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| Montana Administrative Register Notice 37-546 | No. 10 05/26/2011 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF
TO: All Concerned Persons 1. On June 15, 2011, at 3:00 p.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and 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 Department of Public Health and Human Services, no later than 5:00 p.m. on June 6, 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, 3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined: 37.86.3515 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, REIMBURSEMENT (1) and (2) remain the same. (3) The department adopts and incorporates by reference the department's fee schedule dated (4) remains the same. IMP: 53-2-201, 53-6-101, 53-6-113, MCA 37.88.907 MENTAL (a) remains the same. (b) the department's fee for the service as specified in the department's (2) through (6) remain the same. IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA 37.89.125 MENTAL HEALTH SERVICES PLAN, PROVIDER REIMBURSEMENT (1) Reimbursement of enrolled providers for mental health services covered under the plan and provided to plan members is as provided in ARM 37.40.307, 37.85.212, and Title 37, chapters (a) through (5) remain the same. AUTH: 53-2-201, 53-6-113, 53-21-703, MCA IMP: 53-1-601, 53-2-201, 53-6-101, 53-6-116, 53-6-701, 53-6-705, 53-21-202, 53-21-702, MCA 37.89.523 72-HOUR PRESUMPTIVE ELIGIBILITY FOR ADULT CRISIS STABILIZATION SERVICES: REIMBURSEMENT FOR SERVICES (1) The department adopts and incorporates by reference the Medicaid 72 Hour Presumptive Eligibility Crisis Stabilization Services fee schedule dated August 2011. A copy of the department's fee schedule is posted at the (2) and (3) remain the same. IMP: 53-6-101, MCA
37.90.408 HOME AND COMMUNITY-BASED SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS: REIMBURSEMENT (1) The department adopts and incorporates by reference the Medicaid Home and Community-Based Services for Adults With Severe Disabling Mental Illness fee schedule. A copy of the department's fee schedule is posted at the (2) through (10) remain the same. 4. STATEMENT OF REASONABLE NECESSITY: The proposed amendments give notice that the department will be reducing the reimbursement rates to the identified Medicaid providers by up to 2% beginning on August 1, 2011. These provider rate changes are based on a provider rate increase that went into effect in Fiscal Year (FY) 2010, and was held constant in FY 2011. The 2010 provider rate increase was paid for with one-time-only funding appropriated by the 61st Legislative Session in 2009. This one-time-only funding was not included in the budget base for FY 2012 and the funds were not appropriated by the current 62nd Legislative session. The department considered whether a rate decrease could cause a cost shift to a more expensive service. The department considered the impact of the rate changes on efficiency, economy, quality of care, and access to Medicaid services. The department concluded that the rates are still sufficient to meet the requirements of 42 USC 1396a(a)(30)(A). The proposed reduction is $2,981,100 of total funding. In evaluating the reductions needed to live within the legislative appropriation, the department considered the alternatives of eliminating covered services and/or decreasing Medicaid eligibility. The department is unable to decrease eligibility for services after March 23, 2010 and be in compliance with the Medicaid maintenance-of-effort (MOE) requirements of the Patient Protection and Affordable Care Act, PL 111-148, Title II, Sections 2001, et seq. Eliminating optional services was considered and rejected because of the impact on vulnerable Medicaid clients who would lose coverage for services. For these reasons, the department is proposing the following provider rate decreases: ARM 37.88.907 ARM 37.88.907 states the reimbursement rate for providers of mental health center services for adults. The department is incorporating by reference into the Medicaid Adult Mental Health and the Adult Mental Health Services Plan fee schedules that it has previously established, and the new rates will be in effect August 1, 2011. Approximately 15,000 Medicaid clients receive mental health center services and there are approximately nine licensed mental health center providers in ARM 37.89.125 ARM 37.89.125 states the reimbursement rate for providers of services to individuals enrolled in the Mental Health Services Plan. Approximately 2800 clients receive mental health services through this program and there are approximately 70 providers in ARM 37.89.523 In ARM 37.89.523, the department incorporates in rule by reference the fee schedule for the 72-hour Presumptive Eligibility Services for Crisis Stabilization for adults. The department has previously established this fee schedule. Approximately 1,400 clients receive mental health services through this program and there are approximately 30 providers in Montana. The total budget decrease for this program is $24,234 for FY 2012 and the rates stated in the fee schedules will be reduced accordingly. ARM 37.90.408 ARM 37.90.408 incorporates by reference the department's previously established fee schedule for providers of Home and Community-Based Services for Adults with Severe Disabling Mental Illnesses. Approximately 155 clients receive mental health services through this program and there are approximately 4 providers in Montana. In addition, this reduction will impact another 24 agencies that provide services to the individual waiver sites. The total budget decrease for this program is $35,492 for fiscal year 2012 and the rates stated in the fee schedules are being reduced accordingly. 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: Kenneth Mordan, 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., June 23, 2011. 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. 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. 9. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
/s/ Michelle Maltese /s/ Anna Whiting Sorrell Rule Reviewer Anna Whiting Sorrell, Director Public Health and Human Services Certified to the Secretary of State May 16, 2011.
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