DHHS Rule Adoption - Section 21

Rule Adoption: Chapter III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autism Spectrum Disorder

Notice of Emergency Major Substantive Agency Rule-making Adoption 
AGENCY:  Department of Health and Human Services, MaineCare Services 
CHAPTER NUMBER AND TITLE:  10-144 C.M.R., Chapter 101, Chapter III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autism Spectrum Disorder 
ADOPTED RULE NUMBER: 
CONCISE SUMMARY:   This emergency major substantive rule is adopted in accordance with P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (“Act”). The Act gave notice that the Legislature determined that “these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety….”  Pursuant to this Legislative determination, the requirements of 5 M.R.S. § 8054(1) are satisfied.  
The Act provides funding to increase reimbursement rates for specific procedure codes in Chapter III, Section 21.  The legislation directed the Department to increase the rates by rulemaking for the specific procedure codes in equal proportion to the funding provided for that purpose. 
In addition to the 33 rate increases required by P.L. 2017, ch. 459, the Department has also increased the rate for a 34th procedure code – T2017 QC (Home Support, Habilitation, residential, waiver – Remote Support – Monitor only). In accordance with 5 M.R.S. Sec. 8054, the Department has determined that this rate increase needs to be done in this emergency rulemaking for it is necessary to avoid an immediate threat to public health, safety or general welfare. 
These increased rates will be effective retroactive to July 1, 2018, as directed by the Act.  The retroactive application of this rule comports with 22 M.R.S. Sec. 42(8) which authorizes the Department to adopt rules with a retroactive application for a period not to exceed 8 calendar quarters and there is no adverse financial impact on any MaineCare member or provider.  In addition, the Department sought, and obtained, approval by the Center for Medicare and Medicaid Services (“CMS”) to be able to submit a waiver amendment that will make the rate increases for these Medicaid waiver services retroactive to July 1, 2018.  
In creating the increased rates, the Department examined utilization of these services, and then calculated rates to ensure parity between Section 21 and Section 29, to lessen administrative complications for providers. 
The Maine Legislature has designed the Ch. III, Section 21 regulation as a major substantive rule.  Pursuant to 5 M.R.S. §8073, this emergency major substantive rule may be effective for up to twelve months, or until the Legislature has completed its review.  The Department intends to proceed with major substantive rulemaking, which will be provisionally adopted, and then submitted to the Legislature for its review. 
http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. 
EFFECTIVE DATE:                           September 11, 2018 
AGENCY CONTACT PERSON:      Trista Collins, Comprehensive Health Planner [email protected] 
AGENCY NAME:                             Division of Policy 
ADDRESS:                                       242 State Street, 11 State House Station, Augusta, Maine 04333-0011
TELEPHONE:                                  (207)-624-4094   FAX: (207) 287-1864 TTY users call Maine relay 711