Emergency Rulemaking

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Emergency Adoption: Chapter 104, Maine State Services Manual, Section 7, Abortion Services for MaineCare Members WORD  PDF   
Concise Summary: This emergency rulemaking implements P.L. 2019, c. 274, An Act to Prevent Discrimination in Public and Private Insurance Coverage for Pregnant Women in Maine, which requires state-funded coverage for abortion services to MaineCare members when those services are not covered by Medicaid. Federal law limits Medicaid reimbursement to those abortions necessary to protect the life of the mother, or when the pregnancy results from rape or incest (the "Hyde Exceptions."). See, e.g., 42 C.F.R. § § 441.200-441.208; 10-144 C.M.R. Ch. 101 (the MaineCare Benefits Manual), Ch. II, Sec. 90.05-2 (MaineCare rule implementing Hyde Exceptions). The Act requires that, for MaineCare eligible women, abortion services that are outside the Hyde Exceptions (i.e., not covered Medicaid services) must be funded separately by using state funds within existing resources. The Legislature appropriated from the General Fund approximately $227,546 and $375,843, respectively, for the next two fiscal years to provide these new state only funded abortion services. See the Act, Sec. 10 (Appropriations and allocations). The Department requires providers to identify state-funded abortion services when submitting claims for reimbursement of state funded abortion services. This allows the Department to distinguish the state funded abortion claims from those that are covered under the Hyde Exceptions, in order to maintain compliance with federal Medicaid restrictions and requirements for reimbursement. Pursuant to the Act, the Legislature provided the Department with authority to implement these services on an emergency basis, per 5 M.R.S. § 8054, without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health, safety, or general welfare. Emergency rules are effective immediately and valid for ninety days. The Department shall hereafter initiate regular routine technical proposed rulemaking to implement this rule permanently. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: September 19, 2019
 
MaineCare Benefits Manual, Chapter II, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations. WORD  PDF   
Concise Summary: On November 8, 2018, the Department adopted the emergency major substantive rule for Ch. III, Sec. 28 Allowances for Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations. The emergency major substantive rulemaking was done to comply with Public Law 2017, Ch. 460 "the Act" which directed the Department to amend reimbursement rates to Section 28 providers to reflect final rates modeled in the April 2017 Burns report: Rate Study for Behavioral Health and Targeted Case Management Services: Final Proposed Rates for Formal Rulemaking, and also to increase the rate of reimbursement for all services by two percent. The legislation was enacted as an emergency, and directed the Department to make the rate increases effective July 1, 2018. Pursuant to the emergency major substantive rule, in order to comport with federal Medicaid law, the rate increases were made with an August 1, 2018 effective date. The November 8, 2018 emergency major substantive rule also added a new procedure code for Board Certified Behavior Analyst services Procedure Code G9007, pursuant to the Act, which required the Department to establish new reimbursement rates in accordance with the 2017 Burns rate study. The Department proposed rules for Ch. III, Section 28, in accordance with 5 M.R.S. 8072 1, to be provisionally adopted by the Department, pending legislative approval. The Department received comments during that rulemaking requesting clarification on the services that would be eligible for the August 1, 2018 BCBA services rate. Therefore, the Department has determined that emergency rulemaking is required in order to clarify the services that are eligible for the new BCBA service rate. Pursuant to 5 M.R.S. 8054, the Department finds that immediate adoption of the Ch. II, Section 28 rate is necessary to avoid an immediate threat to public health, safety or general welfare, since the Legislature determined through the Act that these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety. P.L. 2017, Ch. 460. This emergency rulemaking provides for a new provision in the rule identifying BCBA services in the Covered Services section of the rule. In addition, the emergency rule identifies the requirements for BCBA providers, consistent with requirements set forth by the Behavioral Analyst Certification Board. These standards are in effect on the effective date of this emergency rule. BCBA services rendered between August 1, 2018, the effective date of the November 8, 2018, Ch. III, Section 28, emergency major substantive rule, and the effective date of this emergency rule, will be reimbursed in accordance with the emergency major substantive rule BCBA rate, and the Ch. II rule in effect at that time. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: June 25, 2019
 
MaineCare Benefits Manual, Chapter II, Section 90, Physician Services WORD  PDF   
Concise Summary: This emergency rulemaking eliminates transsexual procedures from the list of non-covered services in Section 90.07. Elimination of this prohibition on transsexual medical procedures complies with Section 1557 of the Affordable Care Act as codified in 42 USC Sec. 18116 and its enabling regulation, 45 C.F.R. Part 92, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. Pursuant to 5 M.R.S. Section 8054, the Department has determined that immediate adoption of this rule is necessary to avoid an immediate threat to public health, safety, or general welfare by immediately removing the access barrier for transgender individuals that the current language creates. The Department is promptly following this emergency rulemaking with proposed rulemaking. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: June 18, 2019 AGENCY CONTACT PERSON: Anne E. Labonte, Comprehensive Health Planner II AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: anne.labonte@maine.gov TELEPHONE: (207)-624-4082 FAX: (207) 287-6106 TTY users call Maine relay 711
Effective Date: June 18, 2019
 
MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts these emergency rule changes to Chapter III, Section 67, Principles of Reimbursement for Nursing Facility Services, continues to ensure adequate funding for Nursing Facility Services pursuant to Public Law 2017, ch. 460, LD 925, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“the Actâ€), Sections B-1 and B-3. This rulemaking makes a number of changes to the reimbursement methodology for Nursing Facilities pursuant to Public Law 2017, ch. 460. These changes include a change in the Occupancy Adjustment to allow for reduced occupancy percentages, an increase in the utilization payment, and the adoption of a special supplemental allowance to account for wage increases. The Legislature further required that, for state fiscal year beginning July 1, 2018, the base year for each facility is its fiscal year that ended in calendar year 2016; for state fiscal years beginning on or after July 1, 2019, subsequent rebasing must be based on the most recent cost report filings available. Further, for the state fiscal year beginning July 1, 2018, the rates set for each rebasing year must include an inflation adjustment for a cost-of living percentage change in nursing facility reimbursement each year in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index - medical care services index from the prior December for professional services, nursing home, and adult day care services. Finally, the Department added an aggregate hold harmless provision to reflect that the revised method of rebasing a nursing facility’s base year may not result in the rate of reimbursement for direct and routine costs that is lower than the rate in effect June 30, 2018. The Department makes the following findings in support of this emergency rulemaking, consistent with 5 M.R.S.  § 8054. The Department finds that these changes must be implemented immediately to improve the financial condition of Section 67 providers, and protect against a threat to public health and safety posed by instances of providers closing. These changes are a benefit to Nursing Facility Services providers and ensures vulnerable members have access to medically necessary covered services, and otherwise have no adverse impact on either MaineCare providers or members. This emergency adoption will enable these rules to take effect immediately and retroactively, to August 2, 2018, pursuant to 22 M.R. S.  § 42(8). Pursuant to 5 M.R.S.  § 8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: December 4, 2018 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: heidi.bechard@maine.gov TELEPHONE: (207) 624-4074 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: December 4, 2018
 
MaineCare Benefits Manual, Chapters II and III, Section 93, Opioid Health Home Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“Departmentâ€) adopts changes to Chapters II and III, Section 93, Opioid Health Home Services of the MaineCare Benefits Manual on an emergency basis pursuant to P.L. 2017, ch. 460, Part G, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (emergency, effective July 9, 2018) (the “Actâ€) and pursuant to the Department’s emergency rulemaking authority under 5 M.R.S.  § 8054. The Act requires the Department to ensure that a continuum of evidence-based treatment and recovery support services for opioid use disorder is accessible to the people of Maine. The Department is implementing the following emergency rule changes: adding a definition of Integrated Medication Assisted Treatment (IMAT) to describe OHH service expectations; adding urine drug screening as an integral part of IMAT services; establishing levels of care (intensive, intermediate/stabilization, and maintenance) that correspond to the member’s needs; and creating a tiered reimbursement rate structure corresponding to these levels of care. Given the emergency nature of the Act, the Department does not need to make additional emergency findings to support these portions of the emergency rulemaking. In conjunction with these changes, the Department believes in order to address the current opioid epidemic additional changes are needed on an emergency basis pursuant to 5 M.R.S.  § 8054 to improve the Section 93 rules by making it easier for current and new providers to deliver IMAT services through the OHH model. In turn, this will increase accessibility to services for all individuals with opioid use disorder as envisioned under the Act. The State is currently in the midst of an opioid epidemic which claimed approximately one life per day in 2017. Funding and service-delivery requirements supporting IMAT are critical to providing MaineCare members and uninsured individuals high-quality treatment options. The Department is therefore making emergency changes to Section 93 that: alter the current staffing requirements and add a new patient navigator to the OHH team to ensure flexibility for provider organizations and expertise to meet members’ needs; create an allowance for members who meet eligibility for MaineCare Benefits Manual, Section 92, Behavioral Health Home Services, Section 91, Health Home Services, certain Section 13, Targeted Case Management Services, or Section 17, Community Support Services to receive these services in coordination with OHH services; ease requirements regarding the Electronic Health Record to allow provider flexibility in meeting OHH program requirements; provide clarification to covered services; and make minor and technical changes to the operation of OHH. These emergency changes are the result of Departmental review and stakeholder feedback. Both providers and members alike will benefit from these changes. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 27, 2018 AGENCY CONTACT PERSON: Anne E. Labonte, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: anne.labonte@maine.gov TELEPHONE: (207)-624-4082 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 27, 2018
 
