BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the adoption of New Rule I and amendment of ARM 37.86.2801, 37.86.2901, and 37.86.2907 pertaining to Medicaid inpatient hospital services

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NOTICE OF ADOPTION AND AMENDMENT

 

TO:  All Concerned Persons

 

1.  On May 26, 2011, the Department of Public Health and Human Services published MAR Notice No. 37-545 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 884 of the 2011 Montana Administrative Register, Issue Number 10.

 

2.  The department has amended ARM 37.86.2801 as proposed.

 

3.  The department has adopted the following rule as proposed with the following changes from the original proposal.  Matter to be added is underlined.  Matter to be deleted is interlined.

 

NEW RULE I (37.86.2950) GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM   (1) through (4)(e) remain as proposed.

(f)  add the percentage of the Facility Specific Medicaid Utilization Rate (FSMUR) plus the Facility Share of Medicaid Utilization (FSMU) plus the Hospital Percentage of Graduate Medical Education (HPGME) divided by three to acquire the Average Medicaid Utilization (AMU) specific to each eligible hospital; and

FSMUR + FSMU + HPGME = AMU

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(g) through (5) remain as proposed.

 

AUTH:  2-4-201, 53-2-201, 53-6-113, MCA

IMP:     2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

4.  The department has amended the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

            37.86.2901  INPATIENT HOSPITAL SERVICES, DEFINITIONS  (1) through (20) remain as proposed.

            (21)  "Graduate medical education" (GME) means a postgraduate primary care residency program approved by the Accreditation Council for Graduate Medical Education (ACGME) offered by an eligible in-state hospital for the purpose of providing formal hospital-based training and education under the supervision of a licensed medical physician.

            (22) through (43) remain as proposed.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, 53-6-149, MCA

 

37.86.2907  INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION  (1) through (1)(a)(iv) remain as proposed.

            (v)  the client's sex gender;

            (vi) through (2) remain as proposed.

 

AUTH:  2-4-201, 53-2-201, 53-6-113, MCA

IMP:     2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

5.  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 comment was received suggesting additional language be added to the formula in New Rule I [37.86.2950]. This will allow the explanation of the formula to accurately reflect the formula itself.

 

RESPONSE #1:  The department has considered the suggested language and will insert the language into the rule.

 

COMMENT #2:  One comment was received suggesting that additional language be added to the definition of "graduate medical education" as proposed in ARM 37.86.2901(21).  The additional language would require eligible hospitals to be approved by the Accreditation Council for Graduate Medical Education (ACGME).

 

RESPONSE #2:  The department has considered the suggested language and will insert the language into the rule.

 

COMMENT #3:  One comment was received suggesting that the word "sex" be changed to the word "gender" as it appears in ARM 37.86.2907(1)(a)(v).

 

RESPONSE #3:  The department has considered the suggested change in usage and will insert this change into the rule.

 

COMMENT #4:  One comment was received from a provider who believes that there should be, in all cases where an out-of-state transport is being considered, a "vetting" of what can be done in-state for the child.  Also described are the efforts of this in-state provider to improve pediatric medical care, to include specialized pediatric services, to keep clients from seeking pediatric services out of state.  The comment indicates support of the proposed rule, ARM 37.86.2801.

RESPONSE  #4:  The department agrees that there are advantages to providing services in state.  The department has studied the availability of Medicaid services in the past and will continue to stay informed of these services available in Montana.  The department will take this into consideration when approving client travel out of state.  The department also understands that a client has the freedom to choose services from any qualified Medicaid provider.  The department will continue to evaluate the availability of Medicaid services and associated travel costs to ensure appropriate delivery of these services in a cost effective manner.  The department thanks the commenter.

 

 

/s/ John Koch                                     /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