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 37.79.304 pertaining to updating the HMK evidence of coverage document

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

TO: All Concerned Persons

1. On May 27, 2015, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, at 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 May 13, 2015, 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 [email protected].

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

37.79.304 SERVICES COVERED (1) The department adopts and incorporates by reference the HMK Evidence of Coverage dated ~~July 1, 2014~~ July 1, 2015, which is available on the department's web site at www.hmk.mt.gov.

(2) remains the same.

AUTH: 53-4-1009, 53-4-1105, MCA

IMP: 53-4-1005, 53-4-1109, MCA

4. STATEMENT OF REASONABLE NECESSITY

The Department of Public Health and Human Services (the department) is proposing to amend ARM 37.79.304 to incorporate proposed amendments to the Healthy Montana Kids (HMK), Evidence of Coverage (EOC) document.

The HMK EOC document describes the health care benefits available to an HMK coverage group member. ARM 37.79.304 lists the July 1, 2014 version of the EOC as active. The department proposes to make additions, clarifications to benefits, and minor wording and formatting changes to the EOC document. Therefore, the proposed change to July 1, 2015 is necessary to reflect the most recent EOC document.

The proposed amendments to the EOC document listed below are needed to communicate clearly the HMK benefit plan to the public, and to make the document consistent with HMK's other governing documents, such as the CHIP State Plan, HMK Member Guide, and third party administrator contract. For example, the transportation, transplant, and "Therapeutic Youth Group Home Therapeutic Home Leave" topics are being clarified in the State Plan Amendment (SPA). The SPA will also be effective July 1, 2015.

The following changes are being proposed to the EOC:

1. Telemedicine is authorized in the HMK state plan. This service was removed from the benefit exclusion list in the last version of the EOC and publicly noticed but it needs to be added as a benefit. This change is outlined on page 23 of the EOC.

2. Organ and tissue transplants are a covered benefit and the department is clarifying that organ procurement and transplant-related medical services are also covered for a living donor. This change is outlined on page 21 of the EOC.

3. The department is clarifying that per diem and transport are allowed for one adult companion to accompany a child receiving prior approved out-of-town medically necessary services. This change is outlined on page 31 of the EOC.

4. The department proposed to extend the limit on Therapeutic Family Care from 30 to 90 days, effective July 1, 2015. This change is outlined on page 30 of the EOC.

5. If an HMK member is residing at a Therapeutic Group Home and temporarily leaves to go home, the group home provider is compensated for holding that bed open. There has never been a stated leave limit. The department is proposing to adopt a limit of 14 days per year, which coincides with the children's Medicaid home leave limit. This change is outlined on page 29 of the EOC.

6. HMK services deemed not medically necessary, not covered, experimental, investigational, or unproven are not payable under the HMK plan, and members can be billed for these services. The department is giving adequate notice in the EOC to members. This change is outlined on page 12 of the EOC.

7. The department is providing notice that naturopathic physician services will be discontinued effective July 1, 2015. This action will align the HMK benefit plan with the Medicaid benefit plan. This change is outlined on page 41 of the EOC.

8. HMK is expanding coverage from one over-the-counter (OTC) nasal spray to the class of OTC steroid nasal sprays. These products are currently covered as prescription drugs, but recently, several of these products have become available OTC, which allows the department to obtain a much less expensive alternative. This change is outlined on page 34 of the EOC.

9. The department proposes to add benzoyl peroxide products to the allowed OTC drug list because HMK and providers cannot find a prescription version of this drug in the market place. Benzoyl peroxide is a requested first line drug for the treatment of acne and it is preferred and covered. This change is outlined on page 34 of the EOC.

10. The department is correcting spelling and formatting errors in the EOC.

Fiscal Impact

The changes in the Healthy Montana Kids (HMK) EOC document align the document with current practice. As such, HMK does not anticipate any fiscal impact.

5. The department proposes to adopt these amendments to ARM 37.79.304 and to the EOC document itself effective July 1, 2015.

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 [email protected], and must be received no later than 5:00 p.m., May 28, 2015.

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.

/s/ Susan Callaghan /s/ Richard H. Opper

Susan Callaghan, Esq. Richard H. Opper, Director

Rule Reviewer Public Health and Human Services

Certified to the Secretary of State April 20, 2015.