Proposed Rulemaking

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MaineCare Benefits Manual, Section 22, Chapters II & III, Home and Community Benefits for the Physically Disabled WORD  PDF   
Concise Summary: This rule is being proposed to be repealed and incorporated into Section 19, Home and Community Based Benefits for the Elderly and for Adults with Disabilities. This rule is being proposed in order to comply with Resolve 2011, ch 71.This rule blends services from Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities and Section 22, Home and Community Benefits for the Physically Disabled and is being proposed simultaneously with the repeal of Section 19.These changes are subject to CMS approval, a waiver amendment was submitted March 14, 2014. THIS RULE WILL __ WILL NOT X HAVE A FISCAL IMPACT ON MUNICIPALITIES. STATUTORY AUTHORITY: 22 MRSA  42, 3173. DATE AND PLACE OF PUBLIC HEARING: Date: August 12, 2014 10:00 AM Location: Conference Room 110 Department of Health and Human Services 19 Union Street Augusta, ME 04333 The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed above before August 4, 2014.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight, August 22, 2014. Posted: July 22, 2014
 
MaineCare Benefits Manual, Section 19, Ch. II & III, Home and Community Benefits for the Elderly and for Adults with Disabilities WORD  PDF   
Concise Summary: This rule is being proposed in order to comply with Resolve 2011, ch 71. This rule blends services from Sections 19 and Section 22, Home and Community Benefits for the Physically Disabled and is being proposed simultaneously with the repeal of Section 22.These changes are subject to CMS approval, and a waiver amendment was submitted March 14, 2014. The changes proposed in this rule will maintain or increase the level of services available to members, specifically: • The Department is proposing to remove Homemaker Services as a stand-alone service; members will receive instrumental activities of daily living as part of Personal Care or Attendant Services instead. • Assistive Technology, Assistive Technology-Remote Monitoring and Assistive Technology-Transmission are being proposed to be added as new services and are included under the program cap. • The Department is proposing to make changes to the terminology, definitions and requirements for “Self-Direction” and “Family Provider Services Option” (FPSO). These terms are being proposed to be eliminated and replaced with the term “Participant Directed Option.” • The term “Supports Brokerage” is being proposed to be removed and the term “Care Coordination” will be used exclusively. • The requirement for individual managing services under the FPSO to register as an agency with the Division of Licensing and Regulatory Services is being proposed to be eliminated, and the requirements for a Representative under this service delivery option have changed. • The term “Attendant” is being proposed to be added to define the worker providing services for members using the Participant Directed Option and qualifications have been clarified for Attendants. • The Department is proposing to modify eligibility and termination reasons that relate solely to the Participant Directed Option. • Qualifications for Skills Training are being proposed to be added. • Provider requirements for out-of-state services are being proposed to be clarified. • The Department is clarifying the number of hours weekly an individual worker may provide to an individual member or household. • The Department is proposing to standardize requirements regarding face-to-face visits from the Service Coordination Agency. • The Department is proposing to clarify qualifications for Care Coordination staff. • The Department is proposing to change certain definitions. • The Department is proposing to clarify the components of the Attendant rate and Financial Management Service. • The Department is proposing to clarify the responsibilities of the Financial Management Service regarding background checks and Office of Inspector General checks. • The Department is proposing to allow certain individuals who meet specific eligibility to exceed a monthly cap by a certain percentage. • The Department is increasing the limit for Care Coordination to 24 hours annually. • The Department is proposing to clarify the dollar month cap allowable per member per month under this waiver. • The Department is modifying the licensed settings which qualify for reimbursement for respite services. • The Department is proposing to change rates to be consistent between the former Section 19 and Section 22 programs in Chapter III.   THIS RULE WILL NOT HAVE A FISCAL IMPACT ON MUNICIPALITIES. STATUTORY AUTHORITY: 22 MRSA  42, 3173, Resolve 2011, ch 71. DATE AND PLACE OF PUBLIC HEARING: Date: August 12, 2014 9:00 AM Location: Conference Room 110 Department of Health and Human Services 19 Union Street Augusta, ME 04333 The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed above before August 4, 2014.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight August 22, 2014. Posted: July 22, 2014
 
