Montana Administrative Register Notice 37-565 No. 20   10/27/2011    
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In the matter of the amendment of ARM 37.81.304 pertaining to maximum Big Sky Rx premium change






TO:  All Concerned Persons


            1.  On November 16, 2011, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in auditorium 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 Department of Public Health and Human Services no later than 5:00 p.m. on November 9, 2011, to advise us of the nature of the accommodation that you need.  Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; 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:


            37.81.304  AMOUNT OF THE BIG SKY RX BENEFIT  (1)  An applicant eligible for the Big Sky Rx PDP premium assistance may receive a benefit not to exceed $37.47 $36.02 per month.  The benefit amount will not exceed $37.47 $36.02 regardless of the cost of the premium for the PDP the individual chooses.

            (a)  If a portion of the applicant's PDP premium is paid through the Extra Help Program, the Big Sky Rx Program will pay the applicant's portion of the PDP premium up to $37.47 $36.02 per month.

            (b)  Big Sky Rx does not pay for the cost of an enrollee's drugs or the cost of an enrollee's deductible, coinsurance, or copayments.

            (c)  All expenditures are contingent on legislative appropriation.  The amount of the monthly benefit, $37.47 $36.02, extends the Social Security Extra Help benefit amount to Montana residents with income up to 200% FPL.  The department's total expenditure for the program will be based on appropriation and the number of enrolled applicants.


AUTH:  53-2-201, 53-6-1004, MCA

IMP:     53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA


            4.  Statement of Reasonable Necessity


The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.81.304 pertaining to the Big Sky Rx monthly benefit payment.  These rules are being updated to match the Low Income Subsidy (LIS) for Medicare Part D for this region.


ARM 37.81.304


Changes are necessary to this rule to ensure the monthly benefit does not exceed the Low Income Subsidy (LIS) set for this region.  Since the inception of Big Sky Rx the benefit has mirrored the LIS to ensure a reasonable and prudent monthly benefit for enrolled members.


This rule will now match the federal monthly benefit benchmark as set forth in the Centers for Medicaid and Medicare Services (CMS) letter dated August 3, 2011.  The department is attempting to clearly communicate to the public, through this rule amendment, program rules and guidelines.  This amendment was proposed only after extensive consideration of its impact on providers and recipients.


Fiscal Impact


The number of people affected by the decrease of the maximum premium from $37.47 to $36.02 is 2,298.  This will reduce the monthly benefit by $3,332.10 and yearly benefit by $39,985.20.


            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: Kenneth Mordan, 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., November 25, 2011.


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.  An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.


9.  The bill sponsor contact requirements of 2-4-302, MCA, do not apply.




/s/ John Koch                                               /s/ Mary E. Dalton acting for                      

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services


Certified to the Secretary of State October 17, 2011.



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