Montana Administrative Register Notice 37-524 No. 23   12/09/2010    
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In the matter of the adoption of New Rule I and II and the amendment of ARM 37.79.102, 37.79.326, 37.79.503, and 37.79.505 pertaining to Healthy Montana Kids








TO:  All Concerned Persons


1.  On October 28, 2010 the Department of Public Health and Human Services published MAR Notice No. 37-524 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 2521 of the 2010 Montana Administrative Register, Issue Number 20.


2.  The department has adopted New Rule II (37.79.117) as proposed.


3.  The department has amended the ARM 37.79.326, 37.79.503, and 37.79.505 as proposed.


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


            37.79.102  DEFINITIONS  Definitions as used in this subchapter, unless expressly provided otherwise, the following definitions apply:

            (1) through (3) remain as proposed.

            (4)  "Benchmark plan" means a health benefit plan which is actuarially equivalent to the state of Montana employee group health plan.

            (5) through (7) remain as proposed but are renumbered (4) through (6).

            (8)  "Cost effective" means the total amount paid in expenses on behalf of a child under an employer-sponsored plan is less than the department would pay for equivalent services for a child enrolled in HMK. 

            (9) through (11)(c) remain as proposed but are renumbered (7) through (9)(c).

            (12)  "Employer-sponsored plan" means any plan, including a self-insured plan, that meets HMK requirements for creditable coverage and provides health care to employees, former employees, or the families of such employees.

            (13) through (32) remain as proposed but are renumbered (10) through (29).

            (33)  "Premium assistance" means a program to help subsidize the purchase of qualified employer-sponsored health care coverage for children eligible for the HMK coverage group.

            (34) through (42) remain as proposed but are renumbered (30) through (38).


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

IMP:  53-4-1003, 53-4-1004, 53-4-1009, 53-4-1103, 53-4-1104, 53-4-1105, 53-4-1108, MCA


5.  The department has withdrawn New Rule I and amended ARM 37.79.102 with the changes shown above.


            6.  No comments or testimony were received.  The department is withdrawing proposed New Rule I and related amendments to definitions that would have allowed the department to pay cost-effective employer-sponsored plan premiums if the employer-sponsored insurance coverage was equivalent to the existing HMK benchmark plan.  The Centers for Medicare and Medicaid Services (CMS) notified the department that it would require HMK to use actuarial services to compare all employer-sponsored group coverage with the existing HMK coverage before a determination of premium assistance eligibility could be completed.  This mandatory administrative expense would result in premium assistance payments never being cost effective.  The department does not anticipate a material impact from this change.  Relatively few parents or guardians were expected to choose the premium assistance option because the HMK coverage group's benefit plan coverage is broad and the maximum out of pocket expense is $215 for most HMK enrolled families.



/s/ John Koch                                     Laurie Lamson for                                                    

Rule Reviewer                                   Anna Whiting Sorrell, Director

                                                            Public Health and Human Services


Certified to the Secretary of State November 29, 2010


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