BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.85.212 and 37.86.105 pertaining to the resource based relative value scale (RBRVS) and the reimbursement for physician administered drugs

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AMENDED NOTICE OF PUBLIC HEARING AND EXTENSION OF COMMENT PERIOD ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On May 26, 2011, the Department of Public Health and Human Services published MAR Notice No. 37-541 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 865 of the 2011 Montana Administrative Register, Issue Number 10.  The department held a public hearing on June 15, 2011, and the initial comment period was scheduled to end on June 23, 2011.

 

            2.  On July 21, 2011, at 10:00 a.m., the Department of Public Health and Human Services will hold a second 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 rules.  This second hearing will supplement the hearing held on June 15, 2011.

 

            3.  The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who need an alternative accessible format of this notice.  If you need to request an accommodation, contact the department no later than 5:00 p.m. on July 18, 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.

           

            4.  ARM 37.86.105 remains as proposed.

 

5.  ARM 37.85.212 remains as proposed, but with the following changes to the original proposal notice, new matter underlined, deleted matter interlined:

 

37.85.212  RESOURCE BASED RELATIVE VALUE SCALE (RBRVS) REIMBURSEMENT FOR SPECIFIED PROVIDER TYPES  (1) through (1)(b) remain as proposed.

            (i)  physician services, which applies to the following health care professionals listed in (2):  physicians, mid-level practitioners, podiatrists, public health clinics, independent diagnostic testing facilities (IDTF), qualified Medicare beneficiary (QMB) and early and periodic screening, diagnostic and treatment (EPSDT) chiropractors, laboratory and x-ray services, family planning clinics, and dentists providing medical services.  The conversion factor for physician services for state fiscal year 2012 is $32.84 $33.23;

            (ii) remains as proposed.

            (iii)  mental health services, which applies to the following health care professionals listed in (2):  licensed psychologists, licensed clinical social workers, and licensed professional counselors.  The conversion factor for mental health services for state fiscal year 2012 is $22.19 $22.23; and

            (iv) through (14) remain as proposed.  

 

AUTH:  53-2-201, 53-6-113, MCA,

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-125, MCA

 

6.  REASON:  Given legislative appropriations and the requirements of 53-6-124 and 53-6-125, MCA, the department originally proposed in MAR 37-541 conversion factor amounts of: physician services ($32.84), allied services ($23.24), mental health services ($22.19), and anesthesia services ($27.55).

 

Comments were received from the provider community indicating they did not have enough information to review at the initial rule hearing.  In order to accommodate public participation, inspection, and provide sufficient information we are holding a second public hearing.

 

Over the course of several years, providers have shifted their practice location from office settings to facility settings.  Presently more than half of Medicaid dollars for physician claims have a facility place of service.  Because of this changing dynamic, the department remodeled its claims data for RBRVS providers.  The department now finds that the proposed conversion factor amounts are:  physician services ($33.23), allied services ($23.24), mental health services ($22.23), and anesthesia services ($27.55).

 

Fiscal Impact

 

The estimated cumulative fiscal impact of these rules is:

 

                                    Total Cost                  State General Fund              Federal Match

 

9/1/11 - 6/30/12         ($327,452)                 ($110,712)                             ($216,740)

 

This rule amendment is estimated to impact 13,400 Medicaid providers and 108,000 Medicaid clients.

 

            7.  The department is also extending the time within which to submit written comments.  Written data, views, or arguments may be submitted to Kenneth Mordan at the contact information listed in paragraph 3, and must be received no later than 5:00 p.m. on July 25, 2011.  Persons who testified at the initial hearing, or who submitted comments during the initial comment period, need not testify again or resubmit their comments.  Any such previous testimony and comments will be included in the rulemaking record.

 

            8.  The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

9.  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 3 above or may be made by completing a request form at any rules hearing held by the department.

 

10.  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.

 

11.  The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled.  The primary bill sponsor was contacted by mail, e-mail, and telephone on July 5, 2011.

 

 

 

 

/s/ John Koch                                     /s/ Hank Hudson for Anna Whiting Sorrell

Rule Reviewer                                   Anna Whiting Sorrell, Director

                                                            Public Health and Human Services

 

Certified to the Secretary of State July 5, 2011