MaineCare Benefits Manual, Chapter III, Section 97 and Appendices B, C, D, E, and F WORD  PDF   
Concise Summary: The Department of Health and Human Services “the Department†adopts these emergency major substantive rules to implement the requirements of two recently enacted laws: 1 Public Law 2017, ch. 304, An Act to Amend Principles of Reimbursement for Residential Care Facilities The First Act and 2 Public Law 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government The Second Actâ€. The First Act defines the process by which eligible Private Non-Medical Institution PNMI Services providers may request an Extraordinary Circumstances Allowance ECA and allows for certain regulatory compliance costs incurred by PNMI providers to be considered reasonable and necessary; these changes are implemented in Appendices C and F. The Second Act increases reimbursement for Appendices B, C, and E PNMIs. The Department also adopts various other changes to the Section 97 rules, including Appendix D, as described more specifically below. The First Act requires ECA, regulatory compliance cost, and other changes in Chapter III, Section 97 the Main Rule and Appendices C, D, and F. The Department finds that these changes must be implemented through emergency major substantive rulemaking. Separately, the Department is implementing changes required by the First Act in 10-144 C.M.R. Ch. 115, Residential Care Facilities – Room and Board Costs the State Rule those changes are routine technical. Pursuant to 5 M.R.S. 8072, “regular†major substantive rule changes are not legally effective until they are approved by the Legislature and finally adopted by an agency, which can take over a year; as such because the Department seeks to implement the Section 97 changes simultaneously with the state rule changes in order to treat similar providers equitably, it must do so through emergency major substantive rulemaking. These changes will improve the financial condition of Section 97 providers, and protect against a threat to public health and safety posed by instances of providers closing. The changes are a benefit to PNMI providers, and otherwise have no adverse impact on either MaineCare providers or members. The emergency adoption under 5 M.R.S. 8074 will enable the rule changes required by the First Act to take effect immediately, and pursuant to 22 M.R.S. 42(8), retroactively. The Change in Reimbursement Methodology Notice required by 42 C.F.R. 447.205 relating to the ECA and regulatory compliance costs was published on October 19. 2017. The Department is seeking, and anticipating receiving, approval from the federal Centers for Medicare and Medicaid Services CMS for these changes. Pending approval, the ECA and regulatory compliance cost changes in the main rule, and Appendices C and F, will be effective retroactive to November 1, 2017. The Second Act, Section B-4, requires the Department to amend the main rule and Appendix C to provide a special supplemental allowance as more specifically set forth in the rules for the fiscal year ending June 30, 2019. This allowance must be provided for increases in wages and wage-related benefits for direct care and personal care services cost components. The Second Act also directs that, for fiscal year ending June 30, 2020 and thereafter, the Appendix C MaineCare payment rates attributable to wages and salaries in each cost component must be increased by an inflation factor in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index – medical care services index. In addition, the Department added a provision to Appendix C, Sec. 2400.3 to make it clear that the increases in reimbursement required by the Section Act shall not be included in the PNMI facility’s personal care services cost cap. The Second Act, Part D, requires the Department to amend the main rule, and Appendices B and E, to increase reimbursement rates to ensure a net increase in funding of two percent (as specifically set forth in the rules), which reimbursement must be applied to wages and benefits for employees who provide direct services and not to administrators or managers. The Second Act further requires that Section 97 providers must demonstrate to the Department that the increase in wages and benefits has been granted to direct care workers; as stated in the rules, providers must retain documents reflecting compliance with this requirement in their financial records and provide such documentation to the Department upon request. Through the Second Act, the Legislature determined that these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety. As such, the Act requires the Department to implement immediate rate increases, effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Second Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R. 447.205(d) requires that public notice of changes in reimbursement for State Plan services must be published before the proposed effective date of the change. The Department published its notice of reimbursement methodology change for the Section 97 rates on July 31, 2018. Upon advice of the Office of the Attorney General, the increased rates for Appendices B, C, and E will be effective August 1, 2018, this effective date comports with the federal law requirement. Pending approval of the proposed changes to the Section 97 State Plan Amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates in Appendices B, C, and E will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S. 8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S. 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed 8 calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the P.L. 2017, and the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve month appropriation). This is not a rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months. The Department also adopts various other changes to the Section 97 rules, including Appendix D, as described more specifically below. • For Appendix C PNMIs, the Department will calculate each Appendix C PNMIs’ rate setting case mix index using the number of MaineCare residents in each case mix classification group in the facility as of March 1st for the July rate and September 1st for the January rate. • For Appendix C PNMIs, the Department will send a roster of residents and source of payment as of March 1st and September 1st to facilities for verification prior to rate setting. • Removes the Hold Harmless Provision as it is no longer applicable. • Procedure codes: S9484 HA, S9484 HE, and S9484 HI, Temporary High Intensity Services, per report per hour, are added to Appendices D, E, and F. • Removes procedure code S9484, Temporary High Intensity Services, per report per diem, from Appendix D. • Interpreter services is removed from allowability of cost and direct care staff to align with recent Chapter 1 changes. • Appendix D updates “mental retardation†to “intellectual disabilities†and “pervasive developmental disorder†to “autism spectrum disorderâ€. • Appendix D procedure codes 6000.4, 6000.6, and 6000.7 are deleted to align current Appendix D fee for service reimbursement. Procedure code 6000.5 is clearly stated in Chapter II, Section 97, Private Non-Medical Institution Services, and as such is deleted. • Appendix F 3040 Interim Per Diem Rates updates the Office of Rate-Setting as the entity that sets the facility’s interim daily rate from the Office of MaineCare Services. Pursuant to 5 M.R.S. 8073, these emergency major substantive rules will remain in effect for up to one year, or until the Legislature reviews the provisionally adopted rule, followed by the Department’s final adoption of the major substantive rule changes. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents. EFFECTIVE DATE: November 20, 2018 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner Heidi.Bechard@maine.gov AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4074 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 20, 2018
 
10-144 C.M.R. Ch. 115, Principles of Reimbursement for Residential Care Facilities – Room and Board Cost WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts these emergency rule changes in 10-144 C.M.R. Chapter 115, Principles of Reimbursement for Residential Care Facilities – Room and Board Cost to comply with (1) Public Law 2017, ch. 304 (“The First Actâ€) and (2) Public Law 2017, ch. 460, An Act To Amend Principles of Reimbursement for Residential Care Facilities and An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“The Second Actâ€). The First and Second Acts require ECA, regulatory compliance costs, inflation factor, and special wage allowance changes for Residential Care Facilities and MaineCare Section 97, Private Non-Medical Institution (PNMI) Services-Appendix C providers. The Department finds that these changes must be implemented immediately through emergency rulemaking. Separately, the Department is implementing changes required in the First and Second Acts in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 97, and those changes are major substantive. Pursuant to 5 M.R.S.  § 8072 “regular†major substantive rule changes are not legally effective until they are approved by the Legislature and finally adopted by an agency, which can take over a year. As such, because the Department seeks to implement the Section 97 changes simultaneously with this State Rule changes (in order to treat providers equitably), it must do so through emergency rulemaking. These changes will improve the financial condition of Residential Care Facility providers, and protect against a threat to public health and safety posed by instances of providers closing. The changes are a benefit to PNMI Appendix C providers and otherwise have no adverse impact on either MaineCare providers or members. The emergency adoption under 5 M.R.S.  § 8054 will enable the rule changes to take effect immediately, and pursuant to 22 M.R.S.  § 42(8), retroactively. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 20, 2018 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: heidi.bechard@maine.gov TELEPHONE: (207)-624-4074 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 20, 2018
 
MaineCare Benefits Manual, Chapters II & III, Section 26, Day Health Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts this emergency rule pursuant to P.L. 2017, ch. 460, Part B-2, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government. Part B-2 requires the Department to amend its rules to increase reimbursement rates for adult family services, adult day services, and homemaker services for the fiscal year ending June 30, 2019, by ten percent (10%). Part B-2 also requires that effective July 1, 2019, payment rats attributable to wages and salaries for personal care and related services will be increased annually by an inflation adjustment cost-of-living percentage in accordance with the United States Department of labor, Bureau of Labor Statistics Consumer Price Index, Medical care services (professional services, nursing home and adult day care services) from the prior December. These cost of living increases shall continue annually until the Department has completed a rate study for adult family care services, adult day services or homemaker services and the rates in the rate study have been implemented. This emergency rule increases the rate for S5100 HC, Day Care Services. Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  § 447.205(d) requires that public notice of changes in reimbursement for state plan services must “be published before the proposed effective date of the change.†(emphasis added). The Department published its notice of reimbursement methodology change for the Section 26 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018, which effective date comports with the federal law requirement. Pending approval of the proposed changes to the Section 26 state plan amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed (8) calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act, versus the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven-month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve-month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve-month appropriation). This is not an effective rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months. Pursuant to 5 M.R.S.  § 8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes. The Department is seeking, and anticipates receiving, approval from the Centers for Medicare and Medicaid Services (CMS) for these rate changes. Pending CMS approval, the increased rates will be effective August 1, 2018 http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 19, 2018 AGENCY CONTACT PERSON: Anne E. Labonte, Comprehensive Health Planner II AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: Anne.Labonte@maine.gov TELEPHONE: (207)-624-4082 FAX: (207) 287-1864
Effective Date: November 19, 2018
 
MaineCare Benefits Manual, Section 17, Chapter III, Allowances for Community Support Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts this emergency rule to increase the rates of reimbursement for Community Support Services pursuant to Public Law 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (the “Actâ€), Part D. The Act requires the Department to amend its rules for reimbursement rates for Community Support Services provided under the provisions of 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 17, Allowances for Community Support Services. Specific changes are as follows: • Part D of P.L. 2017, ch. 460 directs the Department to increase the rate of reimbursement for all services by two percent. Sec. D-1 and D-2 specifically require the increase in reimbursement to be applied to the wages and benefits of employees who provide direct services and not to administrators or managers. Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  § 447.205(d) requires that public notice of changes in reimbursement for State Plan services must “be published before the proposed effective date of the change.†The Department published its notice of reimbursement methodology change for the Section 17 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018; this date comports with the federal law requirement. Pending approval of the proposed changes to the Section 17 State Plan Amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed eight calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act and the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve month appropriation). This is not an effective rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months. Pursuant to 5 M.R.S.  § 8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: 11/16/2018 AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: Dean.Bugaj@maine.gov TELEPHONE: (207)-624-4045 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 16, 2018
 
MaineCare Benefits Manual, Chapter III, Section 13 Allowances for Targeted Case Management WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts this emergency rule to increase the rates of reimbursement for targeted case management services pursuant to Public Law 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (the “Actâ€), Part D. The Act requires the Department to amend its rules for reimbursement rates for targeted case management services provided under the provisions of 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 13, Allowances for Targeted Case Management. Specific changes are as follows: • Part D of P.L. 2017, ch. 460 directs the Department to increase the rate of reimbursement for all services by two percent. Sec. D-1 and D-2 specifically require the increase in reimbursement to be applied to the wages and benefits of employees who provide direct services and not to administrators or managers. Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  § 447.205(d) requires that public notice of changes in reimbursement for State Plan services must “be published before the proposed effective date of the change.†The Department published its notice of reimbursement methodology change for the Section 13 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018; this date comports with the federal law requirement. Pending approval of the proposed changes to the Section 13 State Plan Amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed eight calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act and the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve month appropriation). This is not an effective rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months. Pursuant to 5 M.R.S.  § 8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: 11/16/2018 AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: Dean.Bugaj@maine.gov TELEPHONE: (207)-624-4045 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 16, 2018
 
MaineCare Benefits Manual, Chapters II and III Section 65, Behavioral Health Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts these emergency rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapters II and III, Section 65, Behavioral Health Services to: (a) ensure broader access to crisis services for adults with intellectual disabilities; and (b) increase the rates of reimbursement for services pursuant to Public Law 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (the “Actâ€), Parts D, E and I. Specific changes are as follows: • Part D of the Act directs the Department to increase the rate of reimbursement for all Section 65 services to ensure a net increase in funding from fiscal year 2008-09 to fiscal year 2018-2019 of two percent as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. The Legislature required this increase in reimbursement to be applied to the wages and benefits of employees providing direct services to MaineCare members, and not to administrators or managers. Section 65 providers must document compliance with this requirement in their financial records and provide such documentation to the Department upon request. • Part E of the Act directs the Department to increase the reimbursement rate for Section 65 Medication Management services by fifteen percent. This increase is in addition to the two percent increase required by Part D of the Act. • Part I of the Act directs the Department to increase the reimbursement rates for Multi-Systemic Therapy (MST), Multi-Systemic Therapy for Problem Sexualized Behaviors (MST-PSB), and Functional Family Therapy (FFT) by twenty percent. This twenty percent increase, which is in addition to the two percent increase, is effective until June 30, 2019. The Department shall publish a separate notice of change in reimbursement methodology, and seek approval from the Centers of Medicare and Medicaid Services (CMS) for the Multi-Systemic Therapy and Functional Family Therapy rate changes that go into effect in 2019. Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  § 447.205(d) requires that public notice of changes in reimbursement for state plan services must “be published before the proposed effective date of the change.†The Department published its notice of reimbursement methodology change for the Section 65 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018; this date comports with the federal law requirement. Pending approval of the proposed changes to the Section 65 State Plan Amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed eight calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act and the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve month appropriation). Additionally, the Department finds that emergency rule changes are required to add certain diagnoses to Crisis Services in Chapter II. The crisis services system for adult developmental services is stressed, as the agency that previously contracted for state funded beds has declined to renew their contract with the Department. The state offers a small amount of crisis beds, but the demand outweighs the supply. Current policy language does not support serving individuals with developmental disabilities. The Department finds that it must broaden the language in Ch. II, Sections 65.06-1, 65.06-2, to extend eligibility to members with developmental disabilities. Without emergency rulemaking, the health, safety, and well-being of these members may be compromised. These rule changes allow any willing and qualified provider of crisis services under Section 65 to offer crisis beds to adult members with developmental disabilities. Additionally, the Department finds that it must add allowable staff (Direct Support Professionals) to treat this population, as those currently available under Section 65 (MHRT) do not have the education or expertise to effectively treat this population. Pursuant to 5 M.R.S.  § 8054, this emergency rule may be effective for up to ninety days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: 11/13/2018 AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: dean.bugaj@maine.gov TELEPHONE: (207)-624-4045 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 13, 2018
 
