BEFORE THE COMMISSIONER OF SECURITIES AND INSURANCE

MONTANA STATE AUDITOR

 

In the matter of the amendment of ARM 6.6.4902, 6.6.4906, 6.6.4907, 6.6.4908, and 6.6.4909 pertaining to Patient-Centered Medical Homes

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

TO: All Concerned Persons

 

1. On November 17, 2016, at 10:00 a.m., the Commissioner of Securities and Insurance, Montana State Auditor (CSI), will hold a public hearing in the 2nd floor conference room, at the Office of the Commissioner of Securities and Insurance, Montana State Auditor, 840 Helena Ave., Helena, Montana, to consider the proposed amendment of the above-stated rules.

 

2. The CSI 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 CSI no later than 5:00 p.m., November 10, 2016, to advise us of the nature of the accommodation that you need. Please contact Darla Sautter, CSI, 840 Helena Avenue, Helena, Montana, 59601; telephone (406) 444-2726; TDD (406) 444-3246; fax (406) 444-3499; or e-mail [email protected].

 

3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            6.6.4902 PATIENT-CENTERED MEDICAL HOME QUALIFICATION

            (1) After January 1, 2014, health plans and primary care practices as defined in 33-40-103, MCA, self-funded government plans, Medicaid plans, and other health care providers offering medical services as defined in 33-22-140, MCA, may not offer or identify themselves as a patient-centered medical home or "medical home" unless the participating provider groups are qualified by the commissioner, and the health plan or other payer payor is utilizing healthcare providers who are qualified when offering "medical home" services to covered individuals under the plan.

            (2) A primary care practice that is currently operating as a patient-centered medical home must submit an application for qualification by December 1, 2013, if the practice wishes to continue using that designation. Thereafter, any Any provider seeking to use the patient-centered medical home designation must apply for qualification and receive approval from the commissioner before holding itself out as a patient-centered medical home.

            (3) through (5) remain the same.

 

            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA

 

            6.6.4906 TIMELINES FOR REQUIRED REPORTING (1) Pursuant to 33-40-105, MCA, a patient-centered medical home shall report on its compliance with quality and performance measures set forth in these rules to participating health plans and other payers payors and the commissioner, no later than March 31 April 30 of each year, beginning with 2015, or according to the timeline required by its contract with each payer payor, whichever is earlier. The commissioner may request that the report also include other information necessary to the evaluation of the Montana patient-centered medical home program.

            (2) A health plan and other payers payors shall report to the patient-centered medical home and the commissioner regarding their compliance with the uniform set of cost and utilization measures set forth in the Act, these rules, or in the provider/payer payor contract, no later than March 31 April 30 of each year, beginning with 2015, or according to the timeline required by its contract with each patient-centered medical home, whichever is earlier. The commissioner may request that the report also includes other information necessary to the evaluation of the Montana patient-centered medical home program.

            (3) The commissioner shall share with the public, in the form of a summary report, de-identified, nonconfidential information contained in the reports listed in (1) and (2) and ARM 6.6.4907 at least once a year, beginning in June 2015 no later than August 31 of each year.

 

            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA

 

            6.6.4907 PATIENT-CENTERED MEDICAL HOME REPORTING—SPECIFIC QUALITY MEASURES REQUIRED (1) A qualified or provisionally qualified patient-centered medical home (PCMH) shall report annually to the commissioner on its performance related to certain standards and health care quality measures, as prescribed by the commissioner. A PCMH health care provider that provides care to adults only, or both children and adults, shall choose at least three of the five quality measures listed in (3)(a) through (e) to report to the commissioner. A PCMH shall choose four out of five measures for the 2016 reporting year, for the report due in March April 2017 and all subsequent years.

            (2) A PCMH health care provider that provides care only to children, referred to as a pediatric practice, shall choose at least the child immunization performance measure in (3)(c). Reporting on depression screening in (3)(e) is optional for pediatric practices until the 2017 reporting year, for the report due in March April 2018. At that time and for subsequent years, all pediatric clinics shall report on both the depression and immunization measures.

            (3) through (3)(b) remain the same.

(c) age appropriate immunization for children who turned age three two during the reporting year;

(d) through (4) remain the same.

