August 30, 2021 MaineCare Updates

Maine Department of Health & Human Services sent this bulletin at 08/30/2021 03:37 PM EDT

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Instructions to Apply for Retainer Payments for Providers of MaineCare Benefits Manual (MBM), Sections 18, 20, 21, and 29 Services

In response to the COVID-19 pandemic’s impact on the provision of Section 18, 20, 21, and 29 Services, per PL 2021, ch. 1, Sec. A-16, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Year Ending June 30, 2021, as approved by the federal Centers for Medicare & Medicaid Services (CMS) in Maine’s amended 1915(c) HCBS waivers with the Emergency Preparedness and Response Appendix Ks, Maine will issue retroactive retainer payments to providers of select services within the following four waivers:

MaineCare Policy Section	Select Eligible Services
Section 18, Home and Community-Based Services for Members with Brain Injury	T2015 Career Planning T2019 Employment Specialist Services S5102 Work Ordered Day Clubhouse H2023 Work Support
Section 20, Home and Community-Based Services for Adults with Other Related Conditions	T2015 Career Planning T2019 Employment Specialist Services H2023 Work Support T2021 Community Support
Section 21, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder	T2015 Career Planning T2019 Employment Specialist Services H2023 Work Support T2021 Community Support
Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder	T2015 Career Planning T2019 Employment Specialist Services H2023 Work Support T2021 Community Support

As a reminder, these payments are intended to provide relief and mitigate the risk of agency closures during the COVID-19 public health emergency (PHE).

Providers must complete and submit an attestation form no later than Friday, September 17, 2021 to be eligible for retainer payments. Earlier submissions are appreciated to facilitate the Department’s review and subsequent payment to providers.

Please refer to the instructions and complete the attestation form available in the Home and Community-Based Services (HCBS) Retainer Payment Request Guidelines. The guidelines also include information about how MaineCare will make payments. The Department will calculate payments based on claims that have been fully adjudicated by Friday, September 10, 2021.

We anticipate that payments will be made by the end of October 2021, and we will issue an e-message when we have a more specific date. Timing of the payments is in part dependent on providers’ timely submission of attestation forms.

Please contact Provider Relations Specialist, Tammy Usher with questions.

Reminder from the Maine Centers for Disease Control and Prevention: Immunization Law Removes Philosophical and Religious Exemptions

Effective September 1, 2021, Maine’s new immunization law removes both philosophical and religious exemptions to school-aged children’s immunization requirements. No child will be permitted to attend school without evidence of immunization or proof of immunity against disease, unless one of more of the following circumstances apply:

1. Written Assurance from Parent of Private Effort to Immunize Child: The parent provides the school with a written assurance that the child will be immunized by private effort within 90 days of enrollment (officially registering) in school or of the child first attending, whichever date is the earliest, in accordance with 20-A MRS § 6355(1).

The granting of this 90-day period is a one-time provision. If, after 90 days have passed, the parent fails to provide the required evidence of immunization or immunity against each of the diseases listed in this rule, then the superintendent must exclude the student from school and may permit the student’s return upon receipt of evidence of the required immunizations, immunity or exemption under law.

2. Written Consent to Immunize Child: The parent grants written consent for the child’s immunization by a public health officer, physician, nurse or other authorized person in their employ, or acting as an agent of the school, where such immunization programs are in effect.

3. Medical exemption in accordance with 20-A MRS § 6355(2).

4. Individualized Education Plan: In accordance with 20-A MRS § 6355(4), a student covered by an individualized education plan on September 1, 2021 who elected a philosophical or religious exemption from immunization requirements on or before September 1, 2021 pursuant to the law in effect prior to that date, may continue to attend school under that student’s existing exemption as long as:

a. The parent or guardian of the student provides a statement from a licensed physician, nurse practitioner or physician assistant that the physician, nurse practitioner or physician assistant has consulted with that parent or guardian and has made that parent or guardian aware of the risks and benefits associated with the choice to immunize; or

b. If the student is 18 years of age or older, the student provides a statement from a licensed physician, nurse practitioner or physician assistant that the physician, nurse practitioner or physician assistant has consulted with that student and has made that student aware of the risks and benefits associated with the choice to immunize.

c. If a student has an immunization exemption in accordance with this section, the student will be able to maintain that exemption after dismissal from special education services and will be considered exempt until the child is no longer eligible for free, appropriate public education (FAPE).

5. The student may be enrolled in a distance education program offered by a school, if the student does not physically attend any classes or programs at the school or a school facility

On July 7, the comment period for the Proposed Rule Immunization Requirements for School Children (ch. 261/126) was posted with a deadline of August 5, 2021. A virtual public hearing took place on July 26. For more information, please see the notice of rulemaking which provides additional details regarding this rulemaking, including public hearing information.

We would like to remind health care providers about the new school immunization law as the 2021- 2022 school year quickly approaches. If you have patients that are either non-immunized or incompletely immunized and may have either a philosophical or a religious exemption for immunizations, now is the time to work with parents to schedule well-child and vaccination appointments to ensure children are up-to-date on their immunizations and prepared for the upcoming school year.

Throughout the pandemic, we have encouraged parents to continue to bring their children in for well- child visits and about the importance of children receiving their recommended immunizations. As COVID-19 circulated throughout our state, we saw our immunization rates fall, particularly with adolescents, with many parents delaying visits and recommended immunizations due to fear of contracting COVID-19. We are now seeing the pandemic outlook improve but we have a lot of work to do to bring our immunization rates back up.

The State of Maine currently requires the following immunizations for all school children:

Required for Kindergarten entry:

5 DTaP (diphtheria, tetanus, and pertussis; 4 DTaP if 4th is given on or after 4th birthday)
4 Polio (if 4th dose given before the 4th birthday, an additional age appropriate IPV should be given on or after the 4th birthday)
2 MMR (measles, mumps, rubella)
1 Varicella (chickenpox) or reliable history of disease

Required for 7th grade entry:

Tdap (tetanus, diphtheria, and pertussis)
1 Meningococcal Conjugate (MCV4)

Required for 12th grade entry:

2 MCV4, only one dose is required if the 1st dose is given on or after 16th birthday

As you vaccinate your patients with the required immunizations for the fall, we strongly encourage you to use this opportunity to include other routinely recommended vaccines. Although not required, but equally important, are the following immunizations:

Immunization Catch-Up Resources from the U.S. CDC:

We thank you for your continued work throughout the pandemic and for helping to keep the children of Maine free from vaccine-preventable diseases. If you have any questions regarding the immunization schedule or vaccines in general, please contact the Maine Immunization Program’s Educator Line at 207-287-9972.

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