Montana Administrative Register Notice 37-732 No. 20   10/29/2015    
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In the matter of the amendment of ARM 37.86.1006 pertaining to the establishment of an annual payment limit for dental services provided through Medicaid








TO: All Concerned Persons


          1. On November 18, 2015, at 1:30 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 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 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:


          37.86.1006 DENTAL SERVICES, COVERED PROCEDURES (1) For purposes of specifying coverage of dental services through the Medicaid program, the department adopts and incorporates by reference the Dental and Denturist Program Provider Manual as provided in ARM 37.85.105(3). The Dental and Denturist Program Provider Manual informs the providers of the requirements applicable to the delivery of services. Copies of the manual are available on the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov http://medicaidprovider.mt.gov and from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

          (2) through (5) remain the same.

          (6)  Medically necessary dental services outlined in (5)(c) through (e) are subject to an annual limit of $1,125 per benefit year. A benefit year begins on July 1st, and ends the following June 30th.

          (6) through (17) remain the same, but are renumbered (7) through (18).


AUTH: 53-2-201, 53-6-113, MCA

IMP: 53-6-101, 53-6-113, MCA




          The Department of Public Health and Human Services (department) proposes amending ARM 37.86.1006 to establish an annual payment limit on Montana Medicaid Program dental treatment services and to provide an updated internet link for the Medicaid provider web site.


Montana Medicaid covers diagnostic and preventative dental services and some restorative dental services, including extractions and prefabricated crowns, with prior authorization. Currently there is no limit on the payment for dental treatment. The department is proposing to set a cap of $1,125.00 per member or participant, per year, for covered services other than diagnostic or preventative services, which would remain uncapped. The proposed amendment is necessary to control dental costs by establishing program limits.


The department must also update the web site link for its Medicaid provider web page to http://medicaidprovider.mt.gov. This housekeeping amendment is necessary to direct providers and interested parties to the relocated web page.


Fiscal Impact


The department estimates there will be no fiscal impact from this rule change because the typical dental expenditure per Medicaid member is currently less than the $1,125 cap.


          5. The department intends to amend this rule 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 rule 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 appropriate for performance-based measurement.  The department will measure the cost and effectiveness of this rulemaking by tracking, over a twelve-month period, the number of members whose dental benefit is capped to determine the number of individuals, if any, who are adversely impacted by the $1,125 annual limit.



/s/ Geralyn Driscoll                               /s/ Richard H. Opper                            

Geralyn Driscoll, 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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