Policy Waivers

The Department plans to submit a waiver amendment in the near future for Section 18, Home and Community Based Services for Adults with Brain Injury. The Department is proposing to make changes to comply with legislative directive 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. The Act provided funding for rate adjustments to reflect the rate models prepared for the Department by Burns & Associates, Inc. Increased rates will be effective starting July 1, 2020. Rates have been increased for Home Support - Level I (Quarter Hour), Home Support Remote Support (Monitor Only), Home Support Remote Support (Interactive Support), Career Planning, Employment Specialist Services, Work Support, and Work Order Clubhouse. Additionally, the Department proposes to increase the cost limit concurrently with the rate increases to ensure waiver members do not lose access to covered services.

The Department is accepting comments from May 29, 2020 through June 28, 2020. Any interested party may obtain a copy of the waiver application by going to the website noted below, or a printed copy may be obtained by emailing at Thomas.Leet@maine.gov. Regional Office for Family Independence locations (a list can be found at this link https://www.maine.gov/dhhs/oms/about-us/contact-us) will also have copies available; however, during the COVID-19 public health emergency the Department encourages individuals to utilize the website or email options in order to maintain social distancing. Regional offices have limited hours for public facing operations at this time that can be viewed on the website.

See https://www.maine.gov/dhhs/oms/about-us/policies-rules/policy-waivers for waiver amendment and to submit comments

STATUTORY AUTHORITY: CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11:59 pm, June 28, 2020.

AGENCY CONTACT PERSON:
Thomas Leet, Long Term Services and Supports Manager
AGENCY NAME: MaineCare Services. ADDRESS: 109 Capitol St. , Augusta, Maine 04333-0011. EMAIL: Thomas.leet@maine.gov. TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Concise Summary:

Notice of Agency Waiver Amendment AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 18, Home and Community-Based Services for Adults with Brain Injury. WAIVER: ME.1082, Home and Community-Based Services for Adults with Brain Injury. CONCISE SUMMARY: The amendment would remove four services that duplicate services that exist in the State Plan. These services are: Community Work Reintegration-Group, Community/Work Reintegration-Individual, Self-Care/Home Management Reintegration-Group, and Self-Care/Home Management Reintegration-Individual. They will remain accessible as State Plan services, MaineCare Benefits Manual, Section 102, but will be removed from this waiver. Currently, no waiver participants are receiving these services through the waiver. The Department will assist any waiver participants who request these services to access them under the State Plan. This change will be effective upon approval of this amendment by the Centers for Medicare and Medicaid Services. DHHS is accepting comments from June 5, 2019 through July 5, 2019. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link https://www.maine.gov/dhhs/ofi/offices/index.html. A printed copy may be obtained by calling Rachel Posner at (207) 624-6951 or emailing rachel.posner@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Friday, July 5, 2019. AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner II AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol Street 11 State House Station Augusta, Maine 04333-0011 rachel.posner@maine.gov TELEPHONE: 207-624-6951 FAX: (207) 287-3373 TTY: 711

Concise Summary:

Notice of Agency Waiver Renewal AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 18, Home and Community-Based Services for Adults with Brain Injury. WAIVER: ME.1082, Home and Community-Based Services for Adults with Brain Injury. CONCISE SUMMARY: The Brief Waiver Description has been changed to reinforce the Departments expectation that each participant has opportunities for full community integration and engagement through promoting the participants autonomy, promoting the dignity of risk and minimizing the individuals dependency on paid support staff. This is achieved through a comprehensive array of services, chosen by the participant, that do not supplant existing natural and non-paid community supports. Information regarding Contact Person(s) has been updated. Home- and Community-Based Settings information has been added (Attachment #2 and Appendix C-5). Participant Access and Eligibility requirements have been revised to emphasize habilitation rather than rehabilitation, by removing the requirement for specific rehabilitation goals (B-3-f and B-6-d). Provisions have also been added regarding procedures and timing for eligible waiver applicants to accept a funded offer, and to start services. Waitlist procedures have been clarified (B-3-f). The Service Description for Care Coordination has been modified, and a provision has been added regarding care coordination services to facilitate discharge from hospital or nursing facility (in C-1/C-3 Service Specification for Care Coordination). The limit in the Service Description for Care Coordination has been modified to 400 units per year. Electronic Visit Verification (EVV) requirement for Home Support-1/4 hour Level I has been added to the Provider Specifications for that service in C-1/C-3. The CBIS certificate name has been updated to Certificate of Fundamentals of Brain Injury in Provider Specifications (C-1/C-3). The annual limit for each waiver participant has been changed to $198,415 (Appendix C-4). Behavioral Regulations Training is being removed (in C-1/C-3), as this training is specific to 14-197 C.M.R. Chapter 5, Regulations Governing Behavioral Support, Modification and Management for People with Intellectual Disabilities or Autism in Maine. This waiver application contains the States behavioral intervention process for individuals with brain injury. This process is further outlined in the MaineCare Benefits Manual, Chapter II, Section 18.11 The CARF requirement has been deleted in Provider Specifications (C-1/C-3) for all services except Home Support-Per Diem Level II, Home Support-Per Diem Level III, and Work-Ordered Day Club House. The description of the Service Plan Development Process has been updated (D-1-d). Appendix G has been updated to reflect revision of State regulations regarding Reportable Events and Adult Protective Services. Appendix H has been updated regarding System Improvements and System Design Changes. Methods for Remediation/Fixing Individual Problems has been updated in Appendices A, B, C, D, and G Performance measures have been revised throughout the renewal. DHHS is accepting comments from December 7, 2018 through January 10, 2019. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html), or a printed copy may be obtained by calling Rachel Posner at (207) 624-6951 or emailing at rachel.posner@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Thursday, January 10, 2019. AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner II AGENCY NAME: MaineCare Services ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 rachel.posner@maine.gov TELEPHONE: 207-624-6951 FAX: (207) 287-1864 TTY: 711

Notice of Agency Waiver Amendment

AGENCY: Department of Health and Human Services, MaineCare Services
RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities.

