MaineCare Notice of Agency Waiver Amendment-ME.0467, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Waiver

Apr 13, 2023

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 MaineCare Notice of Agency Waiver Amendment. You can access the complete details at www.maine.gov/dhhs/about/rulemaking.

Notice of Agency Waiver Amendment

AGENCY:  Department of Health and Human Services, MaineCare Services

RULE TITLE OR SUBJECT: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

WAIVER: ME.0467, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Waiver

CONCISE SUMMARY: The Department is planning to submit an amendment to the Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Home and Community Based Services (HSBS) 1915(c) waiver application, known in Maine as Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder. Some of the proposed appendix updates contained in the waiver amendment include:

General:

• Updated and revised the Brief Waiver Description for clarity and readability.
• Updated and revised Home and Community-Based Settings Waiver Transition Plan regarding Maine’s Final Statewide Transition Plan for compliance with the HCBS Settings rule.
• Ensured compliance with MaineCare Benefits Manual (MBM) Ch, I, Section 6, Global HCBS Waiver Person-Centered Planning and Settings Rule.
• Where applicable, updated and revised language to align and create consistency with Maine’s other 1915(c) HCBS waiver authorities -  ME.1082 (MBM, Section 18), ME.0995 (MBM, Section 20), and ME.0159 (MBM, Section 21).

Appendix A Waiver Administration and Operation:

• Updated and revised information about agencies/entities with whom the Department contracts.

Appendix B Participant Access and Eligibility:

• Strengthened safeguards for waiver Participants by adding a “Request for Exceptions” process to ensure that Participants receive adequate and appropriate services and supports in the most integrated setting to meet their needs, consistent with the Americans with Disabilities Act (ADA), and with health and safety requirements.
• Updated number of individuals served in B-3 a., Unduplicated Participants Served and B-3 b., Number of Participants Served at any Point in Time, for accuracy and to align with historical trends.

Appendix C Participant Services:

• Updated, expanded, and/or clarified, where applicable, the descriptions, limits, and provider qualifications within Service Specifications (C-1/C-3), including adding service descriptions for Self-Direction opportunities including Financial Management Services (FMS), Supports Brokerage Services, and Individual Goods and Services.
• Strengthened safeguards regarding the hiring of employees by including requirements that providers perform background checks with Adult and Child Protective Services and clarified provisions for the same within Criminal History and/or Background Investigations (C-2).
• Updated and revised requirements to permit provider agencies to hire Direct Support Professionals (DSPs) who are seventeen (17) years of age.
• Updated and revised limits on maximum dollar amounts for certain HCBS waiver services where applicable.
• Updated and revised requirements for enrollment and regular re-enrollment responsibilities for providers of HCBS waiver services, consistent with MaineCare regulations and statutory requirements.
• Updated and revised Other State Policies Concerning Payment for Waiver Services Furnished by Relatives/Legal Guardians incorporating allowances related to Participant-Directed Services as described Appendix E.  

Appendix D Participant-Centered Planning and Service Delivery:

• Added requirements that providers comply with Maine’s Global HCBS Waiver Person-Centered Planning and Settings Rule (MBM, Ch. I, Section 6).
• Updated and revised the Person-Centered Service Planning (PCSP) planning process consistent with MBM, Ch. I, Section 6.

Appendix E: Participant Direction of Services:

• Expanded opportunities for Participants to manage and control service and service delivery by adding Self-Direction as descried in Appendix E.

Appendix F Participant Rights:

• Updated and revised Opportunity to Request a Fair Hearing and State Grievance/Complaint System for clarity and readability.

Appendix G Participant Safeguards:

• Updated and revised Response to Critical Events or Incidents, Safeguards Concerning Restraints and Restrictive Interventions, and Medication Management and Administration for clarity, readability, and consistency with ME.0159 (MBM, Section 21) where applicable.
• Updated and revised Quality Improvement: Health and Welfare, to align with Performance Measures in ME.0159 (MBM, Section 21).
• Updated and revised Quality Improvement: Health and Welfare, Performance Measures.

Appendix H Quality Improvement Strategy:

• Updated and revised the description of System Improvements.
• Expanded upon quality assurance activities by adding a Plan of Corrective Action (“POCA”) process to ensure providers comply with service requirements, have sufficient clinical and administrative capability to carry out the intent of the service, and have taken steps to assure the safety, quality, and accessibility of the service.
• Updated and revised the description of the process for monitoring and analyzing the effectiveness of system design changes for clarity and readability.

Appendix I Financial Accountability:

• Updated and revised Financial Integrity and Accountability for clarity and consistency with Maine’s other 1915(c) waivers.
• Substantially revised Rates, Billing and Claims to reflect recently passed State legislation providing annual Cost of Living Adjustments (COLA) and requiring the labor components of rates to equal at least 125% of the State minimum wage for essential workers.

Appendix J Cost Neutrality Demonstration:

• Updated and revised Cost Neutrality and Derivation of Estimates for the final two years of this waiver cycle (through December 31, 2025).  

Please see the accompanying draft application for a complete list of all proposed changes included in the amendment. 

DHHS is accepting comments through Sunday, May 14, 2023. Any interested party may obtain a copy of the waiver application by going to the website noted below or at any regional Office for Family Independence (a list of the offices and locations can be found at this link www.maine.gov/dhhs/about/contact/offices).

A printed copy may be obtained by calling Lisa Weaver at (207) 624-4050 or emailing lisa.weaver@maine.gov.

See www.maine.gov/dhhs/about/rulemaking for waiver amendment and to submit comments.

STATUTORY AUTHORITY:              CFR §441.304

DEADLINE FOR COMMENTS:        Comments must be received by 11:59 pm, May 14, 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

                                                             Heather.bingelis@maine.gov

TELEPHONE:                                    207-624-4951 FAX: (207) 287-1864 TTY: 711