Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the amendment of ARM 37.85.206 pertaining to basic Medicaid services for able-bodied adults

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

TO: All Concerned Persons

1. On November 5, 2009, at 1:30 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 Department of Public Health and Human Services no later than 5:00 p.m. on October 26, 2009 to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; fax (406) 444-9744; or e-mail [email protected].

3. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:

37.85.206 SERVICES PROVIDED (1) through (1)(ah) remain the same.

(2) Individuals who will receive basic Medicaid benefits are: recipients of assistance in the pathways, community services or job supplement components of the Families Achieving Independence in Montana (FAIM) project and who are 21 years of age or older and all recipients of AFDC-related medical assistance only who are participating in the FAIM project and are 21 years of age or older will receive basic Medicaid benefits, except that pregnant women will be entitled to all services specified in (1)(a) through (1)(ah) of this rule. Basic Medicaid benefits are the services specified in (1)(a) through (1)(ah) of this rule except the following:

~~(a) eyeglasses and routine eye exams, whether provided by an optometrist, ophthalmologist or other provider;~~

~~(b) audiology and hearing aids;~~

~~(c) personal care services in the recipient's home;~~

~~(d) dental services; and~~

~~(e) durable medical equipment and supplies.~~

(a) qualified for:

(i) family or family-transitional Medicaid services; or

(ii) MHSP waiver services.

(b) age 21 through 64;

(d) not disabled (according to Social Security Administration (SSA) criteria).

(3) Basic Medicaid benefits are the services specified in (1)(a) through (1)(ah) of this rule except the following:

(a) eyeglasses and routine eye exams, whether provided by an optometrist, ophthalmologist or other provider;

(b) audiology and hearing aids;

(d) dental services; and

(e) durable medical equipment and supplies.

~~(3)~~ (4) With regard to persons identified in (2) who receive basic Medicaid benefits, the department will provide the noncovered services specified in ~~(2)(a) through (2)(e)~~ (3)(a) through (3)(e):

(a) through (b)(ii) remain the same.

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

IMP: 53-2-201, 53-6-101, 53-6-103, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA

4. The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.85.206 pertaining to basic Medicaid for able-bodied adults. The amendments are necessary to provide basic Medicaid services to one additional population, referred to as "MHSP waiver". "MHSP waiver" individuals are otherwise uninsured individuals qualified for the state-only Mental Health Services Plan (MHSP) program, who have schizophrenia or bipolar disorder, who are at least 18 years of age, and who are residents of Montana with incomes at or below 150% of the federal poverty level (FPL).

Montana has been operating a basic Medicaid waiver program since 1996. Recently, Montana has submitted and the Centers for Medicare and Medicaid Services (CMS) anticipates approval of a basic Medicaid extension amendment that would allow continued coverage for 7,704 able-bodied adults, with incomes at or below 33% of the FPL as described in the current basic Medicaid waiver, without change. This extension amendment requests authorization to provide basic Medicaid services to one additional population, referred to as "MHSP waiver". Montana can cover up to an additional 400 individuals in 2010 and up to 800 additional individuals in 2011 and beyond if Medicaid spending remains budget neutral.

ARM 37.85.206

The proposed amendments to this rule would change the description of individuals who receive basic Medicaid by deleting old, outdated language. Proposed new language intended to better describe the able-bodied adult population would also include the "MHSP waiver" population.

Individuals "currently receive basic Medicaid benefits" if they are: "eligible for family or family-transitional Medicaid; age 21 to 64; not pregnant; not disabled according to Social Security Administration (SSA) criteria". The proposed amendment would add "MHSP waiver" individuals to the rule. The following paragraphs and cross-references would be renumbered.

Currently, the Montana Health Services Plan (the plan) includes very limited mental health and mental health pharmacy benefits. Individuals currently receive no physical health benefits through the plan. After the anticipated CMS approval and waiver expansion, the "MHSP waiver" population, up to 800 individuals, would receive the same basic Medicaid benefits, would be subject to the same restrictions and would pay the same cost share as currently eligible able-bodied adults.

If the department determines under ARM 37.82.424 it is cost effective through the current Medicaid Health Plan Premium Payment (HPPP) program, all Medicaid individuals who have access to employer sponsored or other private insurance may have cost share, premiums, and coinsurance paid for by Medicaid and will receive wrap around services. The "MHSP waiver" population would also receive this benefit.

Persons and entities affected

If the proposed amendments are adopted, up to an additional 800 persons could be eligible for basic Medicaid health services in the state of Montana, as long as budget neutrality is maintained.

Fiscal and benefit effects

The department expects to use accumulated federal savings from the existing basic Medicaid waiver to provide federal funding for the addition of the "MHSP waiver" expanded population to the basic Medicaid waiver. State funding would come from the state only MHSP Program.

The accumulated federal savings under the basic Medicaid waiver from February 1, 2004 through January 31, 2009 is estimated at $35,074,915. Total state and federal costs for a three-year extension, February 2009 through January 2012, for continuing the able-bodied adults population and adding one new expansion population, 400 individuals, is estimated at $101,006,485. The budget shows 400 "MHSP waiver" individuals for only one month in waiver year six or 400 "MHSP waiver" individuals each month, each year for waiver years seven and eight. The estimated total three year extension federal cost is $75,783,286 and the estimated total three-year extension state cost is $25,223,199.

Overall, the department expects the proposed amendments to be budget neutral.

5. The department intends the proposed rule changes to be applied effective January 1, 2010.

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: Gwen Knight, 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 [email protected], and must be received no later than 5:00 p.m., November 13, 2009.

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.

/s/ John Koch _/s/ Anna Whiting Sorrell

Rule Reviewer Anna Whiting Sorrell, Director

Public Health and Human Services

Certified to the Secretary of State October 5, 2009.