HOME    SEARCH    ABOUT US    CONTACT US    HELP   
           
Montana Administrative Register Notice 37-878 No. 10   05/24/2019    
Prev Next

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.27.902, 37.85.104, 37.85.105, 37.85.106, and 37.88.101

pertaining to Medicaid rates, services, and benefit changes

)

)

)

)

)

NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On June 13, 2019, at 10:30 a.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 June 4, 2019, to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, 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:

 

37.27.902 MEDICAID SUBSTANCE USE DISORDER SERVICES: AUTHORIZATION REQUIREMENTS (1) remains the same.

(2) In addition to the requirements contained in rule, the department has developed and published the Addictive and Mental Disorders Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health (Manual), dated January 1, 2019 July 1, 2019, which it adopts and incorporates by reference. The purpose of the Manual manual is to implement requirements for utilization management and services. A copy of the Manual manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at http://dphhs.mt.gov/amdd.aspx. 

(3) In addition to the requirements contained in rule, the department has developed and published the Addictive and Mental Disorders Division Non-Medicaid Services Provider Manual for Substance Use Disorder, dated July 1, 2019, which it adopts and incorporates by reference. The purpose of the manual is to implement requirements for utilization management and services. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena MT 59620-2905 or at http://dphhs.mt.gov/amdd.aspx.

 

AUTH: 53-6-113, 53-24-204, 53-24-208, 53-24-209, MCA

IMP: 53-6-101, 53-24-204, 53-24-208, 53-24-209, MCA

 

            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) Mental health services plan provider reimbursement, as provided in ARM 37.89.125, is effective January 1, 2019 July 1, 2019.

            (b) 72-hour presumptive eligibility for adult-crisis stabilization services reimbursement for services, as provided in ARM 37.89.523, is effective January 1, 2019 July 1, 2019.

            (c) Youth respite care services, as provided in ARM 37.87.2203, is effective July 1, 2018, as revised and labeled "version 2 July 1, 2019."

            (d) Substance use disorder services provider reimbursement, as provided in ARM 37.27.905, is effective January 1, 2019 July 1, 2019.

            (2) Copies of the department's current fee schedules are posted at http://medicaidprovider.mt.gov and may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951. A description of the method for setting the reimbursement rate and the administrative rules applicable to the covered services are published in the chapter or subchapter of this title regarding that service.  

 

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) Resource-based relative value scale (RBRVS) means the version of the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services and published at 82 83 Federal Register 219 226, page 52976 59452 (November 15, 2017) (November 23, 2018) effective January 1, 2018 January 1, 2019 which is adopted and incorporated by reference. Procedure codes created after January 1, 2019 will be reimbursed using the relative value units from the Medicare Physician Fee Schedule in place at the time the procedure code is created.

            (b) Fee schedules are effective January 1, 2019 July 1, 2019. The conversion factor for physician services is $37.81 $36.46. The conversion factor for allied services is $23.67 $23.97. The conversion factor for mental health services is $23.92 $23.36. The conversion factor for anesthesia services is $29.76 $30.03.

            (c) through (g) remain the same.

            (h) Optometric services receive a 117% 117.26% provider rate of reimbursement adjustment to the reimbursement for allied services as provided in ARM 37.85.105(2) effective July 1, 2018 July 1, 2019.

            (i) remains the same

            (j) Reimbursement for vaccines described at ARM 37.86.105 is effective January 1, 2019 July 1, 2019.

            (3) The department adopts and incorporates by reference, the fee schedule for the following programs within the Health Resources Division, on the date stated.

            (a) remains the same.

            (b) The outpatient hospital services fee schedules including:

            (i) the Outpatient Prospective Payment System (OPPS) fee schedule as published by the Centers for Medicare and Medicaid Services (CMS) in Federal Register Volume 82 83, Issue 217 225, page 52356 58818 (November 13, 2017) (November 21, 2018), effective January 1, 2018 January 1, 2019, and reviewed annually by CMS as required in 42 CFR 419.5 (2016) as updated by the department;

            (ii) through (iv) remain the same.

            (c) The hearing aid services fee schedule, as provided in ARM 37.86.805, is effective January 1, 2019 July 1, 2019.

            (d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in 2018 2019 resulting in a dental conversion factor of $33.78 $34.09 and fee schedule is effective July 1, 2018 July 1, 2019.

            (e) remains the same.

