BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.85.105 pertaining to updating Medicaid fee schedules and effective dates
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On June 28, 2018, 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 rule.
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 June 15, 2018, to advise us of the nature of the accommodation that you need. Please contact Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; fax (406) 444-9744; or e-mail email@example.com.
3. The rule as proposed to be amended provides as follows, 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 the same.
(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) through (k) remain the same.
Fee The fee schedules for private duty nursing, nutrition, children's special health services, and orientation and mobility specialists, as provided in ARM 37.86.2207(2), are effective July 1, 2018.
(m) through (y) remain the same.
(z) The private duty nursing fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2018.
(4) remains the same.
(5) The department adopts and incorporates by reference, the fee schedule for the following programs within the Addictive and Mental Disorders Division on the date stated:
(a) remains the same.
(b) Home and community-based services for adults with severe disabling mental illness, reimbursement, as provided in ARM 37.90.408, is effective
July 1, 2018 January 1, 2018.
(c) and (6) remain the same.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) has determined that an increase to the private duty nursing fees is necessary to serve high-needs Montana Medicaid members in the least costly setting. According to the Montana Medicaid 2017 Access Monitoring Plan, one private duty nursing provider withdrew as a Medicaid provider between state fiscal years 2016 and 2017, leaving four providers available to serve Montana's Medicaid population. In 2018, one of the four remaining providers notified the department that it could no longer provide private duty nursing at the reimbursement rate currently paid by the Medicaid program and that it would discontinue services within three months. In response, the department analyzed the Medicaid population served, the number of private duty nursing agencies across the state, the existing labor market for nurses, the cost of providing private duty nursing benefits to Medicaid members, and the higher level of care costs avoided by providing the private duty nursing benefit. Therefore, the department now proposes to reimburse private duty nursing providers at the rates of $8.95 per 15 minutes of care by a licensed practical nurse (LPN) and $11.28 per 15 minutes by a registered nurse (RN). The rates are currently $7.38 for LPN services and $8.69 for RN services.
In the interest of clarity, the department proposes to make this change by creating a new subsection for private duty nursing services within the section of the rule that relates to the Health Resources Division (HRD).
In addition to changing the HRD fee schedule, the department will also amend the fee schedule for private duty nursing under the home and community based services for adults with severe disabling mental illness within the Addictive and Mental Disorders Division.
The department intends to make these amendments effective July 1, 2018. The dates for both of these fee schedules were recently changed to July 1, 2018, in MAR Notice No. 37-838. Therefore, the dates for both of these fee schedules will remain July 1, 2018.
In the Health Resources Division, the expected fiscal impact is $393,600.02 in state general fund dollars and $764,730.14 in federal funding. In the Addictive and Mental Disorders Division, the expected fiscal impact is $8,411, state general fund, and $16,344, federal funding.
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: Todd Olson, 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., July 6, 2018.
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. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.
10. 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.
11. The department will apply these rule amendments retroactively to July 1, 2018. A retroactive application of the proposed rule amendments does not result in a negative impact to any affected party.
/s/ Brenda K. Elias /s/ Sheila Hogan
Brenda K. Elias Sheila Hogan, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 29, 2018.