BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.82.701 pertaining to breast and cervical cancer treatment program
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On October 11, 2018, at 9:00 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, at 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 October 2, 2018, to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
37.82.701 GROUPS COVERED, NONINSTITUTIONALIZED FAMILIES AND CHILDREN (1) Medicaid will be provided to:
individuals Individuals under age 19 who currently reside in Montana and are receiving foster care, guardianship, or adoption assistance under Title IV-E of the Social Security Act, whether or not such assistance originated in Montana. Eligibility requirements for Title IV-E foster care and adoption assistance are found in ARM 37.50.101, 37.50.105, 37.50.106, and 45 CFR part 233.
individuals Individuals who have been receiving assistance in the nonmedically needy family Medicaid program and whose assistance is terminated because of earned income. These individuals may continue to receive Medicaid for any or all of the 12 6 calendar months immediately following the month in which nonmedically needy family Medicaid is last received, providing:
(i) in cases where assistance was terminated due to earned income, a member of the assistance unit continues to be employed during the
12 6 months; however, eligibility may continue even though no member of the assistance unit is employed if there was a good cause as defined in the family-related Medicaid Manual, section 1509-1 1508-1, as incorporated by reference in ARM 37.82.101, for the termination or loss of employment;
(ii) they received nonmedically needy family Medicaid for three of the six months immediately prior to the month they became ineligible for nonmedically needy family Medicaid coverage; and
(iii) there continues to be an eligible child in the assistance unit. This coverage group is known as the "family-transitional."
individuals Individuals under age 19 who live with a specified caretaker relative as defined in the family-related Medicaid manual, section 305-1 201-1, as incorporated by reference in ARM 37.82.101, and who meet all other eligibility requirements ;.
a A pregnant woman whose pregnancy has been verified and whose family income and resources meet the requirements listed in ARM 37.82.1106, 37.82.1107, and 37.82.1110. This coverage group is known as the "qualified pregnant woman group." ;
(i) The unborn child shall be considered an additional member of the filing unit for purposes of determining eligibility.
a A pregnant woman whose pregnancy has been verified, whose family income does not exceed 150% 157% of the federal poverty guidelines , and whose countable resources do not exceed $3,000. This coverage group is known as the "pregnancy group." ;
(i) The unborn child shall be considered an additional member of the filing unit for purposes of determining eligibility.
newborn Newborn children are continuously eligible through the month of their first birthday, provided they continue to reside in Montana. This coverage group is known as the "child-newborn group." ;
a A pregnant woman during a period of presumptive eligibility ;.
(i) Presumptive eligibility is established by submission of an application by the applicant on the form specified by the department, to a qualified presumptive eligibility provider, verification of pregnancy and a determination by the qualified presumptive eligibility provider that applicant's household income and resources do not exceed the income and resource standards specified in (1)(e).
(A) A qualified presumptive eligibility provider is an entity which meets the requirements specified in section 3570 of the state Medicaid Manual, published by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services and who is enrolled with the department as a qualified presumptive eligibility provider under the presumptive eligibility program. Section 3570 of the state Medicaid Manual is
hereby adopted and incorporated herein by this reference. A copy of the manual section may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson St., P.O. Box 202925, Helena, MT 59620-2925.
(B) Presumptive eligibility determinations shall be effective through the earlier of the date the department makes a determination of eligibility or ineligibility based upon a Medicaid application, or the last day of the month following the month of the presumptive eligibility determination, if no Medicaid application is filed within such period. An individual is limited to one presumptive eligibility period per pregnancy.
(C) The applicant or recipient shall be entitled to a fair hearing with respect to a determination by the department based upon a Medicaid application.
(ii) During a period of presumptive eligibility, a pregnant woman is limited to ambulatory prenatal care services covered under the Montana Medicaid program. Such services may be provided by any Medicaid provider eligible to receive Medicaid reimbursement for such services under applicable law and regulations.
a A pregnant woman who becomes ineligible for Medicaid due solely to increased income and whose countable resources do not exceed $3,000 and whose pregnancy is disclosed to the department and verified prior to the effective date of Medicaid closure. This coverage group is known as the "continuous pregnant woman group." ;
(i) Eligibility shall be continuous without lapse in Medicaid eligibility from the prior Medicaid eligibility and shall terminate on the last day of the month in which the 60th postpartum day occurs.
a A child who has not yet reached age 19, whose family income does not exceed 133% 143% of the federal poverty guidelines. This coverage group is known as the "Healthy Montana Kids (HMK) Plus" group. There is no resource test for this coverage group". Children determined eligible under the Healthy Montana Kids Plus program will receive up to 12 months of continuous coverage ;.
individuals Individuals under the age of 21 who are receiving foster care or subsidized adoption payments through child welfare services ;.