            (f) The outpatient drugs reimbursement, dispensing fees range as provided in ARM 37.86.1105(3)(b) is effective July 1, 2018 July 1, 2019, as revised and labeled "version 2":

            (i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $2.75 $2.32 and the maximum is $15.00 $15.14;

            (ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $2.75 $2.32 and the maximum is $13.00 $13.12; or

            (iii) for pharmacies with prescription volume greater than 70,000, the minimum is $2.75 $2.32 and the maximum is $11.00 $11.10.

            (g) remains the same.

            (h) The outpatient drugs reimbursement, vaccine administration fee as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $13.83 $14.08 for each additional administered vaccine, effective July 1, 2018 July 1, 2019, as revised and labeled "version 2."

            (i) remains the same.

            (j) The home infusion therapy services fee schedule, as provided in ARM 37.86.1506, is effective July 1, 2018 July 1, 2019.

            (k) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective January 1, 2019 July 1, 2019, which outlines the Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs) as provided in ARM 37.86.1802, effective January 1, 2019 July 1, 2019. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective January 1, 2019 July 1, 2019.

            (l) Fee schedules for nutrition, children's special health services, and orientation and mobility specialists, The nutrition services fee schedule, as provided in ARM 37.86.2207(2), are is effective July 1, 2018 July 1, 2019, as revised and labeled "version 2."

            (m) The children's special health services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2019.

            (n) The orientation and mobility specialist services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2019.

            (m) (o)  The transportation and per diem fee schedule, as provided in ARM 37.86.2405, is effective July 1, 2016 July 1, 2019.

            (n) (p)  The specialized nonemergency medical transportation fee schedule, as provided in ARM 37.86.2505, is effective July 1, 2016 July 1, 2019.

            (o) (q)  The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective July 1, 2018 July 1, 2019, as revised and labeled "version 2."

            (p) (r)  The audiology fee schedule, as provided in ARM 37.86.705, is effective July 1, 2018 July 1, 2019, as revised and labeled "version 2."

            (q) (s)  The therapy fee schedules for occupational therapists, physical therapists, and speech therapists, as provided in ARM 37.86.610, are effective July 1, 2018 July 1, 2019, as revised and labeled "version 2."

            (r) (t)  The optometric services fee schedule, as provided in ARM 37.86.2005, is effective January 1, 2019 July 1, 2019.

            (s) (u)  The chiropractic fee schedule, as provided in ARM 37.85.212(2), is effective July 1, 2018 July 1, 2019, as revised and labeled "version 2."

            (t) (v)  The lab and imaging services fee schedule, as provided in ARM 37.85.212(2) and 37.86.3007, is effective January 1, 2019 July 1, 2019.

            (u)  The Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) fee schedule for add-on services, as provided in ARM 37.86.4412, is effective January 1, 2018.

            (v) (w)  The Targeted Case Management for Children and Youth with Special Health Care Needs fee schedule, as provided in ARM 37.86.3910, is effective July 1, 2018 July 1, 2019.

            (w) (x)  The Targeted Case Management for High Risk Pregnant Women fee schedule, as provided in ARM 37.86.3415, is effective July 1, 2018 July 1, 2019.

            (x) (y)  The mobile imaging services fee schedule, as provided in ARM 37.85.212, is effective January 1, 2019 July 1, 2019.

            (y) (z)  The licensed direct-entry midwife fee schedule, as provided in ARM 37.85.212, is effective January 1, 2019 July 1, 2019.

            (z) (aa)  The private duty nursing services fee schedule, as provided in ARM 37.86.2207(2), is effective July 1, 2018 July 1, 2019.

            (4) The department adopts and incorporates by reference, the fee schedule for the following programs within the Senior and Long Term Care Division on the date stated:

            (a) Home The home and community-based services for elderly and physically disabled persons fee schedule, as provided in ARM 37.40.1421, is effective July 15, 2018 July 1, 2019.

            (b) Home The home health services fee schedule, as provided in ARM 37.40.705, is effective July 1, 2018 July 1, 2019.

            (c) Personal The personal assistance services fee schedule, as provided in ARM 37.40.1135, is effective July 1, 2018 July 1, 2019.

            (d) Self-directed The self-directed personal assistance services fee schedule, as provided in ARM 37.40.1135, is effective July 1, 2018 July 1, 2019.

            (e) Community The community first choice services fee schedule, as provided in ARM 37.40.1026, is effective July 1, 2018 July 1, 2019.

            (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) Mental The mental health center services for adults reimbursement fee schedule, as provided in ARM 37.88.907, is effective January 1, 2019 July 1, 2019.

