MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual Chapter II Section 65
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 Notice of Agency Rule-making Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, Chapter 101, MaineCare Benefits Manual, Chapter II, Section 65, Behavioral Health Services
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
The Department of Health and Human Services (“the Department”) adopted this rule to finalize the following changes to 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter II, Section 65, Behavioral Health Services.
The Department adopts this rule to incorporate various new Intensive Outpatient Program (IOP) Services to be covered in Chapter II, including Mental Health, Developmental Disabilities/Behavioral Health, Geriatric, Dialectical Behavior Therapy, and Eating Disorder (Level I and Level II) IOPs. The adopted rule updates Substance Use IOP requirements and establishes requirements for new IOP services to include: IOP service and staff requirements, general and specific member eligibility criteria, as well as program requirements.
To align with federal regulations under 42 C.F.R. Part 8, the Department adopts language in Chapter II replacing the term “Medication Assisted Treatment with Methadone (MAT)”, with the term, “Opioid Treatment Program (OTP) with Methadone.” The adopted Chapter II rule also updates requirements for OTPs, under Section 65.05-11, to align with the federal regulation including Counseling, Substance Use Disorder Testing, Medication Administration, and Facility Operation requirements in 42 C.F.R. § 8.12.
To reduce barriers to services and administrative burden to providers, the Department adopts a change in the definition of the Crisis Resolution Services “treatment episode” under 65.05-1, from limiting the service to “six (6) face-to-face visits and related follow up phone calls over a thirty (30) day period after the first face-to-face visit,” to “face-to face visits and related follow up phone calls, as clinically indicated, for up to a sixty-day period after the first face-to-face visit.” Additionally, the Department adopts the removal of language from Section 65.07-5(B) that limited substance use individual and family outpatient therapy to three (3) hours per week, for thirty (30) weeks in a forty (40) week period. Each of these changes provide broader access to these Section 65 services.
The rule also adopts clarifications on qualified staff allowed to provide Crisis Resolution Services (65.05-1) and Crisis Residential Services (65.05-2) to include Clinicians (as defined in 65.01-11), Mental Health Rehabilitation Technicians (MHRTs), Behavioral Health Professionals (BHPs), or Direct Support Professionals (DSPs) with Certification at the level appropriate for the services being delivered and for the population being served.
As a result of comments, the Department determined not to adopt a rule change that would have removed the requirement that licensed Mental Health Agencies and Substance Use Agencies must separately contract with the Office of Child and Family Services and/or the Office of Behavioral Health.
The adopted rule reorganizes requirements related to Individualized Treatment Plans in 65.08-4(B) and updates requirements for treatment plans for members receiving OTP services.
In addition and separately, the Department is adopting rulemaking to repeal and replace the former Ch. III of Section 65. The changes in Chapter III, Section 65 make it consistent with the Chapter II-related updates, and related budget initiatives that require reimbursement increases for Section 65 providers, per P.L. 2021, ch. 398. The Chapter III, Section 65 rulemaking shall be filed simultaneously, so that the upcoming changes will be effective at the same time these changes in Chapter II, Section 65 are finally adopted.
Throughout the rule, the Department adopted edits to language to make updates to formatting, citations, and references where necessary, including changes to address potentially stigmatizing language based on recommendations from the Maine opioid task force and legislation passed in 2018 to minimize stigma (P.L. 2017, ch. 407).
The Department shall seek CMS approval for the new covered services and provider requirements, as specifically noted in various adopted rule changes.
Considering public comment, in addition to the changes to the adopted rule described above, the Department made the following changes to the adopted rule:
- Pursuant to Comment #4, The Department updated its definition of Serious Emotional Disturbance in 65.01-41 to align with national standards through SAMHSA.
- Pursuant to Comment #11, 65.05-5.A.2.a has been updated from “Intake and Comprehensive Assessment” to “Intake and service assessment” to reflect the purpose of the assessment under the IOP program.
- Pursuant to Comment #1, 65.07-6 has been updated to remove the prohibition of billing the Comprehensive Assessment separately from final rule.
- Pursuant to Comment #12, 65.07-6 has been updated to add “Members may receive additional outpatient services as medically necessary when the treating condition(s) is distinct from the condition(s) addressed by the IOP.”
- Pursuant to Comment #16, 65.05-1 been amended to change “specific to the population being served” to read “…at the level appropriate for the services being delivered and appropriate for the population being served” to allow for staff types to serve members when appropriate to do so.
- Pursuant to Comment #21, 65.05-5.B.2.a has been updated to note the physician evaluation must be clinically indicated. The change is as follows:
“Assessment by a Clinician; and evaluation by a physician (MD/DO) as clinically indicated, as part of the service assessment; and…”
- Pursuant to Comment #24, 65.05-6.C.2 has been updated to add “or” after each of the at risk criterion to clearly state a member meet one of a-d.
- Pursuant to Comment #25, to 65.05-5.D.5 was updated to add “Otherwise Specified Feeding or Eating Disorder” and “Unspecified Feeding or Eating Disorder” in the final rule.
- Pursuant to Comment #31, 65.05-9.A.1.e was updated to add “or caregiver involvement, when appropriate.”
- Pursuant to Comment #38, 65.08-4.A.1-3 was updated to fix the numbering error.
- Pursuant to Comment #39, the final rule updated references to amend the title of the “Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood” and to update to the current version 5 (“DC: 0-5”).
- As a result of legal review, the Department finds that it must update the definition of “Affected Other” has been updated to more clearly state the “Affected Other” have a familial relationship to the member.
- As a result of legal review, the Department finds that it must make technical edits to 65.05-9.A for clarity and readability.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: November 9, 2022
AGENCY CONTACT PERSON: Dean Bugaj, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4045 FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
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