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 37.79.102, 37.79.304, 37.79.326, 37.86.610, 37.86.705, 37.86.805, 37.86.1005, 37.86.2005, and 37.86.2605 pertaining to Medicaid allied health services program reimbursement and rates

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NOTICE OF ADOPTION AND AMENDMENT

 

TO: All Concerned Persons

 

1. On April 24, 2014, the Department of Public Health and Human Services published MAR Notice No. 37-672 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 816 of the 2014 Montana Administrative Register, Issue Number 8.

 

2.  The department has adopted New Rule I (37.86.1103) as proposed.

 

3. The department has amended ARM 37.79.102, 37.79.304, 37.79.326, 37.86.610, 37.86.705, 37.86.805, 37.86.1005, and 37.86.2005, as proposed.

 

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

 

            37.86.2605 AMBULANCE SERVICES, REIMBURSEMENT (1) and (2) remain as proposed.

            (3) For items and services for which no fee has been set in the department's fee schedule referred to in (2), reimbursement will be set by the following method:

            (a) and (b) remain as proposed.

            (4) For supplies or equipment, where there is no Medicare or Medicaid set fee, the provider's usual and customary charge in (1)(a) will be considered reasonable if set at 75% of the manufacturer's suggested retail price. For items without a manufacturer's suggested retail price, the charge will be considered reasonable if the provider's acquisition cost from the manufacturer is at least 50% of the charge amount.

            (4) remains as proposed but is renumbered (5).

 

AUTH: 53-2-201, 53-6-113, MCA

IMP:     53-6-101, 53-6-113, 53-6-141, 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: One comment was received indicating there was an oversight by the department to include in the proposed rule change, payment methodology for supply codes listed on the fee schedule where no department fee is set. These codes were formally reimbursed using the "By Report" methodology. It is recommended the department consider a billed charge as reasonable, if based on a percentage of Manufacturer's Suggested Retail Price (MSRP), or the provider's acquisition cost when no MSRP is available.

 

RESPONSE #1:  The department thanks the commenter for recognizing this oversight and has added this payment methodology to the ambulance services rule at ARM 37.86.2605(4).

 

            6. These rule amendments are effective July 1, 2014.

 

 

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

John C. Koch                                               Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services

           

Certified to the Secretary of State June 16, 2014