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 pertaining to implementing the Medicaid rate as the reimbursement rate the State of Montana will pay health care providers for services provided to individuals in the care or custody of the Department of Corrections or the Department of Public Health and Human Services

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NOTICE OF ADOPTION

 

TO: All Concerned Persons

 

1. On October 29, 2015, the Department of Public Health and Human Services published MAR Notice No. 37-731 pertaining to the public hearing on the proposed adoption of the above-stated rules at page 1854 of the 2015 Montana Administrative Register, Issue Number 20.

 

2. The department has adopted the following rules as proposed: New Rule II (37.2.1102) and III (37.2.1103).

 

3. The department has adopted the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

NEW RULE I (37.2.1101) PURPOSE (1) The purpose of these rules is to implement 53-6-1312, MCA, which establishes the Medicaid schedule of rates as the reimbursement rates that the State of Montana (State) pays for health care services provided to an individual who does not qualify for Medicaid, Medicare, a health insurer, or another private or governmental program that pays for health care costs and is:

(a) through (2) remain as proposed.

 

AUTH: 53-6-1318, MCA

IMP: 53-6-1312, MCA

 

          NEW RULE IV (37.2.1104) COST SHARING DOES NOT APPLY (1) The cost sharing requirements of ARM 37.85.204 and [New Rule VII, MAR Notice No. 37-730] do not apply to the individuals identified in 53-6-1312, MCA. An individual identified in 53-6-1312, MCA, is neither a member nor a program participant as defined at 53-6-1302, MCA.

 

AUTH: 53-6-1318, MCA

IMP: 53-6-1312, MCA

 

4. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:

 

COMMENT #1: A commenter said the wording of New Rule I is confusing because in addition to individuals who are not covered by Medicaid, the reimbursement rate set by 53-6-1312, MCA, applies if the health care services are not covered by Medicare, a health insurer, or another private or governmental program that pays for health care costs.

 

RESPONSE #1: The department agrees and is changing the wording of New Rule I(1) in the final rule as adopted.

 

COMMENT #2: A commenter said that New Rule IV requires clarification. If this section applies to individuals who do not qualify for State Plan Medicaid or the Montana Health and Economic Livelihood Partnership (HELP) Act, this should be stated in rule.

 

RESPONSE #2: The department agrees and is changing the wording of New Rule IV in the final rule as adopted.

 

          5. These rule adoptions are effective January 1, 2016.

 

 

 

/s/ Geralyn Driscoll                                /s/ Robert Runkel for Richard H. Opper 

Geralyn Driscoll, Attorney                      Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

         

Certified to the Secretary of State December 14, 2015