MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

Aug 23, 2023

Notice of Agency Rule-making Proposal

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:

CONCISE SUMMARY: The Department is proposing to make the following changes to this major substantive rule:

The Department is adding new services which will be reimbursed pursuant to this rule:

• Home Support - Quarter Hour (Self-Directed)
• Shared Living - One member, Increased level of support
• Shared Living - Two members, Increased level of support
• Community Support - Community Only - Individual
• Community Support - Community Only - Group
• Community Support - Community Only - Individual (Self-Directed)
• Home Accessibility Adaptations (Self-Directed)
• Home Accessibility Adaptations Repairs (Self-Directed)
• Assistive Technology - (Monitoring feature/device, stand alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified) (Self-Directed)
• Financial Management Service
• Supports Brokerage
• Individual Goods and Services

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 CMS but was not added to the Ch. II, Sec. 29 rule at that time.  Appendix K expires on November 11, 2023, and the Department is concurrently going through APA rulemaking for Ch. II, Section 29, to add these services to that rule. The Ch. II, Section 29 rule is a routine technical rule and is being proposed separately in anticipation of its being legally effective on or before November 12, 2023. The Department is proposing a retroactive application date of November 12, 2023, for the rates for the new services in this Chapter III rulemaking, so that both the new services and their rates share the same legal effective date.  This retroactive application is authorized by 22 M.R.S. 42(8), as having the retroactive rates for the new services will benefit, and does not harm MaineCare members or providers.

 In accordance with 22 M.R.S. §7402, the Department proposes to implement 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 increase equal to the annual increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W), for the Northeast Region, or its successor index, as published by the United States Department of Labor, Bureau of Labor Statistics or its successor agency.  This increase will  ensure 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. Section 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.  The Department proposes that this annual rate adjustment have a retroactive application date of January 1, 2024. This retroactive application is authorized by 22 M.R.S. Sec. 42(8), as this benefits, and does not harm, any MaineCare member or provider.

As authorized by 22 M.R.S. §3173-J, the Department proposes to remove reimbursement rates from the rule. The Department proposes that all Section 29 reimbursement rates will now be solely listed on the MaineCare Provider Fee Schedule, which is posted on the Department’s website.  

The Department intends to seek permanent approval from the Centers for Medicare & Medicaid Services (CMS) for the added services and for the increased reimbursement rates.

Pursuant to 5 M.R.S. Sections 8071 and 8072, the Department expects that the Commissioner will provisionally adopt this rule after the public hearing and responses to public comments, and then 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.

See http://www.maine.gov/dhhs/oms/rules/index.shtml  for rules and related rulemaking documents.

STATUTORY AUTHORITY: 22 M.R.S. §§ 42 and 42(8), 3173, 3173-J, and 7401 to 7404

DATE FILED WITH THE SECRETARY OF STATE’S OFFICE: August 15, 2023

PUBLIC HEARING: The Department will hold a combined in-person and remote (via Zoom) public hearing.

Date and Time:            September 11, 2023, 12:00 PM Eastern Time (US and Canada)

Location:                       State Office Building, Conference Rooms A & B

                                         109 Capitol Street, Augusta, ME          

Zoom Meeting link:     https://mainestate.zoom.us/j/88458657517

Meeting ID:                    884 5865 7517

Some devices may require downloading a free app from Zoom prior to joining the public hearing event.

The Department requests that any interested party requiring special arrangements to attend the hearing in person contact the agency person listed below before Friday, September 8, 2023.

In addition to the public hearing, individuals may submit written comments to DHHS by the date listed in this notice.

COMMENT DEADLINE: Comments must be received by 11:59 PM on September 21, 2023.

AGENCY CONTACT PERSON:           Heather Bingelis, Comprehensive Health Planner II

AGENCY NAME:                                  MaineCare Services

ADDRESS:                                             109 Capitol Street, 11 State House Station, Augusta, Maine 04333-0011

TELEPHONE:                                    207-624-6951 FAX: (207) 287-6106

                                                            TTY: 711 (Deaf or Hard of Hearing)

EMAIL:                                              heather.bingelis@maine.gov

IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.