BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.5.117, 37.5.331, 37.79.201, 37.79.202, 37.79.206, 37.79.207, 37.79.301, 37.79.302, 37.79.303, 37.79.326, and 37.79.801 pertaining to Healthy Montana Kids Plan

) ) ) ) ) )

NOTICE OF AMENDMENT

 

TO:  All Concerned Persons

 

1.  On August 12, 2010, the Department of Public Health and Human Services published MAR Notice No. 37-516 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1768 of the 2010 Montana Administrative Register, Issue Number 15.

 

2.  The department has amended ARM 37.5.117, 37.5.331, 37.79.201, 37.79.202, 37.79.206, 37.79.207, 37.79.301, 37.79.302, 37.79.303, and 37.79.801 as proposed.

 

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

 

            37.79.326  DENTAL BENEFITS  (1)  The maximum dental benefits paid under the basic dental plan will be 85% of the billed services received up to $1,000 $1,200 paid per benefit year for each enrollee.  For example, $1,176 $1,412 in services received would result in $1,000 $1,200 paid.

            (a) remains as proposed.

            (b)  Providers may bill the enrollee, parent, or guardian for services received in excess of $1,176 $1,412 per benefit year.

            (2) through (4) remain as proposed.

            (5)  Enrollees with significant dental needs beyond those covered in the basic dental plan may, with prior authorization, receive additional services through the HMK coverage group Extended Dental Plan (EDP).  The EDP program is dependent on legislative appropriation for the program.

            (a) and (b) remain as proposed.

            (c)  The maximum basic and EDP payments combined is $2,000 $2,200 ($1,000 $1,200 basic plan and $1,000 EDP) for a benefit year.

            (6) and (7) remain as proposed.

 

AUTH:  53-4-1004, 53-4-1005, 53-4-1009, 53-4-1105, MCA

IMP:  53-4-1003, 53-4-1004, 53-4-1005, 53-4-1009, 53-4-1104, 53-4-1105, 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:  The department should mirror the state employee benefit plan and amend ARM 37.79.326 to raise the maximum dental benefit year payment to $1,200.

 

RESPONSE #1:  The department agrees with the commenter.  Based on the Centers for Medicare and Medicaid Services (CMS) guidance, and to be compliant with federal regulations outlined in the Children's Health Insurance Program Reauthorization Act (CHIPRA), Healthy Montana Kids (HMK) is amending ARM 37.39.326.  HMK is a dental benchmark plan modeled after the state of Montana dependent coverage plan.

 

COMMENT #2:  Representative Mary Caferro commented in support of the rule changes.  In particular, she supports including medically necessary ambulance services as a covered service, increasing the annual dental benefit, and allowing otherwise eligible public employees to enroll their children in HMK.

 

RESPONSE #2:  The department appreciates the comment and support.

 

            5.  The department intends the rule amendments to be applied effective October 1, 2010.

 

 

 

/s/  Geralyn Driscoll                                       /s/  Anna Whiting Sorrell                              

Rule Reviewer                                               Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

 

Certified to the Secretary of State September 13, 2010.