MaineCare Notice of Agency Major Substantive Rulemaking Provisional Adoption, Chapter III, Section 29
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Below, please find a MaineCare Notice of Agency Rulemaking Provisional Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.
Notice of Agency Major Substantive Rulemaking Provisional 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
The Department is provisionally 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 and Medicaid Services (CMS) but was not added to MBM Chapter II, Section 29 at that time. The Department is concurrently going through APA rulemaking for Chapter II, Section 29 to permanently add these services to that rule. The Department also is seeking and anticipates approval from CMS for the added services and for the increased reimbursement rates, in proposed amendments to the Section 29 § 1915(c) home and community-based services waiver. The Chapter II, Section 29 rule is a routine technical rule and is being adopted separately. MBM Chapter II, Section 29 has a prospective legal application date of March 1, 2024, for the new services.
This provisionally adopted Chapter III, Section 29 rule contains what will be a retroactive effective date of March 1, 2024, for reimbursement provisions for the new services listed above, and of January 1, 2024 for the annual cost of living increase provision in the rule; the effective date of other changes in Chapter III, Section 29 will be the effective date of the finally adopted rule following Legislative review and approval. As a result, both the new services and provisions for their reimbursement will 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.
Until the Department receives CMS approval of provisions for reimbursing the newly-added services, the Department will continue to implement these flexibilities under the Appendix K: Emergency Preparedness and Response authority in accordance with State Medicaid Director (SMD) Letter # 23-004.
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). This increase also ensures 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.
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.
Pursuant to 5 M.R.S. §§ 8071 and 8072, the Commissioner provisionally adopts this rule and will submit the rule to the Legislature for approval. This rule will have legal effect only after review by the Legislature followed by final adoption by the Commissioner.
As a result of public comments and further review by the Department and the Office of the Attorney General, there were additional minor changes to the adopted rule language for purposes of clarity. Importantly, the Department corrected the rate table by changing the “Unit of Service” for Shared Living Services from “1/4 hour” to “Per Diem”, added the modifiers for “Community Only-Individual”, “Community Only-Group” (UA and UB, respectively) service delivery methods, as well as for “Increased Level of Support” to the list of Modifiers and Modifier Descriptions on page (8) of the rule, and updated the rule to include statutory requirements for 22 M.R.S. §§ 3173-J and 7402.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
PROVISIONAL ADOPTION DATE: January 11, 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:
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