BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.85.105 pertaining to Medicaid fee schedules and effective dates

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

TO: TO

TO: All Concerned Persons

 

            1.  On April 14, 2022, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider the proposed amendment of the above-stated rule. Interested parties may access the remote conferencing platform in the following ways: 

            (a) Join Zoom Meeting at: https://mt-gov.zoom.us/j/85173394119

meeting ID: 851 7339 4119; Password: 222901 or

            (b) Dial by telephone +1 646 558 8656, meeting ID: 851 7339 4119.  Find your local number: https://mt-gov.zoom.us/u/k4rZjr8q8.

 

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 April 4, 2022, to advise us of the nature of the accommodation that you need. Please contact Valerie St. Clair, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-6863; fax (406) 444-9744; or e-mail [email protected].

 

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

 

            37.85.105 EFFECTIVE DATES, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS OF MONTANA MEDICAID PROVIDER FEE SCHEDULES (1) and (2) remain the same. 

            (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) through (j) remain the same.

            (k) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective January 1, 2022 April 1, 2022, 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, 2022 April 1, 2022. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective January 1, 2022 April 1, 2022.

            (l) through (6) remain the same. 

 

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

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

 

4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) is proposing to amend ARM 37.85.105, pertaining to updating the effective dates of Medicaid fee schedules.

 

The 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.

 

The proposed fee schedule can be found at the following web address: http://medicaidprovider.mt.gov/proposedfs.

 

The proposed amendments are explained below, regarding the specific subsection of ARM 37.85.105.

 

(3)(k) Prosthetic Devices, Durable Medical Equipment, and Medical Supplies

 

The department proposes to update the fee schedule date for prosthetic devices, durable medical equipment, and medical supplies to April 1, 2022.  This update is necessary to adopt updates to procedure codes that the federal Medicare program will enact in April 2022. The federal updates include new code additions, code deletions, and changes to existing code descriptions. Montana Medicaid uses Medicare procedure codes for billing and, therefore, must adopt the changes for the state program.

 

Fiscal Impact

 

This proposed rule amendment is expected to be budget neutral and will impact 501 Montana Healthcare Programs Durable Medical Equipment providers.

 

The department intends for the proposed amendments to be effective retroactive to April 1, 2022.

 

            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: Valerie St. Clair, 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., April 22, 2022.

 

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, do not apply.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.

 

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/ Adam Meier______________             

Brenda K. Elias                                            Adam Meier, Director

Rule Reviewer                                              Public Health and Human Services

 

 

Certified to the Secretary of State March 15, 2022.