BEFORE THE Department of Public

health and human services of the

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.2928 pertaining to inpatient hospital reimbursement

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NOTICE OF AMENDMENT

 

TO: All Concerned Persons

 

1. On October 14, 2016, the Department of Public Health and Human Services published MAR Notice No. 37-772 pertaining to the public hearing on the proposed amendment of the above-stated rule at page 1799 of the 2016 Montana Administrative Register, Issue Number 19.

 

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: One comment was received concerning the permanent change to a "current" 12-month period rests with the fact the department will not have a complete year upon which to distribute supplemental funds.

 

RESPONSE #1: The department agrees this may be a possibility for the first year only. Subsequent years paid claims data will capture missing dates from the prior year. The department intends to monitor and compare the hospitals' distribution prior to and after the implementation of this rule to determine if this rule change has a material effect on the distribution of the supplemental funds.

 

COMMENT #2: One comment was received recommending that the department modify the proposed rule as follows: retain the current policy to use paid claims data as the source to calculate the supplemental payment for the traditional Medicaid population and use the current 12-month paid claims data only to calculate the supplemental payment for the expansion population.  Make this a one-time exception to the process; in future years, use data from paid claims for a 12-month period after closure of the timely billing limit.

 

RESPONSE #2: The department would like to thank the commenter for the suggestions. The department intends to continue with the proposed amendment and will monitor hospital distribution through performance-based measures.

 

COMMENT #3: One comment was received requesting the department establish a dispute resolution process to address appeals of the accuracy of the supplemental payment amounts.

 

RESPONSE #3: The department currently has an appeal process in accordance with ARM 37.5.310, Administrative Review and Fair Hearing Process for Medical Assistance Providers.

 

          4. These rule amendments are effective January 1, 2017.

 

 

 

/s/ Brenda K. Elias                                 /s/ Richard H. Opper                            

Brenda K. Elias, Attorney                      Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

 

         

Certified to the Secretary of State December 12, 2016.