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Montana Administrative Register Notice 37-480 No. 18   09/24/2009    
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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 VII, the amendment of ARM 37.79.101, 37.79.102, 37.79.106, 37.79.201, 37.79.202, 37.79.206, 37.79.207, 37.79.208, 37.79.301, 37.79.302, 37.79.303, 37.79.312, 37.79.317, 37.79.325, 37.79.326, 37.79.501, 37.79.503, 37.79.505, 37.79.601, 37.79.602, 37.79.605, 37.79.801, and 37.82.701, and the repeal of 37.79.209 pertaining to implementing the Healthy Montana Kids Plan Act

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NOTICE OF ADOPTION, AMENDMENT, AND REPEAL

 

TO:  All Concerned Persons

 

            1.  On July 30, 2009, the Department of Public Health and Human Services published MAR Notice No. 37-480 pertaining to the public hearing on the proposed adoption, amendment, and repeal of the above-stated rules at page 1235 of the 2009 Montana Administrative Register, Issue Number 14.

 

            2.  The department has adopted New Rule VII (37.79.140) as proposed.  The department has amended ARM 37.79.101, 37.79.102, 37.79.106, 37.79.202, 37.79.206, 37.79.207, 37.79.301, 37.79.302, 37.79.303, 37.79.312, 37.79.317, 37.79.325, 37.79.501, 37.79.503, 37.79.505, 37.79.601, 37.79.602, 37.79.605, and 37.79.801 and repealed 37.79.209 as proposed.

 

            3.  The department has adopted the following rules as proposed with the following changes from the original proposal.  Matter to be added is underlined.  Matter to be deleted is interlined.

 

            RULE I (37.79.110)  PROCESS FOR IDENTIFYING AND APPROVING ENROLLMENT PARTNERS  (1)  The following entities are qualified to be enrollment partners:

            (a)  a licensed or certified health care provider;

            (b)  a school district;

            (c )  a community-based organization; and

            (d)  a government agency.; and

            (e)  provider associations.

            (2) remains as proposed.

            (3)  A qualified entity becomes an enrollment partner by contacting the department and indicating an interest in becoming an enrollment partner.  The department will notify the entity if it is accepted as an enrollment partner.  The department will provide an enrollment partner with Healthy Montana Kids (HMK) Plan materials and applications.  Enrollment partners must complete department sponsored training and provide application assistance to HMK Plan applicants.

            (4)  The department will recruit, train, provide program materials, and provide ongoing technical assistance to HMK enrollment partners.

            (5)  Enrollment partners must attend and complete department-sponsored training.  The training will address HMK policies and procedures, confidentiality requirements, step-by-step instructions on how to complete the HMK application, and details regarding acceptable documents for citizenship, identity, and income verification.

            (6)  Enrollment partners will distribute program materials and applications.  They will provide assistance to families to complete the application and obtain required documentation.  Enrollment partners will submit the completed application and documentation to the department.  The department will conduct the eligibility determination process and enroll eligible children in the appropriate coverage group of the HMK Plan.

            (4) (7)  The department will maintain a list of the names, addresses, and telephone numbers of its enrollment partners and publish the list on its web site. 

            (5) (8)  Enrollment partners are volunteers who receive no compensation from the state of Montana.  The department has the option of denying or discontinuing enrollment partner status.

 

AUTH:  53-4-1105, MCA

IMP:  53-4-1104, 53-4-1105, MCA

 

            RULE II (37.79.115)  ACTIVE ENROLLMENT PROCESS  (1) remains as proposed.

            (2)  An individual may apply for the HMK Plan coverage group, HMK, or HMK Plus at any time and, if qualified, will be enrolled in the appropriate program.  The department will process applications based upon the date of receipt.  The department will enroll eligible children in the appropriate HMK Plan group based upon the respective program guidelines.  An application can may be submitted to the HMK Plan office, or any county public assistance office., or an enrollment partner.

 

AUTH:  53-4-1105, MCA

IMP:  53-4-1104, 53-4-1105, MCA

 

            RULE III (37.79.120)  MOVEMENT BETWEEN HMK AND HMK PLUS

            (1) remains as proposed.