(i) These individuals must have full or partial financial responsibility assumed by public agencies and must have been placed in foster homes, private institutions, or private homes by a nonprofit agency.
a A child of a minor custodial parent when the custodial parent is living in the child's grandparent's home and the grandparent's income is the sole reason rendering the child ineligible for nonmedically needy family Medicaid ;.
needy Needy caretaker relatives as defined in the family-related Medicaid Manual, section 305-1 201-1, as incorporated by reference in ARM 37.82.101, who have in their care an individual under age 19 who is eligible for Medicaid, and whose countable income does not exceed the state's family Medicaid standards as defined in the family-related Medicaid Manual, section 002 ;.
a A child through the month of the child's 19th birthday, who lives in a household whose income and resources do not exceed the medically needy income and resource standards specified in ARM 37.82.1106, 37.82.1107, and 37.82.1110, provided that the child does not live with a parent or specified caretaker relative as defined in the family-related Medicaid Manual, section 305-1 201-1. This coverage group is known as the "child-medically needy group." ;
women Individuals, under the age of 65 who have been screened through the Montana Breast and Cervical Health Program who:
(i) have been diagnosed with cancer or precancer of the breast or cervix;
(ii) do not have creditable coverage to pay for their cancer/precancer treatment;
(iii) have countable income that does not exceed
200% 250% of the federal poverty level at the time of screening and enrollment into the Montana Breast and Cervical Health Program; and
(iv) are not eligible for any other nonmedically needy Medicaid coverage group. This coverage group is known as "breast and cervical cancer treatment."
families Families who, due to receipt of new or increased child or spousal support, lose eligibility for nonmedically needy family Medicaid. To be eligible the family must:
(i) receive new or increased
child or spousal support in an amount great enough to cause their nonmedically needy family Medicaid eligibility to end; and
(ii) have received nonmedically needy family Medicaid in Montana for three of six months prior to the closure of nonmedically needy family Medicaid. The coverage will continue for four consecutive months. This program is known as the "family-extended group."
women Women ages 19 through 44, who have not been otherwise determined eligible for Medicaid under this title, who are able to become pregnant but are not now pregnant, whose household income does not exceed 211% of the federal poverty level. Services are limited to those family planning services defined at ARM 37.86.1701 and not covered by third party health coverage. This program is limited to 4,000 women at any given time and is known as Plan First. Plan First will not pay any copay or deductible required by member's third party health coverage.
(2) and (3) remain the same.
AUTH: 53-4-212, 53-4-1105, 53-6-113, MCA
IMP: 53-4-231, 53-4-1104, 53-4-1105, 53-6-101, 53-6-131, 53-6-134, MCA
4. STATEMENT OF REASONABLE NECESSITY
Medicaid is a joint federal and state program that is subject to federal and state statutes, regulations, and rules. Funds for the program are appropriated by Congress and the Montana Legislature. The Montana Medicaid Program is administered by the Department of Public Health and Human Services (department) to pay health care costs for Montana's eligibly low income and disabled residents. Medicaid eligibility requirements may vary based on the group covered or the benefits received.
The Legislature delegates authority to the department in 53-4-212, 53-4-1105, and 53-6-113, MCA, to adopt rules that are consistent with statute and establish income and resource eligibility standards for covered groups. Medicaid covered groups are described in ARM 37.82.701. The department is proposing amendments to ARM 37.82.701. These amendments are necessary to clearly and accurately state, in rule, the income and resource standards enacted by the Legislature and currently implemented by the department.
The department is proposing to make the following changes to ARM 37.82.701 for the reasons stated:
Throughout the rule, enumeration corrections are being proposed for internal consistency. The department is also revising some current text to improve clarity.
The department decreased the period of continued eligibility from 12 months to 6 months several years ago. The proposed amendment would make the rule consistent with current practice. This change applies to individuals whose earned income rises above the eligibility ceiling. When the Affordable Care Act was implemented by the Centers for Medicare and Medicaid Services (CMS), the department eliminated the continued eligibility period. The department was advised by CMS that a continued eligibility period had to be offered. The department reinstated a 6-month period, instead of a 12-month period because it was cost effective and complied with federal regulations.
Cross references to policy manual pages are corrected when necessary because the policy manual has been revised.
The maximum family income percentage for pregnant women and HMK Plus is increased. The income maximums are stated as the percentage of the federal poverty guidelines that family income can be to qualify for a coverage group. The rule amendments do not expand the size of the coverage group. These changes are a result of changes required by 42 USC 1396a. In 2014 the federal Department of Health and Human Services changed the methodology it accepted for calculating countable income to an income tax concept – modified adjusted gross income or MAGI – and eliminated income disregards. This change resulted in higher maximum income stated as a percentage of federal poverty guidelines. The department followed the federal methodology effective January 1, 2016, and these rule changes are necessary to conform the department's rules to current practice.
References to resource limits are removed from family Medicaid coverage groups that no longer have resource limits. Resource limits remain in place for Aged Blind and Disabled (ABD) and medically needy Medicaid, but were eliminated for family Medicaid coverage groups. This change is a federal change that occurred in 2014 and these rule changes are necessary to conform the department's rules to current practice.
Wording related to breast and cervical cancer coverage groups is changed to clarify that men and women are eligible for breast cancer coverage. The reference to child support is also removed because a person applying for the breast and cervical coverage group does not include child support in the calculation of MAGI which, by federal regulation, became the standard for measuring family income. This change occurred in 2014 and these rule changes are necessary to conform the department's rules to current practice.
5. 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: Gwen Knight, 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 19, 2018.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. 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 5 above or may be made by completing a request form at any rules hearing held by the department.
8. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
9. 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.
10. 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/ Geralyn Driscoll /s/ Sheila Hogan
Geralyn Driscoll Sheila Hogan, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State September 11, 2018.