Office of MaineCare Services Notice of Agency Rule-making Proposal - Section 29

​Notice of Agency Rule-making Proposal 
AGENCY:  Department of Health and Human Services, MaineCare Services 
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, Section 29, Ch. II, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder  
PROPOSED RULE NUMBER: 
CONCISE SUMMARY: The Department is proposing this routine technical rule 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”). This Act provides funding to increase rates for specific procedure codes in Chapter III, Section 29.  Part B of the Act provided that the Department ensure that caps and limitations on services “are increased to reflect increases in reimbursements that result from this Part.” 
On September 12, 2018, the Department adopted an emergency major substantive rule for Section 29, Ch. III, as directed in the Act, to increase reimbursement rates for eighteen (18) procedure codes, with a retroactive effective date of July 1, 2018. In accordance with Part B of the Act, the Department is adopting an emergency rule for Chapter II, to increase caps in Section 29 to reflect those rate increases. The emergency rulemaking is effective for 90 days. This proposed rule will adopt these cap increases permanently. 
The increased caps will be effective retroactive to July 1, 2018. The retroactive application comports with 22 M.R.S. § 42(8), which authorizes the Department to adopt rules with a retroactive application for a period not to exceed eight calendar quarters and there is no adverse financial impact on any MaineCare member or provider. In addition, the Department sought, and obtained approval, from the Centers for Medicare and Medicaid Services (“CMS”) to submit a waiver amendment making the rate changes retroactive to July 1, 2018. 
The proposed rule includes the following cap changes: 
Limits

• 07-2: Raised annual limit for members who receive Home Support, Community Support, or Shared Living from $52,425.00 to $58,168.50.
• 07-6: Raised limit for Respite Services from $1,100.00 per year to $1,224.60.
• 07-6: Raised the per diem limit for quarter (1/4) hour Respite billing from $90.00 to $110.21 for each date of service. 

In addition, the Department is proposing the changes below.
Provider Qualifications and Requirements

• 10: Added reference to Adult Protective reporting requirements.
• 10-1.C: Updated reference to rules governing Reportable Events (14-197 CMR Ch. 12) and added Adult Protective Services System (10-149 CMR Ch. 1).
• 10-1.C: Deleted the requirement for grievance training to occur before working with members.
• 10-4, Electronic Visit Verification: Added Provider Qualifications and Requirements for Electronic Visit Verification. The Department is seeking and anticipates approval from the Centers for Medicare and Medicaid Services for this change.
• 10-5: Wording corrections for clarity.
• 10-6: Sentence deleted to make Section 29 requirements consistent with those in Section 21.
• 10-8: Reportable Events & Behavioral Treatment: 
  • Updated reference to rules governing Reportable Events (14-197 CMR Ch. 12) and added Adult Protective Services System (10-149 CMR Ch. 1).
  • Added rule citation to clarify meaning of “Behavior Regulations.” 

Appendix IV

• Reports of Abuse, Neglect, or Exploitation: Updated reference to rules governing Reportable Events (14-197 CMR Ch. 12) and Adult Protective Services System (10-149 CMR Ch. 1).

The proposed rule also includes technical corrections and formatting updates for clarity. 
See http://www.maine.gov/dhhs/oms/rules/index.shtml  for rules and related rulemaking documents. 
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173; P.L. 2017, ch. 459, Parts A and B 
PUBLIC HEARING: 
Date and Time:    December 3, 2018, 9:30 a.m.
Location:             The Marquardt Building, Room 118, Door D7
                             32 Blossom Lane
                             Augusta, ME 04333 
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before November 20, 2018. 
DEADLINE FOR COMMENTS:       Comments must be received by 11:59 PM on December 14, 2018.  
AGENCY CONTACT PERSON:       Rachel Posner, Comprehensive Health Planner II
                                                                 [email protected]
AGENCY NAME:                                 MaineCare Services
ADDRESS:                                             242 State Street, 11 State House Station
                                                                 Augusta, Maine 04333-0011 
TELEPHONE:                                 207-6246951 FAX: (207) 287-1864
                                                         TTY: 711 (Deaf or Hard of Hearing) 
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.