BEFORE THE COMMISSIONER OF SECURITIES AND INSURANCE

MONTANA STATE AUDITOR

 

In the matter of the adoption of NEW RULES I (6.6.4901), II (6.6.4902), III (6.6.4903), IV (6.6.4905), and V (6.6.4906) pertaining to Patient-Centered Medical Homes

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NOTICE OF ADOPTION

 

          TO: All Concerned Persons

 

1. On August 8, 2013, the Commissioner of Securities and Insurance, Montana State Auditor, published MAR Notice No. 6-205 pertaining to the public hearing on the proposed adoption of the above-stated rules at page 1414 of the 2013 Montana Administrative Register, Issue Number 15.

 

2. The department has adopted the following rules as proposed: New Rule I (6.6.4901), New Rule II (6.6.4902), New Rule III (6.6.4903), New Rule IV (6.6.4905), New Rule V (6.6.4906).

 

3. On August 29, 2013, a public hearing was held on the proposed adoption of the above-stated rules in Helena. Comments were received by the September 5, 2013, deadline.

 

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 NO. 1: The Montana Department of Public Health and Human Services wishes to set Montana-specific measures that focus on priority health status issues, in particular: blood pressure control, smoking cessation for pregnant women, and meeting immunization goals for children. The commenter believes that the standards used by the national accrediting entities for patient-centered medical homes do not properly measure these health status goals, and therefore, the Montana PCMH program needs to adopt these Montana-specific standards.

 

RESPONSE NO. 1:  The department appreciates this comment and agrees with the goals that the Department of Public Health and Human Services wishes to achieve. The purpose of this first set of rules is to establish the rules necessary to the administration of the PCMH program. The department intends to discuss Montana-specific standards with the stakeholder council soon, and when there is agreement, move forward with additional rules as quickly as possible. The department welcomes the participation and expertise of the public health department in the development of those rules.

 

COMMENT NO. 2: Two commenters, who operate government healthcare programs, asked that the department refrain from restricting the use of the name "patient-centered medical home" or "medical home" to only those healthcare providers who have been qualified by the commissioner pursuant to these rules. One comment was received outside the official comment period. 

 

RESPONSE NO. 2: The Department of Public Health and Human Services has its own rulemaking authority, allowing it to create a patient-centered medical home program for Medicaid recipients. However, that rulemaking authority requires DPHHS to use healthcare providers that have been qualified by the commissioner. The legislation adopted (SB 84) specifically provides that healthcare payer or provider participation in the patient-centered medical home program is completely optional. However, if a plan or provider chooses to brand itself as a patient-centered medical home, it must comply with the legal requirements of the program. Government healthcare programs and health plans are payers, as defined in the act, except that Medicaid has special provisions, outside of those that apply to health plans.

 

The term "medical home" is clearly short-hand for the longer term, "patient-centered medical home." The two terms are synonymous. Allowing healthcare providers or payers to use the term "medical home" when they have not qualified as a PCMH and do not meet the standards would be misleading to consumers and would undermine the integrity of the PCMH program. In addition, allowing nonqualified healthcare providers and payers to call themselves a "medical home," which is the nickname for a patient-centered medical home, would be unfair to the payers and providers who have achieved that status, as well as a misrepresentation to consumers. 

 

COMMENT NO. 3: Several commenters applauded the administrative rules and the implementation of the PCMH program in general. In particular, the commenters support the role of the stakeholder council as defined in the proposed rules.

 

RESPONSE NO. 3: The department appreciates this support and looks forward to its ongoing relationship with the stakeholders. 

 

 

/s/ Brett O'Neil                                               /s/ Christina L. Goe                         

Brett O'Neil                                                   Christina L. Goe

Rule Reviewer                                               General Counsel

           

Certified to the Secretary of State September 9, 2013.