DHHS Notice of Agency Waiver Renewal: Section 29

Notice of Agency Waiver Renewal
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AGENCY:  Department of Health and Human Services, MaineCare Services
RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
WAIVER: ME.0467, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Waiver
CONCISE SUMMARY: The Department plans to submit a five-year renewal for the Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Home and Community Based Services (HCBS) 1915(c) waiver application. 

This five-year waiver renewal proposes to incorporate the following changes:

General:

• Update the Brief Waiver Description for clarity and readability.
• Revise language, where applicable, to align and create consistency with Maine’s four other 1915(c) waiver authorities [ME.1082 (MaineCare Benefits Manual (MBM) Section 18), ME.0276 (MBM, Section 19), ME.0995 (MBM, Section 20), and ME.0159 (MBM, Section 21)].
• Update and revise Performance Measures throughout the waiver, where applicable, to align and create consistency with ME.0159, (MBM, Section 21).
•   Update and include new information related to the 2024 revised 1915(c) HCBS Waiver Application, version 3.7 where applicable.

Appendix A Waiver Administration and Operation:

• Update and revise Appendix A-2-b: Medicaid Agency Oversight of Operating Agency Performance, Appendix A-5: Responsibility for Assessment of Performance of Contracted and/or Local/Regional Non-State Entities, and Appendix A-6: Assessment Methods and Frequency, to align and create consistency with ME.0159 (MBM, Section 21).

Appendix B Participant Access and Eligibility:

• Update the number of Unduplicated Participants Served in Appendix B-3-a and the Number of Participants Served at any Point in Time in Appendix B-3-b to reflect the five-year renewal period. 

Appendix C Participant Services:

• Revise and update Appendix C-1/C-3: Provider Specifications, by adjusting the basic requirements for enrollment and regular re-enrollment requirements for providers of waiver services, consistent with MaineCare regulations and statutory requirements (changed every three years to every five years).
• Expand, clarify and strengthen the list of “Individual Goods and Services (IGS) that are not allowable” as well as the requirement that funds must be accrued and available within the participant’s individual budget to access authorized IGS in Appendix C-1/C-3: Service Specification, Individual Goods and Services. 
• Revise and update provider requirements in Appendix C-2-a: Criminal History and/or Background Investigations, for conducting criminal background checks by requiring compliance and alignment with DHHS Division of Licensing and Certification, Maine Background Check Center (MBCC) Rule (10-144. Chapter 60).  Remove the list of disqualifying offenses because the list of these offenses within the MBCC rule is more extensive. 
• Revise and update Appendix C-2-e: Other State Policies Concerning Payment for Waiver Services Furnished by Relatives/Legal Guardians, by clarifying that under this waiver a qualified legal guardian (when the legal guardian is a parent, stepparent, stepsibling, or other biological family member) may only be paid to deliver the following two provider-managed services: Shared Living Services and Non-Medical Transportation Services.  Additionally, clarify that under this waiver, a qualified family member may only be paid to deliver the following three provider-managed services: Non-Medical Transportation, Shared Living and Respite Services.
•  Clarify and strengthen requirements in Appendix C-2-f: Open Enrollment of Providers, that providers must comply with all applicable state and federal regulations including licensing rules and regulations.
• Revise and update the combined annual limits for certain services in Appendix C-4: Additional Limits on Amount of Waiver Services.  Additionally, include the basis of service limits and that rates and limits are subject to legislative approval and appropriation. 
• Revise and update Appendix C-5: Home and Community-Based Settings, by including the process and standards the Department employs to ensure providers comply, initially and ongoing, with federal HCBS Settings standards.

Appendix D Participant-Centered Planning and Service Delivery:

• Revise and update Appendix D-1-a: Responsibility for Service Plan Development, by including requirements that all training for Case Managers complies with the HCBS Settings Rule and Maine’s Global HCBS Waiver Person-Centered Planning and Settings Rule (“the Global Rule”).
• Revise and update Appendix D-1-c: Supporting the Participant in Service Plan Development, to align and create consistency with ME.0159, (MBM, Section 21).
• Revise and update Appendix D-1-d: Service Plan Development Process, by incorporating the state’s process for ensuring the participant engages in and consents to the Person-Centered Service Plan (PCSP) and process.

Appendix E Participant Direction of Services:

• Revise and update Appendix E: Participant Direction of Services, to align with current protocol and practice. 
• Revise and update requirements that Financial Management Services (FMS) providers fully inform participants that access to prior approved IGS is contingent upon the monthly accrual of adequate funds within the participant’s individual budget.

Appendix F Participant Rights:

• Revise and update Appendix F-3-c: State Grievance/Complaint System to align and create consistency with current process and practice.

Appendix G Participant Safeguards:

• Revise and update Appendix G-1-d: Responsibility for Review of and Response to Critical Events or Incidents, to align with current state licensing rules and practice.

Appendix H Quality Improvement Strategy:

• Update Appendix H-2: Use of a Patient Experience of Care/Quality of Life Survey, to reflect the Department’s adoption and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) satisfaction survey tool. 

Appendix I Financial Accountability:

• Update Appendix I-2-a: Rate Determination Methods, by clarifying that certain reimbursement rate adjustments are contingent on available funding and subject to legislative approval.  

Appendix J Cost Neutrality Demonstration:

• Update Appendix J-1: Composite Overview and Demonstration of Cost-Neutrality Formula, and Appendix J-2: Derivation of Estimates, for the five years of this waiver cycle (through December 31, 2030).

Please see the accompanying draft application for all proposed changes as included in the renewal. 
DHHS is accepting comments through 11:59 pm, August 29, 2025. Any interested party may obtain a copy of the waiver application 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 [email protected].
See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments.

STATUTORY AUTHORITY:            42 CFR §441.304
DEADLINE FOR COMMENTS:      Comments must be received by 11:59 pm, August 29, 2025.
AGENCY CONTACT PERSON:        Heather Bingelis, Comprehensive Health Planner II
AGENCY NAME:                              MaineCare Services
ADDRESS:                                        109 Capitol Street
                                                          Augusta, Maine 04333-0011
EMAIL                                               [email protected]
TELEPHONE:                                  207-624-4951 FAX: (207) 287-1864 TTY: 711