MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 97, Private Non-Medical Institution Services

Notice of Agency Rule-making Adoption

 

AGENCY: Department of Health and Human Services, MaineCare Services

 

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 97, Private Non-Medical Institution Services

 

ADOPTED RULE NUMBER:

 

CONCISE SUMMARY: The Department of Health and Human Services (the “Department”) adopts these rule changes to 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter II, Section 97 to enhance safeguards and protections of client rights under the Bates, et al. v. Commissioner, DHHS, et al, consent decree by creating new provisions addressing terminations from and referrals to Appendix E Private Non-Medical Institutions.

 

First, under Section 97.07-10, Termination, prior to terminating a member’s services, providers must receive written approval from the Office of Behavioral Health (OBH); must issue a 30-day advanced written termination notice to the member, with an exception for cases involving imminent harm; and must assist the member in obtaining clinically necessary services from another provider prior to termination. Adoption of this rule will protect members from inappropriate discharge from these services.

 

Second, under Section 97.07-11, Referrals, providers must acknowledge receipt of Department referrals within three business days for members eligible for Appendix E services and must accept or request permission to decline referrals in accordance with a Department-defined process within five business days of receipt of referral. Providers can only decline a referral with written approval from OBH, otherwise they must admit members within thirty days of receipt of the referral. This adopted language will assist members in receiving timely access to Appendix E services.

 

This adopted rule also provides clarity and consistency in record-keeping processes to align with other MaineCare policies. Specifically, the adopted rule changes the frequency requirement for entering and signing progress notes from a monthly to a daily expectation within Appendix E facilities. This adoption will improve accuracy and quality within member records.

 

In addition, as a result of further review by the Department and the Office of the Attorney General following the comment period, this adopted rule updates offensive terminology throughout the rule. This includes replacing references to “substance abuse” with “substance use” per Public Law 2017, Ch. 407, Part B, Sec. B-1.

 

Finally, this adopted rule include non-substantive technical, grammatical, and other minor changes, including updating the outdated references to current Department office names. The Summary of Public Comments and Department Responses document identifies changes that were made to the final rule following the comment period.

 

This rulemaking will take effect on July 1, 2021 to coincide with the anticipated adoption of changes to the MaineCare Benefits Manual, Section 17 and Section 92, which similarly enhance and safeguard client rights under the Bates consent decree.

 

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

 

EFFECTIVE DATE:                       July 1, 2021

 

AGENCY CONTACT PERSON:   Heather Bingelis, Comprehensive Health Planner

AGENCY NAME:                            Division of Policy

ADDRESS:                                        109 Capitol Street, 11 State House Station

                                                            Augusta, Maine 04333-0011

EMAIL:                                             heather.bingelis@maine.gov

TELEPHONE:                                  (207) 624-6951 FAX: (207) 287-6106

                                                                   TTY: 711 (Deaf or Hard of Hearing)