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| Montana Administrative Register Notice 37-703 | No. 24 12/24/2014 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On January 13, 2015, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of 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 the Department of Public Health and Human Services no later than 5:00 p.m. on January 6, 2015, 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 rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.86.101 PHYSICIAN SERVICES, DEFINITIONS (1) through (4) remain the same. (5) The department adopts and incorporates by reference the Physician-Related Services Manual governing the administration of the Physician program dated (6) through (8) remain the same.
AUTH: 53-6-113, MCA
37.86.105 PHYSICIAN SERVICES, REIMBURSEMENT/GENERAL REQUIREMENTS AND MODIFIERS (1) through (6) remain the same. (7) A Medicaid fee for services without fees is determined for physician services and anesthesia services as defined at ARM 37.85.212 and birth attendant services as defined at ARM 37.86.1201 (a) and (b) remain the same. (8) Reimbursement for primary care services performed by confirmed primary care physicians: (a) and (b) remain the same. (c) for E&M procedure codes and vaccine administration codes not part of the VFC program, in calendar year 2014, is the 2014 Montana Medicare reimbursement amount or the amount determined by multiplying the 2009 Medicare conversion factor by the 2014 relative value unit for Montana, whichever is greater; (d) for E&M procedure codes and vaccine administration codes not part of the VFC program, January 1, 2015 through June 30, 2015, is the 2015 Montana Medicare reimbursement amount or the amount determined by multiplying the 2009 Medicare conversion factor by the 2015 relative value unit for Montana, whichever is greater; (e) for vaccine administration codes for the VFC program, January 1, 2015 through June 30, 2015, is the lesser of the 2015 Montana Medicare reimbursement amount or the maximum regional VFC amount; and (d) remains the same, but is renumbered (f). (9) through (11) remain the same.
37.86.202 MID-LEVEL PRACTITIONER SERVICES, DEFINITIONS For the purpose of these rules, the following definitions will apply: (1) "Advanced practice registered nurse" means a registered professional nurse licensed as provided in Title 37, chapter 8, MCA and (2) through (16) remain the same.
IMP: 53-6-101, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) is proposing an amendment to ARM 37.86.105 to extend payments to primary care practitioners for primary care services from January 1, 2015 through June 30, 2015. This extension will allow the enhanced reimbursement for primary care services, a two-year program established under The Affordable Care Act (ACA) currently scheduled to end December 31, 2014, to end on June 30, 2015. If the primary care rate is allowed to end on December 31, 2014, reimbursement rates for primary care providers would be lowered. The higher reimbursement rate for providers has allowed Medicaid clients greater access to primary care services. Without the higher rate, some primary care providers may decide not to accept Medicaid clients. It is anticipated, beginning July 1, 2015, normal increase in the reimbursement rates for physicians for these services will increase and will equal or exceed the primary care provider rate and special pricing will no longer be needed.
ARM 37.86.101
Proposed revisions were made to the Physician-Related Services Manual and the provider web site. This proposed amendment will update the current listed link and publication date for the most current adopted provider manual as listed in ARM 37.86.101.
ARM 37.86.105
The proposed amendment in ARM 37.86.105(7) details how services without fees are reimbursed. This section will be amended to reinforce the intent of the rule.
ARM 37.86.202
The department is proposing to amend a citation to an administrative rule in (1) that was transferred to a different title and chapter by another department. This oversight was discovered by the Office of the Secretary of State, Administrative Rules Bureau, who sent information to our department's Office of Legal Affairs requesting the correction of the citation. This proposed amendment is necessary to ensure that the department's administrative rules are accurate and up to date.
Fiscal Impact
The enhanced reimbursement for primary care practitioners for primary care services for Calendar Years 2013 and 2014 was funded at 100% FMAP based on Section 2303(a)(2) of the Affordable Care Act. This funding expires on December 31, 2014. Funding for January 1, 2015 through June 30, 2015 will be at the standard FMAP rate. The total additional cost for the enhanced payment is expected to be $6381.00, of which $2174.50 will be state share, and $4206.50 will be federal match. The program is not anticipated to continue in SFY 2016, so there is no cost associated with SFY 2016 or SFY 2017.
Total Cost State General Fund Federal Match SFY2015 $6381.00 $2174.50 $4206.50 SFY2016 0 0 0
5. The department intends to apply these rule amendments retroactively to January 1, 2015. A retroactive application of the proposed rule amendments does not result in a negative impact to any affected party.
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., January 21, 2015.
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 rules will not significantly and directly impact small businesses.
/s/ Susan Callaghan /s/ Richard H. Opper Susan Callaghan, Attorney Richard H. Opper, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State December 15, 2014.
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A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact [email protected].