MaineCare Benefits Manual, Section 18, Chapter II and III, Home and Community-Based Services for Adults with Brain Injury WORD  PDF   
Concise Summary: The Department is creating a new section of the MaineCare Benefits Manual outlining the covered services, program requirements, and reimbursement rates for a home and community-based program for adults with Acquired Brain Injury (ABI). This new MaineCare program, provided to eligible members through a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services, will provide supports necessary to assist individuals with an ABI to live in the community rather than in institutional settings. Chapter II of Section 18 (titled “Home and Community-Based Services for Adults with Brain Injury”) will detail the program requirements and services offered under the waiver. Those services include Assistive Technology, Care Coordination, Career Planning, Community/Work Reintegration, Employment Specialist Services, Home Support, Non-Medical Transportation Services, Self-Care/Home Management Reintegration, Work Ordered Day Club House and Work Support-Individual. Chapter III of Section 18 (titled “Allowances for Home and Community-Based Services for Adults with Brain Injury”) establishes billing procedure codes (based on HIPAA compliant CPT coding) and reimbursement rates for the waiver services. PUBLIC HEARING: Date: August 4, 2014, 9:00-11:00 am Location: Conference Room #110 Department of Health and Human Services 19 Union Street Augusta, ME 04333 The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed above before July 25, 2014.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight, Thursday August 14, 2014. Posted: July 10, 2014
 
MaineCare Benefits Manual, Chapters II & III, Section 30, Family Planning Agency Services WORD  PDF   
Concise Summary: This rulemaking is being proposed in order to conform with industry billing standards and covered services. The Department is required to utilize certain applicable medical data code sets, pursuant to 45 C.F.R. §§ 162.1000 and 162.1002. Each code set is valid within the dates specified by the organization responsible for maintaining that code set pursuant to 45 C.F.R. § 162.1011. The proposed updates include adding the code for the administration of medroxyprogesterone acetate (DepoProvera), and the addition of codes for the following new Family Planning Agency Services in Ch. III: 1) Removal of an IUD; 2) Administration of the HPV vaccine; 3) Insertion of the IUD Skyla®. Finally, these proposed changes remove language referring to retroactive code dates from 2010. The revisions to Ch. II include a reference to a rate setting website in Ch. III and add language stating that Family Planning Agencies will be reimbursed at the same fee-for-service rate as other providers when applicable. PUBLIC HEARING: Date: August 4, 2014 Time: 9:00 AM Location: 302 Cross Office Building, 111 Sewall Street, Augusta, ME 04330 The Department requests that any interested party requiring special arrangements planning to attend the hearing contact the agency person listed below before Wednesday, July 23rd, 2014.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight Thursday, August 14, 2014. Posted: July 9, 2014
 
MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services WORD  PDF   
Concise Summary: To comply with Private and Special Law 2014, Chapter 29, which became law on April 30, 2014 without the Governor’s signature, and was enacted with an emergency preamble to be effective immediately, this emergency rulemaking restores coverage for services provided through a section of the MaineCare Benefits Manual, Section 4, Ambulatory Surgical Center Services, that was previously eliminated, in Public Law 2011, Ch. 657. This rule provides for the reimbursement of ambulatory surgical centers (ASCs) under the MaineCare program effective July 1, 2014, under rules that are identical to the rules that were in effect on January 1, 2012. The Legislature determined that the elimination of coverage for ASC resulted in access problems for MaineCare beneficiaries, and resulted in a shift of services to more expensive settings. The immediate restoration of coverage for ASC services will address access problems and reduce costs in the MaineCare program.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight, August 7, 2014 Posted: July 1, 2014
 
