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 and 37.79.326 pertaining to Healthy Montana Kids (HMK)/CHIP dental benefits and evidence of coverage

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NOTICE OF AMENDMENT

 

TO: All Concerned Persons

 

1. On October 29, 2015, the Department of Public Health and Human Services published MAR Notice No. 37-729 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 1832 of the 2015 Montana Administrative Register, Issue Number 20.

 

2. The department has amended the above-stated rules as proposed.

 

3. 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: Commenters were concerned about three dental procedure codes that would be deleted from covered codes. Their concern was that these codes are essential to the ABCD dental practice standard for qualified dental providers.

 

Response #1: The department appreciates this comment and will ensure the codes related to the practice standard will be added as covered codes for those qualified providers with a specialty code for the ABCD practice standard.

 

Comment #2: A commenter asked if the reimbursement methodology related to Healthy Montana Kids (HMK) is changing.

 

Response #2: The proposed amendments will not affect the payment methodology for the HMK dental program.  Payment remains at 85% of billed charges up to the $1900 limit.

 

Comment #3: A commenter asked for further clarification for the need for prior authorization for general anesthesia.

 

Response #3: The HMK benefit for general anesthesia has not changed. The rule further clarifies the age when prior authorization is needed when medically necessary. This is not to be confused with HMK Plus/Medicaid program, which is a separate program.

 

Comment #4: A commenter asked why these changes were not discussed at the Dental Medicaid Advisory Committee.

 

Response #4: HMK/CHIP is not a part of the Dental Medicaid Advisory Committee. The department will add a HMK/CHIP segment to the committee.

 

Comment #5: A commenter asked if there were any other changes to the CHIP/Medicaid children's dental program of which they are not aware of.

 

Response #5: Again, HMK/CHIP and HMK Plus/Medicaid are two separate programs. All proposed changes for HMK/CHIP dental benefit have been published in the MAR notice.

 

Comment #6: A commenter asked if and when the adoption of the benchmark plan was implemented.

 

Response #6: When the CHIP State Plan was originally implemented, the state employee dental plan was chosen as the benchmark. Over the years, the program has had items added or deleted that were outside the coverage of the state employee dental plan. This proposed amendment is to more closely align the HMK program with the CMS approved state plan.

 

Comment #7: A commenter asked if benefits for HMK/CHIP members would switch to that of the State Employee Dental Benefit Plan.

 

Response #7: No, only the covered codes will be similar and can be viewed at the link outlined on the rule notice.

 

          4. These rule amendments are effective January 1, 2016.

 

 

 

/s/ Shannon McDonald for                     /s/ Robert Runkel for Richard H. Opper 

Susan Callaghan, Attorney                     Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

         

Certified to the Secretary of State December 14, 2015.