Maine Medicaid State Plan Methodology

UPDATED NOTICE: Chapter 101, MaineCare Benefits Manual, Sections 13, 17, 28, 65, and 92

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Sections 13, 17, 28, 65, and 92 NATURE OF PROPOSED CHANGES: The Department is issuing this updated notice to clarify three errors in our original December 30, 2022 posting. All final information can be found in the following tables: Section Service Service Description Procedure Code Modifiers Unit Final Rate Section 13 Targeted Case Management Case Management Services for Adults with HIV T1017 15 min. $24.55 Section 13 Targeted Case Management Case Management Services for Children with Developmental Disabilities T1017 UD 15 min. $24.55 Section 13 Targeted Case Management Case Management Services for Children with Behavioral Health Disorders T1017 UC 15 min. $24.55 Section 13 Targeted Case Management Case Management Services for Children with Chronic Medical Care Needs T1017 UB 15 min. $24.55 Section 13 Targeted Case Management Case Management Services for Adults with Substance Abuse Disorders T1017 HF 15 min. $24.55 Section 13 Targeted Case Management Case Management Services for Members Experiencing Homelessness T1017 U5 15 min. $24.55 Section 13 Targeted Case Management Case Management Services for Adults with Developmental Disabilities G9012 HI 15 min. $24.55 Section 13 Targeted Case Management Case Management Services for Members Experiencing Homelessness (Government Agencies) G9012 U5 15 min. $24.55 Section Service Service Description Procedure Code Modifiers Unit Final Rate Section 17 Community Integration Comprehensive Community Support Services (Community Integration Services) H2015 15 min. $24.74 Section 17 Community Rehabilitation Services Psychosocial Rehabilitation Service (Community Rehabilitation Services ) H2018 Day $114.68 Section 17 Skills Development, One-to-One Skills Training and Development (Skills Development Services) H2014 15 min. $22.23 Section 17 Skills Development, Group Skills Training and Development (Skills Development Services) H2014 HQ 15 min. $7.49 Section 17 Daily Living Support Services Psychosocial Rehabilitation (Daily Living Support Services) H2017 15 min. $17.76 Section 17 Day Support Services Behavioral Health Day Treatment ( Day Support Services) H2012 Hour $23.78 Section 17 Assertive Community Treatment Assertive Community Treatment H0040 Week *$494.06 *Section 17 - The Final rate for Assertive Community Treatment was incorrectly listed as $491.39, this has been updated to indicate the correct Final Rate of $494.06. Section Service Service Description Procedure Code Modifiers Unit Final Rate Section 28 Children's Rehab. and Community Support Home and Community, One-to-One (BHP) H2021 TJ HI 15 min. $20.60 Section 28 Children's Rehab. and Community Support Home and Community, 2 person group (BHP) H2021 TJ HI UN 15 min. $11.23 Section 28 Children's Rehab. and Community Support Home and Community, 3 person group (BHP) H2021 TJ HI UP 15 min. $8.00 Section 28 Children's Rehab. and Community Support Home and Community, 4 person group (BHP) H2021 TJ HI UQ 15 min. $6.48 Section 28 Children's Rehab. and Community Support School-Related, One-to-One (BHP) H2021 TR HI 15 min. $17.43 Section 28 Children's Rehab. and Community Support School-Related, 2 person group (BHP) H2021 TR HI UN 15 min. $9.63 Section 28 Children's Rehab. and Community Support School-Related, 3 person group (BHP) H2021 TR HI UP 15 min. $6.80 Section 28 Children's Rehab. and Community Support School-Related, 4 person group (BHP) H2021 TR HI UQ 15 min. $5.41 Section 28 Children's Rehab. and Community Support School-Related, One-to-One (BHP) - SPT Exempt H2021 HI 15 min. $16.44 Section 28 Children's Rehab. and Community Support School-Related, 2 person group (BHP) - SPT Exempt H2021 HI UN 15 min. $9.09 Section 28 Children's Rehab. and Community Support School-Related, 3 person group (BHP) - SPT Exempt H2021 HI UP 15 min. $6.41 Section 28 Children's Rehab. and Community Support School-Related, 4 person group (BHP) - SPT Exempt H2021 HI UQ 15 min. $5.11 Section 28 Specialized Children's Habilitative Services Specialized Home and Community, One-to-One H2021 U1 HK 15 min. $27.97 Section 28 Specialized Children's Habilitative Services Specialized Home and Community, 2 person group H2021 U1 HK UN 15 min. $15.24 Section 28 Specialized Children's Habilitative Services Specialized Home and Community, 3 person group H2021 U1 HK UP 15 min. $10.86 Section 28 Specialized Children's Habilitative Services Specialized Home and Community, 4 person group H2021 U1 HK UQ 15 min. $8.79 Section 28 Specialized Children's Habilitative Services Specialized School-Related, One-to-One - SPT Exempt H2021 **HK 15 min. $22.20 Section 28 Specialized Children's Habilitative Services Specialized School-Related, 2 person group - SPT Exempt H2021 **HK UN 15 min. $12.27 Section 28 Specialized Children's Habilitative Services Specialized School-Related, 3 person group - SPT Exempt H2021 **HK UP 15 min. $8.66 Section 28 Specialized Children's Habilitative Services Specialized School-Related, 4 person group - SPT Exempt H2021 **HK UQ 15 min. $6.90 Section 28 Specialized Children's Habilitative Services Specialized School-Related, One-to-One H2021 **U2 HK 15 min. $23.53 Section 28 Specialized Children's Habilitative Services Specialized School-Related, 2 person group H2021 **U2 HK UN 15 min. $13.01 Section 28 Specialized Children's Habilitative Services Specialized School-Related, 3 person group H2021 **U2 HK UP 15 min. $9.18 Section 28 Specialized Children's Habilitative Services Specialized School-Related, 4 person group H2021 **U2 HK UQ 15 min. $7.31 Section 28 Children's Rehab. and Community Support, BCBA BCBA School-Related Services - SPT Exempt G9007 HA 15 min. $22.47 Section 28 Children's Rehab. and Community Support, BCBA BCBA Services (Community Based Wrap Around Services) G9007 HA AF 15 min. $23.82 **Section 28 - The U2 modifier was incorrectly placed with certain Specialized School-Related Services. The U2 modifier has been moved from Specialized School-Related- SPT Exempt Services to Specialized School-Related Services. Section Service Service Description Procedure Code Modifiers Unit Final Rate Section 65 Children's Behavioral Health Day Treatment BHP, One-to-One - School H2012 HN 15 min. $17.26 Section 65 Children's Behavioral Health Day Treatment BHP, Group of 2 - School H2012 HN UN 15 min. $9.54 Section 65 Children's Behavioral Health Day Treatment BHP, Group of 3 - School H2012 HN UP 15 min. $6.73 Section 65 Children's Behavioral Health Day Treatment BHP, Group of 4 - School H2012 HN UQ 15 min. $5.36 Section 65 Children's Behavioral Health Day Treatment Master's, One-to-One - School H2012 HO 15 min. $25.43 Section 65 Children's Behavioral Health Day Treatment Master's, Group of 2 - School H2012 HO UN 15 min. $12.85 Section 65 Children's Behavioral Health Day Treatment Master's, Group of 3 - School H2012 HO UP 15 min. $9.07 Section 65 Children's Behavioral Health Day Treatment Master's, Group of 4 - School H2012 HO UQ 15 min. $7.22 Section 65 Outpatient Therapy Psychologist, One-to-One - Office H0004 AH 15 min. $31.75 Section 65 Outpatient Therapy Psychologist, Group - Office H0004 AH HQ 15 min. $10.34 Section 65 Outpatient Therapy LCSW/ LCPC/ LMFT/ APRN, One-to-One - Office H0004 HO 15 min. $25.73 Section 65 Outpatient Therapy LCSW/ LCPC/ LMFT/ APRN, Group - Office H0004 HO HQ 15 min. $8.41 Section 65 Outpatient Therapy Deaf, One-to-One - Office H0004 15 min. $33.27 Section 65 Outpatient Therapy LADC, One-to-One - Office H0004 HN 15 min. $23.81 Section 65 Outpatient Therapy LADC, Group - Office H0004 HN HQ 15 min. $10.39 Section 65 Outpatient Therapy CADC, One-to-One - Office H0004 HM 15 min. $19.75 Section 65 Outpatient Therapy CADC, Group - Office H0004 HM HQ 15 min. $8.65 Section 65 Outpatient Therapy Psychologist - Community H0004 AH U1 15 min. $38.37 Section 65 Outpatient Therapy LCSW/ LCPC/ LMFT/ APRN - Community H0004 HO U1 15 min. $31.26 Section 65 Outpatient Therapy Deaf - Community H0004 U1 15 min. $40.17 Section 65 Outpatient Therapy LADC - Community H0004 HN U1 15 min. $28.99 Section 65 Outpatient Therapy CADC - Community H0004 HM U1 15 min. $24.20 Section 65 ***Comprehensive Assessment Psychologist -Office H2000 AH 15 min. $31.75 Section 65 ***Comprehensive Assessment LCSW/ LCPC/ LMFT/ APRN - Office H2000 HO 15 min. $25.73 Section 65 ***Comprehensive Assessment Deaf Office H2000 15 min. $33.27 Section 65 ***Comprehensive Assessment LADC Office H2000 HN 15 min. $23.81 Section 65 ***Comprehensive Assessment CADC Office H2000 HM 15 min. $19.75 Section 65 ***Comprehensive Assessment Psychologist - Community H2000 AH U1 15 min. $38.37 Section 65 ***Comprehensive Assessment LCSW/ LCPC/ LMFT/ APRN - Community H2000 HO U1 15 min. $31.26 Section 65 ***Comprehensive Assessment Deaf - Community H2000 U1 15 min. $40.17 Section 65 ***Comprehensive Assessment LADC - Community H2000 HN U1 15 min. $28.99 Section 65 ***Comprehensive Assessment CADC - Community H2000 HM U1 15 min. $24.20 Section 65 Medication-Assisted Treatment with Methadone Opioid Treatment Program Services H0020 Week $171.30 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Neurobehavioral Status Exam, Psychologist or Physician (includes face-to-face time with the member, time interpreting test results, and preparing the report) - First Hour 96116 HE Hour $112.32 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Neurobehavioral Status Exam, Psychologist or Physician (includes face-to-face time with the member, time interpreting test results, and preparing the report) Each Additional Hour 96121 HE Hour $112.32 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Psychological testing, Psychologist or Physician (includes face-to-face time administering tests to the member and time interpreting these results and preparing the report) - First Hour 96130 HE Hour $112.32 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Psychological testing, Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these results, and preparing the report) Each Additional Hour 96131 HE Hour $112.32 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Neuropsychological testing (e.g., Halstead Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) - First Hour 96132 HE Hour $112.32 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Neuropsychological testing (e.g., Halstead Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) Each Additional Hour 96133 HE Hour $112.32 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Psychological or Neuropsychological test administration - two or more tests -Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) - First 30 Minutes 96136 HE 30 min. $56.16 Section 65 Neuropsychological and Psychological Testing, Physician/Psychologist Psychological or Neuropsychological test administration - two or more tests -Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these results, and preparing the report) Each Additional 30 Minutes 96137 HE 30 min. $56.16 Section 65 Neuropsychological and Psychological Testing, Psychological Examiner Neuropsychological and Psychological testing- Psychological Examiner (interpretation and report, administered by a technician, face-to-face) First 30 Minutes 96138 HE 30 min. $36.73 Section 65 Neuropsychological and Psychological Testing, Psychological Examiner Neuropsychological and Psychological testing- Psychological Examiner (interpretation and report, administered by a technician, face-to-face) Each Additional 30 Minutes 96139 HE 30 min. $36.73 Section 65 Specialized Group Services Wellness Recovery Action Planning (WRAP) H2019 HH Session $106.49 Section 65 Specialized Group Services Recovery Workbook Group H2019 HE Session $106.49 Section 65 Specialized Group Services Trauma Recovery and Empowerment Group (TREM) H2019 ST Session $87.91 Section 65 Specialized Group Services Dialectical Behavior Therapy (DBT) H2019 HK Session $118.89 Section 65 Children's HCT H2021 HA Week $817.20 Section 65 Children's HCT (OCFS Funded) H2021 HU Week $817.20 Section 65 Children's HCT (TF-CBT) H2021 ST Week $817.20 Section 65 Children's Assertive Community Treatment H0040 HA Week $592.24 Section 65 Mental Health Psychosocial Clubhouse Services H2030 15 min. $7.31 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P 1:1 - Bachelor's T1027 HN HA Session $127.78 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P Group 2-4 members - Bachelor's T1027 HN HA UN Session $95.01 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P Group 5-7 members - Bachelor's T1027 HN HA UR Session $49.15 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P Group 8+ members - Bachelor's T1027 HN HA US Session $33.86 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P 1:1 - Master's T1027 HO HA Session $149.52 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P Group 2-4 members -Master's T1027 HO HA UN Session $110.64 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P Group 5-7 members - Master's T1027 HO HA UR Session $56.95 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Triple P Group 8+ members - Master's T1027 HO HA US Session $39.06 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Incredible Years Group 2-4 members T1027 TJ UN Session $110.64 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Incredible Years Group 5-7 members T1027 TJ UR Session $56.95 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Incredible Years Group 8+ members T1027 TJ US Session $46.76 Section 65 Behavioral Therapies for Disruptive Behavior Disorders Parent-Child Interaction Therapy (PCIT) 1:1 T1027 HA 15 min. $28.07 Section 65 Multisystemic Therapy H2033 Week $706.56 Section 65 Multisystemic Therapy - Problem Sexualized Behavior H2033 HK Week $898.93 Section 65 Functional Family Therapy H2021 HE Week $371.57 Section 65 Outpatient Therapy Trauma-Focused Cognitive Behavioral Therapy - Office H0004 ST 15 min. $31.81 Section 65 Outpatient Therapy Trauma-Focused Cognitive Behavioral Therapy - Community H0004 ST U1 15 min. $38.55 Section 65 Crisis - Residential H0018 Day $676.78 Section 65 Crisis - Residential Children H0018 HA Day $676.78 Section 65 Intensive Outpatient Program Services Substance Use H0015 $208.72 *** Section 65 Comprehensive Assessment services were inadvertently left out of the previous notice, please see these services included in the table above. Section Service Service Description Procedure Code Modifiers Unit Final Rate Section 92 Behavioral Health Home - Adult No Code Indicated Month $558.31 Section 92 Behavioral Health Home - Children No Code Indicated Month $625.18 This amendment also adds a pay-for-performance provision to Section 17 - Assertive Community Treatment (ACT) (adults only), and Section 65 - Home and Community Treatment, and amends the pay-for-performance provision for Section 92 - Behavioral Health Home (BHH) (adults and children). Upon setting applicable performance thresholds within this provision, all providers will initially receive 4% less than the full rate. In this provision, these providers will only receive their full rate if they meet the Minimum Performance Threshold on performance measure(s) which are specific to each service. That remaining 4% of the rate will be paid to providers every three months if the provider satisfies the Minimum Performance Threshold. There will also be an Excellent Performance Threshold where if a provider meets this Excellent Performance Threshold, they will receive an additional 1% of the full rate. The Department shall set the performance thresholds so that no less than 70% of eligible providers (by service) are expected to be above the Minimum Performance Threshold and no less than 20% of providers (by service) are expected to be above the Excellent Performance Threshold. This means that 30% of eligible providers (by service) are not expected to meet the Minimum Performance Threshold and thus will not receive the 4% payment. The Department cannot anticipate the exact percentage of providers that will, during the performance period, satisfy either or neither of the performance thresholds. Providers shall receive reports quarterly to inform them about whether they satisfied the Minimum or Excellent Performance Threshold standards, what their reimbursement shall be, as well as instructions for appeal if they disagree with the Department's determinations. Performance Thresholds and Measures will be posted on the Department's website. REASON FOR PROPOSED CHANGES: All changes are enacted as a result of recently completed rate studies performed by a vendor contracted by the Department and pursuant to P.L. 2021 Ch. 639, An Act to Codify MaineCare Rate System Reform. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $90,001,310 in federal fiscal year 2023, which includes $58,546,022 in federal funds and $31,455,288 in state funds, and will cost $120,242,746 in federal fiscal year 2024, which includes $77,499,293 in federal funds and $42,743,452 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: January 4, 2023

CLARIFICATION TO POSTING BELOW TO UPDATE TITLE ONLY: Updates for Sections 13, 17, 28, 65, and 92

     

Concise Summary: Clarifying the posting below to update the title to include all sections of policy referenced in the notice.

Comment deadline past No comment deadline Posted: January 3, 2023

MaineCare Benefits Manual, Sections 13 - Targeted Case Management Services, 17 - Community Support Services, 28 - Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations, 65 - Behavioral Health Serv

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Sections 13 - Targeted Case Management Services, 17 - Community Support Services, 28 - Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations, 65 - Behavioral Health Services and 92 - Behavioral Health Home Services NATURE OF PROPOSED CHANGES: The Department plans to amend rates as indicated in the following tables: Service Procedure Code Modifier Proposed Unit Final Rate Section 13 Targeted Case Management T1017/ G9012 15 min. $24.55 Service Procedure Code Modifier Proposed Unit Final Rate Section 17 Community Integration H2015 15 min. $24.74 Community Rehabilitation Services H2018 Day $114.68 Skills Development, One-to-One H2014 15 min. $22.23 Skills Development, Group H2014 HQ 15 min. $7.49 Daily Living Support Services H2017 15 min. $17.76 Day Support Services H2012 Hour $23.78 Assertive Community Treatment H0040 Week $491.39 Service Procedure Code Modifier Proposed Unit Final Rate Section 28 Children's Rehab. and Community Support Home and Community, One-to-One (BHP) H2021 TJ HI 15 min. $20.60 Home and Community, 2 person group (BHP) H2021 TJ HI UN 15 min. $11.23 Home and Community, 3 person group (BHP) H2021 TJ HI UP 15 min. $8.00 Home and Community, 4 person group (BHP) H2021 TJ HI UQ 15 min. $6.48 School-Based, One-to-One (BHP) H2021 TR HI 15 min. $17.43 School-Based, 2 person group (BHP) H2021 TR HI UN 15 min. $9.63 School-Based, 3 person group (BHP) H2021 TR HI UP 15 min. $6.80 School-Based, 4 person group (BHP) H2021 TR HI UQ 15 min. $5.41 School-Based, One-to-One (BHP) - SPT Exempt H2021 HI 15 min. $16.44 School-Based, 2 person group (BHP) - SPT Exempt H2021 HI UN 15 min. $9.09 School-Based, 3 person group (BHP) - SPT Exempt H2021 HI UP 15 min. $6.41 School-Based, 4 person group (BHP) - SPT Exempt H2021 HI UQ 15 min. $5.11 Specialized Children's Habilitative Services Specialized Home and Community, One-to-One (BHP) H2021 U1 HK 15 min. $27.97 Specialized Home and Community, 2 person group (BHP) H2021 U1 HK UN 15 min. $15.24 Specialized Home and Community, 3 person group (BHP) H2021 U1 HK UP 15 min. $10.86 Specialized Home and Community, 4 person group (BHP) H2021 U1 HK UQ 15 min. $8.79 Specialized School-Based, One-to-One (BHP) H2021 HK 15 min. $22.20 Specialized School-Based, 2 person group (BHP) H2021 HK UN 15 min. $12.27 Specialized School-Based, 3 person group (BHP) H2021 HK UP 15 min. $8.66 Specialized School-Based, 4 person group (BHP) H2021 HK UQ 15 min. $6.90 Specialized School-Based, One-to-One (BHP) - SPT Exempt H2021 U2 HK 15 min. $23.53 Specialized School-Based, 2 person group (BHP) - SPT Exempt H2021 U2 HK UN 15 min. $13.01 Specialized School-Based, 3 person group (BHP) - SPT Exempt H2021 U2 HK UP 15 min. $9.18 Specialized School-Based, 4 person group (BHP) - SPT Exempt H2021 U2 HK UP 15 min. $7.31 BCBA School-Related Services - SPT Exempt G9007 HA 15 min $22.47 BCBA Services (Community Based Wrap Around Services) G9007 HA AF 15 min. $23.82 Service Procedure Code Modifier Proposed Unit Final Rate Section 65 Children's Behavioral Health Day Treatment BHP, One-to-One - School H2012 HN 15 min. $17.26 BHP, Group of 2 - School H2012 HN UN 15 min. $9.54 BHP, Group of 3 - School H2012 HN UP 15 min. $6.73 BHP, Group of 4 - School H2012 HN UQ 15 min. $5.36 Master's, One-to-One - School H2012 HO 15 min. $25.43 Master's, Group of 2 - School H2012 HO UN 15 min. $12.85 Master's, Group of 3 - School H2012 HO UP 15 min. $9.07 Master's, Group of 4 - School H2012 HO UQ 15 min. $7.22 Outpatient Therapy Psychologist, One-to-One - Office H0004 AH 15 min. $31.75 Psychologist, Group - Office H0004 AH HQ 15 min. $10.34 LCSW/ LCPC/ LMFT/ APRN, One-to-One - Office H0004 HO 15 min. $25.73 LCSW/ LCPC/ LMFT/ APRN, Group - Office H0004 HO HQ 15 min. $8.41 Deaf, One-to-One - Office H0004 15 min. $33.27 LADC, One-to-One - Office H0004 HN 15 min. $23.81 LADC, Group - Office H0004 HN HQ 15 min. $10.39 CADC, One-to-One - Office H0004 HM 15 min. $19.75 CADC, Group - Office H0004 HM HQ 15 min. $8.65 Psychologist - Community H0004 AH U1 15 min. $38.37 LCSW/ LCPC/ LMFT/ APRN - Community H0004 HO U1 15 min. $31.26 Deaf - Community H0004 U1 15 min. $40.17 LADC - Community H0004 HN U1 15 min. $28.99 CADC - Community H0004 HM U1 15 min. $24.20 Medication-Assisted Treatment with Methadone H0020 Week $171.30 Neurobehavioral Status Exam, Psychologist or Physician (includes face-to-face time with the member, time interpreting test results, and preparing the report) - First Hour 96116 HE Hour $112.32 Neurobehavioral Status Exam, Psychologist or Physician (includes face-to-face time with the member, time interpreting test results, and preparing the report) - Each Additional Hour 96121 HE Hour $112.32 Psychological testing, Psychologist or Physician (includes face-to-face time administering tests to the member and time interpreting these results and preparing the report) - First Hour 96130 HE Hour $112.32 Psychological testing, Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these results, and preparing the report) Each Additional Hour 96131 HE Hour $112.32 Neuropsychological testing (e.g., Halstead Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) - First Hour 96132 HE Hour $112.32 Neuropsychological testing (e.g., Halstead Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) Each Additional Hour 96133 HE Hour $112.32 Psychological or Neuropsychological test administration - two or more tests -Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) - First 30 Minutes 96136 HE 30 min. $56.16 Psychological or Neuropsychological test administration - two or more tests -Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these results, and preparing the report) Each Additional 30 Minutes 96137 HE 30 min. $56.16 Neuropsychological and Psychological testing- Psychological Examiner (interpretation and report, administered by a technician, face-to-face) First 30 Minutes 96138 HE 30 min. $36.73 Neuropsychological and Psychological testing- Psychological Examiner (interpretation and report, administered by a technician, face-to-face) Each Additional 30 Minutes 96139 HE 30 min. $36.73 Specialized Group Services Wellness Recovery Action Planning (WRAP) H2019 HH Session $106.49 Recovery Workbook Group H2019 HE $106.49 Trauma Recovery and Empowerment Group (TREM) H2019 ST $87.91 Dialectical Behavior Therapy (DBT) H2019 HK $118.89 Children's HCT Children's HCT H2021 HA Week $875.25 Children's HCT (OCFS Funded) H2021 HU Week $875.25 Children's HCT (TF-CBT) H2021 ST Week $875.25 Children's Assertive Community Treatment H0040 HA Week $592.24 Mental Health Psychosocial Clubhouse Services H2030 15 min. $7.31 Behavioral Therapies for Disruptive Behavior Disorders Triple P 1:1 - Bachelor's T1027 HN HA Session $127.78 Triple P Group 2-4 members - Bachelor's T1027 HN HA UN Session $95.01 Triple P Group 5-7 members - Bachelor's T1027 HN HA UR Session $49.15 Triple P Group 8+ members - Bachelor's T1027 HN HA US Session $33.86 Triple P 1:1 - Master's T1027 HO HA Session $149.52 Triple P Group 2-4 members -Master's T1027 HO HA UN Session $110.64 Triple P Group 5-7 members - Master's T1027 HO HA UR Session $56.95 Triple P Group 8+ members - Master's T1027 HO HA US Session $39.06 Incredible Years Group 2-4 members T1027 TJ UN Session $110.64 Incredible Years Group 5-7 members T1027 TJ UR Session $56.95 Incredible Years Group 8+ members T1027 TJ US Session $46.76 Parent-Child Interaction Therapy (PCIT) 1:1 T1027 HA 15 min. $28.07 Multisystemic Therapy H2033 Week $706.56 Multisystemic Therapy - Problem Sexualized Behavior H2033 HK Week $898.93 Functional Family Therapy H2021 HE Week $371.57 Trauma-Focused Cognitive Behavioral Therapy - Office H0004 ST 15 min. $31.81 Trauma-Focused Cognitive Behavioral Therapy - Community H0004 ST U1 15 min. $38.55 Crisis - Residential H0018 Day $676.78 Crisis - Residential Children H0018 HA Day $676.78 Intensive Outpatient Program Services Substance Use H0015 Day 208.72 Service Procedure Code Proposed Unit Final Rate Section 92 Behavioral Health Home - Adult No Code Indicated Month $558.31 Behavioral Health Home - Children No Code Indicated Month $625.18 This amendment also adds a pay-for-performance provision to Section 17 - Assertive Community Treatment (ACT) (adults only), and Section 65 - Home and Community Treatment, and amends the pay-for-performance provision for Section 92 - Behavioral Health Home (BHH) (adults and children). Upon setting applicable performance thresholds within this provision, all providers will initially receive 4% less than the full rate. In this provision, these providers will only receive their full rate if they meet the Minimum Performance Threshold on performance measure(s) which are specific to each service. That remaining 4% of the rate will be paid to providers every three months if the provider satisfies the Minimum Performance Threshold. There will also be an Excellent Performance Threshold where if a provider meets this Excellent Performance Threshold, they will receive an additional 1% of the full rate. The Department shall set the performance thresholds so that no less than 70% of eligible providers (by service) are expected to be above the Minimum Performance Threshold and no less than 20% of providers (by service) are expected to be above the Excellent Performance Threshold. This means that 30% of eligible providers (by service) are not expected to meet the Minimum Performance Threshold and thus will not receive the 4% payment. The Department cannot anticipate the exact percentage of providers that will, during the performance period, satisfy either or neither of the performance thresholds. Providers shall receive reports quarterly to inform them about whether they satisfied the Minimum or Excellent Performance Threshold standards, what their reimbursement shall be, as well as instructions for appeal if they disagree with the Department's determinations. Performance Thresholds and Measures will be posted on the Department's website. REASON FOR PROPOSED CHANGES: All changes are enacted as a result of recently completed rate studies performed by a vendor contracted by the Department and pursuant to P.L. 2021 Ch. 639, An Act to Codify MaineCare Rate System Reform. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $90,001,310 in federal fiscal year 2023, which includes $58,546,022 in federal funds and $31,455,288 in state funds, and will cost $120,242,746 in federal fiscal year 2024, which includes $77,499,293 in federal funds and $42,743,452 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: December 30, 2022

MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapter III, Nursing Facility Services to enable essential worker wages equal to at least 125% of minimum wage. Effective January 1, 2023, rates will include an add-on component as necessary to enable each facility to cover labor costs for essential support workers to equal at least 125% of the state minimum wage, plus related taxes and benefits. REASON FOR PROPOSED CHANGES: The rate add-on to enable provider payment of at least 125% of minimum wage is pursuant to Public Law 2021 Chapter 398 Section AAAA. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $2,861,708 in federal fiscal year 2023, which includes $1,926,782 in federal funds and $934,926 in state funds, and will cost $12,499,201 in federal fiscal year 2024, which includes $8,330,584 in federal funds and $4,168,617 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: December 30, 2022

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

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 97 - Private Non-Medical Institution Services to enable essential worker wages equal to at least 125% of minimum wage. Effective January 1, 2023, rates will include an add-on component as necessary to enable each facility to cover labor costs for essential support workers to equal at least 125% of the state minimum wage, plus related taxes and benefits. REASON FOR PROPOSED CHANGES: The rate add-on to enable provider payment of at least 125% of minimum wage is pursuant to Public Law 2021 Chapter 398 Section AAAA. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $776,676 in federal fiscal year 2023 which includes $522,934 in federal funds and $253,742 in state funds, and will cost $4,029,771 in federal fiscal year 2024 which includes $2,685,799 in federal funds and $1,343,972 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: December 30, 2022

MaineCare Benefits Manual, Section 96, Private Duty Nursing and Personal Care Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 96, Private Duty Nursing and Personal Care Services NATURE OF PROPOSED CHANGES: The Department plans to submit a future state plan amendment, effective January 1, 2023, to increase reimbursement for services within Section 96, Chapter III, Private Duty Nursing and Personal Care Services equal to an 8.24% cost-of-living adjustment (COLA). As a result of these reimbursement changes, the Department will also increase the Private Duty Nursing level of care caps by an amount proportional to the reimbursement changes. The cap increases are to ensure that members maintain appropriate access to covered services. REASON FOR PROPOSED CHANGES: Changes are directed by Maine P.L. 2021 ch. 639 and 22 MRSA Section 7402, as enacted by Maine P.L. 2021, ch. 398, Part AAAA ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will cost $632,488 in federal fiscal year 2023, which includes $391,921 in federal funds and $240,567 in state funds. The Department anticipates this chance will cost $2,868,613 in federal fiscal year 2024, which includes $1,759,874 in federal funds and $1,108,739 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: December 30, 2022

MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment, effective January 1, 2023, to amend reimbursement for certain services under Section 60, Chapter II, Medical Supplies and Durable Medical Equipment (DME). For DME and medical supplies where there is a Medicare rate, the Department will reimburse 100% of current Medicare rate. The Department is also providing, for medical supplies and equipment that are not covered by Medicare, an annual inflation adjustment based on the Consumer Price Index for All Urban Consumers for medical equipment and supplies (CUUR0000SEMG) each January for services that have not received an adjustment within the last 12 months. REASON FOR PROPOSED CHANGES: These changes are to comply with the Centers for Medicare and Medicaid Services' (CMS) Upper Payment Limit (UPL), as well as the Departments reimbursement reform and rate determination priorities found in P.L. 2021 Ch. 639, An Act to Codify MaineCare Rate System Reform. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $1,102,692 in federal fiscal year 2023 which includes $730,060 in federal funds and $372,632 in state funds, and will cost $1,470,256 in federal fiscal year 2024 which includes $965,637 in federal funds and $504,619 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: December 30, 2022

MaineCare Benefits Manual, Section 26, Day Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 26, Day Health Services NATURE OF PROPOSED CHANGES: The Department plans to amend reimbursement, effective January 1, 2023, for adult day health services as follows: Procedure Code Description Unit of Service Final Rate S5100 Adult Day Health hour 5.18 REASON FOR PROPOSED CHANGES: All changes are enacted as a result of a recently completed rate study performed by a vendor contracted by the Department and pursuant to P.L. 2021 Ch. 639, An Act to Codify MaineCare Rate System Reform. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $136,238 in federal fiscal year 2023, which includes $86,923 in federal funds and $49,314 in state funds, and will cost $181,650 in federal fiscal year 2024, which includes $114,758 in federal funds and $66,892 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: December 30, 2022

MaineCare Benefits Manual, Section 12, Consumer Directed Attendant Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 12, Consumer Directed Attendant Services NATURE OF PROPOSED CHANGES: The Department plans to submit a future state plan amendment, effective January 1, 2023, to increase reimbursement for services within Section 12, Chapter III, Consumer Directed Attendant Services equal to an 8.24% cost-of-living adjustment (COLA). REASON FOR PROPOSED CHANGES: Changes are directed by Maine P.L. 2021 ch. 639 and 22 MRSA Section 7402, as enacted by Maine P.L. 2021, ch. 398, Part AAAA. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will cost $93,119 in federal fiscal year 2023, which includes $57,701 in federal funds and $35,418 in state funds. The Department anticipates this chance will cost $421,390 in federal fiscal year 2024, which includes $258,520 in federal funds and $162,870 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 9, 2023 Posted: December 30, 2022

Notice of Agency State Plan Submission

Notice of Agency State Plan Submission   Draft 1915 k   

Concise Summary: Notice of Agency State Plan Submission AGENCY: Maine Department of Health and Human Services, Office of MaineCare Services RULE TITLE OR SUBJECT: 1915(k) Community First Choice State Plan Option Submission CONCISE SUMMARY: The Maine Department of Health and Human Services (DHHS) plans to submit a 1915(k), Community First Choice (CFC) State Plan Option application to the Centers for Medicare & Medicaid Services (CMS) in the near future. DHHS is proposing to provide home and community-based attendant services and supports to Medicaid members who meet institutional level of care eligibility and who are eligible for medical assistance under the State plan. The CFC Option was originally established under the Affordable Care Act of 2010. In 2019, DHHS hosted the State Convening on Aging and Long-Term Services and Supports (the "Convening"), including over sixty stakeholders from across the state. The objectives of the Convening included reviewing opportunities and challenges related to aging in Maine; gathering feedback on Governor Mills' administrations priorities for aging and long-term services and supports (LTSS); and establishing a process to advance policy in this area. Following the Convening, DHHS Commissioner Jeanne M. Lambrew convened the Aging and LTSS Advisory Committee, including nineteen community stakeholders with contributions from DHHS and the Maine Department of Labor, to formulate specific policies and to advance reform priorities for the state. One of the key recommendations from the Advisory Committee included development and implementation of a Medicaid 1915(k) CFC State Plan Option in Maine. The CFC expands opportunities for the provision of home and community-based LTSS to facilitate community integration and expand access to opportunities for MaineCare members to select and receive eligible services, with an emphasis on self-directed supports. Self-direction is a model of service delivery that helps participants of all ages, with many types of disabilities, maintain their independence at home and within their communities. When a person self-directs services through the 1915(k) option, they decide how, when, and by whom their services and supports will be delivered. Under the CFC Option, eligible MaineCare Members will have access to personal care/attendant services as well as options to receive Matter of Balance (Falls Prevention), Chronic Disease Self-Management, Assistive Technology Devices and Services, Personal Emergency Response Services, Skills Training and Financial Management Services through self-direction. The Department is accepting comments from October 25, 2022 through November 23, 2022. Any interested party may obtain a copy of the full draft CFC application by going to the website noted below: http://www.maine.gov/dhhs/ofi/offices/index.html. A printed copy may be obtained by calling Heather Bingelis at (207) 624-6951 or emailing heather.bingelis@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for draft application and to submit comments DEADLINE FOR COMMENTS: Comments must be received by 11: 59 pm, November 23, 2022. AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner II AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol St. Augusta, Maine 04333-0011 EMAIL: heather.bingelis@maine.gov TELEPHONE: 207-624-6951 FAX: (207) 287-1864 TTY: 711

Comment deadline past Comment Deadline: November 23, 2022 Posted: October 25, 2022

MaineCare Benefits Manual, Section 25, Dental Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 25, Dental Services NATURE OF PROPOSED CHANGES: The Department plans to submit a future State Plan Amendment to address Dental reimbursement. The reimbursement methodology sets rates for diagnostic, endodontic, periodontic, preventive, and limited orthodontic treatment 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. Additionally, the Department is adding coverage and reimbursement of the following services: Code Code Description Rate D0470 DIAGNOSTIC CASTS $77.78 D1310 NUTRITIONAL COUNSELING FOR CONTROL OF DENTAL DISEASE $24.56 D1352 PREVENTIVE RESIN RESTORATION IN A MODERATE TO HIGH CARIES RISK PATIENT - PERMANENT TOOTH $76.42 REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2021, Ch. 398, 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $105,024 in federal fiscal year 2023 which includes $70,263 in federal funds and $34,761 in state funds, and will cost $105,024 in federal fiscal year 2024 which includes $70,263 in federal funds and $34,761 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 9, 2022 Posted: September 29, 2022

MaineCare Accountable Communities Program

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: MaineCare Accountable Communities Program NATURE OF PROPOSED CHANGES: The Department plans to adjust the Accountable Communities (AC) Total Cost of Care (TCOC) reconciliation for Performance Year 7 (PY7) which covers August 2020 through July 2021. The adjustment will include removing COVID-19 costs related to testing, treatment, and vaccinations from the TCOC reconciliation analysis. Additionally, regarding quality measure scoring, if one or more measures indicate special cause variation from previous performance and/or show statistically significant deviation from peer performance, the Department will adjust the affected measure's performance to reflect performance of the most recent performance year unaffected by the public health emergency. REASON FOR PROPOSED CHANGES: These changes are being made per recommendation of the Department's actuarial vendor for AC services to ensure the integrity of the shared savings results from the AC program by minimizing the impact resulting from the COVID-19 pandemic. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 9, 2022 Posted: September 29, 2022

MaineCare Benefits Manual, Section 30 - Family Planning Agency Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 30 - Family Planning Agency Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan amendment to provide add-on payments to providers engaged primarily in the delivery of sexual and reproductive health care services for certain services, as set forth in the table below. The amounts were developed by applying 225 percent to existing MaineCare rates and rounding to the nearest dollar. Procedure Code Description Amount of Add-On Payment, rounded to nearest dollar 11976 Removal, implantable contraceptive capsules $224 11981 Insertion, non-biodegradable drug delivery implant $156 11982 Contraceptive Capsule Removal $175 11983 Contraceptive Capsule Removal & Reinsert $221 54050 Condyloma Treatment (Destruct penis lesion(s)) $218 56501 Condyloma Treatment (Destruct vulva lesion(s) (simple <14) $301 57170 Diaphragm/Cervical Cap Fit $122 57452 Colposcopy $197 57454 Colposcopy And Biopsy $265 58300 Insertion of intrauterine device (IUD) $174 58301 Removal of intrauterine device (IUD) $173 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy $6 81025 Urine pregnancy test, by visual color comparison methods $15 85018 Hemoglobin (Hgb)(To bill this code providers must have their current CLIA-waiver certificates on file with MaineCare and update their provider enrollment with the Department.) $5 86703 HIV-1 and HIV-2, single assay (ex. Oraquick Advance Rapid . (If positive result, providers must recommend Western Blot confirmatory testing and collect a sample, blood or saliva, during the same encounter to send to an outside professional lab for testing. Prepaid Kits to collect the sample are to be purchased from the Maine Center for Disease Control and Prevention, Health and Environmental Testing Laboratory in accordance with MaineCare Benefits Manual, Section 90.04-24). $24 87210 Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types; wet mount for infectious agents (e.g., saline, India ink, KOH preps) $10 90471 Immunization admin (Gardasil - 1st injection) $26 96372 Injection, therapeutic/prophylactic/diagnostic, sc/im $22 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three (3) key components: an expanded problem focused history; an expanded problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or familys needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend twenty (20) minutes face-to-face with the patient and/or family. $112 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three (3) key components: a detailed history; a detailed examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patients and/or familys needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend thirty (30) minutes face-to-face with the patient and/or family. $173 99204 New Patient - Comprehensive $260 99205 New Patient - Complete $344 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five (5) minutes are spent performing or supervising these services. $35 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two (2) of these three (3) key components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend ten (10) minutes face-to-face with the patient and/or family. $87 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two (2) of these three (3) key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend fifteen (15) minutes face-to-face with the patient and/or family. $141 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two (2) of these three (3) key components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend twenty-five (25) minutes face-to-face with the patient and/or family. $199 99215 Continuing Patient - Complete $281 99384 Preventive visit, new, 12-17 $209 99385 Initial comprehensive preventative medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient, adolescent age 18-39 years. (All providers of these services must meet all MaineCare Benefits Manual, Section 94 Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) periodicity requirements for MaineCare members up to their twenty-first (21) birthday.) $203 99386 Preventive visit, new, 40-64 $235 99394 Preventive visit, est, 12-17 $178 99395 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions and the ordering of appropriate laboratory/diagnostic procedures, established patient; age 18- 39 years. (All providers of these services must meet all MaineCare Benefits Manual, Section 94 Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) periodicity requirements for MaineCare members up to their twenty-first (21) birthday.) $182 99396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions and the ordering of appropriate laboratory/diagnostic procedures, established patient; 40-64 years $195 99401 Individual Preventive Counseling: Approx. 15 minutes $60 99402 Individual Preventive Counseling: Approx. 30 minutes $100 The add-on payments will not change the underlying reimbursement amount, or base rate, for these procedure codes. The add-on payments will only be paid to providers engaged primarily in the delivery of services described in 42 United States Code, Section 1396d(a)(4)(C). The Federal Financial Participation (FFP) rate that will apply to the base rate shall also apply to the add-on payment. This means that where the base rate is matched at the enhanced rate of 90 percent provided for family planning services and supplies, the add-on payment shall also be matched at the enhanced rate of 90 percent. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 2022, ch 738 An Act To Protect The Reproductive Rights and Freedoms of Maine People. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $2,140,259 in federal fiscal year 2023 which includes $1,434,187 in federal funds and $706,072 in state funds, and will cost $1,712,207 in federal fiscal year 2024 which includes $1,085,026 in federal funds and $627,181 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 7, 2022 Posted: September 27, 2022

MaineCare Benefits Manual, Section 90, Physicians Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 90, Physicians Services NATURE OF PROPOSED CHANGES: The Department plans to amend reimbursement for Current Procedural Terminology (CPT) code 99188 (application of topical fluoride varnish by a physician or other qualified health care professional) to $24.56 effective August 1, 2022. REASON FOR PROPOSED CHANGES: The Department is amending reimbursement to align with recently proposed changes to Section 25 - Dental Services in order to create consistent reimbursement for like services. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $3,393 in federal fiscal year 2022 which includes $2,414 in federal funds and $979 in state funds and will cost $20,355 in federal fiscal year 2023 which includes $13,428 in federal funds and $6,927 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: August 8, 2022 Posted: July 29, 2022

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

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 97 - Private Non-Medical Institution Services to enable 125% of minimum wage. Effective July 1, 2022, rates will include an add-on component as necessary to enable each facility to cover labor costs for essential support workers to equal at least 125% of the state minimum wage, plus related taxes and benefits. REASON FOR PROPOSED CHANGES: The rate add-on to enable 125% of minimum wage is pursuant to Public Law 2021 Chapter 398 Section AAAA. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $4,846,832 in federal fiscal year 2022 which includes $3,323,240 in federal funds and $1,523,592 in state funds, and will cost $5,689,012 in federal fiscal year 2023 which includes $3,893,353 in federal funds and $1,795,659 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 7, 2022 Posted: June 30, 2022

MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapter III, Nursing Facility Services related to: 1. Rate add-on to enable 125% of minimum wage: Effective July 1, 2022, rates will include an add-on component as necessary to enable each facility to cover labor costs for essential support workers to equal at least 125% of the state minimum wage, plus related taxes and benefits. 2. Revision to High MaineCare Utilization Payments: Prior to July 1, 2022, facilities with MaineCare days constituting more than 80% of total days across all payers received a High MaineCare Utilization Payment of $0.60 per diem for each one percentage (1%) of MaineCare days above eighty percent (80%) if their base year direct and routine aggregate costs per day were less than the median aggregate direct and routine allowable costs for the facility's peer group (and if their base year direct and routine aggregate costs per day were not less than the median aggregate direct and routine allowable costs for the facilitys peer group, the facility received a High MaineCare Utilization Payment of $0.40 per diem for each one percentage (1%) of MaineCare days above eighty percent (80%)). Effective July 1, 2022, MaineCare is eliminating the requirement for base year direct and routine aggregate costs per day to be less than the median aggregate direct and routine allowable costs for the facilitys peer group, so that all facilities with MaineCare days constituting more than 80% of total days across all payers will receive a High MaineCare Utilization Payment of $0.60 per diem for each one percentage (1%) of MaineCare days above eighty percent (80%). REASON FOR PROPOSED CHANGES: The rate add-on to enable 125% of minimum wage is pursuant to Public Law 2021 Chapter 398 Section AAAA-5. The revision to high MaineCare utilization payments is pursuant to LD 684, enacted in 2022. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $877,437 in federal fiscal year 2022 which includes $552,019 in federal funds and $325,418 in state funds, and will cost $3,289,732 in federal fiscal year 2023 which includes $2,052,530 in federal funds and $1,237,202 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 7, 2022 Posted: June 30, 2022

MaineCare Benefits Manual, Section 92, Chapter III, Behavioral Health Home Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 92, Chapter III, Behavioral Health Home Services NATURE OF PROPOSED CHANGES: The Department plans to add in language that, beginning July 1, reimbursement rates for Behavioral Health Home (BHH) will receive an annual cost of living adjustment (COLA) equal to the percentage increase in the state minimum wage as set by the Maine Department of Labor. Services that receive an increase to their rate within the previous 12-month period will not receive the annual July 1 COLA increase. Annual updates will be posted on the Department's website at: https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx?RootFolder=%2FProvider%20Fee%20Schedules%2FRate%20Setting%2FSection%20092%20%2D%20Behavioral%20Health%20Home%20Services&FolderCTID=0x012000264D1FBA0C2BB247BF40A2C571600E81&View=%7B69CEE1D4%2DA5CC%2D4DAE%2D93B6%2D72A66DE366E0%7D. Additionally, this SPA removes the primary care payment that was previously absorbed and approved under Maines Primary Care Plus (PCPlus) program. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2021, ch. 398, 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $ 868,457 in federal fiscal years 2022 which includes $580,389 in federal funds and $288,068 in state funds and will cost $3,288,555 in federal fiscal year 2023 which includes $2,176,830 in federal funds and $1,111,725 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 7, 2022 Posted: June 30, 2022

MaineCare Benefits Manual, Section 91, Chapter III, Health Home Services - Community Care Teams