WAIVER: ME.0276, Home and Community Benefits for the Elderly and Adults with Disabilities

CONCISE SUMMARY: The Department plans to submit a waiver amendment in the near future for Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities. This waiver amendment incorporates internally generated updates to the waiver's appendices including technical and grammatical edits throughout the application. The major changes include the following:

• Updated Appendix A: Waiver Administration and Operation to create consistency across waiver programs;
• Updated the eligibility groups served in this waiver within Appendix B: Participant Access and Eligibility;
• Removed limits on care coordination such that participants may receive unlimited care coordination services based on their medical needs within Appendix C: Service Specifications;
• Included Certified Occupational Therapist Assistant (COTA) under the direct supervision of a Registered Occupational Therapist as a qualified provider of Care Coordination Services within Appendix C;
• Revised the service limit for Personal Care Services within Appendix C: Service Specifications to align waiver requirements and the MaineCare rule;
• Removed all Assistive Technology (AT) services from the monthly program cap within Appendix C: Service Specifications and Additional Limits;
• Included Advanced Practice Providers (Physicians Assistants, Nurse Practitioners, and Clinical Nurse Specialists) as qualified providers to order and recertify a Plan of Care within Appendix C: Participant Services;
• Reduced the minimum age of an Attendant under the Participant-Directed Option to 17 years of age within Appendix C: Service Specifications;
• Added language to further define the Person-Centered Planning (PCP) process, namely that the process is member directed, reflective of individual preferences and goals, and overseen by the Service Coordination Agency (SCA), to align and comply with the federal Home and Community Based Setting Rule within Appendix D: Service Plan Development;
• Clarified roles and responsibilities (including authority to reduce, suspend, or deny services) of the SCA, the Fiscal Intermediary, and the Assessing Services Agency (ASA) Assessor located within Appendix F: Opportunity to Request a Fair Hearing; and
• Amended reimbursement method for the SCA providing care coordination services from fee for service to a per member per month reimbursement within Appendix C: Service Specifications and Appendix I: Financial Accountability.

The Department is accepting comments from November 20, 2020 through December 20, 2020. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov.

See https://www.maine.gov/dhhs/oms/about-us/policies-rules for waiver amendment and to submit comments

STATUTORY AUTHORITY: 42 CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11: 59 pm, December 20, 2020.

AGENCY CONTACT PERSON: Thomas Leet, Long Term Services and Supports Manager
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol St.
Augusta, Maine 04333-0011
EMAIL: Thomas.leet@maine.gov
TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Concise Summary:

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities WAIVER: ME.0276: Home and Community Benefits for the Elderly and Adults with Disabilities CONCISE SUMMARY: The Department plans to submit a waiver amendment in the near future for Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities. The waiver serves older adults and adults with disabilities who need nursing facility level of care to remain at home so they can live independently in their communities. The Department is proposing to make changes to comply with legislative directive 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. The increased rates are effective April 1, 2020. Rates have increased for codes related to Personal Care Services. The Department is also proposing to increase the annual cost limit (Appendix B-2-a) concurrently. The Department proposes to increase the annual cost limit to $78,780, and to increase the monthly cap to $6,565 (Appendix C-4). The Department is accepting comments from May 12, 2020 through June 11, 2020. Any interested party may obtain a copy of the waiver application by going to the website noted below, or a printed copy may be obtained by emailing at Thomas.Leet@maine.gov. Regional Office for Family Independence locations (a list can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html will also have copies available; however, during the COVID-19 public health emergency the Department highly encourages individuals to utilize the website or email options in order to maintain social distancing. Regional offices have limited hours for public facing operations at this time that can be viewed on the website. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by 11: 59 pm, June 11, 2020. AGENCY CONTACT PERSON: Thomas Leet, Long Term Services and Supports Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol St. Augusta, Maine 04333-0011 EMAIL: Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Notice of Agency Waiver Renewal

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities WAIVER: ME.0276, Elderly and Adults with Disabilities Waiver

CONCISE SUMMARY: The Department is planning to submit a renewal of the Elderly and Adults with Disabilities waiver application, known in Maine as Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities. This waiver submission incorporates permanent updates to the waiver's appendices. Some of the proposed appendix updates contained in the waiver renewal include: General: Updated the Brief Waiver Description for clarity and readability.
Ensured compliance with MaineCare Benefits Manual Ch, I, Section 6, Global Home and Community Based Services (HCBS) Waiver Person-Centered Planning and Settings Rule (Global rule) . Where applicable, revised language to align and create consistency with ME.0159 (MaineCare Benefits Manual (MBM) , Section 21), and ME.0995 (MBM Section 20), ME.0467 (MBM Section 29), and ME.1082 (MBM Section 18). Ensured Confidence Interval and Margin of Error reporting is correct for all performance measures.

Appendix A Waiver Administration and Operation: Updated information about agencies/entities with which the Department contracts.

Appendix B Participant Access and Eligibility: Updated language to bring consistency with current Operating Agency practice and MaineCare regulation.

Appendix C Participant Services: Updated, expanded, and/or clarified, where applicable, the descriptions, qualifications, and limits within Service Specifications (C-1/C-3). Strengthened safeguards regarding the hiring of employees by including requirements that providers perform background checks with Adult and Child Protective Services and clarified provisions for background checks within Criminal History and/or Background Investigations (C-2). Added basic requirements for enrollment and regular re-enrollment responsibilities for providers of waiver services, consistent with MaineCare regulations and statutory requirements.

Appendix D Participant-Centered Planning and Service Delivery: Added requirements that providers comply with Maines Global rule. Updated and revised Quality Improvement: Service Plan (a.1.a) performance measure #1 and included a requirement that the Person-Centered Services Plan (PCSP) and Plan of Care includes at least one participant-driven goal.

Appendix E Participant Direction of Services: Included technical and grammatical revisions and updates where applicable for clarity and readability.

Appendix G Participant Safeguards: Revised and updated the description of information and training for participants, families, and legal representatives regarding abuse, neglect, and exploitation. Revised and updated the description of the provider responsibility for oversight, review of, and response to critical incidents and reportable events.

Appendix H Quality Improvement Strategy: Revised and updated the System Improvements description. Expanded upon quality assurance activities by adding a Plan of Corrective Action (POCA) process to ensure providers comply with service requirements, have sufficient clinical and administrative capability to carry out the intent of the service, and have taken steps to assure the safety, quality, and accessibility of the service. Revised and updated the description of the process for monitoring and analyzing the effectiveness of system design changes.

Appendix I Financial Accountability: Updated and revised Financial Integrity and Accountability for clarity and consistency with Maines other 1915(c) waivers. Substantially revised Rates, Billing and Claims to reflect recently passed State legislation providing annual Cost of Living Adjustments (COLA) and requiring that the labor components of rates allow for direct care staff reimbursement of at least 125% of the State minimum wage plus associated benefits.