            (2)  The HMK and HMK Plus coverage groups provide 12 months continuous coverage.  An eligible HMK coverage group enrollee's coverage begins on the first day of the month following the date the application is received.  An eligible HMK Plus coverage group enrollee's coverage begins on the first day of the month in which the application is received.  ARM 37.79.503 states eligibility determination procedures for the HMK coverage group.  ARM 37.82.204 states eligibility determination procedures for the HMK Plus coverage group.

 

AUTH:  53-4-1105, MCA

IMP:  53-4-1104, 53-4-1105, 53-4-1110, MCA

 

            RULE IV (37.79.125)  POINT OF ACCESS  (1)  The department developed a combined Healthy Montana Kids Plan application for the HMK and HMK Plus coverage groups.

            (1) (2)  The department will accept and determine eligibility for all applications for children's health coverage provided by the HMK Plan.  Applications may be submitted directly to the Healthy Montana Kids Plan office or any county office of public assistance (OPA), or to an enrollment partner who will forward it to the Healthy Montana Kids Plan office.  The department Department staff in each location will screen for potential eligibility for the HMK Plan coordinate eligibility determination activities to enroll eligible children in the appropriate HMK Plan coverage group.

            (2)  OPA and HMK Plan staff will coordinate eligibility determination activities and enroll eligible children in the appropriate HMK Plan coverage group, HMK, or HMK Plus.

 

AUTH:  53-4-1105, MCA

IMP:  53-4-1104, 53-4-1105, MCA

 

            RULE V (37.79.130)  TRANSITION  (1) remains as proposed.

            (2)  The second transition will take place when current CHIP enrollees from families with income between 100% and 133% of the FPL transition to the CHIP-funded Medicaid expansion program.  The transition will occur at the time of annual reapplication during federal fiscal year 2010 (October 1, 2009 to September 30, 2010).  Approximately 10,000 current CHIP enrollees will be affected by this transition.  The staggered transition will occur throughout the year.  A parent or guardian of an enrollee in the HMK coverage group may apply for the HMK Plus coverage at any time.

            (a) remains as proposed.

 

AUTH:  53-4-1105, MCA

IMP:  53-4-1104, 53-4-1105, 53-4-1110, MCA

 

            RULE VI (37.79.135)  PROSPECTIVE PAYMENT SYSTEM  FOR FEDERALLY QUALIFIED HEALTH CENTER (FQHC) REIMBURSEMENT  (1)  The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires states with separate or combined CHIP programs to pay federally qualified health centers (FQHCs) and rural health centers (RHCs) using the Medicaid outpatient prospective payment system (OPPS) as described in ARM 37.86.4413.  An OPPS rate for the HMK coverage group will be developed by the department.  The existing CHIP provider rate will be used for the HMK coverage group until the department establishes the OPPS rate for children enrolled in the HMK coverage group.

 

AUTH:  53-4-1105, MCA

IMP:  53-4-1104, 53-4-1105, MCA

 

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

 

            37.79.201 ELIGIBILITY  (1)  An applicant may be eligible for covered services under the HMK coverage group if:

            (a) through (g) remain as proposed

            (h)  the applicant does not have or has not had creditable health insurance coverage for three months prior to becoming eligible for the HMK coverage group.  This three month period does not apply if the parent or guardian providing the insurance:

            (i) through (vi) remain as proposed.

            (vii)  had coverage through the Medicaid Health Insurance Premium Payment (HIPP) program; or

            (viii)  paid more than 50% of the insurance premium.; or

            (ix)  has insurance coverage that is not accessible (e.g. coverage is through an HMO in another state).

            (2) remains as proposed.

            (3)  An applicant who is eligible or potentially eligible for Medicaid the HMK Plus coverage group as determined by the department is not eligible for the HMK coverage group.

            (4)  The department must verify an applicant's citizenship or qualified alien status before an otherwise eligible applicant is enrolled.

            (5)  Family income must be verified to determine eligibility.  The department will request documentation of income from the applicant and wil access various electronic databases to verify income as needed.

            (a) through (13) remain as proposed.

