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| Montana Administrative Register Notice 37-941 | No. 3 02/12/2021 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On March 4, 2021, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider the proposed amendment of the above-stated rule. Because there currently exists a state of emergency in Montana due to the public health crisis caused by the coronavirus, there will be no in-person hearing. Interested parties may access the remote conferencing platform in the following ways: (a) Join Zoom Meeting at: https://mt-gov.zoom.us/j/96575941687; meeting ID: 965 7594 1687; or (b) Dial by Telephone +1 646 558 8656; meeting ID: 965 7594 1687. Find your local number: https://mt-gov.zoom.us/u/ayPTKImRL.
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 February 26, 2021, to advise us of the nature of the accommodation that you need. Please contact Heidi Clark, 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 protected].
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) through (4) remain 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) The home and community-based services for adults with severe disabling mental illness fee schedule, as provided in ARM 37.90.408, is effective (c) and (6) remain the same.
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) administers the Montana Medicaid and non-Medicaid program to provide health care to Montana's qualified low income, elderly, and disabled residents. Medicaid is a public assistance program paid for with state and federal funds appropriated to pay health care providers for the covered medical services they deliver to Medicaid members.
The department has submitted to the Centers for Medicare and Medicaid Services (CMS) an amendment to the Severe and Disabling Mental Illness (SDMI), Home and Community Based waiver program, to implement changes to the SDMI waiver. The proposed rule amendments implement the following changes:
1. The addition of two new self-direct service options on the SDMI waiver, Behavioral Intervention Assistant and Life Coach. These services currently exist as agency-based services. The self-direct option gives plan members an additional option for receiving this service which is necessary to address member needs and access to care. The corresponding rate is: Behavioral Intervention Assistant - $6.24 per 15-minute unit; and Life Coach - $9.86 per 15-minute unit.
2. Rate increases for Residential Habilitation, Assisted Living Facility/Adult Foster Care and Intensive Mental Health Group Home, which is required to remedy identified barriers to access and quality service delivery for Montanans across the state. The proposed rate will increase from $80.24 to $104.00.
The proposed rule amendments in this notice serve to implement the waiver amendment filed with CMS and are intended to promote member access to care and address the needs of members for support services.
Fiscal Impact
The Severe and Disabling Mental Illness (SDMI), Home and Community Based Services waiver for state fiscal year (SFY) 2021 may serve up to 600 members and in SFY 2022 the SDMI waiver may serve up to 650 members.
Behavioral Intervention Assistant and Life Coach – Self Direction
The department proposes to add two additional rates to the Montana Medicaid - Home and Community Based Services (HCBS) for Adults with Severe and Disabling Mental Illness (SDMI) fee schedule. The department calculated this fiscal impact based upon an assumption that current members on the waiver may choose to change their service from an agency-based service model to a self-directed service model which results in no additional expenditures for the waiver in SFY 2021. For SFY 2022, the waiver is approved for an additional 50 unduplicated members resulting in an increase for SFY 2022.
Residential Habilitation, Assisted Living Facility/Adult Foster Care
The department proposes a rate increase for Assisted Living Facility/Adult Foster Care from $80.24 per day to $104.00 per day. With the current waiver amendment, the department has also adjusted their projections for SFY 2021 because the increase in unduplicated members previously projected has been negatively affected by the COVID-19 public emergency, resulting in a negative fiscal impact. For SFY 2022, the waiver is approved for an additional 50 unduplicated members resulting in an increase for SFY 2022.
Residential Habilitation, Intensive Mental Health Group Home
The department proposes a rate increase for Intensive Mental Health Group Homes from $293.31 to $319.54. This increase was a result of reassessing the productivity factor based upon provider feedback.
The department intends for the proposed change to be effective April 1, 2021.
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: Heidi Clark, 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 [email protected], and must be received no later than 5:00 p.m., March 12, 2021.
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.
/s/ Brenda K. Elias /s/ Erica Johnston Brenda K. Elias Erica Johnston, Acting Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State February 2, 2021. |
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 [email protected].
