Montana Administrative Register Notice 37-779 No. 10   05/26/2017    
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In the matter of the amendment of ARM 37.84.106 pertaining to the addition of a contact lens benefit to the HELP plan evidence of coverage document







TO: All Concerned Persons


            1. On June 15, 2017, at 2:30 p.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 June 7, 2017, 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:


            37.84.106 HELP ACT: BENEFITS PLANS (1) and (2) remain the same.

            (3) The department adopts and incorporates by reference the HELP Plan Evidence of Coverage (EOC) dated January 1, 2016 August 1, 2017, which is available on the department's web site at http://dphhs.mt.gov/MontanaHealthcarePrograms.

            (4) through (6) remain the same.


AUTH:  53-2-215, 53-6-113, 53-6-1305, 53-6-1318, MCA

IMP:  53-2-215, 53-6-101, 53-6-1305, MCA




The Department of Public Health and Human Services (department) is proposing to amend ARM 37.84.106 in order to adopt the most recent revisions to evidence of coverage document (EOC) for the Montana Medicaid Health and Economic Livelihood Partnership (HELP) Plan. ARM 37.84.106 adopts the EOC by referencing the document’s revision date, and this rule revision proposes to amend the date of adoption from January 1, 2016, to August 1, 2017.


The following specific modifications will be made within the EOC:


1. add a contact lens benefit for individuals who have one of the following diagnoses on page 32:

            (a) keratoconus;

            (b) aphakia;

            (c) anisometropia of two diopters or more; or

            (d) eyesight cannot be corrected to 20/40 with eyeglasses;

2. adopt Medicaid language to describe pharmacy benefits on page 38;

3. update the definitions of habilitative care on page 10, rehabilitative care on page 15, physical therapy on page 14, occupational therapy on page 13, and speech therapy on page 16;

4. update the first level appeal description to include a phone number and fax number on page 46; and

5. update the abortion exclusion language to clarify the EOC definition, and align with current program on page 43.


Fiscal Impact


This proposed amendment has an estimated total cost of $896.05 per year. The proposed amendment is estimated to affect eight HELP plan participants annually.


            5. The department intends to apply these rules retroactively to January 1, 2017. A retroactive application of the proposed rules 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., June 23, 2017.


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/ Sheila Hogan                                         

Brenda K. Elias, Attorney                            Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services



Certified to the Secretary of State May 15, 2017.


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