            (b) Home The home and community-based services for adults with severe disabling mental illness, reimbursement fee schedule, as provided in ARM 37.90.408, is effective January 1, 2019 July 1, 2019.

            (c) Substance The substance use disorder services reimbursement fee schedule, as provided in ARM 37.27.905, is effective January 1, 2019 July 1, 2019.

            (6)  The department adopts and incorporates by reference, the fee schedule for the following program within the Developmental Services Division, on the date stated: 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, 2018, as revised and labeled "version 2." For the Developmental Services Division, the department adopts and incorporates by reference the Medicaid youth mental health services fee schedule, as provided in ARM 37.87.901, effective July 1, 2019.

 

AUTH: 53-2-201, 53-6-113, MCA

IMP: 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA

 

37.85.106 MEDICAID BEHAVIORAL HEALTH TARGETED CASE MANAGEMENT FEE SCHEDULE (1) remains the same.

(2) The Department of Public Health and Human Services (department) adopts and incorporates by reference the Medicaid Behavioral Health Targeted Case Management Fee Schedule effective July 1, 2018 July 1, 2019, for the following programs within the Developmental Services Division (DSD) and the Addictive and Mental Disorders Division (AMDD):

(a) through (3) remain the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

            37.88.101 MEDICAID MENTAL HEALTH SERVICES FOR ADULTS, AUTHORIZATION REQUIREMENTS (1) remains the same.

            (2) In addition to the requirements contained in rule, the department has developed and published the Addictive and Mental Disorders Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health (Manual), dated January 1, 2019 July 1, 2019, which it adopts and incorporates by reference. The purpose of the Manual is to implement requirements for utilization management and services. A copy of the Manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at http://dphhs.mt.gov/amdd.aspx.

            (3) through (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

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) administers the Montana Medicaid and non-Medicaid program to provide health care to Montana's qualified low income, elderly, and disabled residents. Medicaid is a public assistance program paid for with state and federal funds appropriated to pay health care providers for the covered medical services they deliver to Medicaid members.

 

Pursuant to 53-6-113, MCA, the Montana Legislature has directed the department to use the administrative rulemaking process to establish rates of reimbursement for covered medical services provided to Medicaid members by Medicaid providers. The department proposes these rule amendments to establish Medicaid rates of reimbursement which are necessary for the purposes of the Medicaid program. In establishing the proposed rates of reimbursement, the department considered as primary factors the availability of funds appropriated by the Montana Legislature during the 2019 regular legislative session, the actual cost of services, and the availability of services.

 

The purpose of the proposed rule amendments is to: 

            (1) incorporate legislatively appropriated provider rate increases with an effective date of July 1, 2019;

            (2) incorporate the July 1, 2019 RBRVS changes;

            (3) incorporate the physician conversion factor as provided in 53-6-125, MCA;

            (4) update federal register references for the RBRVS and Outpatient Prospective Payment System payment methodologies;

            (5) revise fee schedules;

            (6) update the Addictive and Mental Disorders Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health;

            (7) adopt and incorporate the Addictive and Mental Disorders Division Non-Medicaid Services Provider Manual for Substance Use Disorder;

            (8) add a bundled rate for Intensive Outpatient Services for substance use disorder; and

            (9) incorporate coverage and reimbursement for peer support services.

 

Proposed Provide Rate Increases

 

The department is proposing provider rate increases effective July 1, 2019, for most Medicaid and non-Medicaid provider rates in accordance with the funding appropriated by the Montana Legislature during the 2019 regular session.

 

Resource-Based Relative Value Scale (RBRVS) Methodology Summary

 

Many Montana Medicaid providers' rates are established through the resource-based relative value scale (RBRVS) model. RBRVS is used nationwide by most health plans, including Medicare and Medicaid to establish Montana Medicaid provider rates. The relative value unit component of RBRVS is revised annually by the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA). The department annually proposes to amend ARM 37.85.105 to adopt the recently revised relative value units (RVUs). An RVU is a numerical value assigned to each medical procedure. RVUs are based on physician work, practice expense, and malpractice insurance expenses, and RVUs express the relative effort and expense expended to provide one procedure compared with another. In the annual revision of RVUs, CMS and the AMA add RVUs for new procedures and increase or decrease RVUs of particular procedures, depending on the factors listed above.

 

"Conversion factor" (CF) means a dollar amount by which RVUs are multiplied to establish the RBRVS fee for a service. The department annually calculates conversion factors for allied services, mental health services, and anesthesia services taking into consideration the changes to RVUs and appropriations.

 

For allied health services, mental health services, and anesthesia services, the conversion factors were calculated to provide for an overall increase of 0.91%.

