MaineCare Notice of Agency Major Substantive Rulemaking Adoption, MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Below, please find a MaineCare Notice of Agency Major Substantive Rulemaking Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.
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Notice of Agency Major Substantive Rulemaking Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
PROPOSED RULE NUMBER: 2023-P173
CONCISE SUMMARY:
The Department is finally adopting the following changes to this major substantive rule:
The Department has added new services, effective March 1, 2024, which will be reimbursed pursuant to this rule:
- Home Support - Quarter Hour (Self-Directed)
- Shared Living – Two Members served
- Shared Living - One Member, Increased level of support
- Shared Living - Two Members, Increased level of support
- Home Accessibility Adaptations (Self-Directed)
- Home Accessibility Adaptations Repairs (Self-Directed)
- Assistive Technology – Devices (Self-Directed)
- Assistive Technology – Transmission (Self-Directed)
- Community Support - Community Only – Individual (Self-Directed)
- Community Support - Community Only - Individual (Provider-Managed)
- Community Support - Community Only – Group
- Financial Management Services (Self-Directed)
- Supports Brokerage (Self-Directed)
- Individual Goods and Services (Self-Directed)
Provision of these services was originally implemented through the Appendix K: Emergency Preparedness and Response authority in response to the COVID-19 Public Health Emergency, which was approved by the Centers for Medicare & Medicaid Services (CMS) but was not added to MBM Chapter II, Section 29 at that time. The Department has permanently added these services to the Chapter II, Section 29 rule, when it adopted the rule amendment, which was legally effective on January 24, 2024. The Department received approval from CMS for the added services and for the increased reimbursement rates, in the Section 29 § 1915(c) home and community-based services waiver. MBM Chapter II, Section 29 had a prospective legal application date of March 1, 2024, for the new services.
The reimbursement provisions in this rule, for the new services listed above, have a retroactive effective date of March 1, 2024, while the annual cost of living increase provision is effective retroactive to January 1, 2024. Other changes in Chapter III, Section 29 are effective upon final adoption of this rule. As a result, both the new services and provisions for their reimbursement share the same legal effective date. Retroactive application, authorized by 22 M.R.S. § 42(8), benefits and does not harm MaineCare Members or providers.
The Department received CMS approval of provisions for reimbursing the newly added services in this rule with an effective date of March 1, 2024.
In accordance with 22 M.R.S. §§ 7402 and 3173-J, the Department implements annual rate adjustments every January 1st. Specifically, Section 29 services that have standard unit rates and that did not receive a rate adjustment within the prior twelve months will receive an annual adjustment equal to the annual increase in the Maine minimum wage, in accordance with 26 M.R.S. § 664(1).
The rule language provides that rates are sufficient to allow reimbursement for services provided by essential support workers to equal to at least 125% of the minimum wage established in 26 M.R.S. § 664. Essential support workers are individuals who by virtue of employment generally provide to individuals direct contact assistance with activities of daily living or instrumental activities of daily living or have direct access to provide care and services to clients, patients or residents regardless of the setting. 22 M.R.S. § 7401. This annual rate adjustment is effective retroactive to January 1, 2024. This retroactive application is authorized by 22 M.R.S. § 42(8), as this benefits and does not harm any MaineCare member or provider.
After this rule was approved by the Legislature, it was brought to the attention of the Department that the precise statutory directive in 22 M.R.S. Sec. 7402(1), was that the Department needed to ensure that the COLA increase would be sufficient to ensure that the labor components of the reimbursement rates (not the entire reimbursement rate) for essential support workers equaled at least 125% of the minimum wage established in 26 M.R.S. Sec. 664. After conferring with the Office of the Attorney General, the Department determined it would not make a change to the rule language, but rather inserted a “NOTE” into the rule. The Department will enforce the precise statutory directive in 22 M.R.S. Sec. 7402(1).
The Department removed reimbursement rates from the rule in accordance with 22 M.R.S. § 3173-J. All Section 29 reimbursement rates are now solely listed on the MaineCare Provider Fee Schedule, which is posted on the Department’s website.
The Maine State Legislature authorized final adoption of this Ch. III major substantive rule. Resolves 2023, ch. 133 was approved by Governor Mills on March 6, 2024. The final adopted rule makes the permanent changes to this rule as required by the Maine State Legislature. The Resolve contained an emergency clause, so that the legislation took effect when approved, on March 6, 2024. Pursuant to the Maine Administrative Procedure Act, this final major substantive rule shall become effective thirty days after filing with the Secretary of State’s Office. 5 M.R.S. §8072(8).
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
ADOPTION DATE: May 30, 2024
AGENCY CONTACT PERSON: Heather Bingelis, Comprehensive Health Planner
AGENCY NAME: Division of Policy
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
EMAIL: heather.bingelis@maine.gov
TELEPHONE: (207)-624-6951 FAX:(207) 287-6106
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