Administrative Rule Review Report  #AR10-063

Legislative Service Office

14-Sep-10

AGENCY: Department of Health.

DATE SUBMITTED: September 2, 2010.

SUBJECT: Chapters 1, 3 and 4, Kid Care CHIP.

NATURE OF RULES:                     Legislative and procedural.

STATUTORY AUTHORITY:         W.S. 35-25-108(a)(iv).

DETERMINATION OF PROCEDURAL COMPLIANCE BASED UPON INFORMATION SUBMITTED BY THE AGENCY TO LSO:  Apparently complete to date.

SUMMARY OF RULES:  The Department of Health administers the Child Health Insurance Program, known informally as KidCare CHIP, pursuant to W.S. 35-25-101 through 35-25-111 and federal law.  The program provides health insurance for children who are not eligible for Medicaid but whose family income is less than 200% of the federal poverty level.  These amendments to existing rules implement coverage changes mandated by the federal Children's Health Insurance Reauthorization of 2009, including coverage parity for mental health/substance abuse benefits, new dental and orthodontic benefits and cost sharing requirements for dental/orthodontic benefits.  The amendments:

• Add new definitions for "dental medical necessity" and "orthodontia medical necessity"

• Repeal coverage limitations, and exceptions to those limitations, on mental health and substance abuse services

• Add an exception to the $1,000/yr limit on dental/orthodontia services if those services are 'medically necessary,' with an annual cost sharing maximum of $25/year for the services.

FINDINGS:  The rules appear to be within the scope of statutory authority and legislative intent.

STAFF RECOMMENDATION:   That the rules be placed on the Consent List and be approved by the Council as submitted by the Agency.

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Gerald W. Laska

Staff Attorney

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Lynda G. Cook

Staff Attorney

GWL/