MaineCare Benefits Manual Chapters II & III, Section 96, Private Duty Nursing and Personal Care Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts these emergency rules to increase the rates of reimbursement and level of care limits for personal care and other related services pursuant to Public Law 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State (“the Actâ€), Part B. The Act requires the Department to amend its rules for reimbursement rates and level of care limits for home-based and community-based personal care and related services provided under the provisions of 10-144 C.M.R Ch. 101, MaineCare Benefits Manual, Chapters II & III, Section 96, Private Duty Nursing and Personal Care Services (“Section 96â€) and referenced in the February 1, 2016 report “Rate Review for Personal Care and Related Services: Final Rate Models†prepared for the Department by Burns & Associates, Inc. Further, Part B-3 directs the Department to ensure that caps and limitations on home-based and community-based services are increased to reflect increases in reimbursement rates that result from P.L. 2017. In addition, a recipient of services may not experience a reduction in hours solely as a result of the increased reimbursement rates authorized by the Act. This Chapter III emergency rule increases the following rates: G0299 TD (0551)-RN Services G0299 TD UN (0551)-RN Services–multiple patients (2) G0299 TD UP (0551)-RN Services-multiple patients (3) G0300 TE (0559)-LPN Services G0300 TE UN (0559)-LPN Services–multiple patients (2) G0300 TE UP (0559)-LPN Services–multiple patients (3) T1000 TD-Independent RN T1000 TD UN-Independent RN-multiple patients (2) T1000 TD UP-Independent RN–multiple patients (3) T1004 (0571)-Home Health Aide/Certified Nursing Assistant Services T1004 UN (0571)-Home Health Aide/Certified Nursing Assistant Services-multiple patients (2) T1004 UP (0571)-Home Health Aide/Certified Nursing Assistant Services–multiple patients (3) T1019 (0589)-Personal Support Services T1019-Personal Support Services (PCA Agencies only) T1019 UN-Personal Support Services (PCA Agencies only) multiple patients (2) T1019 UP-Personal Support Services (PCA Agencies only) multiple patients (3) S5125 TF (0589)-PCA Supervisit S5125 TF UN (0589)-PCA Supervisit-multiple patients (2) S5125 TF UP (0589)-PCA Supervisit–multiple patients (3) S5125 TF-PCA Supervisit (PCA Agencies only) S5125 TF UN-PCA Supervist (PCA Agencies only) multiple patients (2) S5125 TF UP-PCA Supervisit (PCA Agencies only) multiple patients (3) This Chapter II emergency rule increases the following level of care limits: Level I Level II Level III Level IV Level V Level VIII Level IX Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  § 447.205(d) requires that public notice of changes in reimbursement for State Plan services must “be published before the proposed effective date of the change.†The Department published its notice of reimbursement methodology change for the Section 96 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018, this effective date comports with the federal law requirement. Pending approval of the proposed changes to the Section 96 State Plan Amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. There are four separate proposed rate changes and increased level of care limits pending before CMS, one submitted in September 2015 (effective July 1, 2015), one submitted in September 2016 (effective July 29, 2016), one submitted in September 2017 (effective September 6, 2017), and one submitted in July 2018 (effective August 1, 2018); thus, there are four retroactive effective dates applicable for these rates included in Chapter III. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed eight calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act, and the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve month appropriation). This is not a rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months. Pursuant to 5 M.R.S.  § 8054, these emergency rules may be effective for up to ninety (90) days. The Department intends to proceed with routine technical rulemaking to permanently adopt these rules. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 13, 2018 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner Heidi.Bechard@maine.gov AGENCY NAME: Division of Policy ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-624-4074 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 13, 2018
 
MaineCare Benefits Manual, Chapter III, Section 12, Allowances for Consumer-Directed Attendant Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts this emergency rule to increase the rates of reimbursement for personal care services provided through Chapter III, Section 12, Allowances for Consumer-Directed Attendant Services pursuant to Public Law 2017, ch. 459, Part B, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government. The Department is seeking, and anticipates receiving, approval from the federal Centers for Medicare and Medicaid Services (CMS) for this change. Pending approval, the increased rates of reimbursement will be effective retroactive to August 1, 2018. The adopted rule ensures vulnerable members have access to medically necessary covered services and providers of Attendant Care Services will receive increased rates of reimbursement. Otherwise, the Department anticipates no adverse impact on either MaineCare providers or members. Further, this change is not expected to have an adverse effect on the administrative burdens of small businesses. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 13, 2018 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner Heidi.Bechard@maine.gov AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-6951 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 13, 2018
 
MaineCare Benefits Manual, Chapter III, Section 28, Allowances for Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations. WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts this major substantive emergency rule to increase the rates of reimbursement for rehabilitative and community support services pursuant to Public Law 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (the “Actâ€). The Act requires the Department to amend its rules for reimbursement rates for rehabilitative and community support services provided under the provisions of 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III of Section 28, Allowances for Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations. Specific changes are as follows: • Part C of the Act directs the Department to amend the rates of reimbursement to providers of Section 28 services to reflect the final rates modeled in the April 24, 2017 report: “Rate Study for Behavioral Health and Targeted Case Management Services: Final Proposed Rates for Formal Rulemaking†prepared for the Department by Burns & Associates, Inc. Those rate changes were made. • Part D of the Act directs the Department to increase the rate of reimbursement for all services by two percent. Sec. D-1 and D-2 specifically require the increase in reimbursement to be applied to the wages and benefits of employees providing direct services. The two percent rate increase was made to the rates as changed by the Burns study. Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  § 447.205(d) requires that public notice of changes in reimbursement for State Plan services must “be published before the proposed effective date of the change.†The Department published its notice of reimbursement methodology change for the Section 28 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018; this effective date comports with the federal law requirement. Pending approval of the proposed changes to the Section 28 State Plan Amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed eight calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act, and the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve month appropriation). This is not an effective rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months. P.L. 2017, ch. 460, Part C, Sec. C-1 directed that rulemaking authorized by the Sec. C-1 law would be a “major substantive†rule. Sec. C-1 provided for certain rate increases, and rulemaking, for Section 28 services. Therefore, for purposes of this November 8, 2018 rulemaking only, the rule is major substantive. Thereafter, unless otherwise directed by the Legislature, the rule will revert back to routine technical rulemaking status. Pursuant to 5 M.R.S.  § 8054, this emergency major substantive rule will remain in effect for up to one year or until the Legislature has completed its review of the provisionally adopted major substantive rule. The Department shall proceed with rulemaking in order to present the Legislature with a provisionally adopted major substantive rule consistent with this emergency major substantive rule. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 8, 2018 AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: Dean.Bugaj@maine.gov TELEPHONE: (207)-624-4045 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 8, 2018
 
Chapter II, Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder WORD  PDF   
Concise Summary: The Department is adopting this emergency rule in accordance with P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Actâ€). This Act provides funding to increase rates for specific procedure codes in Chapter III, Section 29. Part B of the Act provided that the Department ensure that caps and limitations on services “are increased to reflect increases in reimbursement rates that result from this Part.†The Act gave notice that the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety…†Pursuant to this Legislative determination, the requirements of 5 M.R.S.  § 8054(1) are satisfied. On September 12, 2018, the Department adopted an emergency major substantive rule for Section 29, Ch. III, as directed in the Act, to increase reimbursement rates for eighteen (18) procedure codes, with a retroactive effective date of July 1, 2018. In accordance with Part B of the Act, therefore, this Ch. II rulemaking raises the caps to reflect those rate increases. The emergency rule adopts the following changes: • Raises the combined limit for members who receive Home Support (Remote or  Ľ hour), Community Support, or Shared Living to $58,168.50; • Raises the annual limit on Respite Services to $1,224.60; • Raises the per diem limit for quarter hour (1/4) billing for Respite to $110.21. The increased caps will be effective retroactive to July 1, 2018. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application for a period not to exceed eight calendar quarters, and there is no adverse financial impact on any MaineCare member or provider. In addition, the Department sought, and obtained approval, from the Centers for Medicare and Medicaid Services (“CMSâ€) to submit a waiver amendment making the rate changes retroactive to July 1, 2018. Pursuant to 5 M.R.S.  § 8054(3), this emergency rule will be effective for 90 days. The Department will pursue routine technical rulemaking for Chapter II, Section 29 to avoid any lapse. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 7, 2018 AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner II AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: rachel.posner@maine.gov TELEPHONE: (207) 624-6951 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 7, 2018
 
MaineCare Benefits Manual, Chapters II and III, Section 2 Adult Family Care Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts this emergency rule pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (the “Actâ€), Part B-2. The Act requires the Department to amend its rules to increase reimbursement rates for adult family services, adult day services, and homemaker services for the fiscal year ending June 30, 2019, by ten percent (10%); and directs that MaineCare payment rates for state fiscal year ending June 30, 2020 be increased by an inflation adjustment cost-of-living percentage in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index from the prior December for professional services, nursing home and adult day care services. These cost of living increases shall continue annually until the Department has completed a rate study for adult family care services and the rates in the rate study have been implemented. This rulemaking increases the rates for Adult Family Care Homes and Adult Family Care Homes “Remote Islandâ€. The Act requires that the increased rates must be attributed directly to the wages and salaries of the professional staff delivering the personal care and related services to members. The Act also clarifies that the increased reimbursement rates shall not negatively affect members’ caps on services. As such, the Department implements changes in Chapter II, Section 2, Sections 2.05-2 and 2.05-3 to clarify that the increased reimbursement provided herein shall not be counted towards members’ financial caps for services under Section 96 or under the waiver programs. Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  §sec; 447.205(d) requires that public notice of changes in reimbursement for state plan services must “be published before the proposed effective date of the change.†(emphasis added). The Department published its notice of reimbursement methodology change for the Section 2 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018, which effective date comports with the federal law requirement. Pending approval of the proposed changes to the Section 2 state plan amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §sec;8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  §sec; 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed (8) calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act, versus the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven-month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve-month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve-month appropriation). This is not an effective rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months. Pursuant to 5 M.R.S.  §sec; 8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 6, 2018 AGENCY CONTACT PERSON: Anne E. Labonte, Comprehensive Health Planner II Anne.Labonte@maine.gov AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: Anne.Labonte@maine.gov TELEPHONE: (207) 624-4082 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 6, 2018
 
