BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.86.2205 and 37.86.2211 pertaining to early and periodic screening, diagnostic and treatment (EPSDT) benefits
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On June 15, 2017, at 3:30 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 June 7, 2017, 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 firstname.lastname@example.org.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.86.2205 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), REQUIRED SCREENING AND PREVENTIVE SERVICES (1) remains the same.
(2) The number and timing of comprehensive health, vision, hearing and dental screenings
must be as specified in the EPSDT provider manual. should follow the American Academy of Pediatrics (AAP) Bright Futures schedule.
(a) Screening and preventive services must include assessments, exams, immunizations, tests, and appropriate health education.
(b) Caregiver depression screenings are covered for caregivers of children under one year of age. Appropriate evidence-based screening tools should be administered to caregivers as needed. Positive screenings must be appropriately referred for follow-up care.
(a) (3) More frequent screening services than those specified in the EPSDT provider manual the AAP Bright Futures schedule are covered when considered medically necessary to determine the existence of suspected physical or mental illnesses or conditions.
(3) Screening and preventive services must include assessments, exams, immunizations, tests, health education, and other features as specified in the EPSDT provider manual.
(4) The department adopts and incorporates by reference the department's provider manual dated November 2006 posted at http://medicaidprovider.hhs.mt.gov. The provider manual, issued by the department to all providers of EPSDT services, informs providers of the requirements applicable to the delivery of services. A copy of the department's EPSDT provider manual is available from the Department of Public Health and Human Services, Health Resources Division, Medicaid Services Bureau, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.86.2211 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), CHIROPRACTIC SERVICES (1) remains the same.
(2) There must be documented medical necessity for chiropractic services by the child's primary care provider and the treatment must be directly related to a neuromuscular diagnosis of the spine.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services Health Resources Division is proposing to amend ARM 37.86.2205 and 37.86.2211. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) rules need updating to reflect current practices and current resources.
The proposed amendments:
1. update the resources for screening guidelines in (1) from outdated manuals to our current practice of following the American Academy of Pediatrics Bright Futures schedule; and
2. add to (2) that a caregiver depression screening for caregivers of children under age one is now available to pediatric providers to bill under the child and refer positive screenings for follow-up care appropriately.
The amendments to the EPSDT rules are intended to increase the number of providers offering these health care screenings. Under 53-6-196, MCA the department will measure the rule amendments' intended outcomes over a nine-month period of time. The department will compare the total number of screenings prior to the effective date of the rule amendments and compare that number to the total number of screenings after the rule amendment has been in effect for nine months.
The proposed amendment adds language that there must be documented medical necessity by a child's primary care provider for a child to receive chiropractic services. It also states that the treatment must match the diagnosis and must be a neuromuscular issue directly related to subluxation of the spine. Both of these are already requirements, but this is outlining the requirements in the rule, as random audits have found providers practicing out of this scope.
The proposed rule amendment to ARM 37.86.2205 has an administrative cost of $35,460.00 in state fiscal year (SFY) 2017.
The proposed rule amendment to ARM 37.86.2211 should have no fiscal impact.
The proposed rulemaking is estimated to affect 5,945 Medicaid children or more annually.
5. The department intends to apply ARM 37.86.2205 retroactively to January 1, 2017. The department intends to apply ARM 37.86.2211 retroactively to July 1, 2017. A retroactive application of the proposed rules does not result in a negative impact to any affected party.
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 email@example.com, and must be received no later than 5:00 p.m., June 23, 2017.
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/ Sheila Hogan
Brenda K. Elias Sheila Hogan, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 15, 2017.