 

Physician Conversion Factor

 

Section 53-6-125, MCA, directs the department to increase the physician's conversion factor by the consumer price index (CPI) for medical care for the previous year. 

 

In addition, during the 2019 legislative session, HB 669 amended 53-6-125, MCA, to reduce general fund expenditures for physicians by $200,000 to fund the Health Information Exchange. After applying the federal match, the total expenditure reduction calculated to $570,288.

 

The changes to the physician conversion factor were completed in two steps, first applying the annual CPI increase and then applying the reduction associated with HB 669. These changes were applied multiplicatively resulting in a proposed physician conversion factor of $38.46.

 

Fee Schedules

 

The department is proposing the adoption of fee schedules effective July 1, 2019.  The fee schedules incorporate changes due to the proposed amendments within this rulemaking.

 

In addition, the department proposes to eliminate the reference to the FQHC and RHC fee schedule. The rates and codes referenced in this fee schedule are on the outpatient fee schedule which is the fee schedule FQHC and RHC providers utilize for covered services. Any guidance about billing and reimbursement will be issued within the FQHC and RHC provider manuals and/or FQHC provider notices.

 

The department has posted proposed fee schedules at http://medicaidprovider.mt.gov/proposedfs.

 

Federal Register Updates

 

Effective July 1, 2019, the department is proposing to adopt the January 1, 2019, federal register references for the RBRVS and Outpatient Prospective Payment System reimbursement methodologies. These updates are necessary to incorporate the most up to date changes made by CMS. 

 

Provider Manual Updates

 

ARM 37.27.902 and 37.88.101 refer to provider manuals. These manuals are proposed to be updated. 

 

The Addictive and Mental Disorders Division, Non-Medicaid Services Provider Manual for Substance Use Disorder (SUD), effective July 1, 2019, is proposed to be incorporated into the Administrative Rules of Montana. The Addictive and Mental Disorders Division (AMDD) Non-Medicaid Services Provider Manual provides information and service requirements pertaining to non-Medicaid substance use disorder (SUD) treatment services. This manual replaces the Chemical Dependency Provider Manual.

 

The Addictive and Mental Disorders Division, Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health, effective July 1, 2019 is proposed to be amended to include: 1) peer support services, a new benefit for Medicaid members; 2) new bundled rate reimbursement options for providers delivering substance use disorder intensive outpatient services; 3) allowing additional provider types to conduct substance use disorder assessments and referral to appropriate acute services; and 4) general housekeeping items to provide additional clarity to providers.

 

Proposed manuals can be found at https://dphhs.mt.gov/amdd.

 

Bundled Rate for Substance Use Disorder (SUD) Intensive Outpatient (IOP) Services

 

SUD IOP has historically been delivered and billed as fee-for-service. The department is proposing a comprehensive service bundle with two tiered per-diem rates for adults, one tier for adolescent IOP services, and an enhancement add-on for mental health integration.

 

This reimbursement model will promote individualized treatment planning consistent with ASAM 2.1 criteria while increasing statewide access of intensive outpatient services. 

 

Peer Support

 

The department is proposing to add a new adult member benefit of peer support for substance use disorder and mental health. Peer support services are proposed to be provided in Mental Health Centers, Substance Use Clinics, Federal Qualified Health Centers (FQHC), and Rural Health Clinics (RHC) at a fee schedule rate.

 

Fiscal Impact - Provider Rate Changes

 

The following table displays the number of providers affected by the amended fee schedules, effective dates, conversion factors, and rates for services, as well as the fiscal impact to State general funds for SFY 2020 based on the proposed amendments.

 

Provider Type

 SFY 2020 Budget Impact (State Funds)

 SFY 2020 Budget Impact (Federal Funds)

 SFY 2020 Budget Impact (Total Funds)

 Active Provider Count

 Ambulance

               21,522

               80,396

             101,918

            186

 Audiologist

                     560

                  1,427

                  1,987

              68

 Targeted Case Management - Mental Health

               21,070

               51,804

               72,874

              21

 Targeted Case Management - High Risk Pregnancy

                     339

                     765

                  1,104

              18

 Chemical Dependency Clinic

               15,141

               92,849

             107,990

              41

 Chiropractor

                       87

                     161

                     248

            101

 Community First Choice

             129,722

             249,171

             378,893

              66

 Dental

             168,207

             440,371

             608,578

            617

 Denturist

                  5,804

               20,827

               26,631

              17

 EPSDT

                  2,146

                  5,010

                  7,156

            130

 Hearing Aid Dispenser

                     770

                  1,975

                  2,745

              35

 Home & Comm Based Services

             160,255

             297,040

             457,295

            516

Home Health Agency

1,891

6.165

8,056

26

 