MaineCare Benefits Manual, Chapter III, Section 23, Developmental and Behavioral Clinic Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Departmentâ€) adopts this emergency rule pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government. Part D-1 requires the Department increase the rates of reimbursement for Section 23, Development and Behavioral Clinic Services, to ensure a net increase in funding from fiscal year 2008-2009 to fiscal year 2018-2019 of two (2) % as long as no rates for a service is lower than the rate reimbursed as of January 1, 2018. This rulemaking requires that the increase in reimbursement rates must be applied to wages and benefits for employees who provide direct services as required by Part D-2 of P.L. 2017, ch. 460. In compliance with the law, providers must ensure that the increase in reimbursement rates effective August 1, 2018, is applied in full to wages and benefits to employees who provide direct services. Providers must document compliance with this requirement in their financial records and provide such documentation to the Department upon request. Through the Act, the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety.†As such, the Act requires the Department to implement “immediate rate increases,†effective July 1, 2018. However, the Act did not become law until July 9, 2018, following a Legislative override of the Governor’s veto. Because the Act involves MaineCare reimbursement, these rule changes are also governed by federal Medicaid law. 42 C.F.R.  §sec; 447.205(d) requires that public notice of changes in reimbursement for state plan services must “be published before the proposed effective date of the change.†(emphasis added). The Department published its notice of reimbursement methodology change for the Section 23 rates on July 31, 2018. Upon the advice of the Office of the Attorney General, the increased rates will be effective August 1, 2018, which effective date comports with the federal law requirement. Pending approval of the proposed changes to the Section 23 state plan amendment that were submitted to the Centers for Medicare and Medicaid Services, the increased rates will be implemented with an August 1, 2018 effective date. Pursuant to the Legislative determination regarding the urgent need for these reimbursement increases, the requirements of 5 M.R.S.  §sec;8054(1) are satisfied and emergency rulemaking is appropriate. Similarly, an August 1, 2018 retroactive effective date is necessary to implement these changes as soon as possible. The retroactive application comports with 22 M.R.S.  §sec; 42(8), which authorizes the Department to adopt rules with a retroactive application (where there is no adverse impact on providers or members) for a period not to exceed (8) calendar quarters. To remedy the difference between the July 1, 2018 effective date set forth in the Act, versus the August 1, 2018 date that is permissible pursuant to federal Medicaid law, the Department has recalculated the annual appropriation of funds for this service into a temporary eleven month rate. As such, providers will, over the course of eleven months, receive equivalent aggregate payments as would have been received under a twelve month rate. Beginning on July 1, 2019, rates will be annualized (based upon a twelve month appropriation). This is not an effective rate decrease, but rather a redistribution of the annual appropriation over twelve months, rather than eleven months.   Pursuant to 5 M.R.S.  §sec; 8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes. Please see http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 6, 2018 AGENCY CONTACT PERSON: Thomas M Leet, Comprehensive Health Planner II AGENCY NAME: Division of Policy ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: Thomas.Leet@maine.gov TELEPHONE: (207)-624-4068 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 6, 2018
 
Emergency MaineCare Benefits Manual, Chapter III, Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities WORD  PDF   
Concise Summary: The Department is adopting this emergency rule in accordance with P.L. 2017, ch. 459, Part B, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Actâ€). The Act requires the Department to amend its rules for reimbursement rates for home-based and community-based personal care and related services provided under the provisions of 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities and referenced in the February 1, 2016 report “Rate Review for Personal Care and Related Services: Final Rate Models†prepared for the Department by Burns & Associates, Inc. These increased rates will be effective retroactive to July 1, 2018. The Act gave notice that the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine, and require the following legislation as immediately necessary for the preservation of the public peace, health and safety…†Pursuant to this Legislative determination, the requirements of 5 M.R.S.  § 8054(1) are satisfied. The Department moved to emergency rulemaking once the rates were calculated and finalized. Rates were increased for 30 procedure codes. In addition, the emergency rule adds in the code and rate for Home Health Aide Visit—Home Health Services, which was inadvertently deleted during final adoption of this rule in January, 2018. Pursuant to 5 M.R.S.  § 8054 (3), this emergency rule may be effective for up to ninety (90) days. The Department intends to proceed with routine technical rulemaking to permanently adopt this rule. These increased rates will be effective retroactive to July 1, 2018. The Department has determined that a retroactive increase to the beginning of the state fiscal year is appropriate, since the appropriation is intended for the entire fiscal year. The retroactive application comports with 22 M.R.S. § 42(8) which authorizes the Department to adopt rules with a retroactive application for a period not to exceed eight calendar quarters and there is no adverse financial impact on any MaineCare member or provider. In addition, the Department sought, and obtained approval, by the Centers for Medicare and Medicaid Services (“CMSâ€) to submit a waiver amendment making the rate changes retroactive to July 1, 2018. In addition to this emergency rulemaking, the Department is simultaneously adopting emergency rules for Sec. 19, Ch. II, which rulemaking raises the program cap, in accordance with the Act. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: October 9, 2018 AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner II AGENCY NAME: Division of Policy ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-624-6951 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: October 9, 2018
 
Emergency MaineCare Benefits Manual, Chapter II, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities WORD  PDF   
Concise Summary: The Department is adopting this emergency rule in accordance with P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Actâ€). This Act provides funding to increase personal care and related services provided under Section 19. The Act further directs the Department to “ensure that caps and limitations on home-based and community-based services are increased to reflect increases in reimbursement rates that result from this Part,†and that “A recipient of services may not experience a reduction in hours solely as a result of increased reimbursement.†Act, Sec. B-3. The Act gave notice that the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety…†Pursuant to this Legislative determination, the requirements of 5 M.R.S.  § 8054(1) are satisfied. The Department is adopting emergency rules for Sec. 19, Ch. III, as directed in the Act, and increasing personal care and related rates, simultaneously with the adoption of these emergency Ch. II rules. In accordance with the Act, therefore, this Ch. II rulemaking raises the program cap to $5,425.00 per member per month (Section 19.06.A). The increased cap will be effective retroactive to July 1, 2018. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application for a period not to exceed eight calendar quarters and there is no adverse financial impact on any MaineCare member or provider. In addition, the Department sought, and obtained approval, from the Centers for Medicare and Medicaid Services (“CMSâ€) to submit a waiver amendment making the rate changes retroactive to July 1, 2018. Pursuant to 5 M.R.S.  § 8054(3), this emergency rule will be effective for 90 days. The Department will be pursuing routine technical rulemaking for Chapter II, Section 19 to avoid any lapse. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: October 9, 2018 AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner II AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: rachel.posner@maine.gov TELEPHONE: (207)-624-6951 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: October 9, 2018
 
MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, MaineCare Services CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder EMERGENCY MAJOR SUBSTANTIVE RULE ADOPTED RULE NUMBER: CONCISE SUMMARY: The Department is adopting this emergency major substantive rule in accordance with P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Actâ€). This Act provides funding to increase reimbursement rates for eighteen (18) procedure codes in Chapter III, Section 29. The legislation directs the Department to increase the rates for the specific procedure codes in equal proportion to the funding provided for that purpose, and to do so via major substantive rulemaking. The Act gave notice that the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety…†Pursuant to this Legislative determination, the requirements of 5 M.R.S.  § 8054(1) are satisfied. These increased rates will be effective retroactive to July 1, 2018. The retroactive application comports with 22 M.R.S.  § 42(8), which authorizes the Department to adopt rules with a retroactive application for a period not to exceed 8 calendar quarters and there is no adverse financial impact on any MaineCare member or provider. In addition, the Department sought, and obtained approval, by the Centers for Medicare and Medicaid Services (“CMSâ€) to submit a waiver amendment making the rate changes retroactive to July 1, 2018. In creating the increased rates, the Department examined utilization of these services, and then calculated rates to ensure parity between Section 29 and Section 21, to lessen administrative complications for providers. Consistent with the rate increase, the emergency rule also increases the maximum amount that can be billed in a single day for Respite. Pursuant to 5 M.R.S.  § 8054 (3), this emergency rule may be effective for up 12 months, or until the Legislature has completed its review. The Department intends to proceed with major substantive rulemaking, which will be provisionally adopted, and then submitted to the Legislature for its review. This change is not expected to have an adverse effect on the administrative burdens of small businesses. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: September 12, 2018 AGENCY CONTACT PERSON: Trista Collins, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street, 11 State House Station Trista.Collins@maine.gov Augusta, Maine 04333-0011 TELEPHONE: (207)-624-6951 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: September 12, 2018
 
MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autism Spectrum Disorder WORD  PDF   
Concise Summary: This emergency major substantive rule is adopted in accordance with P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Actâ€). The Act gave notice that the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety….†Pursuant to this Legislative determination, the requirements of 5 M.R.S.  § 8054(1) are satisfied. The Act provides funding to increase reimbursement rates for specific procedure codes in Chapter III, Section 21. The legislation directed the Department to increase the rates by rulemaking for the specific procedure codes in equal proportion to the funding provided for that purpose. In addition to the 33 rate increases required by P.L. 2017, ch. 459, the Department has also increased the rate for a 34th procedure code – T2017 QC (Home Support, Habilitation, residential, waiver – Remote Support – Monitor only). In accordance with 5 M.R.S. Sec. 8054, the Department has determined that this rate increase needs to be done in this emergency rulemaking for it is necessary to avoid an immediate threat to public health, safety or general welfare. These increased rates will be effective retroactive to July 1, 2018, as directed by the Act. The retroactive application of this rule comports with 22 M.R.S. Sec. 42(8) which authorizes the Department to adopt rules with a retroactive application for a period not to exceed 8 calendar quarters and there is no adverse financial impact on any MaineCare member or provider. In addition, the Department sought, and obtained, approval by the Center for Medicare and Medicaid Services (“CMSâ€) to be able to submit a waiver amendment that will make the rate increases for these Medicaid waiver services retroactive to July 1, 2018. In creating the increased rates, the Department examined utilization of these services, and then calculated rates to ensure parity between Section 21 and Section 29, to lessen administrative complications for providers The Maine Legislature has designed the Ch. III, Section 21 regulation as a major substantive rule. Pursuant to 5 M.R.S.  §8073, this emergency major substantive rule may be effective for up to twelve months, or until the Legislature has completed its review. The Department intends to proceed with major substantive rulemaking, which will be provisionally adopted, and then submitted to the Legislature for its review. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: September 11, 2018 AGENCY CONTACT PERSON: Trista Collins, Comprehensive Health Planner Trista.Collins@maine.gov AGENCY NAME: Division of Policy ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-624-4094 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: September 11, 2018
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services WORD  PDF   
Concise Summary: The Department adopts this emergency rule pursuant to Resolves 2017, ch. 41, Resolve, Regarding Medicaid Reimbursement for Rehabilitation Hospitals. The adopted rule amends the Department of Health and Human Services Rule, Chapter 101, MaineCare Benefits Manual, Chapter III, Section 45.06, to increase the Medicaid per discharge reimbursement rate provided to rehabilitation hospitals to fifteen-thousand, one-hundred, sixty-one dollars and forty-three cents ($15,161.43) and reduces the total hospital supplemental pool as described in Section 45.07, by four-hundred thousand dollars ($400,000). The Legislature adjudged that immediate adoption is necessary for the preservation of the public peace, health, and safety under 5 M.R.S.  § 8054. As such, no additional findings by the Department are required in support of this emergency rulemaking. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: July 10, 2018
 