 

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

IMP:  53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA

 

            37.79.208  PROVISIONAL BENEFITS, DETERMINATION OF ELIGIBILITY, AND APPLICATIONS FOR HMK   (1) remains as proposed.

            (a)  submit a completed complete the HMK Plan renewal application process before their HMK coverage group benefits are scheduled to end;

            (b) and (c) remain as proposed.

            (2)  A determination of HMK Plan eligibility will be completed within 45 working calendar days after receipt of a complete application.

            (3)  Applicants who are denied HMK Plus coverage for failure to comply with HMK Plus eligibility requirements:

            (a)  are not eligible for the HMK coverage group benefits; and

            (b)  will not have their application referred to other health care resources.

            (4)  HMK coverage group applications will be processed for those applicants who subsequently provide information which would preclude them from HMK Plus eligibility.

 

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

IMP:  53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA

 

            37.79.326  DENTAL BENEFITS  (1) through (6) remain as proposed.

            (7)  For purposes of applying the provisions of any Medicaid rule as required by this subchapter, references in the Medicaid rule to "Medicaid" or the "Montana Medicaid program" or similar references shall be deemed to apply to the HMK Plan coverage group or the HMK Plus coverage group as the context permits.

 

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

IMP:  53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA

 

            37.82.701  GROUPS COVERED, NONINSTITUTIONALIZED FAMILIES AND CHILDREN  (1)  Medicaid will be provided to:

            (a) through (g)(i) remain as proposed.

            (h)  a child who has not yet reached age 19, whose family income does not exceed 133% of the federal poverty guidelines.  This coverage group is known as the "Healthy Montana Kids (HMK) Plus" group.  There is no resource test for this coverage group;.  Children determined eligible under the Healthy Montana Kids Plus program will receive up to 12 months of continuous coverage;

            (i) through 3 remain as proposed.

 

AUTH:  53-4-212, 53-4-1105, 53-6-113, MCA

IMP:  53-4-231, 53-4-1104, 53-4-1105, 53-6-101, 53-6-131, 53-6-134, MCA

 

            5.  The department is making changes to ARM 37.79.208(2), 37.79.326(7), and 37.82.701(1)(h).  These are technical or grammatical corrections that do not change the intent of the rules as published

 

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

 

Comments and responses to commentor #1:

 

COMMENT #1:  In Rule I (37.79.110) commentor stated that the phrase "licensed health care providers" should be "licensed or certified health care providers" and provider associations should be added to the entities identified as eligible enrollment partners.

 

RESPONSE #1:  The department agrees and will adopt new Rule I (37.79.110) with the proposed change.

 

COMMENT #2:  In Rule III (37.79.120) under the proposed rules enrollees in both the Healthy Montana Kids (HMK) and HMK Plus coverage groups qualify for a 12 month coverage period upon enrollment but the coverage period begins on different dates depending on the coverage group.  An eligible HMK enrollee's coverage begins on the first day of the month following the date the application is received.  An HMK Plus enrollee's coverage begins on the first day of the month of eligibility.  The commentor noted this is a difference that should be clearly stated in rule.

 

RESPONSE #2:  The department agrees and will adopt Rule III (37.79.120) with the proposed change.  Rule III (37.79.120) will also cross reference ARM 37.79.503 for HMK eligibility and ARM 37.82.204 for HMK Plus eligibility.

 

COMMENT #3:  In Rule V (37.79.130) the department was asked to clearly state in this rule that the parent or guardian of a child currently enrolled in the HMK coverage group may transition an eligible child to the HMK Plus coverage group at any time during federal fiscal year 2010 (FFY 2010) rather than wait for the annual redetermination date for HMK eligibility.

 

RESPONSE #3:  The department agrees that Rule V (37.79.130) requires this clarification and will adopt Rule V (37.79.130) with the proposed change.

 

COMMENT #4:  In Rule VI (37.79.135) it was noted that the proposed rule states that the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)  requires states to use the outpatient prospective payment system (OPPS) rate for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs.)  The rule also states that an OPPS rate for the HMK coverage group will be developed by the department.  The commentor questions why a different payment must be developed for HMK coverage group and recommends the department establish the current Medicaid payment amount for this service category until, and if, an alternative rate is established. 