MaineCare Benefits Manual, Chapter II, Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Disorder Word  PDF   
Concise Summary: The Department is proposing many changes in this rulemaking. The Department is proposing to add four new services: Assistive Technology, Career Planning, Home Support-Quarter Hour and Home Support-Remote Support. Additionally, the Department is proposing to split Work Support into two separate services: Work Support-Individual and Work Support-Group. Additionally, the Department is proposing to add performance measures. The primary goal of performance measurement is to use data to determine the level of success a service is achieving in improving the health and wellbeing of members. Performance goals and performance measures have been established to monitor quality, inform, and guide reimbursement decisions and conditions of provider participation across MaineCare services. This focus on performance measurement is anticipated to enhance the overall quality of services provided and raise the level of public accountability for both the Department and MaineCare providers. Other proposed changes to the rule include: • The addition of seven (7) new definitions: Activities of Daily Living, Agency Home Support Authorized Agent, Instrumental Activities of Daily Living, Medical Add On, Prior Authorization and Utilization Review. • Removing the definition of Summary of Authorized Services. • A requirement for Section 29 applicants and their planning teams to estimate the annual cost of services in the course of applying for waiver services. • A requirement that the Personal Plan for members electing the Home Support-Remote Support service incorporate a safety/risk plan. • The addition of limits on Community Support services, Assistive Technology services, Career Planning services, Counseling services, Consultation services, Employment Specialist Services and Home Support-Remote Support services. • The addition of new provider qualifications for those Direct Support staff that provide Home Support services, Work Support-Individual services, Work Support-Group services, Employment Specialist Services and Career Planning services. Other technical language changes are also being proposed. The reason for the rule changes are to comply with the budget bill P.L. 2013, chapter 368 directing the Department to add Assistive Technology. The Department is complying with Resolve, Chapter 24, LD 8, Resolve, Directing the Department of Health and Human Services to Provide Coverage under the MaineCare Program for Home Support Services for Adults with Intellectual Disabilities or Autistic Disorder. This Resolve directs the Department to add Home Support as a covered Service to this waiver. The Department is also complying with a CMS directive to separate Home Support into separate services. The Work Support and Career Planning changes are to comply with LD 8, Resolve, Directing the Department of Health and Human Services to provide coverage under the MaineCare program for Home Support Services for Adults with Intellectual Disabilities or Autistic Disorder. SEE http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents.
Submit Comments (Opens in new window) - Comment Deadline: Midnight, Thursday April 25, 2014. Posted: March 19, 2014
 
MaineCare Benefits Manual, Chapter II, Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder Word  PDF   
Concise Summary: The Department is proposing many changes in this rulemaking. The Department is proposing to add three new services: Assistive Technology, Career Planning and Home Support-Remote Support. The Department is also proposing to split the existing Home Support service into four separate services: Home Support-Agency Per Diem, Home Support-Family Centered Support, Home Support-Quarter Hour, and Shared Living. Additionally, the Department is proposing to split Work Support into two separate services: Work Support-Individual and Work Support-Group. The Department is also proposing to add performance measures. The primary goal of performance measurement is to use data to determine the level of success a service is achieving in improving the health and wellbeing of members. Performance goals and performance measures have been established to monitor quality, inform, and guide reimbursement decisions and conditions of provider participation across MaineCare services. This focus on performance measurement is anticipated to enhance the overall quality of services provided and raise the level of public accountability for both the Department and MaineCare providers. Other proposed changes to the rule include: • The addition of Licensed Audiologists and Assistive Technology Professionals as qualified providers for the Communication Aids service. • The addition of Certified Occupational Therapy Assistants (COTA) under the supervision of an Occupational Therapist Registered (OTR) as qualified providers for the Occupational Therapy (Maintenance) service. • The addition of six (6) new definitions: Activities of Daily Living, Administrative Oversight Agency, Authorized Agent, Instrumental Activities of Daily Living, Prior Authorization and Utilization Review. • Removing the definition of Summary of Authorized Services. • The addition of a reserved capacity category to meet the needs of members under 21 in out-of-state residential placements funded by MaineCare or State funds. • The addition of clarifying language regarding the phase-out of the Home Support-Family Centered Support services. • New procedures for filling vacancies in two-person agency-operated homes. • A requirement for Section 21 applicants and their planning teams to estimate the annual cost of services in the course of applying for waiver services. • A requirement that the Personal Plan for members electing the Home Support-Remote Support service incorporate a safety/risk plan. • The addition of limits on Community Support services, Assistive Technology services, Career Planning services, Counseling services, Consultation services, Employment Specialist Services and Home Support-Remote Support services. • The addition of new provider qualifications for those Direct Support staff that provide Work Support-Individual services, Work Support-Group services, Employment Specialist Services, and Career Planning services. Other technical language changes are also being proposed. The reason for the rule changes are to comply with the budget bill P.L. 2013, chapter 368 directing the Department to add Assistive Technology. The Department is also complying with a CMS directive to separate Home Support into separate services. The work support and career planning changes are to comply with LD 8, Resolve, Directing the Department of Health and Human Services to provide coverage under the MaineCare program for Home Support Services for Adults with Intellectual Disabilities or Autistic Disorder. SEE http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents.
Submit Comments (Opens in new window) - Comment Deadline: Midnight, Thursday, April 24, 2014 Posted: March 19, 2014
 