Appendix J Cost Neutrality Demonstration: Updated Cost Neutrality and Derivation of Estimates for the five years of the waiver renewal cycle (through July 1, 2028).

Please see the accompanying draft application for a complete list of all changes included in the renewal.

DHHS is accepting comments from December 30, 2022, through January 30, 2023. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Lisa Weaver at (207) 624-4050 or emailing lisa.weaver@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments.

STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by 11:59p.m., January 30, 2023.

AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner II AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol Street 11 State House Station Augusta, Maine 04333-0011 Heather.bingelis@maine.gov TELEPHONE: 207-624-4951 FAX: (207) 287-1864 TTY: 711

Concise Summary:

The Maine Department of Health and Human Services (DHHS) is planning to renew the Home and Community-Based Services waiver, known in Maine as Section 19 or the "Elderly and Adults with Disabilities Waiver". This waiver supports members in their homes who are elderly or who need physical assistance. DHHS is proposing to make changes to the total number of participants who can receive services, and revise the performance measures. As part of these changes, CFR 42 441.304 requires a noticing period to inform the public and accept input on these changes. DHHS is accepting comments from February 6, 2018 through March 1, 2018. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html , or a printed copy may be obtained by calling Rachel Posner at (207) 624-6951 or emailing at Rachel.posner@maine.gov. SEE http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Thursday, March 1, 2018. AGENCY CONTACT PERSON: Rachel Posner AGENCY NAME: MaineCare Services ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 Rachel.posner@maine.gov TELEPHONE: 207-624-6951 FAX: (207) 287-1864 TTY: 711

Notice of Agency Waiver Amendment

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 20, Home and Community Based Services for Adults with Other Related Conditions

WAIVER: ME.0995: Home and Community Based Services for Members with Other Related Conditions

CONCISE SUMMARY: The Department plans to submit a waiver amendment in the near future for Section 20, Home and Community Based Services for Adults with Other Related Conditions. The proposed amendment seeks to update the eligibility groups served in Appendix B of this waiver to include the Adult Group as specified in 42 CFR 435.119. Additionally, the proposed amendment attempts to remove an outdated reference in Appendix C-2 limiting homes to only four participants eligible for service.

The Department is accepting comments from February 12th, 2021 through March 14th, 2021. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link https://www.maine.gov/dhhs/about/contact/offices ). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments

STATUTORY AUTHORITY: 42 CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11:59 pm, March 14, 2021.

AGENCY CONTACT PERSON: Thomas Leet, Long Term Services and Supports Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol St. Augusta, Maine 04333-0011 EMAIL: Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Concise Summary:

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 20, Home and Community Based Services for Adults with Other Related Conditions WAIVER: ME.0995: Home and Community Based Services for Members with Other Related Conditions CONCISE SUMMARY: The Department plans to submit a waiver amendment in the near future for Section 20, Home and Community Based Services for Adults with Other Related Condition to comply with federal regulations in the 21st Century CURES Act. The proposed amendment requires every provider of Home Support-Quarter Hour and Personal Care services to comply with Electronic Visit Verification ("EVV") system standards and requirements effective January 1, 2021. The Department is accepting comments from August 28, 2020 through September 27, 2020. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments STATUTORY AUTHORITY: 42 CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by 11: 59 pm, September 27, 2020. AGENCY CONTACT PERSON: Thomas Leet, Long Term Services and Supports Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol St. Augusta, Maine 04333-0011 EMAIL: Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Notice of Agency Waiver Renewal

AGENCY: Department of Health and Human Services, MaineCare Services

RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 20, Home and Community Based Services for Adults with Other Related Conditions

WAIVER: ME.0995: Home and Community Based Services for Adults with Other Related Conditions

CONCISE SUMMARY: The Department is planning to submit a renewal of the Adults with Other Related Conditions waiver, known in Maine as Section 20, Home and Community Based Services (HCBS) for Adults with Other Related Conditions. This waiver submission incorporates permanent updates to the waiver's appendices. Some of the proposed appendix updates contained in the waiver renewal include:

General: Throughout the waiver, updates have been made for compliance with the HCBS Settings Rule. Where applicable, revisions for consistency with ME.0159 (MaineCare Benefits Manual (MBM), Section 21). The Department anticipates that ME.0995-related Reportable Events data will begin to be available via a new platform (Evergreen by FEI Systems) in August 2023. The Department anticipates completing the remaining data migration for ME.0995 (MBM Section 20) in 2025.

Appendix A: Waiver Administration and Operation: Updated information about agencies/entities with which the Department contracts.

Appendix B: Participant Access and Eligibility: Added description of the process by which participants may request an Exception to monetary and unit limitations on services. Clarified that in addition to Registered Nurses and Licensed Clinical Social Workers, the Assessing Services Agency may also employ Licensed Practical Nurses and Qualified Intellectual Disabilities Professionals to perform initial evaluations for level-of-care.

Appendix C-1/C-3 Service Specifications and Provider Specifications: Revisions throughout C-1/C-3 Service Specifications for increased consistency with ME.0159. Added new service, Adult Foster Care/Shared Living. Added 3 tiers for Community Support, i.e., Community Only-Individual, Community-Only-Group, and Community Center-Based. Added 2 tiers for Home Support (Per Diem), i.e., 2-4 beds and 5-6 beds. Added services to support participant direction including Financial Management Services, Supports Brokerage, and Individual Goods and Services. Limit changed to reflect rate increase (Assistive Technology). Updated requirements to permit 17-year-old Direct Service Professionals (DSP) for some services, and added requirements for DSPs who assist with the administration of medication. Added Board Certified Behavioral Analyst (BCBA) for Consultation services.

Other Appendix C: Participant Services: Clarified that a family participant or legal guardian (when the legal guardian is a parent, sibling, or other biological family member) may provide Shared Living services. Added requirement for providers to perform background checks with Adult and Child Protective Services. Added basic requirements for enrollment and ongoing approval as waiver service providers, consistent with current MaineCare regulations currently applicable to ME.0159 (MBM, Section 21) and ME.0467 (MBM, Section 29).

Appendix D: Participant-Centered Planning and Service Delivery: Revised and updated for compliance with HCBS Settings rule requirements and Global HCBS Waiver Person-Centered Planning and Settings Rule (MBM, Ch. I, Section 6).

