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| Montana Administrative Register Notice 37-725 | No. 19 10/15/2015 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On November 4, 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 October 28, 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:
37.86.2803 ALL HOSPITAL REIMBURSEMENT, COST REPORTING (1) Allowable costs will be determined in accordance with generally accepted accounting principles as defined by the American Institute of Certified Public Accountants. (a) remains the same. (b) For cost report periods occurring on or after May 1, 2010, such definition of allowable costs is further defined in accordance with the Medicare Provider Reimbursement Manual, CMS Publication 15, Form 2552-10, Transmittal 2, (c) through (3) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA
37.86.3001 OUTPATIENT HOSPITAL SERVICES, DEFINITIONS (1) through (11) remain the same. (12) "ICD-9-CM" means the International Classification of Diseases, Ninth Revision based on the official version of the United Nations World Health Organization's Ninth Revision, effective for dates of service or discharge date prior to and including September 30, (13) and (14) remain the same. (15) "Lactation services" means support through breastfeeding education and consultations with certified lactation providers to increase the health of both mother and baby. (15) through (22) remain the same, but are renumbered (16) through (23).
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
37.86.3002 OUTPATIENT HOSPITAL SERVICES, SCOPE AND REQUIREMENTS (1) remains the same. (2) Outpatient hospital services are services that would also be covered by Medicaid if provided in a nonhospital setting and are limited to the following diagnostic and therapeutic services furnished by hospitals to outpatients: (a) through (c) remain the same. (d) services provided outside the hospital, as follows: (i) remains the same. (ii) therapeutic services that are (e) (f) lactation services provided in a certified baby-friendly hospital approved by the department and performed by nonphysician providers. These services will only be allowed to be billed by the facility effective on or after January 1, 2016.
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA
37.86.3003 OUTPATIENT HOSPITAL SERVICES, EXCLUSIONS (1) Outpatient hospital services do not include: (a) remains the same. (b) exercise programs and programs primarily educational in nature unless covered as preventative outpatient services, including, but not limited to (c) through (f) remain the same.
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) is proposing to amend ARM 37.86.2803, 37.86.3001, 37.86.3002, and 37.86.3003 regarding changes to the Outpatient Hospital and All Hospital administrative rules of Montana by adding lactation services for Certified Baby-Friendly Hospitals, correcting the ICD-9 end date from 9/30/2014 to 9/30/2015, amending language to not conflict with educational programs that are now covered as Preventative Outpatient Services, and remove the "last updated" date from ARM 37.86.2803 with reference to the Form 2552-10, as it is not necessary to reference a date for this form.
ARM 37.86.2803
The department proposes removing from (1)(b) the reference to the date when Form 2552-10 of CMS Publication 15 was last updated, that is, "last updated August 2011." Form 2552-10 assists providers in completing cost reports turned in to the department by setting forth definitions and expectations for allowable costs. The department believes removal of the reference to the specific date of the latest updating is appropriate because that date is not critical to the meaning and purpose of the rule, and because reference to a specific date of updating might be confusing given that the form is periodically updated.
ARM 37.86.3001
The department proposes correcting a misstatement of date in current (12) by changing the reference to the dates when ICD-9-CM will be effective for dates of service or discharge date prior to and including September 30, 2014 to September 30, 2015. When read together with (13), this change will clarify that ICD-9-CM will be effective for dates of service or discharge up to and including September 30, 2015, and that ICD-10-CM will be effective for dates of service or discharge after September 30, 2015.
The department proposes adding a definition of "lactation services" because those services are being added as covered services for Montana Medicaid Certified Baby- Friendly Outpatient Hospitals and eligible members. The definition describes what the service was designed to provide.
ARM 37.86.3002
The department proposes amending (2)(e) to change references to "diabetic education" to "diabetes education," which is perceived as more person-centered. Current subsection (2)(e) requires that the Medicare Part A program approve a hospital's diabetes education protocol for "diabetes education services" the hospital provides to outpatients to be defined as "outpatient hospital services," and limits coverage for such services to those services meeting 42 CFR, part 40, subpart H, as revised through October 1, 2010. The protocol for diabetes education services has changed since this rule was last revised, and such services no longer go through Medicare; instead, such services are now offered through Montana Medicaid in several diabetes education programs to members by Montana Medicaid. This rule, therefore, proposes replacing the current requirements and coverage limits with a single standard under which diabetes education services a hospital provides to outpatients are defined as "outpatient hospital services" only if the hospital's diabetes education program complies with ARM 37.86.5401 through 37.86.5404, related to Montana Medicaid diabetes services, thus ensuring all hospitals and providers are following the same expectations in offering diabetes education services. The rule also proposes deleting the part of the current rule incorporating by reference 42 CFR, part 40, subpart H and making it available through the department as unnecessary.
The department proposes adding new (2)(f) because the department is adding lactation service as a service it will cover on an outpatient hospital basis. This subsection sets forth the scope and requirements for coverage that such services be provided by a nonphysician provider in a Certified Baby-Friendly Hospital and must be billed by the facility. These services may be billed for on or after January 1, 2016, when the Medicaid Management Information System (MMIS) will be capable of processing such claims.
ARM 37.86.3003
The department proposes adding to (1)(b) language making clear that the exclusion of exercise programs and programs primarily educational in nature in this subsection from the definition of "outpatient hospital services" does not apply if such programs are covered as preventative outpatient services, such as independent exercise programs such as pool therapy, swim programs, or health club memberships. This prevents this section from conflicting with language allowing coverage for other educational and preventative outpatient services, such as lactation services. The department proposes amending (1)(b)(i) through (iii) to remove "cardiac rehabilitation exercise programs," "nutritional programs," and "pulmonary therapy" because Montana Medicaid covers these services on a limited basis, and because these services have their own rules that govern the scope and requirements of each service.
Fiscal Impact
The proposed changes for lactation services will currently affect two Certified Baby-Friendly-approved facilities and other providers as they choose to become certified. As Medicaid will be paying for these services, it will initially minimally increase provider reimbursement (current facilities would receive approximately $8295.00 per fiscal year) and qualifying members (current estimation is 79 members) would receive a newly covered service. Other facilities are currently in the process of becoming Certified Baby-Friendly (approximately 12). If they were all Certified Baby-Friendly and approved by the department, Medicaid could look at an estimated yearly fiscal impact of $176,490.00 based on an estimated 1698 eligible members. The proposed corrected date for ICD-9-CM will affect all Outpatient Hospital Service providers, but there will be no fiscal impact for the state, providers, or members. There will also be no fiscal impact for the removal of the date from All Hospital Reimbursement.
5. 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 12, 2015.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. 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.
8. 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.
9. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
10. 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.
11. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.
The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.
/s/ Francis X. Clinch /s/ Richard H. Opper Francis X. Clinch, Attorney Richard H. Opper, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State October 5, 2015.
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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].
