MaineCare Policy Proposal, Ch. I & II, Section 17 - September 14, 2016
Maine Department of Health & Human Services sent this bulletin at 09/14/2016 09:09 AM EDT
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Below, please find a Notice of Agency Rule-making Proposal. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapters II & III, Section 17, Community Support Services
PROPOSED RULE NUMBER:
CONCISE SUMMARY:
- Following various changes to Chapter 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 Chapter II changes shall be effective retroactive to April 26, 2016. The temporary transition period shall end on June 30, 2017.
- Separately, the Legislature enacted An Act to Increase Payments to MaineCare Providers that are Subject to Maine’s Service Provider Tax, 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).
- 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 was 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 were filed and were effective for ninety (90) days. The Department is now engaging in proposed routine technical rulemaking to permanently adopt these Section 17 rule changes.
- 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 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.
- This rulemaking proposes to remove Clubhouse services and Specialized Group services as they are now available and covered through Section 65, Behavioral Health Services. This will remove the duplication of service and all references to the service within this rule.
- This rule proposes adding a definition for the Adult Needs and Strengths Assessment, as well as provider requirements for filling out and reporting the assessment at regular intervals via the Department’s Enterprise Information System.
- This proposed rule aims to add language giving members the option to request to hold for service if providers are unable to meet the seven (7) day face-to-face requirement of new referrals. Members may elect to hold for service only after an agency has adequately informed the member of their options.
- The rule also seeks to add language to the Individualized Service Plan in 17.04-1.E requiring a goal on a member’s access to primary care, specialty care, and routine appointments. This also requires the MHRT to document evidence of the visit as described in 17.04-1.N.
- Lastly, this rule seeks to update language of CMS approval about the inclusion of Certified Peer Support Specialists (CIPSS) as part of the ACT Team defined in 17.04-3.A-5.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 MRSA, §42, §3173; P.L. 2016, ch. 477 (eff. Apr. 15, 2016); Resolves 2016, ch. 82 (eff. Apr. 26, 2016)
PUBLIC HEARING:
Date: Thursday October 06, 2016
Time: 9am-12pm
Location: 19 Union St. Room 110
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before September 30, 2016.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on Saturday, October 22, 2016
AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 242 State St.
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4045 FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.