Proposed Rules: RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapters II & III, Section 91, Health Home Services

February 1, 2013

PROPOSED RULES

RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapters II & III, Section 91, Health Home Services

CONCISE SUMMARY: This proposed rulemaking seeks to permanently adopt Health Home Services which were put into place via emergency rule, effective January 1, 2013. This is a new MaineCare regulation which establishes “Health Homes” for MaineCare beneficiaries who suffer from certain chronic health conditions (including a mental health condition [excluding Serious and Persistent Mental Illness and Serious Emotional disturbance]; a substance use disorder; tobacco use; diabetes; heart disease; overweight or obese as evidenced by a Body Mass Index over 25; Chronic Obstructive Pulmonary Disease; hypertension; hyperlipidemia; developmental and intellectual disorders; circulatory congenital abnormalities; asthma; acquired brain injury; and seizure disorders).

Congress enacted the Affordable Care Act which, in part, authorized States to offer Medicaid Health Home Services as a way to improve health care through coordinated care and at a reduced cost. For the first two years that a state offers Medicaid Health Home Services, the federal matching rate equals 90%.

Under Maine’s Health Home program, members eligible for Health Home services will be assigned to a “Health Home Practice”(HHP, which is a primary care practice that has completed an application and been approved by MaineCare as an HHP). The HHP is responsible for providing acute and preventive care, managing chronic illnesses, coordinating specialty care and referrals to social, community, and long-term care supports, providing comprehensive care management, and providing access to 24/7 coverage.

The HHP is required to work with a Community Care Team (CCT is a multi-disciplinary, community-based, practice-integrated care management team that has completed an application and been approved by MaineCare as a CCT) to identify members with the most intense health care needs and to provide more intense Health Home services for such members. The number of members receiving CCT services at any point in time is capped at 5% of each HHP’s members.

PUBLIC HEARING:

Date: February 25, 2013 Time: 9:00 AM Location: Room 600 Cross Office Building Augusta, Maine 04333

The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed above before February 11, 2013.

DEADLINE FOR COMMENTS: Comments must be received by midnight, Thursday March 7, 2013.
AGENCY CONTACT PERSON: Peter Kraut, Comprehensive Health Planner II AGENCY NAME: MaineCare Services ADDRESS: 242 State St.
11 State House Station Augusta, Maine 04333-0011

TELEPHONE: 207-287-6131 FAX: (207) 287-9369 TTY: 711 (Deaf or Hard of Hearing)