BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.5110 pertaining to the revision of exceptions for Passport to Health services referrals

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

          1. On September 2, 2015, at 9:00 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, at 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 August 26, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:

 

          37.86.5110 PASSPORT TO HEALTH PROGRAM: SERVICES (1) An enrollee member must obtain services directly from, or through, a Passport referral by the enrollee's member's primary care provider except for:

          (a) through (h) remain the same.

          (i) dental, vision, and hearing, and EPSDT screening and preventive services portion of the screening services for children;

          (j) school-based health services as defined in ARM 37.86.2230;

          (k) through (ad) remain the same.

          (ae) skilled care facility services as defined in ARM 37.50.105 37.40.105;

          (af) through (al) remain the same.

          (am) therapeutic youth group home or therapeutic youth family care home support and therapeutic foster care services under the EPSDT program; and

          (an) hospice as defined in ARM 37.40.801 and 37.40.806.; and

          (ao) professional inpatient services.

          (2) and (3) remain the same.

 

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

IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-116, MCA

 

          4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) has been granted the authority to establish a primary care case management (PCCM) program for Medicaid members by the United States Department of Health and Human Services (HHS), as provided in 42 U.S.C. 1396n(b). The department refers to its PCCM program as the "Passport to Health Program" (Passport).

 

The department proposes to amend ARM 37.86.5110 to streamline the Passport referral process for inpatient hospital stays and, as a result, decrease the regulatory requirements on providers. The current rule requires providers to make additional referrals for inpatient professional services related to the reason for the referral for the inpatient admission. The department has determined that these additional referrals create unnecessary effort for services related to the need for the inpatient stay.

 

The department has further determined that additional rule amendments are necessary to update (i) Medicaid references from enrollees to members; (ii) titles of services to align with other Medicaid programs; and (iii) correct cross-references to other administrative rules. These changes are consistent with departmental goals for clear rule writing and providing consistency between department rules and the Code of Federal Regulations.

 

Fiscal Impact

 

The department anticipates no fiscal impact from the proposed rule amendments.

 

          5. The department intends to apply these rule amendments retroactively to September 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., September 10, 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 rule 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 that the proposed amendments are not amenable to performance-based measures.

 

 

/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 August 3, 2015.