BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.81.104, 37.81.304, and 37.81.322 pertaining to Big Sky Rx

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On December 6, 2018, at 10:00 a.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 rules.

 

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 November 21, 2018, 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) 444-4094; fax (406) 444-9744; or e-mail [email protected].

 

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

 

            37.81.104 DEFINITIONS In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter:

            (1) through (27) remain the same.

            (28) "Renewal" means the process of verification for applicants to return their prepopulated application timely to remain eligible for Big Sky Rx benefits.

            (29) through (33) remain the same.

 

AUTH: 53-2-201, 53-6-1004, MCA

IMP: 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA

 

            37.81.304 AMOUNT OF THE BIG SKY RX BENEFIT (1) An applicant eligible for the Big Sky Rx PDP premium assistance may receive a benefit not to exceed $34.00 $35.80 per month. The benefit amount will not exceed $34.00 $35.80 regardless of the cost of the premium for the PDP the individual chooses.

            (a) If a portion of the applicant's PDP premium is paid through the Extra Help Program, the Big Sky Rx Program will pay the applicant's portion of the PDP premium up to $34.00 $35.80 per month.

            (b) remains the same.

            (c) All expenditures are contingent on legislative appropriation. The amount of the monthly benefit, $34.00 $35.80, extends the Social Security Extra Help benefit amount to Montana residents with income up to 200% FPL. The department's total expenditure for the program will be based on appropriation and the number of enrolled applicants.

 

AUTH: 53-2-201, 53-6-1004, MCA

IMP: 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA

 

            37.81.322 BIG SKY RX APPLICATION RENEWAL (1) Sixty days prior to the end of the 12-month eligibility period, a prepopulated notice will automatically be generated and mailed to the client. This notice is generated based on the client's eligibility enrollment determination date.

            (2) The client must verify the program review the information on the notice by noting any changes on the application and returning it to the department before the eligibility period ends to ensure the information is accurate including, but not limited to, information about income, assets, dependent family members, and contact information.

            (a) The enrollee's renewal application will be processed as a renewal application when received by the department. If the notice has incorrect information, the client must write the correct information on the notice and return the corrected notice to the department before the eligibility period ends.

            (b) The application will be processed according to ARM 37.81.318. If the client has verified the information on the notice is correct, the client does not need to return it or take any other action.

            (3) The department will process the enrollee's returned notice with corrected information as a renewal application in accordance with ARM 37.81.318.

 

AUTH: 53-2-201, 53-6-1004, MCA

IMP: 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services Health Resources Division (department) is proposing to amend ARM 37.81.104, 37.81.304, and 37.81.322 pertaining to Big Sky Rx.

 

ARM 37.81.104

 

The department is proposing to amend ARM 37.81.104(28), the definition of "renewal," to reflect changes in the renewal process for recipients of the Big Sky Rx Program. The proposed definition eliminates reference to the requirement to return a renewal application in order to remain eligible for the program. The proposed definition provides for verification of the client's personal information. The reasonable necessity for this change is to coordinate with the changes proposed in ARM 37.81.322, which is explained below.

 

ARM 37.81.304

 

The Big Sky Rx program contributes to the cost of an eligible Montana resident's premium payment in a federally approved Medicare Prescription Drug Plan (PDP). This rule proposal, if adopted, will increase the maximum amount that Big Sky Rx will contribute to pay the eligible enrollee's monthly premium for a PDP program from $34.00 per month to $35.80 per month. The department is proposing this change to match the federally established Low Income Subsidy (LIS) monthly benefit benchmark. 

 

This rule proposal will affect 2,427 Montanans, who will see an increase in the amount of monetary assistance from Big Sky Rx for their monthly PDP premium.

 

This rule proposal will increase (state and/or federal) spending by $4,368.60 per month or $52,423.20 on an annual basis. 

 

ARM 37.81.322

 

The department is proposing to amend ARM 37.81.322 to reflect changes in the renewal process for members who receive services through the Big Sky Rx Program. The proposed amendment would require members to verify the accuracy of personal information contained on a notice sent to them by the department. Members would be required to return the notice only if information on the notice was incorrect and provide corrected information. If the information on the notice is correct, members need not return the notice to the department.

 

The reasonable necessity for this proposed change is to reduce the program's administrative burden by reducing the amount of data processing required of department employees. The change will reduce the number of returned notices and eliminate data processing for members who have had no change in their personal information. The department will be able to redirect program staff to other areas of the department to increase efficiencies. The change will also benefit members by eliminating the burden of returning the notice if there are not any changes to their personal information.

 

Fiscal Impact

 

There is no fiscal impact associated with this rulemaking.

 

The department intends these amendments to be effective January 1, 2019.

 

            5. 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., December 14, 2018.

 

6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

7. 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 5 above or may be made by completing a request form at any rules hearing held by the department.

 

8. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.

 

10. 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                                            Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services

 

 

Certified to the Secretary of State November 7, 2018.