 

RESPONSE #4:  The department will establish an OPPS rate that is specific to the HMK Plan, but it is waiting for guidance from the Center for Medicare and Medicaid Services (CMS) regarding the CHIPRA requirements for OPPS rates.  A different methodology is needed than the current Medicaid OPPS methodology because it is based on claims for Medicaid clients of all ages.  The department is revising the language of the rule as proposed to state that the existing CHIP provider rate will be used for the HMK coverage group until the department establishes the OPPS rate for children enrolled in the HMK coverage group.

 

Comments and responses to commentor #2:

 

COMMENT #1:  The commentor stated that Rule I (37.79.110) and II (37.79.115) should provide more detail about the functions of enrollment partners and what the HMK active enrollment process will be.  The commentor notes that presumptive eligibility, which 53-4-1105, MCA, directs the department to provide for in rule, will impact the role of enrollment partners and active enrollment. 

 

RESPONSE #1:  The department agrees more detail is needed and is revising the final rules as adopted in Rule I (37.79.110).  The department will be implementing these provisions during the transitional year October 1, 2009 through September 30, 2010 and anticipates further revisions as the program develops.  The department also agrees that presumptive eligibility must be provided for in rule.  During FFY 2010 the department will propose rules on presumptive eligibility.

 

COMMENT #2:  The commentor suggested the department consider coordinating enrollment partner functions with out-stationed eligibility workers, particularly in FQHCS, RHCS, Community Health Centers (CHCs), and hospital emergency rooms.  The department should also investigate whether the OPPS provides reimbursement for this service.

 

RESPONSE #2:  The department will work with CHCs and hospital emergency rooms to enroll HMK Plan enrollment partners.

 

COMMENT #3:  The commentor requested clarification of the exceptions stated in ARM 37.79.201 to the three month delay period when the applicant previously had coverage through Insure Montana.  Will HMK pay for Insure Montana coverage or will the parent discontinue Insure Montana coverage and receive HMK coverage group benefits?

 

RESPONSE #3:  The three month insurance delay period does not apply if children had coverage through the Insure Montana Program.  The department has established an identification and referral process with Insure Montana to assure potentially eligible HMK children are enrolled in HMK, not Insure Montana. 

 

Comments and responses to commentor #3:

 

COMMENT #1:  The commentor recommends the department adopt the logo used by organizations promoting Initiative 155 prior to the November, 2008 election.

 

RESPONSE #1:  The department does not own the campaign logo and was not associated with promoting or opposing I-155.  The department developed a logo for the Healthy Montana Kids Plan that is distinct, easily recognized and easily formatted for a variety of uses.  The logo has been in use for several months and could not be easily changed at this time. 

 

COMMENT #2:  The commentor recommends that Rule I (37.79.110) and II (37.79.115) provide more details regarding enrollment partners and active enrollment.

 

RESPONSE #2:  Several commentors stated more detail about enrollment partners and active enrollment is needed.  The department agrees.  It is revising Rule I (37.79.110) and it will monitor the implementation of HMK during FFY 2010 and will propose more detailed rules on enrollment partners and active enrollment as it develops those aspects of the program.

 

COMMENT #3:  The commentor suggests that in Rule I (37.79.110) and II (37.79.115) the department develop a "train the trainer" program that allows qualified enrollment partners who have attended training to train other members in the organization.

 

RESPONSE #3:  The department does not agree that training can be done by enrollment partners at this time but will reconsider the commenter's suggestion as the program develops.  For FFY 2010 the department will provide direct training throughout the state by department staff and VISTA volunteers.  The department plans to provide on-site training and Webinar training to all qualified entities who apply to become enrollment partners.  In addition to initial training, the department will provide ongoing technical assistance and evaluate the effectiveness of enrollment partner services provided to families.

 

COMMENT #4:  The commentor is opposed to the the three-month waiting period after creditable coverage ends and suggest the department shorten the waiting period or implement presumptive eligibility.

 

RESPONSE #4:  The three-month waiting period was an amendment to 53-4-1004, MCA, enacted pursuant to I-155.  Prior to that statutory change, the department, by administrative rule, used a one-month waiting period after creditable coverage ended and listed some hardship exceptions to that waiting period.  The proposed rules continue and expand the hardship exceptions but the department does not have the authority to shorten a statutory waiting period with an administrative rule.  The department agrees with the commentor, however, that presumptive eligibility will affect this issue and, as it implements presumptive eligibility during FFY 2010, it will consider the impact on this rule and propose changes if necessary.