Appendix E: Participant Direction of Services: Added Appendix E to describe participant direction of services under this waiver.

Appendix G: Participant Safeguards: Revised and updated the description of Maines Reportable Events system. Revised and updated the description of information and training for participants, families, and legal representatives regarding abuse, neglect, and exploitation. Revised and updated the description of the responsibility for oversight, review of, and response to critical incidents and reportable events. Updated regarding safeguards concerning the use of restraints, as well as the use of restrictive interventions, including provisions adopted from ME.1082 (MBM Section 18). Updated regarding medication management and administration. Revised Performance Measures.

Appendix H: Quality Improvement Strategy: Revised and updated description of System Improvements. Added provisions for Plan of Corrective Action (POCA) process to ensure providers compliance with regulations and quality service delivery. Revised and updated the description of the process for monitoring and analyzing the effectiveness of system design changes.

Appendix I: Financial Accountability: Financial Integrity: updated and revised for clarity, and for consistency with Maines other waivers. Rate Determination Methods: substantial revision to reflect recently passed State legislation providing annual Cost of Living Adjustments (COLA) and requiring that the labor components of rates allow for direct care staff reimbursement of at least 125% of the State minimum wage and associated benefits.

Appendix J: Cost Neutrality Demonstration: Cost Neutrality and Derivation of Estimates for the five-year waiver cycle (through July 1, 2028) has been updated and included.

Please see the accompanying draft application for a complete list of all changes included in the renewal.

The Department is accepting comments from December 30, 2022, through January 30, 2023. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Lisa Weaver at (207) 624-4050 or emailing Lisa.Weaver@maine.gov.

See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments.

STATUTORY AUTHORITY: 42 CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m., January 30, 2023.

AGENCY CONTACT PERSON: Heather Bingelis

AGENCY NAME: 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

Concise Summary:

The Maine Department of Health and Human Services (DHHS) is planning to renew the Home and Community-Based Services waiver; known in Maine as Section 20 or the "ORC Waiver." This waiver supports members in their homes who have conditions that would normally require them to live in a nursing facility. This is the first renewal for this waiver. The bed size for waiver group homes has been increased to six beds. The waiver group home system in Maine has many homes with six beds and the limit of four beds has been a barrier to participants' choice and receiving services. In C-4.a., the limit that each waiver participant must stay below has been changed from $161,000.00 to $199,961.00. Also, language referring to PASRR Level II is being removed as this population does not usually have participants with Intellectual Disability or Autism Spectrum Disorder. Reference to a Certified Brain Injury Specialist (CBIS) in provider requirements for Career Planning have been removed, as the language was there erroneously. All other provider requirements have stayed the same. As part of these changes, CFR 42 441.304 requires a noticing period to inform the public and accept input on these changes. DHHS is accepting comments from January 30, 2018 through February 28, 2018. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html or a printed copy may be obtained by calling Ginger Roberts-Scott at (207) 624-4048 or emailing at ginger.roberts-scott@maine.gov. SEE http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Wednesday, February 28, 2018.

Notice of Agency Waiver Amendment

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 21, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder.

WAIVER: ME.0159, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

CONCISE SUMMARY: The Department plans to submit a waiver amendment in the near future for Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder. The Department is proposing to make changes to comply with legislative directive PL 2021 ch. 29, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2022 and June 30, 2023. The Act provided funding for rate adjustments to account for updated wage, benefit and staffing assumptions for Agency Home Support and Agency Home Support with Medical Add-on. The Department is accepting comments from July 23, 2021 through August 23, 2021. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments.

STATUTORY AUTHORITY: 42 CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11:59 pm, August 23, 2021.

AGENCY CONTACT PERSON: Thomas Leet, Long Term Services and Supports Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol St. Augusta, Maine 04333-0011 EMAIL: Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Notice of Agency Waiver Amendment

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 21, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder.

WAIVER: ME.0159, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

CONCISE SUMMARY: The Department plans to submit a waiver amendment in the near future for Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder. The Department is proposing to separate Community Supports into different tiers of service delivery: Community Support-Individual ($11.20 hr), Community Support-Group ($7.13 hr), and Community Support Center-Based ($5.17 hr). The new service tiers will have updated requirements and limits. The three new service tiers will utilize the rate structure reflected in the rate models prepared for the Department in July 2020 by Burns & Associates, Inc. Finally, the Department proposes to increase the associated cost limit concurrently with the rate changes to ensure waiver members do not lose access to covered services.

The Department is accepting comments from March 19, 2021 through April 20, 2021. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov . See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments

STATUTORY AUTHORITY: 42 CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11: 59 pm, April 20, 2021.

AGENCY CONTACT PERSON: Thomas Leet, Long Term Services and Supports Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol St. Augusta, Maine 04333-0011 EMAIL: Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

AGENCY: Department of Health and Human Services, MaineCare Services

RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 21, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder.

WAIVER: ME.0159, Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

CONCISE SUMMARY: The Department plans to submit a waiver amendment in the near future for Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder. The Department is proposing to make changes to comply with legislative directive 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. The Act provided funding for rate adjustments and cap increases to reflect the rate models prepared for the Department by Burns & Associates, Inc. for Section 18, Home and Community-Based Services for Adults with Brain Injury and Section 20, Home and Community Based Services for Adults with Other Related Conditions. The increased rates and caps will be effective starting January 1, 2021. Additionally, this amendment will seek to require the licensing of all Section 21 Home Support- Agency Per Diem settings, commonly called Agency Group Homes.

The Department is accepting comments from August 28, 2020 through September 27, 2020. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link https://www.maine.gov/dhhs/oms/about-us/policies-rules/policy-waivers). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov.

See https://www.maine.gov/dhhs/oms/about-us/policies-rules/policy-waivers for waiver amendment and to submit comments

STATUTORY AUTHORITY: 42 CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11: 59 pm, September 27, 2020.

