BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES
OF THE STATE OF MONTANA
In the matter of the amendment of ARM 37.57.102, 37.57.106, 37.57.111, and 37.57.118 pertaining to the update of children's special health services
NOTICE OF PROPOSED AMENDMENT
NO PUBLIC HEARING CONTEMPLATED
TO: All Concerned Persons
1. On July 20, 2013, the Department of Public Health and Human Services proposes to amend 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 July 12, 2013, 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 MT 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:
37.57.102 DEFINITIONS Unless otherwise indicated, the following definitions apply throughout this subchapter:
(1) through (16) remain the same.
(17) "Poverty income guidelines" means the poverty income guidelines published in
2012 2013 in the Federal Register by the U.S. Department of Health and Human Services. The department adopts and incorporates by reference the federal poverty guidelines that establish income thresholds according to family unit size for purposes of determining eligibility for government assistance or services and that are published in the February 2012 2013, Federal Register. A copy of the 2012 2013 poverty guidelines may be obtained from the Department of Public Health and Human Services, Public Health and Safety Division, Children's Special Health Services Program, 1400 Broadway Rm A-116, Helena, MT 59620, telephone (406) 444-3617.
(18) through (23) remain the same.
AUTH: 50-1-202, MCA
IMP: 50-1-202, MCA
37.57.106 ELIGIBILITY FOR CSHS FINANCIAL ASSISTANCE (1) remains the same.
(2) Family income must be verified to determine eligibility. The department will request documentation of income from the applicant.
(a) Family income may include one or more of the following:
(i) and (ii) remain the same.
(iii) if the parent with whom the child resides the majority of the year has remarried, the stepparent's income is imputed to the parent's income with whom the child resides the majority of the year;
(iv) through (5) remain the same.
(6) CSHS financial eligibility will be determined in accordance with the financial eligibility guidelines contained in HMK's ARM 37.79.201, with the following exceptions:
(a) children may have health
insurance care coverage and the out-of-pocket expenses for health insurance premiums are deducted from household income; and
(b) through (7) remain the same.
AUTH: 50-1-202, MCA
IMP: 50-1-202, MCA
37.57.111 PAYMENT LIMITS AND REQUIREMENTS (1) The department will provide financial assistance for a CSHS-eligible CYSHCN with a covered condition:
(a) through (d) remain the same.
(e) after all third parties, if any, have paid the provider, in which case the department pays any balance remaining for services to the lower of the
insurance health care coverage allowed amount or the CSHS allowed amount for the services in question.
(2) through (5) remain the same.
(6) The department will pay up to the following limits for orthodontia care:
(a) remains the same.
(b) Payment will be based on a treatment plan submitted by the provider that meets the requirements of the department's orthodontic coverage and reimbursement guidelines and that includes, at a minimum, a description of the plan of treatment, the provider's estimated usual and customary charge, and a time line for treatment. The maximum payable amount for any one phase of treatment is 85%. The department will reimburse 40% of the CSHS allowed amount upon initial billing for each phase of treatment, the remainder being paid in monthly installments as determined by the time line established in the provider's treatment plan for completing orthodontic care. Payment is also subject to any
insurance health care coverage a client may have.
(7) For services to a CSHS client, a provider will be paid 85% of the actual submitted charge. If the CSHS client has third-party coverage, the department will pay the remaining balance for services to the lower of the
insurance health care coverage allowed amount or the CSHS allowed amount of the approved services.
(8) Hospitals and surgicenters will be paid 85% of the actual submitted charge, or after all third-party payers, if any, have paid the provider, in which case the department pays any balance remaining for services to the lower of the
insurance health care coverage allowed amount or the CSHS allowed amount for the services in question for on the date of occurrence for inpatient and outpatient services.
(9) Dentists will be paid 85% of billed charges, or after all third-party payers, if any, have paid the provider, in which case the department pays any balance remaining for services to the lower of the
insurance health care coverage allowed amount or the CSHS allowed amount for an annual dental exam and dental extractions related to active or anticipated orthodontic treatment.
(10) and (11) remain the same.
AUTH: 50-1-202, MCA
IMP: 50-1-202, MCA
37.57.118 PROGRAM RECORDS (1) through (5) remain the same.
The department will retain all electronic data as set forth in the Montana Secretary of State records retention schedule, records series title "CHRIS Files." The department will retain CSHS clinic billing files for five calendar years as set forth in the Montana Secretary of State records retention schedule, record series title "Clinic Billing Reimbursement Records."
(7) Clinic billing files will be destroyed after the program receives approval from the state records committee required under 2-6-212, MCA.
(8) The department will retain all electronic data as set forth in the Montana Secretary of State records retention schedule, records series title "CHRIS Files."
AUTH: 50-1-202, MCA
IMP: 50-1-202, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.57.102, 37.57.106, 37.57.111, and 37.57.118 pertaining to Children's Special Health Services (CSHS). CSHS is located in the Family and Community Health Bureau of the Montana Department of Public Health and Human Services. The program is charged by the Federal Maternal Child Health Block Grant (MHBG) to: "Support development and implementation of comprehensive, culturally competent, coordinated systems of care for children and youth who have or are at risk for chronic physical, developmental, behavioral or emotional condition and who require health and related services of a type or amount beyond that required by children generally."
The purpose of the proposed rule amendments is to update the administrative rules governing the CSHS program.
The department is proposing to update this rule to reflect current poverty income guidelines published in 2013 in the Federal Register by the U.S. Department of Health and Human Services. Each year the U.S. Department of Health and Human Services revises and publishes the new poverty income guidelines. The Federal poverty income guidelines are the resource used to confirm that the family income falls within the CSHS rules.
The department is proposing to amend this rule to specify that income from the stepparent is imputed to the "parent's income" and not to the "parent," as previously stated.
This proposed amendment is necessary to specify that all health care coverage is not from insurance programs. For example, Healthy Montana Kids (HMK) and Healthy Montanan Kids Plus/Medicaid are public assistance. This statement previously read "insurance coverage" and will now read as "health care coverage" in (1)e, (5)b, (7), (8), and (9). Not all health coverage is insurance, by removing insurance coverage and naming it "health care coverage" this enables encompassing all payment resources.
This proposed amendment will correlate current record retention schedules as recorded with the Montana Secretary of State Records and Information Bureau of four types of records created in the CSHS program. Records destruction are processed as required by 2-6-212, MCA. The CSHS program has retention schedules for four types of records produced within the program; per the Montana Secretary of State Records and Information Bureau the proposed change will give continuity of information recorded on their required forms.
5. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on July 18, 2013. Comments may also be faxed to (406) 444-9744 or e-mailed to email@example.com.
6. If persons who are directly affected by the proposed actions wish to express their data, views, or arguments orally or in writing at a public hearing, they must make written request for a hearing and submit this request along with any written comments to Kenneth Mordan at the above address no later than 5:00 p.m., July 18, 2013.
7. If the agency receives requests for a public hearing on the proposed action from either 10% or 25, whichever is less, of the persons directly affected by the proposed action; from the appropriate administrative rule review committee of the Legislature; from a governmental subdivision or agency; or from an association having not less than 25 members who will be directly affected, a hearing will be held at a later date. Notice of the hearing will be published in the Montana Administrative Register. Ten percent of those directly affected has been determined to be 4 persons based on an anticipated enrollment of 40 clients.
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 5 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 this 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/ Shannon L. McDonald /s/ Richard H. Opper
Shannon L. McDonald Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State June 10, 2013.