MaineCare Benefits Manual, Chapter II, Section 67, Nursing Facilities Services Word  PDF   
Concise Summary: This rule is being proposed in order to make brain injury eligibility for Section 67: Nursing Facility Services and Section 18: Home and Community Based Services for Members with Brain Injury consistent between policies. Individuals with Acquired Brain Injury will be eligible for Nursing Facility services if they score three or higher in two items on the Mayo-Portland Adaptability Inventory and score a 0.1 or higher on the Brain Injury Health and Safety Assessment. This rulemaking also: a) Updates the Brain Injury definition in Section 67.01-22 to be consistent with the definition developed in Title 22 § 3086; b) Adds the word “Acquired” to “Brain Injury” to be consistent with Title 22 § 3086; c) Changes “Brain Injury” to “Acquired Brain Injury,” and “BI” to “ABI” in the table of contents and on pages 4, 14, 32, 47, 48, 53; d) Requires, for Nursing Facilities working with individuals with brain injury, that all staff have expertise in brain injury rehabilitation as demonstrated by achieving the Certified Brain Injury Specialist (CBIS) designation from the Academy of Certified Brain Injury Specialists, or through an approved equivalent training program; e) Reorganizes Section 67.02-5; and, f) Corrects a numbering error in Section 67.05-13 See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) - Comment Deadline: Saturday, April 17, 2014 Posted: March 12, 2014
 
MaineCare Benefits Manual, Chapter II, Section 13, Targeted Case Management Services Word  PDF   
Concise Summary: This proposed rule seeks to permanently adopt the emergency rule effective December 20, 2013, that updates the Targeted Case Management (TCM) policy to include the Child and Adolescent Needs and Strengths (CANS) assessment as an approved TCM eligibility tool. The Department will no longer fund the Child and Adolescent Functional Assessment Scales (CAFAS) as of January 31, 2014, and must have the CANS in place to assure that providers who cannot self fund the CAFAS have an approved tool to evaluate members for TCM eligibility.
Submit Comments (Opens in new window) - Comment Deadline: February 20, 2014 Posted: January 16, 2014
 
MaineCare Benefits Manual Chapter 101, Section 92, Chapters II & III Behavioral Health Home PDF     
Concise Summary: CONCISE SUMMARY: This proposed rulemaking seeks to create Behavioral Health Homes, effective April 1, 2014, which will provide comprehensive system of care coordination for members with Serious Emotional Disorders (SED), and Serious and Persistent Mental Illness (SPMI). Members eligible for Section 92 services may also be eligible for services under Section 13 (Targeted Case Management), Section 17 (Community Integration Services) and/or Section 91 (Health Home Services); such members may not receive those services at the same time that they receive Section 92 services, and must choose among the different types of services for which they are eligible. Section 92 services shall be provided to eligible members by a Behavioral Health Home Organization (BHHO) that partners with one or more Health Home Practices (HHPs). BHHOs and HHPs shall integrate and coordinate all primary, acute, behavioral health and long term services and supports for eligible members. BHHOs shall develop and implement a comprehensive Plan of Care for each member. Section 92 services are expected to result in improved physical and behavioral health outcomes for members, reduced hospital admissions and emergency room use, better transitional care, improved communication between health care providers, and the increased use of preventive services, community supports, and self-management tools. Section 92 Behavioral Health Homes are implemented pursuant to section 2703 of the Affordable Care Act, 42 U.S.C. § 1396w-4. The Department is seeking approval of a State Plan Amendment from the Centers for Medicare and Medicaid Services. Section 2703 provides an enhanced federal matching rate of 90% for the first eight (8) quarters following the effective date of the program.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight January 24, 2014 Posted: December 19, 2013
 
MaineCare Benefits Manual, Ch 101, Sec 45, Ch III, Hospital Services PDF     
Concise Summary: CONCISE SUMMARY: On November 15, 2013, the Department adopted an emergency rule which increased the MaineCare hospital supplemental pool for Acute Care Non-Critical Access hospitals, hospitals reclassified to a wage area outside Maine and rehabilitation hospitals, to $65.321 million, because the Legislature appropriated an additional $10.472 for this purpose. P.L. 2013, ch. 368, PART A, Sec. A-34. This rulemaking proposes to make the changes in the November 15, 2013 Emergency Rule permanent.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight, Thursday, January 2, 2014 Posted: November 27, 2013
 
