MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter II, Section 45, Hospital Services and Chapter III, Section 45, Principles of Reimbursement for Hospital Services
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 Proposal. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services, Office of MaineCare Services
CHAPTER NUMBER AND TITLE:
- 10-144 C.M.R., Chapter 101, Ch.II, Section 45, Hospital Services
- 10-144 C.M.R. Chapter 101, Ch. III, Section 45, Principles of Reimbursement for Hospital Services
PROPOSED RULE NUMBER:
CONCISE SUMMARY: This rulemaking proposes the following changes.
Ch. II
Adds language to Chapter II, 45.07-1, Discharge Planning, that requires Hospital Emergency Departments to establish procedures for referring eligible individuals with chronic conditions who seek or need treatment in a hospital emergency department to designated Health Home providers as required under the Social Security Act (SSA), Title 19, 42 U.S.C. Section 1945 (d).
Adds language for a new service, Partial Hospitalization Services.
Ch. III
Amends Chapter III, Section 45.01, Definitions, to include Accountable Communities (AC) Initiative.
Adds Section 45.02-9, Value-Based Purchasing (VBP) Supplemental Sub-Pool, pursuant to P.L. 2021, ch 398. The Value-Based Supplemental Sub-Pool distributes $600,000 to eligible hospitals (acute care non-critical access, critical access, and hospitals reclassified to a wage area outside of Maine) that participate in MaineCare programs that incent improved health outcomes and reduced cost of care for the MaineCare program. Standards for distribution of the pool funds can be found on the OMS website, and the public can obtain a printed copy by calling OMS.
Amends Chapter III, Section 45.03 to provide reimbursement for members discharged from Southern Maine Health Care’s psychiatric inpatient unit in the amount of $10,166 per distinct discharge effective October 1, 2021, pursuant to Resolves 2021, ch. 119, Resolve, Regarding Reimbursement for Providing Inpatient Care to Individuals with Acute Mental Health Care Needs. This change can be made retroactively pursuant to 22 M.R.S. Sec. 42(8), as the change has a positive impact on the provider.
Additionally, in order to eliminate the need for annual rulemaking to update supplemental pool amounts, the Department proposes the following changes to Chapter III, Sections 45.04 and 45.07.
Section 45.04-1(C): Removal of supplemental pool dollar amounts from the rule and addition of a link to the MaineCare website and a phone number which the public can call for detailed information on annual supplemental pool amounts.
Section 45.07: Removal of supplemental pool dollar amounts and addition of a link to the MaineCare website and a phone number which the public can call for detailed information on annual supplemental pool amounts.
Replaces references to "substance abuse" with references to "substance use disorder" pursuant to P.L. 2017, ch. 407, An Act To Implement the Recommendations of the Task Force To Address the Opioid Crisis in the State Regarding Respectful Language, Part B.
http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: Resolves 2021, ch. 119; P.L. 2017, ch. 407, Part B; and P.L. 2021, ch. 398.
DATE FILED WITH THE SECRETARY OF STATE’S OFFICE: May 25, 2022
DATE, TIME. AND PLACE OF PUBLIC HEARING: June 14, 2022, 09:00 AM Eastern Time (US and Canada)
Due to the ongoing threat posed by COVID-19, DHHS has determined that its public hearing will be conducted solely remotely, via Zoom. This is in accordance with the DHHS Remote Rulemaking Hearings Policy issued September 10, 2021.
Zoom Meeting Link: https://mainestate.zoom.us/j/84162152721
Meeting ID: 841 6215 2721
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Meeting ID: 841 6215 2721
Find your local number: https://mainestate.zoom.us/u/kdNityBE7z
In addition to the public hearing, individuals may submit written comments to DHHS by the date listed in this notice.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on June 24, 2022.
AGENCY CONTACT PERSON: Derrick Grant, MaineCare Policy derrick.grant@maine.gov
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station, Augusta, Maine 04333-0011
TELEPHONE: 207-624-6931 FAX: (207) 287-6106
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
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