BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.86.2102 and 37.86.2105 pertaining to Medicaid eyeglass reimbursement
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On October 13, 2016, at 1:30 p.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, 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 October 5, 2016, 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 email@example.com.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.86.2102 EYEGLASSES, SERVICES, REQUIREMENTS AND RESTRICTIONS (1) through (5) remain the same.
recipient member may obtain replacement lenses only 365 days after the existing eyeglasses were dispensed if the lenses are unusable.
(7) The following lens features are not covered:
(a) photochromatic or transition lenses;
(b) progressive lenses;
(c) ultraviolet coating;
(d) scratch resistant coating;
(e) anti-reflective coating;
(f) polycarbonate lenses except for monocular members; and
(g) tinted lenses except for rose 1 or rose 2.
(7) remains the same, but is renumbered (8).
AUTH: 53-6-113, MCA
IMP: 53-6-101, 53-6-141, MCA
37.86.2105 EYEGLASSES, REIMBURSEMENT (1) and (2) remain the same.
(3) The department adopts and incorporates by reference the department's Eyeglasses Fee Schedule effective
July 2010 December 2016. A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.hhs.mt.gov http://medicaidprovider.mt.gov. A copy of the department's fee schedule may also be obtained from Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.
AUTH: 53-6-113, MCA
IMP: 53-6-101, 53-6-113, 53-6-141, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing amendments to ARM 37.86.2102 and 37.86.2105. These proposed amendments are necessary because they are associated with the competitive, volume purchase contract which sets the new eyewear rates, and to solidify in rule, the noncovered items that have been included in the Optometric and Eyeglass Services Provider Manual only.
The department is proposing to amend ARM 37.86.2102 to include the noncovered services that have been listed in the Optometric and Eyeglass Services Provider Manual. The eyeglass benefit is to provide the best possible vision to Medicaid members. The noncovered items have been determined not medically necessary and are considered add-on items. Members may purchase add-ons through a private pay arrangement with their provider.
Montana Medicaid offers eyeglass frames and lenses prescribed by a licensed optometrist or ophthalmologist through a single, volume purchase contractor. This current contract expires on November 30, 2016 and is under the competitive bid process. Because of the resulting new contract, the department is proposing to update the fee schedule date in ARM 37.86.2105 to compensate for this change. This updated effective date reflects the correct date of the associated volume purchase contract and fees.
The word "recipient" is being updated to the current term "member" used by the Centers for Medicare and Medicaid Services (CMS) and the department.
The department made a correction in (3) to the web site address for The Montana Medicaid provider web page.
State fiscal year (SFY) 2015 had expenditures of $557,705 for eyeglasses. The fiscal impact is not known at this time and will be available upon contract award resulting from the competitive bid process.
The rulemaking will affect 148 optometric providers and 180,683 Medicaid members.
5. The department intends to adopt these rule amendments effective December 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 firstname.lastname@example.org, and must be received no later than 5:00 p.m., October 21, 2016.
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 appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.
/s/ Brenda K. Elias /s/ Richard H. Opper
Brenda K. Elias, Attorney Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State September 12, 2016.