MaineCare Benefits Manual, Ch 101, Sec 1 Ch I, General Administrative Policies and Procedures PDF     
Concise Summary: CONCISE SUMMARY: The Department is proposing the following changes to this rule, for the following reasons: (1) Removed references to DirigoChoice, since the Maine Legislature has dissolved the Dirigo Health Agency (P.L. 2013, ch. 368, Sec. A-19); (2) As required by 45 CFR 162.410, requires that any MaineCare provider that is a “covered health care provider” must obtain a National Provider Identifier (NPI); (3) Requires that MaineCare providers must include their NPI on their MaineCare Provider Agreements and MaineCare enrollment applications, and requires updates for new or changed NPIs; (4) Requires that all MaineCare providers must include their NPI on all MaineCare claims, pursuant to the Affordable Care Act, Section 6402(a) as codified in 42 CFR 431.107, or those claims will be denied; (5) Pursuant to 42 CFR 455.410, specifies that, in order for MaineCare to reimburse for services or medical supplies or prescriptions resulting from a provider’s order, prescription or referral, the ordering, prescribing or referring (OPR) provider must be enrolled in MaineCare, and the OPR provider’s NPI must be on the claim. This change will be effective when the Maine Medicaid Management Information System (MMIS) is able to process this change, and the Department will notify all providers via the Listserve, and also serve notice on the Secretary of State’s office as required by 5 MRSA 8052(6); (6) Pursuant to P.L. 2013, c. 368, Part A-34, effective January 1, 2014, if approved by CMS, the Department will limit cost sharing payments, for the Qualified Medicare Beneficiary without other Medicaid (QMB Only) population, to hospital and nursing facility providers to the amount necessary to provide a total payment equal to the amount MaineCare would pay for these services under the State Plan. The Department will seek CMS approval to amend its State Plan for this change. (7) Finally, the Department made some additional changes to the 1.07-5 (Medicare provision), all to comport with the current State Plan, and these changes also reflect the Department’s current practice: (a) adding hospitals and nursing facilities to the list of MaineCare providers who may bill MaineCare for cost sharing, however, the cost sharing is limited in that it cannot exceed the lowest rate that Medicare determines to be the allowed amount; (b) deleting references to “Medicare Part B” in provisions where the provisions related both to Medicare A and B, pursuant to the State Plan; (c) deleting a provision regarding claims received from January 1, 1997 to February 29, 2000, since that time period has long passed.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight December 5, 2013 Posted: November 12, 2013
 
MaineCare Benefits Manual, Chapter 101, Section 2, Chapter VI MaineCare DirigoChoice Initiatives PDF     
Concise Summary: CONCISE SUMMARY: By direction of legislative action (P.L. 2013, ch. 368, Sec. A-19), the Department of Health and Human Services (DHHS) is proposing to repeal, in its entirety, MaineCare Benefits Manual, Chapter VI, Section, 2, MaineCare Dirigo Initiative by December 31, 2013. The Department anticipates that this proposed rulemaking will have no impact on MaineCare enrolled members.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight November 14, 2013 Posted: October 9, 2013
 
MaineCare Benefits Manual, Chapter 101, Chapter II, Section 85, Physical Therapy Services PDF     
Concise Summary: CONCISE SUMMARY: The Department is proposing changes to this rule to require Prior Authorization for all Physical Therapy Services for persons age 21 and over. The Department also proposes the following changes: a. Adding a definition for Terminal Illness, b. Adding new covered services and clarifying covered services and their limits, c. Limiting supplies to splinting and adding the link to the Department’s Rate Setting website, d. Adding some language and clerical changes to clarify the policy.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight November 7, 2013 Posted: October 2, 2013
 
MaineCare Benefits Manual, Chapter 101, Chapter II, Section 68, Occupational Therapy Services PDF     
Concise Summary: CONCISE SUMMARY: The Department is proposing changes to this rule to require Prior Authorization for all Occupational Therapy Services for persons age 21 and over. The Department also proposes the following changes: a. Adding a definition for Long-Term Chronic Pain and Terminal Illness, b. Adding new covered services and clarifies covered services and their limits, c. Limiting supplies to splinting only and adds the link to the Department’s Rate Setting website, d. Adding some language and clerical changes to clarify the policy.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight November 7, 2013 Posted: October 2, 2013
 
