BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.79.304 pertaining to clarifying contents of Healthy Montana Kids (HMK) evidence of coverage and adopting the Medicaid ambulance contracts
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On July 14, 2017, at 3:30 p.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rule.
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 July 5, 2017, 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 firstname.lastname@example.org.
3. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
37.79.304 SERVICES COVERED (1) The department adopts and incorporates by reference the HMK Evidence of Coverage dated
January 1, 2016 September 1, 2017, which is available on the department's web site at www.hmk.mt.gov.
(2) remains the same.
AUTH: 53-4-1009, 53-4-1105, MCA
IMP: 53-4-1005, 53-4-1109, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) proposes to amend ARM 37.79.304, which adopts and incorporates by reference the Healthy Montana Kids (HMK) Evidence of Coverage (EOC) document. The EOC document describes the services covered under the HMK health care benefit plan. The proposed rule change would change the effective date of the EOC document from January 1, 2016, to September 1, 2017.
The proposed version of the EOC, to be effective September 1, 2017, incorporates changes to the HMK coverage. Specifically, the department proposes to amend the EOC to change the following services covered under the HMK plan: (1) changing HMK prior authorization procedures to require providers, not parents, to obtain prior authorization for certain services; (2) stating that certain therapies for developmental disabilities are covered; (3) adopting HELP Act and HELP Plan language to describe the HMK pharmacy benefit; (4) updating by adding definitions of "rehabilitation" and "habilitation" to the EOC; (5) having the department's Medicaid fiscal agent administer the ambulance benefit instead of the TPA; (6) removing the ambulance copay; (7) adopting the Medicaid definition of "medically necessary"; and (8) utilizing the third-party administrator to authorize dental anesthesia and dental implants.
The administrative rule change will permit implementation of the latest version of the EOC document. The department estimates the proposed changes in the EOC document will not result in additional costs to the department. The change in the ambulance benefit will result in substantial cost savings.
A copy of the proposed amendments to the EOC may be found on the department's web site at www.hmk.mt.gov.
The department has evaluated the proposed amendments and contends the rule and the changes in the EOC document will not result in additional costs.
5. The department intends to adopt this rule effective September 1, 2017.
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 email@example.com, and must be received no later than 5:00 p.m., July 21, 2017.
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 rule will not significantly and directly impact small businesses.
12. 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 June 12, 2017.