Adopted Rulemaking

The MaineCare Benefits Manual (10-144, Department of Health and Human Services, Chapter 101) is available on the Secretary of State (SOS) website.

There is always a delay between the effective date the Office of MaineCare Services' adopts a rule and the date it is posted on the SOS website. Therefore, the Office of MaineCare Services posts recently adopted rules here until thay are posted on the SOS website.

Clarifications regarding adopted rules are also posted here.

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MaineCare Benefits Manual, Ch. VI, Sec. 1, Primary Care Case Management WORD  PDF 
Concise Summary: The Department is repealing the Patient Centered Medical Home (PCMH) provision of the Primary Care Case Management (PCCM) rule, MaineCare Benefits Manual, Ch. VI, Sec. 1, effective January 1, 2013, because the PCMH program is being replaced by the new “Health Home” program being promulgated as MaineCare Benefits Manual, Ch. II, Sec. 91 and Ch. III, Sec. 91. This rule change is not anticipated to impose any cost upon municipalities or counties or have any adverse impact upon small businesses.
Effective Date: April 1, 2013
View Comments: PDF  Posted: April 2, 2013
 
MaineCare Benefits Manual, Chapters II & III Section 91, Health Home Services WORD  PDF 
Concise Summary: Effective January 1, 2013, the Department began offering and reimbursing Health Home Services under a new section of policy, Chapters II and III, Section 91. Health Homes Services are for MaineCare beneficiaries who suffer from certain chronic health conditions (including a mental health condition; 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). MaineCare beneficiaries who suffer from Serious and Persistent Mental Illness and Serious Emotional disturbance are not eligible for Section 91 services. 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). 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) 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. This rule change is not anticipated to impose any cost upon municipalities or counties or have any adverse impact upon small businesses.
Effective Date: April 1, 2013
View Comments: PDF  Posted: April 2, 2013
 
MaineCare Benefits Manual, Chapters II, Section 4, Ambulatory Surgical Center Services PDF  Word 
Concise Summary: CONCISE SUMMARY: The Department of Health and Human Services (DHHS) is adopting this rule to repeal Chapter 101, MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services, in accordance with Public Law 2011, c. 657, Part A, the Maine State Supplemental Budget.
Effective Date: August 30, 2012
  Posted: August 29, 2012
 
MaineCare Benefits Manual, Section 15, Chapter II, Chiropractic Services Word   PDF  
Concise Summary: With this rule, the Department of Health and Human Services (DHHS) is permanently adopting the April 1, 2012, emergency changes to Chapter 101, MaineCare Benefits Manual, Section 15, Chapter II, Chiropractic Services, pursuant to Public Law 2011, Chapter 477, the Maine Supplemental Budget. The change limits reimbursement for Section 15, Chiropractic Services to twelve (12) visits per rolling calendar year for adult members. The Department is also clarifying Section 15.04, Specific Eligibility for Care, to align with the definition of rehabilitation potential earlier in the Section.
Effective Date: June 26, 2012
View Comments: Word  Posted: June 26, 2012
 
MaineCare Benefits Manual, Chapter III, Section 50, Principles of Reimbursement for Intermediate Care Facilities for the Mentally Retarded (ICF-MR) Services WORD  PDF 
Concise Summary: This is a major substantive rule and will be final thirty days after it is filed. The legislature approved the rule for final adoption in 2011-Resolve chapter 161. In 2011, the Legislature amended 36 M.R.S.A. § 2872 by increasing the tax on ICF-MRs from 5.5% to 6% via P. L. 2011, ch 411. This provisionally adopted rule permits an ICF-MR to obtain reimbursement of the full 6% tax, subject to CMS approval. The rule has a retroactive application with an effective date of January 1, 2012 (authorized under 22 MRSA § 42(8) because this rule will benefit providers by increasing their reimbursement). This change is not expected to have an adverse economic impact on small businesses or municipalities and counties.
Effective Date: Retroactive to January 1, 2012
View Comments: WORD  Posted: June 7, 2012
 
MaineCare Benefits Manual Chapters II & III, Section 3, Ambulatory Care Clinic Services WORD  PDF 
Concise Summary: The adopted rules will consolidate and update all rules pertaining to the reimbursement of Indian Health Service (IHS) clinic services to one new section of MaineCare Benefits Manual (MBM) policy. Services provided by IHS providers are subject to different federal guidelines. Separation of these rules will clarify specific rules for IHS providers. The Department will also add guidelines for co-payment exemptions and tribal consultation to be in compliance with Section 5006(a) of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Public Law 111-5. Currently IHS services are included in MBM Section 3, Ambulatory Care Clinic Services. The Ambulatory Care Clinic Services section of the MBM will be amended at the same time as this rule-making in order to delete those portions that will now be part of Section 9, Indian Health Services.
Effective Date: March 21, 2012
View Comments: WORD  Posted: March 19, 2012
 
MaineCare Benefits Manual, Chapter II, Section 9, Indian Health Services WORD  PDF 
Concise Summary: The adopted rules will consolidate and update all rules pertaining to the reimbursement of Indian Health Service (IHS) clinic services to one new section of MaineCare Benefits Manual (MBM) policy. Services provided by IHS providers are subject to different federal guidelines. Separation of these rules will clarify specific rules for IHS providers. The Department will also add guidelines for co-payment exemptions and tribal consultation to be in compliance with Section 5006(a) of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Public Law111-5. Currently IHS services are included in MBM Section 3, Ambulatory Care Clinic Services. The Ambulatory Care Clinic Services section of the MBM will be amended at the same time as this rule-making in order to delete those portions that will now be part of Section 9, Indian Health Services.
Effective Date: March 21, 2012
View Comments: WORD  Posted: March 19, 2012
 
MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities WORD  PDF 
Concise Summary: This adopted rulemaking, if CMS approves, raises the Cost of Living Adjustment (COLA) for Nursing Facilities to 2% beginning on October 1, 2011. This is prompted by changes to P.L. 2011, ch. 411. The retroactive application of this rule is permitted under 22 MRSA 42(8).
Effective Date: March 3, 2012
View Comments: WORD  Posted: March 2, 2012
 
MaineCare Benefits Manual, Chapters II and III Section 13, Targeted Case Management Services WORD  PDF 
Concise Summary: The adopted rules eliminate two target groups currently being reimbursed under Chapter 13, Targeted Case Management (TCM): “Case Management Services for Children Involved with Protective Services”, and “Case Management Services for Adults Involved with Protective Services”. Additionally the rulemaking adds medical eligibility criteria for the target group “Members Experiencing Homelessness”. Chapter II is also changed to delete obsolete language concerning the 2009 transition to one Comprehensive Case Manager and add a requirement for documentation that members have had choice of providers. Chapter III is changed to align the standard units of service and maximum allowance for two categories of TCM services with the other TCM categories. These rule changes will not impose any cost on municipalities or counties or have any adverse impact on small businesses.
View Comments: WORD  Posted: October 31, 2011
 

 

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