Rule-Making Adoption: Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities
Maine Department of Health & Human Services sent this bulletin at 06/01/2017 08:47 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 Adoption. You can access the complete rules at http://www.maine.gov/dhhs/oms/rules/index.shtml
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: Chapter 101, MaineCare Benefits Manual, Chapters II and III, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
The Department is adopting changes to both Chapter II and Chapter III of Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities, that seek to add services, clarify existing services, increase rates for personal care services, adjust rates and rate methodology for other services, more closely align the rule with federal requirements for waiver services, and make various clerical and formatting updates.
This rule adoption adds three new services that enhance members’ opportunities to access necessary supports and services within their communities: Home Delivered Meals, Living Well for Better Health, and Matter of Balance (Falls Prevention). In addition, the Department is moving Adult Day Health Services from Section 19 to the State Plan. This change benefits members by increasing options for services under the program cap. Services under the State Plan also do not limit members in the same manner under the Section 19 waiver in terms of scope and duration.
The Department is also increasing options for members by adding a definition of “Budget Authority” to allow members under the Participant-Directed Option to determine the wages of hired Attendants, and is adding a definition for “Fiscal Intermediary” so that the responsibilities of the Fiscal Management Services provider are also clear. In addition, the Department added language to the rule which clarifies that, under the Participant-Directed Option, the member is considered the employer of the Attendant. These changes give the member more autonomy in self-directing services under this waiver. Other changes to the Chapter II rule adoption include the addition of the Person-Centered Planning definition and requirement that the Service Coordination Agency follow this model when working with the member to develop and implement services. The adoption of these rule provisions helps move the Section 19 waiver program towards compliance with 42 C.F.R. § 431.301(c). The Department made a number of other changes to the rule adoption to help clarity and improve upon existing processes for determining eligibility. This includes removing the requirement that the member provides a physician’s letter to the Service Coordination Agency, as all services will be medically authorized by the Assessing Services Agency; adding language to the rule that emphasizes consideration of the member’s needs and preferences; and updating the timeframes in which the Assessing Services Agency must complete both assessments and re-assessments, as reflected in current Departmental contracts.
The Department is increasing several rates under Chapter III. To correspond with these rate increases, the Department is increasing the waiver cap in Chapter II. With this rule adoption, the Department is making a number of changes to Chapter III: The Department is adopting rate increases for personal care and related services in accordance with Resolves 2015, ch. 83 (Resolve, Directing the Department of Health and Human Services To Increase Reimbursement Rates for Home-based and Community-based Services). Through this Resolve, the Legislature directed the Department to amend this rule “to reflect 50% of the increase in rates noted in the final rates modeled 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 rate increases will be retroactive to July 29, 2016, the effective date of the Resolve, and pursuant to 22 M.R.S. § 42(8).
The Department is incorporating other changes to Chapter III as a result of other recommendations in the Burns & Associates rate study. The Department has decreased the rate for three procedure codes: Skilled Nursing Visit (RN), Other Nursing (LPN), and Home Health Aide Visit – Home Health services. In addition, the Department has added new rates and procedure codes in accordance, as set forth in the study, for personal care and related services provided to two and three members simultaneously. These changes will take effect on June 1, 2017. The Department also increased the rate for Respite Care Services, not in the home to match the rate under Section 19 with the current nursing facility rate elsewhere in the MaineCare Benefits Manual. This increase will be retroactive to July 1, 2016.
Next, the Department has added procedure codes and rates for the three new services added under Chapter II: Home Delivered Meals, Living Well (Chronic Disease Management), and Matter of Balance (Falls Prevention). The Department has also removed the procedure code and rate for Adult Day Health Services, as this service will now be offered to members under the State Plan. These changes are effective June 1, 2017.
Finally, the Department is adding columns to differentiate between procedure code, modifier, and revenue code in Chapter III, which should assist providers in billing appropriately.
http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: June 1, 2017
AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner
AGENCY NAME: Division of Policy
ADDRESS: 242 State Street
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207)-624-6195 FAX: (207) 287-1864
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