Administrative Rules of the State of Montana

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 the effective dates of Medicaid fee schedules

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

TO: All Concerned Persons

1. On January 13, 2022, 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 rule. Interested parties may access the remote conferencing platform in the following ways:

(a) Join Zoom Meeting at: https://mt-gov.zoom.us/j/84336943425; meeting ID: 843 3694 3425; or

(b) Dial by telephone +1 646 558 8656; meeting ID: 843 3694 3425. Find your local number: https://mt-gov.zoom.us/u/kR2fCyefA.

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 December 30, 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) 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 85 Federal Register Volume 85, Issue 248, page 84472 (December 28, 2020) effective January 1, 2021, which is adopted and incorporated by reference. Procedure codes created after ~~January 1, 2021~~ January 1, 2022 will be reimbursed using the relative value units from the Medicare Physician Fee Schedule in place at the time the procedure code is created.

(b) Fee schedules are effective ~~July 1, 2021~~ January 1, 2022. The conversion factor for physician services is $41.88. The conversion factor for allied services is $24.75. The conversion factor for mental health services is $21.44. The conversion factor for anesthesia services is $30.57.

(d) The BCBA/BCBA-D services policy adjuster is 115.8%, effective July 1, 2021.

(e) The payment-to-charge ratio is effective July 1, 2021, and is 44.4% of the provider's usual and customary charges.

(f) and (g) remain the same.

(h) Midlevel practitioners receive a 90% provider rate of reimbursement adjustment to the reimbursement of physicians for those services described in ARM 37.86.205(5)(b), effective July 1, 2016.

(i) Optometric services receive a 114.79% provider rate of reimbursement adjustment to the reimbursement for allied services, as provided in ARM 37.85.105(2), effective July 1, 2021.

(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) The inpatient hospital services fee schedule and inpatient hospital base fee schedule rates including:

(i) the APR-DRG fee schedule for inpatient hospitals, as provided in ARM 37.86.2907, effective October 1, 2021; and

(ii) the Montana Medicaid APR-DRG relative weight values, average national length of stay (ALOS), outlier thresholds, and APR grouper version 38, ~~are~~ contained in the APR-DRG Table of Weights and Thresholds, effective October 1, 2021. The department adopts and incorporates by reference the APR-DRG Table of Weights and Thresholds effective October 1, 2021.

(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 Federal Register Volume 85, Issue 249, page 85866 (December 29, 2020), effective January 1, 2021, and reviewed annually by CMS, as required in 42 CFR 419.5 (2016) and as updated by the department;

(ii) through (iv) remain the same.

(d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in 2021 resulting in a dental conversion factor of $35.06 and fee schedule is effective ~~July 1, 2021~~ January 1, 2022.

(e) ~~The dental services covered procedures, t~~The Dental and Denturist Program Provider Manual, as provided in ARM 37.86.1006, is effective October 1, 2019.

(f) The outpatient drugs reimbursement, dispensing fees range as provided in ARM 37.86.1105(3)(b) is effective July 1, 2021:

(i) through (iii) remain the same.

(g) The outpatient drugs reimbursement, compound drug dispensing fee range, as provided in ARM 37.86.1105(5), will be $12.50, $17.50, or $22.50, based on the level of effort required by the pharmacist, effective July 1, 2013.

(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 $15.50 for each additional administered vaccine, effective July 1, 2021.

(i) and (j) remain the same.

(k) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective ~~October 1, 2021~~ January 1, 2022, which outlines the Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs), as provided in ARM 37.86.1802, effective ~~October 1, 2021~~ January 1, 2022. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective ~~October 1, 2021~~ January 1, 2022.

(l) through (p) remain the same.

(q) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective ~~July 1, 2021~~ January 1, 2022.

(r) The audiology fee schedule, as provided in ARM 37.86.705, is effective ~~July 1, 2021~~ January 1, 2022.

(s) The therapy fee schedules for occupational therapists, physical therapists, and speech therapists, as provided in ARM 37.86.610, are effective ~~July 1, 2021~~ January 1, 2022.

(t) The optometric services fee schedule, as provided in ARM 37.86.2005, is effective ~~July 1, 2021~~ January 1, 2022.

(u) remains the same.

