Emergency Rules

Chapter II Section 25, Dental Services (repeal); Chapter III, Section 25, Allowances for Dental Services (repeal); Chapter II, Section 25, Dental Services and Reimbursement Methodology (this rule replaces the two repealed rules)

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Notice of Agency Rule-making Adoption

EMERGENCY RULE

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

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 25, Dental Services (repeal) Chapter III, Section 25, Allowances for Dental Services (repeal) Chapter II, Section 25, Dental Services and Reimbursement Methodology (this rule replaces the two repealed rules)

ADOPTED RULE NUMBER:

CONCISE SUMMARY: The Department adopts this emergency rule, which repeals Ch. II and Ch. III, Section 25, and replaces them with a new Ch. II rule, "Dental Services and Reimbursement Methodology."

Emergency Rulemaking Authority for Dental Services: Pursuant to P.L. 2021, Ch. 398 (eff. July 1, 2021), Sec. A-17, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023, (the Budget) Part CCC, Sec. CCC-1, of the Budget enacted changes to the MaineCare dental statute - 22 MRS 3174-F(1)(Coverage for Adult Dental Services), by adding subsection G, which provides: Other comprehensive preventive, diagnostic and restorative dental services to maintain good oral health and overall health in accordance with rules adopted by the department. Section CCC-2 of the Budget required the Department to adopt emergency rules by July 1, 2022, to implement the new provisions of 22 M.R.S. Section 3174-F(1), which expanded covered services for members 21 and older (adults), after consideration of recommendations by the dental subcommittee of the MaineCare Advisory Committee (MAC).

Between August 2021 and May 2022, the Department met with the dental subcommittee of the MAC ten times and with the full MAC once. The Department also held two stakeholder forums to receive input on the benefit design and reimbursement methodology. Stakeholders included MaineCare dental providers and various oral health advocates, including representatives from Maine Equal Justice, Maine Primary Care Association, and Children's Oral Health Network of Maine. This rule incorporates recommendations from this stakeholder engagement, invests $45 million to increase rates and expand the adult dental benefit, as well as fully integrate the children and adult benefits and rates into a single rule. The emergency rule adds a comprehensive array of dental services for adult members, per 22 MRS 3174-F(1).

Emergency Rulemaking Authority for Dental Services Reimbursement Methodology: Part GGGG, Section GGGG-1 of the Budget authorized the Department to amend the rule on an emergency basis to implement recommendations of the MaineCare comprehensive rate system evaluation report for dental rates. The Departments Comprehensive Rate System Evaluation, conducted by the firm Myers and Stauffer, showed that MaineCare rates for preventive, diagnostic, and endodontic services are lower than rates for state Medicaid agencies in Connecticut, New Hampshire, Vermont, North Carolina, and Montana. Through this emergency rulemaking, the Department repeals the current Ch. III, Section 25, and implements a new reimbursement methodology in the emergency Ch. II, Section 25. The new Section 25 dental reimbursement rates will be posted on a website, and those rates will be set based on either the Commercial Median Benchmark or the All-States Medicaid Average Benchmark, as defined by the emergency rule. The dental codes shall undergo annual updates, per the methodology included in the emergency rule. On average, the reimbursement rates for dental services are increasing by 74%. Since April 11, 2022, the Department has conferred multiple times with providers and the MAC regarding this new reimbursement methodology.

Differences Between the Repealed Rules and the Emergency Rule:

The Department finds that the holistic approach of including coverage of both childrens and adult services as well as the reimbursement methodology in a single rule is a more efficient and streamlined approach for the dental rule.

Accordingly, the emergency rulemaking repeals and replaces 10-144 CMR Ch. 101, MaineCare Benefits Manual (the MBM), Chapters II and III, Section 25, Dental Services, and replaces those rules with one Ch. II, Section 25, rule.

The differences between the emergency and the former Chapters II and III, Section 25, rules include the following:

  1. Section 25.06 (Reimbursement Methodology). The rule replaces specified rates with a reimbursement methodology. Whereas the former Chapter II, Section 25, rule stated rates would be the amount listed in Chapter III, Section 25, the emergency rule implements a reimbursement methodology that increases overall reimbursement consistent with recommendations from the comprehensive rate setting evaluation.

The reimbursement methodology sets rates for diagnostic, endodontic, periodontic, and preventative services based on 67% of the Commercial Median Benchmark or 133% of the Medicaid State Average Benchmark, if the Commercial Median Benchmark rate is unavailable or unreliable.

The reimbursement methodology sets rates for adjunctive, oral and maxillofacial surgery, orthodontics, prosthodontics, and restorative services based on 50% of the Commercial Median Benchmark or 100% of the Medicaid State Average Benchmark if the Commercial Median Benchmark rate is unavailable or unreliable.