MaineCare Benefits Manual, Chapters II & III, Section 96, Private Duty Nursing and Personal Care Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Department”) adopts these emergency rules to increase the rates of reimbursement and level of care limits for personal care and other related services pursuant to Public Law 2017, ch. 284, Part MMMMMMM-1, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2018 and June 30, 2019. P.L. 2017, ch. 284, Part MMMMMMM-1 requires the Department to amend its rules for reimbursement rates and level of care limits for home-based and community-based personal care and related services provided under the provisions of 10-144 C.M.R Ch. 101, MaineCare Benefits Manual, Chapters II & III, Section 96, Private Duty Nursing and Personal Care Services and referenced in the February 1, 2016 report “Rate Review for Personal Care and Related Services: Final Rate Models” prepared for the Department by Burns & Associates, Inc. Further, Part MMMMMMM-1 directs the Department that the increase in rates of reimbursement must be applied in equal proportion to all home-based and community-based personal care and related services referenced in the Burns & Associates, Inc. report using the funding provided for that purpose in Chapter 284. Chapter 284 provides funding to increase these rates. See Part ZZZZZZ, Section ZZZZZZ-2. P.L. 2017, ch. 284, Part TTTT, Section TTTT-1 authorizes the Department to adopt rules increasing these rates and level of care limits on an emergency basis without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health, safety or general welfare. The Legislature did not appropriate additional funding for these rate and level of care increases beyond June 30, 2018, therefore, rates and level of care increases will revert to their current levels (pre-July 1, 2017) on July 1, 2018. This Chapter III emergency rule increases the following rates: G0299 (0551)-RN Services G0299 TD UN (0551)-RN Services–multiple patients (2) G0299 TD UP (0551)-RN Services-multiple patients (3) G0300 TE (0559)-LPN Services G0300 TE UN (0559)-LPN Services–multiple patients (2) G0300 TE UP (0559)-LPN Services–multiple patients (3) T1000 TD-Independent RN T1000 TD UN-Independent RN-multiple patients (2) T1000 TD UP-Independent RN–multiple patients (3) T1004 (0571)-Home Health Aide/Certified Nursing Assistant Services T1004 UN (0571)-Home Health Aide/Certified Nursing Assistant Services-multiple patients (2) T1004 UP (0571)-Home Health Aide/Certified Nursing Assistant Services–multiple patients (3) T1019 (0589)-Personal Support Services T1019-Personal Support Services (PCA Agencies only) T1019 UN-Personal Support Services (PCA Agencies only) multiple patients (2) T1019 UP-Personal Support Services (PCA Agencies only) multiple patients (3) S5125 TF (0589)-PCA Supervisit S5125 TF UN (0589)-PCA Supervisit-multiple patients (2) S5125 TF UP (0589)-PCA Supervisit–multiple patients (3) S5125 TF-PCA Supervisit (PCA Agencies only) S5125 TF UN-PCA Supervist (PCA Agencies only) multiple patients (2) S5125 TF UP-PCA Supervisit (PCA Agencies only) multiple patients (3) This Chapter II emergency rule increases the following level of care limits: Level I Level II Level III Level IV Level V Level VIII Level IX Pursuant to 5 M.R.S. § 8054, these emergency rules may be effective for up to ninety (90) days. The Department intends to proceed with routine technical rulemaking to permanently adopt these rules. These changes are not expected to have an adverse effect on the administrative burdens of small businesses. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 14, 2017 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-624-4074 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 14, 2017
 
MaineCare Benefits Manual, Chapter III, Section 12, Consumer-Directed Attendant Services. WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Department”) adopts this emergency rule to increase the rates of reimbursement for personal care services provided through Chapter III, Section 12, Allowances for Consumer-Directed Attendant Services pursuant to Public Law 2017, ch. 284, Part MMMMMMM-1, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2018 and June 30, 2019. The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services (CMS) for this change. Pending approval, the increased rates of reimbursement will be effective retroactive to July 1, 2017 through June 30, 2018. The new rates will sunset on June 30, 2018, as the rate increases were funded by single year appropriations. Rates will revert to original values on July 1, 2018. The adopted rule ensures vulnerable members have access to medically necessary covered services and providers of Attendant Care Services will receive increased rates of reimbursement. Otherwise, the Department anticipates no adverse impact on either MaineCare providers or members. Further, this change is not expected to have an adverse effect on the administrative burdens of small businesses. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: November 14, 2017 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-6951 FAX: (207) 287-1864 TTY users call Maine relay 711
Effective Date: November 14, 2017
 
MaineCare Benefits Manual, Chapter III, Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities WORD  PDF   
Concise Summary: This emergency rule increases reimbursement rates to comply with Public Law 2017, ch. 284, (Chapter 284) Part MMMMMMM-1, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Funds and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2018 and June 30, 2019. P.L. 2017, ch. 284, Part MMMMMMM-1 requires the Department to amend its rules for reimbursement rates for home-based and community-based personal care and related services provided under the provisions of 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities and referenced in the February 1, 2016 report “Rate Review for Personal Care and Related Services: Final Rate Models” prepared for the Department by Burns & Associates, Inc. Further, Part MMMMMMM-1 directs the Department that the increase in rates of reimbursement must be applied in equal proportion to all home-based and community-based personal care and related services referenced in the Burns & Associates, Inc. report using the funding provided for that purpose in Chapter 284. Chapter 284 provides funding to increase these rates. See Part ZZZZZZ, Section ZZZZZZ-2. P.L. 2017, Ch. 284, Part TTTT § TTTT-1 authorizes the Department to adopt rules increasing these rates on an emergency basis without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health, safety or general welfare. The Legislature did not appropriate additional funding for these rate increases beyond June 30, 2018; therefore, rates will revert to their current levels (pre-July 1, 2017) on July 1, 2018. The emergency rule increases the following rates: S5125 U7-Attendant Care Services (Personal Care Services, Participant Directed Option) S5125 U7 UN-Attendant Care Services (Personal Care Services, Participant Directed Option)-2 members served S5125 U7 UP-Attendant Care Services (Personal Care Services, Participant Directed Option)-3 members served T1019 U7 (0589)-Personal Care Services (Agency PSS) T1019 U7 UN-Personal Care Services (Agency PSS)-2 members served T1019 U7 UP-Personal Care Services (Agency PSS)-3 members served T1005 Respite Care Services, in the home T1005 UN- Respite Care Services, in the home-2 members served T1005 UP-Respite Care Services, in the home-3 members served T1005 U7-Respite Care Services, in the home-Participant Directed Option T1005 UN-Respite Care Services, in the home-Participant Directed Option-2 members served T1005 UP-Respite Care Services, in the home-Participant Directed Option-3 members served T1005 (0669) Respite Care, in the home by CNA/Home Health Aide T1005 UN (0669) Respite Care, in the home by CNA/Home Health Aide-2 members served T1005 UP (0669) Respite Care, in the home by CNA/Home Health Aide-3 members served G0299 (0551) Skilled Nursing Visit (R.N.) (Non-Medicare Certified Home Health Agency)-Home Health Services G0299 U7 UN (0551) Skilled Nursing Visit (R.N.) (Non-Medicare Certified Home Health Agency)-Home Health Services-2 members served G0299 U7 UP (0551) Skilled Nursing Visit (R.N.) (Non-Medicare Certified Home Health Agency)-Home Health Services-3 member served G0300 (0559) Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency)-Home Health Services G0300 U7 UN (0559) Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency)-Home Health Services-2 members served G0300 U7 UP (0559) Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency)-Home Health Services-3 members served T1004 (0581) Certified Nurse’s Aide-Home Health Services T1004 U7 UN (0581) Certified Nurse’s Aide-Home Health Services-2 members served T1004 U7 UP (0581) Certified Nurse’s Aide-Home Health Services-3 members served G0156 (0571) Home Health Aide- Home Health Services G0156 (0571) Home Health Aide- Home Health Services-2 members served G0156 (0571) Home Health Aide- Home Health Services-3 members served G0299 Skilled Nursing Visit (R.N.) – Home Health Services G0299 UN Skilled Nursing Visit (R.N.) – Home Health Services-2 members served G0299 UP Skilled Nursing Visit (R.N.) – Home Health Services-3 members served Pursuant to 5 M.R.S. § 8054 (3), this emergency rule may be effective for up to ninety (90) days. The Department intends to proceed with routine technical rulemaking to permanently adopt this rule. These increased rates will be effective retroactive to July 1, 2017. The Department has determined that a retroactive increase to the beginning of the state fiscal year is appropriate, since the appropriation is intended for the entire fiscal year. The retroactive application comports with 22 M.R.S.§ 42(8) which authorizes the Department to adopt rules with a retroactive application for a period not to exceed eight calendar quarters and there is no adverse financial impact on any MaineCare member or provider. This routine technical rule will be effective for 90 days. A companion rule is being proposed to permanently adopt the rate change. This change is not expected to have an adverse effect on the administrative burdens of small businesses. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: November 1, 2017
 
Emergency Major Substantive Rule Adoption, MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder WORD  PDF   
Concise Summary: The Department adopts this emergency rule in accordance with P.L. 2017, ch. 284 (An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2018 and June 30, 2019), §§§ ZZZZZZZ-9, MMMMMMM-2 and TTTT-1, which provided funding to increase reimbursement rates for 16 procedure codes in Chapter III, Section 29, and directed the Department – via major substantive rulemaking – to increase the rates for the specific procedure codes in equal proportion to the funding provided. The Department has also increased the rate for a 17th procedure code in order to create consistency among similar services within the waiver. These rates will be effective retroactive to July 1, 2017. Funding for these rate increases was only appropriated for SFY18. The Legislature did not appropriate additional funding for these rates beyond June 30, 2018; therefore, rates increased for SFY18 will revert to their current levels (pre July 1, 2017) on July 1, 2018. The Legislature granted emergency major substantive rulemaking authority for these rate increases, which the Department commenced once the rates were calculated and finalized. In creating the rates for the codes shown below, the Department examined utilization of these services, and then calculated rates to ensure parity between Section 29 and Section 21, to lessen administrative complications for providers. In addition, the Department is adding two procedure codes for Shared Living services as the Department is contemporaneously adopting an emergency rule for Chapter II, Section 29 to add this benefit as a covered service for members. These rates are consistent with the rates for the same services under Section 21, and include increased rates for SFY18 that will revert to their current levels (pre July 1, 2017) pursuant to P.L. 2017, ch. 284. This change is not expected to have an adverse effect on the administrative burdens of small businesses. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: October 1, 2017
 
Emergency Adopted Major Substantive Rule, MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder WORD  PDF   
Concise Summary: This emergency major substantive rule is adopted in accordance with P.L. 2017, ch. 284, Sec. TTTT-1, which authorized the Department to adopt emergency rules as necessary to implement provisions of P.L. 2017, ch. 284. P.L. 2017, ch. 284 provides funding to increase reimbursement rates for 23 procedure codes in Chapter III, Section 21. The legislation directed the Department to increase the rates for the specific procedure codes in equal proportion to the funding provided for that purpose. In addition to the rate increases required by P.L. 2017, ch. 284, the Department has also increased the rate for a 24th procedure code, as the Department has determined that this rate increase needs to be done in this emergency rulemaking to avoid an immediate threat to public health, safety or general welfare. These increased rates will be effective retroactive to July 1, 2017. The Legislature did not appropriate additional funding for these rate increases beyond June 30, 2018; therefore, rates will revert to their current levels (pre-July 1, 2017) on July 1, 2018. The Department moved to emergency rulemaking once the rates were calculated and finalized. In creating the rates for the 24 codes, the Department examined utilization of these services, and then calculated rates to ensure parity between Section 21 and Section 29, to lessen administrative complications for providers. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: September 29, 2017, retroactive to July 1, 2017
 