MaineCare Benifits, Ch 101, Ch X, Sec 2. Non-Categorical PDF     
Concise Summary: CONCISE SUMMARY: The MaineCare Childless Adults Section 1115 demonstration project that provided health care coverage to childless adults and non-custodial parents with incomes at or below 100% of the Federal Poverty Level (FPL) expires on December 31, 2013. Due to the expiration of the waiver (P.L. 2011, ch. 477, Part M, sec. M-1), the Department of Health and Human Services (DHHS) must repeal Chapter 101, MaineCare Benefits Manual, Chapter X, Section 2, Non-categorical Adults to defund the program.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight November 07, 2013 Posted: September 30, 2013
 
MaineCare Benefits Manual, Ch 101, Sec 45, Ch II-Hospital Services PDF     
Concise Summary: CONCISE SUMMARY: This proposed rulemaking seeks to permanently adopt changes already made on an emergency basis, implementation of budget initiative of P.L. 2013, ch. 368, as amended by P.L. 2013, ch. 423. This rulemaking will, retroactive to April 1, 2013, increase the number of days that MaineCare reimburse a hospital for Therapeutic Leave of Absence- During Days Awaiting Nursing Facility Placement from one (1) day to twenty (20) days per state fiscal year. The rulemaking also makes clerical clarifications and corrections in several places: on pages 8 and 10 changing “days waiting” to “days awaiting” to be consistent with language elsewhere in the rule; and inserting the words “Therapeutic Leave of Absence During Days Awaiting Nursing Facility Placement” on page 7 and changing that entry in the Table of Contents so that it conforms to the language on page 7.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight October 3, 2013 Posted: August 30, 2013
 
MaineCare Benifits Manual, Ch 101, Sec 67, Ch II-Nursing Facility Services PDF     
Concise Summary: CONCISE SUMMARY: This proposed rulemaking seeks to permanently adopt changes already made on an emergency basis, implementation of budget initiative of P.L. 2013, ch. 368, as amended by P.L. 2013, ch. 423. This rulemaking will, retroactive to April 1, 2013, increase the number of days that MaineCare will reimburse a nursing facility for: (a) Therapeutic Leave of Absence from one (1) day to twenty (20) days per state fiscal year, and (b) Bed Hold Days from four (4) per year to seven (7) per inpatient hospitalization. The rulemaking also makes the following clerical changes: (1) inserts the word “Therapeutic” before “Leave Days for a MaineCare Member” on page 39, (2) changes that entry in the Table of Contents so that it conforms to the language on page 39. The Department is seeking approval from the Centers for Medicare and Medicaid Services for a state plan amendment for this change.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight October 3, 2013 Posted: August 30, 2013
 
MaineCare Benefits Manual, Ch 104, Sec 4 Part D Wrap Benefits PDF  Word   
Concise Summary: CONCISE SUMMARY: This rule is proposed to permanently adopt the provisions now in place by emergency rule that eliminate coverage of Medicare Part D copayments for members of the Medicare Savings Program who are not eligible for, or receiving the full MaineCare benefit. This change is being made pursuant to PL 2013, Chapter 368, Part A, Section A-34, the Maine Biennial Budget.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight October 3, 2013 Posted: August 30, 2013
 
MaineCare Benefits Manual, Ch 101 Sec 97 Ch II, Private Non-Medical Institution Services, Intensive Mental Health Services for Infants and/or Toddlers PDF     
Concise Summary: CONCISE SUMMARY: This proposed rule eliminates Private Non-Medical Institution Services (PNMI), Appendix D (Child Care Facilities), Model 3 (Intensive Mental Health Services for Infants and/or Toddlers). In a separate rulemaking for Chapter III, Section 97, the Department seeks to provisionally adopt the emergency major substantive rule that eliminates the reimbursement rate for these services. Although eligible infants and toddlers will no longer have access to PNMI Appendix D, Model 3 intensive mental health services, they remain eligible for medically necessary Behavioral Health Services through Chapter II, Section 65, Behavioral Health Services.
Submit Comments (Opens in new window) - Comment Deadline: Comments must be received by midnight September 5, 2013. Posted: August 16, 2013
 
