MaineCare Notice of Section 1915(b)(4) Waiver Fee-for-Service (FFS) Selective Contracting Program Waiver Submission

MaineCare Notice of Section 1915(b)(4) Waiver Fee-for-Service (FFS) Selective Contracting Program Waiver Submission

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.

Below, please find a MaineCare Notice of Agency Waiver Application Submission. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.

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Notice of Section 1915(b)(4) Waiver Fee-for-Service (FFS), Selective Contracting Program Waiver Submission

AGENCY: Department of Health and Human Services, Office of MaineCare Services

RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 24, Home and Community Based Services Across the Lifespan for Individuals with Intellectual Disabilities or Autism Spectrum Disorder

CONCISE SUMMARY: The Office of MaineCare Services (OMS) plans to submit a Section 1915(b)(4) Waiver Fee-for-Service (FFS) Selective Contracting Program application with the federal Centers for Medicare & Medicaid Services (CMS) to waive participant’s freedom of choice of providers for Community Resource Coordination (comprehensive case management as a waiver service) under the 1915(c) Home and Community Based Services Across the Lifespan for Individuals with Intellectual Disabilities or Autism Spectrum Disorder Waiver (the Lifespan Waiver) application.

Under this 1915(b) authority, the Department proposes to engage in a competitive procurement process for selecting providers who demonstrate capacity to meet the state’s standards for delivering high quality case management services as set forth in a state-defined contract. These providers will be the only entities permitted to furnish the Community Resource Coordinator service. Network participation will be based on contract award, and providers must meet specific criteria such as service capabilities, geographic coverage, and quality standards.

Participants will choose from among the state-selected participating provider(s) to obtain these services.

This delivery model allows the state to:

• Standardize service provision
• Improve monitoring
• Increase administrative efficiency

The state plans to implement the 1915(b)(4) waiver concurrently with the 1915(c) Lifespan Waiver following CMS approval.

Please see the accompanying draft application for Maine’s complete proposal.

DHHS is accepting comments through 11:59 pm, May 13, 2026. Any interested party may obtain a copy of the waiver amendment by going to the website noted below or at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html).

A printed copy may be obtained by calling Lisa Weaver at (207) 624-4050 or emailing lisa.weaver@maine.gov.

See https://www.maine.gov/dhhs/about/rulemaking for the 1915(b) application and to submit comments.

STATUTORY AUTHORITY:                 Section 1915(b) of the Social Security Act

DEADLINE FOR COMMENTS:           Comments must be received by 11:59 pm, May 13, 2026.

AGENCY CONTACT PERSON:            Heather Bingelis, Comprehensive Health Planner II

AGENCY NAME:                                   MaineCare Services

ADDRESS:                                              109 Capitol Street, 11 State House Station

                                                                 Augusta, Maine 04333-0011

                                                                Heather.bingelis@maine.gov

TELEPHONE:                                         207-624-4951 FAX: (207) 287-1864 TTY: 711