Emergency Rulemaking

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MaineCare Benefits Manual, Chapter II, Section 45, Hospital Services WORD  PDF 
Concise Summary: This emergency rulemaking seeks to implement a budget savings initiative of LD 250, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Year Ending June 30, 2013. This change reduces reimbursement for leave of absence days awaiting nursing facility placement from thirty-six days in the State’s fiscal year (July 1 through June 30) to one, and for the period March 1, 2013 through July 1, 2013. Hospitals will be reimbursed for only one day of leave of absence for days awaiting nursing facility placement. The Department is seeking approval from the federal Centers for Medicare and Medicaid Services for a state plan amendment for this change
Effective Date: March 25, 2013
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services word  pdf 
Concise Summary: This emergency rulemaking seeks to implement a budget initiative of LD 250, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Year Ending June 30, 2013. This rule allows reimbursement for a distinct substance abuse unit discharge rate for acute care non-critical access hospitals who meet the standard. The rate is $4,898 per stay. The Department is seeking CMS approval of the state plan for this change.
Effective Date: April 1, 2013
 
Chapter 101, MaineCare Benefits Manual (MBM), Chapter I, Section 1, General Administrative Policies and Procedures. WORD  PDF 
Concise Summary: The 125th Maine Legislature, Second Regular Session, enacted 22 MRSA § 1714-D to conform to the requirements of the Patient Protection and Affordable Care Act of 2010 (PPACA) regarding the suspension of payments, in whole or in part, to providers who are subject to credible allegations of fraud. This emergency rule gives the Department authority to suspend payments to MaineCare providers who are the subject of a credible allegation of fraud. Changes to Chapter I, Section 1, are made to §§1.18 (G) and (H) and 1.19-6, and include a newly created §1.20-3. The Legislature authorized the Department to adopt emergency rules to implement Title 22, MRSA §1714-D without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health or safety or the general welfare, if notice is given through a MaineCare provider listserv notification and five (5) days or more are allowed for comment prior to adoption of the rule. The Department gave notice of the emergency rulemaking to interested parties and providers through a MaineCare provider listserv notification. Public comments regarding the emergency rule were accepted from December 7 through December 12, 2012.
Effective Date: March 26, 2013
 
MaineCare Benefits Manual, Chapter II, Section 67, Nursing Facility Services WORD  PDF 
Concise Summary: This emergency rulemaking seeks to implement a budget savings initiative of LD 250, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Year Ending June 30, 2013. If CMS approves, payment of bed holds for a semi-private room for a short-term hospitalization of the member shall be granted up to four (4) days (midnights) absence through June 30, 2013, as long as the member is expected to return to the nursing facility. Effective July 1, 2013, payment for these bed holds shall be granted up to four (4) days (midnights) absence during the twelve (12) month state fiscal year (July 1 through June 30) and every state fiscal year thereafter. The Department will also, if CMS approves, reduce reimbursement for a leave of absence from thirty-six days in a twelve-month period to no more than one (1) day in leave of absence from March 25, 2013 through June 30, 2013; and, effective July 1, 2013, one (1) day of leave of absence during the twelve (12) month state fiscal year (July 1 through June 30) and every state fiscal year thereafter.
Effective Date: March 25, 2013
 
MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services WORD  PDF 
Concise Summary: This emergency rule implements a budget savings initiative of L.D. 250, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Year Ending June 30, 2013. The amended rule reduces reimbursement rates for Licensed Clinical Professional Counselors (LCPC) and Licensed Marriage and Family Therapists (LFMT) by 5%. This change in rates requires a State Plan Amendment to be approved by the Centers for Medicare and Medicaid Services (CMS); the Department will request approval of a State Plan Amendment retroactive to the effective date of this rule.
Effective Date: March 5, 2013
 
MaineCare Benefits Manual, Ch. VI, Sec. 1, Primary Care Case Management word  pdf 
Concise Summary: The Department is repealing the Patient Centered Medical Home provision of the Primary Care Case Management (PCCM) rule, MaineCare Benefits Manual, Ch. VI, Sec. 1, effective January 1, 2013, through emergency rulemaking, because this service will be offered, effective January 1, 2013, in the MaineCare Benefits Manual, Ch. II, Sec. 91 and Ch. III, Sec. 91 (Health Home Services), also through emergency rulemaking. The State will receive an enhanced federal match of 90% for the Section 91 services, which will save the state money. The DHHS will be seeking Centers for Medicaid and Medicare Services (CMS) approval of the State Plan for these changes, and this rule will become effective upon CMS approval.
 
