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In the matter of the amendment of ARM 37.85.105 pertaining to updating Medicaid provider rates, fee schedules, and effective dates
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
1.  On November 30, 2020, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider the proposed amendment of the above-stated rule. Because there currently exists a state of emergency in Montana due to the public health crisis caused by the coronavirus, there will be no in-person hearing. Interested parties may access the remote conferencing platform in the following ways:
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 November 20, 2020, to advise us of the nature of the accommodation that you need. Please contact Heidi Clark, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
37.85.105 Effective dates, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS of Montana Medicaid Provider Fee Schedules (1) remains the same.
(2) The department adopts and incorporates by reference, the resource-based relative value scale (RBRVS) reimbursement methodology for specific providers as described in ARM 37.85.212 on the date stated.
(a) Resource-based relative value scale (RBRVS) means the version of the Medicare resource-based relative value scale contained in the Medicare Physician Fee Schedule adopted by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services and published at 84 Federal Register 221, page 62568 (November 12, 2019) effective January 1, 2020 which is adopted and incorporated by reference. Procedure codes created after January 1, 2020 January 1, 2021 will be reimbursed using the relative value units from the Medicare Physician Fee Schedule in place at the time the procedure code is created.
(b) Fee schedules are effective July 1, 2020 January 1, 2021.   The conversion factor for physician services is $39.51. The conversion factor for allied services is $24.66. The conversion factor for mental health services is $23.40. The conversion factor for anesthesia services is $30.57.
(c) through (k) remain the same.
(3) The department adopts and incorporates by reference, the fee schedule for the following programs within the Health Resources Division, on the date stated.
(a) and (b) remain the same.
(c) The hearing aid services fee schedule, as provided in ARM 37.86.805, is effective July 1, 2020 January 1, 2021.
(d) The Relative Values for Dentists, as provided in ARM 37.86.1004, reference published in 2020 resulting in a dental conversion factor of $34.71 and fee schedule is effective July 1, 2020 January 1, 2021.
(e) through (j) remain the same.
(k) Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective July 1, 2020 January 1, 2021, which outlines the Medicare coverage criteria for Medicare covered durable medical equipment, local coverage determinations (LCDs), and national coverage determinations (NCDs) as provided in ARM 37.86.1802, effective July 1, 2020 January 1, 2021. The prosthetic devices, durable medical equipment, and medical supplies fee schedule, as provided in ARM 37.86.1807, is effective July 1, 2020 January 1, 2021.
(l) through (p) remain the same.
(q) The ambulance services fee schedule, as provided in ARM 37.86.2605, is effective July 1, 2020 January 1, 2021.
(r) and (s) remain the same.
(t) The optometric services fee schedule, as provided in ARM 37.86.2005, is effective July 1, 2020 January 1, 2021.
(u) remains the same.
(v) The lab and imaging services fee schedule, as provided in ARM 37.85.212(2) and 37.86.3007, is effective July 1, 2020 January 1, 2021.
(w) through (y) remain the same.
(z) The licensed direct-entry midwife fee schedule, as provided in ARM 37.85.212, is effective July 1, 2020 January 1, 2021.
(aa) remains the same.
(4) The department adopts and incorporates by reference, the fee schedule for the following programs within the Senior and Long Term Care Division on the date stated:
(a) The home and community-based services for elderly and physically disabled persons fee schedule, as provided in ARM 37.40.1421, is effective July 1, 2020 October 1, 2020.
(b) through (5) remain the same.
(6) For the Developmental Services Division, the department adopts and incorporates by reference the Medicaid youth mental health services fee schedule, as provided in ARM 37.87.901, effective July 1, 2020 January 1, 2021.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-125, 53-6-402, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing to amend ARM 37.85.105, pertaining to updating the effective dates of Medicaid fee schedules.
The department administers the Montana Medicaid program to provide health care to Montana's qualified low income, elderly, and disabled residents. Medicaid is a public assistance program paid for with state and federal funds appropriated to pay health care providers for the covered medical services they deliver to Medicaid members.
The proposed rule amendments are necessary so that the Montana Medicaid Program can adopt updated Medicare procedure codes that the federal Centers for Medicare and Medicaid Services (CMS) will enact in January 2021. Montana Medicaid uses Medicare procedure codes, and in order to ensure providers can accurately and timely bill for services they provide to Medicaid members, the department must adopt CMS's updated Medicare rates. The updated codes include new code additions, code deletions, and changes to existing code descriptions and rates.
