Administrative Rules of the State of Montana

BEFORE THE Department of Public

health and human services of the

STATE OF MONTANA

In the matter of the amendment of ARM 37.85.105 pertaining to updating Medicaid fee schedules with Medicare rates, procedure codes and updating effective dates

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NOTICE OF AMENDMENT

TO: All Concerned Persons

1. On November 8, 2019, the Department of Public Health and Human Services published MAR Notice No. 37-899 pertaining to the public hearing on the proposed amendment of the above-stated rule at page 1973 of the 2019 Montana Administrative Register, Issue Number 21. On December 27, 2019, the department published a notice of extension of comment period on the proposed amendment at page 2314 of the 2019 Montana Administrative Register, Issue Number 24.

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: A provider association commented they did not have enough time to fully evaluate the department's proposed rule because the proposed fee schedule was not available during the comment period.

RESPONSE #1: In response to the comment the department extended the comment period to January 3, 2020, by filing a notice of extension of comment period on the proposed amendment. The department was able to provide and publish updated fee schedules to its website on December 27, 2019, allowing for public comment of the posted fee schedules.

COMMENT #2: A provider association commented that providing an extended comment period of six calendar days was inadequate and imposed a hardship on parties wishing to analyze the proposed amendment and prepare and submit comments.

RESPONSE #2: The department recognizes the extended comment period was for six days; however, the rule notice had already been open for public comment for 28 days, as required by 2-4-302, MCA. Each year, the department is obligated to adopt new codes that the federal government issues late in the year and which are to be implemented by the start of the following year. This process, including establishing rates and fee schedules to reflect the federal government's new procedure codes, is dependent on the federal government issuing the new codes and other pertinent information. The department was able to provide and publish updated fee schedules to its website on December 27, 2019. The department made every effort to provide timely information about rates and fee schedules to providers and the public; however, the department was limited by the timing of the federal government's issuance of the new procedure codes.

COMMENT #3: A provider association commented that it supported the proposed rule amendment because it adopts increased reimbursement fees for providers effective January 1, 2020. The association, however, asserted that optometrists should be reimbursed a fee equal to the rate physicians are paid for performing the same services.

RESPONSE #3: The department appreciates the support. As provided in 53-6-125, MCA, the legislature has directed the department to establish a conversion factor for physicians with doctor of medicine or doctor of osteopathy degrees relative to the increase in the consumer price index for medical care for the previous year. The department uses the same resource-based relative value scale (RBRVS) methodology in determining reimbursement rates for physicians who are ophthalmologists and optometrists, and thus the professions are reimbursed in the same manner.

4. The department intends to apply this rule retroactively to January 1, 2020. A retroactive application of the rule does not result in a negative impact to any affected party.

/s/ Brenda K. Elias /s/ Sheila Hogan

Brenda K. Elias Sheila Hogan, Director

Rule Reviewer Public Health and Human Services

Certified to the Secretary of State January 7, 2020.