  1. In addition, the rule eliminates inconsistent payment for services billed as medical versus dental services. To ensure that there is not a rate disparity between CDT and CPT codes that represent the same service, the emergency rule removes coverage of some oral and maxillofacial surgery and maxillofacial prosthetic services so that they are solely covered under Section 90, Physician Services. The Department removes services from the proposed rule that have a CPT code equivalent, that are medical in nature, and are primarily delivered by oral surgeons who already bill the services under Section 90, Physician Services.

  2. Replaces emergency-only adult dental coverage with comprehensive adult dental coverage. To implement the new comprehensive adult dental benefit, the emergency rule adds coverage for adults for diagnostic, preventive, restorative, endodontic, periodontic, prosthodontic, oral and maxillofacial surgery, and adjunctive services. To enable this comprehensive adult coverage, the emergency rule removes the Section 25.04 requirement that adult dental care be limited to acute surgical care directly related to an accident; oral medical procedures not involving the dentition and gingiva; extraction of teeth that are severely decayed and pose a serious threat of infection during cardiovascular surgery; or treatment necessary to relive pain, eliminate infection, or prevent imminent tooth loss.

  3. Replaces separate adult and child coverage provisions with a single covered services description generally applicable to all members. As a result of removing the restrictions on adult dental coverage, the emergency rule contains one Covered Services provision, which includes the services, limits, and other requirements
    for all members, regardless of age, unless otherwise specified. Some services will continue to be age-limited, and they are noted as such in the rule.

  4. In addition to adding broad coverage for adult dental services, the emergency rule adds or increases coverage for many existing services, including the following:

a. Comprehensive periodontal evaluations b. Counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use c. Removable unilateral space maintainers d. Multiple types of crowns e. Prefabricated crowns f. Apicoectomies g. Immediate partial dentures h. Complete denture repairs i. Partial denture relines j. Multiple types of pontics and prosthodontic retainers k. Re-cement or re-bond and repairs of fixed partial dentures l. Dental case management m. Single bitewings n. Panoramic radiographs o. Topical fluoride p. Denture adjustments

  1. Aligns limits and prior authorization requirements with other state Medicaid agencies, commercial payers, and stakeholder recommendations. Because of the limited scope of the adult dental benefit in the current rule, the emergency rule makes changes to align the covered services and limits with typical comprehensive dental coverage. Specifically:

a. The emergency rule removes the requirement that adults have a qualifying medical condition to receive removable prosthodontics (dentures).

b. The emergency rule establishes medically appropriate limitations where none previously existed, based on recommendations from clinical consultation and alignment with other comprehensive dental coverage (commercial payers and other Medicaid agencies).

c. The emergency rule adds and removes prior authorizations to align with other payors and based on recommendations from clinical consultation and provider feedback.

d. The emergency rule removes the more than once every 150 days requirement for detailed and extensive and periodic oral evaluations and prophylaxis treatments.

  1. Removes unnecessary and overly detailed provisions. The emergency rule removes the following from the rule:

a. Unnecessary and unused definitions. b. Reference to coverage for members residing in an Intermediate Care Facility for Persons with Mental Retardation (ICF-IID) because these members will now receive the services covered for members 21 and over (adults). c. Requirements that address the covered services certain provider types can provide under their scope of practices because providers scope of practices are already defined in 32 MRS Ch. 147. d. Prescriptive descriptions of services that are overly detailed for the rule.
e. Section 25.03-9, Temporomandibular Joint Services, because it is not clear what specific services this provision encompasses and because services that are related to the temporomandibular joint are listed in the new covered services Section f. Section 25.06-1, Members Records, because Chapter I, Section 1.03-8(M) and Board rule 02-313 CMR Chapter 12 both contain member/patient record requirements. g. Section 25.06-2, The Division of Program Integrity, because it only refers providers to Chapter I, which already applies to all providers. h. Requirements and instructions in Section 25.06-3, Prior Authorization of Dental Services, because they either exist in Chapter I of the MBM or in MaineCares Prior Authorization Manual on the HealthPAS Portal. i. Section 25.06-5, Case Management, because it describes standard health care provider practices and because the emergency rule adds coverage for a dental case management service. j. Sections 25.07-4, Denturist Services, and 25.07-5, Dental Hygienist Services, because it is unnecessary to include the services that these providers can deliver under their scopes of practice, which are defined in 32 MRS Ch. 147. Section 25.07-5 also includes outdated guidance. k. Section 25.07-6, Independent Practice Dental Hygienist (IPDH) Services, because IPDHs must comply with their scope of practice, as defined in 32 MRS Ch. 143 18375, and it is redundant to list services that IPDHs can deliver in rule. In addition, the requirements for IPDHs delivering temporary fillings no longer have a basis in Board rules and have been a roadblock to delivering this service. The requirements for processing and exposing radiographs are also no longer in effect. l. The appendix because the forms either exist on the HealthPAS Portal or will no longer be required.