(v) The lab and imaging services fee schedule, as provided in ARM 37.85.212(2) and 37.86.3007, is effective ~~July 1, 2021~~ January 1, 2022.

(w) and (x) remain the same.

(y) The mobile imaging services fee schedule, as provided in ARM 37.85.212, is effective ~~July 1, 2021~~ January 1, 2022.

(z) The licensed direct-entry midwife fee schedule, as provided in ARM 37.85.212, is effective ~~July 1, 2021~~ January 1, 2022.

(aa) through (5) remain the same.

(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 ~~July 1, 2021~~ October 1, 2021.

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) is proposing to amend ARM 37.85.105, pertaining to updating the effective dates of Medicaid fee schedules.

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 rule amendments are necessary so that the Montana Medicaid Program can adopt updated Medicare procedure codes that the federal Centers for Medicare & Medicaid Services (CMS) will adopt in January 2022. Montana Medicaid uses Medicare procedure codes. To ensure providers can accurately and timely bill for services they provide to Medicaid members, the department must adopt CMS' updated Medicare rates. Final Medicaid fee schedules are posted after CMS publishes its final fee schedules. The updated codes include new code additions, code deletions, and changes to existing code descriptions and rates.

The proposed changes also include correcting the name of the Centers for Medicare & Medicaid Services, standardizing citations to the Federal Register, and minor grammar and punctuation edits.

The proposed amendments are explained below, regarding the specific subsection of ARM 37.85.105.

(2)(a) and (b) Resource-Based Relative Value Scale (RBRVS)

The department proposes to reimburse procedure codes created on or after January 1, 2022, using the relative value units currently in place, and then revise the fee schedule effective date to January 1, 2022, which is being revised to reflect the updated Medicare procedure codes adopted by the federal Medicare program.

(3)(c), (q), (r), (s), (t), (v), (y), and (z) Fee Schedules

The department proposes to revise the effective date for the following fee schedules to January 1, 2022, to reflect the updated Medicare procedure codes adopted by CMS: hearing aid services, ambulance services, audiology, occupational therapists, physical therapists, and speech therapists, optometric services, lab and imaging services, and licensed direct-entry midwives fee schedules.

(3)(d) Dentist fee schedule

The department proposes to update the Dentist Fee schedule, effective January 1, 2022, to reflect changes to the Current Dental Terminology (CDT) 2021 by removing applicable deleted covered codes and including their updated replacements.

(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 January 1, 2022, and revise the effective date of local coverage determinations (LCDs) and national coverage determinations (NCDs), that are provided in ARM 37.86.1802, to January 1, 2022.

The department is also proposing to revise the effective dates for the durable medical equipment fee schedule to January 1, 2022, to reflect the Calendar Year 2022 Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule. This will allow the department to update Medicare fees, additions, deletions, or changes to procedure codes when Medicare releases and updates their fee schedule

(6) Developmental Services Division

The department proposes to update the Medicaid youth mental health services fee schedule to October 1, 2021, to change the reimbursement rate for the Comprehensive School and Community Treatment (CSCT) program to $96.00 per day of service. A rural differential payment of 115% of unit rate is proposed to reflect higher costs of services in frontier communities. The updated rate addresses the updated costs providers incur as a result of the CSCT program redesign, as proposed in MAR Notice No. 37-963, which was published on November 5, 2021. The CSCT program is the only rate change proposed on the youth mental health services fee schedule under this proposal.

Fiscal Impact

This proposed rule amendment has estimated costs listed in the table below for the changes related to the CSCT program. The required state share will be provided by local education agencies through intergovernmental transfer agreements.

	SFY2022
State Share	$1,687,641
Federal Share	$3,202,074
Total	$4,889,715

These proposed rule amendments are expected to be budget neutral for all other services.

The department intends to apply these proposed rule amendments retroactively to January 1, 2022, except for the proposed amendment to ARM 37.85.105(6), which the department intends to apply retroactively to October 1, 2021. A retroactive application of the proposed rule amendments does not result in a negative impact to any affected party.

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., January 21, 2022.

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/ Adam Meier

Brenda K. Elias Adam Meier, Director

Rule Reviewer Public Health and Human Services

Certified to the Secretary of State December 14, 2021.