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 updating the fee schedules for adult and children's mental health fee schedules

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

          1. On August 19, 2015, at 1:30 p.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 August 12, 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:

 

          37.85.104 EFFECTIVE DATES OF PROVIDER FEE SCHEDULES FOR MONTANA NON-MEDICAID SERVICES (1) The department adopts and incorporates by reference the fee schedule for the following programs within the Addictive and Mental Disorders Division and Developmental Services Division on the dates stated:

          (a) and (b) remain the same.

          (c) Youth respite care services, reimbursement for services as provided in ARM 37.87.2233 37.87.2203, is effective July 1, 2015 October 1, 2015.

          (2) remains the same.

 

AUTH: 53-2-201, 53-6-101, 53-6-113, MCA

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

 

          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) and (b) remain the same.

          (c) Policy adjustors are effective July 1, 2015. The maternity policy adjustor is 112%. The family planning policy adjustor is 105%. The psychological testing for youth policy adjustor is 145%. The psychological testing policy adjustor applies only to psychologists.

          (d) through (4) remain the same.

          (5) The department adopts and incorporates by reference, the fee schedule for the following programs within the Addictive and Mental Disorders Division on the date stated:

          (a) and (b) remain the same.

          (c) Home and community-based services for adults with severe disabling mental illness, reimbursement, as provided in ARM 37.90.408, is effective July 1, 2015 October 1, 2015.

          (d) remains the same.

          (6) The department adopts and incorporates by reference, the fee schedules for the following programs within the Developmental Services Division, on the date stated:

          (a) Mental health services for youth, as provided in ARM 37.87.901 in the Medicaid Youth Mental Health Services Fee Schedule, is effective July 1, 2015 October 1, 2015.

          (b) and (c) 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

 

Section 53-6-111, MCA, requires the Department of Public Health and Human Services (the department) to establish the Montana Medicaid provider reimbursement rates.  The department establishes rates based on the estimated demand for services, the legislative appropriation, and federal matching funds.  Rates are stated in program fee schedules and rates are changed by revising the fee schedule as of the stated effective date of the schedule.  The department adopts fee schedules and fee schedule changes by amending ARM 37.85.105.

 

The department also sets provider reimbursement rates for some services not paid for as part of the Medicaid program. The fee schedules and effective date are stated in ARM 37.85.104.

 

SUMMARY OF PROPOSED AMENDMENTS TO ARM 37.85.104 AND 37.85.105

 

These summaries are categorized according to the following divisions:  Developmental Services Division, Children's Mental Health Bureau (DSD CMHB) and the Addictive and Mental Disorders Division (AMDD).

 

Summary of Proposed Amendments - DSD CMHB

 

ARM 37.85.104 and 37.85.105

 

The department is proposing to amend the rates established in the Medicaid Youth Mental Health Fee Schedule, Individuals Under 18 Years of Age, to change the date from July 1, 2015 to October 1, 2015.  Pursuant to 45 CFR 162.1000, the department is required to use applicable medical data code sets as described in 45 CFR 162.1002, Medical data code sets. Per the Health Care Financing Administration Common Procedure Coding System (HCPCS), adopted in 45 CFR 162.1002, the code currently used for the Extraordinary Needs Aide Service (ENA), which is S5145 UD, is defined as a "per diem" or daily rate and cannot be paid at an hourly rate. In order to be in compliance with 45 CFR 162.1002, Medical data code sets, it is necessary for the department to amend procedure code S5145 UD to H2019 TG, which is a 15 minute unit.  Providers will need to begin billing for ENA using H2019 TG with a 15 minute unit effective October 1, 2015.

 

In ARM 37.85.104, the department is proposing to amend the ARM reference for non-Medicaid Respite Care Service from ARM 37.87.2233 to ARM 37.87.2203 and add the word "care" to the description of the service. In MAR Notice No. 37-713, the department is proposing to repeal ARM 37.87.2233 and combine the non-Medicaid Respite Care Services and the Children's Mental Health Bureau's Non-Medicaid Services Program Provider Manual.

 

In ARM 37.85.105, the department is proposing to amend 37.85.105(2)(c) to clarify that the psychological testing policy adjuster only applies to psychologists. This is not a change in rates or current policy. The clarification is consistent with the intent of the policy adjuster to increase access to psychologists for psychological testing.

 

Fiscal Impact

 

There is no fiscal impact to these changes.

 

Summary of Proposed Amendments - AMDD, Mental Health Services Bureau

 

ARM 37.85.105

 

The Severe Disabling Mental Illness Home and Community-Based Services waiver program is discontinuing the supported living bundled service.  This fee schedule change will be effective October 1, 2015.

 

Fiscal Impact

 

Two providers will be impacted by discontinuing the bundled service. The 26 waiver members will continue to receive services and should not see any difference in the delivery of the service. The services received are personal assistance and habilitation aid which are currently provided under the bundled service. The two providers can continue providing services but will have to unbundle the services and request reimbursement using the other services listed on the fee schedule.

The fiscal impact, if any, is unknown but is expected to be minimal.

 

          5. The department intends to adopt these rule amendments effective October 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., August 27, 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.

 

12. With regard to the requirement of Chapter 453(1), Session Laws of Montana (2015), the department has determined this is a rule implementing rates and the performance-based measurements do not apply.

 

 

/s/ Geralyn Driscoll                                /s/ Richard H. Opper                            

Geralyn Driscoll, Attorney                      Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

 

 

Certified to the Secretary of State July 20, 2015.