BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.79.326 pertaining to Healthy Montana Kids (HMK) Dental Benefits
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On April 19, 2019, 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, 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 April 3, 2019, 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 firstname.lastname@example.org.
3. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
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 2018) (CDT 2019).
(3) Effective July 1,
2018 2019, only the dental procedures listed at http://dphhs.mt.gov/hmk.aspx are benefits of the HMK coverage group Dental Program.
(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
4. STATEMENT OF REASONABLE NECESSITY
Healthy Montana Kids (HMK) CHIP continues to follow the State of Montana Employee Dental Benefit as a benchmark for the Healthy Montana Kids dental benefit as stated in the Centers for Medicare and Medicaid Services (CMS) approved CHIP State Plan. The department proposes to update dental procedure codes, as needed, following the state employee benchmark plan changes. This change will reflect new procedure code updates, code additions and deletions, and changes to existing code descriptions. Also included is an update to the Current Dental Terminology (CDT) code book reference from 2018 to 2019.
The proposed rule amendment would be effective July 1, 2019. All other rules regarding the HMK Plan will remain the same.
CMS has approved the State Plan citing the State of Montana Employee Dental Benefit as a benchmark. The proposed amendment will comply with the benchmark plan and 2019 CDT Dental Procedure Codes.
The State Employee Dental Benefit Plan (Delta Dental) issues a revised list of covered procedure codes each January 1. When Delta Dental releases the code file with deletions, additions, and changes to descriptions with a January effective date, the department reviews this file and applies any of the changes to the program. The department also reviews the new codes if they replace deleted ones or are in addition to existing codes currently covered. The department examines and makes appropriate changes to any descriptions of codes that may have resulted with the release of the file.
The proposed dental procedure code changes should have no fiscal impact at this time. The proposed rule changes could affect an estimated 507 dental providers and 32,597 HMK members.
All dental providers would meet the criteria of a small business with less than 50 full-time employees as defined in Senate Bill 139. The amendment of this rule should have no impact on these small businesses.
These proposed rule amendments are necessary for the department to administer and maintain compliance with federal funding requirements.
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 email@example.com, and must be received no later than 5:00 p.m., April 26, 2019.
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/ 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 March 19, 2019.