Rule Adoption: Ch. II & III, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities

Maine Department of Health & Human Services sent this bulletin at 01/07/2019 08:51 AM EST

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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 two notices of Agency Rule-making Adoptions. 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, Office of MaineCare Services

CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Ch. II, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities

ADOPTED RULE NUMBER:

CONCISE SUMMARY:

The Department is adopting this rule in accordance with P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Act”). This Act provides funding to increase personal care and related services provided under Section 19. The Act further directs the Department to “ensure that caps and limitations on home-based and community-based services are increased to reflect increases in reimbursement rates that result from this Part,” and that “A recipient of services may not experience a reduction in hours solely as a result of increased reimbursement” (Act, Sec. B-3).

The Department is adopting rules for Sec. 19, Ch. III, as directed in the Act, and increasing personal care and related rates, simultaneously with the adoption of these Ch. II rules. In accordance with the Act, therefore, this Ch. II rulemaking raises the program cap to $5,425.00 per member per month (Section 19.06(A)).

On October 9, 2018, the Department adopted the increased cap through emergency rulemaking. This rulemaking permanently adopts the emergency cap increase.

In addition, the Department adopts the following changes to this rule:

Adds a requirement for Electronic Visit Verification (“EVV”), consistent with the requirements of Section 12006 of the 21^st Century CURES Act (P.L. 114-255), as codified in 42 U.S.C. § 1396b(l)(1). THIS CHANGE REQUIRES CMS APPROVAL, BUT IS EFFECTIVE PENDING APPROVAL.
Adds an exception to the Limit of 40/hours week of service by an individual worker that is reimbursable. The exception is for a member who is at risk for institutionalization unless the individual worker can be reimbursed for more than 40 hour/week. The provision sets forth criteria for the Department to consider in its evaluation of the request. The provision also adds that the Department’s decision must be in writing, and given to the member. Members can appeal an adverse decision. This exception language is required pursuant to the Settlement Agreement in Roy v. Dept. of Health and Human Services, U.S. Dist. Ct., D. Me., Civil No. 1:16-cv-00592-NT. THIS CHANGE REQUIRES CMS APPROVAL BUT IS EFFECTIVE PENDING APPROVAL.
Deletes a provision in § 19.02-3(H) that provided that a portion of the member capacity for this Section 19 service would be reserved for members eligible and participating in the Department’s Follow the Money (Homeward Bound) program. The Department is deleting this provision since there is no waiting list for the Section 19 service, and so it is unnecessary to reserve capacity. In addition, the Department will shortly submit an amendment to the Section 19 waiver which will significantly increase the number of funded openings for Section 19 services over the next five years. CMS HAS APPROVED THIS CHANGE.

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

EFFECTIVE DATE: January 7, 2019

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

EMAIL: Rachel.Posner@maine.gov

TELEPHONE: (207)-624-6951 FAX: (207) 287-1864

TTY users call Maine relay 711

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, Chapter III, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities

ADOPTED RULE NUMBER:

CONCISE SUMMARY: The Department is adopting this routine technical rule in accordance with P.L. 2017, ch. 459, Part B, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Act”). The Act requires the Department to amend its rules for reimbursement rates for home-based and community-based personal care and related services provided under the provisions of 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities and referenced 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 increased rates will be effective retroactive to July 1, 2018.

On October 9, 2018, the Department adopted these rate increases via emergency rulemaking, with a retroactive effective date of July 1, 2018. In this rulemaking the Department is now permanently adopting these Section 19 rule changes.

The adopted rule increases rates for 30 procedure codes. In addition, the rule adds in the code and rate for Home Health Aide Visit—Home Health Services, which was inadvertently deleted during final adoption of this rule in January 2018.

These increased rates will be effective retroactive to July 1, 2018. The Department has determined that a retroactive increase to the beginning of the state fiscal year is appropriate, since the appropriation is intended for the entire fiscal year. The retroactive application comports with 22 M.R.S.§ 42(8) which authorizes the Department to adopt rules with a retroactive application for a period not to exceed eight calendar quarters and there is no adverse financial impact on any MaineCare member or provider. In addition, the Department sought, and obtained approval, from the Centers for Medicare and Medicaid Services (“CMS”) to submit a waiver amendment making the rate changes retroactive to July 1, 2018.

In addition to this adopted rulemaking for Section 19, Ch. III, the Department is simultaneously adopting rules for Sec. 19, Ch. II, which rulemaking raises the program cap, in accordance with the Act.

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