BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.1102, 37.86.1103, and 37.86.1105 pertaining to Medicaid outpatient drug services

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On May 31, 2018, at 3:00 p.m., the Department of Public Health and Human Services will hold a public hearing in Room 107 of the Department of Public Health and Human Services Building, 111 North Sanders, at Helena, Montana, to consider the proposed amendment of the above-stated rules.

 

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 the Department of Public Health and Human Services no later than 5:00 p.m. on May 21, 2018, to advise us of the nature of the accommodation that you need. Please contact Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; fax (406) 444-9744; or e-mail [email protected].

 

3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.86.1102 OUTPATIENT DRUGS, REQUIREMENTS (1) through (6) remain the same.

            (7) The department may pay for nonrebatable API bulk powders and excipients compounded in accordance with ARM 37.86.1105(4)(5).

            (8) through (11) remain the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

37.86.1103 OUTPATIENT DRUGS, FRAUD, WASTE, AND ABUSE 

(1) through (7) remain the same.

           (8) The use of tamper-resistant pads for written prescriptions is required. The department follows ARM 24.174.510 24.174.831 established by the Montana Board of Pharmacy to define tamper-resistant prescriptions.

            (9) remains the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

            37.86.1105 OUTPATIENT DRUGS, REIMBURSEMENT (1) through (3) remain the same.

            (4) In-state All pharmacy providers that are new to the Montana Medicaid program are assigned the maximum dispensing fee in ARM 37.85.105(3)(f)(i) until a dispensing fee questionnaire, as provided in (3), can be completed for six months of operation. At that time, a new dispensing fee is assigned which is the lower of the dispensing fee calculated in accordance with (3) for the pharmacy or the maximum allowed dispensing fee provided in (3)(b). If the provider fails to submit the

six-month dispensing fee questionnaire, the provider will receive a dispensing fee in an amount equal to the lowest calculated cost to dispense assigned that year.

            (5) through (13) remain the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) proposes to amend ARM 37.86.1102, 37.86.1103, and 37.86.1105 to reflect amendments made to sources, authority, or the current Medicaid state plan which are cross-referenced in these rules. It is necessary for the department to apply these amendments to ensure the referenced rules and other conferred authority to the department are correctly referenced.

 

Specifically, the department proposes to apply the following amendments:

 

ARM 37.86.1102

 

The department proposes to amend ARM 37.86.1102(7) to accurately reflect the payment of nonrebatable API bulk powder and excipient compounds from ARM 37.86.1105(4) to 37.86.1105(5).

 

ARM 37.86.1103

 

The department proposes to amend ARM 37.86.1103(8) to reflect the transfer of the cross-referenced Montana Board of Pharmacy's rule defining tamper-resistant prescriptions from ARM 24.174.510 to ARM 24.174.831.

 

ARM 37.86.1105

 

The department proposes to amend ARM 37.86.1105(4) by striking the words "In-state" and replacing it with "All." This amendment will permit the department to comply with the approved pharmacy state plan in its business with providers new to Montana Medicaid who are assigned the maximum pharmacy dispensing fee. This amendment is necessary because the Centers for Medicare and Medicaid (CMS) and the department agreed to assign all newly enrolled pharmacies - some of which are new to Montana - the maximum dispensing fee, until a dispensing fee questionnaire can be completed after six months of operation when a new dispensing fee is assigned. Without this amendment, the department cannot comply with its agreement with CMS.

 

FISCAL IMPACT

 

The department does not anticipate any fiscal impact associated with the proposed rulemaking.

 

           5. The department intends the proposed rule amendments to be applied effective July 1, 2018.

 

6. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to:  Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail [email protected], and must be received no later than 5:00 p.m., June 8, 2018.

 

7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

8. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 6 above or may be made by completing a request form at any rules hearing held by the department.

 

9. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.

 

10. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.

 

11. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.

 

The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.

 

 

/s/ Brenda K. Elias                                       /s/ Laura Smith for                                      

Brenda K. Elias                                            Sheila Hogan, Director

Rule Reviewer                                              Public Health and Human Services

 

Certified to the Secretary of State May 1, 2018.