Adopted Rule: MaineCare Benefits Manual, Chapter II, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations

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. ch. 101, MaineCare Benefits Manual, Chapter II, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations

 

ADOPTED RULE NUMBER:

 

CONCISE SUMMARY: On June 25, 2019, the Department adopted an emergency Ch. II, Section 28 rule. The Department adopts these rule changes in order to make those changes permanent.

 

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 for 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 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. This adopted rulemaking will finalize Ch. II rule changes and provides for a new provision in the rule identifying BCBA services in the Covered Services section of the rule. In addition, the adopted rule identifies the requirements for BCBA providers, consistent with requirements set forth by the Behavioral Analyst Certification Board. These standards were originally in effect on the effective date of the emergency rule, June 25, 2019.

 

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 the emergency rule, June 25, 2019, 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 changes described above, this adopted rulemaking adds telemedicine language under Provider Requirements. As a result of public comments and review by the Office of the Attorney General, the Department amended the final rule to remove the EVV language. While Section 28 providers are subject to the EVV requirement, the Department removed the language requiring EVV as