June 4, 2021 MaineCare Updates

Attention: Providers of Sections 18, 19, 20, 21 and 29 - Appendix K to Maine’s Home- and Community-Based Waiver Programs Amended

Service Caps and Related Provisions Extended and Modified Through September 30, 2021

Appendix K to Maine’s Home and Community-Based Services 1915(c) waiver programs provides flexibility to operate waiver programs during an emergency. Maine’s Appendix K and amendments may be found here. 

Service Caps and Other Provisions Extended and Modified Through September 30, 2021

 

Section K-2.b.ii. of Maine’s Appendix K was originally set to expire on May 31, 2020, but due to continuing need, the Department has extended this provision four times, most recently through June 30, 2021. At this time, given continuing challenges related to COVID-19 throughout Maine, the Department will continue to provide flexibility under Section K-2.b.ii through September 30, 2021. 

 

Extended provisions include, but are not limited to the following flexibilities:    

• Budget allocations may be exceeded to address emergency needs;  
• Certain service caps may be exceeded to address emergency needs;
• Data transmission charges may be allowed up to $200 per person per month to accommodate greater access to telehealth services; and
• Per Diem staffing levels may be lower than 92.5% of authorized levels.

Provisions vary by waiver. Please read the additional information below for details.   

Appendix K, Section K-2.b.ii Provisions Extended Through September 30, 2021 

 

Appendix C-4:   

 

The budget allocations enumerated in Appendix C-4 of the Home and Community-Based Services for Members with Brain Injury (ME.1082), the Elderly and for Adults with Disabilities (ME.0276), the Home and Community Based Services for Adults with Other Related Conditions (ME. 0995), the Home and Community Based Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (ME 0159), and the Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (ME.0467) waivers may be temporarily exceeded to provide needed services for emergency care.    

 

Service Limits in Sections C-1/C-3   

 

ME.0276 (Section 19)   

• Increase the limit of available hours within Personal Care Services by up to 20 percent per week.   
• Increase the limit for the provision of care coordination by up to 20 percent per month   
• Increase the limit on Assistive Technology Device and Services to $6,000 and $200 per month for Assistive Technology- Transmission with prior authorization, and remove these services from the monthly program cap.   
• Increase the limit on Respite Services by up to 20 percent per week.   
• Increase the limit on Home Delivered Meals from one meal/day to two meals/day and remove the total cost from the monthly cap of combined Personal Care, Attendant Care, Respite, Assistive Technology and Living Well/Matter of Balance services.   
• Remove budget allocation limits and individual caps on service to accommodate these temporary service increases.    

ME.1082 (Section 18), ME.0995 (Section 20), ME.0159 (Section 21), and ME.0467 (Section 29)    

• Increase the service limits to Quarter Hour Home Supports to up to 64 units per day.   
• Increase the limit on Assistive Technology Transmission to $200 per month for data transmission with prior authorization and remove Assistive Technology Transmission from the overall cap for ME.1082 and ME.0995.   
• Modify limitations on Respite Services for ME.0467.   
• Modify limits on Care Coordination units for ME.1082 and ME.0995.   
• The provision allowing per diem staffing levels to fall below authorized levels, provided that agencies can ensure members’ health and safety, is modified as follows:
  • January 1, 2021 to September 30, 2021: Staffing levels may be no lower than 70% of authorized levels.

The Department is extending the staffing level provision due to persistent staffing shortages which are expected to last through the summer tourist season.  Providers should plan to return staffing levels to at least 92.5% of authorized levels by October 1, 2021. 

Please note that all other provisions currently allowed in the Appendix K will continue until six months after the end of the Federal Public Health Emergency.

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Individuals Excluded by Maine or Federal Government Reminder

MaineCare providers are prohibited from employing or contracting with people who have been excluded by the state or federal government.

Providers must screen all employees and contractors for exclusions and require their contractors to screen their staff for excluded individuals. Providers must screen all new potential employees prior to hire and should routinely screen all staff at set time intervals, e.g. annually, quarterly, etc.

Providers must check both the state and federal websites. Maine may have excluded someone who is not excluded by the federal government, and the federal government may have excluded someone who is not listed on Maine’s website.

Search for People Excluded by the State

The Maine Excluded Providers Database, found on the Health PAS Online Portal, is a tool used to search for people who have been excluded by the state. You can search potential employees by last name. You can then verify the Social Security or Employer Identification Number using this tool.

To find the Maine Excluded Provider Database, you can also follow this pathway on the Health PAS Online Portal and following this pathway: Provider Tab > Useful Links > Provider Exclusion Check - Individual Search. If you want to check the Monthly Exclusion Report, select Provider Exclusion Check – Monthly Exclusion Report instead of the Individual Search Option.

Search for People Excluded by the Federal Government

To check whether a person is excluded by the federal government, providers can use the Office of Inspector General Excluded Providers Database. Another federal exclusion website to check is the System for Award Management.

Please contact the Program Integrity Unit at 207-287-4660 with questions.