Statewide HCBS Transition Plan

Maine's Final Statewide Transition Plan For Implementing The Federal Home & Community-Based Services Rule

Notice of Second Public Comment Period for Home and Community-Based Services (HCBS) Settings AGENCY: Department of Health and Human Services, Office of MaineCare Services RULE TITLE OR SUBJECT: The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) has published regulations that define the settings in which it is permissible for states to pay for Medicaid HCBS services. For the aspects of the rule that apply to HCBS settings, states have until March 2023 to align the state's policies, programs, and provider settings with the federal settings criteria. States must submit a Statewide Transition Plan (STP) that describes the states overall strategies, processes, and resources it will deploy to complete all implementation efforts by the end of the transition period. The STP is required as part of ensuring Maine comes into full compliance with the federal regulations.

Maines Final STP describes the strategies, processes, and resources the state has deployed to complete all efforts necessary to come into full compliance with the federal regulations by the end of the transition period afforded to the state. The Final STP serves as the states roadmap for implementing the federal HCBS rule and outlines a detailed work plan and timeline for ensuring that all settings in which HCBS services are provided comply with the federal standards by March 17, 2023. The state held a public comment period on the Final STP from April 20, 2022, to May 20, 2022, and hosted a public hearing May 10, 2022.

In accordance with the federal regulations, Maine is required to hold a second public comment period regarding settings that were deemed to have isolating qualities and to require Heightened Scrutiny Review, but which were not included in the initial public comment period. The list of these settings is available here: http://www.maine.gov/dhhs/oms/rules/transition-plan.shtml The Department welcomes your comments related to these settings and their ability to overcome their isolating qualities by March 17, 2023.

WAIVERS: The following waivers are subject to the new federal and state requirements within CMS 2249-F/CMS 2296-F:

Section 18, Home- and Community-Based Services for Adults with Brain Injury (ME 1082) Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities (ME 0276) Section 20, Home and Community Services for Adults with Other Related Conditions (ME 0995) Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder (ME 0159) Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Disorder (ME 0467).

SUMMARY: Pursuant to 42 CFR 441.301(c)(6), Home and Community-Based Settings: Compliance and Transition, Maine Department of Health and Human Services gives notice of a second public comment period specific to settings identified as having isolating qualities which require Heightened Scrutiny Review. Maines HCBS Statewide Transition Plan and Appendices as initially posted for public comment in April-May 2022, as well as the list of settings on which comment is sought, are available online at http://www.maine.gov/dhhs/oms/rules/transition-plan.shtml. Maines Final HCBS Statewide Transition Plan was submitted to CMS on July 19, 2022 and will be effective upon CMS approval.

STATUTORY AUTHORITY: 42 CFR 441.301(c)(6) PUBLIC COMMENTS:

The Department welcomes public comments on the remaining settings identified as having isolating qualities which require Heightened Scrutiny Review. Comments may be submitted by 11:59 p.m. on September 30, 2022: OMS rulemaking mailbox; or HCBS.DHHS@maine.gov

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

RULE TITLE OR SUBJECT: The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) has published regulations that define the settings in which it is permissible for states to pay for Medicaid HCBS services. The Statewide Transition Plan is required as part of ensuring Maine comes into full compliance with the federal regulations.

This Final STP describes the strategies, processes, and resources the state has deployed to complete all efforts necessary to come into full compliance with the federal regulations by the end of the transition period afforded to the state. The Final STP serves as the state's roadmap for implementing the federal HCBS rule and outlines a detailed work plan and timeline for ensuring that all settings in which HCBS services are provided comply with the federal standards by March 17, 2023.

WAIVERS: The following waivers are subject to the new federal and state requirements within CMS 2249-F/CMS 2296-F:

Section 18, Home- and Community-Based Services for Adults with Brain Injury (ME 1082) Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities (ME 0276) Section 20, Home and Community Services for Adults with Other Related Conditions (ME 0995) Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder (ME 0159) Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Disorder (ME 0467).

SUMMARY: Pursuant to 42 CFR 441.301(c)(6), Home and Community-Based Settings: Compliance and Transition, Maine Department of Health and Human Services gives notice that Maines Final HCBS Statewide Transition Plan has been released for a 30-day public comment period. The full public notice and revised Maine HCBS Statewide Transition Plan are available online at http://www.maine.gov/dhhs/oms/rules/transition-plan.shtml. Maines Final HCBS Statewide Transition Plan will be submitted to CMS in July 2022 and will be effective upon CMS approval.

For the aspects of the rule that apply to HCBS settings, states have until March 2023 to align the states policies, programs, and provider settings with the federal settings criteria. States must submit a Statewide Transition Plan (STP) that describes the states overall strategies, processes, and resources it will deploy to complete all implementation efforts by the end of the transition period. The STP describes Maines efforts to implement the federal HCBS rule with fidelity and outlines a detailed work plan and timeline for ensuring that all settings in which HCBS services are provided comply with the federal standards by March 2023.

The State of Maine is using the federal rule as a catalyst for implementing other improvements to policy, payment, and practice associated with Medicaid-funded HCBS to improve access to and quality of HCBS services and options throughout the state. As such, the state will continue to work with stakeholders on several additional systems change efforts that complement the vision of the federal HCBS rule.

STATUTORY AUTHORITY: 42 CFR 441.301(c)(6) DATE, TIME AND PLACE OF PUBLIC HEARING: May 10, 2022, 10:00 AM Eastern Time (US and Canada)

Due to the ongoing threat posed by COVID-19, DHHS has determined that its public hearing will be conducted solely remotely, via Zoom. This is in accordance with the DHHS Remote Rulemaking Hearings Policy issued September 10, 2021.

The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before May 3, 2022.

