BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.40.830 pertaining to hospice reimbursement

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On January 15, 2014, at 1:30 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 Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rule.

 

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 January 8, 2014, 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, 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:

 

37.40.830 HOSPICE, REIMBURSEMENT (1) remains the same.

(2) The department hereby adopts and incorporates by reference 42 CFR 418.302, effective August 6, 2009, and 42 CFR 418.306, effective August 8, 2008, as amended through October 1, 1988, which sets forth the Medicare payment procedures. Copies of 42 CFR 418.302 and 42 CFR 418.306, as amended through October 1, 1988, are available from the Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951. at the federal web site: http://cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html.

(3) The board and room rate to be paid a hospice for a Medicaid recipient who resides in a nursing facility (SNF/ICF) will be the Medicaid rate established by the department in ARM 37.40.307 for the individual facility minus the amount the recipient pays toward his own cost of care. Payment for board and room will be made to the hospice and, in turn, the hospice will reimburse the nursing facility. General inpatient care or hospice respite care in a nursing facility will not be reimbursed directly by the Medicaid program when a Medicaid recipient elects the hospice benefit payment. Under such circumstances payment will be made to the hospice in accordance with this rule.

(a) through (7) remain the same.

(8) The department hereby adopts and incorporates by reference 42 CFR 418.309, effective August 4, 2011, as amended through October 1, 1988, which sets forth Medicare's methodology for calculating the hospice cap amount. Copies of 42 CFR 418.309, as amended through October 1, 1988, are available from the Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951. at the federal web site: http://cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html.

(9) and (10) remain the same.

(11) The hospice fee schedules are effective October 1, 2013. Copies of the department's current fee schedules are posted at http://medicaidprovider.hhs.mt.gov and may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59602-2951.

 

AUTH:     53-6-113, MCA

IMP:       53-6-101, MCA

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.40.830, pertaining to hospice reimbursement. The proposed amendments to this rule incorporate changes to the federal register for hospice reimbursement which include an effective date and update references to the administrative rule; and will correctly direct people to additional information.

 

Fiscal Impact

 

This proposed amendment will have a fiscal impact on the hospice program. In Fiscal Year 2012, 400 Medicaid recipients received the hospice benefit and 27 agencies delivered hospice services.

 

Hospice rates are affected by a wage index, which is applied by county. A majority of counties in Montana will see an increase. The average increase is 1 percent. A majority of hospice's $4.5 million budget covers nursing facility room and board. A 1 percent increase in non-room-and-board hospice services is projected to be $14,000.

 

There are two counties that will experience a rate decrease, Cascade and Missoula. The rate decrease in Missoula County is minimal and the fiscal impact will be negligible. There are two hospice agencies that service Missoula County. The decrease in Cascade County is about 3 percent, which is anticipated to cost $5900 based on 2013 paid claims. There is one hospice agency that serves Cascade County.

 

The increase in hospice rates will be retroactive to October 1, 2013. The decrease in hospice rates will be effective upon adoption of the rule.  If any provider would experience a decrease in hospice rates, the decrease will not be applied retroactively. It will begin on the final adoption of this proposed rule. Therefore, there will be no retroactive negative impact to any hospice program.

 

            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., January 23, 2014.

 

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.

 

10. 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.

 

 

/s/ Valerie A. Bashor                                    /s/ Richard H. Opper                                   

Valerie A. Bashor                                         Richard H. Opper, Director

Rule Reviewer                                              Public Health and Human Services

           

Certified to the Secretary of State December 16, 2013.