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, 37.81.310, and 37.81.318 pertaining to Pharmacy Access Prescription Drug Benefit Program (Big Sky Rx Program)

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On November 5, 2009, at 10:30 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 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 Rhonda Lesofski, 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 dphhslegal@mt.gov.

 

            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 (14) remain the same.

            (15)  "Income" or "family income" means salary, wage, self-employment net earnings, in-kind support, royalties, honoraria, social security benefits, veterans benefits, railroad benefits, pensions, workers compensation, alimony, net rental income, trust income, dividends, and interest.

            (16) and (17) remain the same.

            (18)  "In-kind income" means the value of food and shelter given to the person for which someone else pays.

            (19) through (34) remain the same but are renumbered (18) through (33).

 

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 $33.19 $37.55 per month.  The benefit amount will not exceed $33.19 $37.55 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 $33.19 $37.55 per month.

            (b) remains the same.

            (c)  All expenditures are contingent on legislative appropriation.  The amount of the monthly benefit, $33.19 $37.55, 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

 

            37.81.310  INCOME AND FAMILY SIZE CRITERIA FOR BIG SKY RX

            (1) through (3) remain the same.

            (4)  The applicants' declared value of in-kind support.

            (5) (4)  Income tax refunds, assistance based on need funded by a state or local government, and small amounts of income received infrequently or irregularly are not counted.  The income listed in (2), and (3), and (4) may also be decreased based on the adjustments stated in 20 CFR 416 to calculate income for purposes of Social Security Supplemental Income (SSI).

            (6) (5)  The result of adding (2), and (3), and (4) and making any disregards of income provided for in (5) (4) equals countable income.

            (7) remains the same but is renumbered (6).

 

AUTH:  53-2-201, 53-6-1004, MCA

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

 

            37.81.318  PROCESSING BIG SKY RX PARTICIPANT APPLICATIONS

            (1) through (2)(e) remain the same.

            (3)  A completed application consists of:

            (a)  a signed Big Sky Rx application form with the following information:

            (i) through (xi) remain the same.

            (xii)  in-kind support;

            (xiii) through (xv) remain the same but are renumbered (xii) through (xiv).

            (4) through (13) 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

 

            4.  The Department of Public Health and Human Services (the department) is proposing amendments to ARM 37.81.104, 37.81.304, 37.81.310, and 37.81.318 pertaining to the Pharmacy Access Prescription Drug Benefit Program (Big Sky Rx Program).  The proposed rule changes are necessary to coincide with the changes in the federal program Social Security Extra Help and are being updated to match the federal monthly benefit benchmark.

 

The proposed amendment to ARM 37.81.104(15) shall be changed to remove the words "in-kind support", ARM 37.81.104(18) shall be removed, 37.81.310(4) shall be removed, and 37.81.318(3)(xii) shall be removed.  The department proposes to remove in-kind support as counted income for the Big Sky Rx Program in order to coincide with the federal program Social Security Extra Help.

 

The proposed amendment to ARM 37.81.304(1)(a) and (c) shall be changed to increase the maximum monthly benefit from $33.19 to $37.55.  This increase will match the new federal monthly benefit benchmark.

 

The proposed amendments will help the Big Sky Rx Program evaluate income level to determine if applicants should apply for the federal program Social Security Extra Help.

 

The maximum monthly benefit increase will help Big Sky Rx enrollees to pay their monthly Medicare Part D premiums which in turn allow them more money to pay their other monthly expenses.

 

Alternative considered

 

The department considered keeping in-kind support as counted income for the Big Sky Rx Program but concluded that it would be difficult to determine if the applicants should apply for Social Security Extra Help.

 

The department considered not increasing the maximum monthly benefit of the Big Sky Rx Program which would have meant an average out-of-pocket increase of $2.81 per month per enrollee.

 

Financial Impact

 

The financial impact for increasing the maximum monthly benefit for the Big Sky Rx Program is approximately $15,696 per month.

 

Number of persons effected

 

Currently Big Sky Rx has 328 applications that have listed in-kind as income.

The increase in premiums will affect approximately 3,600 Big Sky Rx enrollees which will have premiums fall above the new benchmark.

 

            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: Rhonda Lesofski, 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 dphhslegal@mt.gov, 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.