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 91, Chapter III, Health Home Services - Community Care Teams NATURE OF PROPOSED CHANGES: The Department is establishing Home Outreach and Member Engagement (HOME) services which are specialized Community Care Team (CCT) services to provide housing outreach and Member engagement to eligible Members with Long-term Homelessness. Initial Member eligibility criteria for HOME services require that a Member have two chronic conditions or one chronic condition and be at risk for a second chronic condition. Chronic conditions and at-risk chronic conditions are defined by the Department. There are three tiers of HOME services Per Member Per Month (PMPM) payment rates, each based on acuity level and how the HOME provider team addresses individual's needs. Each tier is inclusive of the 6 section 2703 health home services, while the service intensity increases through the tiers. To be eligible for Tier One, Intensive Services, Members must have Long-term Homelessness (as defined in the Population Criteria Section of this SPA Submission) and be homeless or have previously received Tier One services. For Tier One, the full PMPM payment is $835.53. To be eligible for Tier Two, Stabilization Services, Members must be housed and have a Services Prioritization Decision Assistance Tool (SPDAT) or Youth Service Prioritization Decision Assistance Tool (Y-SPDAT) score of twenty (20) to sixty (60). For Tier Two, the full PMPM payment is $484.30. To be eligible for Tier Three, Maintenance Services, Members must be housed and have a SPDAT or Y-SPDAT score of four (4) to nineteen (19). For Tier Three, the full PMPM payment is $260.11. The PMPM amounts were established based on the independent rate study used for the States Behavioral Health Home services. The State believes that required staff time differs between the tiers, and adjusted accordingly, the cost data assumptions, contributions and caseload to reflect the higher-level of support provided by the HOME Provider. This rate was developed by determining the monthly cost per case of each team Member, applicable administrative support cost per case, and operating overhead rates. The costs were informed by provider reported costs and national standards. To be an eligible provider, a HOME Provider shall complete and attest to meeting the following requirements to receive the PMPM reimbursement: ensure appropriate collaboration with the Member and other appropriate providers, complete and/or update a comprehensive, whole-person assessment and develop and/or update the Plan of Care with pertinent information from monthly activities or developments in accordance with the provisions of this policy. Providers shall also submit Health Home Core Standards implementation progress reports, submit cost and utilization reports, scan the utilization data for its assigned population, and document each service provided to each Member. In addition to the requirements above, HOME provider teams must meet minimum service delivery requirements which include, but are not limited to, providing regular minimum monthly contact with each Member to deliver and/or assess the Members need for each of the 6 core Health Home services pursuant to the Members Plan of Care; delivering adequate care management, coordination, and supports to provide transitional continuity of care and to address the health conditions and social determinants of health that destabilize housing status; and providing housing navigation services to ensure timely connection with housing resources. Regular Community Care Team (CCT) services will receive a cost-of-living adjustment (COLA) equal to 4.94% above the currently established rate. Annual changes: Each July 1, HOME and CCT services will receive an annual cost-of-living adjustment (COLA) equal to the percentage increase in the state minimum wage as set by the Department of Labor. Services that received an increase to their rate within the previous 12-month period will not receive the annual COLA increase effective the following July 1. Annual updates will be posted on the Departments website at: https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx?RootFolder=%2FProvider%20Fee%20Schedules%2FRate%20Setting%2FSection%20091%20%2D%20Health%20Home%20Services&FolderCTID=0x012000264D1FBA0C2BB247BF40A2C571600E81&View=%7B69CEE1D4%2DA5CC%2D4DAE%2D93B6%2D72A66DE366E0%7D. *As a reminder, the reimbursement for Health Home services is being removed from this SPA as the services and reimbursement were absorbed and approved under Maines Primary Care Plus program. REASON FOR PROPOSED CHANGES: All changes are pursuant to LD 1318 (129th Legislature 2019), Resolve, To Increase Access to Housing-related Support Services; P.L. 2021, ch. 398, 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 ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $717,347 in federal fiscal years 2022 which includes $593,838 in federal funds and $123,509 in state funds and will cost $2,078,268 in federal fiscal year 2023 which includes $1,715,073 in federal funds and $363,195 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 7, 2022 Posted: June 30, 2022

MaineCare Benefits Manual, Section 25, Dental Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 25, Dental Services NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment to update coverage and the reimbursement methodology for Dental Services. The Department is expanding coverage for adult (members over age 21) dental services from emergency only to also include the following: Diagnostic services, such as oral evaluations and x-rays Preventive services, such as cleanings, fluoride, and tobacco and substance use counseling Restorative services, such as fillings and crowns Endodontic services, such as root canals Periodontic services, such as various gum surgeries and cleanings that occur below the gums Complete, partial, and immediate dentures and denture repairs Oral surgeries, such as tooth extractions and removal of tumors and lesions Adjunctive services, such as sedation and night guards In addition to the expanded coverage above, effective July 1, 2022, rates for diagnostic, endodontic, periodontic, and preventive services will be based on 67% of the Maine Commercial Median Benchmark, or 133% of the Medicaid State Average Benchmark, if the Maine Commercial Median Benchmark rate is unavailable or unreliable. For limited and comprehensive orthodontic treatment, the Department will establish a bundled rate for services included in both limited and comprehensive treatment using this methodology for individual services and then developing an average reimbursement rate for each of the orthodontic bundles which varies based on dentition of the individual patient. Medicament will be reimbursed at 133% of the Medicaid State Average Benchmark. Reimbursement for adjunctive, oral and maxillofacial surgery, orthodontics (excluding limited and comprehensive services as described above), prosthodontics, and restorative services will be based on 50% of the Maine Commercial Median Benchmark or 100% of the Medicaid State Average Benchmark if the Maine Commercial Median Benchmark rate is unavailable or unreliable. This methodology will also apply to codes for extraction of an erupted or exposed root only through June 30, 2024. Reimbursement for deep and intravenous moderate sedation service is equal to 50% of the Maine Commercial Median Benchmark for the CDT code that represents the first fifteen (15) minutes of deep sedation. The Department applies an inflation adjustment to all rates based on the Consumer Price Index (CPI) for dental services in U.S. city average, all urban consumers, seasonally adjusted (CUSR0000SEMC02) to adjust rates to the current year. The Maine Commercial Median Benchmark is the median of Maine commercial payer dental claim allowed amounts when the claim is paid as primary with an allowed amount greater than zero (0) based on data from the Maine Health Data Organization's All Payer Claims Database. The Maine Commercial Median Benchmark rate for a CDT code must have equal to or greater than one-hundred (100) claims billed in the source data used to set the benchmarks in order for the Department to consider it reliable. Benchmarks are updated every two (2) years utilizing claims from the most recent Maine state fiscal year. The Medicaid State Average Benchmark is the average of all other states Medicaid rates for a CDT code, where rates are available and reliable. The Department excludes any rates as unreliable in the determination of the Medicaid State Average Benchmark when they represent outliers in comparison to the other state rates, or when there is excessive variation across all state rates available. If a Medicaid agency uses different child and adult rates, the Department uses the average of the rates. Benchmarks are updated every two years utilizing the most current rates available as of the time of the rate schedule update. REASON FOR PROPOSED CHANGES: All changes are 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $ 11,270,084 in federal fiscal years 2022 which includes $ 7,272,253 in federal funds and $ 3,997,832 in state funds and will cost $45,080,337 in federal fiscal year 2023 which includes $29,089,011 in federal funds and $ 15,991,326 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 6, 2022 Posted: June 29, 2022

MaineCare Benefits Manual, Several Sections Included Within Chapter 101, COLA

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Several sections included within Chapter 101, MaineCare Benefits Manual NATURE OF PROPOSED CHANGES: The Department plans to amend reimbursement of certain services through a cost-of-living adjustment (COLA). The COLA will be equal to an increase of 4.94% above the currently established rate(s). Sections of the MaineCare Benefits Manual and the services impacted by the COLA adjustment, as well as the new rate effective July 1, 2022, are included in the tables below. Section 13 - Targeted Case Management Procedure Code Code Description Modifier Rate effective 7/1/2022 G9012 Case Management Services for Adults with Developmental Disabilities HI $23.03 G9012 Case Management Services for Members Experiencing Homelessness (Government Agencies) U5 $23.03 T1017 Case Management Services for Adults with Substance Abuse Disorders HF $23.03 T1017 Case Management Services for Members Experiencing Homelessness U5 $23.03 T1017 Case Management Services for Children with Chronic Medical Care Needs UB $23.03 T1017 Case Management Services for Children with Behavioral Health Disorders UC $23.03 T1017 Case Management Services for Children with Developmental Disabilities UD $23.03 T1017 Case Management Services for Adults with HIV $23.03 Section 17 - Community Support Services Procedure Code Code Description Modifier Rate effective 7/1/2022 H0038 CIPSS-Self Help/peer services $11.88 H2014 Skills Training and Development HQ $3.26 H2014 Skills Training and Development $13.05 H2015 Community Integration Services $22.33 H2017 Daily Living Support Services $8.32 H2018 Community Rehabilitation Services $79.63 H2025 Skills Development Services/training $13.05 Section 17 - Community Support Services Provider Procedure Code Code Description Rate effective 7/1/2022 Community Health and Counseling Services H0040 Assertive Community Treatment $82.81 Catholic Charities Maine H0040 Assertive Community Treatment $63.23 Maine General Community Care H0040 Assertive Community Treatment $63.23 MaineHealth H0040 Assertive Community Treatment $63.23 Spurwink Services H0040 Assertive Community Treatment $63.23 Sweetser H0040 Assertive Community Treatment $63.23 Tri-County Mental Health Services H0040 Assertive Community Treatment $63.23 Crooked River Counseling H2012 Behavioral Health Day Treatment $16.07 Goodwill Industries of Northern New England H2012 Behavioral Health Day Treatment $16.07 Northeast Occupational Exchange, Inc H2012 Behavioral Health Day Treatment $16.07 MaineHealth H2012 Behavioral Health Day Treatment $44.79 Becket Academy, Inc H2012 Behavioral Health Day Treatment $101.69 Section 23 - Developmental and Behavioral Evaluation Clinic Services Procedure Code Code Description Modifier Rate effective 7/1/2022 T1026 Child Abuse Evaluation HK $101.69 T1026 Developmental and Behavioral Evaluation $82.30 Section 28 - Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations Procedure Code Code Description Modifier Rate effective 7/1/2022 H2021 Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) 1:1 HI $11.06 H2021 Specialized Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) 1:1 HK $15.31 H2021 Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) Group-Two Patients Served UN, HI, HQ $5.58 H2021 Specialized Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) Group - Two Patients Served UN, HQ, HK $7.74 H2021 Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) Group - Three Patients Served UP, HQ, HI $3.84 H2021 Specialized Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) Group - Three Patients Served UP, HQ, HK $5.30 H2021 Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) Group - Four Persons Served UQ, HQ, HI $2.97 H2021 Specialized Services for Children with Cognitive Impairment and Functional Limitations (Community Based Wrap Around Services) Group - Four Patients Served UQ, HQ, HK $4.10 G9007 BCBA Services HA $17.42 Section 30 - Family Planning Services Procedure Code Code Description Modifier Rate effective 7/1/2022 A4266 Diaphragm for contraceptive use FP $22.54 A4267 Contraceptive supply, condom, male, each FP $0.68 A4268 Contraceptive supply, condom, female, each FP $2.20 A4269 Contraceptive supply, spermicide (e.g., foam, gel) each FP $9.02 S0199 Medical abortion including all servs exc drug 343.94 Section 40 - Home Health Services Revenue Code Procedure Code Code Description Modifier Rate effective 7/1/2022 0421 G0151 Services of physical therapist assistant in home health setting TF $26.88 0421 G0151 Services of physical therapist in home health setting $38.39 0431 G0152 Services of occupational therapist assistant in home health setting TF $27.06 0431 G0152 Services of occupational therapist in home health setting $38.65 0441 G0153 Services of a speech and language pathologist assistant in home health setting TF $29.20 0441 G0153 Services of a speech and language pathologist in home health setting $41.71 0561 G0155 Services of clinical social worker in home health setting $38.64 0571 G0156 Services of home health aide in home health setting $15.91 0551 G0299 Services of skilled nurse in home health setting (RN) $35.11 0559 G0300 Services of skilled nurse in home health setting (LPN) $24.58 0551 T1502 Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional $89.15 Section 65 Behavioral Health Services Procedure Code Code Description Modifier Rate effective 7/1/2022 H2000 Outpatient Services Comprehensive Assessment $23.55 H2000 Outpatient Services Comprehensive Assessment $22.48 H2000 Outpatient Services Comprehensive Assessment HH $22.48 H2000 Outpatient Services Comprehensive Assessment $32.92 H2000 Outpatient Services Comprehensive Assessment $14.72 H2000 Outpatient Services Comprehensive Assessment $22.48 H2000 Outpatient Services Comprehensive Assessment $21.41 H2000 Outpatient Services Comprehensive Assessment $15.52 H0004 Outpatient Services Individual/Family Therapy: $23.55 H0004 Outpatient Services Individual/Family Therapy: $22.48 H0004 Outpatient Services Individual/Family Therapy: HH $22.48 H0004 Outpatient Services Individual/Family Therapy: $32.92 H0004 Outpatient Services Individual/Family Therapy: $14.72 H0004 Outpatient Services Individual/Family Therapy: $22.48 H0004 Outpatient Services Individual/Family Therapy: $21.41 H0004 Outpatient Services Individual/Family Therapy: $15.52 H0004 Outpatient Services Individual/Family Therapy: ST $27.21 H0004 Outpatient Services Group Therapy: HQ $5.89 H0004 Outpatient Services Group Therapy: HQ $5.62 H0004 Mental Health Agency-Co-occurring HQ HH $5.62 H0004 Outpatient Services Group Therapy: HQ $9.63 H0004 Outpatient Services Group Therapy: HQ $9.10 H0004 Outpatient Services Group Therapy: HQ $7.49 H0004 Outpatient Services Group Therapy: HQ $3.68 H0025 Family Psychoeducational Treatment - Children $79.03 H2027 Family Psychoeducational Treatment - Adults $10.12 96116 Neurobehavioral Status Exam Psychologist or Physician 1st hr HE $84.77 96121 Neurobehavioral Status Exam Psychologist or Physician, ea add'l hr HE $84.77 96130 Psychological testing, Psychologist or Physician 1st hr HE $84.77 96131 Psychological testing, Psychologist or Physician, ea ad'l hr HE $84.77 96132 Neuropsychological testing - 1st hr HE $84.77 96133 Neuropsychological testing - ea add'l hr HE $84.77 96136 Psychological or Neuropsychological test administration - two or more tests - Psychologist or Physician - 1st 30 min HE $42.39 96137 Psychological or Neuropsychological test administration - two or more tests - Psychologist or Physician - ea add'l 30 min HE $42.39 96138 Neuropsychological and Psychological testing- Psychological Examiner - 1st 30 min HE $26.88 96139 Neuropsychological and Psychological testing- Psychological Examiner ea add'l 30 min HE $26.88 96112 Adaptive Assessment First Hour HE $88.87 96113 Adaptive Assessment Each Add. 30 min HE $44.44 H2021 Children's Comprehensive Community Support Services - Home and Community Based Treatment (HCT) HO $24.92 H2021 Childrens Comprehensive Community Support Services - Home and Community Based Treatment (HCT) HU $24.92 H2021 Childrens Comprehensive Community Support Services - Home and Community Based Treatment (HCT) ST $24.92 G9007 Childrens Comprehensive Community Support Services - Home and Community Based Treatment (HCT) HO $24.92 G9007 Childrens Comprehensive Community Support Services - Home and Community Based Treatment (HCT) HU $24.92 H2021 Childrens Comprehensive Community Support Services - Home and Community Based Treatment (HCT) HN $17.40 H2021 Childrens Comprehensive Community Support Services - Home and Community Based Treatment (HCT) HU U1 $17.40 G9007 Childrens Comprehensive Community Support Services - Home and Community Based Treatment (HCT) HN $17.40 H2021 Childrens Comprehensive Community Support Services - Functional Family Therapy (FFT), HE $302.26 H2033 Childrens Comprehensive Community Support Services - Multi-Systemic Therapy (MST) $601.05 H2033 Childrens Comprehensive Community Support Services - MST for Problem Sexualized Behaviors (MST-PSB): HK $776.61 H0020 Opioid Treatment Program Services $115.43 H2012 Childrens Behavioral Health Day Treatment HN $62.72 H2012 Childrens Behavioral Health Day Treatment HN UN $31.37 H2012 Childrens Behavioral Health Day Treatment HN UP $20.90 H2012 Childrens Behavioral Health Day Treatment HN UQ $15.68 H2012 Childrens Behavioral Health Day Treatment HO $101.69 H2012 Childrens Behavioral Health Day Treatment HO UN $50.84 H2012 Childrens Behavioral Health Day Treatment HO UP $33.83 H2012 Childrens Behavioral Health Day Treatment HO UQ $25.43 99406 Smoking and Tobacco Cessation Counseling; $9.28 99407 Smoking and Tobacco Cessation Counseling; $18.00 99411 Preventive Medicine, Tobacco Cessation $12.35 99412 Preventive Medicine, Tobacco Cessation $16.10 H2030 Mental Health Clubhouse Services $6.33 H2019 Specialized Group Services - Wellness Recovery Action Planning $11.21 H2019 Specialized Group Services - Recovery Workbook $11.21 H2019 Specialized Group Services - Trauma Recovery and Empowerment $11.21 H2019 Specialized Group Services - Dialectical Behavior Therapy $11.21 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Triple P 1:1 HA $22.48 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Triple P Group 2-4 members HA HQ UN $11.53 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Triple P Group 5-7 members HA HQ UR $4.84 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Triple P Group 8+ members HA HQ US $3.12 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Incredible Years Group 2-4 members TJ HQ UN $13.13 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Incredible Years Group 5-7 members TJ HQ UR $5.48 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Incredible Years Group 8+ members TJ HQ US $3.55 T1027 Behavioral Therapies for Children with Disruptive Behavior Disorders - Parent-Child Interaction Therapy (PCIT) HO $25.12 H2011 Crisis Resolution - Adult $61.82 H2011 Crisis Resolution Children HA $61.82 S9482 Crisis Residential In Home $18.65 S9482 Crisis Residential In Home - Children HA $18.65 Section 65 Behavioral Health Services Provider Procedure Code Code Description Rate effective 7/1/2022 Aroostook Mental Health Services, Inc. H0018 Crisis Residential - Adult $589.49 Community Health and Counseling Services H0018 Crisis Residential - Adult $487.54 Crisis and Counseling Centers Inc H0018 Crisis Residential - Adult $546.28 MaineHealth - Beach St H0018 Crisis Residential - Adult $411.21 Oxford County Mental Health Services H0018 Crisis Residential - Adult $411.21 Sweetser H0018 Crisis Residential - Adult $483.61 The Opportunity Alliance H0018 Crisis Residential - Adult $511.26 Aroostook Mental Health Services, Inc. H0018 Crisis Residential Children $492.10 Aroostook Mental Health Services, Inc. Calais H0018 Crisis Residential Children $492.10 Community Health and Counseling Services H0018 Crisis Residential Children $443.37 Crisis and Counseling Centers Inc H0018 Crisis Residential Children $581.16 Sweetser H0018 Crisis Residential Children $551.75 Counseling Services, Inc H0040 Childrens Assertive Community Treatment (ACT): $111.46 Harbor Schools of Maine, Inc. H0040 Childrens Assertive Community Treatment (ACT): $111.46 Spring Harbor Community Services H0040 Childrens Assertive Community Treatment (ACT): $111.46 Sweetser H0040 Childrens Assertive Community Treatment (ACT): $103.25 Aroostook Mental Health Services, Inc. H0018 Crisis Residential - Adult $589.49 Community Health and Counseling Services H0018 Crisis Residential - Adult $487.54 Section 91- Health Home Services - Community Care Teams Service Type Units Rate effective 7/1/2022 Community Care Teams Per Member Per Month $135.90 Section 92 - Behavioral Health Home Services Service Type Units Rate effective 7/1/2022 Behavioral Health Home Organizations (BHHOs) Per Member Per Month $413.88 97 - Private Non-Medical Institution Services, Appendix D: Principles of Reimbursement for Children's Residential Care Facilities Procedure Code Code Description Modifier Rate effective 7/1/2022 H0019 Therapeutic Foster Care HU $108.62 H0019 Therapeutic Foster Care-Multidimensional (Juvenile Justice) HY $157.88 Section 102 - Rehabilitative Services Procedure Code Code Description Modifier Rate effective 7/1/2022 96156 Health behavior assessment or reassessment includes health-focused clinical interviews, behavioral observations, and clinical decision making $21.66 96158 Health behavior intervention, individual, face-to-face; initial 30 minutes $44.03 96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes $22.02 96164 Health behavior intervention, group, face-to-face; initial 30 minutes $43.89 96165 Health behavior intervention, group; face-to-face; each additional 15 minutes $21.94 96167 Health behavior intervention, family, face-to-face; initial 30 minutes $42.12 96168 Health behavior intervention, family; face-to-face; each additional 15 minutes $21.06 97129 Therapeutic interventions that focus on cognitive function (e.g. attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g. managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes ST $27.31 97130 Add on code: each additional 15 minutes ST $27.31 97535 Self Care/Home Management Reintegration $15.10 97535 Self Care/Home Management Reintegration- group HQ $15.10 97537 Community/Work Reintegration $14.74 97537 Community/Work Reintegration- group HQ $14.74 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $5,275,014 in federal fiscal years 2022 which includes $3,378,793 in federal funds and $1,896,221 in state funds and will cost $20,906,870 in federal fiscal year 2023 which includes $13,248,256 in federal funds and $7,658,614 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: June 29, 2022 Posted: June 22, 2022

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

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 97, Chapter III, Private Non-Medical Institution Services NATURE OF PROPOSED CHANGES: The Department plans to amend the unit of service for Aftercare Services available through our Children's Residential Care Facilities from hourly to quarter hour reimbursement. The exact change is as follows: From: PROCEDURE CODE MODIFIER DESCRIPTION UNIT RATE 99510 HR Aftercare Services - Service Per hour $53.34 To: PROCEDURE CODE MODIFIER DESCRIPTION UNIT RATE 99510 HR Aftercare Services - Service Quarter Hour $13.34 REASON FOR PROPOSED CHANGES: This change is in response to public comment during our formal rulemaking process and allows providers greater flexibility in billing and reimbursement of Aftercare activities. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: This change will be cost neutral in Federal Fiscal Years 2022 and 2023. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: June 28, 2022 Posted: June 21, 2022

MaineCare Benefits Manual, Several Sections Included Within Chapter 101

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Several sections included within Chapter 101, MaineCare Benefits Manual NATURE OF PROPOSED CHANGES: Effective July 1, 2022, the Department is updating reimbursement for certain sections of the MaineCare Benefits Manual consistent with legislation that passed in the first regular session of 2021 and recommendations from the Department's comprehensive rate system evaluation completed by the independent firm Myers and Stauffer in 2021. A comprehensive list of these sections and providers can be found in the following table: MaineCare Benefits Manual Section/Title Section 14 Advanced Practice Registered Nursing Services(*except Certified Registered Nurse Anesthetists and laboratory services) Section 15 Chiropractic Services Section 30 Family Planning Services Section 68 Occupational Therapy Services(*except Occupational Therapy Assistants, and prosthetics and orthotics) Section 75 Vision Services(*except eyeglasses) Section 85 Physical Therapy Services(*except Physical Therapy Assistants and prosthetics and orthotics) Section 90 Physician Services (*except Enhanced Primary Care Providers, drugs administered by other than oral methods and laboratory services) Section 95 Podiatric Services(*except laboratory services) Section 101 Medical Imaging Services Section 109 Speech and Hearing Services(*except hearing aids) Under this updated methodology, the Department will reimburse the indicated services, where Medicare provides a reimbursement rate, at the lowest of the following: (1) seventy-two point four percent (72.4%) of the current years Medicare rate per code, including appropriate Medicare fee adjustments for place-of-service modifiers in effect at the time of service; or (2) the providers usual or customary charge. The MaineCare rates of reimbursement are posted and updated on the DHHS website at: https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx Additionally, the Department will also update reimbursement for select enhanced primary care services, found in Section 90 - Physicians Services, from 100% of 2014 Medicare rate to 100% of the current Maine Medicare area '99 rate. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2021, Ch. 398, 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"), and in alignment with the recommendations from the Departments comprehensive rate system evaluation completed by the independent firm Myers and Stauffer in 2021. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $13,511,515 in federal fiscal year 2022, which includes $8,647,370 in federal funds and $4,864,145 in state funds, and will cost $54,046,066 in federal fiscal year 2023, which includes 34,205,755 in federal funds and $19,840,311 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: June 28, 2022 Posted: June 21, 2022

MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to add a value-based supplemental sub-pool which distributes $600,000 to eligible hospitals (acute care non-critical access, critical access, and hospitals reclassified to a wage area outside of Maine) that participate in MaineCare programs. This sub-pool is designed to incent improved health outcomes and reduced cost of care for the MaineCare program. Allocations will not exceed the total supplemental pool amount and will not exceed allowable aggregate upper payment limits. Acute care and critical access hospitals participating in the MaineCare Accountable Communities (AC) Program are eligible for the value-based supplemental sub-pool. Participation is demonstrated by one of the following: The hospital's Emergency Department is in an AC contract as a location that contributes to member attribution to the AC; The hospital is an official contracted partner of the AC; or The hospital is part of the same ownership Employer Identification Number/Taxpayer Identification Number (EIN/TIN) as the AC. Funds will be distributed based on performance on one or more quality measures. The Department will notify hospitals at least one hundred twenty (120) days prior to any changes to the value-based supplemental sub-pool quality measure(s). Current quality measure(s) will be listed on: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing. The $600,000 will be allocated according to performance rank ($300,000 divided) and performance weighted by Hospital Service Area (HSA) size ($300,000 divided). Performance rank Portion of Payment= (HSA measure result) Member Count*Per Member Average* (Top 8 average measure result) Performance weighted by HSA size: Performance Rank Share of Sub-Pool per ranked HSA Top ranked HSA $75,000 2nd and 3rd ranked HSA $50,000 4th through 8th ranked HSA $25,000 If an awarded HSA contains more than one hospital from different ACs, the amount of funds will be distributed proportionate to the number of AC attributed lives within the HSA associated with each hospitals corresponding AC. If an awarded HSA contains more than one hospital from the same AC, the funds are distributed according to a secondary AC-specific measure. Measure example: The inverse of the hospitals share of the ACs memberships non-emergent ED visits that occurs within their HSA, according to the most recent annual AC report. Each awarded hospital will receive its relative share of this supplemental payment, distributed annually in May. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 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 ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $600,000 in Federal Fiscal Years 2022, which includes $421,200 in federal funds and $178,800 in state funds, and anticipates a cost of $600,000 in Federal Fiscal Year 2023, which includes $379,740 in federal funds and $220,260 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 26, 2022 Posted: March 16, 2022

MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home (OHH) Services and Section 89, MaineMOM Services (Perinatal OUD Care)

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home (OHH) Services and Section 89, MaineMOM Services (Perinatal OUD Care) NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) in the near future to establish coverage and reimbursement of MaineMOM Services under the current OHH SPA, add a pay-for-performance provision for services within OHH and MaineMOM Services, and incorporate a Cost-of-Living Adjustment (COLA) for OHH SPA services. The Department plans to alter reimbursement rates for individuals receiving Tier 3 OHH Services by creating MaineMOM Services. MaineMOM Services are provided through three service models, accounting for varying levels of involvement of the Perinatal Provider on the care team: 1) Integrated service model PMPM is $555.05; 2) Partnership service model PMPM payment is $456.23; 3) Perinatal Navigation service model PMPM payment is $625.63. The amendment also adds a pay-for-performance provision which withholds four percent of total OHH PMPM payments for all OHH Tiers. This amount shall be paid to providers every six months if they satisfy the minimum performance threshold, and providers that meet the excellent performance threshold are eligible to receive any additional available amount. The Department shall set the performance thresholds so that no less than 70% of eligible OHHs are expected to be above the minimum performance threshold and no less than 20% of OHHs are expected to be above the excellent performance threshold. This means that 30% of eligible OHHs are not expected to meet the minimum performance threshold and thus will not receive the four percent payment. Those four percent amounts will be combined and distributed to OHH providers that meet the excellent performance threshold. If all OHH providers satisfy the minimum performance threshold, then no amount would be distributed to OHH providers who satisfy the excellent performance threshold. Performance calculations shall be based on the composite score of three performance measures, as set forth in the rule. Providers shall receive reports quarterly to inform them about whether they satisfied the minimum or excellent performance threshold standards, what their reimbursement shall be, as well as instructions for appeal if they disagree with the Department's determinations. Lastly, this amendment adds language indicating services will receive an annual COLA equal to the percentage increase in the state minimum wage as set by the Maine Department of Labor. Services that received an increase to their rate within the previous 12-month period will not receive the annual COLA increase effective the following July 1. OHH will begin receiving this COLA effective July 1, 2022 and MaineMOM will begin receiving this COLA effective July 1, 2023.Annual updates will be posted on the Departments website. REASON FOR PROPOSED CHANGES: All changes are pursuant to departmental initiatives, including but not limited to, MaineCares 5-year cooperative agreement with the Centers for Medicare and Medicaid (CMS) called the Maternal Opioid Misuse (MOM) model. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $565,574 in Federal Fiscal Year 2022, which includes $419,743 in federal funds and $145,831 in state funds, and will cost $2,256,448 in Federal Fiscal Year 2023, which includes $1,612,008 in federal funds and $644,440 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 11, 2022 Posted: March 1, 2022

MaineCare Benefits Manual, Section 23, Chapters II and III, Developmental and Behavioral Evaluation Clinics.

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 23, Chapters II and III, Developmental and Behavioral Evaluation Clinics. NATURE OF PROPOSED CHANGES: The Department plans to add coverage of new services to be delivered through the Pediatric Rapid Evaluation Program (PREP) to assist in planning for the appropriate management, treatment, and placement, as necessary, of children who are entering into the care of the Department of Health and Human Services as a result of abuse and/or neglect. The Department is adding coverage of services delivered through the Pediatric Rapid Evaluation Program (PREP). PREP services include an initial, comprehensive Pediatric Rapid Evaluation, which is comprised of intake services and a medical evaluation and will result in provider submission of a Comprehensive Pediatric Rapid Evaluation Summary Report to the Department, as well as a psychosocial evaluation. PREP services also include follow-up evaluations at six (6) to eight (8) months after the initial evaluation. Billable services and corresponding reimbursement amounts are described in the table below. PROC. CODE DESCRIPTION UNIT RATE H2000 HT Pediatric Rapid Evaluation (Bundled Services) Per Evaluation $633.23 99354 TJ Comprehensive Psychosocial Evaluation - with member - first hour 1 hour $61.46 99355 TJ Comprehensive Psychosocial Evaluation - with member - additional 30 minutes 30 minutes $60.89 99358 TJ Comprehensive Psychosocial Evaluation - with birth parent - first hour 1 hour $76.26 99359 TJ Comprehensive Psychosocial Evaluation - with birth parent - additional 30 mins 30 minutes $36.67 H2000 HT TS Pediatric Rapid Evaluation - 6-8 Month Follow-Up (Bundled Services) Per Evaluation $345.30 99354 TJ TS Follow-Up Comprehensive Psychosocial Evaluation - with member 1 hour $61.46 REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2019, ch. 162, An Act to Ensure the Provision of Medical Assessments for Youth in Foster Care ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $295,158 in federal fiscal year 2022, which includes $207,201 in federal funds and $87,957 in state funds, and $1,180,634 in federal fiscal year 2023, which includes $820,422 in federal funds and $360,211 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 11, 2022 Posted: March 1, 2022

MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to add a value-based supplemental sub-pool which distributes $600,000 to eligible hospitals (acute care non-critical access, critical access, and hospitals reclassified to a wage area outside of Maine) that participate in MaineCare programs. This sub-pool is designed to incent improved health outcomes and reduced cost of care for the MaineCare program. Allocations will not exceed the total supplemental pool amount and will not exceed allowable aggregate upper payment limits. Acute care and critical access hospitals participating in the MaineCare Accountable Communities (AC) Program are eligible for the value-based supplemental sub-pool. Participation is demonstrated by one of the following: The hospital's Emergency Department is in an AC contract as a location that contributes to member attribution to the AC; The hospital is an official contracted partner of the AC; or The hospital is part of the same ownership Employer Identification Number/Taxpayer Identification Number (EIN/TIN) as the AC. Funds will be distributed based on performance on one or more quality measures. The Department will notify hospitals at least one hundred twenty (120) days prior to any changes to the value-based supplemental sub-pool quality measure(s). Current quality measure(s) will be listed on: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing. The $600,000 will be allocated according to performance rank ($300,000 divided) and performance weighted by Hospital Service Area (HSA) size ($300,000 divided). Performance rank Portion of Payment= (HSA measure result) Member Count*Per Member Average* (Top 8 average measure result) Performance weighted by HSA size: Performance Rank Share of Sub-Pool per ranked HSA Top ranked HSA $75,000 2nd and 3rd ranked HSA $50,000 4th through 8th ranked HSA $25,000 If an awarded HSA contains more than one hospital from different ACs, the amount of funds will be distributed proportionate to the number of AC attributed lives within the HSA associated with each hospitals corresponding AC. If an awarded HSA contains more than one hospital from the same AC, the funds are distributed according to a secondary AC-specific measure. Measure example: The inverse of the hospitals share of the ACs memberships non-emergent ED visits that occurs within their HSA, according to the most recent annual AC report. Each awarded hospital will receive its relative share of this supplemental payment, distributed annually in May. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 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 ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $600,000 in Federal Fiscal Years 2022, which includes $421,200 in federal funds and $178,800 in state funds, and anticipates a cost of $600,000 in Federal Fiscal Year 2023, which includes $379,740 in federal funds and $220,260 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 10, 2022 Posted: February 28, 2022

MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment NATURE OF PROPOSED CHANGES: The Department plans to submit a future state plan amendment to alter the reimbursement for certain MaineCare covered medical supplies within Chapter 101, MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment. Effective March 1, 2022, the reimbursement for ostomy supplies that Medicare also covers will be 88.2% of the current Maine Medicare rate. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 2021 ch. 467, An Act To Require MaineCare Coverage for Ostomy Equipment. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $150,635 in Federal Fiscal Year 2022, which includes $105,752 in federal funds and $44,883 in state funds, and $258,231 in Federal Fiscal Year 2023, which includes $171,609 in federal funds and $86,622 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 10, 2022 Posted: February 28, 2022

MaineCare Benefits Manual, Section 12, Chapter III, Consumer Directed Attendant Services and Section 96, Chapter III, Private Duty Nursing and Personal Care Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 12, Chapter III, Consumer Directed Attendant Services and Section 96, Chapter III, Private Duty Nursing and Personal Care Services NATURE OF PROPOSED CHANGES: The Department plans to submit a future state plan amendment to adjust reimbursement for certain direct care services. These changes impact certain Consumer Directed Attendant Services as well as Private Duty Nursing and Personal Care Services. These changes represent increases as a result of cost-of-living adjustments (COLA) and/or to ensure that the labor components of rates reflect wages that equal at least 125% of minimum wage in Maine. As a result of these reimbursement changes, the Department will also increase the Private Duty Nursing level of care caps by an amount proportional to the reimbursement changes. The cap increases are to ensure that members maintain appropriate access to covered services. Reimbursement changes effective January 1, 2022 are described in the tables below. Additionally, these services will also receive an annual January 1 COLA adjustment going forward to ensure wages and other rate components keep pace with inflation. Exceptions are made for services that received an increase to their rate within the previous 12-month period: those services will not receive the January 1 COLA increase for non-wage-related components for that year. Consumer Directed Attendant Services Service Procedure Code Modifier Rate 1/1/22 Attendant Care Services S5125 U2 $ 6.13 Attendant Care Services - 2 person S5125 U2, UN $ 3.37 Attendant Care Services - 3 person S5125 U2, UP $ 2.45 Skills Training H2014 $ 14.72 Care Coordination, Initial G9001 $ 17.84 Care Coordination, Ongoing G9002 $ 17.84 Private Duty Nursing and Personal Care Services Service Revenue Code Procedure Code Modifier Rate 1/1/22 Personal Support Services (FPSO) S5125 $ 6.13 Personal Support Services (FPSO) - 2 person S5125 UN $ 3.37 Personal Support Services (FPSO) - 3 person S5125 UP $ 2.45 Home Health Aide/ CNA Services 0571 T1004 $ 7.53 Home Health Aide/ CNA Services - 2 person 0571 T1004 UN $ 4.14 Home Health Aide/ CNA Services - 3 person 0571 T1004 UP $ 3.01 Personal Support Services (PSS) 0589 T1019 $ 7.53 Personal Support Services (PSS) - (for PCA Agencies only) T1019 $ 7.53 Personal Support Services (PSS) (for PCA Agencies only) - 2 person T1019 UN $ 4.14 Personal Support Services (PSS) (for PCA Agencies only) - 3 person T1019 UP $ 3.01 RN 1:1 0551 G0299 TD $ 14.42 RN 2:1 0551 G0299 TD, UN $ 7.93 RN 3:1 0551 G0299 TD, UP $ 5.77 LPN 1:1 0559 G0300 TE $ 10.23 LPN 2:1 0559 G0300 TE, UN $ 5.64 LPN 3:1 0559 G0300 TE, UP $ 4.09 Care Coordination G9001 $ 17.84 Care Coordination Maint. G9002 $ 17.84 Skills Training H2014 $ 14.72 Chore Services S5120 $ 6.13 Independent RN 1:1 T1000 TD $ 14.42 Independent RN 2:1 T1000 TD, UN $ 7.93 Independent RN 3:1 T1000 TD, UP $ 5.77 Med Administration T1502 $ 7.79 PCA Supervisit 0589 S5125 TF $ 30.26 PCA Supervisit multiple patients (2) 0589 S5125 TF, UN $ 16.64 PCA Supervisit multiple patients (3) 0589 S5125 TF, UP $ 12.10 PCA Supervisit (for PCA Agencies only) S5125 TF $ 30.26 PCA Supervisit (for PCA Agencies only) multiple patients (2) S5125 TF, UN $ 16.64 PCA Supervisit (for PCA Agencies only) multiple patients (3) S5125 TF, UP $ 12.10 REASON FOR PROPOSED CHANGES: These adjustments are necessary to fulfill the written directive and intent of Maine 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. Additional appropriations to fund the full amount of these increases are subject to approval by the Maine Legislature. If changes occur beyond what is detailed above the Department will release an updated notice. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will cost $4,744,800 in federal fiscal year 2022 which includes $2,972,522 in federal funds and $1,772,278 in state funds. The Department anticipates this chance will cost $8,526,643 in federal fiscal year 2023 which includes $5,283,533 in federal funds and $3,243,110 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 6, 2022 Posted: February 24, 2022

MaineCare Benefits Manual, Section 5, Chapter III, Ambulance Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 5, Chapter III, Ambulance Services NATURE OF PROPOSED CHANGES: The Department plans to submit a future amendment to adjust reimbursement for certain Section 5, Chapter III, Ambulance Services that are also services covered by Medicare. Effective April 1, 2022 the Department will begin reimbursing these services at 100% of the Maine Medicare area '99' urban, rural, or super rural rate. Services will be reimbursed in accordance with the applicable locality (urban, rural, or super rural as defined by Medicare) based on the pick-up location of the member. Providers should bill the following modifiers on claims to indicate the applicable locality: No modifier - Urban locations TN Rural locations UD Super Rural locations REASON FOR PROPOSED CHANGES: All changes are pursuant to 2021 Resolve, CH 118, To Provide Add-on Payments for Ambulance Services Reimbursed by the MaineCare Program and To Increase Reimbursement Rates for Physical Therapy under the MaineCare Program ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost a total of $891,604 in federal fiscal year 2022, which includes $647,809 in federal funds and $243,795 in state funds. Additionally, the Department anticipates this will result in a total cost of $1,783,119 in federal fiscal year 2023, which includes $1,245,190 in federal funds and $537,929 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 6, 2022 Posted: February 24, 2022

MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to submit a future state plan amendment to add various Mental Health Intensive Outpatient Program (IOP) Services. These services are being implemented to ensure necessary supports and reduce barriers for Maine Medicaid members. Please see the following chart for a list of new services and the applicable reimbursement per service. Procedure Code Modifier Description Unit Rate H0015 HE Mental Health Intensive Outpatient Program (IOP) Per Diem $231.11 H0015 HI Developmental Disabilities /Behavioral Health (DD/BH-IOP) Per Diem $316.53 H0015 HC Geriatric (G-IOP) Per Diem $231.11 H0015 HK Dialectical Behavior Therapy (DBT-IOP) Per Diem $188.84 H0015 HT Eating Disorder (ED-IOP) - Level I Per Diem $247.81 H0015 HT AT Eating Disorder (ED-IOP) - Level II Per Diem $407.60 REASON FOR PROPOSED CHANGES: All changes are pursuant to 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") and an independent rate study. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $5,168,882 in Federal Fiscal Year 2022, which includes $4,186,810 in federal funds and $982,072 in state funds, and $19,641,750 in Federal Fiscal Year 2023, which includes $15,615,774 in federal funds and $4,025,975 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 6, 2022 Posted: February 24, 2022

MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department is issuing this notice to correct certain information provided in a previous notice posted December 27, 2021. In the December 27, 2021 notice, the Department communicated plans to submit a state plan amendment in the near future related to the reimbursement of intensive outpatient therapy (IOP) services specific to substance use disorders (SUD), effective January 1, 2022: please note that this information is not changing. In addition, however, the December 27, 2021 notice also indicated that, effective April 1, 2022, providers should bill these services by appending an HF modifier. The Department is now electing to update this previous guidance to indicate that it will no longer require this billing change for SUD IOP services; providers can continue to bill procedure code H0015 specific to substance use disorder intensive outpatient therapy services without a modifier beyond April 1, 2022. Procedure Code Modifier Description Unit Date Rate H0015 Substance Use IOP Per Diem 01/01/2022 $192.83 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 6, 2022 Posted: February 24, 2022

MaineCare Benefits Manual, Section 3, Chapter VI, Primary Care Plus

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 3, Chapter VI, Primary Care Plus NATURE OF PROPOSED CHANGES: The Department plans to submit a future amendment to implement Primary Care Plus (PCPlus), a value-based payment model designed to give primary care providers greater flexibility and incentives to meet member needs, and in order to simplify and integrate Maine's three existing primary care programs into a single program. The key components of this model include: Population-Based Payment Population-Based Payments (PBPs) are monthly payments that the Department shall calculate quarterly for each participating PCP. The Department calculates the PBP by adding a Tier PMPM Rate and a Population Group and Risk Category PMPM Rate and multiplying the sum by the PCPs total number of Attributed Members. Both PMPM rates are determined annually. A. Tier PMPM Rate This PMPM rate is determined by the providers Tier, and the Department adjusts this PMPM rate by the Performance-Based Adjustment (PBA). The Tier PMPM rates are as follows: Tier One: $2.10 Tier Two: $6.30 Tier Three: $6.90 B. Population Group and Risk Category PMPM Rate Annually, the Department will assign Members to a population group based on their eligibility category in the most recent month of the Assessment Period and a risk category based on the most recent Risk Score. The population groups are children, adults, aged/blind/disabled, and dual-eligible. The risk categories are "generally well" and complex. Each combination of population group and risk category has a PMPM rate (see Figure 1). The Department calculates the overall PMPM rate by multiplying the number of Members the PCP has in each combination of population group and risk category by the assigned PMPM rate. The Department then adds the totals from each combination and divides by the PCPs number of Members. Figure 1. Population group and risk category PMPM rates Population Group Risk Category Generally Well PMPM Complex PMPM Children $1.65 $4.95 Adults $1.15 $3.00 Aged, Blind, Disabled $2.25 $6.60 Duals $2.50 $8.75 Performance-Based Adjustment The PBA is based on a PCPs performance on no more than ten (10) quality measures. Current quality measures will be listed on: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing. The PBA may range from negative ten percent (-10%) to a positive twenty five percent (25%) and is applied quarterly to the Tier PMPM rate. For the first year of the PCPlus program, the Department will apply a PBA of 25% to Tier One PCPs, 8.3% to Tier Two PCPs, and 7.6% to Tier Three PCPs. Performance data will be shared for informational purposes only during this time. Beginning one (1) year after the effective date of the PCPlus program, the Department will calculate and apply the PBA, as described herein. A. Calculation of PBA. The PBA equals the sum of the quality measures Improvement and Achievement Adjustments (see subparts 3 and 4), which are based on a PCPs Percentile Score (see subpart 1) for each quality measure and each quality measures domain (see subpart 2). 1. Percentile Score. To calculate the Percentile Score, the Department first calculates the PCPs performance on each quality measure. Calculating performance varies for each measure. For example, performance on the Lead Testing in Children quality measure equals the percentage of Members two (2) years of age who had at least one capillary or venous lead blood test for lead poisoning by their second birthday. The Department then compares the PCPs performance on each quality measure with the performance of the PCPs in its MaineCare Peer Group to determine its Percentile Score for each quality measure. A PCPs Percentile Score represents the percentage of PCPs that performed below the PCPs performance level, e.g. a PCP with a Percentile Score of 65% performed better than 65% of the PCPs in its MaineCare Peer Group. 2. Domain. Each quality measure falls under either the Utilization or Comprehensive Care domain. For example, Acute Hospital Utilization falls under the Utilization domain, and Developmental Screening in the First Three Years of Life and Total Cost of Care fall under the Comprehensive Care domain. Each domain has a unique set of Improvement and Achievement Adjustment percentages that apply to the quality measures that fall under each domain (see Figure 2). The total minimum and maximum adjustment amounts from the quality measure(s) under the Utilization and Comprehensive Care domains are 30% and 70%, respectively, of the minimum and maximum PBA. 3. Improvement Adjustment. The Department will determine Improvement Adjustments by comparing the PCPs Percentile Score for each quality measure in the most recent Assessment Period to the PCPs Percentile Score in the calendar year that falls two (2) years prior to the end date of the current Assessment Period, e.g. an Assessment Period ending July 2023 would be compared to calendar year 2021. A PCPs Percentile Score must improve by at least three percent (3%), regardless of whether the PCPs MaineCare Peer Group is different than its MaineCare Peer Group in the comparison year, to be eligible for the Improvement Adjustment, e.g. a PCP with a Percentile Score of 65% in the comparison year would have to achieve a Percentile Score of at least 68% in the Assessment Period to obtain the Improvement Adjustment for a quality measure (see Figure 2). 4. Achievement Adjustment. The Department will determine Achievement Adjustments for each quality measure based on Percentile Score (see Figure 2). a. Through 2023, the Department will calculate Percentile Scores for the Achievement Adjustments by comparing the PCPs performance to its MaineCare Peer Groups performance from the most recent Assessment Period. b. Beginning in 2024, the Department will calculate Percentile Scores for the Achievement Adjustments by comparing the PCPs performance from the most recent Assessment Period to the performance of its MaineCare Peer Group in the calendar year that falls two (2) years prior to the end date of the current Assessment Period. 5. Methodology Illustration. To illustrate the methodology, Figure 2 shows that a PCP with a Percentile Score between 60% and 69% for the Acute Hospital Utilization quality measure would receive an Achievement Adjustment of 1.5%. If the PCPs Percentile Score improved by at least 3% from the comparison year, it would also earn the 1.3% Improvement Adjustment. Figure 2. Achievement and Improvement Adjustments* under the Utilization and Comprehensive Care domains, adapted from the Centers for Medicare and Medicaid Innovation, Primary Care First methodology. Percentile Scores Relative to Peer Group Utilization Comprehensive Care Achievement adjustment (%) Improvement adjustment (if earned) (%) Achievement adjustment (%) Improvement adjustment (if earned) (%) <25 -3.0 2.5 -0.9 0.8 25-49 0 0.5 0 0.2 50-59 .8 0.7 0.3 0.1 60-69 1.5 1.3 0.4 0.4 70-79 3.5 1.0 1.0 0.3 80-89 5.0 0.9 1.5 0.2 >90 7.0 0.5 2.1 0.1 If the PCP earned a Percentile Score between 50% and 59% for the Total Cost of Care quality measure, it would receive a 0.3% Achievement Adjustment. If the PCPs Percentile Score did not improve by at least 3% from the comparison year, it would not earn the 0.1% Improvement Adjustment. This assessment is done for each quality measure, and the PBA equals the sum of the Achievement and Improvement Adjustments. *The adjustment percentages in Figure 2 are based on using nine (9) quality measures, one (1) under the Utilization domain and eight (8) under the Comprehensive Care domain. If more or fewer quality measures are used, the Department will change the adjustment percentages proportionally so the PBA range remains between negative ten (-10) and 25% and so the total minimum and maximum adjustment amounts from the quality measure(s) under the Utilization and Comprehensive Care domains remains 30% and 70%, respectively, of the minimum and maximum PBA. B. The Department shall use a rolling twelve- (12) )-month Assessment Period to collect claims data for the PBA and apply the PBA six (6) months after the Assessment Period ends to allow for three (3) months of claims run out and three (3) months to calculate the PBA. C. A quality measure will only be used to assess performance if there is a sufficient quality measure-eligible population size to allow for appropriate assessment. The sufficient quality measure-eligible population size for each quality measure will be listed on: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing. If a quality measure cannot be included in the performance assessment because of an insufficient quality measure-eligible population size, the respective portion of the PBA for that quality measure will be redistributed equally among all other qualifying quality measures within the same domain. D. PCPs must have a sufficient quality measure-eligible population size on at least one (1) quality measure in the Utilization domain and at least three (3) quality measures in the Comprehensive Care domain to be eligible for each quality measures adjustments within their domain. If a PCP does not meet the minimum quality measure requirement for a domain, they shall receive a neutral PBA (zero percent (0%)) for that domain. E. The Department will notify PCPs at least one hundred twenty (120) days prior to any changes to the quality measures. The Department will provide PCPs quarterly reports on performance on quality measures, beginning no later than the second quarter of PCPlus program implementation. REASON FOR PROPOSED CHANGES: All changes are pursuant to departmental initiatives. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral in Federal Fiscal Years 2022 and 2023. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME Office of MaineCare Services ADDRESS 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 27, 2022 Posted: January 20, 2022