In addition to updating codes, the proposed amendments include revisions to the youth mental health services fee schedule and the fee schedule for the Big Sky waiver, which are explained below.
The proposed amendments are explained below, with reference to the specific subsection of ARM 37.85.105.
(2)(a) and (b) Resource-Based Relative Value Scale (RBRVS)
The department proposes to reimburse procedure codes created on or after January 1, 2021, using the relative value units currently in place, and then revise the fee schedule effective date to January 1, 2021, which is being revised to reflect the updated Medicare procedure codes adopted by the federal Medicare program.
(3)(c), (q), (t), (v), and (z) Fee Schedules
The department proposes to revise the effective date for the following fee schedules to January 1, 2021, to reflect the updated Medicare procedure codes adopted by CMS: hearing aid services; dentist; prosthetic devices, ambulance; optometric; lab and imaging; and licensed direct-entry midwives.
(3)(d) Dentist fee schedule
The department proposes to update the dentist fee schedule effective January 1, 2021, to reflect changes to the Current Dental Terminology (CDT) 2021 by removing applicable deleted covered codes and including their updated replacements.
(3)(k) Prosthetic Devices, Durable Medical Equipment, and Medical Supplies
The department proposes to revise the effective date of the reference to the Region D Supplier Manual to January 1, 2021, and revise the effective date of local coverage determinations (LCDs) and national coverage determinations (NCDs), that are provided in ARM 37.86.1802 to January 1, 2021.
The department is also proposing to revise the effective dates for the durable medical equipment fee schedule to January 1, 2021 to reflect the Calendar Year 2021 Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule. This will allow the department to update Medicare fees, additions, deletions, or changes to procedure codes when Medicare releases and updates their fee schedule
(4)(a) – Home and Community-based Services for Elderly and Physically Disabled Persons Fee Schedule
The department proposes to adopt and incorporate by reference a revised fee schedule, dated October 1, 2020, to add an additional procedure code of Independence Advisor for Big Sky Bonanza (self-option) members at the rate of $177.44 per month. This proposed rule change is necessary to implement a waiver application amendment recently approved by the Centers for Medicare and Medicaid Services and to ensure providers receive reimbursement for the service. Independence Advisor services have historically been provided as an administrative function by department staff due to the lack of availability of any willing and qualified providers. The department has recently identified a willing and qualified provider to offer the Independence Advisor service. This proposed rule change will allow members to receive Independence Advisor services from a Medicaid provider rather than from department staff who also oversee service delivery and effectiveness. The department anticipates no negative impact to members resulting from this transition in services.
(6) Fee Schedule for Children's Mental Health Bureau with Serious Emotional Disturbance
The department proposes to adopt and incorporate by reference a revised fee schedule, dated January 1, 2021, which reflects a reimbursement rate of $18.50 per 15-minute unit of time for Home Support Services (HSS). The updated rate is intended to address the additional cost providers will incur as a result of the HSS program redesign, which is proposed in MAR Notice No. 37-934, filed on October 27, 2020.
The revised fee schedule, dated January 1, 2021, also reflects a reimbursement rate of $17.67 per 15-minute unit of time for Comprehensive School and Community Treatment (CSCT). This rate does not change the amount of money received by mental health centers that provide services to students in Montana public schools. CMS directed Montana Medicaid to change the funding methodology so that the CSCT rate no longer includes the in-kind match provided by public school districts. Mental health centers do not receive the in-kind match, so the updated rate more accurately reflects the rate in dollars that mental health centers receive for CSCT services. The current CSCT funding methodology is updated in EPSDT SPA MT 20-0014 effective July 1, 2020.
The proposed rule amendments for (2)(a) and (b) and (3)(c), (d), (k), (q), (t), (v), and (z) will be budget neutral.
The fiscal impact for the addition of the Independence Advisor code to the Big Sky waiver program is as follows:
FY21 - $41,520 ($177 X 26 members X 9 months)
FY22 - $55,361 ($177 X 26 members X 12 months)
The fiscal impact for home support services is as follows:
Federal Fiscal Year FFY
Home Support Services (HSS)
The department intends for these amendments to be effective January 1, 2021.
5. 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: Heidi Clark, 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., December 4, 2020.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. 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 5 above or may be made by completing a request form at any rules hearing held by the department.
8. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.
10. 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/ Sheila Hogan
Brenda K. Elias                                            Sheila Hogan, Director
Rule Reviewer                                              Public Health and Human Services
Certified to the Secretary of State October 27, 2020.
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