MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual Chapter III, 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.
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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 III, Section 65, Behavioral Health Service
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
The Department of Health and Human Services (the “Department”) adopts this rule to repeal and replace the prior 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services.
The Department adopts this rule to comply with P.L. 2021, Ch. 398 (the “Budget”) and P.L. 2021, Ch. 635 (the “Supplemental Budget”). Per the Budget, the rule adopts increased medication management rates. This provision will be effective retroactive to October 1, 2021, as directed by the Supplemental Budget, and in alignment with 22 M.R.S. § 42(8), which authorizes the Department to adopt retroactive rules that do not have any adverse financial impact on any MaineCare provider or member. The Department received CMS approval for these rate changes in January 2022.
Additionally, pursuant to Legislative directive and funding, the rule will incorporate updates to Chapter III from an independent rate study recommending increases to rates for Substance Use Disorder Intensive Outpatient Program (IOP) services. This provision will be effective retroactive to January 1, 2022, pursuant to 22 M.R.S. § 42(8). On March 31, 2022, the Department submitted a request for changes to its SPA to implement these changes.
Also, pursuant to Legislative directive and funding, from the Budget as well as the Supplemental Budget, the rule adopts cost-of-living adjustments (COLAs) for services that have not received a rate adjustment in the prior 12 months, according to appropriate criteria for calculating COLAs. This provision will be effective retroactive to July 1, 2022, pursuant to 22 M.R.S. § 42(8). On September 30, 2022, the Department submitted a request for changes to its SPA to implement these changes.
The Department is adopting a separate rule for Chapter II, Section 65, simultaneous with this adopted rule. The adopted changes in Chapter II include the addition of various new IOP Services including Mental Health, Developmental Disabilities/Behavioral Health, Geriatric, Dialectical Behavior Therapy, and Eating Disorder (Level I and Level II). The Department also adopted a new modifier (ST) for use with the H2021 code, for reimbursement tracking purposes of the Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) treatment modality, which is already allowable under Children’s Comprehensive Community Support Services – HCT-Master’s Level. This Chapter III rulemaking will adopt rates from an independent rate study for the new IOP Services pursuant to Legislative directive and funding from the Budget. These reimbursement rates shall be effective prospectively, upon the legal effective date of the adopted rule.
Throughout the rule, the Department adopts language consistent with the adopted Chapter II rule 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 made the following change to the final rule:
- As a result of the Department’s review, the Department finds that it must delete the term LADC because it was erroneously included in the proposed rule under the designated Substance Use Agency codes of H0004 (Outpatient Services – Individual/Family Therapy) and H0004 HQ (Outpatient Services – Group Therapy). See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: November 9, 2022
AGENCY CONTACT: Melanie Miller, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4087 FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
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