MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 94, Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT)

Date posted:

Attachment(s):

Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE:  10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 94, Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT)

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

The Department of Health and Human Services (Department) finally adopts the rule changes in 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter II, Section 94, Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT).

This adopted rulemaking makes the following changes:

  • Addition of well-child visit: In response to the COVID-19 pandemic, on May 13, 2020, the Department adopted on an emergency basis MaineCare Benefits Manual, Ch. I, Section 5, COVID-19 Public Health Emergency Services, which allowed members to receive a second well-child visit when an initial visit was completed via telehealth. This adopted rule permanently adds that extra visit as a new service in Section 94.06-1 to expand access to services.
  • Immunizations: The adopted rule adds coverage for immunization counseling in Section 94.04-4 in response to the Center for Medicare & Medicaid Services State Health Official letter #22-002.
  • Bright Futures Periodicity Schedule: The adopted rule deletes Appendix I – Recommendations for Preventive Pediatric Health Care Committee on Practice and Ambulatory Medicine. After conferring with the Office of the Attorney General, the adopted rule provides that MaineCare has adopted the 2022 4th edition of the American Academy of Pediatrics Bright Futures Recommendations for Preventive Pediatric Health Care (Bright Futures Periodicity Schedule) and incorporates it by reference in the rule. The Bright Futures Periodicity Schedule is available online at the American Academy of Pediatrics website and upon request to the Office of MaineCare Services at https://www.maine.gov/dhhs/oms and a copy of such was filed with the Secretary of State’s office with this rulemaking, in accord with 5 M.R.S. 8056(B).

Section 94.02-2 (Eligibility for Services): The Department has decided to not adopt the proposed provision which would have added a certain group of pregnant individuals as being eligible for EPSDT services, after conferring with the Office of the Attorney General. That group of pregnant individuals, eligible under what is also known as the “Unborn Child Option”, is eligible for services under the Maine CHIP program. See 67 Fed. Reg. 61974 (Oct. 2, 2002)(42 C.F.R. Sec. 457.10, amending the definition of “child”). Maine offers medical services to this group under its CHIP program, see MaineCare Eligibility Manual, 10-144 CMR Ch. 332, Part 3, Section 2.3(III)(Coverage for Pregnant Individuals for the Health of Unborn Children), including EPSDT-like services.  

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

EFFECTIVE DATE:                            April 22, 2024

AGENCY CONTACT PERSON:       Laurel Noddin, Comprehensive Health Planner II

AGENCY NAME:                              Division of Policy

ADDRESS:                                         109 Capitol Street, 11 State House Station

                                                           Augusta, Maine 04333-0011

                                                           Email: laurel.noddin@maine.gov

TELEPHONE:(207)-624-4019 FAX: (207)-287-6106

                                                            TTY users call Maine relay 711

Office: MaineCare Services

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