 

COMMENT #5:  The commentor is concerned that ARM 37.79.201 states an applicant cannot be enrolled in the HMK coverage group until proof of citizenship, or qualified resident status is provided.  The commentor stated this requirement will make the enrollment process more cumbersome for everyone and delay enrollment for eligible Montana residents.  The commentor would prefer that an individual be enrolled and allowed a reasonable time period to provide required documentation.

 

RESPONSE #5:  Federal law requires a state that accepts federal CHIP funding to verify the citizenship or lawful permanent residency status of individuals who receive coverage.  This is a program integrity and accountability provision.  The department agrees with the commentor that the department should minimize, to the extent possible, the paperwork and delay that citizenship verification of citizenship or lawful permanent residing status can cause.  The department allows enrollment in the HMK coverage group with a reasonable opportunity to verify citizenship or residency status.  If the application states the child was born in Montana, the department will verify citizenship itself, if possible, through its Montana vital records electronic database.  The department is exploring alternative means to verify citizenship for children not born in Montana.  When the Social Security Administration's citizenship and identity electronic verification system is available the department will apply for access.  The department will monitor this issue during FFY 2010.

 

COMMENT #6:  In ARM 37.79.201, the commentor is opposed to requiring a signature on renewal applications because it may result in otherwise eligible children losing coverage.

 

RESPONSE #6:  The department does not agree.  Signed renewal applications are necessary to efficiently and effectively administer the program.  The department accepts electronic applications and electronic signatures and will evaluate alternative renewal application processes during FFY 2010.

 

COMMENT #7:  The commentor is opposed to requiring income verification from the applicant.  It would prefer the department use existing databases to verify income and suggests that the department use the Department of Labor's and Food Stamps database.

 

RESPONSE #7:  Income verification is required for the Medicaid program; therefore, if HMK and HMK Plus coverage groups are going to be implemented as one seamless program, income verification is necessary.  The department also considers income verification appropriate for program integrity and accountability.  The department agrees that while verification is necessary, the inconvenience should be minimized for as many applicants as possible.  The department will access various electronic databases for verification of income, when available, in an effort to reduce the burden on Montana families.  The HMK staff will access the Department of Labor and Supplemental Nutrition Assistance Program (formerly Food Stamps) database. 

 

COMMENT #8:  In ARM 37.79.208 the commentor is opposed to increasing the application processing time from 20 working days to 45 calendar days.

 

RESPONSE #8:  The increase is in the maximum time allowed to process an application.  The department hopes to process applications in a shorter time and processing time will vary based on the application.  The additional maximum time allowed is a reasonable and necessary estimate of the time period it could take to process an application if the applicant does not provide the needed income verification at the time of application.  The effective date of coverage is changing from the first of the month following the eligibility determination to the first of the month after the receipt of the application for children in the HMK coverage group.  The time a child does not have health care coverage is reduced despite the increase in the application processing time.

 

COMMENT #9:  The commentor stated that language in ARM 37.79.208(3) is confusing. 

 

RESPONSE #9:  The department agrees that this language is unclear and the matter addressed is covered in other rules.  It has revised the rule as adopted by omitting subsections (3) and (4).

 

Comments and responses to commentor #4:

 

COMMENT #1:  A commentor stated that in ARM 37.79.201 an additional exception to the three-month waiting period after creditable coverage ends should be added for children whose insurance coverage could not be used in Montana.  An example would be coverage through an HMO in another state.

 

RESPONSE #1:  The department agrees and will adopt the final rule with the proposed change.

 

Comments and responses to commentor #5:

 

COMMENT #1:  Regarding Rule III (37.79.120), a commentor states that a waiting list for the HMK coverage group is contrary to section 12 of Initiative 155, now codified as 53-6-131(1)(g), MCA.  The commentor notes that the department established 133%, not 185%, of the federal poverty level (FPL) as the HMK Plus income ceiling and states that this violates 53-6-131(1)(g), MCA.  The commentor interprets state law to require that a child from a family with income below 185% of FPL be placed in the HMK Plus coverage group unless there is coverage available in the HMK coverage group. 