Emergency Adoption, MaineCare Benefits Manual, Chapter II, Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder WORD  PDF   
Concise Summary: The Department adopts this emergency rule in accordance with P.L. 2017, ch. 284 (An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2018 and June 30, 2019), which provided funding to increase the annual cap for services provided under Section 29 from $23,771 to $47,500. The Act funded Shared Living services as a new residential Covered Service available to eligible members under Section 29. The Department has increased the annual combined services cap from the $47,500 in the legislation to $52,425, to accommodate the annual cost of the newly added Shared Living service, given the rate increase for this service for SFY18, as implemented in a contemporaneous emergency rule for Chapter III, Section 29. In addition, the Department is adding Shared Living, and removing Work Support from, this cap, which will now include Home Support, Community Support, and Shared Living. The Department has increased the annual cap on Respite services to accommodate the rate increase for this service for SFY18 in Chapter III, Section 29, which the Department is also engaged in concurrent emergency rulemaking. Both of these increases in caps will be retroactive to July 1, 2017, pursuant to the increased rates for services in the legislation, and pursuant to 22 M.R.S. 42(8). The emergency rule implements these changes by adding definitions for Administrative Oversight Agency, Shared Living, and Shared Living Provider, and by adding Shared Living as a Covered Service. The combined services cap has been increased to $52,425, and Shared Living has been added to the services included under the cap. Work Support-Individual and Work Support-Group have been removed from the cap. Removing these services from the cap removes the limit on Work Support, and allows members flexibility to use the capped amount for the other services. The annual limit on Respite has been increased from $1,000 to $1,100. The weekly cap on Home Support-Remote Support has been removed to increase member flexibility. These changes are not expected to have an adverse effect on the administrative burdens of small businesses. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: October 1, 2017
 
Emergency Adoption, MaineCare Benefits Manual, Chapters II & III, Section 93, Opioid Health Home Services WORD  PDF  | Link To Application For Opioid Health Homes 
Concise Summary: The Emergency adopted rule establishes the MaineCare Opioid Health Home (OHH) Services program for addressing the opioid crisis in Maine. The OHH initiative is an innovative model providing comprehensive, coordinated care focused on serving the MaineCare population. In addition to expanding primary care access to treatment for an individual’s substance abuse dependency, the OHH integrates physical, social, and emotional supports to provide holistic care. The model provides a community-based support system focused on team-based clinical care. The OHH team model involves a range of qualified staff, including a Clinical Team Lead, Medication Assisted Therapy (MAT) prescriber, Nurse Consultant, Licensed Alcohol and Drug Counselor, Certified Clinical Supervisor, and Peer Recovery Coach. It is expected that this newly established OHH program will not only result in more individuals receiving the substance abuse treatment they need, but will also lead to improvements in the quality of care they are receiving. OHH services are optional, and members can choose to receive the services from any OHH. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. LINK TO OPIOID HEALTH HOMES APPLICATION: https://www.surveymonkey.com/r/OHHApplication
Effective Date: April 11, 2017
 
MaineCare Benefits Manual, Chapter III, Section 18, Allowances for Home and Community Based Services for Adults with Brain Injury WORD  PDF   
Concise Summary: The Department is adopting via emergency rulemaking a 1% increase to certain rates in Chapter III, Section 18 in accordance with P.L. 2016, ch. 477 (An Act to Increase Payments to MaineCare Providers That Are Subject to Maine’s Service Provider Tax), which provides additional appropriations to certain MaineCare providers that are subject to the service provider tax and that have experienced a recent increase in the tax from 5% to 6%. The Legislature enacted this law as an emergency measure, effective April 15, 2016, recognizing that providers affected by the tax increase had insufficient reserves to withstand this cost increase and that immediate funding was necessary to enable providers to continue providing MaineCare services. As set forth in the Basis Statement, the Department adopts changes to this rule on an emergency basis with the increased rates effective retroactive to April 15, 2016.
Effective Date: November 15, 2016
 
MaineCare Benefits Manual, Chapter III, Section 97, Private Non-Medical Institution Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Department”) adopts this emergency major substantive rule to increase the rates of reimbursement to Private Non-Medical Institution Services providers pursuant to Public Law 2016, Chapter 477, An Act To Increase Payments to MaineCare Providers That Are Subject to Maine’s Service Provider Tax. In addition, for Chapter III, Section 97 (the “Main Rule”) and Chapter III, Section 97, Appendix C only, the Department repeals and replaces the March 8, 2016 emergency major substantive rule, which made changes pursuant to Resolves 2015, ch. 45, Resolve, To Require the Department of Health and Human Services to Provide Supplemental Reimbursement to Residential Care Facilities in Remote Island Location. Those changes are incorporated into this emergency major substantive rulemaking. The Department makes the following findings in support of this emergency major substantive rulemaking. Similar to the determinations made by the Legislature in P.L. 2016, ch. 477, the Department finds that these rule changes should be implemented immediately to preserve public health and safety. Section 97 providers have insufficient reserves to withstand cost increases and have experienced an increase in the Service Provider Tax since January 1, 2016. In addition Appendix C providers who are “remote island facilities” also require that the reimbursement rate increases implemented pursuant to Resolves 2015, ch. 45 and the Department’s March 8, 2016 emergency major substantive rule be continued, so that providers are not negatively affected. Remote Island Facilities are facilities located on an island not connected to the mainland by a bridge. All of these changes provide benefits to Section 97 providers, and ensure the continued provision of services to MaineCare members. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: October 25, 2016
 
MaineCare Benefits Manual, Chapter III, Section 20, Allowances for Home and Community-Based Services for Adults with Other Related Conditions WORD  PDF   
Concise Summary: The Department is adopting via emergency rulemaking a 1% increase to certain rates in Chapter III, Section 20 in accordance with P.L. 2016, ch. 477 (An Act to Increase Payments to MaineCare Providers That Are Subject to Maine’s Service Provider Tax), which provides additional appropriations to certain MaineCare providers that are subject to the service provider tax and that have experienced a recent increase in the tax from 5% to 6%. The Legislature enacted this law as an emergency measure, effective April 15, 2016, recognizing that providers affected by the tax increase had insufficient reserves to withstand this cost increase and that immediate funding was necessary to enable providers to continue providing MaineCare services. As set forth in the Basis Statement, the Department adopts changes to this rule on an emergency basis with the increased rates effective retroactive to April 15, 2016. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: October 5, 2016
 
MaineCare Benefits Manual, Chapter III, Section 2, Adult Family Care Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (“the Department”) adopts this emergency rule to increase the rates of reimbursement for Adult Family Care Services pursuant to: 1) Public Law 2016, Chapter 481, Part C, An Act To Provide Funding to the Maine Budget Stabilization Fund and To Make Additional Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2016 and June 30, 2017. This emergency adopted rule implements a four (4) percent cost-of-living rate increase for adult family care homes for the fiscal year ending June 30, 2017. The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services (CMS) for this change. Pending approval, the four (4) percent rate increase will be effective retroactive to July 1, 2016. 2) Resolves 2015, ch. 45, Resolve, To Require the Department of Health and Human Services To Provide Supplemental Reimbursement to Adult Family Care Homes and Residential Care Facilities in Remote Island Locations. The Department previously engaged in emergency rulemaking followed by routine technical rulemaking that added language to the rule providing for a supplemental rate payment of fifteen (15) percent to adult family care homes that satisfy the definition of remote island facilities. The Department did not include a case mix chart specific to remote island facilities that identified the increased rates and now seeks to do so with an emergency adoption of this rule. As noted previously, the Department is seeking and anticipates receiving CMS approval for the change so that the supplemental rate payment will be retroactive to October 1, 2015. Both of these rate increases for Adult Family Care Services ensure vulnerable members have access to medically necessary covered services, and otherwise have no adverse impact on either MaineCare providers or members. Further, this change is not expected to have an adverse effect on the administrative burdens of small businesses. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: October 4, 2016
 
MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Based Benefits for Adults with Intellectual Disabilities or Autistic Disorder WORD  PDF   
Concise Summary: The Department is adopting via emergency major substantive rulemaking a 1% increase to certain rates in Chapter III, Section 21, in accordance with P.L. 2016, ch. 477 (An Act to Increase Payments to MaineCare Providers That Are Subject to Maine’s Service Provider Tax), which provides additional appropriations to certain MaineCare providers that are subject to the service provider tax and that have experienced a recent increase in the tax from 5% to 6%. The Legislature enacted this law as an emergency measure, effective April 15, 2016, recognizing that providers affected by the tax increase had insufficient reserves to withstand this cost increase and that immediate funding was necessary to enable providers to continue providing MaineCare services. As set forth in the Basis Statement, the Department adopts changes to this rule on an emergency basis with the increased rates effective retroactive to April 15, 2016. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: September 28, 2016
 
MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder WORD  PDF   
Concise Summary: The Department is adopting via emergency major substantive rulemaking a 1% increase to certain rates in Chapter III, Section 29, in accordance with P.L. 2016, ch. 477 (An Act to Increase Payments to MaineCare Providers That Are Subject to Maine’s Service Provider Tax), which provides additional appropriations to certain MaineCare providers that are subject to the service provider tax and that have experienced a recent increase in the tax from 5% to 6%. The Legislature enacted this law as an emergency measure, effective April 15, 2016, recognizing that providers affected by the tax increase had insufficient reserves to withstand this cost increase and that immediate funding was necessary to enable providers to continue providing MaineCare services. As set forth in the Basis Statement, the Department adopts changes to this rule on an emergency basis with the increased rates effective retroactive to April 15, 2016. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: September 28, 2016
 
MaineCare Benefits Manual, Chapters II & III, Section 17, Community Support Services and Allowances for Community Support Services WORD  PDF   
Concise Summary: The Department adopts this emergency rule to effectuate the following changes: 1. Following various changes to Ch. II Section 17 Community Support Services adopted by the Department on March 22, 2016, certain members no longer met clinical criteria for Community Support Services. This prompted a legislative review of the Section 17 rule changes, after which the legislature enacted Resolves 2016, ch. 82 (eff. Apr. 26, 2016). This Resolve requires the Department to extend the authorized service period for certain individuals who no longer meet clinical criteria for Section 17 services after the rule changes adopted on March 22, 2016. For members affected by the March 22nd rule change, the Department shall authorize a 120 day extension for the member’s Section 17 services. Additionally, 90-day extensions may be granted, provided the member is able to reasonably demonstrate to the Department, or Authorized Entity, that he or she has attempted to and has been unable to access medically necessary covered services under any other section of the MaineCare Benefits Manual. The Ch. II changes shall be effective retroactive to April 26, 2016. The temporary transition period shall end on June 30, 2017. 2. Separately, the legislature enacted An Act to Increase Payments to MaineCare Providers that are Subject to Maine’s Service Provider Tax, P.L. 2016, ch. 477 (eff. Apr. 15, 2016). Certain MaineCare providers subject to the service provider tax have experienced an increase in the tax to 6% since January 1, 2016. The legislature thus provided additional appropriations to certain MaineCare providers, including Section 17 providers, in an effort to offset the increase in the provider tax. The Department is seeking and anticipates CMS approval of the reimbursement changes for Section 17 providers. Pending approval, the Department will reimburse providers under the new increased rates retroactively to July 1, 2016 pursuant to P.L. 2016, ch. 477 (eff. Apr. 15, 2016). 3. Each of the new laws were enacted by the Legislature on an emergency basis. Given that each law provides benefits to the regulated community, and the time-sensitive, limited nature of the extension in eligibility, the Department is authorized to enact these changes to Section 17 on an emergency basis, without the findings required by 5 M.R.S. § 8054(2). These emergency rule changes shall be effective for ninety (90) days. The Department shall engage in proposed routine technical rulemaking to permanently adopt these Section 17 rule changes. 4. Finally, the Department notes that on April 29, 2016, the legislature overrode the Governor’s veto of LD 1696, Resolve, To Establish a Moratorium on Rate Changes Related to Rule Chapter 101: MaineCare Benefits Manual, Sections 13, 17, 28 and 65 (Resolves 2016, ch. 88). That law imposes a moratorium on rulemaking to change reimbursement rates, including Section 17, until after a rate study has been completed and presented to the Legislature. The Department consulted with the Office of Attorney General and the Office of the Attorney General determined and has advised the Department that Resolves 2016, ch. 88 does not prevent the instant rule changes because (1) the separate law, P.L. 2016, ch. 477, is more specific in regard to changing reimbursement for providers impacted by the Service Provider Tax increase; and (2) these are reimbursement rate increases, thus providing a benefit to MaineCare providers. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: September 2, 2016
 