The Department will propose a routine technical rule to permanently repeal Chapters II and III, Section 25, and replace them with the single Ch. II, Section 25, rule.

The Department shall seek approval from the Centers for Medicare and Medicaid Services (CMS) of state plan amendments (SPAs) for the changes in this rulemaking. Additionally, on or before July 1, 2022, the Department will publish a notice of change in reimbursement methodology pursuant to 42 C.F.R. 447.205.

See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

EFFECTIVE DATE: July 1, 2022

AGENCY CONTACT PERSON: Henry Eckerson, Comprehensive Health Planner II AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: henry.eckerson@maine.gov TELEPHONE: 207-624-4085 FAX: (207) 287-6106 TTY: 711 (Deaf or Hard of Hearing)

Comment deadline past No comment deadline | Posted: July 1, 2022

Emergency Adoption: MaineCare Benefits Manual, Section 29, Chapter III, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

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Concise Summary:

Notice of Agency Rule-making Adoption

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

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

ADOPTED RULE NUMBER:

CONCISE SUMMARY: In response to the statewide staffing crisis and to comply with P.L. 2021, ch. 398 (the "Act"), the Department is implementing emergency routine technical rule changes to increase rates for providers of services under Ch. III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder.

Section AAAA-1 of the Act enacts 22 M.R.S. Chapter 1627, Essential Support Worker Reimbursement. The new law requires that, effective January 1, 2022, the labor components of MaineCare reimbursement rates for specified services delivered by essential support workers must equal at least 125% of the minimum wage established in Title 26, section 664, subsection 1. Essential support workers are individuals who by virtue of employment generally provide to individuals direct contact assistance with activities of daily living or instrumental activities of daily living or have direct access to provide care and services to clients, patients or residents regardless of the setting. 22 M.R.S. 7401. In addition, Part AAAA states that the reimbursement rate must include an amount necessary to reimburse the provider for taxes and benefits related to the wages. 22 M.R.S. 7402(2). Section AAAA-2 of the Act specifies that the 125% of minimum wage requirement for essential support workers applies to Ch. III, Section 29 services.

Additionally, Part OOO of the Act authorizes the Department to implement cost of living increases (COLAs). In calculating the rate increases necessary to comply with Part AAAA of the Act, the Legislature and the Department took into consideration the impact of planned COLAs on ensuring the labor components of the reimbursement rates for Section 29 and other services specified under Part AAAA are equal to at least 125 percent of minimum wage.

Rulemaking required for these particular rule changes are routine technical per 22 M.R.S. 7404 (for the essential support worker increases), and Part OOO of the Act (for the COLA-related increases) even though Ch. III, Section 29 is generally a major substantive rule. See, e.g., 22 M.R.S. 3195.

Section GGGG-1 of the Act provides the Department with authority to enact these routine technical changes on an emergency basis, without the need to make findings in support of an emergency per 5 M.R.S. 8054. These routine technical emergency rule changes shall be effective for up to 90 days. The Department intends to proceed with proposed routine technical rulemaking to make permanent the increases to reimbursement rates enacted through this emergency adoption.

These increased rates will be effective retroactive to January 1, 2022, as directed by the Act. The retroactive application of this rule comports with 22 M.R.S. 42(8), which provides state authority for the Department to adopt rules with a retroactive application for a period not to exceed eight (8) calendar quarters where there is no adverse financial impact on any MaineCare member or provider. Here, the rule change is a beneficial change for the providers.

Separately, effective December 31, 2021, and coinciding with the adoption of this emergency routine technical rule, the Department shall repeal an emergency major substantive rule that was adopted on April 7, 2021, and that included reimbursement rate increases for certain services under Ch. III, Section 29 pursuant to P.L. 2019, ch. 616; emergency major substantive rules are effective for up to twelve months, or until Legislative review. The Department has not yet initiated the proposed major substantive rulemaking associated with the April 7, 2021, emergency major substantive rule, and thus there is no provisional major substantive rule pending for review before the Legislature. There is no decrease in reimbursement for any service affected by the repeal of the April 2021 emergency major substantive rule.

The Department shall seek approval from the Centers for Medicare & Medicaid Services (CMS) for the increased reimbursement rates. In addition, the Governor's proposed budget will ask the legislature for additional funds to support these increases and to meet the intent of Part AAAA of the Act ensuring labor components of all rates are at least equal to 125% of minimum wage.

