MaineCare Notice of Agency Waiver Renewal, ME.0995, Home and Community Based Services for Adults with Other Related Conditions (re-posted to update links)
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 20, Home and Community Based Services for Adults with Other Related Conditions
WAIVER: ME.0995: Home and Community Based Services for Adults with Other Related Conditions
CONCISE SUMMARY: The Department is planning to submit a renewal of the Adults with Other Related Conditions waiver, known in Maine as Section 20, Home and Community Based Services (HCBS) for Adults with Other Related Conditions. This waiver submission incorporates permanent updates to the waiver’s appendices. Some of the proposed appendix updates contained in the waiver renewal include:
General:
• Throughout the waiver, updates have been made for compliance with the HCBS Settings Rule.
• Where applicable, revisions for consistency with ME.0159 (MaineCare Benefits Manual (MBM), Section 21).
• The Department anticipates that ME.0995-related Reportable Events data will begin to be available via a new platform (Evergreen by FEI Systems) in August 2023. The Department anticipates completing the remaining data migration for ME.0995 (MBM Section 20) in 2025.
Appendix A: Waiver Administration and Operation:
• Updated information about agencies/entities with which the Department contracts.
Appendix B: Participant Access and Eligibility:
• Added description of the process by which participants may request an Exception to monetary and unit limitations on services.
• Clarified that in addition to Registered Nurses and Licensed Clinical Social Workers, the Assessing Services Agency may also employ Licensed Practical Nurses and Qualified Intellectual Disabilities Professionals to perform initial evaluations for level-of-care.
Appendix C-1/C-3 Service Specifications and Provider Specifications:
• Revisions throughout C-1/C-3 Service Specifications for increased consistency with ME.0159.
• Added new service, Adult Foster Care/Shared Living.
• Added 3 tiers for Community Support, i.e., Community Only-Individual, Community-Only-Group, and Community Center-Based.
• Added 2 tiers for Home Support (Per Diem), i.e., 2-4 beds and 5-6 beds.
• Added services to support participant direction including Financial Management Services, Supports Brokerage, and Individual Goods and Services.
• Limit changed to reflect rate increase (Assistive Technology).
• Updated requirements to permit 17-year-old Direct Service Professionals (DSP) for some services, and added requirements for DSPs who assist with the administration of medication.
• Added Board Certified Behavioral Analyst (BCBA) for Consultation services.
Other Appendix C: Participant Services:
• Clarified that a family participant or legal guardian (when the legal guardian is a parent, sibling, or other biological family member) may provide Shared Living services.
• Added requirement for providers to perform background checks with Adult and Child Protective Services.
• Added basic requirements for enrollment and ongoing approval as waiver service providers, consistent with current MaineCare regulations currently applicable to ME.0159 (MBM, Section 21) and ME.0467 (MBM, Section 29).
Appendix D: Participant-Centered Planning and Service Delivery:
• Revised and updated for compliance with HCBS Settings rule requirements and Global HCBS Waiver Person-Centered Planning and Settings Rule (MBM, Ch. I, Section 6).
Appendix E: Participant Direction of Services:
• Added Appendix E to describe participant direction of services under this waiver.
Appendix G: Participant Safeguards:
• Revised and updated the description of Maine’s Reportable Events system.
• 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 responsibility for oversight, review of, and response to critical incidents and reportable events.
• Updated regarding safeguards concerning the use of restraints, as well as the use of restrictive interventions, including provisions adopted from ME.1082 (MBM Section 18).
• Updated regarding medication management and administration.
• Revised Performance Measures.
Appendix H: Quality Improvement Strategy:
• Revised and updated description of System Improvements.
• Added provisions for Plan of Corrective Action (POCA) process to ensure providers’ compliance with regulations and quality service delivery.
• Revised and updated the description of the process for monitoring and analyzing the effectiveness of system design changes.
Appendix I: Financial Accountability:
• Financial Integrity: updated and revised for clarity, and for consistency with Maine’s other waivers.
• Rate Determination Methods: substantial revision 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 and associated benefits.
Appendix J: Cost Neutrality Demonstration:
• Cost Neutrality and Derivation of Estimates for the five-year waiver cycle (through July 1, 2028) has been updated and included.
Please see the accompanying draft application for a complete list of all changes included in the renewal.
The Department 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 location (a list of the offices and locations can be found at this link . 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 renewal and to submit comments.
STATUTORY AUTHORITY: 42 CFR §441.304
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m., January 30, 2023.
AGENCY CONTACT PERSON: Heather Bingelis
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol St.
Augusta, Maine 04333-0011
EMAIL: Heather.bingelis@maine.gov
TELEPHONE: 207-624-6951 FAX: (207) 287-1864 TTY: 711
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