MaineCare Benefits Manual (MBM), Chapters II and III, Section 65, Behavioral Health Services WORD  PDF   
Concise Summary: This emergency rule adoption adds coverage of Mental Health Psychosocial Clubhouse Services and Specialized Group Services to Ch. II, Section 65, Behavioral Health Services of the MBM effective March 22, 2016. These services are currently provided under Ch. II, Section 17, Community Support Services, but due to recent changes in the Section 17 eligibility criteria, the services are being transitioned to Section 65 on an emergency basis so as to not adversely affect members in need of these services. This rulemaking also updates Ch. III, Section 65 by providing reimbursement for Mental Health Psychological Clubhouse Services and Specialized Group Services. The HCPCS procedure code for Specialized Group Services mirrors that currently found in Ch. III, Section 17. For the Mental Health Psychological Clubhouse Services, the Department has replaced the current per-hour Behavioral Day Treatment HCPCS procedure code utilized in Ch. III, Section 17 with the more appropriate per-fifteen minute Mental Health Clubhouse Services HCPCS procedure code. Providers of these services will not be impacted as the rates remain the same. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: Retroactive to March 22, 2016
 
MaineCare Benefits Manual, Chapters II & III, Section 2, Adult Family Care Services WORD  PDF   
Concise Summary: This emergency rule implements Resolves 2015, ch. 45 Resolve, To Require the Department of Health and Human Services to Provide Supplemental Reimbursement to Adult Family Care Homes in Remote Island Locations. This law went into effect on July 12, 2015 without the Governor’s signature. This rulemaking implements supplemental payment representing a fifteen (15) percent rate increase, from the MaineCare rate, to Adult Family Care Homes that satisfy the definition of a “remote island facility.” The Department is seeking approval from the Center for Medicare and Medicaid Services (CMS) for a State Plan Amendment. Pursuant to 22 M.R.S. §42(8), if CMS approves, the supplemental payment for Adult Family Care Homes that satisfy the definition of “remote island facility” will be effective retroactive to October 1, 2015. A Change in Reimbursement Methodology Notice was published on September 30, 2015. This change is not expected to have an adverse effect on the administrative burdens of small businesses. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: April 5, 2016
 
MaineCare Benefits Manual, Chapter III, Section 97, Private Non-Medical Institution Services WORD  PDF   
Concise Summary: This emergency major substantive rule seeks to provide a supplemental payment of fifteen (15) percent, in addition to the facility’s MaineCare rate, to residential care facilities in remote island locations. Eligible facilities are Appendix C Private Non-Medical Institutions (PNMI) located on an island not connected to the mainland by a bridge. In addition, this rule seeks to increase Appendix C and F PNMIs’ assisted living reimbursement rate by four (4) percent. The Department shall seek approval from the federal Centers for Medicare and Medicaid Services (CMS) for a State Plan Amendment for these changes. If CMS approves, the fifteen (15) percent supplemental payments to remote island facilities will be effective retroactive to October 1, 2015. Appendix C and F PNMIs’ assisted living reimbursement rate increase of four (4) percent will be effective retroactive to July 1, 2015. This emergency major substantive rule will remain in effect for up to one year or earlier if the Legislature approves the provisionally adopted major substantive rule. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: July 1, 2015 & October 1, 2015
 
MaineCare Benefits Manual (MBM), Chapter III, Section 67, Nursing Facility Services WORD  PDF   
Concise Summary: This letter gives notice of an emergency rule change to MaineCare Benefits Manual (MBM), Chapter III, Section 67, Nursing Facility Services pursuant to 22 M.R.S.A. 42(8). This emergency rule change seeks to implement the following: 1. Increase the final prospective rate from 95.12 percent to 97.44 percent. 2. Include the cost of continuing education for direct care staff as a direct care cost component rather than a routine cost component. These changes are being done in order to comply with Public Law 2015, Chapter 267, Part A and Resolves 2015, ch. 34, An Act To Implement the Recommendations of the Commission to Continue the Study of Long-term Care Facilities. The Department has submitted a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS). If CMS approves, the final prospective rate increase and the cost of continuing education for direct care staff as a direct care cost component will be effective retroactive to July 1, 2015. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: Retroactive to July 1, 2015 AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner II AGENCY NAME: Division of Policy ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-4074 FAX: (207) 287-9369 TTY: 711 (Deaf/Hard of Hearing)
Effective Date: Retroactive to July 1, 2015
 
MaineCare Benefits Manual, Emergency Rule, Chapters II & III, Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities WORD  PDF   
Concise Summary: Effective July 1, 2015, the state’s biennial budget, Public Law 2015, Chapter 267 (702 – L.D. 109), increased the reimbursement rate for providers of Attendant Care Services and Personal Care Services in the MaineCare Benefits Manual, Chapter III Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities. The Department also proposed to increase – in Chapter II, Section 19, the monthly limits for members’ Section 19 services from $4,200/month to $4,603/month. Section 19 services are governed by a Section 1915(c) waiver approved by the Centers for Medicare and Medicaid Services (CMS). Pursuant to 5 M.R.S.A. §8054, the Department makes these reimbursement changes in Section 19 through emergency rule making. Pursuant to PART UU Sec. UU-1 of the budget, the Legislature provided that the Department need not demonstrate emergency findings in support of this emergency rulemaking. In Chapter III, Section 19, these emergency rule changes allow MaineCare to increase: (1) Attendant Care Services (Personal Care Services, Participant Directed Option), billing code S5125, from $2.93 per quarter hour to $3.21 per quarter hour; and (2) Personal Care Services (Agency PSS), billing code T1019 from $3.75 per quarter hour to $4.10 per quarter hour. Because the Department is increasing reimbursement for services in Chapter III of Section 19, it also seeks to increase the monthly program cap for MaineCare members, so that they are not adversely affected by the reimbursement changes. As such, these emergency rule changes in Chapter II, Section 19 increase the limitation in Sec. 19.06(A) from $4,200 per member, per month to $4,603 per member, per month. Given that the budget was effective July 1, 2015, the Department seeks to make these changes retroactive to July 1, 2015. The Department has authority for the retroactive effective date under 22 M.R.S.A. §42(8), because these changes increase reimbursement for providers, ensure that members have access to medically necessary covered services, and otherwise have no adverse impact on either MaineCare providers or members.
Effective Date: July 1, 2015
 
MaineCare Benefits Manual, Chapters II and III, Section 96, Private Duty Nursing and Personal Care Services WORD  PDF   
Concise Summary: This emergency rule retroactively increases the reimbursement rates for Personal Support Services (PSS) provided under the MaineCare Benefits Manual, Chapters II and III, Section 96, Private Duty Nursing and Personal Care Services. This emergency rule adoption follows the enactment of the State’s biennial budget, which increased the rates for PSS effective July 1, 2015 (P.L. 2015, ch. 267, Part A, Sec. A-32). To avoid a reduction in services available to members as a result of the increase in reimbursement rates for PSS, this rulemaking also includes a proportional increase in the monthly cost caps for affected members’ levels of care. To implement these rate changes, the budget also authorized the Department to adopt emergency rules pursuant to 5 M.R.S.A. § 8054 without needing to demonstrate the emergency findings in support of emergency rulemaking (P.L. 2015, ch. 267, Part UU, Sec. UU-1). This emergency rule adoption will be effective for a ninety (90) day period in accordance with 5 M.R.S.A. § 8054(3), during which time the Department will engage in routine rulemaking to avoid a lapse in this reimbursement rate increase. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: Retroactive to July 1, 2015
 
MaineCare Benefits Manual, Chapter III, Section 2, Adult Family Care Services WORD  PDF   
Concise Summary: This emergency rule retroactively increases reimbursement rates by 4% for Adult Family Care Services at residential care facilities provided under MaineCare Benefits Manual, Chapter III, Section 2, Adult Family Care Services. This emergency rule adoption follows the enactment of the State’s biennial budget, which among other MaineCare rate increases, increased the rates for Section 2 services effective July 1, 2015. P.L. 2015, ch. 267, 702 – L.D. 1019, Part A, Sec. A-32, and Part UUUU, Sec. UUUU-1. To implement these rate changes, the budget also authorized the Department to adopt emergency rules pursuant to 5 M.R.S.A. § 8054 without needing to demonstrate the emergency findings in support of emergency rulemaking. P.L. 2015, ch. 267, 702 – L.D. 1019, Part UU, Sec. UU-1. This emergency rule adoption will be effective for a ninety-day period in accordance with 5 M.R.S.A. § 8054(3), during which time the Department will engage in routine rulemaking to avoid a lapse in this reimbursement rate increase. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: Retroactive to July 1, 2015
 
MaineCare Benefits Manual, Chapter 101, Chapter III, Section 45, Hospital Services WORD  PDF   
Concise Summary: CONCISE SUMMARY: In compliance with the State’s biennial budget, this rulemaking reduces reimbursement for non-emergent use of the Emergency Department (“ED”). This reimbursement reduction applies to in-state Acute Care Non-Critical Access Hospitals only. The rule change reduces reimbursement of nonemergency use of ED to the rate of a comparable visit delivered in a private physician office for a non-facility based provider. Non-emergent use of the ED will be identified by the primary diagnosis, as indicated by the ICD-10 codes listed in MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services, Appendix B. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: October 1, 2015
 