AGENCY CONTACT PERSON:
Thomas Leet, Long Term Services and Supports Manager
AGENCY NAME:
MaineCare Services
ADDRESS:
109 Capitol St.
Augusta, Maine 04333-0011
EMAIL: Thomas.leet@maine.gov
TELEPHONE: 207-624-4068
FAX: (207) 287-1864 TTY: 711

Concise Summary:

This waiver supports participants with Intellectual Disabilities and Autism Spectrum Disorder. The Department is proposing to amend this waiver to bring consistency between the waiver (ME.0159) and the MaineCare rule (Section 21) regarding payment to legal guardians for providing Shared Living services. The amendment clarifies that services provided directly or indirectly by the legal guardian will not be reimbursed unless the legal guardian is the participant's parent, sibling or other biological family member, and that this provision will not be avoided by adult adoption. This amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS). DHHS is accepting comments from October 1, 2019 through October 31, 2019. Any interested party may obtain a copy of the waiver application by going to the website noted below, or at any regional Office for Family Independence (a list of the offices and locations can be found at this link https://www.maine.gov/dhhs/ofi/offices/index.html . A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing Thomas.leet@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Thursday, October 31, 2019. AGENCY CONTACT PERSON: Thomas Leet, Waiver Services Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol Street 11 State House Station Augusta, Maine 04333-0011 Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Concise Summary:

The State of Maine is planning to amend the Home and Community Based Services waiver, known in Maine as Section 21 of the MaineCare Benefits Manual. This comprehensive waiver supports participants with Intellectual Disabilities and Autism Spectrum Disorder. The Department of Health and Human Services is proposing to make changes to comply with legislative directive P.L. 2017, ch. 459, Parts A and B, which provided funding to increase reimbursement rates for Home Support, Shared Living, Community Support, Career Planning, Employment Specialist Services, Work Support, and Crisis Intervention Services. The increased rates are effective starting July 1, 2018. Appendix J reflects the rate increase in Years 4 and 5. The legislation also provides that the Department ensure that caps and limitations on services are increased to reflect the rate increases. Therefore, DHHS also proposes to raise limits within this waiver, to ensure that rate increases do not result in any decrease in level of services for participants. DHHS proposes to raise the annual limit (funding cap) that includes Community Support and Work Support to $32,623.58, to ensure that rate increases do not result in any decrease in level of services for participants (Appendix C-4-a). In Appendix C, the amendment adds a requirement that all service locations providing Per Diem Home Support must be licensed by the Maine Department of Health and Human Services, Division of Licensing and Certification, effective July 1, 2020. Licensing will provide increased Department oversight for the Per Diem Home Support services that are not currently licensed. This oversight will improve protections for participants, particularly in the areas of health and safety. For additional information on the licensing requirements for Per Diem Home Support, please see http://www.maine.gov/dhhs/oms/rules/. To comply with Federal requirements in the 21st Century CURES Act, DHHS is adding a requirement in Appendix C that providers of Home Support-1/4 Hour must comply with Maine DHHS Electronic Visit Verification system standards and requirements. This requirement will be effective January 1, 2020. Additionally, DHHS is proposing to increase the number of participants served by this waiver. P.L. 2017, ch. 460, Part A provided funds to add new participants to this waiver, beginning October 1, 2018. For Years 4 and 5 of this waiver, DHHS proposes to raise the unduplicated number of participants to 3,473, from 3,190 (Appendix B-3-a), and the number of participants served at any point in time to 3,373, from 3,100 (Appendix B-3-b). DHHS is accepting comments from April 2, 2019 through May 2, 2019. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link https://www.maine.gov/dhhs/ofi/offices/index.html, or a printed copy may be obtained by calling Rachel Posner at (207) 624-6951 or emailing at rachel.posner@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments

Concise Summary:

Concise Summary:

The Maine Department of Health and Human Services (DHHS) is planning to amend the Home and Community-Based Services waiver, known as Section 21 or the "Comprehensive Waiver." DHHS is proposing to make changes to comply with legislative directive P.L. 2017, Ch. 284, § MMMMMMM-2, which increases funding for Home Support, Shared Living, Community Support, Career Planning, Employment Specialist Services, Work Support, and Crisis Intervention Services. The increased rates are effective July 1, 2017 to June 30, 2018. Appendix J reflects the temporary rate increase in the third year. Additionally, DHHS is proposing to make a change in Appendix B-3. f. Selection of Entrants to the Waiver to be consistent with the adoption of the state rule making changes to the criteria for the Priority 1 wait list for a funded opening for the waiver. The expansion of the Priority 1 waitlist applies to participants who do not yet meet the need for Adult Protective Services, but: (1) whose primary caregiver has reached the age of 65 or has a terminal illness; (2) who have no other responsible or willing caregiver; and (3) who satisfy at least one and are at risk of another additional risk factors. Performance measures have also been updated in Appendices A, B, C, D, G, and I. DHHS is accepting comments from March 27, 2018 through April 25, 2018. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html), or a printed copy may be obtained by calling Rachel Posner at (207) 624-6951 or emailing at rachel.posner@maine.gov. SEE http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments STATUTORY AUTHORITY: CFR §441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Wednesday, April 25, 2018. AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner AGENCY NAME: MaineCare Services ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011 rachel.posner@maine.gov TELEPHONE: 207-624-6951 FAX: (207) 287-1864 TTY: 711

Concise Summary:

The Department is planning to renew the Intellectual Disabilities or Autism Spectrum Disorder waiver, known in Maine as Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder. This waiver renewal incorporates internally-generated updates to the waiver's appendices. The following are appendix updates: Appendix A: Waiver Operational and Administrative Functions have been updated. Appendix B: Eligibility Groups Served in the Waiver and Post-Eligibility Treatment of Income have been updated. Appendix C: Service Definitions for Per Diem Home Support, Adult Foster Care/Shared Living, Home Support - Quarter Hour, Work Support-Individual, Work Support-Group, Community Support, Career Planning, and Family Centered Support have been revised to incorporate requirements for the federal Home and Community-Based Services Settings Rule. Service Definitions for Per Diem Home Support, Adult Foster Care/Shared Living, Community Support, Work Support-Group, Work Support-Individual, Family Centered Support, Employment Specialist, Career Planning, and Counseling have been updated for accuracy and completeness. Provider Qualifications have been updated for Direct Support Professional for Career Planning, Employment Specialist, Work Support-Group, and Work Support-Individual. Counseling Services will be phased out, effective December 31, 2020. These services are accessible through the State Plan. Work Support-Group will be phased out effective December 31, 2020, consistent with the federal Home and Community-Based Services Settings Rule. No new participants and no new providers will be added to Family-Centered Support effective December 31, 2020. Members currently living in these homes may continue to receive this service. Payment for services furnished by relatives (C-2-e) has been revised/updated to bring consistency between the waiver and the MaineCare rule regarding payment to legal guardians for providing Shared Living services. A Provisional Provider Approval was added to C-2-f. Appendix D: Plan Development has been updated. Qualifications for Mental Health and Childrens Case Management have been added. Appendix F: The State Grievance and Complaint System has been updated. Appendix G: Protocols and processes for reportable events; critical incidents; and allegations of abuse, neglect and/or exploitation have been updated and included. Removed one performance measure in G-c. Added one performance measure in G-d. Appendix H: The System Improvement Plan has been updated. Appendix I: Financial Integrity, Accountability, and Rate Setting Methodology have been updated. Appendix J: Cost Neutrality and Derivation of Estimates for the five years of the waiver renewal (through June 30, 2025) have been updated and included. DHHS is accepting comments February 3, 2020 through March 4, 2020. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov . See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Wednesday, March 4, 2020. AGENCY CONTACT PERSON: Thomas Leet, Long-Term Services and Supports Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol Street 11 State House Station Augusta, Maine 04333-0011 Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Concise Summary:

The Section 21 Waiver Amendment was submitted to CMS on October 12, 2016. Please see the version that was submitted after the public comment period. Also, please see the public comments about the changes and the Department's responses. Please contact Ginger Roberts-Scott with questions.

Concise Summary:

The Section 21 waiver will be amended with a requested effective date of January 1, 2017 to remove the Supports Intensity Scale (SIS) that was going to be added as the assessment instrument and resource allocation tool. The Department is deleting four new services, as they were dependent on the SIS structure: Semi-Independent Supported Living, Qualified Extra Support Service, Skilled Nursing for Persons with Intellectual Disability or Autism Spectrum Disorder, and Respite.

The Department is removing references to Goold Health Systems (GHS) conducting SIS assessments. Changes have been made to provider qualifications; a typographical error was corrected to say CPR and First Aid. The state rule has required this of providers, so this is not a change but a correction in the WMS waiver application.

The Department is adding an additional six hours of continuing education to provider qualifications for Career Planning. Home Accessibility Adaptation has been changed to state that this service in not available in a family's home who is also a provider. The Behavior Regulations for Persons with Intellectual Disability have been updated. Institution has been clarified.

The quality review for Sections 21- Home and Community-Based Benefits for Adults with Intellectual Disabilities or Autism Spectrum Disorder and 29- Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder are also being condensed so that only one report will need to be submitted to CMS.

The Centers for Medicare and Medicaid Services (CMS) set standards for amending a waiver, and 42 CFR § 441.304 requires that if substantive changes are being done to a waiver, the state must provide public notice of any significant proposed change in methods and standards for setting payment rates for services.

The waiver amendment is posted on the MaineCare Services website at this link titled "Section 21 Waiver amendment".

Please go to: http://www.maine.gov/dhhs/oms/rules/index.shtml

The waiver amendment has been posted and comments are being accepted for 30 days (July 22-August 21, 2016) to allow for public input. There is a link included on the website to submit comments to Ginger Roberts-Scott at MaineCare Services. A copy of the waiver amendment may be viewed at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/DHSaddresses.htm ) or a printed copy may be obtained by calling Ginger Roberts-Scott at 207-624-4048 or emailing at ginger.roberts-scott@maine.gov.

Concise Summary:

The Centers for Medicare and Medicaid (CMS) has implemented new rules governing Medicaid-funded Home and Community-Based Services (HCBS) authorized under § 1915(c) of the Social Security Act. The new rules set standards for amending a waiver, and 42 CFR § 441.304 requires that if substantive changes are being done to a waiver, the State must provide public notice of any significant proposed change in methods and standards for setting payment rates for services. The waiver renewal has been posted and comments are being accepted for 14 days to allow for public input. There is a link included on the website to submit comments to Ginger Roberts-Scott at MaineCare. Please contact Ginger with any questions at 207-624-4048 or via email at ginger.roberts-scott@maine.gov

Notice of Agency Waiver Amendment

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Spectrum Disorder.

WAIVER: ME.0457: Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

CONCISE SUMMARY: The Department is planning to amend the Home and Community-based Services waiver ME.0467, known in Maine as Section 29 of the MaineCare Benefits Manual. The Department is proposing to make changes to comply with legislative directive PL 2021 ch. 29, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2022 and June 30, 2023. The Act provided funding to increase the unduplicated member count from 3035 to 3755 (Appendix B-3-a), and the point in time member limit from 2870 to 3590 (Appendix B-3-b) during the current waiver cycle. The Department is accepting comments from September 10, 2021 through October 10, 2021. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence location (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov . See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments.

STATUTORY AUTHORITY: 42 CFR 441.304

DEADLINE FOR COMMENTS: Comments must be received by 11: 59 pm, October 10, 2021

AGENCY CONTACT PERSON: Thomas Leet, Long Term Services and Supports Manager thomas.leet@maine.gov AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol St. Augusta, Maine 04333-0011 EMAIL: Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Concise Summary:

Notice of Agency Waiver Amendment AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Spectrum Disorder WAIVER: ME.0457: Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder CONCISE SUMMARY: The State of Maine is planning to amend the Home- and Community-based Services waiver, known in Maine as Section 29 of the MaineCare Benefits Manual. The waiver serves participants with Intellectual Disabilities and Autism Spectrum Disorder. DHHS is proposing to make changes to comply with legislative directive P.L. 2017, ch. 459, Parts A and B, which provided funding to increase reimbursement rates for Home Support, Shared Living, Community Support, Employment Specialist Services, Work Support, Career Planning, and Respite services. The increased rates are effective starting July 1, 2018. Appendix J reflects the rate increase in years three through five. The legislation also provides that the Department ensure that caps and limitations on services are increased to reflect the rate increases. Therefore, DHHS also proposes to raise limits within this waiver, to ensure that rate increases do not result in any decrease in level of services for participants. The annual limit for participants who receive Home Support, Community support, or Shared Living will increase to $58,168.50 (Appendix C-4), and the annual limit for Respite Services will increase to $1,224.60 per year (Appendix C1/C3). Additionally, DHHS is proposing to increase the number of participants served by this waiver. DHHS proposes to raise the unduplicated number of participants to 2,635 for years three through five (Appendix B-3-a). For years three through five, DHHS proposes to raise the number of participants served at any point in time to 2,470 (Appendix B-3-b). To comply with federal requirements in the 21st Century CURES Act, DHHS is adding a requirement in Appendix C that providers of Home Support-1/4 Hour and Respite services in the home must comply with Maine DHHS Electronic Visit Verification system standards and requirements. This requirement will be effective January 1, 2020. Performance measures have been updated in Appendices A, B, C, D, G, and I. These revisions will make the performance measure in this waiver (ME.0467) consistent with those in ME.0159. Appendix G, Participant Safeguards, has been updated to reflect changes in Maine's regulations governing Reportable Events (14-197 C.M.R. Ch. 12) and Adult Protective Services (10-149 C.M.R. Ch. 1). DHHS is accepting comments from October 30, 2018 through November 29, 2018. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html), or a printed copy may be obtained by calling Rachel Posner at (207) 624-6951 or emailing at rachel.posner@maine.gov. See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver renewal and to submit comments. STATUTORY AUTHORITY: CFR §441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Thursday, November 29, 2018. AGENCY CONTACT PERSON: Rachel Posner, Comprehensive Health Planner AGENCY NAME: MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 Rachel.posner@maine.gov TELEPHONE: 207-624-6951 FAX: (207) 287-1864 TTY: 711

