BEFORE THE DEPARTMENT OF PUBLIC

 HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

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

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On November 13, 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 the Department of Public Health and Human Services no later than 5:00 p.m. on November 6, 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:

 

            37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) remains the same.

            (2) The department adopts and incorporates by reference, the resource-based relative value scale (RBRVS) reimbursement methodology for specific providers as described in ARM 37.85.212 on the date stated.

            (a) remains the same.

            (b) Fee schedules are effective July 1, 2014 January 1, 2015. The conversion factor for physician services is $35.86. The conversion factor for allied services is $24.33. The conversion factor for mental health services is $23.87. The conversion factor for anesthesia services is $28.66.

            (c) through (i) remain the same.

            (3) The department adopts and incorporates by reference, the fee schedule for the following programs within the Health Resources Division, on the date stated.

            (a) and (b) remain the same.

            (c) The hearing aid services fee schedule, as provided in ARM 37.86.805, is effective July 1, 2014 January 1, 2015.

            (d) through (k) remain the same.

            (l) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual which outlines the Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs) as provided in ARM 37.86.1802, effective October 1, 2014 January 1, 2015. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective October 1, 2014 January 1, 2015.

            (m) through (r) remain the same.

            (s) The optometric fee schedule provided in ARM 37.86.2005, is effective January 1, 2015.

            (4) through (6) remain the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

            4. STATEMENT OF REASONABLE NECESSITY

 

            The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.85.105(2)(b) and (3)(c) to change the effective date for federal Medicare procedure codes and provider fee reimbursement schedules for RBRVS and hearing aid services, from July 1, 2014 to January 1, 2015, and to amend the effective date reference in ARM 37.85.105(3)(l) for DME fee schedules from October 1, 2014 to January 1, 2015. The department is proposing to further amend ARM 37.85.105(3) through the insertion of new (3)(s) to incorporate by reference citation of an Optometric program provider fee schedule provided in ARM 37.86.2005, effective January 1, 2015.

 

            The department administers the Montana Medicaid program as a joint federal-state program pursuant to 53-6-101, MCA, et seq., and Title XIX of the Social Security Act, 42 U.S.C. 1396, et seq., for the purpose of providing necessary medical services to eligible persons who have need for medical assistance. The Medicare physician fee schedules and procedure codes described and incorporated by reference in (2)(a) of this rule are revised annually, effective January 1, to reflect additions, deletions, and changes in the federal Medicare program. The department receives, examines, and implements these changes to affected Medicaid programs as authorized under 53-6-101(8), MCA. The proposed rule amendments are necessary for the department to administer Montana Medicaid for calendar year 2015 within agreed federal funding requirements and to maintain federal program compliance without undue loss of funding or services to Medicaid members. The proposed addition of the Optometric program's provider fee schedule and procedure coding references in (3)(s) is a continuation of the department's efforts to consolidate all program provider fee schedules and procedure codes affected by the periodic Medicare coding and fee reimbursement adjustments into one rule, minimizing the amount of rulemaking required by the department's programs when such periodic adjustments occur.

 

Fiscal Impact

 

The department estimates the general fund impact of the proposed amendment to ARM 37.85.105(2)(b), regarding RBRVS rates, is approximately $36,800 and the proposed amendment to ARM 37.85.105(3)(l), regarding DME services, is approximately $36,500. The proposed amendments to ARM 37.85.105(3)(c) and (s) for hearing aid services and optometric services have no material impact.

 

The proposed amendments could affect an estimated 15,900 RBRVS providers, 391 DME providers, 27 hearing aide providers, 160 optometric providers, and 124,874 Medicaid eligible clients.

 

            5. The department intends to adopt these rule amendments effective January 1, 2015.

 

            6. 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., November 20, 2014.

 

7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

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 6 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 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.

 

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 rule will not significantly and directly impact small businesses.

 

 

/s/ Geralyn Driscoll                                      /s/ Mary E. Dalton acting for                      

Geralyn Driscoll, Attorney                            Richard H. Opper, Director

Rule Reviewer                                            Public Health and Human Services

           

Certified to the Secretary of State October 14, 2014.