MaineCare Benefits Manual, Section 29, Chapter III, Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder WORD  PDF   
Concise Summary: Pursuant to 5 MRSA Sections 8073 and 8054, the Department has determined that immediate adoption of this rule is necessary to avoid an immediate threat to public health, safety or general welfare. The Department’s findings with regard to the existence of an emergency are as follows: Section 29 services are governed by a Centers for Medicare and Medicaid (CMS) Medicaid waiver. On April 18, 2014, CMS approved changes to the Section 29 waiver, effective July 1, 2014, adding new services as requested by the Department. In order to add these additional services to the waiver, the Department is amending Section 29, Chapter II to add the services, through routine rulemaking. However, Chapter III, Section 29 is a major substantive rule, requiring the approval of the Legislature, which may take up to one year for that process. In order to be able to reimburse for the new services effective September 1, 2014, which is a benefit to the Section 29 beneficiaries, and in order to comply with the CMS-approved waiver, the Department needs to adopt these rules immediately. This emergency major substantive rule allows MaineCare reimbursement for the following new services: 1. Assistive Technology services, which includes (a) Assistive Technology-Assessment; (b) Assistive Technology – Transmission (Utility Services); and (c) Assistive Technology – Devices. Adding these services complies with P.L. 2013, ch 368, PART SS, which authorized MaineCare “reimbursement for the use of appropriate electronic technology as a means of reducing the costs of supporting people currently being served [on the Section 29 waiver].” Assistive Technology – Devices are limited to a cap of $6,000 per year, and Assistive Technology – Transmission (Utility Services) are limited to a cap of $50.00 per month. 2. Home Support services, which includes: (a) Home Support – Quarter Hour; (b) Home Support – Remote Support – Monitor Only; and (c) Home Support – Remote Support – Interactive Support. Adding these services complies with Resolves 2013, Ch. 24 (“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”). Additionally, the Department is clarifying the reimbursement and billing for Work Support – Group services so that the exact reimbursement rate, depending on the number of members in the group, is indicated. Finally, the Department is deleting Home Accessibility Adaptation services from the calculation for the Standard Unit Rate, since this service is paid per invoice, as indicated in Appendix I. On March 18, 2014, the Department proposed rules for Chapter III, Section 29, which it will provisionally adopt on or about September 1, 2014, pending Legislative approval. This emergency major substantive rule will remain in effect for up to one year or earlier if the Legislature approves the provisionally adopted major substantive rule. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: EMERGENCY ADOPTION August 29, 2014
 
MaineCare Benefits Manual, Section 21, Chapter III, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder WORD  PDF   
Concise Summary: This emergency major substantive rule makes the following changes, and those rule changes will be effective as of September 1, 2014: This emergency rule allows MaineCare reimbursement for the following new services: Home Support – Remote Support services which includes: (a) Home support- Remote Support – Monitor Only; and (b) Home support – Remote Support – Interactive Support. This emergency rule allows MaineCare reimbursement for the following new services: Assistive Technology services, which includes: (a) Assistive Technology – Assessment services; (b) Assistive Technology – Transmission (Utility Services); and (c) Assistive Technology – Devices services. Adding these services complies with P.L. 2013, Ch. 368, PART SS, which authorized MaineCare “reimbursement for the use of appropriate electronic technology as a means of reducing the costs of supporting people currently being served…” The Department is adding a new modifier (“U5”) to the code for all of the Home Support – Family Centered Support – which indicates that the services are Family Centered Support services. The Department is adding another new service: Career Planning services. This emergency major substantive rule also separates out services, Home Support into four different services. Home Support-Agency Home Support (Per Diem), Home Support-Quarter Hour (1/4 hour), Home Support-Family Centered Support and Home Support-Shared Living. The Department is deleting some of the language in the second paragraph of Principle 1900 (Billing Procedure), that relates to rates for Work Support Services – Group, and replacing the language with the actual rates per unit, depending on the number of members in a group. This emergency rule also adds a service, which can be provided by a new type of provider: “Occupational Therapy (Maintenance) – which can be provided by a Certified Occupational Therapy Assistant (COTA) under the supervision of an Occupational Therapist Registered (OTR). This change is not expected to have an adverse effect on the administrative burdens of small businesses. HTTP://WWW.MAINE.GOV/DHHS/OMS/RULES/INDEX.SHTML for rules and related rulemaking documents.
Effective Date: EMERGENCY ADOPTION August 29, 2014
 
Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities WORD  PDF   
Concise Summary: On May 1, 2014, the Maine Legislature enacted emergency law, P.L. 2014, ch. 594 (“An Act to Implement the Recommendations of the Commission to Study Long-term Care Facilities”), which directed the Department of Health and Human Services (“Department”) to amend its regulation for the MaineCare reimbursement of Nursing Facilities (MaineCare Benefits Manual, Chapter III, Section 67), to increase the rate of reimbursement beginning July 1, 2014. Pursuant to emergency law, P.L. 2014, ch. 594, the Department is adopting this emergency rule without making the emergency findings otherwise required by 5 MRSA Sec. 8054, since the law allows the Department to do so if it provided a seven day notice and opportunity to comment on a draft rule. On June 16, 2014, the Department provided interested parties with a copy of the draft rule and opportunity to comment. The Department carefully reviewed the comments received from the nursing facility providers, which delayed the adoption of this emergency rule. This emergency rule has a retroactive application back to July 1, 2014 for the rule changes. Retroactive application for MaineCare reimbursement regulations is permitted by 22 M.R.S.A. Section 42(8) if the “reimbursement or other payments under the amended rule [is] equal to or greater than the reimbursement under the rules previously in effect.” In order to comply with 22 M.R.S.A. Sec. 42(8), this emergency rule adds a provision, Principle 83, that provides: “On August 15, 2014, the Department adopted an emergency rule with a retroactive application date of July 1, 2014. For the period July 1, 2014 through August 15, 2014, the reimbursement or other payments under the August 15, 2014 emergency rule must be equal to or greater than the reimbursement under the rules previously in effect.” This emergency rule makes the following additional changes: 1. Establishes a new base year for nursing facilities which is the fiscal year of each nursing facility ending in calendar year 2011. The base year will be updated every two years. 2. For the routine care cost and for direct care cost, the peer group upper limit is increased to 110% of the median. 3. Eliminates the Administration and Management Expense ceiling, although those costs are still subject to allowability standards. 4. Establishes a payment to nursing facilities that have a high MaineCare Utilization rate (defined as greater than 70% MaineCare days of care). This payment is cost settled. 5. Changed the methodology for calculating each nursing facility’s specific case mix index for the base year to the following: (1) first, the Department calculates the nursing facility’s 2011 average direct care case mix adjusted rate by dividing each nursing facility’s gross direct care payments received for their 2011 base year, by the 2011 base year MaineCare direct care resident days; (2) second, the Department calculates the nursing facility’s 2011 case mix index by dividing the nursing facility’s 2011 average direct care case mix adjusted rate as calculated in (1) by the nursing facility’s 2005 base year direct care rate. 6. Eliminates the use of the 2009 CMS Nursing Home without Capital Market Basket Index for inflation adjustments, and substitutes: (a) the United States Department of Labor, Bureau of Labor Statistics, Consumer Price Index for Medical Care Services – Nursing Homes and Adult Day Care Services to adjust for inflation for the Routine Cost Component; and (b) the United States Department of Labor, Bureau of Labor Statistics, Consumer Price Index, Historical Consumer Price Index for Urban Wage Earners and Clerical Workers – Nursing Home and Adult Day service for the Direct care Component. 7. Provides that inflation adjustments will be done every year. 8. Amended the Direct Care Add-on Principle so that December 31, 2013, rather than July 1, 2008, is used for the inflation calculation, and the facility-specific average case mix index for the base year is used as the applicable case mix index for this calculation. 9. The Direct Care Hold Harmless Provision was amended so that the differential which will be applied is the difference between each nursing facility’s direct care rate for the first fiscal year to which the July 1, 2014 amendments to the rule apply, and the nursing facility’s direct care rate in effect on April 1, 2014. 10. The Routine Hold Harmless Provision was amended so that the differential which will be applied is the difference between each nursing facility’s routine rate for the first fiscal year to which the July 1, 2014 amendments to the rule apply, and the nursing facility’s routine rate in effect on April 1, 2014. 11. Changed the heading for Principle 81 from “Interim and Subsequent Rates” to “Interim, Subsequent, and Prospective Rates” because Principle 81 was amended to add a provision regarding Prospective Rates. 12. Added Principle 81.3 (Prospective Rate), which provides that the prospective rate, excluding fixed costs, will be adjusted down to 95.12% of all the calculated Direct Care cost components and all of the Routine Care cost components. The Final Prospective Rate will remain at 95.12%. 13. Added Principle 81.4 (Funding Adjustment), which provides that in the case of an individual nursing facility, whose rebased, adjusted direct and routine care rates totaled together are less than that nursing facility’s April 1, 2014, direct and routine rates, totaled together, then the Department will make a Funding Adjustment, by adding the difference to the rebased routine rate. P.L. 2014, ch. 594’s requirement that the rule be amended to increase the specific resident classification group case mix weight that is attributable to a nursing home resident who is diagnosed with dementia is not directly applicable to the case mix methodology which is set forth in the rule, which is function or level-of-service based, and not based on diagnosis. The rule’s case mix methodology already provides that a dementia patient whose condition worsens, and needs a higher level of care, is put in a case mix with a greater weight. The Department will continue to review this issue during the regular rulemaking which will follow this emergency rulemaking. CMS approval is needed for these changes, and the Department is seeking to amend its State Plan accordingly. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: August 15, 2014
 
Emergency Rule, 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. The Department is seeking approval of a State Plan Amendment from the Centers for Medicare and Medicaid Services.
Effective Date: July 1, 2014
 
MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities Word  PDF   
Concise Summary: In this emergency rulemaking, the Department adopts the changes required by Resolve 2013, ch. 72 (LD 1189), to clarify the timeframe during which nursing facilities must demonstrate their compliance with the October 1, 2011 2% cost-of-living adjustment (COLA) for front line staff. If CMS approves, the following applies for the 2% October 2011 COLA that the Department gave to nursing facilities: nursing facilities must demonstrate, to the satisfaction of the Department, a 2% increase in the average wage and benefit rate per hour for front line employees for their first fiscal years ending after July 1, 2013, from the average wage and benefit rate per hour for front line employees that was in effect for their fiscal years ending 2008. If the nursing facilities cannot demonstrate that 2% increase to the satisfaction of the Department, then the Department will recoup, at time of audit, the difference between what the average wage and benefit rate per hour for front line employees for the first fiscal years ending after July 1, 2013 should have been if it had been increased by 2% from what it was. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: February 28, 2014
 
MaineCare Benefits Manual, Chapter II, Section 13, Targeted Case Management  
Concise Summary: CONCISE SUMMARY: This emergency rule updates the Targeted Case Management (TCM) policy to include the Child and Adolescent Needs and Strength (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. Without the immediate implementation of these changes, MaineCare members' access to medically necessary services is at risk. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: December 20, 2013
 
MaineCare Benefits Manual, Ch 101, Sec 45, Ch III, Hospital Services PDF   
Concise Summary: CONCISE SUMMARY: This emergency rule increases the MaineCare hospital supplemental pool to $65.321 million, because the Legislature appropriated an additional $10.472 million. P.L. 2013, ch. 368, PART A, Sec. A-34. The Department is seeking approval from the Centers for Medicare and Medicaid Services, to amend its State plan related to hospital reimbursement, for this change.
Effective Date: November 15, 2013
 
MaineCare Benifits Ch 101, Ch II, Sec 67, 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.
Effective Date: 08-27-2013
 
MaineCare Benifits Manual,Ch II, Sec 45, Hospital Services PDF   
Concise Summary: CONCISE SUMMARY: This emergency rulemaking, effective August 27, 2013, retroactive to April 1, 2013 seeks to implement a provision in the 2014-15 budget law (P.L. 2013, ch. 368), as amended by P.L. 2013, ch. 423. Specifically, this rulemaking will increase the number of days that MaineCare will 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.
Effective Date: 08-27-2013
 
MaineCare Benefits Manual, Ch 104, Sec 4 Maine Part D Wrap Benefits Word   
Concise Summary: CONCISE SUMMARY: The emergency rule will eliminate Medicare Part D prescription drug copayments for Medicare Savings Program members who are not also eligible for and receiving the full MaineCare benefit. This change is being made pursuant to PL 2013, Chapter 368, Part A, Section A-34, and Part UU, Section UU-1, of the State of Maine Biennial Budget.
Effective Date: August 09, 2013
 

 

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