 

 

 

 

 Home Infusion Therapy

                  5,403

               14,905

               20,308

              16

 Independent Diagnostic Testing Facility

                  2,509

               10,577

               13,086

              20

 Laboratory

               31,060

             156,161

             187,221

            174

 Licensed Professional Counselor

               50,406

             164,482

             214,888

            849

 Mental Health Center

               79,600

             186,638

             266,238

              28

 Mid-Level Practitioner

             193,193

             689,534

             882,727

         4,557

 Mobile Imaging Service

                     170

                     407

                     577

                 1

 Nutritionist/Dietitian

                     262

                     653

                     915

              96

 Occupational Therapist

                  9,994

               20,798

               30,792

            228

 Optician

                     295

                     952

                  1,247

              28

 Optometrist

               15,850

               49,130

               64,980

            221

 Orientation and Mobility

                        614  

1,148

1,762

3 

 Personal Care Agency

                  2,150

                  4,666

                  6,816

              66

 Personal Care Agency Adult MH

                     101

                     241

                     342

              66

 Pharmacy Dispensing Fee

               55,740

             248,641

             304,381

            435

 Physical Therapist

               14,911

               62,318

               77,229

            797

 Physician

             616,246

          2,246,049

          2,862,295

       11,505

 Podiatrist

                  9,081

               36,876

               45,957

              66

 Private Duty Nursing Agency

               12,794

               23,688

               36,482

                 4

 PRTF

               58,813

             131,444

             190,257

              26

 Psychiatrist

               26,597

               80,537

             107,134

            225

 Psychologist

                  3,264

               11,675

               14,939

            276

 Social Worker

               29,072

               97,656

             126,728

            657

 Speech Pathologist

               10,397

               20,330

               30,727

            220

Personal and Commercial Transportation

                     620

                  1,459

                  2,079

              13

 Therapeutic Family Care

               12,921

               29,498

               42,419

              14

 Therapeutic Group Home

               61,739

             126,180

             187,919

              20

 Transportation Non-Emergency

                       55

                     103

                     158

                 7

 

 

Fiscal Impact - Peer Support Services

 

The following table displays the number of providers affected by implementing a reimbursement avenue for peer support services, as well as the fiscal impact to State general Funds for SFY 2020 based on the proposed amendments. 

 

Provider Type

SFY 2020

 Budget Impact (State Funds)

SFY 2020

Budget Impact (Federal Funds)

SFY 2020 Budget Impact (Total Funds)

Active Provider Count

Mental Health Centers

              $1,005,296

                      $3,476,310

 $4,481,606

28 

Federally Qualified Health Centers

                    $260,207

                         $899,797

                 $1,160,004

59 

Rural Health Clinics

                    $107,584

                         $372,024

                    $479,608

66 

Substance Use Clinics

$680,121

$2,368,398

$3,048,519

41

 

Fiscal Impact - Intensive Outpatient Services

 

The following table displays the number of providers affected by the changes to intensive outpatient services reimbursement, as well as the fiscal impact to State general funds for SFY 2020 based on the proposed amendments.

 

Provider Type

SFY 2020 Budget Impact (State Funds)

SFY 2020 Budget Impact (Federal Funds)

SFY 2020 Budget Impact (Total Funds)

Active Provider Count

Substance Use Clinics

$440,848.76

$3,263,887.23

$3,704,736

41

 

The proposed rulemaking is estimated to affect 271,283 Medicaid members. In addition, it will impact the provider populations outlined in the tables above.

 

The department intends to apply the proposed rule amendments retroactively to July 1, 2019.

 

            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: Gwen Knight, 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., June 21, 2019.

 

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. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The primary bill sponsors were notified by electronic mail on May 14, 2019.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules may significantly and directly impact small businesses that are state-approved substance use disorder providers and mental health centers.

 

10. 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/ Brenda K. Elias                                       /s/ Sheila Hogan                                         

Brenda K. Elias                                            Sheila Hogan, Director

Rule Reviewer                                              Public Health and Human Services

 

 

Certified to the Secretary of State May 14, 2019.

 
Home  |   Search  |   About Us  |   Contact Us  |   Help  |   Disclaimer  |   Privacy & Security
For questions regarding the content, interpretation, or application of a specific rule, please contact the agency that issued the rule.
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].