Concise Summary:

The Maine Department of Health and Human Services (DHHS) is planning to amend the Home and Community-Based Services waiver; known in Maine as Section 29 or the "Supports Waiver". This waiver supports members with Intellectual Disabilities and Autism Spectrum Disorder. DHHS is proposing to add Shared Living (Adult Foster Care) as a service to this waiver. At the same time, DHHS would like to change the limit of combined services from $23,985.00 to $52,425.00; a member may receive Home Support, Shared Living, or Community Support and must remain under this new limit for these services combined. Work Support will be removed from the combined limit. These changes are being made to comply with legislative directive P.L. 2017, Ch 284, §§ MMMMMMM-2. Additionally, DHHS would like to change the limit on Respite from $1,000.00 a year to $1,100.00 a year. DHHS is proposing to increase the unduplicated member count from 2,078 to 2,150 and the point in time member limit from 1,850 to 2,000. This will allow DHHS to offer more funded openings to members and increase the number of members who can get care. The State is also responding to P. L. 2017, ch. 284 and increasing funding for Home Support, Community Support, Employment Specialist Services, Work Support, Career Planning, Respite and Shared Living, which is a new service being added in this waiver amendment, for one year. The increased rates are effective 7/1/17 to 6/30/18. Appendix J reflects the temporary rate increase in year 2. Lastly, DHHS would like to update the name for the service Transportation to Non-Medical Transportation, which is the correct term for the service. The waiver manager's name has been updated as well. As part of these changes, CFR 42 §441.304 requires a comment period to accept public input on these changes. DHHS is accepted comments October 19-November 26, 2017. However, noticed a clerical error and is re-noticing this waiver amendment December 8, 2017 through January 8, 2018. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/DHSaddresses.htm ), or a printed copy may be obtained by calling Ginger Roberts-Scott at (207) 624-4048 or emailing at ginger.roberts-scott@maine.gov. SEE http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments STATUTORY AUTHORITY: CFR §441.304 DEADLINE FOR COMMENTS: Comments must be received by midnight, Monday, January 8, 2018. AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: MaineCare Services ADDRESS: 242 State Street, SHS#11 Augusta, Maine 04333-0011 Ginger.roberts-scott@maine.gov TELEPHONE: 207-624-4048 FAX: (207) 287-1864 TTY: 711

Concise Summary:

AGENCY: Department of Health and Human Services, MaineCare Services RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder. WAIVER: ME.0467, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Waiver CONCISE SUMMARY: The Department is planning to renew the Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder waiver, known in Maine as Section 29 of the MaineCare Benefits Manual. This waiver renewal incorporates internally-generated updates to the waiver's appendices. Some of the major changes in the renewal are as follows: Appendix A: Updated Waiver Operational and Administrative Functions. Appendix B: Updated Individual Cost Limits, including Participant Safeguards, Eligibility Groups Served in the Waiver, Number of Individuals Served, Post-Eligibility Treatment of Income, Level of Care Method of Remediation, Freedom of Choice, and Access to Services. Appendix C: Revised Service Definitions for Adult Foster Care/Shared Living, Home Support - Quarter Hour, Work Support-Individual, Work Support-Group, Community Support, and Career Planning to incorporate requirements for the federal Home-and Community-Based Services Settings Rule. Updated Service Definitions for Home Support-Quarter Hour, Home Support-Remote Support, Work Support, Adult Foster Care/Shared Living, and Career Planning for accuracy and completeness. Separated Community Supports into different tiers of service delivery: Community Only-Individual, Community Only-Group, and Center-Based, to more broadly support individualized needs of the participant population. The new services will have updated requirements and limits. Updated Provider Qualifications for a Direct Support Professional delivering Career Planning, Community Support, Home Support (Quarter Hour & Remote), and Adult Foster Care/Shared Living. Updated Provider Agency Standards for Career Planning. Revised/updated payment for services furnished by relatives (C-2-e) to align waiver language and the MaineCare rule regarding circumstances under which payment to legal guardians for providing Shared Living services can be made. Added Provisional Provider Approval to C-2-f. Updated limits on Sets of Services (C-4) to include an exceptions process, additional service limitations and updated annual cost limit. Appendix D: Updated and revised Service Plan Development, including Process, Risk Mitigation, Informed Choice, approval, Monitoring, and Quality Improvement Measures, for accuracy and completeness. Added qualifications for Case Managers and Social Workers. Appendix F: Updated Opportunity to Request a Fair Hearing, Dispute Resolution, and the State Grievance and Complaint System, for completeness and accuracy. Appendix G: Updated Response to Critical Events, Safeguards Concerning Restraints, and Medication Monitoring for completeness and accuracy. Included protocols and processes for reportable events; critical incidents; and allegations of abuse, neglect and/or exploitation. Amended and updated performance measures for the next waiver cycle. Appendix H: Updated the System Improvement Plan to align with the HCBS Quality Framework. Appendix I: Updated Financial Integrity, Accountability, and Rate Setting Methodology. Furthermore, rates and caps have been amended to comply with legislative directive 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. The rates for certain services will now reflect the rate models prepared for the Department by Burns & Associates, Inc in July 2020. Appendix J: Updated and included Cost Neutrality and Derivation of Estimates for the five years of the waiver renewal (through December 31, 2025). DHHS is accepting comments August 14, 2020 through September 13, 2020. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Thomas Leet at (207) 624-4068 or emailing thomas.leet@maine.gov . See http://www.maine.gov/dhhs/oms/rules/index.shtml for the complete waiver renewal draft with all proposed changes and to submit comments STATUTORY AUTHORITY: CFR 441.304 DEADLINE FOR COMMENTS: Comments must be received by 11: 59 PM, September 13, 2020. AGENCY CONTACT PERSON: Thomas Leet, Long-Term Services and Supports Manager AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 Thomas.leet@maine.gov TELEPHONE: 207-624-4068 FAX: (207) 287-1864 TTY: 711