Chapter 101, MaineCare Benefits Manual, Section 32, Chapter II, Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders Word  PDF   
Concise Summary: The Department is proposing changes to the rule to comply with the concurrent operation of a 1915 (b) Non-Emergency Transportation Waiver. These proposed changes to Section 32 will be effective only upon implementation of the 1915(b) Non-Emergency Transportation Waiver. The proposed changes to Section 32 include referencing the regional, risk-based, Pre-Paid Ambulatory Health Plan (PAHP) Brokerages operating under a 1915(b) waiver approved by the Centers for Medicare and Medicaid Services (CMS). Under risk-based contractual agreements, the Department will contract with Broker(s) to establish, manage, authorize, coordinate and reimburse the provision of Non-Emergency Transportation (NET) services for eligible MaineCare members. The Broker(s) will be responsible for establishing a network of NET drivers to deliver NET transportation services to eligible members who live in their assigned region. The Department is also proposing a number of other changes: 1. The Department is proposing changes to the definitions of “seclusion” and “restraint” to conform to the definitions employed in the Department of Education’s regulations (5-71 C.M.R. ch. 33). The Department of Health and Human Services was directed by the Legislature’s Committee on Health and Human Services to amend Chapter II to mirror the definitions of seclusion and restraint in the Department of Education’s regulations. 2. The Department is proposing to replace the term “aggression” throughout the rule with “self-injurious behavior and/or aggression.” 3. The Department is proposing to add language clarifying that, for purposes of initial and continuing eligibility, the annual cost of a member’s services under Section 32 may not exceed the statewide average annual cost of care for an individual in either (a) an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), or (b) an Inpatient Psychiatric facility for individuals age 21 and under, depending upon the level of care at which the individual qualified for the waiver. This is not a new limit; the Department is proposing the changes to clarify that these limits are not fixed numbers, but instead change each year based upon the prior year’s statewide average annual cost of care for the respective facility type. 4. The Department is proposing to add a number of definitions (including Authorized Agent, Intellectual Disability, and Pervasive Developmental Disorders), and to change the term “Mentally Retarded” to “Intellectually Disabled,” as required by P.L. 2012, ch. 542, § B(5), An Act To Implement the Recommendations of the Department of Health and Human Services and the Maine Developmental Disabilities Council Regarding Respectful Language. 5. The Department is proposing clarification of, and additions to, the requirements for providers of Section 32 services. These include, among others, clarification of the circumstances under which Behavioral Health Professionals may assist with administration of medication, requirements for Respite Service providers, and a requirement that providers put in place a Department-approved informed consent policy.
Submit Comments (Opens in new window) - Comment Deadline: 09/05/2013 Posted: August 6, 2013
 
MaineCare Benefits Manual, Chapters II & III, Section 20, Home and Community Based Services for Adults with Other Related Conditions WORD  PDF   
Concise Summary: The Department is creating a new Section of the MaineCare Benefits Manual outlining the covered services, program requirements, and reimbursement rates for a home- and community-based program for adults with “Related Conditions.” A “Related Condition” (defined in full at 42 C.F.R. § 435.1010) is a condition that causes impairment of general intellectual functioning or adaptive behavior similar to the impairment characteristic of an intellectual disability. This new MaineCare program, provided to eligible members through a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services, will provide supports necessary to assist individuals with a Related Condition to live in the community rather than in institutional settings. Chapter II of Section 20 (titled “Home and Community Based Services for Adults with Other Related Conditions Services”) will detail the program requirements and services offered under the waiver. Those services include Assistive Technology, Care Coordination, Communication Aids, Community Support, Consultation and Assessment, Employment Specialist Services, Home Accessibility Adaptations, Home Support, Non-Medical Transportation Services, Non-Traditional Communication Assessment, Non-Traditional Communication Consultation, Occupational Therapy (Maintenance) Service, Personal Care, Physical Therapy (Maintenance) Service, Specialized Medical Equipment, Speech Therapy (Maintenance) Service, and Work Support. Chapter III of Section 20 (titled “Allowances for Home and Community Based Services for Adults with Other Related Conditions“) establishes billing procedure codes (based on HIPAA compliant CPT coding) and reimbursement rates for the waiver services.
Submit Comments (Opens in new window) - Comment Deadline: May 11, 2013 Posted: April 4, 2013
 
