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, 37.86.1701, 37.86.1705 and 37.86.1706 pertaining to plan first 1115 waiver implementation

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On February 29, 2012, at 10:00 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 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 Department of Public Health and Human Services no later than 5:00 p.m. on February 22, 2012, 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 rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.82.701  GROUPS COVERED, NONINSTITUTIONALIZED FAMILIES AND CHILDREN  (1)  Medicaid will be provided to:

            (a) through (n)(i) remain the same.

            (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".

(o)  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 200% of the federal poverty level, and do not have third party insurance coverage for family planning services.  Services are limited to those family planning services defined at ARM 37.86.1701.  This program is limited to 4,000 women at any given time and is known as Plan First.

            (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

 

            37.86.1701  FAMILY PLANNING SERVICES  (1)  Family planning services may be provided by a physician in accordance with ARM 37.86.101 through 37.86.105, a nurse-practitioner mid-level practitioner in accordance with ARM 37.86.201 through 37.86.205 or a local delegate agency of the Family Planning program of the Department of Public Health and Human Services , or a local family planning program defined at ARM 37.19.101.  Family planning services provided by a local delegate agency may include:

            (a)  annual visit;

            (b)(a)  comprehensive history;

            (b)  contraceptive supplies and procedures;

            (c)  initial physical examination;

            (d)(c)  initial, routine, and annual visits and examinations;

            (e)(d)  laboratory services;

            (f)(e)  medical counseling; and

            (g)(f) routine visit testing and treatment for sexually transmitted infections and testing for human immunodeficiency virus (HIV).

            (2)  "Annual visit" means a return visit at least once per year, following the initial visit, for a physical examination, laboratory services, and health history.  The physical will include all examinations and services required for the initial physical.  The laboratory services may include a urinalysis, hematocrit, and Pap test.

            (2)  A copy of the family planning procedures and service code table for Plan First may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT  59620-2951.

            (3)  "Comprehensive history" means a complete history of obstetrical/gynecological conditions, significant illnesses, disease, hospitalization, problems relating to previous contraceptive use, and relevant family health, psychiatric or social information which is recorded and maintained in the recipient's medical record.

            (4)  "Contraceptive supplies" means FDA approved intrauterine devices (IUD), spermicidals, barrier methods, implants, and oral contraceptives.

            (5)  "Local delegate agency" means a clinic receiving funding through the department under Title X, the Family Planning Services and Population Research Act of 1970, under the Public Health Services Act, 42 USC 300 et seq.

            (6)  "Initial physical examination" means an examination that may include the following procedures conducted at the initial visit of the recipient:

            (a)  thyroid palpation;

            (b)  inspection and palpation of breasts and axillary glands, with instruction to the recipient for self-examination;

            (c)  auscultation of heart and lungs;

            (d)  blood pressure;

            (e)  weight and height;

            (f)  abdominal examination;

            (g)  pelvic, including speculum, bimanual, and recto vaginal examination;

            (h)  insertion, fitting, or removal of an IUD or diaphragm; and

            (i)  implantation or removal of subcutaneous contraceptives.

            (7)  "Initial visit" means the first contact of the recipient and may include:

            (a)  initial comprehensive review of medical history;

            (b)  physical examination;

            (c)  information and education regarding contraceptive methods;

            (d)  ordering of laboratory services;

            (e)  prescription for contraceptive supplies;

            (f)  postexamination interview;

            (g)  any counseling rendered the day of the visit;

            (h)  insertion fitting or removal of an IUD or diaphragm; and

            (i)  implantation or removal of subcutaneous contraceptives.

            (8)  "Laboratory services" means the delegate agency ordered tests with specimen collection carried out by the provider.

            (9)  "Medical counseling" means counseling services provided by a physician, mid-level practitioner, or other medical professional under the supervision of the clinic's medical director regarding:

            (a)  preconceptual problems;

            (b)  problem pregnancies;

            (c)  HIV sexuality issues;

            (d)  sexually transmitted diseases;

            (e)  abnormal Pap smears;

            (f)  sexuality and the developmentally disabled client; and

            (g)  sterilization.