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

EFFECTIVE DATE: March 22, 2022

AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: heather.bingelis@maine.gov TELEPHONE: (207)-624-6951 FAX: (207) 287-6106 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: March 23, 2022

Emergency Adoption: MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder

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

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder

ADOPTED RULE NUMBER:

CONCISE SUMMARY: CONCISE SUMMARY: In response to the statewide staffing crisis and to comply with P.L. 2021, ch. 398 (the "Act"), the Department is implementing emergency routine technical rule changes to increase rates for providers of services under Ch. III, Section 21, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder.

Section AAAA-1 of the Act enacts 22 M.R.S. Chapter 1627, Essential Support Worker Reimbursement. The new law requires that, effective January 1, 2022, the labor components of MaineCare reimbursement rates for specified services delivered by essential support workers must equal at least 125% of the minimum wage established in Title 26, section 664, subsection 1. Essential support workers are individuals who by virtue of employment generally provide to individuals direct contact assistance with activities of daily living or instrumental activities of daily living or have direct access to provide care and services to clients, patients or residents regardless of the setting. 22 M.R.S. 7401. In addition, Part AAAA states that the reimbursement rate must include an amount necessary to reimburse the provider for taxes and benefits related to the wages. 22 M.R.S. 7402(2). Section AAAA-2 of the Act specifies that the 125% of minimum wage requirement for essential support workers applies to Ch. III, Section 21 services.

Additionally, Part OOO of the Act authorizes the Department to implement cost of living increases (COLAs). In calculating the rate increases necessary to comply with Part AAAA of the Act, the Legislature and the Department took into consideration the impact of planned COLAs on ensuring the labor components of the reimbursement rates for Section 21 and other services specified under Part AAAA are equal to at least 125 percent of minimum wage.

Rulemaking required for these particular rule changes are routine technical per 22 M.R.S. 7404 (for the essential support worker increases), and Part OOO of the Act (for the COLA-related increases) even though Ch. III, Section 21 is generally a major substantive rule. See, e.g., 22 M.R.S. 3195.

Section GGGG-1 of the Act provides the Department with authority to enact these routine technical changes on an emergency basis, without the need to make findings in support of an emergency per 5 M.R.S. 8054. These routine technical emergency rule changes shall be effective for up to 90 days. The Department intends to proceed with proposed routine technical rulemaking to make permanent the increases to reimbursement rates enacted through this emergency adoption.

These increased rates will be effective retroactive to January 1, 2022, as directed by the Act. The retroactive application of this rule comports with 22 M.R.S. 42(8), which provides state authority for the Department to adopt rules with a retroactive application for a period not to exceed eight (8) calendar quarters where there is no adverse financial impact on any MaineCare member or provider. Here, the rule change is a beneficial change for the providers.

Separately, effective December 31, 2021, and coinciding with the adoption of this emergency routine technical rule, the Department shall repeal an emergency major substantive rule that was adopted on April 7, 2021, and that included reimbursement rate increases for certain services under Ch. III, Section 21 pursuant to P.L. 2019, ch. 616; emergency major substantive rules are effective for up to twelve months, or until Legislative review. The Department has not yet initiated the proposed major substantive rulemaking associated with the April 7, 2021, emergency major substantive rule, and thus there is no provisional major substantive rule pending for review before the Legislature. There is no decrease in reimbursement for any service affected by the repeal of the April 2021 emergency major substantive rule.

The Department shall seek approval from the Centers for Medicare & Medicaid Services (CMS) for the increased reimbursement rates. In addition, the Governor's proposed budget will ask the legislature for additional funds to support these increases and to meet the intent of Part AAAA of the Act ensuring labor components of all rates are at least equal to 125% of minimum wage.

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

EFFECTIVE DATE: March 22, 2022

AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street 11 State House Station Augusta, Maine 04333-0011 EMAIL: heather.bingelis@maine.gov TELEPHONE: (207)-624-6951 FAX: (207) 287-6106 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: March 23, 2022

MaineCare Benefits Manual, Chapter VII, Section 5, Estate Recovery

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Concise Summary:

Notice of Agency Rule-making Emergency Adoption

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

CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter VII, Section 5, Estate Recovery

ADOPTED RULE NUMBER:

CONCISE SUMMARY:

This emergency rulemaking implements P.L. 2021, ch. 398, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023, Part A, A-1, pg. 99, an initiative that provides funding to modify MaineCare estate recovery rules to conform with the minimum mandatory federal requirements (The Omnibus Budget Reconciliation Act of 1993 (P.L. 103-66)). Chapter VII, Section 5, Estate Recovery, of the MaineCare Benefits Manual (MBM), is modified as follows: Effective November 24, 2021, the Department's claim is limited to the amount paid by MaineCare for all nursing facility services, home and community-based services, and related hospital and prescription drug services paid on behalf of the Member prior to their death. These services for which recovery is required under federal law. Pursuant to Act, the Legislature provided the Department with rulemaking authority to implement these services on an emergency basis, per 5 M.R.S. 8054, without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health, safety, or general welfare. Emergency rules are effective immediately and valid for ninety days. The Department shall hereafter initiate "regular" routine technical proposed rulemaking to implement this rule permanently.

