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

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On June 14, 2018, 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 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 June 1, 2018, to advise us of the nature of the accommodation that you need. Please contact Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; 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:

 

37.79.304 SERVICES COVERED (1) The department adopts and incorporates by reference the HMK Evidence of Coverage dated October 14, 2017 November 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 department is proposing the rule amendment in order to adopt a revised EOC document, which describes the following changes to HMK benefits:

 

(1)  Removing the limits on the HMK extended mental health (EMH) benefit. This change is necessary to comply with the federal Mental Health Parity and Addiction Equity Act.

(2)  Moving the administration of the community based psychiatric rehabilitation and support (CBPRS) benefit from the department’s Medicaid fiscal agent to the HMK third party administrator. All other HMK mental health benefits are administered through the third party administrator, and centralizing the CBPRS benefit with the third party administrator will allow mental health benefits to be better coordinated.

(3)  Eliminating prior authorization for dental anesthesia and implants and clarifying the dental anesthesia benefit. This change is intended to streamline dental care by removing the requirement for prior authorization for these services. This change will allow providers to follow best practices standards.

(4)  Removing the exclusion for transgender services, which is required by Section 1557 of the Affordable Care Act.

(5)  Providing contact information for the ambulance benefit administration, which is intended to provide additional information for providers and members.

 

The revised EOC would be effective retroactively to November 1, 2017.

 

FISCAL IMPACT

 

The department estimates that removing the limits on the EMH benefit will cost the department approximately $164,187 annually. The department calculated that figure by assuming HMK members would use the EMH benefits at the same rate as Medicaid enrolled children whose program has no limits on these benefits.

 

The department has determined the remaining changes to HMK benefits will not have any impact to the state general fund.

 

            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: Todd Olson, 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., July 6, 2018.

 

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.

 

11. The department intends to apply this rule amendment retroactively to November 1, 2017. A retroactive application of the proposed rule amendment 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 May 15, 2018.