Credible Allegation of Fraud Word     
Concise Summary: This letter gives notice of an emergency rule which amends MaineCare Benefits Manual (MBM), Chapter 1, Section 1, § 1.18 (H), Program Integrity; § 1.19-6, Suspension or Withholding of Payments; § 1.20-3, Suspension of Payments Upon Credible Allegation of Fraud. The federal Patient Protection and Affordable Care Act of 2010 (PPACA) requires the suspension of payments to providers who are the subject of a credible allegation of fraud. The 125th Maine Legislature, Second Regular Session, enacted 22 MRSA § 1714-D to conform with PPACA requirements regarding the suspension of payments, in whole or in part, to providers who are subject to credible allegations of fraud. The rule defines the term “credible allegations of fraud” and provides for exceptions and expedited relief from suspension of payments. The effective date of the emergency rule is December 28, 2012. Before the emergency rule is adopted, the Department will give notice of the emergency rulemaking to interested parties and providers through a MaineCare provider listserv notification. Public comments regarding the emergency rule will be accepted from December 7, 2012 through December 12, 2012.
Submit Comments (Opens in new window) - Comment Deadline: December 12, 2012 Posted: December 6, 2012
 
MaineCare Redesign Task Force Word     
Concise Summary: The MaineCare Redesign Task Force will hold a public hearing on the draft of the “MaineCare Redesign Task Force, Recommendation Report” that was written pursuant to Public Law 2011, Chapter 657, Part T. The hearing will be held on December 11, 2012 from 1 – 3 pm in Statehouse, Room 228 (Appropriations Committee Room). Interested parties are encouraged to provide testimony on the draft report, which can be viewed at http://www.maine.gov/dhhs/mainecare-task-force/. To ensure all interested parties are able to provide input, oral testimony will be limited to 3 minutes per participant. For those who would like to submit written testimony it can be emailed to nick.adolphsen@maine.gov; mailed to Nick Adolphsen, Department of Health and Human Service, 11 State House Station, Augusta, ME 04333; or delivered to the Task Force at the hearing on 12/11.
Submit Comments (Opens in new window) - Comment Deadline: December 11, 2012 Posted: December 4, 2012
 
MaineCare Benefits Manual, Chapters II & III, Section 65, Behavioral Health Services WORD  PDF   
Concise Summary: This rule is being proposed, in part, to comply with Public Law 2011, Chapter 477, (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, section M-1 of which required that MaineCare Services reduce reimbursement of Opioid Treatment (Methadone) from $72.00 per week to $60.00. This change is currently in effect through an emergency rule, effective June 29, 2012. PLEASE NOTE THAT DEADLINE FOR RECEIVING COMMENTS IS SEPTEMBER 14, 2012
Submit Comments (Opens in new window) - Comment Deadline: September 14, 2012 Posted: August 16, 2012
 
MaineCare Benefits Manual, Ch II, Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorders WORD  PDF   
Concise Summary: The Department is proposing a number of unrelated changes to this rule. First, the Department proposes, as required by Resolves 2011, ch. 49, to remove language from § 21.02-7 (Employment Setting) stating that “Members with disabilities should constitute no more than 50% of the business’s workforce at any given worksite or location.” Second, the Department proposes to add language to clarify that a Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC) can provide psychological or behavioral consultation. Additionally, if approved by CMS, the Department is proposing to expand the list of qualified providers who can provide psychological or behavioral consultation to include Board Certified Behavior Analysts (BCBAs). Third, the Department is proposing several limits on Section 21 services. Under the proposed rule, no one-member Agency Home Support placements will be approved after the rule has been adopted. Also, the Home Support ¼ hour- T2017 will be limited to three hundred and thirty six (336) quarter hour units or eighty four (84) hours a week. The proposed rule would also limit authorizations for services to be provided out-of-state to (60) days of service within a given fiscal year and sixty (60) days within any six (6) month period. Fourth and lastly, language that had previously been in provider contracts or riders is being proposed to be added to the policy, and various technical language changes are also being proposed. PLEASE NOTE THAT DEADLINE FOR RECEIVING COMMENTS IS AUGUST 26, 2012.
Submit Comments (Opens in new window) - Comment Deadline: August 26, 2012 Posted: July 19, 2012
 
MaineCare Benefits Manual, Chapter III, Section 2, Adult Family Care Services Word   PDF    
Concise Summary: This proposed rule seeks to reduce rates paid under this section by 10%. These changes would permanently adopt changes already made on an emergency basis that took effect April 1, 2012. The reduction in rates was directed in the supplemental budget, P.L. 2011, ch. 477, part M-1.
Submit Comments (Opens in new window) - Comment Deadline: June 1, 2012 Posted: May 1, 2012
 

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