(5) A PCMH health care provider may not change the reporting measures the provider chose for the 2014 reporting year until after the 2016 reporting year for the report due in March April of 2017, or until otherwise instructed by the commissioner. However, a provider may report on additional measures at any time.

            (6) Annually, the data on standards and quality measures are due to the commissioner on March 31 April 30 for the previous calendar year.

(7) The commissioner shall provide detailed instructions on the agency web site for reporting by qualified and provisionally qualified PCMH's on the quality measures described in (3). Data reporting requirements must be aligned with the federal Physician Quality Reporting System (PQRS), except for childhood immunizations, Centers for Medicaid & Medicare services (CMS) electronic Clinical Quality Measures (eCQMs) and the instructions provided on the commissioner's web site.

(8) and (9) remain the same.

            (10) Payers Payors who choose to participate in the Montana PCMH program, and who require reporting on quality measures in their contract with PCMH health care providers shall also use the same data reporting requirements prescribed by the commissioner, if the payer payor collects data on the measures described in (3).

 

            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA

 

            6.6.4908 STANDARDS FOR PAYMENT METHODS (1) A payor that currently has a medical home or patient-centered medical home component in its provider contracts or in insurance contracts issued to Montana residents shall submit a letter to the commissioner describing its method of compensating providers no later than January 1, 2015 of each year, if there are changes from the prior year.

            (2) through (4) remain the same.

            (5) The commissioner shall maintain copies of the payor letters. After approval, these letters are available to the public, upon request and posted on the commissioner's web site. If the commissioner determines that a payor letter contains trade secret information as defined in 30-14-402(4), MCA, the commissioner shall redact or otherwise withhold such information from the public.

            (6) remains the same.

            (a) payment for practice transformation and achieving for patient-centered medical home recognition status;

            (b) through (f) remain the same.

 

            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA

 

            6.6.4909 MEASURES RELATED TO COST AND MEDICAL USAGE—UTILIZATION MEASURES (1) through (3) remain the same.

            (4) The first report is due March 31, 2015, and annually thereafter annually on April 30.

 

            AUTH: 33-40-104, MCA

            IMP: 33-40-104, 33-40-105, MCA

 

            4. STATEMENT OF REASONABLE NECESSITY: The Commissioner of Securities and Insurance, Montana State Auditor, Monica J. Lindeen, (commissioner) is the statewide elected official responsible for administering the Montana Insurance Code and regulating the business of insurance.

 

The amendments to ARM 6.6.4902, 6.6.4906, 6.6.4907, 6.6.4908, and 6.6.4909 are reasonably necessary in order to clean up references to outdated requirements, update references to more appropriate federal standards for data reporting, and adjust timelines to allow additional time for date reporting.

 

Pursuant to 33-40-104, MCA, the interested parties and the stakeholder council was consulted by the CSI during the drafting of these amendments. The PCMH stakeholder council has approved these amendments.

 

            5. Concerned persons may submit their data, views, or arguments concerning the proposed actions either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to Christina L. Goe, General Counsel, Office of the Commissioner of Securities and Insurance, Montana State Auditor, 840 Helena Ave., Helena, Montana, 59601; telephone (406) 444-1942; fax (406) 444-5223; or e-mail [email protected], and must be received no later than 5:00 p.m., November 25, 2016.

 

            6.  Christina L. Goe, General Counsel, has been designated to preside over and conduct this hearing.

 

            7. The CSI maintains a list of concerned persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list may sign up by clicking on the blue button on the CSI's web site at: http://csimt.gov/laws-rules/ to specify 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. Requests may also be sent to the CSI in writing. Such written request may be mailed or delivered to the contact information in 2 above, or may be made by completing a request form at any rules hearing held by the CSI.

 

            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. Pursuant to 2-4-302, MCA, the bill sponsor contact requirements apply and have be been fulfilled. Christine Kaufmann is the sponsor, and she was notified by e-mail on October 14, 2016.

 

            10. With regard to the requirements of 2-4-111, MCA, the CSI has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses. In the alternative, the only impact on small businesses would be positive, in that these amendments provide additional time each year to meet existing reporting requirements.

 

 

            /s/Michael A. Kakuk                         /s/Christina L. Goe                          

            Michael A. Kakuk                             Christina L. Goe

            Rule Reviewer                                 General Counsel

 

            Certified to the Secretary of State October 17, 2016.