MaineCare Benefits Manual, Chapters II and III Section 65, Behavioral Health Services

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 101, MaineCare Benefits Manual, Chapters II & III, Section 65, Behavioral Health Service

 

PROPOSED RULE NUMBER:

 

CONCISE SUMMARY:

 

The Department of Health and Human Services (“the Department”) proposes the following changes to 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapters II and III, Section 65, Behavioral Health Services.

 

In Chapter II, the Department proposes to remove the twenty-four (24) month lifetime limit for reimbursement for Medication Assisted Treatment (“MAT”) with Methadone for opioid addiction to align with changes in state law which took effect on March 14, 2019 under P.L. 2019 Ch. 4, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of Law Necessary to the Proper Operations of State Government for the Fiscal Year Ending June 30, 2019, and which were previously announced via the Department’s list serv to interested parties on March 22, 2019. The Act repealed 22 M.R.S.A. §§ 3174-SS and 3174-VV which had set limitations on these services. By removing the lifetime limit, members may access MAT with Methadone for as long as medically necessary, with no lifetime cap of services. The Department’s removal of the 24- month cap has already been approved by the Centers for Medicare and Medicaid Services (“CMS”).

 

Additionally, in Chapter III the Department proposes this rule to seek to increase the rate of reimbursement for MAT with Methadone retroactive to July 1, 2019. Pursuant to P.L. 2019, Ch. 343, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2019, June 30, 2020 and June 30, 2021, (effective June 17, 2019), the Legislature increased funding for the weekly reimbursement rate for MAT services for the FY2020 and FY2021 state budgets. In light of the state’s ongoing opioid crisis, the Department has found that the immediate adoption of the MAT rate increase is necessary to avoid an immediate threat to public health, safety, or general welfare under 5 M.R.S. § 8054, and will be adopting an emergency rule concurrent with this rule proposal. The emergency rate increase and the Department’s intended adoption of the increase following this routine technical rulemaking will benefit both providers and members and will further support the delivery of these critical services to those in need.

 

The Department is seeking and anticipates approval from the CMS for the MAT rate increase. The Department published a Notice of MaineCare Reimbursement Methodology Change on June 28, 2019 notifying providers of this increase and is awaiting approval of a state plan amendment. Pending that approval, the Department will reimburse MAT services at the increased rate retroactive to July 1, 2019.

 

Additionally, the Department proposes to increase of the rates of reimbursement in Chapter III for Functional Family Therapy (FFT), Multisystemic Therapy (MST), Multisystemic Therapy for Problem Sexualized Behaviors (MST-PSB) by 20% effective January 1, 2020 in accordance with Resolves 2019, Ch. 110, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children (effective January 12, 2020). In approving this legislation (which became law without the Governor’s signature), the Legislature determined that an immediate effective date was necessary given the rates had “not been adjusted in more than 8 years” and the rates were “insufficient to enable some providers to continue to provide services.” The Department agrees with and incorporated these findings in support of this emergency rulemaking under 5 M.R.S. § 8054.

 

The Department is seeking and anticipates CMS approval for the 20% rate increases for FFT, MST, and MST-PSB services. The Department published a Notice of MaineCare Reimbursement Methodology Change on June 28, 2019 of the intended 20% rate increases with the expectation that the Legislature would approve the increases effective July 1, 2019. The Department believes this notice is sufficient despite the legislation not taking effect until January 12, 2020. Pending CMS approval, the Department will reimburse FFT, MST, and MST-PSB services at increased rates retroactive to January 1, 2020.

 

Additionally, following the completion of the rate study directed by Resolves 2019, Ch. 110 and completed by Burns and Associates, the Department is proposing new increased rates for MST, MST-PSB, and FFT. The additional funding has been approved for the FY2021 state budget pursuant to P.L. 2019, Ch. 616, An Act Making Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021 (effective March 18, 2020). Through the rate study process and in line with the Legislature’s directive in the Resolve, the Department has made the determination to switch reimbursement from quarter hour billing to a weekly case rate to reflect the requirements for the evidence-based models. In Chapter II, the Department has ended Collateral Contacts for MST, MST-PSB, and FFT as these services have been incorporated into the new weekly case rate, and the Department has also proposed minimum contact standards for providers accessing this new weekly case rate. In Chapter III, the Department has deleted the prior quarter hour codes and added in the new weekly codes and rates. In response to financial challenges and civil emergency created by the COVID-19 pandemic, the Department has advanced the increased rates from the anticipated July 1, 2020 start date approved in the FY2021 budget retroactively to May 1, 2020, in order to provide financial relief, to support stability in the workforce, and to increase access to members in need. The Department has further found that the immediate adoption of the MST, MST-PSB, and FFT rate increases is necessary to avoid an immediate threat to public health, safety, or general welfare under 5 M.R.S. § 8054, and will be adopting an emergency rule concurrent with this rule proposal. The emergency rate increase and the Department’s intended adoption of the increase following this routine technical rulemaking will benefit both providers and members and will further support the delivery of these critical services to those in need.

 

The Department published a Notice of MaineCare Reimbursement Methodology Change on April 30, 2020 of the intended rate increases and intends to file a State Plan Amendment within the quarter. Pending CMS approval, the Department will reimburse MST, MST-PSB, and FFT at increased weekly rates retroactive to May 1, 2020.