Concise Summary:

The Department of Health and Human Services is preparing to submit a waiver renewal application for Section 29 to the Centers for Medicare and Medicaid (CMS). In accordance with 42 CFR §441.304, the Department must engage in a public input process on the changes to the waiver application and allow for a comment period. Any interested party may obtain a copy of the waiver application by going to the website noted below, at any regional Office for Family Independence (a list of the offices and locations can be found at this link http://www.maine.gov/dhhs/DHSaddresses.htm ), or a printed copy may be obtained by calling Ginger Roberts-Scott at (207) 624-4048 or emailing at ginger.roberts-scott@maine.gov . The Department is renewing Section 29 with no major changes. This waiver renewal has had some changes made to it but no major structural or rate changes are included. Appendix A has been updated with a new waiver manager. Appendix B has been updated. B-1 has had eligibility language changed to conform to the DSM V; the term Autism Spectrum Disorder is being used. No participant eligibility changes are expected as a result of this change. B-3 has been updated with new unduplicated member count, as well as the point in time number. B-4 has been updated to reflect that §1931 has been split into three groups. B-5 has been updated to comply with spousal impoverishment rules as required by §2404 of the Affordable Care Act. Appendix C has had provider qualifications updated, with reference to the statute involved with the training requirement. Career Planning training requirements have been changed from 6 to 12 hours. Respite has had extraneous language removed. Language in Appendix G and H have been updated. Performance measures have been updated and rewritten. SEE http://www.maine.gov/dhhs/oms/rules/index.shtml for a copy of the waiver renewal.

Notice of Waiver Amendment

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

RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Section 113, Non-Emergency Transportation Waiver

CONCISE SUMMARY: The Office of MaineCare Services (OMS) is filing an application with the federal Centers for Medicare & Medicaid Services (CMS) to renew and amend Maine's Non-Emergency Transportation (NET) waiver. CMS requires periodic renewal of all waivers, including this waiver which authorizes Maine to use a brokerage system to provide MaineCare members with transportation to non-emergency covered services. The proposed renewal would have a duration of 5 years. The primary purpose of this submission is to renew the waiver to continue to be able to provide non-emergency transportation to MaineCare members. OMS is also proposing the following amendments which represent a change from the prior waiver:

In accordance with federal requirements, using a single capitation rate per region determined by the State rather than allowing bidders to select from a range of actuarially sound rates, and making related changes to RFP requirements. This results in bidders for the brokerages competing on quality and experience alone, since the cost is fixed Revising performance measures and reporting periods Indicating that a new RFP is being issued and contractors may change Updating the list of non-English languages Making other minor and technical amendments

For a full list of all changes, please view the draft waiver amendment. The waiver amendment has been posted on the OMS website at: https://www.maine.gov/dhhs/oms/about-us/policies-rules/policy-waivers. In addition, a copy of the waiver application may be viewed at any regional Office for Family Independence. A list of the offices and locations can be found at: https://www.maine.gov/dhhs/about/contact/offices.

To allow for public input on the waiver amendment, OMS is accepting comments for 30 days. There is a link included on the website to submit comments to Lisa Weaver at the OMS Policy Division.

DEADLINE FOR COMMENTS: Comments must be received by midnight on Friday, November 4, 2022.

AGENCY CONTACT PERSON: Lisa Weaver, Planning and Research Associate, Policy Division AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 EMAIL: Lisa.Weaver@maine.gov TELEPHONE: 207-624-4050 FAX: (207) 287-1864 TTY: 711.

Concise Summary:

Maine's Non-Emergency Transportation (NET) waiver is being amended. Throughout the implementation of Maines Medicaid Expansion, the Department indicated to the Centers for Medicare and Medicaid Services (CMS) its intent that expansion members would be eligible to receive NET services. While CMS previously confirmed their understanding and approved Maines authority to provide NET services to the expansion population, the Department was recently advised that it also needs to add the expansion population to the NET waiver. The purpose of this waiver amendment is to formally add coverage of the expansion population, also known as the New Adult Group, under sections 1902(a)(10)(A)(i)(VIII) of the Social Security Act, and 42 CFR 435.119. The waiver amendment has been posted on the Office of MaineCare Services website at: http://www.maine.gov/dhhs/oms/rules/index.shtml and a copy of the waiver application may also be viewed at any regional Office for Family Independence. A list of the offices and locations can be found at: http://www.maine.gov/dhhs/ofi/offices/index.html. Comments are being accepted for 30 days to allow for public input. There is a link included on the website to submit comments to Kristin Merrill at MaineCare. DEADLINE FOR COMMENTS: Comments must be received by midnight Wednesday, March 11, 2020. AGENCY CONTACT PERSON: Kristin Merrill, State Plan and Policy Development Manager AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 Kristin.Merrill@maine.gov TELEPHONE: 207-624-4006 FAX: (207) 287-1864 TTY: 711

Concise Summary:

The waiver is being renewed. This waiver renewal has had some changes made to it, but no major structural changes are included. The State contact and finance personnel have been updated. Financial information and dates have been updated. The Centers for Medicare and Medicaid Services (CMS) has implemented new rules governing Medicaid-funded services authorized under 1915(b) of the Social Security Act. The new rules set standards for amending a waiver, and 42 CFR 441.304 requires that if substantive changes are being done to a waiver, the State must provide public notice of any significant proposed change in methods and standards for setting payment rates for services. The waiver renewal has been posted and comments are being accepted for 30 days to allow for public input. There is a link included on the website to submit comments to Ginger Roberts-Scott at MaineCare. Please contact Ginger with any questions, or for a hard copy, at 207-624-4048 or via email at ginger.roberts-scott@maine.gov. A copy of the waiver application may also be viewed at any regional Office for Family Independence. A list of the offices and locations can be found at: http://www.maine.gov/dhhs/DHSaddresses.htm.