BEFORE THE DEPARTMENT OF PUBLIC HEALTH

AND HUMAN SERVICES

OF THE STATE OF MONTANA

 

In the matter of the adoption of New Rules I through VIII and the amendment of ARM 37.84.101, 37.84.102, 37.84.103, 37.84.106, and 37.84.107 pertaining to Health and Economic Livelihood Partnership (HELP) Act

) ) ) ) ) ) )

NOTICE OF ADOPTION AND AMENDMENT

 

TO: All Concerned Persons

 

1. On November 6, 2020, the Department of Public Health and Human Services published MAR Notice No. 37-935 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 2062 of the 2020 Montana Administrative Register, Issue Number 21.

 

2. The department has adopted the following rules as proposed: New Rules I (37.84.116), II (37.84.117), III (37.84.118), IV (37.84.119), V (37.84.120), VI (37.84.121), and VIII (37.84.123) as proposed.

 

3.  The department has amended ARM 37.84.101, 37.84.103, and 37.84.106 as proposed.

 

4. The department has adopted the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

            NEW RULE VII (37.84.122) HELP ACT: COMMUNITY ENGAGEMENT ACTIVITY PARTICIPATION: COVERAGE SUSPENSION (1) through (4) remain as proposed.

            (5) Upon the end of the suspension period, a participant will shall have coverage reinstated so long as the participant continues to be eligible for the HELP program.

            (6) and (7) remain as proposed.

 

AUTH: 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA

IMP: 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA

 

5. The department has amended the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

            37.84.102 HELP ACT: DEFINITIONS (1) through (10) remain as proposed.

            (11) "Participant" means a member with a modified adjusted gross income at or below 138% of the federal poverty level and enrolled in Medicaid under the HELP Act program.

            (12) through (14) remain as proposed.

 

AUTH: 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA

IMP: 53-2-215, 53-6-101, 53-6-113, 53-6-1304, 53-6-1305, 53-6-1306, 53-6-1307, 53-6-1308, 53-6-1309, MCA

 

            37.84.107 HELP ACT: PREMIUMS (1) remains as proposed.

            (2) Except as provided in subsection (3), the premiums must:

            (a) remains as proposed.

            (b) increase by 0.5% in each consecutive subsequent year that a participant receives coverage, up to a maximum of 4% of the participant's income.

            (3) through (10) remain as proposed.

 

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

IMP: 53-2-215, 53-6-101, 53-6-1307, MCA

 

6.  The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:

 

Comment #1: The department received comments in support of implementing New Rules I through III, VI, and VIII as written.

 

Response #1: The department appreciates these comments of support.

 

Comment #2: Commenters expressed support for New Rule IV with requested changes. The commenters asked the department to allow for wage calculations to be done on an annual basis rather than "each reporting" period. They stated the annual basis calculation will better reflect the employment status of seasonal workers.

 

Response #2: The department appreciates the recommendation but will not be making this change. A six-month reporting period is consistent with the originating legislation, is equitable across all program features, and can be implemented with reasonable costs.

 

Comment #3: The department received comments requesting modification to New Rule V(1)(e) to require the department to analyze claims data for the purpose of identifying an exemption based on an individual's inability to work due to a mental or physical condition.

 

Response #3: This recommendation cannot be adopted as claims data does not provide sufficient information to document a physical or mental impairment rendering an individual unable to work.

 

Comment #4: Commenters asked to revise New Rule V(1)(f) to require the department to review available electronic records on a monthly basis to identify if the applicant is the primary caregiver of a person under the age of 19 who is unable to care for themselves.

 

Response #4: The department appreciates the recommendation but feels that allowing primary caregiver exemption per child is reasonable and consistent with the originating legislation. The department must receive attestation by the caregiver, as electronic identification is not feasible.

 

Comment #5: The department received comments requesting the department strike the limitation in New Rule V(1)(f)(ii) stating only one participant may be deemed the primary caregiver of an individual.

 

Response #5: The department appreciates the recommendation but feels that allowing primary caregiver exemption per child is reasonable and consistent with the originating legislation.

 

Comment #6: Commenters requested the department strike "in the last 24 months" from New Rule V(1)(l)(i).

 

Response #6: The department appreciates the comment but will not be implementing the recommendation. The language ensures the exemption condition is current.

 

Comment #7: A commenter asked the department to modify the language of New Rule VII(5), from "the department will" to "the department shall."

 

Response #7: The department agrees with this recommendation and will modify the rule language accordingly.

 

Comment #8: A commenter requested the department modify the proposed definition of "participant" in ARM 37.84.102(11) from "under the HELP ACT" to "under the HELP program."

 

Response #8: The department agrees with this recommendation and will modify the rule language accordingly.

 

Comment #9: Commenters requested the department clarify in ARM 37.84.107 that the department will consider consecutive years in coverage when applying the required premium increases.

 

Response #9: The department agrees with this recommendation and will add the word "consecutive" to the rule language.

 

            7. These rule adoptions and amendments are effective January 1, 2021.

 

/s/ Brenda K. Elias                                       /s/ Erica Johnston                                       

Brenda K. Elias                                            Erica Johnston, Interim Director

Rule Reviewer                                              Public Health and Human Services

           

Certified to the Secretary of State December 15, 2020.