Rule Adoption: Chapters II and III, Section 107, Psychiatric Residential Treatment Facility Services
Maine Department of Health & Human Services sent this bulletin at 10/03/2018 03:25 PM EDT
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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 rule at http://www.maine.gov/dhhs/oms/rules/index.shtml
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 and III, Section 107, Psychiatric Residential Treatment Facility Services
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
This rulemaking adopts a new section of policy describing Psychiatric Residential Treatment Facilities (PRTF) services and reimbursement for such services. PRTFs are Medicaid services authorized and governed under: 42 U.S.C. § 1396d(a)(16) and (h) and 42 C.F.R. 441 Subpart D and 42 C.F.R.483 Subpart G. The services are offered only to members under the age of 21.
NOTE: The Department will seek approval from CMS for the PRTF service. The service will not be offered, and this rule will not become effective, until CMS has approved. Upon CMS approval, the Department will issue notice to the Secretary of State and Interested Parties informing of CMS approval pursuant to Title 5 §8052(6).
The rule describes the PRTFs’ covered services, policies and procedures, standards, and reimbursement methodology. This service is intended to address a current gap in Maine’s offering of behavioral health services to youth under the age of 21. The PRTF is being created to specifically support Maine’s most vulnerable youth, including: youth in out of state placement, youth stranded in psychiatric hospitalization with no safe discharge option, youth stranded in emergency rooms with no safe placement, and incarcerated youth in need of mental health treatment. This rule was developed by a multidisciplinary team including members from the Office of Child and Family Services, the Department of Education, the Department of Corrections, Maine Centers for Disease Control and Prevention, and the Office of MaineCare services. The development of this policy included stakeholder input. A public hearing was held on May 21, 2018, and, in addition, public comments were received.
This service will be reimbursed using a statewide per diem rate for medical, clinical and direct care costs (direct care services) and using a facility-specific rate for routine and fixed costs (room and board costs). The routine and fixed costs facility rate is informed by annual cost reporting performed by providers using a state-developed cost report form. The medical, clinical and direct care per diem rate is not cost settled. The routine and fixed cost rate is cost settled by the Department based on allowable fixed and routine costs.
The Department has issued notice to the Legislature prior to rulemaking adoption and complies with 34-B M.R.S. §§15002 (Children’s Mental Health Services).
As a result of public comments and review by the Office of the Attorney General, the Department has deleted the utilization of chemical restraints in this service. The Department added language for Medication Pro Re Nata (PRN), which clarifies that PRN medication may not be utilized as a chemical restraint.
The Department added language to clarify that this rulemaking complies with the following regulations: the Rights of Recipients of Mental Health Services who are Children in Need of Treatment by a Provider, 14-172 C.M.R. ch. 1, and also the Rights of Recipients of Mental Health Services, 14-193 C.M.R. ch. 1. These changes were adapted to ensure compliance with all state and federal regulation and to ensure members are afforded the highest level of protections.
At the same time it is adopting this rulemaking, the Department is also adopting new licensing rules, which will govern the licensing of PRTFs. Those rules are the Children’s Residential Care Facilities Licensing Rule, 10-144 C.M.R. ch. 36.
http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: The rule will become effective upon CMS approval
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
TELEPHONE: (207)-624-4045 FAX: (207) 287-1864
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