MaineCare Benefits Manual, Section 12, Chapter III, Consumer Directed Attendant Services and Section 96, Chapter III, Private Duty Nursing and Personal Care Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 12, Chapter III, Consumer Directed Attendant Services and Section 96, Chapter III, Private Duty Nursing and Personal Care Services NATURE OF PROPOSED CHANGES: The Department plans to submit a future state plan amendment to adjust reimbursement for certain direct care services. These changes impact certain Consumer Directed Attendant Services as well as Private Duty Nursing and Personal Care Services. These changes represent increases as a result of cost-of-living adjustments (COLA) and/or to ensure that the labor components of rates reflect wages that equal at least 125% of minimum wage in Maine. As a result of these reimbursement changes, the Department will also increase the Private Duty Nursing level of care caps by an amount proportional to the reimbursement changes. The cap increases are to ensure that members maintain appropriate access to covered services. Reimbursement changes effective January 1, 2022 are described in the tables below. Additionally, these services will also receive an annual January 1 COLA adjustment going forward to ensure wages and other rate components keep pace with inflation. Consumer Directed Attendant Services Service Procedure Code Modifier Rate 1/1/22 Attendant Care Services S5125 U2 $ 6.13 Attendant Care Services - 2 person S5125 U2, UN $ 3.37 Attendant Care Services - 3 person S5125 U2, UP $ 2.45 Skills Training H2014 $ 14.72 Care Coordination, Initial G9001 $ 17.84 Care Coordination, Ongoing G9002 $ 17.84 Private Duty Nursing and Personal Care Services Service Revenue Code Procedure Code Modifier Rate 1/1/22 Personal Support Services (FPSO) S5125 $ 6.13 Personal Support Services (FPSO) - 2 person S5125 UN $ 3.37 Personal Support Services (FPSO) - 3 person S5125 UP $ 2.45 Home Health Aide/ CNA Services 0571 T1004 $ 7.53 Home Health Aide/ CNA Services - 2 person 0571 T1004 UN $ 4.14 Home Health Aide/ CNA Services - 3 person 0571 T1004 UP $ 3.01 Personal Support Services (PSS) - (for PCA Agencies only) T1019 $ 7.53 Personal Support Services (PSS) (for PCA Agencies only) - 2 person T1019 UN $ 4.14 Personal Support Services (PSS) (for PCA Agencies only) - 3 person T1019 UP $ 3.01 RN 1:1 0551 G0299 TD $ 14.42 RN 2:1 0551 G0299 TD, UN $ 7.93 RN 3:1 0551 G0299 TD, UP $ 5.77 LPN 1:1 0559 G0300 TE $ 10.23 LPN 2:1 0559 G0300 TE, UN $ 5.64 LPN 3:1 0559 G0300 TE, UP $ 4.09 Care Coordination G9001 $ 17.84 Care Coordination Maint. G9002 $ 17.84 Skills Training H2014 $ 14.72 Chore Services S5120 $ 2.41 Independent RN 1:1 T1000 TD $ 14.42 Independent RN 2:1 T1000 TD, UN $ 7.93 Independent RN 3:1 T1000 TD, UP $ 5.77 Med Administration T1502 $ 7.79 PCA Supervisit 0589 S5125 TF $ 30.26 PCA Supervisit multiple patients (2) 0589 S5125 TF, UN $ 16.64 PCA Supervisit multiple patients (3) 0589 S5125 TF, UP $ 12.10 PCA Supervisit (for PCA Agencies only) S5125 TF $ 30.26 PCA Supervisit (for PCA Agencies only) multiple patients (2) S5125 TF, UN $ 16.64 PCA Supervisit (for PCA Agencies only) multiple patients (3) S5125 TF, UP $ 12.10 REASON FOR PROPOSED CHANGES: These adjustments are necessary to fulfill the written directive and intent of Maine 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. Additional appropriations to fund the full amount of these increases are subject to approval by the Maine Legislature. If changes occur beyond what is detailed above the Department will release an updated notice. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will cost $4,744,800 in federal fiscal year 2022 which includes $2,972,522 in federal funds and $1,772,278 in state funds. The Department anticipates this chance will cost $8,526,643 in federal fiscal year 2023 which includes $5,283,533 in federal funds and $3,243,110 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 10, 2022 Posted: December 30, 2021

MaineCare Accountable Communities Program

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: MaineCare Accountable Communities Program NATURE OF PROPOSED CHANGES: The Department plans to adjust the Accountable Communities (AC) Total Cost of Care (TCOC) reconciliation for Performance Year 6 (PY6) which covers August 2019 through July 2020. The adjustment will include shortening the PY to a seven-month period, covering August 2019 through February 2020, and multiplying by the total number of member months for the full twelve-month period to equal the total annual shared savings payment. Corresponding changes to trend factors, claims caps, and policy adjustments will also be applied. REASON FOR PROPOSED CHANGES: These changes are being made per recommendation of the Department's actuarial vendor for AC services to ensure the integrity of the shared savings results from the AC program by minimizing the impact resulting from the COVID-19 pandemic. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 7, 2022 Posted: December 27, 2021

MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment in the near future to reimburse intensive outpatient therapy (IOP) services specific to substance use disorders as follows: Procedure Code Modifier Description Unit Date Rate H0015 Substance Use IOP Per Diem 01/01/2022 $192.83 H0015 HF Substance Use IOP Per Diem 04/01/2022 $192.83 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $1,835,152 in federal fiscal year 2022 which includes $1,464,121 in federal funds and $371,031 in state funds. The Department anticipates this changed will cost $2,446,869 in federal fiscal year 2023 which includes $1,945,334 in federal funds and $501,536 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 7, 2022 Posted: December 27, 2021

Routine Services Provided In Conjunction With Qualifying Clinical Trials

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Routine services provided in conjunction with qualifying clinical trials NATURE OF PROPOSED CHANGES: The Department plans to submit a future state plan amendment to address requirements related to routine services performed in conjunction with qualifying clinical trials. As suggested by the Centers for Medicare and Medicaid Services (CMS) the state is submitting a notice prior to January 1, 2022 indicating that we intend to submit any necessary changes resulting from the Consolidated Appropriations Act (CAA) clinic trial requirements to CMS for review and approval. The Department does not anticipate any changes to payment methods and standards for services identified as routine because these services are already covered. To the extent that the expected changes are modified as a result of the SPA submission and resulting negotiations with CMS or additional guidance from CMS, the Department may update the notice accordingly. REASON FOR PROPOSED CHANGES: All changes are pursuant to Division CC, Title II, Section 210 of the Consolidated Appropriations Act, 2021 (Public Law 116-260) (section 210) amended section 1905(a) of the Social Security Act (the Act). ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral in Federal Fiscal Years 2022 and 2023. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 7, 2022 Posted: December 27, 2021

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

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 97, Chapter III, Private Non-Medical Institution Services NATURE OF PROPOSED CHANGES: Effective November 1, 2021, the Department plans to increase reimbursement rates for certain Private Non-Medical Institution services as detailed below. SUBSTANCE USE TREATMENT FACILITIES PROCEDURE CODE MODIFIER DESCRIPTION UNIT EFFECTIVE H0010 Medically Supervised Withdrawal Services (Non-Hospital based) Per diem $385.55 H0010 TD Medically Supervised Withdrawal Services (Non-Hospital based - exception rate for low RN Per diem $238.12 H2034 Halfway House Services Per diem $165.67 H2036 Extended Care Per diem $137.21 H2036 HF Residential Rehabilitation Type 1 Per diem $287.91 H2034 HF Residential Rehabilitation Type II Per diem $165.67 H2036 HA Adolescent Residential Rehabilitation Per diem $254.78 T1020 HF Personal Care - Substance Use (Substance Use Shelter Services) Per diem $56.87 CHILDREN'S RESIDENTIAL TREATMENT FACILITIES PROCEDURE CODE MODIFIER DESCRIPTION UNIT EFFECTIVE H0019 HE Mental Health Residential Treatment Facility Per diem $580.09 H0019 HI Intellectual Disabilities/Developmental Disabilities Residential Treatment Facility Per diem $727.98 H0019 HA Crisis Stabilization Residential Services Per diem $539.89 99510 HR Aftercare Services - Service Per diem $53.34 A0425 HI Aftercare Services - Mileage Per mile $2.13 H0019 HU Therapeutic Foster Care Per diem $103.51 H0019 HY Therapeutic Foster Care -Multidimensional (Juvenile Justice) Per diem $150.45 S9484 HA Temporary High Intensity Service for Children in ITRT Setting. This service is only available for Mental Health Level I and II and Intellectual Disabilities Level I and II Per hour By Report REASON FOR PROPOSED CHANGES: All changes are pursuant to The Family First Prevention Services Act, Public Law 115-123 (as part of Division E in the Bipartisan Budget Act of 2018 (H.R. 1892) (eff. Feb. 9, 2018) (as Amended through P.L. 116260, enacted December 27, 2020), 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, and pursuant to a recently completed rate study. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost the department $19,301,282 in federal fiscal year 2022 which includes $7,605,198 in state funds and $11,696,085 in federal funds and will cost $21,055,944 in federal fiscal year 2023 which includes $8,386,050 in state funds and $12,669,895 in federal funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: November 4, 2021 Posted: October 28, 2021

MaineCare Benefits Manual, Section 68, Chapter III, Occupational Therapy Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 68, Chapter III, Occupational Therapy Services NATURE OF PROPOSED CHANGES: The Department plans to establish reimbursement for 96125 [Standard cognitive performance testing (eg., Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face with the patient and time interpreting test results and preparing the report] effective November 1, 2021. The reimbursement rate for an occupational therapist (OT) is $40.37 and the rate for an OT assistant is $36.33. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $1,477 in Federal Fiscal Year 2022, which includes $1,037 in federal funds and $440 in state funds and will cost $1,611 in Federal Fiscal Year 2023, which includes $1,020 in federal funds and $591 in state funds ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: November 4, 2021 Posted: October 28, 2021

MaineCare Benefits Manual, Section 4, Chapter II, Ambulatory Surgical Center Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 4, Chapter II, Ambulatory Surgical Center Services NATURE OF PROPOSED CHANGES: The Department plans to add reimbursement of $1,250 per 41899 [Unlisted procedure, dentoalveolar structures] procedure for freestanding ambulatory surgical centers effective November 1, 2021. REASON FOR PROPOSED CHANGES: All changes are pursuant to Ch. 112, Resolve, To Ensure That Access to Oral and Facial Ambulatory Surgical Centers in Maine Remains Viable. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $509,896 in Federal Fiscal Year (FFY) 2022 which includes $352,153 in federal funds and $157,743 in state funds and will cost $556,250 in FFY 2023 which includes $384,166 in federal funds and $172,084 in state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: November 4, 2021 Posted: October 28, 2021

MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services

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Concise Summary: Notice of MaineCare Reimbursement Methodology Change AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to amend hospital supplemental payments for critical access hospitals and inpatient acute care hospitals as well as amend the inpatient psychiatric discharge rate for patients discharged from Southern Maine Health Care's psychiatric inpatient unit. This amendment will increase the inpatient acute supplemental payment by $9,787,503 and the critical access hospital supplemental payment by $1,308,488. This amendment will also provide reimbursement for patients discharged from Southern Maine Health Care's psychiatric inpatient unit in the amount of $10,166 per distinct discharge. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine 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 and Resolve 2021, ch 119, Resolve, Regarding Reimbursement for Providing Inpatient Care to Individuals with Acute Mental Health Care Needs ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will cost $12,445,267 in Federal Fiscal Years 2022 and in 2023. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: September 17, 2021 Posted: September 10, 2021

MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment

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Concise Summary: Notice of MaineCare Reimbursement Methodology Change AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment NATURE OF PROPOSED CHANGES: The Department plans to adjust the reimbursement methodology from 100% of the current Medicare rural rates for Medicare-covered Durable Medical Equipment (DME) impacted by the 21st Century Cures Act and from 85% of 2011 Medicare rates for Medicare-covered DME not impacted by the 21st Century Cures Act and for Medicare-covered prosthetics, orthotics, and supplies to 88.2% of the current Medicare urban and rural rates. REASON FOR PROPOSED CHANGES: The purpose of these changes is to comply with the CMS' Upper Payment Limit (UPL) requirement for DME as well as to a establish a clear, consistent and regularly updated Medicare benchmark for reimbursement of DME and supplies. All changes are pursuant to P.L. 2021, Ch. 398, 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in a total cost savings of $422,275 in Federal Fiscal Year 2022, of which $295,350 is federal funds and $126,925 is state funds. The Department anticipates that this change will result in a total cost savings of $422,275 in Federal Fiscal Year 2023, of which $288,984 is federal funds and $133,291 is state funds. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: Friday, September 17 Posted: September 10, 2021

MaineCare Benefits Manual, Section 109, Chapter III, Speech and Hearing Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 109, Chapter III, Speech and Hearing Services NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment in the near future to add coverage of the following services: Procedure Code Description Agency Rate Independent Rate 92517 Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP) $55.78 $50.20 92518 Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) $52.10 $46.89 92519 Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP) $86.54 $77.89 REASON FOR PROPOSED CHANGES: All changes are pursuant to national code additions. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $538.81 in federal expenditures in federal fiscal year 2021 and $1,173.31 in federal expenditures in federal fiscal year 2022. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 3, 2021 Posted: February 24, 2021

MaineCare Benefits Manual, Section 1, Chapter I, General Administrative Policies and Procedures

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 1, Chapter I, General Administrative Policies and Procedures NATURE OF PROPOSED CHANGES: Clarifying reimbursement for the state's 340B providers for drugs purchased through the federal 340B program. REASON FOR PROPOSED CHANGES: The Department plans to submit a State Plan Amendment in the near future to clarify in the state plan that MaineCare does not allow 340B covered entity-owned or contracted retail pharmacies to carve-in Medicaid. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates no changes in expenditures in Federal Fiscal Years 2021 and 2022. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 7, 2021 Posted: December 31, 2020

MaineCare Benefits Manual, Chapter III, Section 67, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapter III, Nursing Facility Services. The SPA makes clerical changes to replace outdated dates and other calculations with language that (1) aligns dates and other calculations in the State Plan with rebasing instructions within the State Plan, and (2) the State Plan will no longer need to be amended every two years solely to update dates when the state rebases under approved authority. Specifically, the amendment will: 1. Add a definition of "rebasing year" and replace all instances of December 31, 2017 with six months before the start of a rebasing year. 2. Replace references to 2016 in the case mix index section with base year. 3. Delete the numeric results of the Direct Care Regional Indices calculation from the prior rebasing, and allow the methodology language to stand on its own. Also adds language to clarify that the New Direct Care Regional Indices are calculated whenever a rebasing occurs. REASON FOR PROPOSED CHANGES: To ensure that when the Office of MaineCare Services conducts rebasing the State Plan will no longer need to be amended every two years solely to update dates when the state rebases under the approved authority. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates no changes in expenditures in Federal Fiscal Years 2021 and 2022. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 6, 2021 Posted: December 30, 2020

Child Health Insurance Program (CHIP) State Plan Amendment

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Child Health Insurance Program (CHIP) State Plan Amendment NATURE OF PROPOSED CHANGES: The Department plans to submit a CHIP State Plan Amendment to seek CMS approval for funding for Health Service Initiatives (HSI) allowable under CHIP with the goal of improving child health outcomes. These initiatives are as follows: Safe Sleep Initiative: The Department is planning to propose an HSI which will help to fund a Safe Sleep Initiative in Maine on an ongoing basis with a specific focus on providing education and cribs for low income families with newborns. This would be done in partnership with the Maine Center for Disease Control and Prevention (CDC). Funds will support the expansion of an existing effort working with birth hospitals on safe sleep for newborns. In order to increase access to a safe sleep environment, families with newborns who are deemed eligible will receive a safe sleep kit that includes a cribette. The HSI funding would be used to cover the costs of the kits, develop a central tracking system, support safe sleep education, and staff a safe sleep coordinator to run the program. Lead Testing: The HSI will focus on increasing lead testing rates by conducting a quality improvement project between MaineCare and the Maine CDC's Childhood Lead Poisoning Prevention Unit. MaineCare will identify primary care practices with both low testing rates and large numbers of children enrolled in MaineCare. HSI funds will allow for the purchase of ten point-of-care testing machines for lead. The Childhood Lead Poisoning Prevention Unit will provide quality improvement (QI) support to the practices, including QI education, review of practice data, and assistance with workflow. Lead Abatement: The Department plans to propose the use of HSI funds to expand the reach of the current mix of state and federal funding for lead abatement activities in Maine, to improve the well-being of families with children, and to maintain access to affordable housing that is lead safe. Maine is somewhat uncommon compared to other states in that State law requires that the Department inspect every other housing unit in a multi-unit dwelling when a lead poisoned child is found in any individual unit. If lead hazards are identified, they must be abated using State licensed abatement contractors who use methods established by state and federal regulations to permanently remove lead hazards. In 2015, Maine law lowered Maine CDCs blood lead reference level in the regulatory definition of lead poisoning that triggers inspection requirements. This change resulted in a nearly seven-fold increase in inspection activity. Given this increase, the need for additional funds to support lead abatement costs to preserve lead-safe affordable housing for low income families with children is paramount. The proposal will include funding for lead abatement in approximately 50 housing units. Developmental Screening: The Legislative Report, "Resolve, To Improve Access to Early and Periodic Screening, Diagnostic, and Treatment Services for Children," in response to Resolves 2019, Ch. 66 (LD 1635), identified increasing Maines rate of developmental screening as a major focus in upcoming years, with a goal that 80% of Maines youth receive a screen. One current challenge in assessment and data collection is that most developmental screening programs are paper-based. With COVID-19, there has been a reduction in office well-child visits and fewer screenings completed. A virtual solution is needed to augment the current screening strategy. In order to improve developmental and socio-emotional screening rates, the Department is proposing to use HSI funds to purchase and set up the Ages and Stages Questionnaire (ASQ) Online screening system for both developmental screening and social-emotional screening (ASQ-SE). The ASQ online system allows families and providers to do screening online and have results sent to both primary care providers and families for review. The online system will allow providers, MaineCare, Maine Women and Infants and Children Nutrition Program, Early Head Start, Head Start, Public Health Nursing, Home Visiting, Child Care providers, Child Development Services, and medical providers to see results and help manage referrals. HSI funding will be used to purchase the program, set up the connections between the ASQ Enterprise program and the state immunization registry, and pay for IT support. REASON FOR PROPOSED CHANGES: These changes will improve the health and wellness of Maines low-income youth and families. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $1,130,000 for FFY 21, accounting for $898,110 in federal funding and $231,890 in State funding, at the current CHIP match rate of 78.92%. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 10, 2020 Posted: September 30, 2020

Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to add coverage and reimbursement for three evidence-based parenting programs for children with disruptive behavior disorders: Positive Parenting Program (Triple P), the Incredible Years (IY), and Parent-Child Interaction Therapy (PCIT). The following are the proposed Behavioral Therapies for Disruptive Behavior Disorders: Procedure Code Modifier Modifier Unit Service Description Maximum Allowance per unit T1027 HA hour Triple P 1:1 $21.42 T1027 HA HQ UN hour Triple P - Group 2-4 members $10.99 T1027 HA HQ UR hour Triple P Group 5-7 members $4.61 T1027 HA HQ US hour Triple P Group 8-10 members $2.97 T1027 TJ HQ UN hour Incredible Years Group 2-4 members $12.51 T1027 TJ HQ UR hour Incredible Years Group 5-7 members $5.22 T1027 TJ HQ US hour Incredible Years Group 8-10 members $3.38 T1027 HO hour Parent-Child Interaction Therapy (PCIT) 1:1 $23.94 REASON FOR PROPOSED CHANGES: To provide coverage and reimbursement of medically necessary, evidence-based parenting programs for children with disruptive behavior disorders. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost a total of $569,194 in FFY 2021, $206,674 in state expenditures and $362,520 in federal expenditures. The Department anticipates that this change will cost a total of $948,657 in FFY 2022, $344,457 in state expenditures and $604,199 in federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: August 14, 2020 Posted: August 7, 2020

MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services NATURE OF PROPOSED CHANGES: The Department plans to submit a Telehealth State Plan Amendment (SPA) in the near future. The main purpose of this SPA is to add coverage of the following services: PROCEDURE CODE DESCRIPTION Non-Facility Rate Facility Rate D9995 Teledentistry - synchronous; real-time encounter. Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service. D9996 Teledentistry asynchronous; information stored and forwarded to dentist for subsequent review. Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service. G2010 Store-and-Forward (asynchronous) telehealth is only permitted for Established Patients and involves the transmission of recorded clinical information (including, but not limited to radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a Health Care Provider. In order for the Health Care Provider to be reimbursed for a covered service delivered via Store-and-Forward Telehealth, a Member must not be present. G2012 A brief communication where an Established Member checks in with a Health Care Provider using a telephone or other telecommunications device for 5-10 minutes to determine the status of a chronic clinical condition(s) and to determine whether an office visit is needed. Modalities permitted for Virtual Check-Ins include Telephonic Services or Interactive Telehealth Services. Communications exclusively by email, text, or voicemail are not reimbursable. G2061 Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes. G2062 Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes. G2063 Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes. G0071 Payment for communication technology-based services for 5 minutes or more of a virtual (not face-to-face) communication between an RHC or FQHC practitioner and RHC or FQHC patient. 5 minutes or more. 98966 Telephone assessment and management service provided by a qualified non-physician health care professional; 5-10 minutes of medical discussion. 98967 Telephone assessment and management service provided by a qualified non-physician health care professional; 11-20 minutes of medical discussion. 98968 Telephone assessment and management service provided by a qualified non-physician health care professional; 21-30 minutes of medical discussion. 99421 Online E/M service, for an established patient, for up to 7 days, cumulative timing during the 7 days; 5-10 minutes. 99422 Online digital E/M service, for an established patient, for up to 7 days; 11-20 minutes. 99423 Online digital E/M service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes. 99441 Telephone evaluation and management service; 5-10 minutes of medical discussion. 99442 Telephone evaluation and management service; 11-20 minutes of medical discussion. 99443 Telephone evaluation and management service; 21-30 minutes of medical discussion. 99451 Interprofessional telephone/Internet/Electronic Health Record assessment and management service provided by a Consultative Physician including a written report to the patient's Treating/Requesting Physician or other qualified health care professional, 5 or more minutes of medical consultative time. 99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a Treating/Requesting Physician or qualified health care professional, 30 minutes. REASON FOR PROPOSED CHANGES: To continue increased access to currently covered services via telehealth. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 12, 2020 Posted: July 2, 2020

MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapter III, Nursing Facility Services related to: Special Wage Allowance: Effective July 1, 2020 through June 30, 2021 a special supplemental allowance must be made to provide for increases in contract labor and allowable wages and associated benefits and taxes in the direct care and routine care cost component. The allocated amount, up to 10% of allowable wages and associated benefits and taxes and contract labor as reported on each facility's most recent and available as-filed cost report for the fiscal year ending in calendar year 2017, must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. REASON FOR PROPOSED CHANGES: All changes are pursuant to LD 1758 "An Act To Clarify and Amend MaineCare Reimbursement Provisions for Nursing and Residential Care Facilities" in the first session of the 129th Maine Legislature. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in a decrease of $44,824 state and $78,999 federal in State Fiscal Year 2021. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 7, 2020 Posted: June 30, 2020

MaineCare Benefits Manual, Section 97, Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101: MaineCare Benefits Manual, Section 97, Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 97, Chapter III, Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities related to: Special Wage Allowance: Effective July 1, 2020 through June 30, 2021 a special supplemental allowance must be made to provide for increases in contract labor and allowable wages and associated benefits and taxes in the direct care and routine care cost component. The allocated amount, up to 10% of allowable wages and associated benefits and taxes and contract labor as reported on each facility's most recent and available as-filed cost report for the fiscal year ending in calendar year 2017, must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. REASON FOR PROPOSED CHANGES: All changes are pursuant to LD 1758 "An Act To Clarify and Amend MaineCare Reimbursement Provisions for Nursing and Residential Care Facilities" in the first session of the 129th Maine Legislature. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $44,824 state and $79,000 federal in State Fiscal Year 2021. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 7, 2020 Posted: June 30, 2020

MaineCare Benefits Manual, Section 65, Behavioral Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to update existing reimbursement methodologies for Multisystemic Therapy (MST), Multisystemic Therapy for Problem Sexualized Behaviors (MST-PSB), and Functional Family Therapy (FFT) in order to reflect requirements for the evidence-based models, and to change the unit of service from a quarter-hour to a week. As a result, the updated reimbursement amounts are as follows: Procedure Code Modifier Unit Service Description Maximum Allowance per unit effective 5/1/2020 H2021 HE weekly Comprehensive Community Support Services - Functional Family Therapy (FFT) $288.03 H2033 weekly Multi-systemic Therapy for juveniles (MST) $572.76 H2033 HK weekly Multi-systemic Therapy for juveniles Problem Sexualized Behavior (MST-PSB) $740.05 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine Resolve 2019, ch. 110, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children. This Resolve directed the Department to conduct a rate study for MST, MST-PSB, and FFT services. The Department contracted with Burns and Associates to complete this rate study in accordance with the Resolve. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $92,831 in state dollars and $216,604 in federal dollars in Federal Fiscal Year 2020 and $223,610 in state dollars and $519,033 in federal dollars in Federal Fiscal Year 2021. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: May 7, 2020 Posted: April 30, 2020

MaineCare Benefits Manual, Chapter III, Section 96, Private Duty Nursing and Personal Care Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 96, Chapter III, Private Duty Nursing and Personal Care Services NATURE OF PROPOSED CHANGES: The Department plans to increase Private Duty Nursing (PDN) caps to the following: Level of Care Effective 4/1/2020 Level I $1,374 Level II $1,723 Level III $2,838 Level IV (under 21 years of age, only) $5,181 Level V $29,072 Level VIII $957 Level IX $3,377 REASON FOR PROPOSED CHANGES: All changes are as a result of Maine PL 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 the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: Any estimated increase for this change is already identified in previous noticing posted March 31, 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: April 30, 2020 Posted: April 23, 2020

MaineCare Benefits Manual, Chapter III, Section 5, Ambulance Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 5, Chapter III, Ambulance Services NATURE OF PROPOSED CHANGES: Beginning January 1, 2020, the Department shall reimburse for ambulance services under MaineCare at a level that is not less than the average allowable reimbursement rate under Medicare for such services and shall reimburse for neonatal transport services under MaineCare at the average rate for critical care transport services under Medicare. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 2019, ch. 530, An Act To Prevent and Reduce Tobacco Use with Adequate Funding and by Equalizing the Taxes on Tobacco Products and To Improve Public Health ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $2,497,230 in state expenditures and $ 4,401,195 in federal expenditures in FFY 2019 and $3,337,918 in state expenditures and $5,859,982 in federal expenditures in FFY 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: April 7, 2020 Posted: March 31, 2020

MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment in the near future to increase reimbursement rates for certain psychiatric medication management services and home and community-based behavioral therapy service rates. These increases are detailed below: Children's Home and Community Based Treatment Services: HCPC Code Modifier Modifier Description Old Rate New Rate H2021 HN Comprehensive Community Support Services-Bachelors level $14.65 $16.58 H2021 HU U1 Comprehensive Community Support Services-Bachelors level-OCFS $14.65 $16.58 G9007 HN Collateral Services - Bachelors level $14.65 $16.58 Medication Management Services: HCPC Code Modifier Modifier Description Old Rate New Rate H2010 AF Medication Management Services - Physician $65.26 $74.56 H2010 HA AF Medication Management Services-Childrens - Physician $74.59 $80.20 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 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 the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost a total of $1,219,538 in Federal Fiscal Year 2020, including $869,269 in federal dollars and $ 350,269 in state dollars and $2,439,077 in Federal Fiscal Year 2021, including $1,736,027 in federal dollars and $703,050 in state dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: April 7, 2020 Posted: March 31, 2020

MaineCare Benefits Manual, Section 12, Chapter III, Allowances for Consumer Directed Attendant Services and Chapter 101, MaineCare Benefits Manual, Section 96, Chapter III, Private Duty Nursing and Personal Care Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 12, Chapter III, Allowances for Consumer Directed Attendant Services and Chapter 101, MaineCare Benefits Manual, Section 96, Chapter III, Private Duty Nursing and Personal Care Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment in the near future to increase reimbursement for Personal Support Services (PSS) as follows: Section 12 - Allowances for Consumer Directed Attendant Services: HCPC Code Modifier Modifier Description Old Rate New Rate S5125 U2 Attendant Care Services, 15 Min $3.73 $4.86 S5125 U2 UN Attendant Care Services, 15 Min, 2 members $2.05 $2.67 S5125 U2 UP Attendant Care Services, 15 Min, 3 members $1.49 $1.94 Section 96 - Private Duty Nursing and Personal Care Services: HCPC Code Rev Code Modifier Modifier Description Old Rate New Rate T1004 0571 CNA, 15 Min $5.50 $7.06 T1004 0571 UN CNA, 15 Min, 2 members $3.03 $3.88 T1004 0571 UP CNA, 15 Min, 3 members $2.20 $2.82 S5125 15 Min $3.73 $4.86 S5125 UN 15 Min 2 members $2.05 $2.67 S5125 UP 15 Min 3 members $1.49 $1.94 S5125 TF (for PCA Agencies only) $21.57 $26.60 S5125 TF UN 2 members (for PCA Agencies only) $11.87 $14.63 S5125 TF UP 3 members (for PCA Agencies only) $8.63 $10.64 S5125 0589 TF $21.57 $26.60 S5125 0589 TF UN 2 members $11.87 $14.63 S5125 0589 TF UP 3 members $8.63 $10.64 T1019 (for PCA Agencies only) $5.13 $6.55 T1019 UN 2 members (for PCA Agencies only) $2.82 $3.60 T1019 UP 3 members (for PCA Agencies only) $2.05 $2.62 T1019 0589 $5.13 $6.55 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 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 the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2020 and June 30, 2021. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost a total of $10,873,544 in Federal Fiscal Year 2020 including $7,611,481 in federal dollars and $3,262,063 in state dollars and a total of $21,747,088 in Federal Fiscal Year 2021 including $15,199,039 in federal dollars and $6,548,049 in state dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: April 7, 2020 Posted: March 31, 2020

MaineCare Benefits Manual, Chapter III, Section 67, Nursing Facility Reimbursement

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Reimbursement NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment in the near future identifying the following: For state fiscal years 2020 and 2021 only, establishing an annual temporary payment adjustment in recognition of nursing facilities that provide services to MaineCare veterans who reside in nursing facilities that provide comprehensive care to unique veterans' needs and ensure access to these services. In order to receive payment, a nursing facility must meet the following criteria: 1. The facility provides critical access to veteran-focused care, including specialized training and care of war-related injuries and conditions, such as PTSD and service-connected disabilities; 2. The nursing facility is subject to Department of Veterans Affairs (VA) regulations, oversight, and reporting requirements; 3. The nursing facility board of directors are appointed by the Governor; and 4. The nursing facility participates in the Maine Public Employees Retirement System. Principle. A nursing facility that qualifies under this section will be reimbursed annually for services provided to residents covered under Title XIX of the United States Social Security Act based on audited cost reports. Rate Setting. For fiscal years 2020 and 2021, the temporary adjustment will be paid annually within the state fiscal year fourth quarter and no later than June 30th each fiscal year. The payment adjustment will be calculated using the uniform cost reports filed by the facilities in November of each year, by using the following methodology: 1. The difference between the MaineCare payments and actual allowed MaineCare costs as reported on the most recent and filed cost reports for all eligible nursing facility services delivered by eligible nursing facilities as defined above; 2. For each year the temporary payment adjustment across all eligible facilities shall not exceed the lesser of $2,071,000 or the difference as calculated under Step 1; 3. Each facilitys annual payment adjustment shall be proportionate to its overall share of the amount calculated under Step 1 and limited to the aggregate amount across all facilities available under Step 2; and 4. For each facility, if the amount calculated under Step 1 is greater than or equal to zero, the facility is not eligible for the temporary adjustment. Audit. The annual payment is subject to the year-end uniform desk review auditand will be adjusted not to exceed the actual allowable costs of providing services to eligible residents. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $2,071,000 is SFY 2020 and $2,071,000 in SFY 2021. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: April 7, 2020 Posted: March 31, 2020

MaineCare Benefits Manual, Chapter III, Section 67, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapter III, Nursing Facility Services to allow rebasing determinations based on each facility's most recently filed cost report available by June 1st instead of April 1st of the re-basing year. REASON FOR PROPOSED CHANGES: To ensure that when the Office of MaineCare Services conducts rebasing, it can use cost reports for the same fiscal year for all facilities. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates no changes in expenditures in Federal Fiscal Years 2020 and 2021. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: April 7, 2020 Posted: March 31, 2020

MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services NATURE OF PROPOSED CHANGES: The Department plans the following temporary change until a time in which there is no longer a public health emergency. The Department will reimburse providers for telephone evaluation and management services provided to members when rendered by a qualified professional actively enrolled in MaineCare or contracted through an enrolled MaineCare provider. Telephone evaluation management services are not to be billed if clinical decision-making dictates a need to see the member for an office visit within 24 hours or at the next available appointment. In those circumstances, the telephone service shall be considered a part of the subsequent office visit. If the telephone call follows an office visit performed and reported within the past seven (7) days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable. The services are as follows: CPT Code Description Unit Rate 99441 Telephone evaluation and management service; 5-10 minutes of medical discussion $11.89 99442 Telephone evaluation and management service; 11-20 minutes of medical discussion $23.16 99443 Telephone evaluation and management service; 21-30 minutes of medical discussion $33.95 REASON FOR PROPOSED CHANGES: All changes are pursuant to 5 M.R.S. 8054 and 8073. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $878,947 in FFY 2020 which includes $278,611 in state expenditures and $600,336 in federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: March 31, 2020 Posted: March 24, 2020

MaineCare Benefits Manual, Chapter III, Section 97, Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101: MaineCare Benefits Manual, Section 97, Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 97, Chapter III, Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities related to: Special Wage Allowance: Effective January 1, 2020 two special supplemental allowances must be made to provide for increases in contract labor and allowable wages and associated benefits and taxes in the direct care and routine care cost component. The first allocated amount, up to 10% of allowable wages and associated benefits and taxes as reported on each facility's most recent and available as-filed cost report for the fiscal year ending in calendar year 2016, must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. The second allocated amount, up to 10% of allowable contract labor as reported on each facility's most recent and available as-filed cost report for the fiscal year ending in calendar year 2017, must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. REASON FOR PROPOSED CHANGES: All changes are pursuant to LD 1758 "An Act To Clarify and Amend MaineCare Reimbursement Provisions for Nursing and Residential Care Facilities" in the first session of the 129th Maine Legislature. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $1,504,433 state and $2,651,460 federal in State Fiscal Year 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 10, 2020 Posted: December 30, 2019

MaineCare Benefits Manual, Chapter III, Section 67, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapter III, Nursing Facility Services related to: Special Wage Allowance: Effective January 1, 2020 two special supplemental allowances must be made to provide for increases in contract labor and allowable wages and associated benefits and taxes in the direct care and routine care cost component. The first allocated amount, up to 10% of allowable wages and associated benefits and taxes as reported on each facility's most recent and available as-filed cost report for the fiscal year ending in calendar year 2016, must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. This first supplemental allowance must be paid in each state fiscal year until the fiscal year in which a rebasing under the Maine Revised Statutes, Title 22, section 1708, subsection 3, paragraph F is based on 2019 as-filed cost report data and has incorporated the costs of wages and allowable benefits and taxes of a facility. The second allocated amount, up to 10% of allowable contract labor as reported on each facility's most recent and available as-filed cost report for the fiscal year ending in calendar year 2017, must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. This second supplemental allowance must be paid in each state fiscal year until the fiscal year in which a rebasing under the Maine Revised Statutes, Title 22, section 1708, subsection 3, paragraph F is based on 2021 as-filed cost report data and has incorporated the costs of contract labor of a facility. REASON FOR PROPOSED CHANGES: All changes are pursuant to LD 1758 "An Act To Clarify and Amend MaineCare Reimbursement Provisions for Nursing and Residential Care Facilities" in the first session of the 129th Maine Legislature. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $4,014,206 state and $7,074,760 federal in State Fiscal Year 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 10, 2020 Posted: December 30, 2019

MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to add coverage and reimbursement for three evidence-based parenting programs for children with disruptive behavior disorders: Positive Parenting Program (Triple P), the Incredible Years (IY), and Parent-Child Interaction Therapy (PCIT). The following are the proposed Behavioral Therapies for Disruptive Behavior Disorders: Procedure Code Modifier Modifier Unit Service Description Maximum Allowance per unit T1027 HA hour Triple P 1:1 $16.27 T1027 HA HQ UN hour Triple P - Group 2-4 members $9.05 T1027 HA HQ UR hour Triple P Group 5-7 members $3.81 T1027 HA HQ US hour Triple P Group 8-10 members $2.47 T1027 TJ HQ UN hour Incredible Years Group 2-4 members $10.96 T1027 TJ HQ UR hour Incredible Years Group 5-7 members $4.59 T1027 TJ HQ US hour Incredible Years Group 8-10 members $2.97 T1027 HO hour Parent-Child Interaction Therapy (PCIT) 1:1 $19.75 REASON FOR PROPOSED CHANGES: To provide coverage and reimbursement of medically necessary, evidence-based parenting programs for children with disruptive behavior disorders. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost a total of $458,695 in FFY 2020, $166,048 in state expenditures and $292,648 in federal expenditures. The Department anticipates that this change will cost a total of $611,594 in FFY 2021, $221,947 in state expenditures and $389,646 in federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 3, 2020 Posted: December 24, 2019

MaineCare Benefits Manual, Chapter III, Section 25, Dental Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 25, Chapter III, Dental Services NATURE OF PROPOSED CHANGES: The Department intends to submit a State Plan Amendment (SPA) to implement 2020 Current Dental Terminology (CDT) code deletions and replacements. The codes identified in column one (DELETED CDT CODES) are being replaced by the codes identified in column two (REPLACEMENT CDT CODES). The reimbursement amounts currently established will not change. DELETED CDT CODES REPLACEMENT CDT CODES REIMBURSEMENT RATE D1550 D1551 $22.50 D1550 D1552 $22.50 D1550 D1553 $22.50 D1555 D1556 $50.00 D1555 D1557 $50.00 D1555 D1558 $50.00 D8691 D8696 $75.00 D8691 D8697 $75.00 D8693 D8698 $50.00 D8693 D8699 $50.00 D8692 D8703 $125.00 D8692 D8704 $125.00 REASON FOR PROPOSED CHANGES: The Department is updating the above CDT codes for the year 2020 consistent with annual revisions as communicated by the American Dental Association (ADA). ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates no changes in expenditures in Federal Fiscal Years 2020 and 2021. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 3, 2020 Posted: December 24, 2019

MaineCare Benefits Manual, Chapter II, Section 103, Rural Health Clinic Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 103, Chapter II, Rural Health Clinic Services NATURE OF PROPOSED CHANGES: The Department intends to submit a State Plan Amendment (SPA) for Rural Health Clinics to provide an alternative payment methodology option that, effective January 1, 2020, is the same as the existing methodology except that rural health clinics may be reimbursed on the basis of 100% of the average of the reasonable costs of providing MaineCare-covered services during calendar years 2016 and 2017 as long as reimbursement is no less than reimbursement received under the prospective payment system described in Section 1902(bb) of the United States Social Security Act. Each rural health clinic must be given the option to be reimbursed under the methodology required by this section or under the existing prospective payment system methodology. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 2019, ch. 530, An Act To Prevent and Reduce Tobacco Use with Adequate Funding and by Equalizing the Taxes on Tobacco Products and To Improve Public Health ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates this change to cost $1,259,001 in state expenditures and $2,218,903 in federal expenditures FFY 2020 and $1,682,842 in state expenditures and $2,954,363 in federal expenditures in FFY 2021. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 3, 2020 Posted: December 24, 2019

MaineCare Benefits Manual, Chapter III, Section 5, Ambulance Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 5, Chapter III, Ambulance Services NATURE OF PROPOSED CHANGES: Beginning January 1, 2020, the Department shall reimburse for ambulance services under MaineCare at a level that is not less than the average allowable reimbursement rate under Maine Medicare area '99' for such services and shall reimburse for neonatal transport services under MaineCare at the average rate for critical care transport services under Medicare. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 2019, ch. 530, An Act To Prevent and Reduce Tobacco Use with Adequate Funding and by Equalizing the Taxes on Tobacco Products and To Improve Public Health ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $2,497,230 in state expenditures and $ 4,401,195 in federal expenditures in FFY 2019 and $3,337,918 in state expenditures and $5,859,982 in federal expenditures in FFY 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 3, 2020 Posted: December 24, 2019

MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services 12-24-19

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department will submit a State Plan Amendment (SPA) to add the following definitions for both Rural Hospitals and Non-rural Hospitals. RURAL HOSPITAL: is a hospital that meets one of the following criteria: 1) Is a "sole community hospital" as defined by Medicare, which does not reclassify into the York/Cumberland Core-Based Statistical Area (CBSA) for Medicare Wage Index purposes. A sole community hospital as defined by Medicare means a hospital: a. That the Secretary determines is located more than 35 road miles from another hospital; b. That, by reason of factors such as the time required for an individual to travel to the nearest alternative source of appropriate inpatient care (in accordance with standards promulgated by the Secretary), location, weather conditions, travel conditions, or absence of other like hospitals (as determined by the Secretary), is the sole source of inpatient hospital services reasonably available to individuals in a geographic area who are entitled to benefits under Medicare Part A; or c. That is located in a rural area and designated by the Secretary as an essential access communication hospital under 1820(i)(1) as in effect on September 30, 1997; or 2) Is a Medicare-dependent hospital as defined by Medicare, meaning a small rural hospital; a. Located in a rural area; b. That has not more than 100 beds; c. That is not classified as a sole community hospital; and d. For which not less than 60% of its inpatient days or discharges during the cost reporting period beginning in fiscal year 1987, or two of the three most recently audited cost reporting periods for which the Secretary has a settled cost report, were attributable to inpatients entitled to benefits under Medicare Part A; or 3) Is a Rural Community Hospital Demonstration accepted into the Rural Community Hospital Demonstration Program by Medicare. NON-RURAL HOSPITAL: includes psychiatric, rehabilitation, and state hospitals, and any other hospital that does not meet the definition of a Rural Hospital as defined in this Chapter (see Definition 45.01-25.) Additionally, the department is modifying hospital-based physician reimbursement as follows: ACUTE CARE NON-CRITICAL ACCESS HOSPITALS: 1) Non-rural hospitals: a. 93.3% of its share of inpatient hospital-based physician costs, b. 93.4% of its share of outpatient emergency room hospital-based physician costs, and c. 83.8% of non-emergency room outpatient hospital-based physician costs. 2) Rural hospitals: a. 100% of its share of inpatient hospital-based physician costs, b. 100% of its share of outpatient emergency room hospital-based physician costs, c. 100% of graduate medical education costs; and d. 100% of non-emergency room outpatient hospital-based physician costs. ACUTE CARE CRITICAL ACCESS HOSPITALS: a. 100% of its share of inpatient hospital-based physician costs, b. 100% of its share of outpatient emergency room hospital-based physician costs, c. 100% of graduate medical education costs; and d. 100% of non-emergency room outpatient hospital-based physician costs. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine PL 2019, ch. 530, An Act To Prevent and Reduce Tobacco Use with Adequate Funding and by Equalizing the Taxes on Tobacco Products and To Improve Public Health ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates this change to cost $1,081,500 in state expenditures and $1,906,067 in federal expenditures in FFY 2020 and $1,445,584 in state expenditures and $2,537,838 in FFY 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 3, 2020 Posted: December 24, 2019

MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services 11-13-19

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment in the near future to amend the following: SUPPLEMENTAL POOL FOR NON CRITICAL ACCESS HOSPITALS, HOSPITALS RECLASSIFIED TO A WAGE AREA OUTSIDE MAINE AND REHABILITATION HOSPITALS: The Department plans to increase the total inpatient and outpatient supplemental pool for the privately owned and operated Acute Care Non-Critical Access hospitals, hospitals reclassified to a wage area outside Maine by the Medicare Geographic Classification Review Board, and rehabilitation hospitals. Effective November 14, 2019, the total pool amount will increase to $80,575,379. Of the $80,575,379, up to $42,481,159 will be allocated to inpatient services and up to $38,094,220 will be allocated to outpatient services. Effective November 14, 2020 the total pool amount will increase to $80,914,112. Of the $80,914,112, up to $42,819,892 will be allocated to inpatient services and up to $38,094,220 will be allocated to outpatient services. The allocated inpatient pool amount will be distributed based on each hospital's relative share of inpatient MaineCare payments, defined as the hospitals inpatient MaineCare payment in the applicable state fiscal year divided by inpatient MaineCare payments made to all privately owned and operated Acute Care Non-Critical Access hospitals, hospitals reclassified to a wage area outside Maine by the Medicare Geographic Classification Review Board, and rehabilitation hospitals, multiplied by the supplemental pool amount. For state fiscal years beginning on or after July 1, 2019 but before July 1, 2021, the hospital's taxable year is the hospitals fiscal year that ended during calendar year 2016. Each hospital in the pool will receive its relative share of this supplemental payment. Supplemental payments will be distributed semiannually in November and May. This pool will be decreased by the amount a hospital would have received if that hospital was in the pool when the total pool amount was set but subsequently became an approved critical access hospital. This supplemental pool payment is not subject to cost settlement. ACUTE CARE CRITICAL ACCESS HOSPITALS AND HOSPITAL RECLASSIFIED TO A WAGE AREA OTUSIDE MAINE BY THE MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD (MGCRB) PRIOR TO OCTOBER 1, 2008: Additionally, effective November 14, 2019, the Department plans to increase the total inpatient pool for privately owned and operated critical access hospitals only, not those hospitals reclassified to a wage area outside Maine by the Medicare Geographic Classification Review Board or public hospitals, from $4,000,000 to $5,613,061. Effective November 14, 2020, the total inpatient pool for privately owned and operated critical access hospitals will increase from $5,613,061 to $5,672,482. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $10,808,368 in federal fiscal year 2020: $6,353,002 will be federal expenditures and $4,455,366 will be state expenditures. This change will result in an increase of $11,206,522 in federal fiscal year 2021: $6,511,780 will be federal expenditures and $4,694,742 will be state expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: November 20, 2019 Posted: November 13, 2019

MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services 09-26-19

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: Beginning October 1, 2019, the Department of Health and Human Services shall provide reimbursement to hospitals other than acute care critical access hospitals for each day after the 10th day that a MaineCare-eligible individual is in the care of a hospital while awaiting placement in a nursing facility. The Department shall reimburse hospitals at the statewide average rate per MaineCare member day for nursing facility services. The Department shall compute the statewide average rate per MaineCare member day based on the simple average of the nursing facility rate per MaineCare member day for the applicable state fiscal year, or years prorated for the hospital's fiscal year. Reimbursement for days awaiting placement pursuant to this section is limited to a maximum of $500,000 of combined State General Fund funds and federal funds for each year for a period of five years. The Department will reimburse quarterly by order of claim date. In the event the cap is expected to be exceeded in any quarter, reimbursement for claims in that quarter will be paid out proportionately, and a notification of total funds expended for that year will be sent out to providers. This provision is repealed December 31, 2023. REASON FOR PROPOSED CHANGES: All changes are pursuant to P. L. 2017, ch. 454, An Act to Require Reimbursement to Hospitals for Patients Awaiting Placement in Nursing Facilities. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates this will cost approximately $99,244 in SFY 2020, which includes $35,390 in state dollars and $63,854 in federal dollars and approximately $99,244 in SFY 2021, which includes $35,390 in state dollars and $63,854 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 3, 2019 Posted: September 26, 2019

MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services 09-24-19

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to increase the total inpatient and outpatient supplemental pool amount by $10,808,368. The total pool amount will increase to $82,188,440. Of the $82,188,440, up to $44,094,220 will be allocated to inpatient services and up to $38,094,220 will be allocated to outpatient services. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost a total of $82,188,440 in each federal fiscal year 2020 and 2021; $29,752,216 will be state expenditures and $52,436,224 will be federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 1, 2019 Posted: September 24, 2019

MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services NATURE OF PROPOSED CHANGES: The Department previously requested approval from the Centers for Medicare and Medicaid Services (CMS) for changes to the reimbursement of Opioid Health Home (OHH) Services. The proposed changes included the addition of a tiered rate structure as identified below. This revised notice provides information at the request of CMS to clarify the amounts specific to the six Health Homes services and the tiered rate structure. *All payments go to the OHH. All OHHs have capacity to deliver all 6 health home services and receive the payment for these services. Non-health home services are covered in other approved state plan pages and are not duplicative of health home services. Rates are based on member acuity. For individuals receiving Tier 1 services, the full Per Member Per Month (PMPM) payment that covers the section 2703 health home services is $394.40. To be eligible for Tier 1 services, members must have an opioid use disorder and have a second chronic condition or be at risk of a second chronic condition consistent with the Maine Opioid Health Home SPA approved Executive Summary and Population Criteria. For individuals receiving Tier 2 services, the full PMPM payment that covers the 2703 health home services is $409.40. This acuity level is for members with chronic condition management needs when partnering with an enhanced primary care practice. To be eligible for Tier 2 services the member must meet the eligibility criteria for Tier 1 AND they must also be diagnosed with two (2) or more of the following chronic conditions, OR one (1) chronic condition AND be at risk for another chronic condition as indicated below: Chronic Conditions: 1. a mental health condition; 2. a substance use disorder; 3. tobacco use; 4. diabetes; 5. heart disease; 6. overweight or obese as evidenced by a body mass index over 25; 7. Chronic Obstructive Pulmonary Disease (COPD); 8. hypertension; 9. hyperlipidemia; 10. developmental and intellectual disorders; 11. circulatory congenital abnormalities; 12. asthma; 13. acquired brain injury; and 14. seizure disorders. At Risk for Another Chronic Condition: 1. A member is deemed to be at risk for another chronic condition if the member has been diagnosed with any of the following: a. a mental health condition; b. a substance use disorder; c. tobacco use; d. diabetes; e. heart disease; f. overweight or obese as evidenced by a body mass index over 25; g. chronic obstructive pulmonary disease (COPD); h. hypertension; i. hyperlipidemia; j. developmental and intellectual disorders; or, k. circulatory congenital abnormalities Of the PMPM, the OHH may pass through $15 to the enhanced primary care practice partner. For individuals receiving Tier 3 services the full PMPM payment that covers the section 2703 health home services is $534.49. This acuity level is for members with additional community support needs related to mental health, HIV, and homelessness. To be eligible for Tier 3 services a member must have an opioid use disorder and have a second chronic condition or be at risk of a second chronic condition consistent with the Maine Opioid Health Home SPA approved Executive Summary and Population Criteria and must also be diagnosed with a Serious and Persistent Mental Illness (SPMI), Serious Emotional Disturbance (SED), HIV or experiencing homelessness. Of the PMPM, the OHH may pass through $394.40 to the additional community support team members. REASON FOR PROPOSED CHANGES: The Department is issuing this revised notice at the request of CMS to further clarify the previous Notice of MaineCare Reimbursement Methodology Change issued September 27, 2018 for MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $4,951,297 in State Fiscal Year (SFY) 2019, which includes $1,173,978 in state dollars and $3,777,319 in federal dollars, and $15,299,506 in SFY 2020, which includes $5,131,753 in state dollars and $10,167,753 in federal dollars ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capital Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 17, 2019 Posted: July 10, 2019

MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services (MST/FFT)

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: In anticipation of the passing of LD 1809, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children (the "Resolve"), from the 129th Maine Legislature's first regular session-2019 the Department is issuing this notice to provide communication of the intent to submit a State Plan Amendment (SPA) for Section 65, Chapter III, Behavioral Health Services should this LD become law. This notice indicates our resulting intent to extend the 20% rate increase, pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government, for multisystemic therapy (MST), multisystemic therapy for problem sexualized behavior, and functional family therapy (FFT) services that was previously scheduled to end June 30, 2019. This extended increase of 20%, pursuant to the signing of the Resolve, will be effective July 1, 2019 through June 30, 2020. REASON FOR PROPOSED CHANGES: All changes are pursuant to LD 1809, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children, from the 129th Maine Legislatures first regular session-2019. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will result in an increase of $697,624 in State Fiscal Year 2020, of which $262,306 is state expenditures and $435,318 is federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 5, 2019 Posted: June 28, 2019

MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services (MAT)

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) to increase the reimbursement rate for Section 65, Chapter III, Behavioral Health Services Medication Assisted Treatment (MAT) effective July 1, 2019 to $110.00 per week. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $3,375,624 in State Fiscal Year 2020, of which $1,215,900 is state expenditures and $2,159,724 is federal expenditures. The Department anticipates that this change will result in an increase of $3,375,624 in State Fiscal Year 2021, of which $1,221,976 is state expenditures and $2,153,648 is federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: July 5, 2019 Posted: June 28, 2019

MaineCare Benefits Manual, Chapters II and III, Section 109, Speech & Hearing Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Chapters II and III, Section 109, Speech & Hearing Services NATURE OF PROPOSED CHANGES: The Department plans to increase reimbursement as follows: ·Agency rates at 69% of Medicare for codes 92507 (GN), 92521 (GN), 92522 (GN), 92523 (GN), 92607 (GN), 92608 (GN), 92609 (GN), and 92610 ·Adding Independent rates at 90% of Agency for codes 92507 (GN), 92507 (TF, GN), 92508 (HQ, GN), 92508 (TF, HQ, GN), 92521 (GN), 92522 (GN), 92523 (GN), 92524 (GN), 92526 (GN), 92607 (GN), 92608 (GN), 92609 (GN), and 92610 ·Adding Agency and Independent codes 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546, 92547, 92548, 92570, 92611, 92612, and V5011 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine Public Law 2017, ch. 60, Resolve, Regarding Reimbursement for Speech and Language Pathology. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $159,156 in SFY 2019, which includes $102,687 in federal dollars, and $636,622 in SFY 2020, which includes $409,157 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 18, 2019 Posted: January 11, 2019

MaineCare Benefits Manual, Section 15, Chapters II and III, Chiropractic Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 15, Chapters II and III, Chiropractic Services NATURE OF PROPOSED CHANGES: The Department plans to add coverage of certain evaluation and management codes for chiropractors, pursuant to Public Law 2017, ch. 421, An Act To Provide MaineCare Coverage for Chiropractic Treatment. The Department is limiting the evaluation codes to 99201-99215 for the purpose of examining and diagnosing a spinal condition; reimbursement of these codes and services will be located on the Maine Physicians’ fee schedule. Additionally, the Department is adopting changing the requirement of “subluxation” to “conditions” to align with Medicaid requirements. REASON FOR PROPOSED CHANGES: All changes are pursuant to Public Law 2017, ch. 421, An Act To Provide MaineCare Coverage for Chiropractic Treatment. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $84,351 in SFY 2019, which includes $29,928 in state dollars and $54,423 in federal dollars, and $253,054 in SFY 2020, which includes $89,784 in state dollars and $163,270 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 18, 2019 Posted: January 11, 2019

MaineCare Benefits Manual, Section 25, Dental Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 25, Dental Services NATURE OF PROPOSED CHANGES: The Department plans to request approval to amend coverage of dental services by including reimbursement of the following procedure codes at the rates listed below: PROCEDURE CODE DESCRIPTION AMOUNT D1516 space maintainer – fixed – bilateral, maxillary $220.00 D1517 space maintainer – fixed – bilateral, mandibular $220.00 D1526 space maintainer – removable – bilateral, maxillary $110.00 D1527 space maintainer – removable – bilateral, mandibular $110.00 D9944 occlusal guard – hard appliance, full arch $110.00 D9945 occlusal guard – soft appliance, full arch $110.00 D9946 occlusal guard – hard appliance, partial arch $110.00 D1354 Interim caries arresting medicament application – per tooth $24.74 REASON FOR PROPOSED CHANGES: These changes are being made to provide coverage for the services listed, when appropriate. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department expects that this rulemaking will save the Department approximately $7,368 in State Fiscal Year 2019 and $14,376 in State Fiscal Year 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: January 2, 2019 Posted: December 21, 2018

MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services NATURE OF PROPOSED CHANGES: The Department of Health and Human Services plans to request approval from the Centers for Medicare and Medicaid Services (CMS) for a State Plan Amendment (SPA) related to reimbursement for drugs purchased through the pharmacy 340B drug pricing program. The 340B drug pricing program is outlined in 42 C.F.R. § 10. The State of Maine plans to reimburse for these drugs at the Average Sales Price (ASP) minus 22.5 percent. The State of Maine also plans to allow for 340B covered entities to carve out of the 340B drug pricing program. The State of Maine will also be requesting to remove the Rural Dispensing Fee Adjustment from the State Plan and Section 80 of the MaineCare Benefits Manual following the approval and implementation of the 2017 dispensing fee increase related to the New England States Consortium Systems Organization (NESCSO) pharmacy cost and dispensing survey. REASON FOR PROPOSED CHANGES: This change adds the 340B reimbursement methodology to the Maine State Plan in accordance with 42 C.F.R. § 10. Additionally, the State is seeking to remove the Rural Dispensing Fee Adjustment from the State Plan following the NESCSO survey and updated dispensing fee implementation. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that the costs of this rulemaking are unable to be determined at this time. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M. Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: December 30, 2018 Posted: December 19, 2018

MaineCare Benefits Manual, Section 45, Chapters II & III, Hospital Services

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Concise Summary: Beginning January 1, 2019, the Department of Health and Human Services shall provide reimbursement to acute care non-critical access hospitals for each day after the 10th day that a MaineCare-eligible individual is in the care of a hospital while awaiting placement in a nursing facility. The Department shall reimburse hospitals at the statewide average rate per MaineCare member day for nursing facility services. The Department shall compute the statewide average rate per MaineCare member day based on the simple average of the nursing facility rate per MaineCare member day for the applicable state fiscal year, or years prorated for the hospital's fiscal year. Reimbursement for days awaiting placement pursuant to this section is limited to a maximum of $500,000 of combined State General Fund funds and federal funds for each year for a period of five years. This section will be repealed on December 31, 2023. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 454, An Act to Require Reimbursement to Hospitals for Patients Awaiting Placement in Nursing Facilities. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $49,622 in FY 2019, which includes $17,690 in state dollars and $31,932 in federal dollars. The rulemaking will cost approximately $99,244 in SFY 2020, which includes $35,390 in state dollars and $63,854 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: December 30, 2018 Posted: December 19, 2018

DRAFT of Maine Alternative Benefit Plan SPA Submission

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Concise Summary: The Maine Department of Health and Human Services provides notice of its intent to submit a State Plan Amendment to define the Alternative Benefit Plan that will be used to allow for expansion of Medicaid eligibility to individuals aged 1964 with incomes at or below 133 percent of the Federal Poverty Level who are not enrolled in or eligible for Medicare, consistent with the expanded eligibility criteria as defined by the Affordable Care Act, referred to here as the Adult Expansion Group. This ABP will be applicable to individuals in the Adult Expansion Group who are eligible for MaineCare. The Maine Department of Health and Human Services expects to submit this SPA to the Centers for Medicare and Medicaid Services no later than December 31, 2018.Any comments regarding the proposed State Plan Amendment covered by this public notice, or requests for a written copy, may be submitted in writing to: Office of MaineCare Services, Division of MaineCare Policy, State House Station #11, 242 Water St., Augusta, ME 04333 or via email at Policy.DHHS@maine.gov. Written comments may be reviewed by the public at 242 State St, Augusta, ME 04330. Comments will be accepted until December 19, 2018. There is no public hearing scheduled.

Comment deadline past Comment Deadline: December 19, 2018 Posted: November 30, 2018

MaineCare Benefits Manual, Section 40, Chapter III, Home Health Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 40, Chapter III, Home Health Services NATURE OF PROPOSED CHANGES: The Department plans to increase reimbursement rates for certain procedure codes. Effective January 1, 2019, the updated rate per 15-minute unit is as follows: • G0299 - $33.46; • G0300 - $23.42; • G0156 - $15.16; • G0152 - $36.83; • G0152 TF - $25.79; • G0151 - $36.58; • G0151 TF - $25.61; • G0153 - $39.75; • G0153 TF - $27.83; and • G0155 - $36.82 REASON FOR PROPOSED CHANGES: All changes are pursuant to Public Law 2017, Chapter 61, Resolves Reimbursement rate increase for home health services. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in approximately $405,009, which includes $143,697 in state dollars and $261,312 in federal dollars for SFY 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services, 242 State Street, 11 State House Station, Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: December 2, 2018 Posted: November 21, 2018

PUBLIC NOTICE: State Plan Amendment regarding an Alternative Benefit Plan for an Expanded Adult Population

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Concise Summary: PUBLIC NOTICE Maine Department of Health and Human Services Office of MaineCare Services State Plan Amendment regarding an Alternative Benefit Plan for an Expanded Adult Population The Maine Department of Health and Human Services provides notice of its intent to submit a State Plan Amendment, SPA, to define the Alternative Benefit Plan, ABP, that will be used to allow for expansion of Medicaid eligibility to individuals aged 19 - 64 with incomes at or below 133% of the Federal Poverty Level, FPL, who are not enrolled in or eligible for Medicare, consistent with the expanded eligibility criteria as defined by the Affordable Care Act referred to here as the "Adult Expansion Group". This ABP will be applicable to individuals in the Adult Expansion Group who are eligible for MaineCare, Maine's Medicaid program. The Maine Department of Health and Human Services expects to submit this SPA to the Centers for Medicare and Medicaid Services no later than December 31, 2018. Once approved, the ABP will provide eligible individuals in the Adult Expansion Group with access to the federally mandated Essential Health Benefits. These Essential Health Benefits include the following services: Ambulatory patient services; Emergency services; Hospitalization; Maternity and newborn care; Mental health and substance use disorder services, including behavioral health treatment; Prescription drugs; Rehabilitative and habilitative services and devices; Laboratory services; Preventive and wellness services and chronic disease management; Pediatric services, including oral and vision care; Early and Periodic Screening, Diagnostic and Treatment, "EPSDT", services will be provided to those eligible individuals in the Adult Expansion Group who are under age 21 as required by law and regulation, and consistent with current state policy regarding the delivery of these services. Other covered services will include medically necessary services as prior authorized, as well as other services required to be covered pursuant to state or federal law, regulation, or policy. The "section 1937 coverage option" for the ABP will be "Secretary-Approved Coverage" that is based on, and consistent with, the benefits provided in Maine's approved state Medicaid plan. The "base benchmark plan" will be the largest plan by enrollment of the three largest small group insurance products in Maine's small-group market. Consistent with federal law and the Maine Medicaid State Plan, the State Plan, the State Medicaid Director will provide written notice regarding this proposed State Plan Amendment to the appropriate tribal contacts on November 19, 2018. In accordance with the State Plan, additional information regarding the proposed changes will be provided to the tribal contacts upon request, and consultation will occur as requested or as otherwise appropriate.

Comment deadline past Comment Deadline: December 19, 2018 Posted: November 19, 2018

MaineCare Benefits Manual, Chapters II and III, Section 67, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapters II and III, Section 67, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapters II and III, Nursing Facility Services related to: 1. Special wage allowance for fiscal year 2018-19. For the state fiscal year ending June 30, 2019, a special supplemental allowance must be made to provide for increases in wages and wage-related benefits in both the direct care cost component and routine care cost component as follows: the allocated amount, up to 10%, of allowable wages and associated benefits and taxes as reported on each facility's as-filed cost report for its fiscal year ending in calendar year 2016 must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. 2. Changes in occupancy penalty. For the state fiscal years ending June 30, 2019, June 30, 2020 and June 30, 2021, the reduction in allowable cost per day in the fixed costs component based on minimum occupancy standards applies only for an annual level of occupancy less than 70%. For fiscal years ending June 30, 2022 and thereafter, the reduction in allowable cost applies only for an annual level of occupancy less than 85% for facilities with 61 or more beds and 80% for facilities with 60 or fewer beds. 3. Low-cost, high Medicaid nursing facilities. Beginning July 1, 2019, the supplemental payment established by Public Law 2013, chapter 594, section 3, subsection 5 must be revised to provide that the supplemental payment increase to 60¢ per resident day, is not subject to cost settlement and must be retained by the facility in its entirety for any nursing facility whose MaineCare residents constitute more than 80% of the nursing facility's total number of residents and whose base year direct and routine aggregate costs per day are less than the median aggregate direct and routine allowable costs for the facility's peer group. The supplemental payment must continue to apply as provided in Public Law 2013, chapter 594, section 3, subsection 5 for facilities that do not meet the standard set forth in this subsection. 4. Establish a nursing facility's base year. For the state fiscal year beginning July 1, 2018, the base year for each facility is its fiscal year that ended in the calendar year 2016. For state fiscal years beginning on or after July 1, 2019, subsequent rebasing must be based on the most recent cost report filings available. Beginning in the state fiscal year beginning July 1, 2018, the rates set for each rebasing year must include an inflation adjustment for a cost-of-living percentage change in nursing facility reimbursement each year in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index. Any rebasing done pursuant to this paragraph may not result in a nursing facility receiving a reimbursement rate that is lower than the rate in effect on June 30, 2018. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government, ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $18,467,741 in State Fiscal Year 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 3, 2018 Posted: September 27, 2018

MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services for changes to the reimbursement of Opioid Health Home Services. The proposed changes include the addition of a tiered rate structure for Intensive Outpatient Therapy, Intermediate/Stabilization, and Maintenance levels of treatment. Additional adjustments are made for individuals receiving coordinated case management. REASON FOR PROPOSED CHANGES: Based on provider feedback, the previous rate structure was insufficient to cover the cost of delivering the services. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $2,519,842 in State Fiscal Year (SFY) 2019, which includes $143,787 in state dollars and $2,376,055 in federal dollars, and $6,880,534 in SFY 2020, which includes $1,749,958 in state dollars and $5,130,576 in federal dollars. The new rates are listed below: For individuals not receiving external coordinated case management services as described in 93.08(c): Intensive Outpatient Therapy (IOP) Level of Care: $2,217.76 per member per month Intermediate/Stabilization Level of Care: $1,045.01 per member per month Maintenance Level of Care: $662.68 per member per month. For individuals receiving coordinated case management as described in 93.08(c): Intensive Outpatient Therapy (IOP) Level of Care: $1,963.45 per member per month Intermediate/Stabilization Level of Care: $790.70 per member per month Maintenance Level of Care: $408.37 per member per month. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M. Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: October 7, 2018 Posted: September 27, 2018

MaineCare Benefits Manual, Chapters II and III, Section 67, Nursing Facility Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter II and III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit State Plan Amendment (SPA) for Section 67, Chapter II and III, Nursing Facility Services related to: 1. Special wage allowance for fiscal year 2018-19. For the state fiscal year ending June 30, 2019, a special supplemental allowance must be made to provide for increases in wages and wage-related benefits in both the direct care cost component and routine care cost component as follows. The allocated amount, up to 10%, of allowable wages and associated benefits and taxes as reported on each facility's as-filed cost report for its fiscal year ending in calendar year 2016 must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. 2. Changes in occupancy penalty. For the state fiscal years ending June 30, 2019, June 30, 2020 and June 30, 2021, the reduction in allowable cost per day in the fixed costs component based on minimum occupancy standards applies only for an annual level of occupancy less than 70%. For fiscal years ending June 30, 2022 and thereafter, the reduction in allowable cost applies only for an annual level of occupancy less than 85% for facilities with 61 or more beds and 80% for facilities with 60 or fewer beds. 3. Low-cost, high Medicaid nursing facilities. Beginning July 1, 2019, the supplemental payment established by Public Law 2013, chapter 594, section 3, subsection 5 must be revised to provide that the supplemental payment increases to 60¢ per resident day, is not subject to cost settlement and must be retained by the facility in its entirety for any nursing facility whose MaineCare residents constitute more than 80% of the nursing facility's total number of residents and whose base year direct and routine aggregate costs per day are less than the median aggregate direct and routine allowable costs for the facility's peer group. The supplemental payment must continue to apply as provided in Public Law 2013, chapter 594, section 3, subsection 5 for facilities that do not meet the standard set forth in this subsection. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government, Sec. B-3. Rate increases for nursing facilities ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $18,467,741 in State Fiscal Year 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml f

Comment deadline past Comment Deadline: August 8, 2018 Posted: August 1, 2018

MaineCare Benefits Manual Chaper III, Sections 2, 13, 17, 23, 26, 28, 65, 97 Appendix C and 97 B and E.

