BEFORE THE Department of Public

health and human services of the

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.3607 pertaining to the rates of reimbursement for the provision by provider entities of Medicaid funded targeted case management services to persons with developmental disabilities

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NOTICE OF AMENDMENT

 

TO:  All Concerned Persons

 

1.  On May 26, 2011, the Department of Public Health and Human Services published MAR Notice No. 37-544 pertaining to the public hearing on the proposed amendment of the above-stated rule at page 881 of the 2011 Montana Administrative Register, Issue Number 10.

 

2.  The department has amended the above-stated rule as proposed.

 

3.  The department has thoroughly considered the comments and testimony received.  A summary of the comments received and the department's responses are as follows:

 

COMMENT #1:  A change was required to be made in Section V of the Developmental Disabilities Program (DDP) Manual of Service Reimbursement Rates and Procedures.  This manual has been incorporated by reference in ARM 37.86.3607.  The change is being made in the manual, not in the rule.  An analysis of Section V was conducted by DDP fiscal staff and they discovered that a provider’s full time equivalent (FTE) calculation was incorrectly listed.  The FTE amount was discussed with the provider in question and that provider verified that the amount was incorrect.

 

RESPONSE #1:  The department has changed Section V of the manual to state the correct FTE number.

 

COMMENT #2:  An analysis of Section VI of the Developmental Disabilities Program (DDP) Manual of Service Reimbursement Rates and Procedures was conducted by DDP fiscal staff as they were reviewing the manual.  The original section states:

 

VI.        Calculation of the Caseload Increase Adjustment to the Billing Cap:

1.  At 4438.72 units/yr/FTE and 35 clients on the caseload for each FTE the number of units per client per year is 4438.72 / = 126.82 (round to 127).

2.  127 units per client times $15.45 (rate) = $1,962.15 per client per year.

3.  For each client on the caseload above 35 the billing cap is increased by $1,962.15 per client per FTE.

 

RESPONSE #2:  The department concluded that the Section VI was unnecessarily complex in nature and attempts to apply the formula could create confusion about the correct amount and be potentially misleading to providers and the public.  The DDP decided to change the section for the sake of clarity. The department has corrected the language to read:

 

VI.        Calculation of the Caseload Increase Adjustment to the Billing Cap:

 

1.  If a provider delivers units of services in excess of the dollar amounts in Section V, the additional units are to be compensated at $15.45 per unit.

 

There is no fiscal impact due to this change.

 

 

/s/ Cary B. Lund                                             /s/ Mary E. Dalton for                                   

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

 

           

            Certified to the Secretary of State July 18, 2011.