BEFORE THE COMMISSIONER OF SECURITIES AND INSURANCE

MONTANA STATE AUDITOR

 

In the matter of the amendment of ARM 6.6.4902, 6.6.4906, 6.6.4907, 6.6.4908, and 6.6.4909 pertaining to Patient-Centered Medical Homes

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NOTICE OF AMENDMENT

TO: All Concerned Persons

 

1. On October 28, 2016, the Commissioner of Securities and Insurance, Montana State Auditor (CSI), published MAR Notice No. 6-228 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1895 of the 2016 Montana Administrative Register, Issue Number 20.

 

2. A hearing was held on November 17, 2016. No testimony was received, but the CSI has thoroughly considered written comments received, and the comments and responses are as follows:

 

COMMENT NO. 1: Health Care Service Corporation, DBA, BlueCross BlueShield of Montana (BCBSMT) commented that after the word "program," it would like to add "upon mutual agreement of the health plan or payor," to avoid uncertainty around the reporting requirements. This allows the parties to review, discuss, and agree on any additional reporting requests that are not defined in the rule.

 

RESPONSE NO. 1: This addition to the rule was requested by the majority of the stakeholder council to mirror for the language that is currently in the rule with regard to reporting by health care providers. It is important to keep the requirements the same for both payors and healthcare providers whenever possible. The language that BCBSMT requests is not necessary because 33-40-104, MCA, already requires the commissioner to consult with stakeholders when carrying out the duties of this related to this program and creates a stakeholder council. The council discusses the contents of these reports in detail and makes recommendations to the commissioner. The commissioner uses the recommendation to finalize the reporting requirements and the council reviews and approves the final requirements.

 

COMMENT NO. 2: BCBSMT requests that a great deal of additional language, including citations to existing statutes be added to ARM 6.6.4908 to further describe the legal process of determining whether certain insurer information can be treated as a trade secret.

 

RESPONSE NO. 2: The current rule already acknowledges that parts of the letter of intent to act as a PCMH payor may contain trade secrets. It allows the insurer to make a claim of trade secret and the commissioner to make a determination of the legitimacy of the claim according to applicable statutes and case law. It is not necessary to outline the law concerning trade secret determinations in this rule.

 

COMMENT NO. 3: PacificSource Health Plans commented that the changes to the rules should not be made because the Act itself is set to sunset at the end of 2017. There are bills proposed to the legislature that would remove the sunset, but no one knows the outcome of that legislation yet. PacificSource goes on to suggest other changes that would have to be made in statute, not rule.

 

RESPONSE NO. 3: The majority of stakeholders specifically requested these rule changes and the council is fully aware of the sunset on the Act. In these rules, the commissioner is making minor changes in the timeline for reporting and a small change to a quality metric that was specifically requested by the majority of the stakeholder council.

 

COMMENT NO. 4: PacificSource requests substantive changes to ARM 6.6.4902 that were not part of the proposed rule change notice and not discussed by the stakeholder council.

 

RESPONSE NO. 4: Because this comment requests substantive changes in the rule that were never exposed for public comment, these changes cannot be considered in this adoption notice.

 

COMMENT NO. 5: PacificSource objects to the "overly broad scope" of the change to ARM 6.6.4906(2) and states that it would require them to "collect and keep data" not yet established on a timeline not yet established.

 

RESPONSE NO. 5: This addition to the rule was requested by the majority of the stakeholder council to mirror for the language that is currently in the rule with regard to reporting by healthcare providers. It is important to keep the requirements the same for both payors and healthcare providers whenever possible.

 

Section 33-40-104, MCA, requires the commissioner to consult with stakeholders when carrying out the duties of this related to this program and creates a stakeholder council. The council discusses the contents of these reports in detail and makes recommendations to the commissioner before reporting is required. The commissioner uses the recommendations for the council to finalize the reporting requirements.

 

The timeline and content for the payor report was established in 2014 and the payors, including PacificSource submitted these reports in 2015 and 2016. There is no change to content for 2017. The proposed rule change was made to formalize a process that was already established.

 

          3. The CSI has amended the above-stated rules as proposed.

 

/s/ Michael A. Kakuk                              /s/ Christina L. Goe

Michael A. Kakuk                                  Christina L. Goe

Rule Reviewer                                       General Counsel

                             

Certified to the Secretary of State December 27, 2016.