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Concise Summary: Chapter 101, MaineCare Benefits Manual, Section 2, Chapter III, Adult Family Care Services; Chapter 101, MaineCare Benefits Manual, Section 13, Chapter III, Targeted Case Management Services; Chapter 101, MaineCare Benefits Manual, Section 17, Chapter III, Community Support Services; Chapter 101, MaineCare Benefits Manual, Section 23, Chapter III, Developmental and Behavioral Clinic Services; Chapter 101, MaineCare Benefits Manual, Section 26, Chapter III, Day Health Services; Chapter 101, MaineCare Benefits Manual, Section 28 Chapter III, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations; Chapter 101, MaineCare Benefits Manual, Section 65, Chapters II and III, Behavioral Health Services; Chapter 101, MaineCare Benefits Manual, Section 97, Chapter III, Private Non-Medical Institution Services, Appendix C; Chapter 101, MaineCare Benefits Manual, Section 97, Chapter III, Private Non-Medical Institution Services, Appendix B and Appendix E; NATURE OF PROPOSED CHANGES: The Department plans to submit State Plan Amendments (SPAs) for the following: Section 2, Chapter III, Adult Family Care Services: For the state fiscal year ending June 30, 2019, the MaineCare payment rates attributable to wages and salaries for personal care and related services provided pursuant to each of the rules are increased by 10%. For the state fiscal year ending June 30, 2020 and each year thereafter until the completion of the rate study, the MaineCare payment rates attributable to wages and salaries for personal care and related services above must be increased by an inflation adjustment cost-of-living percentage change in reimbursement in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index. Section 13, Chapter III, Targeted Care Management Services: Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 17, Chapter III, Community Support Services: Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 23, Chapter III, Developmental and Behavioral Clinic Services: Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 26, Chapter III, Day Health Services: For the state fiscal year ending June 30, 2019, the MaineCare payment rates attributable to wages and salaries for personal care and related services provided pursuant to each of the rules are increased by 10%. Section 28, Chapter III, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations: The Department will establish reimbursement rates and increase existing reimbursement rates in accordance with the April 24, 2017 report Rate Study for Behavioral Health and Targeted Case Management Services: Final Proposed Rates for Formal Rulemaking prepared for the department by Burns & Associates, Inc. Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 65, Chapters II and III, Behavioral Health Services: The Department intends to increase rates by 15% for Medication Management services. Additionally, the Department intends to increase rates for multisystemic therapy (MST), multisystemic therapy for problem sexualized behavior and functional family therapy (FFT) services by 20% through June 30, 2019. Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 97, Chapter III, Private Non-Medical Institution Services, Appendix C: For the state fiscal year ending June 30, 2019, a special supplemental allowance must be made to provide for increases in wages and wage-related benefits in the direct care, personal care services, and routine cost components as follows. An amount equal to 10% of wages and associated benefits and taxes as reported on each facility's as-filed cost report for its fiscal year ending in calendar year 2016 must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in each component that is cost settled in that fiscal year. For the state fiscal year ending June 30, 2020 and each year thereafter, the MaineCare payment rates attributable to wages and salaries in each cost component specified in subsection 1 must be increased by an inflation factor in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index Section 97, Chapter III, Private Non-Medical Institution Services, Appendix B and Appendix E: to increase rates effective July 1, 2018 by 2% over the rates in fiscal year 2008-2009, provided rates do not decrease below those set as of January 1, 2018. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will result in an aggregate increase of $39,349,141 in State Fiscal Year 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: August 7, 2018 Posted: July 31, 2018

MaineCare Benefits Manual Chapter III, Sections 12 and 96

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Concise Summary: SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 12, Chapter III, Allowances for Consumer Directed Attendant Services; and Chapter 101, MaineCare Benefits Manual, Section 96, Chapter III, Private Duty Nursing and Personal Care Services; NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services to amend the rates of reimbursement for personal care and related services under both Chapter 101, MaineCare Benefits Manual, Section 12, Chapter III, Allowances for Consumer Directed Attendant Services, and Chapter 101, MaineCare Benefits Manual, Section 96, Chapter III, Private Duty Nursing and Personal Care Services. The rates will be amended to reflect 100% of the final rates modeled in the February 1, 2016 report Rate Review for Personal Care and Related Services: Final Rate Models prepared by Burns & Associates, Inc. REASON FOR PROPOSED CHANGES: All changes are pursuant to 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an aggregate increase of $3,969,529 in SFY 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: August 7, 2018 Posted: July 31, 2018

MaineCare Benefits Manual Chapter III, Sections 19, 21, and 29

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Concise Summary: SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 19, Chapter III, Home and Community Benefits for the Elderly and Adults with Disabilities; Chapter 101, MaineCare Benefits Manual, Section 21, Chapter III, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder; and Chapter 101, MaineCare Benefits Manual, Section 29, Chapter III, Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder; NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services to amend the rates of reimbursement for personal care and related services under Chapter 101, MaineCare Benefits Manual, Section 19, Chapter III, Home and Community Benefits for the Elderly and Adults with Disabilities. The rates will be amended to reflect 100% of the final rates modeled in the February 1, 2016 report Rate Review for Personal Care and Related Services: Final Rate Models prepared by Burns & Associates, Inc. Also, the Department plans to request approval from the Centers for Medicare and Medicaid Services to amend the rates of reimbursement for services provided to adult MaineCare members with intellectual disabilities or autism under a waiver granted by the federal Centers for Medicare and Medicaid Services for home-based and community-based care on the basis of rates and a methodology established by Department rulemaking. The Chapter 101, MaineCare Benefits Manual, Section 21, Chapter III, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder amended procedure codes are:

• T2017 home support;
• T2017 SC home support with medical add-on;
• T2017 GT home support - remote support;
• T2016 agency home support;
• T2016 agency home support over 168 hours;
• T2016 SC agency home support with medical add-on;
• S5140 shared living foster care, adult, one member;
• S5140 TG shared living foster care, adult, one member, increased level of support;
• S5140 UN shared living foster care, adult, 2 members;
• S5140 UN TG shared living foster care, adult, 2 members, increased level of support;
• T2021 community support;
• T2021 SC community support with medical add-on;
• T2015 career planning;
• T2019 employment specialist services;
• T2019 SC employment specialist services with medical add-on;
• H2023 work support, individual;
• H2023 SC work support with medical add-on;
• H2023 UN work support, group, 2 members;
• H2023 UP work support, group, 3 members;
• H2023 UQ work support, group, 4 members;
• H2023 UR work support, group, 5 members;
• H2023 US work support, group, 6 members;
• T2034 crisis intervention services;
• T2016 U5 home support, family-centered support, one member;
• T2016 TG U5 home support, family-centered support, one member, increased level of support;
• T2016 UN U5 home support, family-centered support, 2 members;
• T2016 UN TG U5 home support, family-centered support, 2 members, increased level of support;
• T2016 UP U5 home support, family-centered support, 3 members;
• T2016 UP TG U5 home support, family-centered support, 3 members, increased level of support;
• T2016 UQ U5 home support, family-centered support, 4 members;
• T2016 UQ TG U5 home support, family-centered support, 4 members, increased level of support;
• T2016 UR U5 home support, family-centered support, 5 or more members; and
• T2016 UR TG U5 home support, family-centered support, 5 or more members, increased level of support.

Furthermore, the Chapter 101, MaineCare Benefits Manual, Section 29, Chapter III, Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder amended procedure codes are:

• T2017 home support, 1/4 hour;
• T2017 GT home support, remote support;
• T2021 community support;
• T2021 SC community support with medical add-on;
• T2019 employment specialist services;
• T2019 SC employment specialist services with medical add-on;
• H2023 work support, individual;
• H2023 SC work support - supported employment with medical add-on;
• H2023 UN work support, group, 2 members;
• H2023 UP work support, group, 3 members;
• H2023 UQ work support, group, 4 members;
• H2023 UR work support, group, 5 members;
• H2023 US work support, group, 6 members;
• T2015 career planning;
• S5150 respite, 1/4 hour;
• S5151 respite, per diem;
• S5140 shared living foster care, adult, one member; and
• S5140 UN shared living foster care, adult, 2 members.

REASON FOR PROPOSED CHANGES: All changes are pursuant to 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. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an aggregate increase of $81,217,539 in SFY 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See https://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: August 7, 2018 Posted: July 31, 2018

MaineCare Accountable Communities Program

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Concise Summary: The Department of Health and Human Services (DHHS) will request approval from the Centers for Medicare and Medicaid Services to make changes to MaineCares Accountable Communities (AC) program, for performance years beginning August 1, 2018. The proposed changes include the following methodology changes, beginning in performance year five: Under the new quality scoring proposal, ACs can receive achievement points and improvement points dependent on their performance on a given quality measure. ACs may receive up to a maximum of two achievement points on each quality measure within each domain, and have the potential to receive supplemental improvement points. Maximum possible points within each domain is equal to the number of achievement points possible within each domain. Total improvement points that contribute to an ACs quality score in a domain cannot exceed a quarter of the total point value possible through achievement points. Point values are totaled at the domain level and then domain level scores are weighted to generate an ACs overall score. o Achievement. An attainment threshold and excellence benchmark will be established for each measure, set at the 25th and 90th percentiles, respectively, of Maine non-AC practices, when available. An AC will receive zero achievement points if its performance score is less than the attainment threshold, two achievement points if its performance score meets or exceeds the attainment threshold, and if its performance score is between the attainment threshold and the excellence benchmark. Achievement points are determined by the following formula: 2*((performance score- attainment threshold)/(excellence benchmark- attainment threshold)). o Improvement. An AC will receive zero improvement points if they do not have a performance score for the quality measure in the previous performance year. An AC will receive zero improvement points if it does not improve the gap between its previous years score and the excellence benchmark by 10%. An AC will receive one improvement point if it improves the gap between its previous years score and the excellence benchmark by 10%. Update the base year used in the Total Cost Of Care (TCOC) analysis to August 1, 2016 " July 31, 2017; Update the claims cap used in the TCOC analysis based on more current data. The claims caps adjustment is used to minimize variations from one year to the next due to AC members with large claims. The proposal is that total annual claims for any individual member in excess of the following claims caps not be included in TCOC: Attributed Members in AC Lead Entity Claims Cap 1,000 1,999 $50,000 2,000 4,999 $155,000 5,000+ $210,000 REASON FOR PROPOSED CHANGES: These changes are being made to ensure the quality measurement aspect of the program is relevant and reflective of Department goals and to ensure the TCOC analysis is using appropriate data. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: There is not expected to be any increase or decrease in annual expenditure due to these changes specifically. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Olivia Alford AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4059 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing)

Comment deadline past Comment Deadline: September 11, 2018 Posted: July 30, 2018

MaineCare Benefits Manual, Chapters II & III, Section 107, Psychiatric Residential Treatment Facilities

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Concise Summary: The Department plans to request approval from the Centers for Medicare and Medicaid Services for the addition of a new covered service for Psychiatric Residential Treatment Facilities (PRTF). The request addresses the PRTFs? covered services, policies and procedures, standards, and reimbursement methodology. This service is intended to address a current gap in Maine?s offering of behavioral health services to youth under the age of 21. The PRTF is being created to specifically address a high need to support Maine?s most vulnerable youth, including: youth in out of state placement, youth stranded in psychiatric hospitalization with no safe discharge option, youth stranded in emergency rooms with no safe placement, and incarcerated youth in need of mental health treatment. PRTFs are federally regulated facilities by the Centers for Medicare and Medicaid Services (CMS) via 42 C.F.R. 441 Subpart D and 42 C.F.R.483 Subpart G. PRTFs will be reimbursed for direct services from qualified practitioners and include a cost-settled component for allowable costs. REASON FOR PROPOSED CHANGES: This rulemaking intends to create a new section of policy describing Psychiatric Residential Treatment Facilities, pursuant to 42 C.F.R. 441 Subpart D and 42 C.F.R.483 Subpart G. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that the costs of this rulemaking are unable to be determined at this time due to the complexity of the rule and inability to accurately determine how many members will seek to access PRTF programs from incarceration, hospitalization, and out of state placement. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M. Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: June 24, 2018 Posted: June 14, 2018

MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to decrease the supplemental pool payments for Non-Critical Access hospitals, Rehabilitation Hospitals, and hospitals classified to a wage area outside of Maine by the Medicare Geographic Classification Review Board (as defined in MBM, Section 45). The Department also plans to increase the Rehabilitation Hospital per discharge rate. The total pool shall equal $71,380,072. Up to $60,000,000 will be allocated to outpatient services, and up to $60,000,000 will be allocated to inpatient services, not to exceed the total supplemental pool amount and not to exceed allowable aggregate upper payment limits. The Medicaid per discharge reimbursement rate provided to rehabilitation hospitals is increasing from $12,440.44 to $15,161.43. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2018, ch. 41, Resolve, Regarding Medicaid Reimbursement for Rehabilitation Hospitals. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral in Federal Fiscal Years 2018 and 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: June 5, 2018 Posted: May 29, 2018

MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment

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Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment (DME) NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services for the following changes to Medical Supplies and Durable Medical Equipment (DME) reimbursement: Updates reimbursement for certain DME items to align with current Medicare rural rates: o Items impacted are those which are required to be in alignment per the scope of the 21st Century Cures Act. Institutes reimbursement methodology for specially modified low protein foods for members with inborn errors of metabolism. Further defines reimbursement methodology for items that are not Medicare covered or are Medicare covered but not impacted by the 21st Century Cures Act. REASON FOR PROPOSED CHANGES: To comply with 42 C.F.R 440.70 and 42 U.S. C. 1396b ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: This rulemaking is estimated to save $411,053 in SFY 2018, which includes $146,581 in state dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Comment deadline past Comment Deadline: June 5, 2018 Posted: May 29, 2018

MaineCare Benefits Manual, Section 92, Chapters II and III, Behavioral Health Home (BHH) Services

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Concise Summary: The Department plans to request approval from the Centers for Medicare and Medicaid Services related to Section 92, Behavioral Health Homes reimbursement. Other changes encompassed surround Pay-for-Performance and minimum billable activities. Please see the attachment for a full description. Please submit any comments or concerns related to these changes via the ?Submit Comments? function below, or by contacting Kristin Cook by email at Kristin.cook@maine.gov; by phone at (207) 624-4006 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: April 11, 2018 Posted: April 3, 2018

MaineCare Benefits Manual, Section 25, Dental Services

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Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to amend coverage of Section 25 dental services by including reimbursement for the procedure codes included in the attached document. Please see the attachment for a full description. Please submit any comments or concerns related to these changes via the ?Submit Comments? function below, or by contacting Tom Leet by email at Thomas.leet@maine.gov; by phone at (207) 624-4068 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: January 8, 2018 Posted: December 28, 2017

MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services (Appendices C and F)

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Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to allow Appendix C and Appendix F, Private Non-Medical Institutions to request an adjustment to a prospective rate and/or a temporary supplemental payment for certain costs related to regulation compliance and/or extraordinary circumstances. Please submit any comments or concerns related to these changes via the ?Submit Comments? function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: October 26, 2017 Posted: October 19, 2017

MaineCare Benefits Manual, Section 45, Chapters II and II, Hospital Services

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Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to make a number of reimbursement and administrative changes to Section 45, Hospital Services. Please see the attached document for a full description. Please submit any comments or concerns related to these changes via the ?Submit Comments? function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: October 13, 2017 Posted: October 3, 2017

MaineCare Benefits Manual, Section 96 Private Duty Nursing and Personal Care Services

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Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to increase the monthly costs caps for Section 96, Private Duty Nursing and Personal Care Services to account for recent reimbursement increases for certain Section 96 services. Please submit any comments or concerns related to this change via the ?Submit Comments? function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: October 10, 2017 Posted: October 2, 2017

MaineCare Benefits Manual, Section 12, CDA Services and Section 96, PDN and PCS

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Concise Summary: Concise summary: In accordance with P.L. 2017 Ch. 284 Sec. MMMMMMM-1, the Department plans to request approval from the Centers for Medicare and Medicaid Services to increase reimbursement for certain personal care and related services under Section 12, Consumer Directed Attendant Services and Section 96, Private Duty Nursing and Personal Care Services. As part of these changes, the Department will implement the corresponding recommendation from the rate study referenced in the budget to change billing of the PCA Supervisit from a 15-minute/unit service to a ?per visit? service. Please submit any comments or concerns related to this change via the ?Submit Comments? function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: September 8, 2017 Posted: September 5, 2017

MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services

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Concise Summary: This SPA aligns the MaineCare Benefits Manual, Section 80, Pharmacy Services with the CMS Covered Outpatient Drug Final Rule (CMS-2345-FC), provides updated reimbursement methodologies, increases the professional dispensing fee for most medications to $11.89, and clarifies existing pharmacy coverage parameters. Please submit any comments or concerns related to this change via the ?Submit Comments? function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: August 23, 2017 Posted: August 15, 2017

MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services

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Concise Summary: The Department plans to submit a State Plan Amendment to increase the supplemental pool dollar amount for Non-Critical Access hospitals, hospitals classified to a wage area outside of Maine by the Medicare Geographic Classification Review Board, and Rehabilitation hospitals in accordance with P.L. 2017 Ch. 284 Sec. ZZZZZZ-9. The Department also seeks to amend the supplemental pool allocation methodology to ensure that the annual supplemental payments do not exceed the allowable upper payment. Please submit any comments or concerns related to this change via the ?Submit Comments? function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: August 5, 2017 Posted: July 26, 2017

MaineCare Benefits Manual, Chapter II, Section 75, Vision Services

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Concise Summary: The Department will submit a State Plan Amendment (SPA) to add 65778, Placement of amniotic membrane on the ocular surface; without sutures, (reimbursed at $629.73) to the Vision Services section of the State Plan. This SPA will also add the existing reimbursement methodology for MaineCare Benefits Manual, Chapter II, Section 75, Vision Services, into the State Plan. Please submit any comments or concerns related to this change via the ?Submit Comments? function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: July 9, 2017 Posted: June 29, 2017

MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services, Appendix C; Section 2, Adult Family Care Services

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Concise Summary: This State Plan Amendment seeks to implement a three and a half (3.5) percent cost-of-living rate increase for Section 2, Adult Family Care Services and Section 97, Appendix C, Private Non-Medical Institution Services for fiscal year ending June 30, 2018. Please submit any comments or concerns related to this change via the "Submit Comments" function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: June 30, 2017 Posted: June 28, 2017

MaineCare Benefits Manual, Section 93, Opioid Health Home Services

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Concise Summary: The Department plans to request approval from the Centers for Medicare and Medicaid Services to implement an Opioid Health Home (OHH) for members with opioid dependency who are receiving Medication-Assisted Treatment (MAT) in the form of buprenorphine, buprenorphine derivatives, and/or naltrexone. OHH care management/care coordination (?health home?) services will be reimbursed at $394.40 per member per month. However, the OHH providers will receive this as part of a bundled rate. Eligible OHH providers must bundle a monthly office visit with the MAT prescriber and counseling related to opioid dependency. The OHH provider may bundle in the reimbursement of the buprenorphine, buprenorphine derivatives, and/or naltrexone medications. The full bundled rate will be $1,000 per member per month. The rate without the medications is $496.00. Please submit any comments or concerns related to this change via the ?Submit Comments? function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: April 10, 2017 Posted: April 5, 2017

MaineCare Benefits Manual, Section 25, Dental Services

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Concise Summary: The Department will request approval to add the following dental procedures codes at the given rates: D1575 ($95.00); D3221 ($88.00), D4346 ($40.00), D9248 ($98.50). Please submit any comments or concerns related to this change via the "Submit Comments" function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: February 26, 2017 Posted: February 16, 2017

MaineCare Benefits Manual, Section 96, Private Duty Nursing and Personal Care Services

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Concise Summary: The Department of Health and Human Services (DHHS) previously requested approval from the Centers for Medicare and Medicaid Services to increase reimbursement for personal care and related services, pursuant to Public Law 2016, Chapter 83 Resolves. Through the corresponding rulemaking process, the Department determined another code in MBM, Section 96, should see a rate increase. This code is T1019 0589, and the rate will be increased to $4.62. The correction of this clerical error is consistent with the rate for the same service under Procedure Code T1019 that was set forth in the rule proposal, and is a benefit to both providers and members. Please submit any comments or concerns related to this change via the "Submit Comments" function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: January 13, 2017 Posted: January 9, 2017

MaineCare Benefits Manual, Section 68, Occupational Therapy Services and Section 85, Physical Therapy Services

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Concise Summary: Effective January 1, 2017, the Current Procedural Terminology coding manual Occupational Therapy codes 97003 and 97004 are being eliminated and replaced with codes 97165, 97166, 97167, and 97168. Effective the same date, the Current Procedural Terminology Physical Therapy coding manual codes 97001, 97002, are being eliminated and replaced with codes 97161, 97162, 97163, and 97164. Please see attachment for proposed rates. Please submit any comments or concerns related to this change via the "Submit Comments" function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: January 2, 2017 Posted: December 22, 2016

MaineCare Benefits Manual, Chapter III, Section 5, Ambulance Services

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Concise Summary: The Department will request approval to institute the following reimbursement rates for Ambulance Services. Medicare-covered codes will be reimbursed at 65% of the current published Maine Medicare area ?99? rates, except for the following services which will continue to be reimbursed at current levels: A0430, A0431, A0434, A0436 . Non-Medicare covered ambulance services will continue to be reimbursed based on the current fee schedule. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine County. To find out where the Maine DHHS offices are, call 1-800-452-1926. Please submit any comments or concerns related to this change via the ?Submit Comments? function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: December 30, 2016 Posted: December 15, 2016

MaineCare Benefits Manual, Section 109, Speech and Hearing Services (UPDATED NOTICE)

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Concise Summary: This entry contains an updated fiscal impact estimate for the addition of the following code to the State Plan: 92586: Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited (see below).

Comment deadline past Comment Deadline: December 9, 2016 Posted: December 8, 2016

MaineCare Benefits Manual, Section 109, Speech and Hearing Services

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Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to add the following procedure code to the Speech and Hearing Services' fee schedule in the State Plan: 92586: Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited. Agency Rate: $37.14 per session, Independent Rate $26.82 per session. The additional code allows providers to bill for limited audiometry and/or testing of the central nervous system; comprehensive audiometry and/or testing is already a covered service. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. Please submit any comments or concerns related to this change via the "Submit Comments" function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.

Comment deadline past Comment Deadline: December 9, 2016 Posted: December 6, 2016

MaineCare Benefits Manual, Section 95, Podiatric Services

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Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to describe the reimbursement methodology for Podiatric Service. The following language does not reflect a change in reimbursement: The fee schedule reimburses at the lowest of the following for covered services: 1) The lowest amount allowed by Medicare Part B for Maine area "99" fee, 2) 47.70% of the 2005 Medicare Part B for Maine area 99 fee or 47.70% of the rate in the first year that Medicare assigned a rate for the code, or 3) Where no other options are applicable, the Department will research other State Medicaid agencies that cover the relevant service/code and base its rates on the average cost of the relevant services/codes from those other agencies. If the provider's usual and customary charge for a service is lower than the fee schedule rate, the providers usual and customary charge will be reimbursed. In addition, the following code will be added to Section 95, Podiatric Services: 97762, Checkout for orthotic/prosthetic use, established patient, each 15 minutes. Reimbursement will be $11.48 for non-facilities, and $7.79 facilities. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. Please submit any comments or concerns related to this change via the Submit Comments function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333. Comments are due by 11:59 PM on Monday, September 19, 2016.

Comment deadline past Comment Deadline: September 19, 2016 Posted: September 8, 2016

CLARIFICATION TO POSTING BELOW: MaineCare Benefits Manual Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services

     

Concise Summary: The comment deadline for MaineCare Benefits Manual Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services is 11:59 p.m. Tuesday, September 13th.

Comment deadline past Comment Deadline: September 13, 2016 Posted: September 8, 2016

MaineCare Benefits Manual Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services

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Concise Summary: The Department of Health and Human Services (DHHS) will request approval from the Centers for Medicare and Medicaid Services to increase reimbursement for personal care and related services, pursuant to Public Law 2016, Chapter 83 Resolves. Please see the attachment for how rates in MaineCare Benefits Manual, Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services will be restructured. To avoid a reduction in services available to members receiving services under Section 96, Private Duty Nursing and Personal Care Services, DHHS will increase the applicable monthly cost caps to account only for the increase in reimbursement. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. Please submit any comments or concerns related to this change via the "Submit Comments" function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333. Comments are due by 11:59 PM on Tuesday, September 6, 2016. Note: This methodology notice was originally published in state newspapers on July 28, 2016.

Comment deadline past Comment Deadline: September 13, 2016 Posted: September 2, 2016