MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapters II and III, Section 45
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, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter II, Section 45, Hospital Services and Chapter III, Section 45, Principles of Reimbursement for Hospital Services
CONCISE SUMMARY: This letter gives notice of adopted rule: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 45, Hospital Services and Chapter III, Section 45, Principles of Reimbursement for Hospital Services.
The Department adopts the following changes:
A. CHAPTER II, SECTION 45, HOSPITAL SERVICES
The adopted rule adds Outpatient Partial Hospitalization Services as a covered service for MaineCare members. These services may be offered by Acute Care Non-Critical Access Hospitals, Acute Care Non-Critical Access hospital-based clinics, or in a distinct part of the Acute Care Non-Critical Access Hospital, if allowed by the Hospital’s license. These programs provide intensive psychiatric care that is more intensive than outpatient day treatment but less intensive than an inpatient program. Upon admission, a physician must certify that the member would need inpatient hospitalization services if the partial hospitalization services were not provided. The certification must include the diagnosis and psychiatric need for partial hospitalization. The adopted rule also allows for Certified Intentional Peer Support Specialist (someone who has undergone the training for this specialty and who maintains their certification) to be part of the multi-disciplinary team that provides Outpatient Partial Hospitalization Services.
After public comment, the Department declined to adopt the proposed rule change that required Hospital Emergency Departments to make referrals to designated Health Home providers. Instead, the adopted rule requires that Hospital Emergency Departments include discharge instructions for eligible individuals with chronic conditions to contact designated Health Home providers as required under the Social Security Act (SSA), Title 19, 42 U.S.C. Section 1945 (d).
After public comment, the Department received CMS approval for several changes to the rule and updated the language in the adopted rule to reflect these approvals. The Department finds that these changes are necessary to improve clarity in the rules and to accurately reflect CMS’ approval.
B. CHAPTER III, SECTION 45, PRINCIPLES OF REIMBURSEMENT FOR HOSPITAL SERVICES
The adopted rule adds Ch. III, Sec. 45.07, Value-Based Purchasing (VBP) Supplemental Sub-Pool, pursuant to P.L. 2021, ch. 398. The VBP Supplemental Sub-Pool distributes $600,000 annually, to eligible hospitals (acute care non-critical access, critical access, and hospitals reclassified to a wage area outside of Maine) that participate in the MaineCare Accountable Communities initiative (defined by Ch. III, Sec. 45.01-1). The funds are distributed based on performance of one or more quality measures. The Department ranks each eligible hospital based on the quality measures and allocates the funds according to performance, weighted by its Hospital Service Area.
Pursuant to Resolves 2021, Ch. 119, the adopted rule also provides reimbursement for members discharged from Southern Maine Health Care’s psychiatric inpatient unit in the amount of $10,166 per distinct discharge effective retroactively to October 1, 2021.
The adopted rule also eliminates the need for annual rulemaking to update the supplemental pool amounts. The specific dollar amounts for the supplemental pools have been removed from the rule and replaced with a link to the MaineCare website and a phone number, which the public can call for detailed information on annual supplemental pool amounts. Ch. III, Sec. 45.04-1(C); 45.08.
The proposed rule included a change to Ch. III, Sec. 45.03(3), which would have removed payments for graduate medical education costs in non-rural hospitals. After reviewing the public comments, the Department declines to adopt this provision of the proposed rule. The original language of this section remains unaltered in the adopted rule.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: October 24, 2022
AGENCY CONTACT PERSON: Derrick Grant, Special Projects
AGENCY NAME: Division of Policy
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
EMAIL: derrick.grant@maine.gov
TELEPHONE: (207)-624-6931 FAX: (207) 287-6106
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