BEFORE THE DEPARTMENT OF PUBLIC

                                    HEALTH AND HUMAN SERVICES OF THE

                                                       STATE OF MONTANA

 

In the matter of the adoption of New Rules I through IV and amendment of ARM 37.85.206 pertaining to Medicaid diabetes and cardiovascular disease prevention services

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION AND AMENDMENT

 

TO: All Concerned Persons

 

            1. On March 28, 2012, at 10:00 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 adoption and 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 Department of Public Health and Human Services no later than 5:00 p.m. on March 21, 2012, 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 [email protected].

 

3. The rules as proposed to be adopted provide as follows:

 

NEW RULE I PURPOSE (1) The rules in this chapter implement Montana Medicaid diabetes and cardiovascular disease prevention services. Diabetes and cardiovascular disease prevention services are evidence-based to assist in preventing Medicaid eligible individuals from developing diabetes and cardiovascular disease.

 

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

IMP:     53-2-201, 53-6-101, 53-6-131, MCA

 

NEW RULE II  DEFINITIONS  For purposes of Montana Medicaid diabetes and cardiovascular disease prevention services, the following definitions apply:

(1) "After core program" means six consecutive monthly sessions.

(2) "Core program" means 16 consecutive weekly sessions.

(3) "Eligible client" means Medicaid eligible individuals at high risk for developing diabetes or cardiovascular disease.

(4) "Eligible provider" means Medicaid providers with licensed and trained health care professionals on staff delivering standardized curriculum and reporting data to the Public Health and Safety Division of the Department of Public Health and Human Services.

(5)  "Evidence-based intervention" means the group-based National Institutes of Health's Diabetes Prevention Program as adapted by the Public Health and Safety Division of the Department of Public Health and Human Services.

 

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

IMP:     53-2-201, 53-6-101, 53-6-131, MCA

 

NEW RULE III DIABETES AND CARDIOVASCULAR DISEASE PREVENTION SERVICES GENERAL (1)  Diabetes and cardiovascular disease prevention services include the following evidence-based intervention services:

(a)  Group nutrition counseling to prevent diabetes and cardiovascular disease; and

(b) Physical activity coaching to prevent diabetes and cardiovascular disease.

(2)  Services are provided to eligible clients in 16 core program weekly sessions and six after core program monthly sessions.

 

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

IMP:     53-2-201, 53-6-101, 53-6-131, MCA

 

NEW RULE IV DIABETES AND CARDIOVASCULAR DISEASE PREVENTION SERVICES REIMBURSEMENT (1) Reimbursement for diabetes and cardiovascular disease prevention services to eligible providers is in accordance with fee-for-service fee schedules for appropriate provider types posted on the department's web site at www.mtmedicaid.org.

 

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

IMP:     53-2-201, 53-6-101, 53-6-131, MCA

 

4. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:

 

            37.85.206 SERVICES PROVIDED (1)  Except as otherwise provided in this rule, the following medical or remedial care and services shall be available to all persons who are certified eligible for Medicaid benefits under this chapter (including deceased persons, categorically related, who would have been eligible had death not prevented them from applying). However, only those medical or remedial care and services also covered by Medicare shall be available to a person who is certified eligible for Medicaid benefits as a qualified Medicare beneficiary under ARM 37.83.201 and 37.83.202.

            (a) through (af) remain the same.

            (ag) institutions for mental diseases for persons age 65 and over; and

            (ah) payment of premiums, co-insurance, deductibles, and other cost sharing obligations under an individual or group health plan in accordance with the provisions of ARM 37.82.424.; and

            (ai) diabetes and cardiovascular disease prevention services.

            (2) through (4) remain the same.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:    53-2-201, 53-6-101, 53-6-103, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA

 

            5. STATEMENT OF REASONABLE NECESSITY

 

            The Department of Public Health and Human Services (department) is proposing to adopt new rules to implement Medicaid diabetes and cardiovascular disease prevention services. The prevalence of diabetes is significantly higher among Medicaid eligible individuals compared to the general Montana population. Obese individuals are at higher risk to develop cardiovascular disease and diabetes. The diabetes and cardiovascular disease prevention services are evidence-based and cost effective. The Public Health and Safety Division of the department has successfully implemented these services for the general Montana population.

 

ARM 37.85.206

 

The department is proposing to add diabetes and cardiovascular disease prevention to the list of services provided by Montana Medicaid.

 

New Rule I

 

This new rule is necessary to state the purpose of diabetes and cardiovascular disease prevention services and to assist the reader in understanding this subchapter.

 

New Rule II

 

This new rule is necessary to define the terms used when describing diabetes and cardiovascular disease prevention services.

 

New Rule III

 

This new rule is necessary to describe interventions delivered by diabetes and cardiovascular disease prevention providers.

 

New Rule IV

 

This new rule is necessary to reference the location of current provider reimbursement amounts for diabetes and cardiovascular prevention services.

 

Fiscal Impact

 

The estimated cumulative fiscal impact of these rules is as follows:

 

                        Total Cost                  State General Fund             Federal Match

 

SFY 2012      $ 42,500                                $ 14,361                           $28,139

 

SFY 2013      $103,500                               $ 35,211                           $68,289

 

This rule proposal is estimated to impact 14 Medicaid providers and 207 Medicaid clients, annually.

 

            6. The department intends the proposed new and amended rules to be applied retroactively to February 2, 2012. There is no negative impact to Medicaid clients or providers by applying the new rules retroactively. People have been participating in the program and they justifiably expect to get paid as proposed. The Centers for Medicare and Medicaid Services (CMS) has requested that this rulemaking be effective on February 2, 2012 and is in compliance with the department's proposed State Plan Amendment with CMS.

 

            7. 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 [email protected], and must be received no later than 5:00 p.m., April 5, 2012.

 

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

 

9. 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 7 above or may be made by completing a request form at any rules hearing held by the department.

 

10. 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.

 

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

 

 

/s/ John Koch                                               /s/ Anna Whiting Sorrell                            

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

           

Certified to the Secretary of State February 27, 2012.