Montana Administrative Register Notice 37-682 No. 14   07/24/2014    
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In the matter of the amendment of ARM 37.82.701 pertaining to the update of federal poverty level and health coverage status when determining Plan First eligibility










TO: All Concerned Persons


1. On August 23, 2014, the Department of Public Health and Human Services proposes to amend 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 Department of Public Health and Human Services no later than 5:00 p.m. on August 14, 2014, 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 dphhslegal@mt.gov.


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:

            (a) through (n) remain the same.

            (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% 211% 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 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




The Department of Public Health and Human Services (the department) is proposing to amend ARM 37.82.701. This proposed amendment is necessary to allow women with third party insurance coverage to participate in Plan First.  The proposed amendments would be consistent with the federal Patient Protection and Affordable Care Act (ACA), effective January 1, 2014. The Centers for Medicare and Medicaid Services (CMS) instructed states to increase the percentage of the federal poverty level (FPL) used for eligibility, to conform to a new method of income calculation known as Modified Adjusted Gross Income (MAGI). CMS has projected that the increased FPL should not translate to additional costs, as various income disregards used in the past will no longer be used in MAGI calculations.


The department proposes that women who have third party insurance coverage be allowed to participate in Plan First, although Plan First will not pay any copays or deductibles required by the other health coverage.   CMS will allow the department to include women with insurance. All claims will be submitted to the other coverage before Montana Medicaid will be responsible for the costs.


The proposed amendments will not negatively affect Plan First recipients or Medicaid Providers.


The proposed change in the method for income calculation for Medicaid programs is standardized and updated by the ACA. This proposal would allow all potentially eligible women to take advantage of this program. This program is designed to minimize the birth costs paid by Montana Medicaid. Insurance coverage for family planning services varies greatly. The enrollment is capped at 4,000 and the program enrollment currently sits at 2,900.


ARM 37.82.701:


The department is proposing to amend the FPL from 200% to 211%. The department is proposing to remove language prohibiting women with insurance or health coverage from being eligible.


Fiscal Impact:


The proposed rule will not increase benefits to Plan First members or to Montana Medicaid providers. It may change the eligibility requirements for members. Current Plan First enrollment stands at approximately 2,900 out of the 4,000 enrollees authorized by the Centers for Medicare and Medicaid Services (CMS), which provides most of the funding for this program. Montana Medicaid pays for a large percentage of low income births. Pregnancy prevented by this program should decrease overall Montana Medicaid costs. This rule change is expected to be budget neutral.


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 August 21, 2014. Comments may also be faxed to (406) 444-9744 or e-mailed to dphhslegal@mt.gov.


6. If persons who are directly affected by the proposed action 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., August 21, 2014.


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 290 persons based on the number of persons currently enrolled in the Plan First program.


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.


11. 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.


12. The department intends to apply this rule amendment retroactively to July 1, 2014. A retroactive application of the proposed rule amendment does not result in a negative impact to any affected party.



/s/ John C. Koch                                          /s/ Richard H. Opper                                   

John C. Koch                                               Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services


Certified to the Secretary of State July 14, 2014.



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