MaineCare Notice of Agency Rule-making Adoption, 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 (MBM), Chapter II, Section 97, Private Non-Medical Institution Services

 

ADOPTED RULE NUMBER:

 

CONCISE SUMMARY:

 

The Department of Health and Human Services (the “Department”) adopts the following changes to 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual (MBM), Chapter II, Section 97, Private Non-Medical Institution Services.

 

The Department adopts these rule changes to align Section 97 requirements with the Family First Prevention Services Act (FFPSA), which establishes standards for children’s residential treatment programs in order to improve quality and oversight of services. The adopted changes are specific to Private Non-Medical Institution (PNMI) Appendix D Facilities, and are reflected in the definitions, eligibility for care, covered services and policies and procedures sections of this rule. Additionally, as directed under the FFPSA, the adopted rule includes requirements for Appendix D providers to meet Qualified Residential Treatment Programs (QRTP) standards, which include obtaining and maintaining specified licensing and accreditation standards, as well as delivering trauma-informed treatment.

 

For compliance with the FFPSA related to improving quality and oversight of services, the Department amended Appendix D language referring to Child Care Facility Services and Models of Child Care Facilities, to be replaced with the term, “Children’s Residential Care Facilities” (CRCFs). The adopted rule distinguishes models of residential care that address specific treatment needs of different member populations. CRCF models include Intellectual Disabilities/Developmental Disabilities (ID/DD-CRCF), Mental Health (MH-CRCF), Crisis Stabilization (CS-CRCF), and Child and Adolescent Therapeutic Foster Care. This rule further adopts amended language referring to “Intensive Temporary Residential Treatment Services” by replacing this with the term “Temporary High Intensity Services” and including language clarifying the covered services while also establishing the requirement for a Prior Authorization process.

 

The rule also adopts the use of Department-approved, age appropriate Level of Care/Service Intensity tools, which is required as a component of eligibility determination for ID/DD, MH, and CS CRCFs. The Level of Care/Service Intensity tools replace outdated instruments, to include the Child and Adolescent Functional Assessment Scale (CAFAS), the Children’s Global Assessment Scale (C-GAS), the Global Assessment Functioning (GAF), and the Children’s Habilitation Assessment Tool (CHAT); and streamline the process by utilizing one tool that is evidence based and clinically appropriate by age, to include the Early Childhood Service Intensity Instrument (ECSII), the Child and Adolescent Level of Care/Service Intensity Utilization System (CALOCUS-CASII) and the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS).

 

Additionally, this rule adopts various new covered services, including Aftercare Support Services, which are designed to promote a continuation of treatment gains with the goal of supporting the child in their home and community environment, and must be provided to youth for at least six (6) months post discharge from MH and ID/DD CRCFs. The Department is additionally requiring a new position, a Family Transition Specialist (FTS), to aid in the delivery of aftercare and transition services for the youth and family.

 

To further align with the FFPSA to achieve improved quality and oversight of services, this adopted rule clarifies Appendix D requirements for the CRCF assessment, Individual Treatment Plan, progress notes, and discharge summary as well as adding various new defined terms.

 

The Department additionally adopted language that requires providers operating under Appendix D and Adolescent Residential Rehabilitation Services operating under Appendix B, to demonstrate utilization of the Federal Substance Abuse and Mental Health Services Administration’s (SAMHSA) System of Care Principles. The rule requires delivery of trauma-informed care through the completion of a Trauma-Informed Agency Assessment, staff training and incorporation of these principles into program policy and procedures.

 

The Department also adopts specific requirements regarding background checks for providers operating under Appendix D and Adolescent Residential Rehabilitation Services providers operating under Appendix B. Children’s residential facility providers must follow the requirements set forth in 22 M.R.S. § 8110 and 42 U.S.C. § 671(20). Behavioral Health Services providers must conduct background checks every five (5) years and fingerprinting. The adopted rule requires completed background checks for all staff and all adults providing services to a member within ninety (90) days of the effective date of this rule and that all background checks are to be completed every five (5) years thereafter.

