MaineCare Notice of Agency Waiver Renewal-MaineCare Benefits Manual, Section 18, Home and Community Based Services for Members with Brain Injury

Mar 22, 2024

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 Renewal. You can access the complete details at http://www.maine.gov/dhhs/oms/rules/index.shtml.

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Notice of Agency Waiver Renewal

AGENCY:  Department of Health and Human Services, MaineCare Services

RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 18, Home and Community Based Services for Members with Brain Injury

WAIVER: ME.1082, Home and Community Based Services for Members with Brain Injury Waiver

CONCISE SUMMARY: The Department plans to submit a waiver renewal for Section 18, Home and Community Based Services for Members with Brain Injury.  Maine submitted and received Centers for Medicaid & Medicare Services (CMS) approval for a comprehensive amendment to this waiver following the end of the Covid-19 Public Health Emergency with an effective date of March 1, 2024.  This waiver renewal submission incorporates Department updates to the waiver’s appendices that align with Maine’s four other 1915(c) waivers and current procedure. Proposed updates contained in the waiver renewal include:

General:

• Where applicable, revised language to align and create consistency with ME.0159 (MaineCare Benefits Manual, Section 21), and ME.0995 (MBM Section 20), ME.0467 (MBM Section 29), and ME.1082 (MBM Section 18).

Appendix A Waiver Administration and Operation:

• Updated Quality Improvement: Administrative Authority of the Single State Medicaid Agency, by revising the Performance Measures (a-i, PM 1 and PM 2) to align with Maine’s other 1915(c) waivers and more accurately reflect the State Medicaid Agency’s oversight of the performance of waiver functions.

Appendix B Participant Access and Eligibility:

• To calculate the annual individual cost of care more accurately based on the specific population receiving services under this waiver, we specified in B-2-b that the annual individual cost limit to gain access to and remain on the waiver is based upon the combined average of institutional costs for individuals receiving services in Intermediate Care Facilities and Nursing Facilities with Acquired Brain Injury classification.
• In B-6, updated and revised the level of care criteria, the process for LOC evaluation/reevaluation, and the eligibility criteria to align with current practice.

Appendix C Participant Services:

• In C-1/C-3 updated the service description for Home Support-Per Diem by removing the requirement that providers specify the minimum number of 1:1 direct support hours within the PCSP allowing providers greater flexibility to deliver individualized, responsive, and high-quality Home Support Per Diem services.
• Updated Assistive Technology Services by allowing qualified providers to conduct Assistive Technology Assessments via telehealth when the provider ensures that the assessment via telehealth meets the requirements of the scope of the service and updated the service description to align with Maine’s other 1915(c) waivers namely, ME.0467 (Section 29).
• Revised the Service Description for Home Support-Remote Support for clarity.
• Increased the annual individual cost limit in C-4 to $286,580.30 and specified that the cost limit will increase on an annual basis proportionately to the scheduled Appendix J and I-2-a reimbursement rate increases to ensure participants do not lose access to eligible services as an unintended result of the scheduled rate increases.

Appendix E Participant Direction of Services:

• Removed the requirement that the participant attend skills training for continued participation in Self-Direction in E-1-m.
• Clarified the responsibilities of the Fiscal Intermediary (FI) and Supports Broker in E-2-a-ii regarding informing and making available, rather than providing, training for the Participant to fulfill their employer responsibilities so as not to imply the FMS is the employer.
• Updated E-2-a-ii by removing the requirement that the Self-Directed employee must attend Department-sponsored trainings and complete them within 6 months of hire and every 36 months thereafter.  The Participant, as the employer, will train their employees according to their identified needs.
• In E-2-a-ii clarified and specified that the Supports Broker will annually provide information to the Participant, Representative and self-directed employees on and how to report abuse, neglect and exploitation and in using the self-directed incident reporting form.
• Clarified the Participant’s and Representative’s responsibilities in E-2-b-ii by specifying that participant and/or designated representative approve their employee’s electronic timesheets for services rendered by use of the FMS web portal, or by providing signatures on paper timesheets. 
• Specified in E-2-b-ii that the Participant or Representative must comply with Electronic Visit Verification (EVV) requirements unless an exception is available.

Appendix G Participant Safeguards:

• Updated the date of completion of full migration to the Office of Aging and Disability Services new Management Information System, Evergreen, from Fall 2023 to Spring 2024 to ensure a smooth transition for providers and stakeholders.

Appendix J Cost Neutrality Demonstration:

• Updated Cost Neutrality and Derivation of Estimates for the five-years of the waiver renewal cycle (through July 1, 2029).

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

DHHS is accepting comments through 11:59pm, April 20, 2024. 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 http://www.maine.gov/dhhs/ofi/offices/index.html).

A printed copy may be obtained by calling Heather Bingelis at (207) 624-4951 or emailingheather.bingelis@maine.gov .

See http://www.maine.gov/dhhs/oms/rules/index.shtml for waiver amendment and to submit comments.

STATUTORY AUTHORITY:               CFR §441.304

DEADLINE FOR COMMENTS:         Comments must be received by 11:59pm, April 20, 2024.

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