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

EFFECTIVE DATE: November 24, 2021

AGENCY CONTACT PERSON: Anne E. Labonte, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: Anne.Labonte@Maine.gov TELEPHONE: (207)-624-4082 FAX: (207) 287-1606 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: November 24, 2021

MaineCare Benefits Manual, Chapter III, Section 97, Private Non-Medical Institution Services

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

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Ch. III, Section 97, Private Non-Medical Institution Services

ADOPTED RULE NUMBER:

CONCISE SUMMARY:

The Department of Health and Human Services (the "Department") adopts the following emergency major substantive rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 97, Private Non-Medical Institution Services, including Chapter III (the Main Rule) and Appendices B (Substance Abuse Treatment Facilities) and D (Child Care Facilities).

In Chapter III, the Department is updating the Main Rule and corresponding appendices for Appendix B and Appendix D to support the final adopted changes in Chapter II, Section 97, with the rules intended to be filed simultaneously. The Chapter II rule changes implement various new requirements on Appendix D providers per the Family First Prevention Services Act (FFPSA), and also adds new covered MaineCare services. Chapter II also imposes new requirements on Appendix B providers and broadens those covered services.

In recognition of these new requirements, the Department implements these emergency major substantive reimbursement rate increases. The new rates were authorized by the Legislature pursuant to P.L. 2021, Ch. 29, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2022 and June 30, 2023 (the Budget) and P.L. 2021, Ch. 398, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023 (the Supplemental Budget). The rates are also consistent with independent rate studies completed for Appendix B and Appendix D services.

Section GGGG-1 of the Supplemental Budget provides the Department with authority to enact these changes on an emergency basis, without the need to make findings in support of an emergency per 5 M.R.S. 8054. Emergency major substantive rules are effective for up to 12 months or until the Legislature has completed review of the provisionally adopted major substantive rule. 5 M.R.S. 8073. The Department shall seek approval from the Centers for Medicare and Medicaid Services (CMS) for the increased Appendix B and Appendix D rates. The Department shall file the corresponding Chapter III, Section 97 proposed major substantive rules in order to begin the process for implementing these changes permanently.

In addition to the above, the Main Rule and relevant Appendices has been updated to reflect changes to certain services in order to gain consistency with Chapter II, including updating Crisis Residential services to Crisis Stabilization services, Treatment Foster Care to Therapeutic Foster Care, and Substance Abuse treatment to Substance Use treatment.

Appendix B implements rate updates from an independent rate study, recommending substantial increases, consistent with appropriations approved by the Budget and the Supplemental Budget. Additional changes are required to ensure that the terminology in Appendix B is consistent with what is utilized in the finally adopted Chapter II rule; for example, Detoxification programs are changed to Medically Supervised Withdrawal Services. This rulemaking creates two tiers of reimbursement, one tier incorporating all medical personnel, and another tier as an exception rate for low nursing staff, given substantial workforce challenges. Lastly, service components of the rate in 2400.1 were updated to clarify social workers as licensed clinical social workers and to add licensed marriage and family therapists, to align with changes adopted in Chapter II.

Appendix D updates the name from Childcare Facilities to Children's Residential Care Facilities in order to align with changes adopted in Chapter II. In Section 2400.1, board certified behavioral analyst services, board certified assistant behavior analyst services, and registered behavior technician services were added to align with changes in Chapter II. Following the independent rate study, rate recommendations are incorporated, including consolidating Mental Health Level I and Level II services into a single Mental Health level of reimbursement, and consolidating Intellectual Disabilities and Autism Spectrum Disorder Levels I and II into a single Intellectual Disabilities/Developmental Disabilities residential treatment rate. Due to the rate changes and finally adopted changes in Chapter II, Section 97, this rule removes language from Section 6000 because the referenced member assessment is no longer required. Chapter III also establishes rates for a proposed new MaineCare covered service, Aftercare Services, for the service itself and for mileage reimbursement. Aftercare is a required component of the FFPSA, and establishing the rate is necessary in order to meet the requirements of the FFPSA and the changes adopted in Chapter II, Section 97. The Department shall seek approval from CMS for the new Aftercare Services and the additional practitioners allowable under this Appendix.

Finally, in order to be consistent with the changes that will be finally adopted in Chapter II, the Department implements necessary updates to further address potentially stigmatizing language pursuant to P.L. 2017, ch. 407, and to update references to the Office of Behavioral Health from the Office of Substance Abuse.

