BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.81.1002, 37.81.1018, 37.86.805, 37.86.1105, 37.86.1506, 37.86.2105, 37.86.2207, 37.86.2405, 37.86.2505, 37.86.2605, and 37.86.2907 pertaining to Montana PharmAssist Program and Medicaid reimbursement rates for some services with rates not set under resource based relative value scale (RBRVS)

) ) ) ) ) ) ) ) ) )

NOTICE OF AMENDMENT

 

TO:  All Concerned Persons

 

1.  On September 10, 2009, the Department of Public Health and Human Services published MAR Notice No. 37-484 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1570 of the 2009 Montana Administrative Register, Issue Number 17.

 

2.  The department has amended ARM 37.81.1002, 37.81.1018, 37.86.805, 37.86.1105, 37.86.1506, 37.86.2105, 37.86.2207, 37.86.2405, 37.86.2505, and 37.86.2605 as proposed.

 

3.  The department has amended the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

            37.86.2907  INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION  (1)  The department's APR-DRG prospective payment rate for inpatient hospital services is based on the classification of inpatient hospital discharges to APR-DRGs.  The procedure for determining the APR-DRG prospective payment rate is as follows:

            (a) through (b) remain as proposed.

            (c)  The department computes a Montana average base price per case.  Effective July 1, 2009 the average base price, including capital expenses, is $4,209 $4,235.  Disproportionate share payments are not included in this price.

            (i) through (2) remain as proposed.

 

AUTH:  2-4-201, 53-2-201, 53-6-113, MCA

IMP:  2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

4.  The department has thoroughly considered the comments and testimony received.  A summary of the comments received and the department's responses are as follows:

 

COMMENT #1:  ARM 37.86.2907(1)(c) states the prospective payment rate for inpatient hospital services.  The department proposed to change the average base price from $ 4,129 to $4,209 because of the 2% increase appropriated in House Bill 2 by the 2009 Montana Legislative Session.  The Health Resource Division of the Department of Public Health and Human Services incorrectly calculated the average base price in the rule as proposed.  The correct amount is $4,235.

 

RESPONSE #1:  The department is adopting the correctly calculated base rate of $4,235.

 

            5.  The department intends for the amendment of ARM 37.81.1002, 37.81.1018, 37.86.805, 37.86.1105, 37.86.1506, 37.86.2105, 37.86.2405, 37.86.2505, 37.86.2605, and 37.86.2907 to be applied retroactively to July 1, 2009.  The department intends to apply ARM 37.86.2207(9) retroactively to October 1, 2009.  A retroactive application of the proposed rules does not result in a negative impact to any affected party.

 

 

 

/s/  Geralyn Driscoll                                       /s/  Anna Whiting Sorrell                              

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

           

Certified to the Secretary of State October 19, 2009.