Notice of Agency Rule-making Adoption: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services, Ch. III

Mar 08, 2022

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

CHAPTER NUMBER AND TITLE:   10-144 C.M.R. Chapter 101, MaineCare Benefits Manual,

                                                            Section 97, Private Non-Medical Institution Services, Ch. III

PROVISIONALLY ADOPTED RULE

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

The Department of Health and Human Services (the “Department”) provisionally adopted the following major substantive rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 97, Principles of Reimbursement, Private Non-Medical Institution Services, including Ch. III (the “Main Rule”) and Appendices B (Substance Abuse Treatment Facilities) and D (Child Care Facilities).

These changes were originally implemented in Chapter III through emergency major substantive rules, effective Nov. 1, 2021, which imposed reimbursement increases in Ch. III in order to support final adopted routine technical Ch. II, Section 97 rule changes, also effective Nov. 1, 2021.   The Ch. II changes implemented various new requirements on Appendix D providers per the Family First Prevention Services Act (FFPSA), and also added new covered MaineCare services.  Ch. II also imposed new requirements on Appendix B providers and broadened those covered services.  Emergency major substantive rule changes are effective for up to one year or until Legislative review.  To make these reimbursement rate increases and other changes permanent, shortly after issuance of the emergency rule, the Department initiated proposed major substantive rulemaking for Ch. III.  This provisionally adopted major substantive rule shall now go to the Legislature for review and authorization for final adoption, per 5 M.R.S. § 8072.

The new reimbursement rates were authorized by the Legislature pursuant to P.L. 2021, Ch. 29 (the “Budget”) and P.L. 2021, Ch. 398 (the “Supplemental Budget”).  The rates are also consistent with independent rate studies completed for Appendix B and Appendix D services. The Department shall seek approval from the Centers for Medicare and Medicaid Services (CMS) for the increased Appendix B and Appendix D rates.

In addition to the above, the Main Rule and relevant Appendices changes names to certain services in order to gain consistency with Chapter II, including updating “Crisis Residential” services to “Crisis Stabilization” services, “Treatment Foster Care” to “Therapeutic Foster Care,” and “Substance Abuse treatment” to “Substance Use treatment.” The rule also ensures that the terminology in Appendix B is consistent with what is utilized in the finally adopted Ch. II rule, for example, “Detoxification” programs are now referred to as “Medically Supervised Withdrawal Services.”  The name of Appendix D shall change from “Childcare Facilities” to “Children’s Residential Care Facilities” in order to align with changes adopted in Chapter II.

This rulemaking seeks to create two tiers of reimbursement, one tier accounting for all medical personnel, and another tier as an exception rate for low nursing staff, in the case of substantial workforce challenges. Lastly, service components of the rate in 2400.1 clarify that social workers are licensed clinical social workers and add licensed marriage and family therapists, to align with changes adopted in Chapter II. Similarly, in Appendix D, Section 2400.1, board certified behavioral analyst services, board certified assistant behavior analyst services, and registered behavior technician services are added to align with changes in Chapter II.

The independent rate study recommended that Mental Health Level I and Level II services be consolidated into a single Mental Health level of reimbursement, and that Intellectual Disabilities and Autism Spectrum Disorder Levels I and II be consolidated into a single Intellectual Disabilities/Developmental Disabilities residential treatment rate. This rule removes language from Section 6000 because the referenced member assessment is no longer required. The Main Rule also adds reimbursement rates for a new MaineCare covered service, Aftercare Services, for the service itself and for mileage reimbursement. Aftercare is a required component of the FFPSA. The Department shall seek approval from CMS for the new Aftercare Services and the additional practitioners allowable under this Appendix.

The Department implemented necessary updates to further address potentially stigmatizing language pursuant to P.L. 2017, ch. 407, and to update references to the Office of Behavioral Health from the Office of Substance Abuse.

Finally, pursuant to public comment, this provisionally adopted rule makes changes from the proposed major substantive Main Rule and Appendix D to update reimbursement for Aftercare Services from hourly to quarter-hour reimbursement, to provide greater flexibility in reimbursement for the services provided, and has updated CMS approval language in the Main Rule, Appendix B, and Appendix D to reflect current standards. Please note that the emergency major substantive rule reimburses based on an hourly rate for Aftercare services, and that shall continue to be effective until such time that the Legislature authorizes and the Department finally adopts these major substantive rule changes, per 5 M.R.S. § 8072(8). The Department plans to retain the hourly reimbursement in the future final adopted rule so providers may know how to seek reimbursement for Aftercare Services from November 1, 2021 to the effective date of the final adopted rule.

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

EFFECTIVE DATE:

AGENCY CONTACT PERSON:        Dean Bugaj, Children’s and Behavioral Health Manager

AGENCY NAME:                               Division of Policy

ADDRESS:                                          109 Capitol Street, 11 State House Station

                                                            Augusta, Maine 04333-0011

EMAIL:                                               Dean.Bugaj@maine.gov

TELEPHONE:                                    (207)-624-4045 FAX: (207) 287-6106