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

EFFECTIVE DATE: 11/1/2021

AGENCY CONTACT PERSON: Dean Bugaj, Childrens and Behavioral Health Manager AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: Dean.Bugaj@maine.gov TELEPHONE: (207)-624-4045 FAX: (207) 287-6106 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: November 1, 2021

MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

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Concise Summary:

The Department is adopting this emergency major substantive rule in accordance with P.L. 2019, ch. 616, Part A, Sec. A-7, An Act Making Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021. The Act provides funding to increase reimbursement rates for specific procedure codes in Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder.

The Department has determined that these rate increases are necessary to avoid an immediate threat to public health, safety or general welfare. The Department's findings of an emergency are as follows: delivery of Medicaid services is predicated on an adequate provider pool to treat and meet the unique needs of the most vulnerable populations of members, and the increases will seek to ensure reimbursement rates are adequate to provide members with access to important services through an adequate provider pool.

The emergency major substantive rule increases the rates with a retroactive application date of January 1, 2021 for four (4) services including: Supported Employment Services, Career Planning Services, Employment Specialist Services, and Home Support-Quarter Hour Services. The Maine Legislature has authorized the Department to adopt rules with a retroactive application where the Department has determined that the change does not have an adverse financial impact on any MaineCare provider or Member. 42 M.R.S. 42(8). Here, the rule change is a positive change for the providers.

This emergency major substantive rule is effective upon adoption and filing with the Secretary of State. Pursuant to 5 M.R.S. 8054 (3), this emergency major substantive rule may be effective for up 12 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: April 7, 2021

AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: heather.bingelis@maine.gov TELEPHONE: (207)-624-6951 FAX: (207) 287-6106 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: April 8, 2021

MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder

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Concise Summary:

The Department is adopting this emergency major substantive rule in accordance with P.L. 2019, ch. 616, Part A, Sec. A-7, An Act Making Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021. The Act provides funding to increase reimbursement rates for specific procedure codes in Chapter III, Section 21, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder.

The Department has determined that these rate increases are necessary to avoid an immediate threat to public health, safety, or general welfare. The Department's findings of an emergency are as follows: Delivery of Medicaid services is predicated on an adequate provider pool to treat and meet the unique needs of the most vulnerable populations of members; and The increases will seek to ensure reimbursement rates are adequate to provide members with access to important services through an adequate provider pool.

The emergency major substantive rule increases the rates effective January 1, 2021 for four (4) services: Supported Employment Services, Career Planning Services, Employment Specialist Services, and Home Support-Quarter Hour Services. The Maine Legislature has authorized the Department to adopt rules with a retroactive application where the Department has sought CMS approval for such changes, and where the change does not have an adverse financial impact on any MaineCare provider or Member. 42 M.R.S. 42(8).

This emergency major substantive rule is effective upon adoption and filing with the Secretary of State. Pursuant to 5 M.R.S. 8054 (3), this emergency major substantive rule may be effective for up to 12 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: April 7, 2021

AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: heather.bingelis@maine.gov TELEPHONE: (207)-624-6951 FAX: (207) 287-6106 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: April 8, 2021

MaineCare Benefits Manual, Chapters II & III Section 65, Behavioral Health Services

