BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.40.307, 37.40.311, 37.40.337, and 37.40.361 pertaining to revising nursing facility reimbursement rates for state fiscal year 2018

) ) ) ) )

NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On August 15, 2017, at 1:30 p.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium 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 2, 2017, 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:

 

37.40.307 NURSING FACILITY REIMBURSEMENT (1) remains the same.

            (2) Effective July 1, 2001, and in subsequent rate years, nursing facilities will be reimbursed using a price-based reimbursement methodology. The rate for each facility will be determined using the operating component defined in (2)(a) and the direct resident care component defined in (2)(b):

            (a) through (c) remain the same.

            (d) The total payment rate available for the period July 1, 2016 July 1, 2017 through June 30, 2017 June 30, 2018 will be the rate as computed in (2), plus any additional amount computed in ARM 37.40.311 and 37.40.361.

            (3) Providers who, as of July 1 of the rate year, have not filed with the department a cost report covering a period of at least six months participation in the Medicaid program in a newly constructed facility will have a rate set at the statewide median price as computed on July 1, 2016 July 1, 2017. Following a change in provider as defined in ARM 37.40.325, the per diem rate for the new provider will be set at the previous provider's rate, as if no change in provider had occurred.

            (4) through (12) remain the same.

 

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

IMP: 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.40.311 RATE ADJUSTMENT FOR COUNTY FUNDED RURAL NURSING FACILITIES (1) remains the same.

            (2) A nursing facility is eligible to participate in this lump sum payment distribution if it is a nonstate government owned or operated facility that has provided Medicaid services in the current state fiscal year.

            (a) through (7) remain the same.

 

AUTH: 53-6-113, MCA

IMP: 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.40.337 REIMBURSEMENT TO OUT-OF-STATE FACILITIES (1) and (2) remain the same.

            (3) To receive payments, the out-of-state provider must enroll in the Montana Medicaid program. Enrollment information and instructions may be obtained from the department's fiscal intermediary, XEROX, at P.O. Box 4936, Helena, MT 59604-4936.

            (4) and (5) remain the same.

 

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

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

 

            37.40.361 DIRECT CARE AND ANCILLARY SERVICES WORKERS' WAGE REPORTING/ADDITIONAL PAYMENTS INCLUDING LUMP SUM PAYMENTS FOR DIRECT CARE AND ANCILLARY SERVICES WORKERS' WAGE AND BENEFIT INCREASES (1) Effective for the period July 1, 2016 July 1, 2017 and for the six months thereafter, nursing facilities must report to the department actual hourly wage and benefit rates paid for all direct care and ancillary services workers or the lump sum payment amounts for all direct care and ancillary services workers that will receive the benefit of the increased funds. The reported data will be used by the department for the purpose of comparing types and rates of payment for comparable services and tracking distribution of direct care wage funds to designated workers.

            (2) The department will pay Medicaid certified nursing care facilities located in Montana that submit an approved request to the department a lump sum payment in addition to the amount paid as provided in ARM 37.40.307 and 37.40.311 to their computed Medicaid payment rate to be used only for wage and benefit increases or lump sum payments for direct care or ancillary services workers in nursing facilities.

            (a) The department will determine the lump sum payments, twice a year commencing July 1, 2016 July 1, 2017, and again in six months from that date as a pro rata share of appropriated funds allocated for increases in direct care and ancillary services workers' wages and benefits or lump sum payments to direct care and ancillary services workers.

            (b) through (3) remain the same.

 

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

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

 

            4. STATEMENT OF REASONABLE NECESSITY

 

Medicaid nursing facility rates will be effective July 1, 2017, for the upcoming state fiscal year (SFY). The Department of Public Health and Human Services (department) is proposing amendments to ARM 37.40.307, 37.40.311, 37.40.337, and 37.40.361 pertaining to revising nursing facility reimbursement rates for the upcoming SFY 2018.

 

The proposed amendments to the rules are as follows:

 

ARM 37.40.307

 

The proposed amendment to (2)(d) updates the SFY 2017 reference (July 1, 2016, through June 30, 2017), to SFY 2018 (July 1, 2017, through June 30, 2018). This change is necessary for the department to provide notice of the current period for funding of Medicaid nursing facility provider rates.

 

The proposed amendment to (3) updates the SFY 2017 reference (July 1, 2016), to SFY 2018 (July 1, 2017). This change is necessary for the department to provide notice of the current period Medicaid nursing facility statewide median price.

 

Rate calculations include House Bill (HB2) and HB618 funding appropriated by the 65th Legislative Session, annualized FY2017 Medicaid paid days, and individual facility case mix index (resident acuity) to determine nursing facility providers' reimbursement according to the methodology outlined in (2), (2)(a), and (2)(b) of this rule.

 

ARM 37.40.311

 

The proposed amendment to (2) amends the wording in the rule relative to the "at risk" payment to county affiliated nursing facilities that close during a SFY.  Given the recent trend of county nursing facilities closing before the end of the current SFY, this proposed change is necessary to allow county nursing facilities to participate or not in the Intergovernmental Transfer Program (IGT).

 

ARM 37.40.337

 

The proposed amendment to (3) deletes the name and address of the department's fiscal intermediary. This change is necessary since the fiscal intermediary's name and address is on the provider website. We will not have to amend this rule when the fiscal intermediary's name and address changes.

 

ARM 37.40.361

 

The proposed amendment to (1) and (2)(a) updates the SFY 2017 reference (July 1, 2016), to SFY 2018 (July 1, 2017). This change is necessary for the department to provide notice of the current period for funding of Medicaid direct-care wage payments to the nursing facility providers.

 

Fiscal Impact

 

Nursing facility reimbursement will include an increase of 6.21% in provider rates. The 65th Legislative Session appropriated $144,088,879 in HB2 and $11,132,634 in HB618 for Medicaid nursing facility reimbursement. The estimated total funding available for SFY 2018 for nursing facility reimbursement is estimated at approximately $187,546,323 of combined state funds and federal funds, including $32,324,810 in patient contributions. These numbers do not include at risk provider funds or direct care wage funding.

 

Anticipated days for SFY2018 are 1,002,009 using estimates from SFY2017 Medicaid paid days.

 

The SFY 2018 appropriated funding for lump-sum payments to providers for direct care and ancillary workers is $6,970,153 for the nursing facility direct-care worker wage program.

 

Seventy-three nursing facility providers participated in the Medicaid nursing facility payment program and approximately 4,200 recipients received services in nursing facilities under Medicaid.

 

            5. The department intends to apply these rule amendments retroactively to July 1, 2017. 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., August 18, 2017.

 

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. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The primary bill sponsor was notified by electronic mail (e-mail) on July 10, 2017.

 

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/ Caroline Warne                                       /s/ Laura Smith for                                      

Caroline Warne                                            Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services

 

 

Certified to the Secretary of State July 10, 2017.