Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 45, Hospital 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, MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services

 

PROPOSED RULE NUMBER:

 

CONCISE SUMMARY: This rulemaking proposes to make the following changes:

 

As directed by P.L. 2019, ch. 530, An Act to Prevent and Reduce Tobacco Use with Adequate Funding and by Equalizing the Taxes on Tobacco Products and To Improve Public Health, the Department is proposing the following changes:

 

1. Pursuant to Sec. C-2, the Department proposes to establish two subsets of Private Acute Care Non-Critical Access Hospitals; rural hospitals and non-rural hospitals. The Department’s proposed definition of “rural hospital” followed the Legislative directive so that the definition reflects the regional access to hospital care and the population density of the public health district in which the hospital is located. The proposed definition of a private acute care non-critical access “rural” hospital is a hospital, as reported on the hospital’s Medicare cost report, which is either: a “Sole Community Hospital”, OR a “Medicare -Dependent Hospital”, OR is a hospital participating in the Medicare “Rural Community Hospital Demonstration”. As required by the law, the following hospitals meet the “rural hospital” definition: Northern Light A.R. Gould Hospital in Presque Isle; Cary Medical Center in Caribou; Franklin Memorial Hospital in Farmington; Northern Light Inland Hospital in Waterville; Northern Light Maine Coast Hospital in Ellsworth; and Northern Maine Medical Center in Fort Kent.

 

2. Pursuant to Sec. C-2, the Department proposes to reimburse Private Acute Care Non-Critical Access Rural Hospitals at 100% of inpatient hospital- based physician costs, outpatient emergency room hospital- based physician costs, outpatient non-emergency room hospital-based physician costs and graduate medical education costs. Pursuant to Legislative directive and funding, this provision will be effective retroactive to January 1, 2020. The retroactive application of this provision is authorized pursuant to 22 M.R.S. § 42(8), which allows retroactive application where there is a benefit to a provider, as is the case with this rule.

 

3. Pursuant to Sec. C-2, the Department proposes to reimburse Private Acute Care Non-Critical Access Non-Rural Hospitals at 93.3% of inpatient hospital-based physician costs, 93.4% of outpatient emergency room hospital-based physician costs and 83.8% of outpatient nonemergency room hospital- based physician costs. Pursuant to Legislative directive and funding, this provision will be effective retroactive to January 1, 2020. The retroactive application of this provision is authorized pursuant to 22 M.R.S.§ 42(8), which allows retroactive application where there is a benefit to a provider, as is the case with this rule.

 

4. Pursuant to Sec. C-3, the Department proposes to reimburse Acute Care Critical Access Hospitals for 100% for all hospital-based physician costs. Pursuant to Legislative directive and funding, this provision will be effective retroactive to January 1, 2020. The retroactive application of this provision is authorized pursuant to 22 M.R.S. § 42(8), which allows retroactive application where there is a benefit to a provider, as is the case with this rule.

 

The Department has submitted State Plan Amendment requests to CMS and anticipates approval of the SPA requests.

As directed by 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, Part A, Sec. 129, the Department is proposing the following change:

 

The Supplemental Pool for the Acute Care Critical Access Hospitals and also for Non-Critical Access Hospitals, Hospitals Reclassified to a Wage Area Outside Maine, and Rehabilitation Hospitals was increased.

 

In addition: The Department is proposing to clarify that each hospital’s year, as used for the calculation, is the hospital’s fiscal year that ended during calendar year 2016.

 

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

 

STATUTORY AUTHORITY: 22 M.R.S. §§ 42(1) & (8), 3173

 

PUBLIC HEARING:  No public hearing is scheduled.

 

NOTE: 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 in lieu of a public hearing.

 

PUBLIC NOTICE:  June 17, 2020

 

COMMENT DEADLINE:                  Comments must be received by 11:59 PM on July 17, 2020.

 

AGENCY CONTACT PERSON:       Anne E. Labonte, Comprehensive Health Planner II

AGENCY NAME:                                MaineCare Services

ADDRESS:                                            109 Capitol Street, 11 State House Station

                                                                Augusta, Maine 04333-0011

EMAIL:                                                 Anne.Labonte@Maine.gov

TELEPHONE:                                     (207)-624-4082 FAX: (207) 287-6106

                                                               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.