BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES

OF THE STATE OF MONTANA

 

In the matter of the adoption of New Rules I and II, and the amendment of ARM 37.40.705, 37.40.1105, 37.40.1303, 37.79.102, 37.79.304, 37.85.105, 37.85.212, 37.86.105, 37.86.205, 37.86.805, 37.86.1004, 37.86.1006, 37.86.1105, 37.86.1506, 37.86.1802, 37.86.1807, 37.86.2005, 37.86.2206, 37.86.2207, 37.86.2230, 37.86.2405, 37.86.2505, 37.86.2605, 37.86.3020, 37.86.3515, 37.86.4010, 37.86.4205, 37.87.901, 37.87.1303, 37.87.1313, 37.87.1314, 37.87.1333, 37.87.2233, 37.88.907, 37.89.125, 37.89.523, and 37.90.408 pertaining to revision of fee schedules for Medicaid provider rates

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AMENDED NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION AND AMENDMENT

 

TO: All Concerned Persons

 

1. On April 25, 2013, the Department of Public Health and Human Services published MAR Notice No. 37-636 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 621 of the 2013 Montana Administrative Register, Issue Number 8.

 

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 Department of Public Health and Human Services no later than 5:00 p.m. on May 28, 2013, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail [email protected].

 

3.  The Department of Public Health and Human Services (the department) is proposing to amend this rulemaking. At the time of the original notice, House Bill 2 (HB2) of the 63rd Montana Legislature was not finalized; therefore, the department was unable to determine the actual rates affecting Medicaid reimbursement.  For this reason, an amended proposed notice is being filed to advise the public of the correct rates affecting Medicaid reimbursement and to extend the comment period for public comment.

 

Proposed conversion factor amounts and the by-report percentages have been calculated and are included in the body of this rule amendment. Please note that the calculation of fees for resource-based relative value scale (RBRVS) providers is determined by multiplying the conversion factor amount by the relative value unit. Even though the fees for RBRVS providers are increasing, it is possible that the conversion factor amount will decrease if the relative value unit increases.  Subsequently, the conversion factor for allied services providers has decreased.

 

RBRVS provider rates established for psychiatrists are presently 125% of the rate paid to nonpsychiatrist physicians due to inadequate access to mental health services by Medicaid members. These services will continue to have a favorable provider rate adjustment to address access problems but the favorable provider rate adjustment will be reduced from 125% to 112% to implement the final RBRVS rates for state fiscal year (SFY) 2014 as directed by the Legislature. The department's proposed change remains a positive rate adjustment for psychiatrists in relation to other licensed physicians.

 

In addition, new information regarding federal sequestration has indicated that Medicaid fee schedules will not be affected by the sequester.  Since federal sequestration no longer applies, information regarding the effect of federal sequestration upon Medicaid fee schedules found in the statement of reasonable necessity no longer applies.

 

A typographical error in ARM 37.85.212 is being corrected. The (3) has been changed to (2) to indicate the correct subsection in ARM 37.85.105.

 

Copies of the department's SFY 2014 fee schedules are posted at http://medicaidprovider.hhs.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.

 

4. The rules as proposed to be amended provide as follows:

 

            37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) remains as proposed.

            (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) remains as proposed.

            (b) Fee schedules are effective July 1, 2013. The conversion factor for physician services is $31.86 $34.32. The conversion factor for allied services is $23.11 $23.08. The conversion factor for mental health services is $22.81 $24.29. The conversion factor for anesthesia services is $27.55 $28.10.

            (c) remains as proposed.

            (d) The by-report rate is effective July 1, 2013 and is 46% 44% of the provider's usual and customary charges.

            (e) remains as proposed.

            (f) Psychiatrists receive a 125% 112% provider rate of reimbursement adjustment to the reimbursement of physicians effective July 1, 2013.

            (g) through (6) remain as proposed.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

            37.85.212 RESOURCE-BASED RELATIVE VALUE SCALE (RBRVS) REIMBURSEMENT FOR SPECIFIED PROVIDER TYPES (1) through (11) remain as proposed.

            (12) Subject to the provisions of (12)(a), when billed with a modifier, payment for procedures established under the provisions of (7) is a percentage of the rate established for the procedures.

            (a) The methodology to determine the specific percent for each modifier is as follows:

            (i) and (ii) remain as proposed.

            (iii) The department's list of the specific percents for the modifiers used by Medicaid is adopted and incorporated by reference. A copy of the list is available on the department's web site at: hhtp://medicaidprovider.hhs.mt.gov/pdf/manuals/physician.pdf. The effective date and amounts are as provided in ARM 37.85.105(3)(2).

            (13) and (14) remain as proposed.

 

AUTH: 53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-125, MCA

 

5. The public comment period has been extended. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on May 30, 2013. Comments may also be faxed to (406) 444-9744 or e-mailed to [email protected].

 

/s/ John Koch                                               /s/ Richard H. Opper                                   

Rule Reviewer                                             Richard H. Opper, Director

                                                                        Public Health and Human Services

 

Certified to the Secretary of State May 13, 2013.