 

The rate study described above additionally developed a rate for an evidence-based modality of outpatient therapy, Trauma Focused Cognitive Behavioral Therapy (TF-CBT). The Department is proposing a service description, and provider requirements in Chapter II and rate in Chapter III for this evidence-based practice. The Department will be seeking and anticipates CMS approval for these new services that are intended to benefit providers and members alike.

 

In addition, this rulemaking proposes coverage in Chapter II and reimbursement in Chapter III for three evidence-based parenting programs for children with disruptive behavior disorders: Positive Parenting Program (Triple P), the Incredible Years (IY), and Parent-Child Interaction Therapy (PCIT). The Department will be seeking and anticipates CMS approval for these new services that are intended to benefit providers and members alike.

 

With this rule proposal, the Department proposes coding changes to comport with coding updates per the National Correct Coding Initiative for certain Neuropsychological testing services effective January 1, 2019. The reimbursement table for these codes in Chapter III have been adjusted to reflect billing as of January 1, 2019. The changes were made in the system and the public notified via list serve of the coding changes on January 31, 2019, and now the Department wishes to update policy for consistency. Coverage language in Chapter II has been updated to reflect the intent of the new codes.

 

Additionally, the Department proposes changes to the educational requirements for Behavioral Health Professionals in accordance with Resolves 2019, Ch. 99, Resolve, To Change the Educational Requirements of Certain Behavioral Health Professionals (effective Sept. 19, 2019), creating three educational levels: high school diploma or equivalent with a minimum of 3 years direct experience working with children in a behavioral health with a specific plan for supervision and training; a minimum of 60 higher education credit hours in a related field of social services, human services, health or education; and a minimum of 90 higher education credit hours in an unrelated field with a specific plan for supervision and training. The Department has received CMS approval for these changes.

 

The Department proposes to increase rates for certain services in accordance with P.L. 2019 Ch. 616. In response to the COVID emergency and hardships created during this period of civil emergency, the Department has made the decision to advance these rate increase to be effective retroactively to April 1, 2020. The rate changes include an increase for physicians delivering medication management, and an increase for Behavioral Health Professionals providing Home and Community-based Treatment (HCT) services. In order for physicians to access the increased rate of reimbursement, they will be required to use the AF modifier on their claims. Department has found that the immediate adoption of the medication management and HCT rate increases is necessary to avoid an immediate threat to public health, safety, or general welfare under 5 M.R.S. § 8054, and will be adopting an emergency rule concurrent with this rule proposal. The emergency rate increases, and the Department’s intended adoption of the increase following this routine technical rulemaking will benefit both providers and members and will further support the delivery of these critical services to those in need. 

 

The Department published a Notice of MaineCare Reimbursement Methodology Change on March 31, 2020 of the intended rate increases and intends to file a State Plan Amendment within the quarter. Pending CMS approval, the Department will reimburse Behavioral Health Professionals delivering HCT and physicians delivering Medication Management at increased rates retroactive to April 1, 2020.

 

The Department is also proposing to add coverage for Adaptive Assessments, namely the Vineland, ABAS, Bayley, and Battelle rating scales, proposing coverage language within Chapter II and coding within Chapter III of this section. The Department has been allowing coverage for these assessments via the Comprehensive Assessment (code H2000) and wishes to clarify coverage, coding, and rate per assessment.  

In addition to the above changes, the Department proposes in Chapter II to: 

• Add protections for Adults with Serious and Persistent Mental Illness regarding providers terminating services and accepting referrals for this population as defined in the rule;
• Modify HCT required team language to allow for flexibility when clinically appropriate;
• Add background check requirements for staff having direct interaction with members within the provision of services;
• Update the Comprehensive Assessment and Individualized Treatment Plan (ITP) sections to clearly note what services do not require these documents, and to include in the ITP section a schedule of development and review of the new services;
• Update Appendix I and II to reflect the changes proposed in this rulemaking; and
• Update formatting, citations, and references where necessary, including changing “Office of Substance Abuse and Mental Health Services” to “Office of Behavioral Health” throughout the rule.For Chapter III, the Department is additionally proposing to add a modifier to Medication Management for Treatment with Suboxone to more clearly show coverage of that medication, which will aid in the Department’s licensing efforts for these programs. 

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

 

STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173; 5 M.R.S. § 8053; P.L. 2019, Ch. 4; P.L. 2019 Ch. 343; Resolves 2019, Ch. 99; Resolves 2019, Ch. 110; P.L. 2019, Ch. 616

 

PUBLIC HEARING:

 

No public hearing scheduled. During the Civil State of Emergency declared by the Governor, public hearings are now closed to the public physically attending.  During this State of Emergency, the Department will be providing a 30-day comment period instead of a public hearing.

 

COMMENT DEADLINE:                  Comments must be received by 11:59 pm on July 3, 2020.

 

AGENCY CONTACT PERSON:       Dean Bugaj, Comprehensive Health Planner II

AGENCY NAME:                                MaineCare Services

ADDRESS:                                            109 Capitol Street, 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.