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The Department of Health and Human Services (Department) adopts the following emergency rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapters II and III, Section 65, Behavioral Health Services. In Chapter III, the Department is increasing the rate of reimbursement for Medication Assisted Treatment with Methadone (MAT) retroactive to July 1, 2019. Pursuant to P.L. 2019, Ch. 343, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2019, June 30, 2020 and June 30, 2021, (effective June 17, 2019), the Legislature increased funding for the weekly reimbursement rate for MAT services for the FY2020 and FY2021 state budgets. In light of the state's ongoing opioid crisis, the Department finds that the immediate adoption of the MAT rate increase is necessary to avoid an immediate threat to public health, safety, or general welfare under 5 M.R.S. 8054. The emergency rate increase benefits both providers and members and will further support the delivery of these critical services to those in need. The Department is seeking and anticipates approval from the Centers for Medicare and Medicaid Services (CMS) for the MAT rate increase. The Department published a Notice of MaineCare Reimbursement Methodology Change on June 28, 2019 notifying providers of this increase and is awaiting approval of a state plan amendment. Pending that approval, the Department will reimburse MAT services at the increased rate retroactive to July 1, 2019. Additionally, this rulemaking will increase the rates of reimbursement in Chapter III for Functional Family Therapy (FFT), Multisystemic Therapy (MST), Multisystemic Therapy for Problem Sexualized Behaviors (MST-PSB) by 20% effective January 1, 2020 in accordance with Resolves 2019, Ch. 110, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children (effective January 12, 2020). In approving this legislation (which became law without the Governors signature), the Legislature determined that an immediate effective date was necessary given the rates had "not been adjusted in more than 8 years" and the rates were insufficient to enable some providers to continue to provide services. The Department agrees with and incorporates these findings in support of this emergency rulemaking under 5 M.R.S. 8054. The Department is seeking and anticipates CMS approval for the 20% rate increases for FFT, MST, and MST-PSB services. The Department published a Notice of MaineCare Reimbursement Methodology Change on June 28, 2019 of the intended 20% rate increases with the expectation that the Legislature would approve the increases effective July 1, 2019. The Department believes this notice is sufficient despite the legislation not taking effect until January 12, 2020. Pending CMS approval, the Department will reimburse FFT, MST, and MST-PSB services at increased rates retroactive to January 1, 2020. Additionally, following the completion of the rate study directed by Resolves 2019, Ch. 110 and completed by Burns and Associates, the Department has developed new increased rates for MST, MST-PSB, and FFT. The additional funding has been approved for the FY2021 state budget pursuant to P.L. 2019, Ch. 616, An Act Making Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021 (effective March 18, 2020). Through the rate study process and in line with the Legislatures directive in the Resolve, the Department has made the determination to switch reimbursement from quarter hour billing to a weekly case rate to reflect the requirements for the evidence-based models. Concurrent with these rate changes in Chapter III, in Chapter II, the Department has ended Collateral Contacts for MST, MST-PSB, and FFT as these services have been incorporated into the new weekly case rate. The Department has also adopted minimum contact standards for providers to provide guidance to providers accessing this new weekly case rate. In Chapter III, the Department has deleted the prior quarter hour codes and added in the new weekly codes and rates. In response to financial challenges and civil emergency created by the COVID-19 pandemic, the Department has advanced the increased rates from the anticipated July 1, 2020 start date retroactively to May 1, 2020, in order to provide financial relief, to support stability in the workforce, and to increase access to members in need. Because of this, the Department has determined emergency rulemaking is necessary to support these providers and members receiving these services under 5 M.R.S. 8054 The Department published a Notice of MaineCare Reimbursement Methodology Change on April 30, 2020 of the intended rate increases and intends to file a State Plan Amendment within the quarter. Pending CMS approval, the Department will reimburse MST, MST-PSB, and FFT at increased weekly rates retroactive to May 1, 2020. Finally, P.L. 2019, Ch. 616 also included funding for the Department to increase rates for certain services effective July 1, 2020. In response to the COVID-19 emergency and hardships created during this period of civil emergency, the Department has made the decision to advance these rate increases to be effective retroactively to April 1, 2020. The rate changes include an increase for physicians delivering medication management, and an increase for Behavioral Health Professionals providing Home and Community-based Treatment (HCT) services. In order for physicians to access the increased rate of reimbursement, they will be required to use the AF modifier on their claims. The Department has determined emergency rulemaking is necessary to support these providers and members receiving these services under 5 M.R.S. 8054. The Department published a Notice of MaineCare Reimbursement Methodology Change on March 31, 2020 of the intended rate increases and intends to file a State Plan Amendment within the quarter. Pending CMS approval, the Department will reimburse Behavioral Health Professionals delivering HCT and physicians delivering Medication Management at increased rates retroactive to April 1, 2020. This emergency rulemaking will take effect upon filing with the Secretary of State and will remain in effect for ninety days. 5 M.R.S. 8052(6), 8054(3). To avoid a lapse, the Department is concurrently proposing non-emergency routine technical changes. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: 5/21/20 AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 1 State House Station Augusta, Maine 04333-0011 EMAIL: dean.bugaj@maine.gov TELEPHONE: (207)-624-4045 FAX: (207) 287-1864 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: May 22, 2020

MaineCare Benefits Manual, Ch. I, Section 5, COVID-19 Public Health Emergency Services

