Rule-making Adoption: Ch. II & III, Section 92, Behavioral Health Home Services

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, updating the effective date of the Adopted Rule. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml

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Notice of Agency Rule-making Adoption 

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

CHAPTER NUMBER AND TITLE:   10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapters II & III, Section 92, Behavioral Health Home Services 

ADOPTED RULE NUMBER: 

CONCISE SUMMARY:  This rule is being adopted to institute pay-for-performance in the Behavioral Health Home program by making one percent of Behavioral Health Home Organization (BHHO) total Per Member Per Month (PMPM) payments subject to recoupment if the BHHO does not achieve a minimum level of quality, as defined by performance on Department-defined quality measures related to chronic disease management. The rulemaking formally adopts an increased reimbursement rate for BHHOs. Effective retroactive to January 1, 2016, the reimbursement rate for BHHOs is $394.40 per member per month (PMPM) for both adult and child members. The new rates are the result of a comprehensive and public rate review conducted by Burns & Associates, Inc. 

Additional changes include: 

• Clarifications have been made to the provider requirements and how they are different from covered services. The Department believes these changes will assist providers in determining when they have met service delivery requirements.
• Member Eligibility has been updated to require the Child and Adolescent Needs and Strengths (CANS) assessment to be reviewed and updated by the BHH a minimum of every one hundred and eighty (180) days. It also requires that all relevant CANS domains must be entered in the Maine ASO database, or approved equivalent data system, and that this information be used to inform and guide in the development of the plan of care.
• Enrollment has been changed to an opt-in model with a certification process. This model and the new requirements are intended to ensure that members are counseled on the various services for which they are eligible and that duplicative services are avoided. The rule clarifies language around duplication of services, and adds Opioid Health Homes as a service which is considered duplicative for both adults and children.
• More clearly defines what the Department expects to be core components of service delivery and removes separate reporting requirement of the Health Home Provider Functional Requirements.
• The addition of Referral to Community and Social Support Services is made to align with the Maine State Plan.
• Removes the one-hour minimum billable activity requirement from the minimum requirements for reimbursement and replaces it with the requirement that at least one of the monthly services must include a member encounter. The change to the one-hour minimal billable activity requirement was discussed in the 2015 independent rate study which resulted in the higher BHH PMPM payment. 

Please refer to the following hyperlink to view the adopted rule:

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. 

EFFECTIVE DATE:                          April 21, 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

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