MaineCare Notice of Agency Waiver Renewal, ME.0276, Elderly and Adults with Disabilities Waiver (reposted to update links)

Dec 30, 2022

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 19, Home and Community Benefits for the Elderly and Adults with Disabilities

WAIVER: ME.0276, Elderly and Adults with Disabilities Waiver

CONCISE SUMMARY: The Department is planning to submit a renewal of the Elderly and Adults with Disabilities waiver application, known in Maine as Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities. This waiver submission incorporates permanent updates to the waiver’s appendices. Some of the proposed appendix updates contained in the waiver renewal include:

General:

• Updated the Brief Waiver Description for clarity and readability. 
• Ensured compliance with MaineCare Benefits Manual Ch, I, Section 6, Global Home and Community Based Services (HCBS) Waiver Person-Centered Planning and Settings Rule (Global rule) .
• Where applicable, revised language to align and create consistency with ME.0159 (MaineCare Benefits Manual (MBM) , Section 21), and ME.0995 (MBM Section 20), ME.0467 (MBM Section 29), and ME.1082 (MBM Section 18).
• Ensured Confidence Interval and Margin of Error reporting is correct for all performance measures.

Appendix A Waiver Administration and Operation:

• Updated information about agencies/entities with which the Department contracts.

Appendix B Participant Access and Eligibility:

• Updated language to bring consistency with current Operating Agency practice and MaineCare regulation.  

Appendix C Participant Services:

• Updated, expanded, and/or clarified, where applicable, the descriptions, qualifications, and limits within Service Specifications (C-1/C-3).
• 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 background checks within Criminal History and/or Background Investigations (C-2).
• Added basic requirements for enrollment and regular re-enrollment responsibilities for providers of waiver services, consistent with MaineCare regulations and statutory requirements.

Appendix D Participant-Centered Planning and Service Delivery:

• Added requirements that providers comply with Maine’s Global rule.
• Updated and revised Quality Improvement: Service Plan (a.1.a) performance measure #1 and included a requirement that the Person-Centered Services Plan (PCSP) and Plan of Care includes at least one participant-driven goal.

Appendix E Participant Direction of Services:

• Included technical and grammatical revisions and updates where applicable for clarity and readability.                

Appendix G Participant Safeguards:

• Revised and updated the description of information and training for participants, families, and legal representatives regarding abuse, neglect, and exploitation.
• Revised and updated the description of the provider responsibility for oversight, review of, and response to critical incidents and reportable events.

Appendix H Quality Improvement Strategy:

• Revised and updated the System Improvements description.
• 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.
• Revised and updated the description of the process for monitoring and analyzing the effectiveness of system design changes.

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 that the labor components of rates allow for direct care staff reimbursement of at least 125% of the State minimum wage plus associated benefits.

Appendix J Cost Neutrality Demonstration:

• Updated Cost Neutrality and Derivation of Estimates for the five years of the waiver renewal cycle (through July 1, 2028).  

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

DHHS is accepting comments from December 30, 2022, through January 30, 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 http://www.maine.gov/dhhs/ofi/offices/index.html). A printed copy may be obtained by calling Lisa Weaver at (207) 624-4050 or emailing lisa.weaver@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 11:59p.m., January 30, 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

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