            (10)  "Routine visit" means a visit to provide contraceptive follow-up and monitoring and to correct any problems associated with utilization of medical services including treatment for vaginal infections.  Medical revisit may be used for a return visit for a diaphragm, IUD, or subcutaneous device and includes the insertion, fitting, implantation, or removal of the device.

 

AUTH:  53-6-113, MCA

IMP:     53-6-101, 53-6-141, MCA

 

            37.86.1705  FAMILY PLANNING SERVICES, REQUIREMENTS  (1)  These requirements are in addition to those contained in ARM 37.85.401, 37.85.406, 37.85.407, 37.85.410, and 37.85.414.

            (1) (a)  Contraceptive clinic services are the services of a physician, a mid-level practitioner or the services of the local delegate agencies of the Family Planning program of the Department of Public Health and Human Services , or a local family planning program defined at ARM 37.19.101.

            (2) (b)  Laboratory services must be ordered by a physician or a mid-level practitioner.

            (3) (c)  Contraceptive supplies must be prescribed by a physician or a mid-level practitioner with prescriptive authority.

            (4) (d)  Eligible recipients clients requesting family planning services must be free from coercion or mental pressure and free to choose the method of family planning to be used.

 

AUTH:  53-6-113, MCA

IMP:     53-6-101, 53-6-141, MCA

 

            37.86.1706  FAMILY PLANNING SERVICES, REIMBURSEMENT

            (1)  Reimbursement for family planning services is as follows:

            (a) remains the same.

            (b)  for mid-level practitioners reimbursement is provided in accordance with the methodologies described in ARM 37.85.212 and 37.86.205 and 37.86.212;

            (c)  for local delegate agencies the lowest of the provider's usual and customary charge for this service or the department's fee schedule for local family planning programs as defined at ARM 37.19.101 reimbursement is provided in accordance with the methodologies described in ARM 37.85.212, 37.86.105, and 37.86.205.

            (2)  The fees in the department's fee schedule for the local delegate agencies are for each item or procedure the average of the charges for that item or procedure submitted by the delegate agencies during the preceding fiscal year.  The adjustments to the fee schedule based upon the annual averaging may not exceed the adjustment for family planning services authorized by the legislature for that fiscal year.  The fees in the fee schedule for services provided by physicians or mid-level practitioners may not exceed the fees available for those services set forth in ARM 37.86.105 or 37.86.205 and 37.86.212.

            (3)(2)  The procedure billing codes and department fee schedules are available from at the department's fiscal agent web site located at http://medicaidprovider.hhs.mt.gov/providerpages/providertype/16.shtml#feeschedules.

 

AUTH:  53-6-113, MCA

IMP:     53-6-101, 53-6-141, MCA

 

            4.  STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.82.701, 37.86.1701, 37.86.1705 and 37.86.1706.  These rule amendments are necessary to implement the Plan First waiver.

 

Plan First is a waiver for a new eligibility group that would consist of women ages 19 through 44, who have not been determined eligible for Medicaid, who are able to become pregnant but are not now pregnant, whose household income does not exceed 200% of the federal poverty level, and do not have third party insurance coverage for family planning services.  Services are limited to those family planning services defined at ARM 37.86.1701.  This program is limited to 4,000 women at any given time.

 

Since Plan First would be implemented strictly in accordance with the terms of a waiver, no alternative was considered.

 

ARM 37.82.701

 

The department is proposing to amend this rule by adding a new eligibility group called Plan First.

 

ARM 37.86.1701, 37.86.1705, and 37.86.1706

 

The department is proposing to amend these rules by updating the family planning services definitions, requirements, and reimbursement.

 

Fiscal Impact

 

The estimated cumulative fiscal impact of these rules is:

 

                        Total Cost                  State General Fund              Federal Match

 

SFY 2012       $1,088,950                $369,045                               $719,905

SFY 2013       ($64,614)                   ($22,137)                               ($42,477)

 

This rule amendment is estimated to impact 4,000 Montana women and 500 Medicaid providers.

 

            5.  The department intends the proposed rule changes to be applied effective February 1, 2012.

 

            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., March 8, 2012.

 

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.

 

 

/s/ John Koch                                     /s/ Anna Whiting Sorrell                               

Rule Reviewer                                   Anna Whiting Sorrell, Director

                                                            Public Health and Human Services

           

Certified to the Secretary of State January 30, 2012.