MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 43, Hospice Services, and Chapter III, Section 43, Allowances for Hospice Services (repeal)

Date posted:

Attachment(s):

Notice of Agency Rule-making Adoption

AGENCY: Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter II, Section 43, Hospice Services, and Chapter III, Section 43, Allowances for Hospice Services (repeal)

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

The Department adopts this amended Chapter II, Section 43 rule and repeals Chapter III, Section 43.

  1. Adds a requirement for Electronic Visit Verification (“EVV”) for Hospice Services delivered in-home. Federal Medicaid law mandates that EVV be utilized for personal care services and home health care services that require an in-home visit by a provider (42 U.S.C. Sec. 1396b(l)). The federal EVV requirement does not explicitly include Hospice services, however, to remain consistent with MaineCare efforts to prevent fraud, waste, and abuse for home-based services, EVV requirements are implemented for all Hospice Services delivered in-home. The adopted rule also clarifies that Physician Services are delivered and billed separately as described in MBM Ch. II, Section 90, and are exempt from EVV requirements. On February 6, 2023, CMS approved the Maine SPA which requires EVV for in-home hospice services. CMS, Maine state Plan, TN No 22-0044, Attachment 3.1-A, #18 (Hospice Care), Page 7, Effective Date: 1/1/23 (“The state will require Electronic Visit Verification System (EVV) requirements for in-home services effective January 1, 2023.”). Hence, EVV is mandated for these MaineCare Hospice Services by the Federal Government.

Facilities providing Hospice Services will not be subject to EVV, this requirement only applies to services offered within the member’s home. EVV implementation for all in-home Hospice Services, including those reimbursed at a per diem rate, will support the Department’s goal of improving oversight of Hospice Services and, in turn, reduce the occurrence of fraud, waste, and abuse in home settings. Providers may utilize the Department’s EVV system at no cost or may procure and utilize their own EVV system, so long as the Department’s EVV system can accept and integrate data from the provider-owned EVV system and the provider-owned system is otherwise compatible with the Department’s system and billing guidelines. 

In response to comments, the Department changed the effective date of the EVV requirement from January 1 to July 1, 2024, in order to give providers more time.

  1. Amends the definition of “Attending Physician” to include Nurse Practitioners and Physician Assistants. This is consistent with Section 51006 of the Bipartisan Budget Act (BBA) of 2018 (P. L. 115-123), as codified in 42 U.S.C. § 1395x(dd)(3)(B). The BBA considers Physician Assistants to be qualified to provide Hospice Services as an Attending Physician. Nurse Practitioners were qualified Attending Physicians in Section 1861(dd)(3)(B) of the Social Security Act (SSA) prior to the passing of the BBA. The adopted rule mirrors SSA statute, stating an Attending Physician must be a medical Doctor of Medicine or Osteopathy, Nurse Practitioner, or Physician Assistant licensed in the state of Maine.
  1. Adds a definition for the term “Benefit Period” which appears multiple times throughout this rule to provide clarity.
  1. Section 43.07-5 (Payment for Inpatient Care): Changes the date by which Hospice providers must submit inpatient data to the Department, upon Department request, from January 1st to October 1st, following the period ending September 30th of the previous year, in keeping with the federal fiscal year. This change grants providers additional time to compile and submit reports to the Department.
  1. Adds Opioid Health Home Services to the list of services that may be continued after the election of hospice. The Department recognizes treatment for Substance Use Disorder may be required through the end of a member’s life. As such, MaineCare will reimburse for services under Chapter II, Section 93 Opioid Health Home Services and under Chapter II, Hospice Services provided concurrently.
  1. Makes minor technical edits to improve the clarity of the rule.
  1. Sec. 43.09: Adds a new section – Allowances for Hospice Services – which is largely moved from the Ch. III rule, which is being repealed. The Department will henceforth list the specific reimbursement rates on the MaineCare Fee Provider Schedule which is posted on the Department’s website, as authorized by 22 M.R.S. Sec. 3173-J(7). The Department, after OAG review, added language explaining the current methodology of annual adjustments to the reimbursement for the services. CMS has approved this methodology in the Maine Medicaid state Plan, and this is the methodology that has been utilized by the Department historically. In accordance with 22 M.R.S. Section 3173-J, the Department will not have to go through rulemaking if there is no change to this methodology and the rates are posted in accordance with this law.

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

EFFECTIVE DATE: January 17, 2024

STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173 and 3173-J

AGENCY CONTACT PERSON:          Julieanna Scott, Comprehensive Health Planner II

AGENCY NAME:                                 MaineCare Services

ADDRESS:                                            109 Capitol Street, 11 State House Station                                                        

                                                                Augusta, Maine 04333-0011

EMAIL:                                                   julieanna.scott@maine.gov

TELEPHONE:207-287-2286 FAX: (207) 287-6106

                        TTY: 711 (Deaf or Hard of Hearing)

Office: MaineCare Services

Comment deadline:

Effective date:

Comments for this rule have been closed.