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In the matter of the amendment of ARM 37.86.4401 and 37.86.4406 pertaining to the federally qualified health centers and rural health clinics
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
1. On May 20, 2015, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, 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 13, 2015, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.86.4401 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, DEFINITIONS In this subchapter the following definitions apply:
(2) through (6) remain the same but are renumbered (3) through (7).
(7) (2)  "Increase or decrease Change in the scope of service" means the addition or deletion of a service or a change in the magnitude, intensity, or character of services provided by an FQHC or RHC or one of their sites a change that affects the type, intensity, duration, or amount of services provided by an FQHC or RHC. The increase or decrease change in the scope of service must reasonably be expected to last at least one year. The term includes but is not limited to:
(a) an increase or decrease a change in intensity attributable to changes in the types of patients served, including but not limited to HIV/AIDS, the homeless, elderly, migrant or other chronic diseases, or special populations;
(b) remains the same.
(c) increases or decreases changes in operating costs that have occurred during the fiscal year and that are attributable to capital expenditures, including new service facilities or regulatory compliance; and
(d) remains the same.
(8) through (16) remain the same.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.86.4406 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, SERVICE REQUIREMENTS (1) remains the same.
(2) The Montana Medicaid program will not reimburse an RHC or FQHC for RHC or FQHC services that are services covered by a health maintenance organization for an enrolled recipient member, as provided in ARM Title 37, chapter 86, subchapter 50, except as provided in ARM 37.86.4414.
(3) RHC services are covered by Montana Medicaid when provided in accordance with these rules to a recipient member at the clinic, the recipient's member's residence, or other medical facility. RHC services are not covered by Montana Medicaid when provided to a hospital patient.
(4) FQHC services are covered by Montana Medicaid when provided in accordance with these rules to a recipient member in an outpatient setting only, which may include the recipient's member's place of residence. The recipient's member's place of residence may include a skilled nursing facility or a nursing facility. FQHC services are not covered by Montana Medicaid when provided to a hospital patient.
(5) remains the same.
(6) A provider must notify the department, in writing, of an increase or decrease a change in the scope of service offered by the RHC or FQHC to Medicaid recipients members. Upon the request of a provider, the department will determine if a the reported change qualifies as an increase or decrease a change in the scope of service, and if so, the amount and effective date of any rate increase or decrease change.
(a) As a condition of approval, the department may require the provider to submit documentation and information necessary to demonstrate compliance with requirements applicable to the category of service. and/or documentation and  The department may also require information necessary to determine the increase or decrease change in the reimbursement rate due to an increase or decrease a change in the scope of service including any increase or decrease change in the costs of the service and any increase or decrease change in the number of visits.
(b) remains the same.
(c) Any increase in the rate of reimbursement due to an increase or decrease a change in the scope of service shall be is effective from the date of notification by the provider to the department. Any decrease in the rate of reimbursement due to an increase or decrease a change in the scope of service shall be is effective from the date the department was notified by the provider or the date the department determines the increase or decrease change in the scope of services occurred, whichever is occurs first.
(d) The department shall must complete the determination within 60 days of the written request or within 60 days of receipt of any required documentation and information, whichever is later.
(7) remains the same.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) proposes to amend ARM 37.86.4401 and 37.86.4406 regarding Federally Qualified Health Centers (FQHC) and the Rural Health Clinics (RHC).
The amendments are necessary to make the wording of ARM 37.86.4401 and 37.86.4406 consistent with the Centers for Medicare and Medicaid Services definition. Replacing the phrase "increase or decrease" with "change" clarifies that a change in the scope of services is not always a decrease or an increase.
The department is proposing to amend these rules by changing the word "recipient(s)" to "member(s)." This is necessary to align these rules with the current term used to describe those persons who receive Medicaid services.
The department is proposing to amend this rule by replacing the definition of increase or decrease in the scope of service with "Change in scope of service" and replacing "increase or decrease" with "change" throughout (7)(a) and (b).
The department is proposing to amend (6)(a), (b), and (c) by replacing the phrase "increase or decrease" with the word "change."
There will be no fiscal impact due to the proposed amendment to this rule regarding the FQHCs or RHCs.  Services provided to Medicaid members will not be affected.
5. The department intends to adopt these rule amendments effective July 1, 2015.
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: Kenneth Mordan, 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 dphhslegal@mt.gov, and must be received no later than 5:00 p.m., May 28, 2015.
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. An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.
10. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
11. 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.
/s/ Susan Callaghan                              /s/ Richard H. Opper
Susan Callaghan, Attorney                    Richard H. Opper, Director
Rule Reviewer                                       Public Health and Human Services
Certified to the Secretary of State April 20, 2015.
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