Rule-making Proposal: Chapter II, Section 13, Targeted Case Management

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 rules at http://www.maine.gov/dhhs/oms/rules/index.shtml

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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, Chapter II, Section 13, Targeted Case Management

PROPOSED RULE NUMBER:

CONCISE SUMMARY:

This rulemaking will update eligibility language to current terminology, guidelines, and practices. The rulemaking will add provider requirements and training/supervision requirements to increase the quality of services delivered. There are also other technical edits to close potential audit risks and other grammatical edits. A brief overview of the changes are as follows:

1. Adds definitions for CD4 count and viral load and requires HIV case managers to take an active role in monitoring their client’s health needs.
2. Removes the CAFAS and CHAT assessments for eligibility for children’s TCM services.
3. Adds a definition of Natural Supports.
4. The Individual Plan of Care (IPC) covered service has been updated to clarify the expectation of initial development and periodic review timelines.
5. Substance abuse disorders has been updated to substance use disorders, consistent with current terminology.
6. Eligibility for Children’s Behavioral Health and Developmental Disabilities TCM has been updated to reflect a consolidated Child and Adolescent Needs and Strengths assessment (CANS) and use of current diagnosis terminology as described in the Diagnostic and Statistical Manual of Mental Disorders, version 5.
7. Updates eligibility criteria for adult developmental disabilities to reflect current language in statute, using the Office of Aging and Disability Services’ (OADS) Certification Rule 14-197 Chapter 3 definition of intellectual disabilities combined with the current M.R.S.A. §6002, which defines autism.
8. Updates eligibility criteria for adults with substance use disorders to include members who are receiving treatment, opposed to just seeking treatment as currently described in policy, and to remove the stipulation that the provider must receive funding from the Substance Abuse Prevention Treatment Block Grant.
9. Adds a stipulation that HIV TCM providers must be approved by the Office of MaineCare Services (OMS), and that staff must have experience with the population served.
10. Adds financial services (i.e. rep. payee) costs for paperwork or internal meetings, transportation, and services intended to supplement housekeeping to the list of Non-Covered Services.
11. Adds limitation language and a subsequent grid and appendix outlining circumstances for appropriate overlap of TCM services with Private Non-Medical Institutions (PNMIs), nursing facilities, intermediate care facilities for individuals with intellectual disabilities, and psychiatric hospitalization.
12. Adds a provision that all TCM providers servicing children must be approved by the Office of Child and Family Services prior to delivering TCM services to children.
13. Adds requirements for adults with developmental disabilities that providers must adhere to OADS’ Certification rule 14-197 Chapter 10, and have written approval from OADS to deliver TCM services, and adding a maximum staffing ratio of one staff to 35 members, with an added requirement of case managers having at least one monthly contact unless otherwise specified in the person-centered plan, and one face-to-face contact with each member quarterly.
14. HIV TCM providers will facilitate and monitor a member’s access to medical providers at minimum every six months, and will make efforts to engage the member with his or her primary and/or specialty physician.
15. Requires staff with related degrees to have subsequent training and supervision relevant to the population served.
16. Adds staff orientation subject matter requirements and new supervision requirements to better detail expectation to increase overall case manager training and support.
17. Updates record and data entry requirements for the CANS assessment.
18. Requires the date, signature, and credential of staff completing the comprehensive assessment.
19. Updates the Individual Plan of Care (IPC) requirement to utilize the person-centered plan process for OADS-eligible TCM members, ensure the plan reflects the member’s strengths and needs, and ensure the plan will reflect the resources required to meet the member’s goals to include natural supports. The IPC will require the date, signature, and credential of the staff completing the plan, with case manager review at minimum every 90 days. The IPC must be updated annually at minimum.
20. Adds a documentation requirement for 90-day reviews.
21. Updates psychiatric nurse description for clarification of this credential.
22. Removes advance practice psychiatric nurse as an allowable supervisor, as this credential is already covered as an advance practice registered nurse.
23. Requires that record entry (progress notes) be completed within 72 hours of the delivery of services, and include the date and duration of the services provided as well as the provider name, signature, and credential of the individual delivering the service.
24. Clarifies provider enrollment requirements when office approval and/or licensure is required for serving specific target groups.
25. Clarifies the credentials of professional staff qualified to serve as supervisors of a TCM program by target group.
26. Adds Children’s TCM requirement for face-to-face visits to policy that is currently stated in the MaineCare Provider Agreement Rider A.

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

STATUTORY AUTHORITY: 22 M.R.S., §§ 42, 42(8), 3173; 5 M.R.S. § 8054

PUBLIC HEARING:

Date and Time:             Tuesday, July 31, 2018; 9:00 a.m.

Location:                      32 Blossom Lane, Marquardt Building Door D7, Augusta, ME 04333

The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before Monday, July 23, 2018.

DEADLINE FOR COMMENTS:         Comments must be received by 11:59 PM on Friday, August 10, 2018.

AGENCY CONTACT PERSON:        Dean Bugaj Comprehensive Health Planner II

                                                                 Dean.Bugaj@maine.gov

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.