BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES

OF THE STATE OF MONTANA

 

In the matter of the amendment of ARM 37.88.205, 37.88.305, and 37.88.605 pertaining to updating the date of the current procedural terminology (CPT) codes

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NOTICE OF PROPOSED AMENDMENT   NO PUBLIC HEARING CONTEMPLATED

 

TO: All Concerned Persons

 

1. On September 20, 2014, the Department of Public Health and Human Services proposes to amend the above-stated rules.

 

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 September 11, 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 MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail [email protected].

 

3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.88.205 LICENSED CLINICAL SOCIAL WORK SERVICES, REQUIREMENTS (1) remains the same.

            (2) For purposes of Medicaid coverage and reimbursement, licensed social work services are limited to the services designated in the department's Covered Social Work CPT Codes List (2004) (2014). The department adopts and incorporates by reference the Covered Social Work CPT Codes List (2004) (2014). A copy of the Covered Social Work CPT Codes List (2004) (2014) may be obtained from the department web site at http://medicaidprovider.hhs.mt.gov/providerpages/providertype/58.shtml or Department of Public Health and Human Services, Addictive and Mental Disorders Division, 555 Fuller, P.O. Box 202905, Helena, MT 59620-2905.

            (3) remains the same.

            (4) When an eligible child receives licensed clinical social worker services and the provider consults with the parent as part of the child's treatment, the time with the parent may be billed to Medicaid under the child's name, subject to the requirements of these rules. The provider shall must indicate on the claim that the child is the patient and state the child's diagnosis. He shall The provider must also indicate consultation was with the parent.

            (5) through (7) remain the same.

            (8) Inpatient social work services provided in a hospital on an inpatient basis that are covered by Medicaid as part of the diagnosis related group (DRG) payment under ARM 37.86.2907 are not reimbursable as licensed clinical social worker services. These noncovered services include:

            (a) and (b) remain the same.

            (c) services, including, but not limited to, group therapy, that are required as part of hospital licensure or certification.

 

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

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

 

            37.88.305 LICENSED PROFESSIONAL COUNSELOR SERVICES, REQUIREMENTS (1) remains the same.

            (2) For purposes of Medicaid coverage and reimbursement, licensed professional counselor services are limited to the services designated in the department's Covered Licensed Professional Counselor CPT Codes List (2004) (2014). The department adopts and incorporates by reference the Covered Licensed Professional Counselor CPT Codes List (2004) (2014). A copy of the Covered Licensed Professional Counselor CPT Codes List (2004) (2014) may be obtained from the department web site at http://medicaidprovider.hhs.mt.gov/providerpages/providertype/58.shtml or Department of Public Health and Human Services, Addictive and Mental Disorders Division, 555 Fuller, P.O. Box 202905, Helena, MT 59620-2905.

            (3) remains the same.

            (4) When an eligible child receives professional counselor services and the professional counselor consults with the parent as part of the child's treatment, the time with the parent may be billed to Medicaid under the child's name, subject to the requirements of these rules. The provider shall must indicate on the claim that the child is the patient and state the child's diagnosis. He shall The provider must also indicate consultation was with the parent.

            (5) through (7) remain the same.

            (8) Inpatient professional counselor services provided in a hospital on an inpatient basis that are covered by Medicaid as part of the diagnosis related group (DRG) payment under ARM 37.86.2907 are not reimbursable as licensed professional counselor services.  These noncovered services include:

            (a) and (b) remain the same.

            (c) services, including, but not limited to, group therapy, that are required as part of hospital licensure or certification.

 

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

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

 

            37.88.605 LICENSED PSYCHOLOGIST SERVICES, REQUIREMENTS

            (1) remains the same.

            (2) For purposes of Medicaid coverage and reimbursement, licensed psychologist services are limited to the services designated in the department's Covered Psychologist CPT Codes List (2004) (2014). The department adopts and incorporates by reference the Covered Psychologist CPT Codes List (2004) (2014). A copy of the Covered Psychologist CPT Codes List (2004) (2014) may be obtained from the department web site at http://medicaidprovider.hhs.mt.gov/providerpages/providertype/58.shtml or Department of Public Health and Human Services, Addictive and Mental Disorders Division, 555 Fuller, P.O. Box 202905, Helena, MT 59620-2905.

            (3) remains the same.

            (4) When an eligible child receives licensed psychologist services, and the psychologist consults with the parent as part of the child's treatment, time spent with the parent may be billed to Medicaid under the child's name, subject to the requirements of these rules. The provider shall must indicate on the claim that the child is the patient and state the child's diagnosis. He shall The provider must also indicate consultation was with the parent.

            (5) and (6) remain the same.

            (7) Licensed psychologist services provided in a hospital on an inpatient basis that are covered by Medicaid as part of the diagnosis related group (DRG) payment under ARM 37.86.2907 are not reimbursable as psychological services. These noncovered services include:

            (a) remain the same.

            (c) services including, but not limited to, group therapy, that are required as a part of hospital licensure or certification.

 

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

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

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.88.205, 37.88.305, and 37.88.605 regarding updating the date of the 2004 CPT Codes to 2014. The 2004 CPT Codes are outdated and these are necessary housekeeping amendments to update the CPT Codes to the current fee schedule year. The Addictive and Mental Disorders Division (AMDD) have moved to a new location so it is necessary to remove their old address.

 

The department is proposing minor corrections and revisions to the rule to ensure consistent use of terminology and to comply with current grammar and formatting requirements.

 

The current 2014 CPT Code fee schedules may be viewed at the following web site:

http://medicaidprovider.hhs.mt.gov/providerpages/providertype/58.shtml.

 

ARM 37.88.205, 37.88.305, and 37.88.605

 

The department is proposing in each of these rules to update the adoption date of the Covered Psychologist CPT Codes List from 2004 to 2014. The address at 555 Fuller is being removed because the AMDD has relocated. They are using their post office box for their mailing address.

 

Fiscal Impact

 

These proposed amendments are expected to be budget neutral as no services are being added or changed.

 

5. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on September 18, 2014. Comments may also be faxed to (406) 444-9744 or e-mailed to [email protected].

 

6. If persons who are directly affected by the proposed actions wish to express their data, views, or arguments orally or in writing at a public hearing, they must make written request for a hearing and submit this request along with any written comments to Kenneth Mordan at the above address no later than 5:00 p.m., September 18, 2014.

 

7. If the agency receives requests for a public hearing on the proposed action from either 10% or 25, whichever is less, of the persons directly affected by the proposed action; from the appropriate administrative rule review committee of the Legislature; from a governmental subdivision or agency; or from an association having not less than 25 members who will be directly affected, a hearing will be held at a later date. Notice of the hearing will be published in the Montana Administrative Register.  Ten percent of those directly affected has been determined to be 11 persons based on a total of 105 persons enrolled in this program.

 

8. 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.

 

9. 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 this 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.

 

10. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.

 

11. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.

 

 

/s/ Valerie Bashor                                        Robert Runkel for Richard H. Opper       

Valerie Bashor                                             Richard H. Opper, Director

Rule Reviewer                                             Public Health and Human Services

 

Certified to the Secretary of State August 11, 2014.