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| Montana Administrative Register Notice 37-944 | No. 11 06/11/2021 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On July 1, 2021, at 10:00 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 rules. 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/87819771558; meeting ID: 878 1977 1558; or (b) Dial by telephone +1 646 558 8656; meeting ID: 878 1977 1558. Find your local number: https://mt-gov.zoom.us/u/klwkz8SKp.
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 25, 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 rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.85.104 EFFECTIVE DATES OF PROVIDER FEE SCHEDULES FOR MONTANA NON-MEDICAID SERVICES (1) The department adopts and incorporates by reference the fee schedule for the following programs within the Addictive and Mental Disorders Division and Developmental Services Division on the dates stated: (a) Mental health services plan provider reimbursement, as provided in ARM 37.89.125, is effective (b) 72-hour presumptive eligibility for adult-crisis stabilization services reimbursement for services, as provided in ARM 37.89.523, is effective
(c) Youth respite care services, as provided in ARM 37.87.2203, is effective (d) Substance use disorder services provider reimbursement, as provided in ARM 37.27.905, is effective (2) remains the same.
AUTH: 53-2-201, 53-6-101, 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) remains the same. (2) The department adopts and incorporates by reference, the resource-based relative value scale (RBRVS) reimbursement methodology for specific providers as described in ARM 37.85.212 on the date stated. (a) Resource-based relative value scale (RBRVS) means the version of the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services and published at (b) Fee schedules are effective (c) Policy adjustors are effective (d) The BCBA/BCBA-D services policy adjuster is (e) The payment-to-charge ratio is effective (f) through (h) remain the same. (i) Optometric services receive a (j) and (k) 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) remains the same. (b) The outpatient hospital services fee schedules including: (i) the Outpatient Prospective Payment System (OPPS) fee schedule as published by the Centers for Medicare and Medicaid Services (CMS) in (ii) remains the same. (iii) the Medicaid statewide average outpatient cost-to-charge ratio is (iv) the bundled composite rate of (c) The hearing aid services fee schedule, as provided in ARM 37.86.805, is effective (d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in (e) remains the same. (f) The outpatient drugs reimbursement, dispensing fees range as provided in ARM 37.86.1105(3)(b) is effective (i) for pharmacies with prescription volume between 0 and 39,999, the minimum is (ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is (iii) for pharmacies with prescription volume greater than 70,000, the minimum is (g) remains the same. (h) The outpatient drugs reimbursement, vaccine administration fee as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and (i) remains the same. (j) The home infusion therapy services fee schedule, as provided in ARM 37.86.1506, is effective (k) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective (l) The nutrition services fee schedule, as provided in ARM 37.86.2207(2), is effective (m) remains the same. (n) The orientation and mobility specialist services fee schedule, as provided in ARM 37.86.2207(2), is effective (o) The transportation and per diem fee schedule, as provided in ARM 37.86.2405, is effective (p) The specialized nonemergency medical transportation fee schedule, as provided in ARM 37.86.2505, is effective (q) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective (r) The audiology fee schedule, as provided in ARM 37.86.705, is effective (s) The therapy fee schedules for occupational therapists, physical therapists, and speech therapists, as provided in ARM 37.86.610, are effective (t) The optometric services fee schedule, as provided in ARM 37.86.2005, is effective (u) The chiropractic fee schedule, as provided in ARM 37.85.212(2), is effective (v) The lab and imaging services fee schedule, as provided in ARM 37.85.212(2) and 37.86.3007, is effective (w) The Targeted Case Management for Children and Youth with Special Health Care Needs fee schedule, as provided in ARM 37.86.3910, is effective (x) The Targeted Case Management for High Risk Pregnant Women fee schedule, as provided in ARM 37.86.3415, is effective (y) The mobile imaging services fee schedule, as provided in ARM 37.85.212, is effective (z) The licensed direct-entry midwife fee schedule, as provided in ARM 37.85.212, is effective (aa) The private duty nursing services fee schedule, as provided in ARM 37.86.2207(2), is effective (4) The department adopts and incorporates by reference, the fee schedule for the following programs within the Senior and Long Term Care Division on the date stated: (a) The home and community-based services for elderly and physically disabled persons fee schedule, as provided in ARM 37.40.1421, is effective (b) The home health services fee schedule, as provided in ARM 37.40.705, is effective (c) The personal assistance services fee schedule, as provided in ARM 37.40.1135, is effective (d) The self-directed personal assistance services fee schedule, as provided in ARM 37.40.1135, is effective (e) The community first choice services fee schedule, as provided in ARM 37.40.1026, is effective (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) The mental health center services for adults fee schedule, as provided in ARM 37.88.907, is effective (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) The substance use disorder services fee schedule, as provided in ARM 37.27.905, is effective (6) For the Developmental Services Division, the department adopts and incorporates by reference the Medicaid youth mental health services fee schedule, as provided in ARM 37.87.901, effective
AUTH: 53-2-201, 53-6-113, MCA, MCA IMP: 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA
37.85.106 MEDICAID BEHAVIORAL HEALTH TARGETED CASE MANAGEMENT FEE SCHEDULE (1) remains the same. (2) The Department of Public Health and Human Services (department) adopts and incorporates by reference the Medicaid Behavioral Health Targeted Case Management Fee Schedule effective (a) through (3) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-113, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing to amend ARM 37.85.104, 37.85.105, and 37.85.106 pertaining to updating Medicaid and non-Medicaid provider rates, fee schedules, and effective dates.