 

The commentor states that the 133% ceiling for HMK Plus may be acceptable during FFY 2010 as the department transitions the programs, but if there is a waiting list for the HMK coverage group, the133% HMK Plus coverage group ceiling should be raised so that there is no waiting list for the HMK coverage group.

 

RESPONSE #1:  The department does not agree that 53-6-131(1)(g), MCA establishes 185% of FPL as the mandatory ceiling for the HMK Plus coverage group and it does not agree that a waiting list for the  HMK coverage group would be a violation of state law.

 

The department set the HMK Plus ceiling based on its ongoing projections regarding state and federal funding.  This is required by statute and by the Legislature's power to appropriate.  Section 53-6-131(1)(g), MCA states that:

 

            "Medical assistance under the Montana medicaid program may be granted to a person who is determined by the department of public health and human services, in its discretion, to be eligible as follows:

 . . . (g)  the person is under 19 years of age and lives with a family having a combined income that does not exceed 185% of the federal poverty level.  The department may establish lower income levels to the extent necessary to maximize federal matching funds provided for in 53-4-1104."

 

This gives the department the authority to set the HMK Plus ceiling based on state and federal appropriations and it has done so.  The department set 133% of FPL as a ceiling for HMK Plus based on the amount of money appropriated by the 2009 Legislature for the HMK Plan. 

 

As stated in the proposed rules, the income ceilings for the HMK Plus program were raised.  Income between 0 and 133% of FPL now qualifies a child for the HMK Plus coverage group.  The ceiling for the HMK coverage group (formerly CHIP) participation was also raised, by Initiative 155, from 175% of FPL to 250% of FPL.  Income between 134% and 250% of FPL now qualifies a child for the HMK coverage group, which may have a waiting list.  The department agrees that if a waiting list comes into existence it should be closely monitored and the ceiling of 133% reviewed.   It will do so and, if a waiting list occurs, it will bring the issue to the attention of the Legislature.

 

COMMENT #2:  A commentor stated that Rule IV (37.79.125) should provide that applications may be submitted through enrollment partners.

 

RESPONSE #2:  The department agrees and the final rule adopted reflects this change.

 

COMMENT #3:  A commentor stated that the language "participation in the HMK coverage group is voluntary and an enrollee may withdraw from the program at any time" in ARM 37.79.505 conflicts with section 5 of the Act (codified at 53-4-1105(4), MCA).  The commentor interprets the Healthy Montana Kids Act to require that parents enroll their children in HMK or HMK Plus unless the listed exceptions apply.  Under this interpretation the Healthy Montana Kid Plan is a mandatory "opt-out" program. 

 

RESPONSE #3:  The department does not agree that the HMK Plan is a mandatory program.  It is a discretionary program for which parents and guardians may choose to apply for health care coverage for their children.

 

COMMENT #4:  A commentor stated that, while I-155 did not contemplate a delay in implementation, not all of the pieces of this reform can be implemented at the same time.  Premium assistance and presumptive eligibility must be implemented as soon as practicable.

 

RESPONSE #4:  The department agrees that these provisions must be promptly implemented.  FFY 2010 is the transitional year and will provide experience in the strengths and weakness of the implementation.  The department is currently resolving premium assistance and presumptive eligibility questions and will publish proposed rules during FFY 2010.

 

COMMENT #5:  The commentor stated that income verification should not be required for either the HMK or the HMK Plus coverage groups once presumptive eligibility is implemented.

 

RESPONSE #5:  Income verification is required for the Medicaid program; therefore, if HMK and HMK Plus coverage groups are going to be implemented as a seamless program, income verification is necessary.  Income verification is appropriate and necessary for program integrity and accountability to taxpayers.  The department agrees that while verification is necessary, inconvenience should be minimized.  It will access various electronic databases for verification of income, when available, in an effort to reduce the burden on Montana families.

 

            7.  The department intends to apply these rules effective October 1, 2009.

 

 

 

/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 14, 2009

 

 

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