Montana Administrative Register Notice 37-766 No. 15   08/05/2016    
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In the matter of the amendment of ARM 37.86.1005 pertaining to the removal of dental orthodontia service lifetime limits in Medicaid dental services







TO: All Concerned Persons


          1. On August 25, 2016, at 9:00 a.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium 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 August 17, 2016, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:


          37.86.1005 DENTAL SERVICES, REIMBURSEMENT (1) through (5) remain the same.

          (6) Payment for orthodontia is limited to an overall lifetime cap of $7,000 for interceptive and full band orthodontia phases unless otherwise provided by these rules. Services included in the separate phases including monthly visits, are as listed in the department's orthodontic coverage and reimbursement guidelines. Surgeries are not included in this lifetime cap.


AUTH: 53-2-201, 53-6-113, MCA

IMP: 53-6-101, 53-6-113, MCA




The Department of Public Health and Human Services (department) is proposing an amendment to ARM 37.86.1005(6) regarding the removal of dental orthodontia service lifetime limits.  This rule is being updated to match the guidelines for children under the Early Periodic Screening Diagnostic and Treatment (EPSDT) services program guidelines. It is necessary for the department to provide this update to the rule by removing language informing members there is not an overall lifetime cap.


ARM 37.86.1005


This proposed amendment removes language that limits payment for orthodontia services to an overall lifetime cap of $7,000 for interceptive and full band orthodontia phases. All orthodontia service requests require prior authorization for medical necessity. When medical necessity criteria are met, as per EPSDT guidelines, all services are provided. These proposed changes are necessary to provide clarity to providers and members in regards to program benefits and rules. The department has noted an inconsistency with regard to limits placed on EPSDT services. This simple rule change corrects and clarifies this administrative rule.


Fiscal Impact


No fiscal impact is anticipated due to this rulemaking.


          5. The department intends to apply this rule amendment retroactively to July 1, 2016. A retroactive application of the proposed rule amendment does not result in a negative impact to any affected party.


          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., September 2, 2016.


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.


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. 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/ Richard H. Opper                            

Brenda K. Elias                                     Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services



Certified to the Secretary of State July 25, 2016.


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