The following explanation represents the reasonable necessity for the proposed amendments. The 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 proposed amendments are explained below, with reference to the specific subsections of ARM 37.85.104, 37.85.105, and 37.85.106.
ARM 37.85.104 Effective Dates of Provider Fee Schedules for Montana Non-Medicaid Services
(1)(a), (b), and (d) Addictive and Mental Disorders Division Non-Medicaid Fee Schedules The department proposes to amend the fee schedules for the Mental Health Services Plan, 72-Hour Presumptive Eligibility for Adult Crisis Stabilization, and non-Medicaid Substance Use Disorder Services July 1, 2021. This change is necessary to incorporate the legislatively approved provider rate increase. The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(1)(c) Children's Mental Health Bureau Fee Schedule Although the department proposes no changes to youth respite care services, the date for this fee schedule must be amended to July 1, 2021, because the department proposes changes in other parts of that fee schedule and the date will be changed. See below at ARM 37.85.105(6).
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
ARM 37.85.105 Effective Dates, Conversion Factors, Policy Adjusters, And Cost-To-Charge Ratios of Montana Medicaid Provider Fee Schedules
(2)(a) Resource-Based Relative Value Scale (RBRVS) Federal Register The department proposes to adopt the January 1, 2021, federal register for the RBRVS reimbursement methodology. This adoption is necessary to adopt and incorporate the most up-to-date changes made by the Centers for Medicare and Medicaid Services (CMS).
(2)(b) RBRVS Conversion Factors (CF) For allied health services, mental health services, and anesthesia services, the conversion factors were calculated and proposed to provide for an overall provider rate increase of 1.0%, effective July 1, 2021.
For the physician services conversion factor, the department is directed by 53-6-125, MCA, to increase the conversion factor by the consumer price index for medical care for the previous year which for this adjustment period is 6%.
(2)(c) Policy Adjustors Montana Medicaid utilizes payment policy adjustors to modify reimbursement. Effective July 1, 2021, Montana Medicaid is proposing to decrease the maternity policy adjustor to 1.0 and is proposing a new policy adjustor of 0.8367 for Evaluation and Management codes (CPT 99202-99499). These proposed changes are necessary to offset the Medicare increases in RVUs and to maintain budget neutral expenditures for physicians. Physicians were excluded from the provider rate increase approved in HB2 by the Montana Legislature.
(2)(d) BCBA/BCBA-D Services Policy Adjuster The BCBA/BCBA-D services policy adjuster rate of reimbursement changed from 105% to 115.8% effective July 1, 2021, due to changes in relative values.
(2)(e) Payment to Charge Ratio The payment to charge ratio, which is utilized to price some allowable procedures which do not have set reimbursement, is proposed to be 44.4%, effective July 1, 2021. This ratio is updated annually as part of the department's annual RBRVS updates and will change when there are changes in the average provider charges and/or changes to reimbursement.
(2)(i) Optometric Services Provider Rate of Reimbursement The optometric services provider rate of reimbursement changed from 117.50% to 115.69% due to changes in relative values and an increase in the allied health conversion factor. This will ensure the optical service provider rate increase meets the provider rate increase approved by the Montana Legislature.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(3)(b)(i) Outpatient Prospective Payment System (OPPS) Federal Register Effective July 1, 2021, the department proposes to adopt the January 1, 2021, federal register for the OPPS reimbursement methodology. This adoption is necessary to ensure outpatient hospital updates are aligned with CMS.
(3)(b)(iii) Medicaid Statewide Average Cost-to-Charge Ratio The Medicaid statewide average cost-to-charge ratio is calculated utilizing submitted cost reports and is updated annually. The proposed updated cost-to-charge ratio is 41.06%. Individual hospital cost-to-charge ratios can fluctuate annually which can result in shifts to the Montana statewide average cost-to-charge ratio. This ratio is required to be updated annually to keep the ratio current.
