Chapter II, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations 

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 rule 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, Division of Policy 

CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, Chapter II, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations 

PROPOSED RULE NUMBER: 

CONCISE SUMMARY: 

The Department is proposing this rule in order to make permanent changes adopted via emergency rulemaking on June 25, 2019. 

Background: On November 8, 2018, the Department adopted an emergency major substantive rule for Ch. III, Sec. 28 (Allowances for Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations).  The emergency major substantive rulemaking was done to comply with Public Law 2017, Ch. 460 (“the Act”) which directed the Department to amend reimbursement rates to Section 28 providers to reflect final rates modeled in the April 2017 Burns report: Rate Study for Behavioral Health and Targeted Case Management Services: Final Proposed Rates for Formal Rulemaking, and also to increase the rate of reimbursement for all services by two percent.  The legislation was enacted as an emergency, and directed the Department to make the rate increases effective July 1, 2018.  Pursuant to the emergency major substantive rule, in order to comport with federal Medicaid law, the rate increases were made with an August 1, 2018 effective date. 

The November 8, 2018 emergency major substantive rule also added a new procedure code for Board Certified Behavior Analyst *(BCBA) services (Procedure Code G9007), pursuant to the Act, which required the Department to “establish new reimbursement rates” in accordance with the 2017 Burns rate study.

The Department proposed rules for Ch. III, Section 28, in accordance with 5 M.R.S. § 8072(1), to be provisionally adopted by the Department, pending legislative approval.  The Department received comments during that rulemaking requesting clarification on the services that would be eligible for the August 1, 2018 BCBA services rate. 

Therefore, the Department has determined that rulemaking for Ch. II, Section 28, is required in order to clarify the services that are eligible for the new BCBA service rate.  As stated above, the Department adopted an emergency Ch. II Section 28 rule on June 25, 2019 which clarified the BCBA services. That rule will expire 90 days from adoption. This proposed rulemaking will make the emergency Ch. II rule changes permanent and provides for a new provision in the rule identifying BCBA services in the Covered Services section of the rule.  In addition, the proposed rule identifies the requirements for BCBA providers, consistent with requirements set forth by the Behavioral Analyst Certification Board. These standards were in effect on the effective date of the emergency rule. 

BCBA services rendered between August 1, 2018, the effective date of the November 8, 2018, Ch. III, Section 28, emergency major substantive rule, and the effective date of this emergency rule, will be reimbursed in accordance with the emergency major substantive rule BCBA rate, and the Ch. II rule in effect at that time. 

In addition to the above changes, the Department is adding telemedicine language under Provider Requirements, and adding Electronic Visit Verification under Provider Requirements, complying with Section 12006 of the 21^st Century CURES Act (P.L. 114-225), as codified in 42 U.S.C. § 1396b(l)(1). 

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

STATUTORY AUTHORITY:  22 M.R.S. §§ 42, 3173; P.L. 2017, ch. 460 

PUBLIC HEARING: 

Date and Time:  July 23, 2019 10:30 am

Location:            Cross Office Building Room 600

              111 Sewall Street Augusta, ME 04330   

The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed above before July 16, 2019 

COMMENT DEADLINE:               Comments must be received by 11:59 PM on August 2, 2019. 

AGENCY CONTACT PERSON:     Dean Bugaj, Comprehensive Health Planner

AGENCY NAME:                              Division of Policy

ADDRESS:                                         109 Capitol Street

                                                            11 State House Station

                                                            Augusta, Maine 04333-0011

EMAIL:                                              Dean.Bugaj@maine.gov

TELEPHONE:                                   (207)-624-4045   FAX: (207) 287-6106

                                                            TTY users call Maine relay 711 

IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties. 

CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A