Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the adoption of New Rules I through III, and the amendment of ARM 37.86.4401, 37.86.4402, 37.86.4406, 37.86.4412, 37.86.4413, and 37.86.4420 pertaining to rural health clinics and federally qualified health centers

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NOTICE OF EXTENSION OF COMMENT PERIOD ON PROPOSED ADOPTION AND AMENDMENT

TO: All Concerned Persons

1. On July 26, 2019, the Department of Public Health and Human Services published MAR Notice No. 37-877 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 1017 of the 2019 Montana Administrative Register, Issue Number 14.

2. A public hearing was held on August 15, 2019, and the department received comments until 5:00 p.m., August 23, 2019. A comment was received asking what methodology the department will use to determine whether or not an RHC's or FQHC's change in scope of service will result in an incremental change to the facility's PPS rate. The department has determined the comment is well taken and that the calculations should be published in the administrative rules. The department now proposes the following additional amendment to ARM 37.86.4412 that includes the calculations and a reference to the alternative payment methodology. Also, the department proposes the following additional amendment to ARM 37.86.4401 to make clear that the definition of "baseline PPS rate" includes rates established pursuant to the alternative payment methodology and rates established at the conclusion of a change in scope of service application. In light of the additional proposed amendments, the department is extending the comment period on these rules to 5:00 p.m., September 27, 2019.

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

37.86.4401 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, DEFINITIONS (1) remains as proposed.

(2) "Baseline PPS rate" is defined as an RHC's or FQHC's current ~~the~~ PPS rate established in accordance with ARM 37.86.4413~~(1)~~, ARM 37.86.4420(2), [NEW RULE II], or [NEW RULE III], as adjusted annually by the Medicare economic index (MEI).

(3) through (18) remain as proposed.

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

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

37.86.4412 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, REIMBURSEMENT (1) through (5) remain as proposed.

(6) For RHCs or FQHCs that had their initial Medicaid prospective payment system base visit rate calculated in 2001 or starting with the third fiscal year (for "new" RHCs or FQHCs as defined at ARM 37.86.4413), the prospective payment system per-visit rate may be adjusted to take into account any increase or decrease in the scope of service. The department uses the following calculations to determine the amount of an incremental change, if any, and the resulting new PPS rate:

A/B = C

D/E = F

F-C = IC

Current PPS rate + IC = New PPS rate

(a) "A" represents allowable costs before the change in scope of service;

(b) "B" represents total visits before the change in scope of service;

(d) "D" represents allowable costs after the change in scope of service;

(e) "E" represents total visits after the change in scope of service;

(f) "F" represents cost per visit after the change in scope of service; and

(g) "IC" represents the incremental change due to the change in scope of services.

(7) and (8) remain as proposed.

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

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

4. 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 September 24, 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].

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., September 27, 2019.

/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 September 10, 2019