The Department welcomes public comments on Maines Final HCBS Statewide Transition Plan. Comments may be submitted: In writing to the agency contact person listed below; or OMS rulemaking mailbox; or HCBS.DHHS@maine.gov

Zoom Meeting link: https://mainestate.zoom.us/j/81668467764 Meeting ID: 816 6846 7764 One tap mobile +13017158592,,81668467764# US (Washington DC) +13126266799,,81668467764# US (Chicago) Dial by your location +1 301 715 8592 US (Washington DC) +1 312 626 6799 US (Chicago) +1 646 876 9923 US (New York) +1 253 215 8782 US (Tacoma) +1 346 248 7799 US (Houston) +1 408 638 0968 US (San Jose) +1 669 900 6833 US (San Jose) Meeting ID: 816 6846 7764 Find your local number: https://mainestate.zoom.us/u/kcflxx8EVz

In addition to the public hearing, individuals may submit written comments to DHHS by the date listed in this notice.

COMMENT DEADLINE: May 20, 2022 by 11:59 p.m. (EST)

AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner II heather.bingelis@maine.gov AGENCY NAME: MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: 207-624-6951 FAX: (207) 287-6106 TTY: 711 (Deaf or Hard of Hearing)

Concise Summary:

CMS APPROVAL OF MAINE'S INITIAL STATEWIDE TRANSITION PLAN The Offices of MaineCare Services and Aging and Disability Services are pleased to announce the Centers for Medicare and Medicaid Services (CMS) has granted initial approval of Maines Statewide Transition Plan (STP) to bring settings into compliance with the federal home and community-based services (HCBS) regulations found at 42 CFR Section 441.301(c)(4)(5) and Section 441.710(a)(1)(2). In January 2014, the federal Centers for Medicare & Medicaid Services (CMS) released a new rule regarding Home- and Community-Based Services (HCBS) which took effect March 17, 2014. The rule requires that people who receive home- and community-based services and supports funded through Medicaid (known as MaineCare in Maine) must receive those services and supports in settings (places) that meet specific standards. The standards are designed to ensure the settings are truly home- and community-based. This means that individuals receiving services in these settings have full access to the greater community and can enjoy all of the benefits of community living. The rule came into effect after a five-year federal rulemaking process with multiple public comment periods during which over 2,000 comments were submitted from across the country, including comments from individuals with disabilities and their families. The overall goal is to ensure all HCBS programs provide a setting and experience that is very distinct from an institution [e.g. a hospital, nursing facility or intermediate care facility for people with intellectual disabilities (ICF-IID)]. The STP is intended to serve as the states roadmap for implementing the federal HCBS rule with fidelity and outlines a detailed work plan and timeline for ensuring that all settings in which HCBS services are provided comply with the new standards by March of 2022. The state of Maine is deeply committed to not only implementing the federal HCBS requirements with fidelity, but to use the rule as a catalyst for implementing other improvements to policy, payment, and practice associated with Medicaid-funded HCBS in an effort to improve access to and quality of HCBS services and options throughout the state. As such, the state has been working with stakeholders on a number of additional systems-change efforts that complement the vision of the federal HCBS rule. As outlined in the STP, Maine has an aggressive work plan ahead to achieve final STP approval from CMS by March 2022. We look forward to working with our partners in reaching this goal. Maines approved initial STP can be viewed at: https://www.maine.gov/dhhs/oms/rules/transition-plan.shtml

Concise Summary:

The Maine Department of Health and Human Services, pursuant to the requirements of the Centers for Medicare and Medicaid Services' (CMS) Home- and Community-Based Services (HCBS) Rule at 42 CFR 441.301(c)(6), gives notice that the revised Maine HCBS Statewide Transition Plan has been released for a 30-day public comment period. The full public notice and revised Maine HCBS Statewide Transition Plan are available online at http://www.maine.gov/dhhs/oms/rules/transition-plan.shtml The revised Maine HCBS Statewide Transition Plan will be submitted to CMS in April 2020 and will be effective upon CMS approval. For the aspects of the rule that apply to HCBS settings, states have until March 2022 to ensure alignment of the states policies, programs, and provider settings with the federal settings criteria. States must submit a Statewide Transition Plan (STP) that describes the states overall strategies, processes, and resources it will deploy to complete all implementation efforts by the end of the transition period. The STP is also intended to serve as the states roadmap for implementing the federal HCBS rule with fidelity and outlines a detailed work plan and timeline for ensuring that all settings in which HCBS services are provided comply with the new standards by March 2022. The State of Maine is deeply committed to implementing the federal HCBS requirements with fidelity, and is using the rule as a catalyst for implementing other improvements to policy, payment, and practice associated with Medicaid-funded HCBS in an effort to improve access to and quality of HCBS services and options throughout the state. As such, the state has been working with stakeholders on several additional systems change efforts that complement the vision of the federal HCBS rule.

Concise Summary:

The State of Maine has submitted a revised HCBS Transition Plan on June 23, 2016, based on feedback from CMS. Above is a copy of the plan. A copy of the Transition Plan may also viewed at any regional Office for Family Independence (regional DHHS office). A printed copy may be obtained by calling Ginger Roberts-Scott at 207-624-4048 or emailing her at ginger.roberts-scott@maine.gov.

Concise Summary:

The Centers for Medicare and Medicaid Services (CMS) has implemented new rules governing Medicaid-funded Home and Community-Based Services (HCBS) authorized under §1915(c), §1915(i) and §1915(k) of the Social Security Act. The new rules set standards for person-centered planning, conflict-free case management, and the settings in which HCBS is provided. The rules became effective March 17, 2014. For the standards that apply to HCBS settings, DHHS must submit a "Transition Plan" to CMS. The Transition Plan must document compliance with the rules and develop a plan for addressing noncompliance. A copy of the Transition Plan 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.