Montana Administrative Register Notice 37-725 No. 20   10/29/2015    
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In the matter of the amendment of ARM 37.86.2803, 37.86.3001, 37.86.3002, and 37.86.3003 pertaining to the addition of lactation services to Medicaid outpatient hospital services








TO: All Concerned Persons


1. On October 15, 2015, the Department of Public Health and Human Services published MAR Notice No. 37-725 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1661 of the 2015 Montana Administrative Register, Issue Number 19.


2. As originally scheduled, on November 4, 2015, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana.  The department is extending the comment period to November 19, 2015.


3. 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 the Department of Public Health and Human Services no later than 5:00 p.m. on November 2, 2015, 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 MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.


4.  Two sections of information were inadvertently left out of the original MAR notice. One of these sections helps describe why these proposed amendments are needed and will be added to the statement of reasonable necessity. The other section pertains to the performance-based measurement requirement of 53-6-196, MCA, and will be added to paragraph 11.


5. The "statement of reasonable necessity" will remain the same except for the addition of the following new text after the second paragraph of the statement of reasonable necessity under ARM 37.86.3002:


Montana currently offers only very limited coverage for lactation services. Outpatient hospital and physician systems currently allow reimbursement of lactation services only for normal pre- or postnatal appointments with patients' obstetrical provider. Lactation consults at the time of delivery are currently bundled into the inpatient payment for all hospitals.


The department proposes expanding coverage of and payment for outpatient lactation support for members (mother and child) through breastfeeding education and consults with certified lactation providers because evidence indicates doing so will decrease the risk of health care issues for children and mothers and reduce the formula cost for eligible members under WIC and SNAP. A 2011 Surgeon General report indicates that compared with breastfed children, non-breastfed children experienced higher percentage risks of:


•         childhood obesity (32%);

•         type 2 diabetes (64%); and

•         sudden infant death syndrome (56%).


A 2011 Surgeon General's Call to Action to Support Breastfeeding indicated mothers who have never breastfed experience higher percentage risk of:


•         breast cancer (4%); and

•         ovarian cancer (27%).


Cigna Insurance Company reports by increasing their coverage of lactation services they save an estimated $240,000 annually in women's health care expenses.


          6. The department has determined that with the exception of the proposed program changes presented in this notice related to the reference in ARM 37.86.3001(15) and 37.86.3002(2)(f) to the addition of lactation services as a service it will cover on an outpatient basis, the changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measurements requirement of 53-6-196, MCA.


The outcomes related to the addition of lactation services as a service the department will cover on an outpatient basis under ARM 37.86.3001(15) and 37.86.3002(2)(f) will be measured by:


  • measuring the number of Medicaid women who receive outpatient lactation services yearly;
  • measuring the number of breast pump rentals for Medicaid members yearly;
  • comparing the 2016 breastfeeding rates at time of discharge, three months, and six months to the 2014 Breastfeeding Report Card by the Centers for Disease Control and Prevention (CDC) for increases in these rates; and
  • comparing the 2015 WIC and SNAP formula expenditures for any county in which a Baby-Friendly Facility provides service to the 2016 WIC and SNAP formula expenditures.


7. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, and arguments may also be submitted to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on November 19, 2015.  Comments may also be faxed to (406) 444-9744 or e-mailed to dphhslegal@mt.gov. The department has extended the comment period seven days.



/s/ Francis X. Clinch                              /s/ Richard H. Opper                            

Francis X. Clinch, Attorney                    Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services



Certified to the Secretary of State October 19, 2015.


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