(3)(b)(iv) Outpatient Maintenance Dialysis Clinic The bundled composite rate for outpatient maintenance dialysis clinics is proposed to increase to $258.02 to incorporate the provider rate increase approved by the Montana Legislature.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(3)(c), (j), (l), and (n) through (aa) Fee Schedules The department proposes the adoption of fee schedules effective July 1, 2021. The fee schedules incorporate changes proposed within this rule notice, including federal register changes, conversion factor updates, and the legislatively approved provider rate increases. The above-listed subsections represent the following fee schedules: hearing aid services; home infusion therapy services; nutrition services; orientation and mobility specialist services; transportation and per diem fee schedule; specialized nonemergency medical transportation; ambulance services, audiology services; physical, occupational, and speech therapy services; optometric services; EPSDT chiropractic services; lab and imaging services; Targeted Case Management (TCM) for Children and Youth with Special Health Care Needs; TCM for High Risk Pregnant Women; mobile imaging services; licensed direct-entry midwife; and private duty nursing.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(3)(d) Dental Reimbursement The department proposes three changes to this subsection: 1) adoption of the Relative Values for Dentist reference published in 2021; 2) modification of the dental conversion factor to $35.06; and 3) adoption of the July 1, 2021 Dental Services fee schedules. These proposed changes are necessary to incorporate the legislatively approved provider rate increase and keep current with updated dental procedure codes.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(3)(f) Outpatient Drugs Dispensing Fee Annually the department surveys enrolled pharmacies to establish the state fiscal year minimum dispensing fee. The results from the annual survey provide the data necessary to calculate the minimum dispensing fee, which is proposed to be $6.06. The maximum dispensing fee, for each volume range, is proposed to increase to incorporate the legislatively approved provider rate increase.
(3)(h) Outpatient Drugs Reimbursement Vaccine Administration Fee The department proposes to increase the fee paid for each additional vaccine administered to $15.50. This change is necessary to maintain a vaccine administration fee aligned with physicians.
(3)(k) Prosthetic Devices, Durable Medical Equipment, and Medical Supplies The department proposes to revise the effective date of the reference to the Region D Supplier Manual to July 1, 2021, and to revise the effective date of local coverage determinations (LCDs) and national coverage determinations (NCDs), that are provided in ARM 37.86.1802 to July 1, 2021.
The department also proposes to revise the effective dates for the durable medical equipment fee schedule to July 1, 2021, to reflect the Calendar Year 2021 Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule. This allows the department to update department set fees, Medicare fees, additions, deletions, or changes to procedure codes when Medicare releases and updates their fee schedule.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(4)(a) through (e) Senior and Long-Term Care Division The department proposes the adoption of fee schedules effective July 1, 2021. The changes incorporate the legislatively approved provider rate increase. The above-listed subsections are for the following fee schedules: home and community-based services for elderly and physically disabled persons; home health services; personal assistance services; self-directed personal services; and community first choices services.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(5) Addictive and Mental Disorders Division The department proposes to amend the fee schedules for Mental Health Center Services for Adults, Home and Community Based Services for Adults with Severe and Disabling Mental Illness, and Substance Use Disorder Services to July 1, 2021. This is necessary to incorporate the provider rate increase approved by the Montana Legislature during the 2021 regular session.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
(6) Developmental Services Division Medicaid youth mental health services fee schedule The department proposes to revise the effective dates and reimbursements on the Medicaid youth mental health services fee schedule to July 1, 2021. This update incorporates the legislatively approved provider rate increase.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
ARM 37.85.106 Medicaid Behavioral Health Targeted Case Management Fee Schedule
(2) Fee schedule The department proposes to amend ARM 37.85.106 to update the fee schedule date for the Medicaid Behavioral Health Targeted Case Management Fee Schedule to July 1, 2021. This proposed change is necessary to incorporate the provider rate increase approved by the Montana Legislature during the 2021 regular session.
The proposed July 1, 2021 fee schedules can be found at https://medicaidprovider.mt.gov/proposedfs.
Fiscal Impact
The following table displays the number of providers affected by the amended fee schedules, effective dates, conversion factors, and rates for services for SFY 2022 based on the proposed amendments.
The department intends for the proposed amendments to be effective retroactively to July 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., July 9, 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, apply and have been fulfilled. The primary bill sponsor was notified by email on June 1, 2021.
9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will 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 for Adam Meier Brenda K. Elias Adam Meier, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State June 1, 2021.
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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].
