Montana Administrative Register Notice 37-729 No. 20   10/29/2015    
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In the matter of the amendment of ARM 37.79.304 and 37.79.326 pertaining to Healthy Montana Kids (HMK)/CHIP dental benefits and evidence of coverage








TO: All Concerned Persons


          1. On November 18, 2015, at 2:30 p.m., the Department of Public Health and Human Services will hold a public hearing in the 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 rules.


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 the Department of Public Health and Human Services no later than 5:00 p.m. on November 10, 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, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.


3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:


          37.79.304 SERVICES COVERED (1) The department adopts and incorporates by reference the HMK Evidence of Coverage dated July 1, 2015 January 1, 2016, which is available on the department's web site at www.hmk.mt.gov.

          (2) remains the same.


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

IMP: 53-4-1005, 53-4-1109, MCA


          37.79.326 DENTAL BENEFITS (1) remains the same.

          (2) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained in the American Dental Association Manual of Current Dental Terminology (CDT 2014 2016).

          (3) The following procedures are not Effective January 1, 2016, only the dental procedures listed at http://dphhs.mt.gov/HMK/HMKDental.aspx are a benefits of the HMK coverage group Dental Program. :

          (a) D5900 through D5999 maxillofacial prosthetics;

          (b) D7610 through D7780 treatment of fractures;

          (c) D7940 through D7999 other repair procedures; and

          (d) D8000 through D8999 orthodontics.

          (4) through (6) remain the same.


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




The Centers for Medicare and Medicaid Services (CMS) approved the Montana Medicaid state plan (and the CHIP state plan contained within) citing the requirement for the Department of Public Health and Human Services Healthy Montana Kids (HMK)/CHIP program (department) to adopt an operational benchmark for its HMK dental program, such as the State of Montana Employee Dental Benefit Plan. The department proposes to follow the Employee Dental Benefit Plan as the benchmark for the HMK dental program, as required in the approved CMS state plan.


As a part of the department modeling the Employee Dental Benefit Plan, the department proposes to amend ARM 37.79.304 regarding the effective date of a proposed revised HMK Evidence of Coverage (EOC), which is adopted and incorporated by reference in the rule. The proposed revised EOC, effective January 1, 2016, can be located at the current HMK web site listed in (1).


The department also proposes to amend ARM 37.79.326 to remove dental procedure codes that will not be covered under the HMK dental program from administrative rule as covered procedures will be listed on the department's web site only at http://dphhs.mt.gov/HMK/HMKDental.


Lastly, the department desires to use this rulemaking opportunity to further amend the EOC for other HMK/CHIP state plan purposes, to include folic acid as a covered over-the-counter medication.


The proposed amendments to the EOC described in ARM 37.79.304 are as follows:


1. Revise language on page 22 to clarify that prior authorization is required for hospital-administered dental anesthesia for children over age 6.


2. Make general housekeeping revisions on pages 10 and 22 to improve general readability of the EOC; and


3. Amend page 34 of the EOC for the above-described inclusion of folic acid as a covered over-the-counter medication.


The EOC amendments described in #1 are necessary because the age limit will be further clarified to determine necessity for prior authorization.  Based on its periodic review of the EOC, the department contends the amendments in #2 are necessary to clarify EOC provisions and generally improve the text contained in the EOC. The EOC amendments described in #3 for the HMK/CHIP state plan are proposed and are deemed necessary at this time because scientific data indicates preconception folic acid supplementation for expectant mothers prevents 69 percent of recurrent fetal neural tube defects and folic acid is already covered as a prescription drug. The proposed addition of folic acid also follows the department's efforts to review continually pharmacy benefits for beneficial changes.


As for the proposed amendments to ARM 37.79.326, the department proposes to:


1. Revise (2) to reflect the department's proposed use of 2016 Current Dental Terminology (CDT) code book reference from the 2014 version.


2. Revise (3) to change those dental procedure codes that are not covered by the HMK dental program to include only those dental procedure codes listed at the department's web site. 


The amendment for the updated reference of the CDT code book is necessary because CDT codes change frequently, as does the HMK dental program's acceptance of those codes. Adopting the most current reference will keep the department and its providers compliant with federal requirements and industry standards.


The proposed changes to (3) are necessary because the list of covered dental procedure codes is too lengthy to include in administrative rule and the removal will eliminate procedures such as dental hygiene instructions and nutritional counseling, which are not part of the benchmark plan.


The result of adopting the proposed amendments will enable the department and the HMK dental program to function like the Employee Dental Benefit Plan. As the Employee Dental Benefit Plan issues revised covered procedure codes lists each January 1, the department will be able to review this list and apply changes (new, deleted, or revised codes) to its operation of the HMK dental program.


Fiscal Impact


The proposed rule changes pertaining to CDT codes and the department's adoption of the Employee Dental Benefit Plan benchmark may affect an estimated 456 dental providers and 32,597 HMK members. The proposed dental procedure code changes should have no fiscal impact at this time.


The folic acid addition to the EOC affects approximately 40 HMK-enrolled teens each year who give birth. The folic acid addition should be budget neutral as this preventive drug is effective in preventing certain birth defects.


          5. The department intends to adopt these new rules effective January 1, 2016.


          6. 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 27, 2015.


7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.


8. 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 6 above or may be made by completing a request form at any rules hearing held by the department.


9. 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.


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


11. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.


12. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement.  The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.


The department has determined that the proposed program changes presented in this notice are not subject to the performance-based measures requirement of 53-6-196, MCA, as they implement a federal Medicaid requirement.



/s/ Susan Callaghan                               /s/ Richard H. Opper                            

Susan Callaghan, 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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