The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Below, please find a MaineCare Notice of Agency Rule-making Proposal. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144, C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 89, MaineMOM Services and Reimbursement
PROPOSED RULE NUMBER:
The proposed rulemaking establishes 10-144 CMR Ch. 101, MaineCare Benefits Manual (the “MBM”), Chapter II, Section 89, MaineMOM Services and Reimbursement.
The Department proposes this rule in order to create a new section of policy describing MaineMOM Services. The rulemaking addresses MaineMOM provider requirements, member eligibility, policies and procedures, covered services, and reimbursement methodology. The proposed MaineMOM Services rule is intended to expand Maine’s offering of substance use treatment service for pregnant and postpartum MaineCare members. This service is being created specifically to address and improve care for pregnant and postpartum people with Opioid Use Disorder (OUD) and their infants by integrating perinatal and substance use treatment services. The rule proposes to establish a new model of care which builds upon Opioid Health Home Services, within the Health Home Services Medicaid State Plan benefit, designed to integrate and coordinate medical and behavioral health services and supports for people living with chronic conditions.
MaineMOM services are separate from Section 93, Opioid Health Home Services. MaineCare will not reimburse a MaineMOM provider for delivering MaineMOM services to a member if that member also receives Section 93 services.
The Department proposes service and provider requirements for MaineMOM Services that are consistent with Health Home Service requirements, to include core Health Home Services and Standards, and the delivery of person-centered, quality-driven health care services. These proposed core services include creating care plans that support individual needs of patients, identifying health-related social needs, connecting individuals to needed resources, providing education related to substance use and perinatal care, supporting transitions between inpatient and outpatient care settings, and offering access to recovery-focused services. The Department further proposes that MaineMOM Services be provided by an interdisciplinary care team that includes a clinical lead, a Medications for Opioid Used Disorder (MOUD) prescriber, a perinatal provider, a nurse care manager, a clinical counselor, a patient navigator, and a recovery coach.
The proposed rule establishes three (3) models of MaineMOM Services to accommodate various provider and member situations. The three (3) models are:
- the Integrated Model,
- the Partnership Model, and
- the Perinatal Navigation Model
In compliance with 22 M.R.S. Section 3173-J(3), this proposed rule establishes the reimbursement rate methodology for Section 89 services, as follows:
- For each of the three (3) models of MaineMOM Services, the proposed rule establishes a monthly Per Member Per Month (PMPM) reimbursement rate which incorporates quality of care incentives with the review of performance on two quality measures (access to postpartum services and screening for viral hepatitis C in pregnant patients).
- 4% of the PMPM payments are withheld from regular payments and redistributed every six months in accordance with the Performance-Based Adjustments rule provision.
- In compliance with 22 M.R.S. Section 3173-J, the proposed reimbursement methodology applies an annual cost of living adjustment (COLA) equal to the percentage increase in the state minimum wage as set by the Department of Labor, pursuant to 26 M.R.S. Section 664(1), effective July 1, 2024, to the three MaineMOM PMPM rates.
- The PMPM rates and the annual COLA adjustments will be posted on the Department’s website.
The Department has received approval from the Centers for Medicare and Medicaid Services (CMS) for most of the new covered services and rates. The rule notates which provisions the Department is seeking a State Plan Amendment for.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173
DATE, TIME, AND LOCATION OF PUBLIC HEARING: Monday, July 24, 2023; 1:00pm
The Department will hold a combined in-person and remote (via Zoom) public hearing.
Location: State Office Building, Conference Rooms Maine A and Maine B
109 Capitol Street, Augusta, ME
Meeting ID: 841 0050 1626
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Meeting ID: 841 0050 1626
Find your local number: https://mainestate.zoom.us/u/k8n3iYZes
Some devices may require downloading a free app from Zoom prior to joining the public hearing event. The Department requests that any individual requiring special arrangements to attend the hearing in person contact the agency person listed below 5 days in advance of the hearing.
In addition to the public hearing, individuals may submit written comments to DHHS by the date listed in this notice.
COMMENT DEADLINE: Comments must be received by 11:59 pm on August 3, 2023.
AGENCY CONTACT PERSON: Melanie Miller, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4087 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.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A
STATUTORY AUTHORITY FOR THIS RULE: 22 M.R.S. §§ 42, 3173
Office: MaineCare Services