12) to change the effective date of its Medicaid hospice reimbursement fee schedule from January 1, 2018 to October 1, 2017, in accordance with changes in the federal hospice reimbursement rates set by the Centers for Medicare and Medicaid Services (CMS) in the Federal Register effective October 1, 2017. Medicaid hospice incorporates the Medicare reimbursement methodology and the reimbursement updates as specified in the Federal Register. The proposed fee schedule implements an approximate, aggregate reimbursement rate increase of one percent as computed and published by CMS, which will apply to providers in all 56 counties. A 1% increase in the hospice reimbursement rate equals approximately $53,000 of the Montana Medicaid Hospice program budget of $5.3 million.
Montana hospice rates are affected by a wage index applied geographically by county. The Fiscal Year (FY) 2018 wage index for Carbon, Yellowstone, and Golden Valley Counties has increased by approximately 1.1%. The FY 2018 wage index for Cascade County has decreased by approximately 20.9% and has decreased for Missoula County by approximately 2.2%. All other Montana counties are subject to the FY 2018 Montana rural wage index rate which has increased by approximately 0.9%.
Four hospice providers, two of whom are no longer active Medicaid providers, will be subject to a hospice reimbursement rate decrease of two percent because they failed to comply with federal quality data submission requirements during the prior fiscal year. A copy of the proposed hospice fee schedule can be found at http://medicaidprovider.mt.gov/proposedfs.
Fiscal Impact
Proposed amendments to ARM 37.40.830 will have a fiscal impact on the hospice program. Funds impacted will be from federal Medicaid fund course (03585) and general fund course (01100). In Fiscal Year (FY) 2017, approximately 453 Medicaid recipients received the hospice benefit.
A majority of the Medicaid hospice program's approximately $5.3 million budget provides reimbursement for hospice services provided in nursing facilities in the form of room and board for inpatient nursing facility hospice.
Montana hospice rates are affected by a wage index applied geographically by county. The Fiscal Year (FY) 2018 wage index for Carbon, Yellowstone, and Golden Valley Counties has increased by approximately 1.1%. The FY 2018 wage index for Cascade County has decreased by approximately 20.9% and has decreased for Missoula County by approximately 2.2%. All other Montana counties are subject to the FY 2018 Montana rural wage index rate which has increased by approximately 0.9%.
Four hospice providers, two of whom are no longer active Medicaid providers, will be subject to a hospice reimbursement rate decrease of two percent because they failed to comply with federal quality data submission requirements during the prior fiscal year. A copy of the proposed hospice fee schedule can be found at http://medicaidprovider.mt.gov/proposedfs.
5. The increase in hospice rates will be retroactive to October 1, 2017. Decreases in hospice rates will not be applied retroactively and will be effective upon adoption of rule.
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: 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., June 8, 2018.
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. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
10. 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 except in Cascade and Missoula Counties. Montana hospice rates are affected by a wage index applied geographically by county. Except for five counties, the Fiscal Year (FY) 2018 rural wage index for all Montana counties increased by approximately 0.9%. The FY 2018 wage index increased by approximately 1.1% for Carbon, Yellowstone, and Golden Valley Counties. The FY 2018 wage index decreased by approximately 20.9% for Cascade County and by approximately 2.2% for Missoula County, which will reduce hospice rates in those counties.
11. 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/ Francis X. Clinch /s/ Laura Smith for Francis X. Clinch Sheila Hogan, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 1, 2018. |
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.