MaineCare Benefits Manual, Chapters II & III, Section 91, Health Home Services word  pdf 
Concise Summary: Effective January 1, 2013, the Department will offer and reimburse Health Home Services under a new section of policy, Chapters II and III, Section 91. Health Home Practices will be reimbursed at a rate of $12.00 per member per month and Community Care Teams will be reimbursed at a rate of $129.50 per member per month under this section of policy, if they meet the standards of Section 91. This new MaineCare service will be offered to eligible MaineCare members who have been diagnosed with two chronic conditions, or who have one chronic condition and are at risk for another chronic condition. Under a Plan of Care, members will receive all or some of the following services: Comprehensive Care Management, Care Coordination, Health Promotion, Comprehensive Transitional Care, Individual and Family Support Services, and Referral to Community and Social Support Services. These services are unique and will not duplicate other MaineCare services. The DHHS will be seeking CMS approval of the State Plan for these changes.
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapter II, Section 85, Physical Therapy Services word  pdf 
Concise Summary: This emergency rule is being adopted in accordance with PL 2011, ch. 657, Part O. The changes made in this rule allow more Physical Therapy services, up to five (5) treatment visits and one (1) evaluation within twelve (12) months, when provided pursuant to a pain management care plan as described in the MaineCare Benefits Manual Section 80.07-5(D)(3).
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services word  pdf 
Concise Summary: The Department of Health and Human Services (DHHS) has adopted an emergency rule to impose limits on opioid medications used for the treatment of pain, PL 2011, ch. 657, Part O and section L-1. This emergency rule includes definitions of acute and non-acute pain, establishes certain exclusions as described in the legislation, mandates the use of a pain management care plan when a member requires the extended use of opioid medications for the treatment of pain and identifies therapeutic treatment options that must be utilized for members who are prescribed opioid medications to treat non-acute pain.
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapter II, Section 65, Behavioral Health Services word  pdf 
Concise Summary: This emergency rule is adopted in accordance with PL 2011, ch. 657, Section S-1, and will limit MaineCare reimbursement for methadone treatment of addiction to opioids to a maximum of twenty four (24) months per lifetime, except as permitted with prior authorization beyond twenty-four (24) months. Only treatment after the effective date of this rule (January 1, 2013) will count toward the limit.
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapters II and III, Section 65, Behavioral Health Services WORD  PDF 
Concise Summary: On May 16, 2012, the Department of Health and Human Services (DHHS) proposed rulemaking for Chapters II and III, Section 65, Behavioral Health Services, proposing to require providers to: (1) employ or contract a Medical Director; and (2) change several HCPC codes to CPT codes. The Department received a significant number of comments from various providers and advocates across the state emphasizing the considerable administrative burden this rulemaking would cause for their agencies. After considering the comments, the Department has decided not to adopt these provisions of the proposed rule. In order to comply with section M-1 of the 1st Supplemental Budget P.L. 2011, ch. 477, Parts M-1 and EE-1, the Department is adopting this emergency rule that will continue a rule provision previously adopted via emergency on April 1, 2012 and proposed on May 16, 2012 that reduced the weekly rate for Opioid Treatment (Methadone) from $72.00 to $60.00 per week. The Department is adopting a second emergency rule because portions of the first emergency rule, effective April 1, 2012, need to be retained, while other parts can be proposed through routine rulemaking. Through this emergency rule, the Department is eliminating language indicating that “Only Mental Health Agencies who are also Private Special Purpose Schools are allowed to provide Children’s Behavioral Health Day Treatment.” The elimination of this language will allow other types of providers to provide Children’s Behavioral Health Day Treatment. The Department is also requesting to revise the modifiers and rates for codes H2021-Comprehensive Community Support Services-Functional Family Therapy and G9007-Collateral Services-Functional Family Therapy in order to assure that providers can bill and are paid appropriately for services rendered. This change is a benefit to the providers.
Effective Date: June 29, 2012
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services WORD  PDF 
Concise Summary: This emergency rulemaking seeks to implement the use of the Ambulatory Payment Classification (APC) system-based reimbursement for almost all outpatient services, including lab and radiology, for private Non-Critical Access and rehabilitation hospitals, effective July 1. Maine is adopting Medicare methodology and will pay 93% of the Medicare rate. These hospitals will no longer receive any Prospective Interim Payments (PIP). Non-state, public, Non-Critical Access hospitals will still be paid on a percentage of cost basis and will receive an outpatient PIP. Reflecting these changes, the general description of the types of hospitals in Maine and the related reimbursement methodologies will change. Critical Access Hospitals would be exempted from the requirements to count readmissions within 72 hours as part of the initial discharge. The DHHS will be seeking CMS approval of the State Plan for these changes.
Effective Date: July 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder Word  PDF 
Concise Summary: This Emergency Major Substantive Rule adopts a 5% decrease in rates for Agency Home Support per diem as directed by P.L. 2011, Chapter 477, § M-1. This change is not expected to have an adverse effect on the administrative burdens of small businesses.
Effective Date: July 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services WORD  PDF 
Concise Summary: The emergency adopted rule specifies that the weekly rate for Opioid Treatment (Methadone) is reduced from $72.00 to $60.00 per week.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 2, Adult Family Care Services WORD  PDF 
Concise Summary: This emergency rule is being adopted pursuant to Public Law, Chapter 477, LD 1816, the Maine State Supplemental Budget passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012, which directed the Department to reduce reimbursement of Adult Family Care Services by 10%. This change is not expected to have an adverse effect on the administrative burdens of small businesses.
Effective Date: April 1, 2012
 

 

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