 

The Department further adopts, under Appendix D, the addition of Behavioral Health Professionals (BHP) and Family Transitional Specialists (FTS) as Other Qualified Residential Treatment Facility Staff as well as including Board Certified Behavior Analyst services, Registered Behavior Technician services and Board Certified Assistant Behavior Analyst services. The Department is requiring confirmation that prospective BHPs are not annotated in the registry (per 10-144 C.M.R. ch. 128, Certified Nursing Assistant and Direct Care Worker Registry Rule) prior to qualifying as a staff member under this rule.

 

In addition to the above adopted changes, the Department adopted language increasing access to necessary services by removing the ‘single admission’ limitation and increasing the number of allowable covered days for Halfway House and Extended Care Services under PNMI Appendix B of this rule. The Department also adopted edits to language to accurately reflect current practices as well as updates to formatting, citations, and references where necessary, including changes to address potentially stigmatizing language based on recommendations from Maine’s opioid task force and legislation passed in 2018 to minimize stigma (P.L. 2017, ch. 407).

 

The Department shall seek CMS approval for the new covered services and provider requirements, as specifically noted in various adopted rule changes.

 

In addition, the Department intends to implement corresponding changes as needed in the MBM, Chapter III, Section 97, to ensure adequate reimbursement for providers to deliver all new covered services and meet QRTP standards and other Chapter II-related updates. For example, Chapter III Appendix D Section 2400.1 must be updated in order to ensure that rates cover the costs of Board Certified Behavior Analysts and the other new types of direct service staff. The Chapter III, Section 97 rule is major substantive, and the upcoming changes shall be filed as an emergency rule no later than Nov. 1, 2021, so that they will be effective at the same time the changes in Chapter II, Section 97 are finally adopted.

 

Considering public comment and legal advice from the Office of Attorney General, the Department made various changes to the final rule from what was proposed.

 

Changing requirements for Appendix D providers, service delivery, and provisions of treatment to provide more specificity and allow for more flexibility for providers, include:

 

• Updating language related to accreditation, under 97.07-2(F)(h)(2) to allow for accreditation to be completed within 12 months.

 

• Extending the Prior Authorization for Temporary High Intensity Services (97.02-5(C)) from a seven (7) day authorization to “up to thirty (30) days.”

 

• Including language under 97.08-2.G(6) to address exemptions related to Aftercare Support Services.

 

• Adding language under 97.06-3 (Non-Reimbursable Days), to include, “Members receiving services in an emergency department are exempt from this provision when emergency treatment is sought at 8:00pm or later and the member returns to the facility the following day.”

 

• Removing references that limit telehealth services and reducing the frequency of required in-person contact for Aftercare Support Services.

 

• Clarifying that both ITPs and FBAs are reviewed minimally every thirty (30) days.

 

• Updating language, under 97.08-2(C)(2), to include more flexibilities for behavioral and/or rehabilitative therapies.

 

• Clarifying language related to family involvement in treatment under Appendix D CRCFs to include more involvement by the Department’s Office of Child and Family Services (OCFS) and specific requirements.

 

Changing requirements for Appendix D CRCF staff include:

 

• Allowing for, under 97.07-2(H)(2), a bachelor’s degree in an unrelated field with at least one (1) year of related professional experience, extending time for staff to obtain BHP certification for new hires to six (6) months from the date of hire and staff currently employed to one (1) year from the effective date of the rule.

 

• Updating CRCF staff supervision requirements to include a minimum of three (3) hours per month includes one (1) hour of individual and one (1) hour of clinical supervision conducted by a Clinician as defined in 97.01-4.

 

All changes are specifically listed in the separate document, Summary of Comments and Responses and List of Changes to the Final Rule.

 

See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. Please note that that the rule isn’t effective until November 1, 2021. Certified copies of rules are available on-line at the Secretary of State’s website.

 

 

EFFECTIVE DATE:                       November 1, 2021

 

AGENCY CONTACT PERSON:   Melanie Miller, Comprehensive Health Planner II

            Melanie.Miller@maine.gov

AGENCY NAME:                            MaineCare Services

ADDRESS:                                        109 Capitol Street, 11 State House Station

                                                            Augusta, Maine 04333-0011

TELEPHONE:                                  207-624-4087 FAX: (207) 287-6106

                                                            TTY: 711 (Deaf or Hard of Hearing)