BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.85.104 and 37.85.105 pertaining to the revision of fee schedules for Medicaid provider rates

) ) ) )

NOTICE OF AMENDMENT

 

TO: All Concerned Persons

 

1. On April 24, 2014, the Department of Public Health and Human Services published MAR Notice No. 37-670 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 797 of the 2014 Montana Administrative Register, Issue Number 8.

 

2. The department has amended ARM 37.85.104 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:

 

            37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) through (3)(l) remain as proposed.

            (m) The early and periodic screening, diagnostic and treatment (EPSDT) services fee schedules for private duty nursing, nutrition, and orientation, and mobility specialists as provided in ARM 37.86.2207(2), is effective July 1, 2014.

            (n) through (6) remain as proposed.

 

AUTH: 53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 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:

 

HOSPITAL SERVICES

 

Responses to comments regarding hospital services are as follows:

 

COMMENT #1: One comment was received stating support for the department's proposal to rebase the inpatient Diagnosis Related Group (DRG) payment system, modify the outlier payment policy, and make other adjustments to the payment system.

 

RESPONSE #1: The department thanks the commenter for their support of the adjustments made to the DRG payment system.

 

COMMENT #2: One commenter stated that putting the complete appropriation for the 2% hospital rate increase into the outpatient hospital Ambulatory Payment Classification (APC) system was reasonable because no payment adjustments have been made for outpatient services in recent memory. The commenter also stated that the policy is reasonable since the inpatient payment amounts are near the Medicare upper limit and the outpatient payments are well below the federal cap.

 

RESPONSE #2: The department thanks the commenter for their support regarding the appropriation of this rate increase.

 

COMMENT #3: One comment stated that the commenter appreciates the department's efforts to work collaboratively with the Montana Hospital Association (MHA) Task Force on Facility Reimbursement in advance of the proposed rules.

 

RESPONSE #3: The department recognizes the need for effective communication and cooperation with providers regarding the review of policy implications generated by proposed rule amendments. The department is committed to working with members of the health care industry regarding these issues. The department thanks the commenter for their support.

 

COMMENT #4: One commenter stated that they recognize the delivery of health care is a team effort in Montana and expressed support of the efforts to increase reimbursement rates for other Medicaid providers.

 

RESPONSE #4: The department thanks the commenter for their support of the rule.

 

COMMENT #5: One commenter stated that the inpatient hospital base rate for out-of-state facilities designated as Centers of Excellence was miscalculated and should be 3.7% less than the base rate currently being proposed within the All Patient Refined – Diagnosis Related Groups (APR-DRG) inpatient fee schedule. The commenter indicated that correcting the calculated rate would amend the proposed Centers of Excellence inpatient base rate from $8,403.00 to $8,095.00.

 

RESPONSE #5: The department thanks the commenter for recognizing this miscalculation.  The proposed inpatient base rate in the Medicaid provider fee schedule for Centers of Excellence will be amended to reflect the new rate of $8,095.00.  The department would like to clarify that even though the base rate was decreased from the original proposal, the new proposed rate of $8,095.00 still reflects an increase in the base rate for Centers of Excellence from last year's base rate amount.

 

PHYSICIAN SERVICES

 

Responses to comments regarding physician services are as follows:

 

COMMENT #1: One commenter expressed support for the department's amendments to the fee schedule amounts paid for through physician services.

 

RESPONSE #1: The department thanks the commenter for their support of the rule.

 

COMMENT #2: One comment stated that the commenter understands the department annually calculates conversion factors for physician services and the adjustments proposed reflect the increased reimbursement for physician services as directed by the legislature. The commenter expressed appreciation of the steps taken by the legislature and department to ensure vulnerable patients have ongoing access to care. Additionally, the commenter indicated support for the proposed change to physician provider rates.

 

RESPONSE #2: The department thanks the commenter for their support of the rule.

 

ALLIED HEALTH SERVICES

 

Responses to comments regarding Allied Health Services are as follows:

 

COMMENT #1: One comment was received indicating that a comma was incorrectly placed when referring to the orientation and mobility specialist. The orientation and mobility specialist is a sole provider and a comma should not appear within this title.

 

RESPONSE #1: The department thanks the commenter for recognizing this oversight. The comma will be removed from this portion of the rule to indicate that the orientation and mobility specialist is a sole provider.

 

COMMENT #2: One commenter expressed support for the department's amendments to the fee schedule amounts paid for through allied health services.

 

RESPONSE #2: The department thanks the commenter for their support of the rule.

 

            5. These rule amendments are effective July 1, 2014.

 

 

/s/ John C. Koch                                          /s/ Richard H. Opper                                   

John C. Koch                                               Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services

           

Certified to the Secretary of State June 16, 2014