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AGENCY: Department of Health and Human Services, Office of MaineCare Services CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Ch. I, Section 5, COVID-19 Public Health Emergency Services ADOPTED RULE NUMBER: CONCISE SUMMARY: This emergency rulemaking institutes measures, effective immediately, to expedite and improve access to medical care for MaineCare members due to the 2019 Novel Coronavirus (COVID-19). Pursuant to 5 M.R.S. Sections 8054 and 8073, the Department has determined that immediate adoption of this rule is necessary to avoid a potentially severe and immediate threat to public health, safety or general welfare. The Department's findings of emergency are set forth in detail in the Emergency Basis Statement. Maine is facing a substantial public health threat posed by the global spread of COVID-19. On March 11, 2020 the World Health Organization declared COVID-19 a worldwide pandemic. On March 15, 2020, Governor Janet T. Mills declared a state of civil emergency in Maine. On March 20, 2020, the Department implemented the first COVID-19 Public Health Emergency Services rule (the "COVID-19 Rule"). This is the second set of emergency changes to the COVID-19 Rule (the Second COVID-19 Rule). On April 28, 2020, the Governor issued Executive Order No. 48 FY 19/20, An Order Modifying Certain Procedural Requirements for Emergency Rulemaking to Maximize Federal COVID-19 Funding for MaineCare (the Executive Order). Pursuant to 5 M.R.S. 8054 and 8073, and the Executive Order, this single emergency rulemaking implements temporary changes to various sections of the MaineCare Benefits Manual (MBM) in order to expedite and improve access to medical care for MaineCare members in light of the substantial public health threat posed by COVID-19. The COVID-19 Rule impacts the following sections of MaineCare policy: Chapter I, Section 1 (General Administrative Policies and Procedures); Chapter 1, Section 4 (Telehealth Services); Chapter II, Section 12 (Consumer-Directed Attendant Services); Chapter II, Section 17 (Community Support Services); Chapters II and III, Section 31 (Federally Qualified Health Center Services); Chapters II and III, Section 40 (Home Health Services); Chapters II and III, Section 45 (Hospital Services); Chapter II, Section 55 (Laboratory Services); Chapter II, Section 60 (Medical Supplies and Durable Medical Equipment); Chapter II, Section 67 (Nursing Facility Services); Chapters II and III, Section 94 (Early and Periodic Screening, Diagnosis and Treatment Services); Chapters II and III, Section 96 (Private Duty Nursing and Personal Care Services); Chapter III, Section 97 (Private Non-Medical Institution Services); Chapter X, Section 3 (Katie Beckett Benefit); and Chapter X, Section 1 (Benefit for People Living with HIV/AIDS). This emergency rulemaking implements the following changes to the COVID-19 Rule: The Department is waiving co-payments for some MaineCare services for Consumer Directed Attendant Services and Private Duty Nursing, Personal Care Services, and under the Benefit for People Living with HIV/AIDS. The Department is waiving all enrollment fees, premiums, and similar charges for all beneficiaries. The Department is authorizing and adding Advanced Practice Providers to prescribe Durable Medical Equipment. The Department is waiving the requirement that an MD, DO, PA, or APRN must prescribe an order for hearing aids. A note from an audiologist will justify medical necessity. The Department is authorizing Advanced Practice Providers as qualified providers to order and recertify a Plan of Care for Home Health Services. The Department is adding various CPT coverage codes to Telehealth Services. The Department is allowing, under Bright Futures Health Assessment Visits in Early and Periodic Screening, Diagnosis and Treatment, for one additional health assessment visit per member within a year following an initial assessment via Telehealth for each age shown on the MaineCare Bright Futures periodic health assessment schedule. The Department is allocating a special supplemental pool for privately owned and operated Acute Care Non-Critical Access Hospitals and Critical Access Hospitals. The Department is increasing reimbursement under Private Non-Medical Institution Services for Substance Abuse Treatment Facilities from 3/1/2020 to 5/31/2020. The Department is covering the cost of testing and diagnosis of COVID-19 for a new uninsured eligibility group. The Department, under Community Support Services, is allowing, for Members who require annual verification, the retention of eligibility through previously-rendered diagnoses and clinical judgment. The Department, under Community Support Services, is changing the verification of Eligibility Requirements from within 60 days of the start of the date of services. If eligibility is not submitted by close of business on day 60, MaineCare will cease payment for services under this section on day 61. The Department is extending Personal Support Specialist training requirements under Private Duty Nursing and Personal Care Services. The Department is waiving the Preadmission Screening and Resident Review (PASRR) requirement for Nursing Facility Services. Except as otherwise noted in the COVID-19 Rule, the changes shall be retroactive to March 18, 2020. The Executive Order suspended and modified the relevant provisions of the MAPA in order for these emergency rule changes to: (1) remain in effect until the later of the end of the Federal Proclamation of Emergency or the end of CMSs approval of the MaineCare program changes, even if that period exceeds ninety days; and (2) automatically repeal upon termination of the Federal Proclamation of Emergency or the end of CMSs approval of the MaineCare program changes (whichever is later), without further rulemaking by the Department. In the event of conflict between the COVID-19 Rule and any other MaineCare rule, the terms of this rule supersede other rules and shall apply. http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents. EFFECTIVE DATE: 5/13/2020 AGENCY CONTACT PERSON: Derrick Grant AGENCY NAME: Division of Policy ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: derrick.grant@Maine.gov TELEPHONE: (207)-624-6931 FAX: (207) 287-1606 TTY users call Maine relay 711

Comment deadline past No comment deadline | Posted: May 14, 2020